What The Cup !? A Podcast
Here you'll find podcast episodes and other resources all about human resiliency, endurance sports, strength and exercise training, Myofascial Decompression, the latest fascial science, and other MSK concepts from your friends at Cup Therapy. Listen to interviews with Dr. Christopher DaPrato and some of the best athletes, clinicians, and researchers in their fields. Thanks for rating and subscribing!
What The Cup !? A Podcast
Ep. 29 Mike Stella, ATC: Why We Should End the Ice Age @mikestella_atc
This month, Chris sits down with Mike Stella, an athletic trainer who is trying to change the way we think about acute injuries and the optimal healing process. We've always advised people to ice after a strain or sprain, but do we ever think about why? What's the mechanism? Does it really change long term outcomes? Does it actually improve the local swelling? Maybe we should think about MEAT instead of RICE for injury management. Deep dive into all the options for injury recovery other than NSAIDs, ice, and rest with this evidence based info packed episode.
Find out more about Mike and the End of the Ice Age at mikestellamovement.com, and @mikestella_atc on social media.
And so the question that I ask my clients is, do you want the least painful, road, or do you want the road that leads to the most growth? Because you can't have both. And, and so for the person who goes, I just don't wanna suffer by all means. Take your NSAIDs, bury your shit in ice.
Chris:All right. So I am here for episode 29, and this is gonna be a gun slinging shoot from the cuff. Have some fun with a good guy out in long island named Mike Stella. How you doing mike?
Mike:I'm doing great. Chris, how about yourself? Amazing. Amazing. So let's just start right in and, and give us your, like your pronouns or identifiers. Where are you at? What are you doing? Um, oh, I'm just, I'm just a normal red blooded guy, man. Um, you know, so I identify exactly how you wanna identify me. That's fine by me. So, uh, yeah, my, I mean, my background, I'm an athletic trainer by trade and a strength coach. Um, I mostly work on the athletic training side, but in a non-traditional setting. So I don't, I left kind of that traditional model of athletic training behind, and now I have my own, my own practice. I know, I see athletes and clients, you know, privately and, and just building my business here a little bit at a time, trying to break some, break, some stigmas and bust some myths and, and just help people feel better, move better and move more. That's that's the goal.
Chris:Absolutely. And i, I think that's why this is really fun. I, I think you are my east coast version of myself and, you know, some of the, the way you look at things with inflamm inflammation and ice, and some of the things that are like, you know, quid pro quo, that dogma is finally starting to go away and we're gonna talk all about ice and inflammation and what other things you could do better than just slapping ice on things. But, um, tell us about this root and journey out of the traditional athletic trainer role, which, you know, again, I've been in sports medicine at the NCAA, a level since 2013, or sorry, 2008. So like 13 years worth. And I know it's a, it's a hard trench to live in. At that division one level for a long time, right. Salaries, aren't amazing. Time and hours are ridiculous. And I, I'm sure there's a lot of burnout in the field. Tell us what that looked like for you and how did it draw you into where you're at now?
Mike:I mean, you know, you know, I get this, the origin story a lot. Um, but I fell in the, in love with athletic training because I was an injured athlete in high school. You know, I was a highly recruited lacrosse player, ended up having a complex knee, blow out ACL PCL, MC meniscus, Tio plateau, like the whole shebang. Um, and, and that was kind of really my, my Swee or my introduction of the sports medicine and, and I just kind of fell in love with it. Um, and so, you know, I did my undergrad in athletic training and I worked in that traditional model and you're right. It is a ton of hours. It was a lot of burnout. I worked for all the way from S E C like division one, like the highest ND ones you can work. Right. All the way down to mid-major division ones. And, you know, for me as an injured athlete who never got back to where I wanted to be, it, it kind of was, I wanted to be the guy. I wanted to be the guy that I needed in my corner when I was going through my recovery, you know? And so I really wanted to work with high level athletes. And that was like an early career career goal of mine. You know, I ended up jumping in at the SCC level right away. And that's kind of, when I got my, you know, you kinda get your, your school of hard knocks a little bit, you go, okay, this is a lot different than it seems like. It's like, oh, you wanna be a D one athletic trainer. And it's like, you know, a hundred hours a week later. that gets old real quick, you know? And, and so, but it was awesome for me because I got to, I, I call it sports medicine in a bubble. You know, I got to work with the highest level of athletes with really no financial restriction whatsoever. It was like, if you could give your athlete a 1% benefit, do it. Because it's worth it. And so it's just a different mindset than I experienced years later in the private sector, when I worked at a physical therapy clinic, like kind of like a classic physical therapy outpatient model. And it was the exact opposite of that. It was so cost conscious. It was so time conscious and yeah, the end result of that experience, most people didn't get better. You know, you just couldn't spend enough time to really educate people on how to take care of themselves and how to self treat and how to move better. And, and so I got burnt out in that for entirely different reasons. And so, so yeah, I mean, um, the Genesis of my business outta the movement underground is really like kind of giving my clients that D one experience, but without me having to sacrifice everything about my personal life in order to do so. Um, so that's kind of where we're at
Chris:now. Yeah. And what I've found, you know, working at Cal Berkeley, you know, great athletes, amazing sports medicine team with multidisciplinary, you know, Communication. And, and it's beautiful to see the nuances of every discipline trying to help that client as much as possible, but there's a lot of bureaucracy and there's a lot of inadequacies and there's a lot of, I think, antiquated thought on the way sports medicine should be practiced. So let's talk about that as a segue, like what I see, and I've seen it for many years at the highest level of sports, working with pro teams as well is we're kind of just still in that traditional put some stim on it, put some ice on it. Let's do some recovery that way. And I don't think I've seen much change in 13 years in the overall management of an acute injury. And tell us what that looked like for you at the SCC level. And how did that shape, or maybe that was part of the catalyst for you shifting out of that model into something more
Mike:pro. Yeah, listen, you're, you're a hundred percent, right. It's still that way across all of NCAA and professional sports. And, uh, I forget where I heard this. I really would love to give the right credit, but I, I can't remember. It's new ideas take about 30 years to, uh, permeate into academia. Yeah. Um, into that setting and, and the reason why isn't, because it takes that long to learn stuff's because that's the average tenured professor's career. They gotta, they gotta get some boot out. Right. And so, and so you're talking, you're looking at a system where, you know, you're, you, you kind of idolized those, I don't wanna say old timers, but people have been there for, I always joke. It's like, what's the fastest way to become an N a T a hall of Famer. It's like go to a school, stay there for 35 years and don't do anything that rocks the boat. and you get your green jacket. And I know offense to the hall of Famers, again, nothing but respect and love. It's just, that's what we reward and so, you know, my whole thing about like going against the traditional grain wasn't to piss people off it wasn't to, you know, make a wave so that people would notice me was I wanted to give my athletes the absolute best care possible and be the best sports medicine practitioner I could be. And what that led to was me just being very curious and asking why, and I guess in a, in a way questioning what was always done, you know, like I. Even when I was in a student, I had a hard time with the whole icing thing. It's like, well, if we're trying to get blood flow and this and that, like why I don't understand how this fits in. Like I just don't get it. And my program director's response to me at that time was because this is what we do. This is why. Yeah. And, and I'm like, that's not good enough, man. I, I can't, I can't wrap my head around the mechanistic action behind this. And your answer to me is don't worry about it, do it because that's the way it's always been done. It's like, that's the it just for whatever reason. Couldn't accept that. And so, yeah. You know, so what do you do? You, you, you research and you, you know, start to dig through stuff. And that's kind of where the Genesis of the course came from was I felt like early in my career, you know, I got better results from not using ice, especially with acute injuries and getting my athletes moving quicker, you know, not being stupid, but getting them moving through the process quicker. And I always felt like I did a really, really good job managing the short term. And I, and I anecdotally saw that those athletes were less injured or less re-injured yeah. Long term. And so. My COVID project was let me put this together in a course, because I don't think it's good enough to just say ice doesn't work. Don't do it. Well, what are you gonna replace it with? Totally. It's not good. It's not enough to just say this. Isn't good. It's what, well, what do we have? That's better. And so,
Chris:and blanket statements don't work anyways. I mean, we see blanket statements in our industry. The the board. Right. So, so much. And it's unfortunate because people will take that, that tagline or that research article and just run with it and apply it to all situations in all demographics.
Mike:Right, right. Oh, totally. Yeah. And, and again, it's just, everybody wants that simple solution of a complex problem, or I think, I think now it happens more just cuz people want to be, uh, controversial, you know, so you take a con take a unpopular opinion. Now throw a blanket statement at it. And all of a sudden people are looking at you. And, and again again, on social media that works for attention, but it lacks depth. Right. It lacks substance and, and honestly it's a nuanced con everything across clinical care is nuanced. Right. It's, there's a, I always say to all my clients, people like, oh, you hate ice, right? I'm like, there's a time and a place for everything. Yeah. There's absolutely a time and a place for everything, including ice, but let's be specific about what that time and place is and use the right tool for the right job. That that's, that's the whole point. Absolutely.
Chris:So. Yeah, I think you, you hit it on the head where you're at it with a place that has more resources, more ideas swirling around because everybody wants their product to be promoted with this great, you know, division one team or this pro team, you have the chance to try out a bunch of things. And I think what's nice is you start to see what really works regardless of what the research says, right? Because you are there for, like you said, the, the one to 2% gain that's going to affect their performance, affect their practice, affect their ability to be the best that they could be with things. And you have this time and, and this energy to practice in that niche. And you probably spent, you know, how many hours setting up somebody for an instrument assisted soft tissue mobilization, like, you know, a billion hours, because at that time you're just, you're. Your tool is getting crafted and chiseled because you have so much contact with that, you know,
Mike:type of thing that is, you nailed it, man. And people always ask me, like, how do I learn? How do I, how can I be yeah, good. Like you and do what you do. And it's like, I've had a lot of time in the trenches. And I think that's when people, people like to bash athletic training for lots of different reasons, poor pay lot of hours. But tell me a sports medicine practitioner that gets that time in the trenches. Like you said, in a BU that's what I mean by in a bubble. Yeah. It's almost like you, you get this ability to practice with very little outside influence, which is good and bad, but you get to practice and try on healthy, neurologically, intact people. And those athletes are very in tune with their body. They're gonna let you know instantly if they feel something's effective or not. And it's hard to ignore an Olympic gold medalist when he is telling you, I feel better with this. Right. So. How can you ignore that? Yes. Is that evidence anecdotal? Definitely. But is it meaningful? It sure as hell shaped my career and the way that I look at these kinds of problems. So, yeah, and I, I think you, you nailed it. It's just, when you have a lot of resource, you put a lot of time and just like anything else, right? 10,000 hours of mastery to master something in a subject matter. Uh, I just think, you know, athletic training, the, the benefit is you get a lot of that early on, and if you embrace. It can really shape your career and, and, uh, and, and you as a clinician.
Chris:Absolutely. That's great sound advice for young clinicians up and coming. I, I think it's really interesting just to see the way you modify your practice behavior, because you do most people read some literature, re stay up on some research, and then you modify your behaviors based on what this. Feedback is from the athlete and athletes, especially at the D division one NCAA level. They don't waste time because you're a student and an athlete at the same time. They have no time for anything. That's not worth their, their while basically. And at the higher levels as well, like they're just so much training, so much other stuff going on.
Mike:Yeah. Yeah. Can't agree with you more. That's that's exactly. That's exactly why I think working with athletes can be really fun, but also highly stressful because, you know, it's just like, well, the evidence says this. It's like, well, it doesn't matter if it's not making that athlete feel better. So, you know what I mean? There's a GI, there's the art and the science to it. And you have to be able to blend the two and you gotta get them to buy in.
Chris:Totally, totally. So let's shift into that. You know, you're working with these athletes, you're getting some feedback. You you're gonna go back and see, what does the literature say about this? Cuz we, we should all be evidence inform practitioners. And if I look at a quick pub med search, I see nothing on ice for about 15 or 20 years. Right. We didn't get good ice data until the last five or 10 years maybe. And there was like this epic hole of people not analyzing cuz they just took it for granted. So what. Kind of catalyzed you into like going down the research hole of, you know, what is ice really practical for and what it's helpful for and what are some of the, you know, really groundbreaking studies that you saw in the last five or 10 years?
Mike:You know, it that's, it's, it's really interesting. And I think the first thing I looked at was like the trend, the, the, the trends in the literature, what were, what were the big hits. And, and so you could find ice literature as far as like clinical practice going back, you start to see it more in the seventies and eighties, right? Late seventies, early eighties. And what happened was, I think there was some early correlative data that got a causative label early on, and that set the trend in the literature. So what do we see? We see. And it, you know, people are subjectively reporting less pain after ice treatment. And we're seeing reduction in girth, right. Size, uh, or swelling size by girth measurements. So those were two things that basically said, see ice reduces inflammation, it's reducing swelling. Therefore it must be good. And then the trend in the eighties was really looking at. How to get the best cooling effect or how deep does the cooling go technique with different type? Yeah. Very, very mechanistic, very, very, uh, parameter based research. Yeah, totally. But the problem was the fundamental, the fundamental assumption was that it was good. There was not a whole lot, or really any research you a hundred percent right on the physiological histological, what's happening at a cellular level. What's happening at a hormonal level. What's happening at all of, you know, this, the physiology of what's going on under the hood, as far as the healing process was concerned, we just kind of assumed it was good. We took it as that. Um, so you're dead, right? So I do reference one study by William McMaster in, in 1980. And it was, and it, there was nothing remarkable about this study except for the trend was set, which is this, this researcher, this physician, I, uh, he acknowledges the fact that there's no real mechanistic data to suggest that it's. Efficacious or positive yet. He recommends it universally in acute subacute and chronic injuries and illnesses anyway. and that is remarkable to me. It's like, well, we don't know why it works or how it works, or if it's good or not, but we see stuff get smaller. So it's good. Therefore I recommend using it. It's like what?
Chris:Yeah. I mean, this is a great moment for if you're out there and you don't question everything, you're not gonna see that some of the foundations that you were built upon are just, they're built on sand. They're not built on street
Mike:foundation. So some small assumption errors, and then built everything on top of
Chris:and an expert at some point said, this is the way to go. And everybody just ran with it. Or you see a study like this from 1980. There's so often spin in a discussion or conclusions aspect of a research paper that they find this data, and then they spin their own bias into it at the end to say, well, we think we should use ice in both acute subacute and chronic, and nobody ever actually studied the data of those actual parameters. Right. Right. So, so you're in this kind of epic bubble of like, whoa, this stuff is not holding up. And then you get to say 2010, 2015 things start unraveling a little bit. What does that look like in terms of the
Mike:literature? Well, I think we start seeing, you know, in the, in the 2000, like, like you're saying 2000 tens and on, we start to see a lot more like animal studies. Uh, and, and again, this is kind of. Some people even poo poo the animal studies because, oh, but it's just a rat. Oh, it's just a pig. It's like, well, listen, a million physiology is mam million physiology. And we can learn a lot from these animal studies if we pay attention. And, you know, so we start to see a lot of research on, you know, ice and crush injuries and rats. So basically inducing muscle trauma, inducing, deep tissue trauma, and then using no ice versus ice and seeing what it shakes out. But the nice thing about these animal studies is they're actually looking at the physiology and the chemical healing nature. And what we start to see is yes, maybe we have reduced pain, obviously in those subject. Trials, but we also see, uh, uh, inhibition of the migration of fibroblasts into the healing tissue. We see an inhibition of, uh, white blood cells and, and leukocytes and all these things that need to kind of kickstart the actual healing process. And so basically we start to see that we're slowing down recovery.
Arpita:Quick breakdown on the cell as mentioned. Fibroblasts contribute to the formation of connective tissue, which is key in wound healing. There's many different types of white blood cells. Like leucocytes macrophages, monocytes, and granulocytes. Without getting too technical we basically need all of these cells to be active after an injury to promote healing and to remove foreign substances
Mike:we're actually inhibiting the healing process and in doing so with excessive icing, we're actually leading to more scar tissue formation. And so, you know, how many people complain about, oh, I had this surgery and then, oh, but I ha now I have excessive scar tissue. Now I need surgery, get rid of my scar tissue. And it's like, well, let me guess you spent a lot of time bearing that thing in ice. Didn't you mm-hmm And, and that tends to be the trend. Right. And so. It's even funny still how we'll get some people that say, oh, but it's just an animal study. It's like, well, listen, you know, it's kind of really hard for manual therapy research, like what you're dealing with and or stuff like this, where we have to induce an injury to get people, to sign up for that and stick with it the whole, however many months that study's gonna go for. Right. So that's kind of where the whole, I wouldn't say anti ice movement started happening, but I think that's in the 2000 tens and on is when we started seeing more people say, ah, but wait, is this as good as we think it is? Because prior to that ice and ed saids really were like the acute, I call it the acute care fleet. They were the standard operating gold standard of approach for any care with regard to a sprain, a strain. Or any type of acute injury, right? So if you went to a hospital, ER, an acute care clinic, a physio, a physical therapist chiro, anywhere you went with an acute injury ice, a mobilization and possibly an N an NSAID or a non-oral anti-inflammatory drug were the three things that you got and maybe immobilization. Yeah. And so the, my whole thing was, well, if, if ice, isn't what it's cracked up to be, are there better alternatives? And that's the question that I saw to answer. Now there's a lot more research and I think even our research methods are just getting better at the ability to look at a lot of these things like, you know, your blood. Yeah. We have so much more technology to be able to measure these things. Um, but now we're starting to see a lot more, even a re reemergence of like cold, cold water immersion research, you know, and we're starting to see this subtleties and difference in there. And, and so I think we're, we're starting to get into a really exciting time. And, you know, end of the ice age was just kind of my, like ushering in this, this new, new wave of embracing technology and, and what we have available that can replace these things, but also kind of kicking it old school and getting hands on and, and showing just how we can move fluid and how we can be effective and actually augmenting the healing process with things that are simple as manual therapy to self-care tools that people can do at home.
Chris:Totally well. And it's like you said, like, The standard operating procedure for any ER, doc for any primary care for any sports medicine professional for 20, 30 years has been NSAIDs and ice. And that comes at a price, right? If you are going to get a little swelling down for that immediate short term effect, what are we doing to the physiologic system? That's kind of the, the opposite. It's a double edged sword. You're really paying big price. So talk to us about what those fee for, you know, getting a little swelling down is what, what, what are the prices we're paying for that?
Mike:I mean, you know, it, it, that's such a great, and that's the fundamental question that I asked, what is, what is the cost? Cause everything has a cost. And so basically kind of how it manifested in my mind is there's, there's basically two paths you can take as a patient, right? If you have an injury or surgery or whatever the case is, you're dealing with an acute injury or trauma. How do you move forward? There's the. The path of the least amount of suffering, and then there's the optimized path and they're not the same thing. Yeah. They're not the same thing. And so the question that I ask my clients is, do you want the least painful, uh, road, or do you want the road that leads to the most growth? Yeah, because you can't have both. And, and so for the person who goes, I just don't wanna suffer by all means. Take your NSAIDs, bury your shit in ice. Sorry, I didn't mean to curse. I just kind of out, um, by all means, you know, ice is a fantastic pain reducer. I admit it. Fantastic pain reducer. Yeah. But. At the cost of healing. And, and I think, you know, anytime you say, but it's, but it's this it's like, but you also have to add at the cost of healing at the end of that statement, cuz that's the cost, right? You're slowing things down. You're, you're creating vasoconstriction. Um, you know, and multiple studies show like, you know, there was this theory of the hunter effect, right? Where you'd have all the Hunter's effect. I forget exactly the terminology for it, which is like, oh, once you create a lot of vaso constriction with cold, you know, your body has to rewarm. So it, it opens everything up. As soon as you're done and that's kind of been disproven. It doesn't happen in, in, in the effect of like local tissue.
Arpita:Mike's referring to the hunting response, which is a process of alternating vasoconstriction and vasodilation and extremities exposed to cold. Basal constriction occurs first to reduce heat loss. But then also result in strong cooling of the extremities. So approximately five to 10 minutes after the start cold exposure, the blood vessels in the extremities will suddenly be so dilate. This cold induced vasodilation increases blood flow and subsequently the temperature of the extremity. A new phase of vasoconstriction follows the phase of dilation after which the process repeats itself
Mike:um, and so, you know, to answer your question directly, you know, what is the cost? Well, you know, obviously on the icing side of it is slower fibroblastic, um, migration, and with slower fibroblastic migration, you also end up getting incomplete healing and more tissue scarring. Right. So, and random, right? Amazing and randomization a hundred percent. That also happens when you immobilize stuff too. There's no, there's no stress. There's no load for these fiberblast to orient themselves too, to lay down collagen and fibroin and all these, you know, um, protein strands in the right direction so that you have that disorganization of, of tissue. Um, and that's kind of where I get into external loading, which is definitely in your school. And, and what you talk about a. Yeah, but, you know, we also just get, you know, poor blood flow, we get incomplete vascularization of that tissue. We get, you know, again, we just, we just complicate the whole process. Right. Because we think inflammation's bad. Yeah. Right. Because we see, okay, inflammatory response comes with pain. So we, you know, putting those two things together and marrying them together was one of the worst things we went on this witch hunt, this crusade against inflammation, and that's kind of where the NSAIDs come in. Yeah. You know, and NSAIDs for the most part, depending on which drug, you know, obviously there's hundreds of different drugs in the anti-inflammatory classifications, but you know, traditional NSAIDs work by their, their Cox inhibitors. Right. They actually inhibit prostaglandins,
Arpita:cox is an enzyme that's responsible for the formation of prostate landings, which are powerful visa dilators. And they're the key in the inflammatory response. Therefore by inhibiting cox which is basically what an inset does you reduce the amount of inflammation that takes place
Mike:so let's just say you strain a muscle, right? You have muscle fibers that are torn. Those damaged cells were releasing cytokines that not only call in your immune systems function, right. They're calling in the white blood cells, the monocytes, the macrophages that are cleaning up into breeding that damaged tissue, but they also then release their own cytokines that call on the fiberblast for repair. Yeah. So essentially what we're doing, whether you're doing that locally with something like ice, or you're doing. Globally with like a, like an anti-inflammatory drug is that you're delaying that process from happening. Yeah. And your body's response to that as well. If I can't reproduce this tissue, like for like, or regenerate it, right. Mitosis for bio 1 0 1, you're gonna get scarring, the secondary approach to healing up that tissue with scar tissue. That's fibrosis that's what's gonna happen. Right. So now, instead of giving your body the most adaptability to heal and re regenerate, like for like you've essentially created the recipe for excessive scar tissue formation.
Chris:Yeah. Now let's take it a step further from that you're stuck in a TCO brace for your knee. And you're not moving it for four to six weeks. Cuz you also had a meniscus repair now, what is that doing to your fiberblast not getting the right turnover, not responding to loads cuz you're not loading it. Right. Right. And that's where my, my biggest, I think pet peeve is not adding loads to the things you're doing. Whether it's instrument assisted or cups or whatever it is like if you don't load it, you're not turning the fibroblasts onto. Orient, those collagen fibers that are getting laid down, you
Mike:know, I a hundred percent agree with you. And I think the other crime that goes with like the acute car has just rested for four weeks. Yes. Okay. Or people have a surgery it's like, don't go to rehab yet. You gotta rest it. It's like, well, what's exactly happening when your S is on the couch covered in Cheeto, dust, nothing. You're doing nothing for yourself. You know what I mean? Not to mention, you're not loading it at least at some point getting some hands on, at least there's some external loading that can happen. You know, if you really can't be weight bearing, you know, like there are certain, let's say surgical procedures where weight bearing super contraindicated you know, if you really can't load. Go get some external load, man, go get some treatment, go get some manual therapy, you know, go get some, some cardio, non painful cardio around the other areas. You body just get your body working on some level.
Chris:Cause load is not just lifting weights. Load is so much of the things that
Mike:might just talk about passive range of motion is load load. I think, you know, and just like the earlier the better. And I can't stress that enough for people. It's like, Hey Mike, I just had surgery. When should I come see you? Like now? Like as like today. Okay. Like when did you have surgery yesterday? Good. Get in today. Yeah. And I just wish, you know, so I'm working on a new version of end of the ice age called the surgeons cut. Um, I'm trying to trim it down and, and give and make it an hour and, and, and really target it to surgeons because we need our orthos to get on board with this, because so much of the dogma and so much of the not progressing, this comes because the MD says don't do it. Yeah. And, and unfortunately, For all our MDs out there. I love you guys and I love you girls, but at the end of the day, it's you don't realize how much your words matter. And when you tell somebody when you're just trying to get to your next patient or your next case, don't do it. You're, you're really putting people in a hole where there's so much they can do. You know, let's not focus on what they can't do. Deal is focus on what they can do. Um, and, and I think that's gonna get people having a whole lot less secondary issues later down the line. Totally.
Chris:So let's, let's talk a little bit about the resistance to this idea that rice needs to go away. And, and the acronym I always loved. I I've been teaching this since like 2011. I like meat more than rice. Yeah. Meat is like muscle activation, exercise analgesics instead of anti-inflammatories and treatment. Right? Right. So meat is always my preferred go-to instead of rice. Right. Plus I like meat better.
Mike:I think people, I like meat better too. People want an if then statement. Yeah. If this happens, then you do this, they want the algorithm, they want the exact protocol. And the problem with something like meat is it's too general. Whereas rice was like rest ice compression, elevation. I know exactly what to do. I can do this. Yes. Awesome. Right. And so meat's a little too general and people don't know. It's like, okay, well, how do I load this if I'm not sure. So I actually came up with my own acronym as part of the course and I call it the mindful method. Um, and so it's kind of like a little bit of a double Tre. I worked really hard on that, but kind of giving more specificity to the meat acronym. So. Um, movement inspire and inform. Um, uh, no NSAIDs is the N but also stands for nutrition, right? Where we can kind of use nutritional, uh, recommendations, general, keeping it simple for people about, I basically teach people how to eat clean and, and, and the goal is maybe they can use this traumatic experience to kind of install some healthy habits for their lifestyle, not even just for the here and now. Right. Um, the D stands for, you're gonna love this ready decompression instead of compression. I talk about edema taping specifically, and, and why I really like that as a model, we could talk more about compression, cuz there is a time and a place there. Um, I'm very specific about acute injuries and using decompression. It's just a preference. Um, the F stands for force. Or load. I just, I, I needed the L for something else. So the U stands for unity, which is creating that therapeutic Alliance. And the L is for lymphatics and really focusing our target of, you know, in the acute stage, focusing our target on the lymphatic system and how there's a lot of opportunity and upside there for us is as clinicians to address the edema problem very, very early and often. So that's, that's my acronym. It's a little deeper, it's got a lot of, you know, double meanings in there. um, it's just being aware that everything you do, everything you say actually does matter. Um, and especially in that early on, if I think one of the things that I'm I'm most proud of is, you know, I created all of these infographics and, and resources that come with the course that are unbranded and, and I'm literally telling clinicians, like, get out, take the, yeah. Brand them as yours and use it, get it out there, done for you resources to educate and, and help reinforce the messaging that you're saying and help people have a plan. I think, you know, if you have understand what your plan is ahead of. Like, let's just say, you know, I'm gonna have surgery next week and I can really, Hey, this is how we're gonna biohack this. This is how we're gonna, you know, attack your recovery from day one on that helps reduce people's anxiety. It helps reduce their fear. And if you could do those, they're gonna have a lot less pain. And that's that psychosocial side of it. And I talk a lot about that in the course as well, like the, the psychosocial implications of pain.
Chris:Yeah, let's talk about alternatives, right? So you're gonna need an alternative for a lot of times that traditionally clinicians would use ice to get down swelling. Even though we don't know ice really doesn't shrink swelling that much, but let's talk about lymphatics because I think that's the gateway to provide alternatives. Right. And I did a great podcast with Perry Nicholson, a few back, and we talked all about, I mean, he's, he's
Mike:the guru of limp. He's the lymphatics guy. And a lot of it's a lot of what I did was inspired by him. But there's other like manual therapy, like lymphatic drainage certifications out there, and I'm not gonna name names, but they're always named after the guy who invented it. It's the X, Y, Z guy's last name method. Right. And those people are so devout and it's like, you have to do the drainage in a very, very particular way, or it's not gonna work. And it's like, that is a business model, not a clinical model. You know, fluid dynamics is fluid dynamics. And if you understand the basic anatomy and physiology of the lymphatic system, you can move mountains with very, very little effort in keeping it real, simple, very
Chris:little and very gentle too. Right? Yeah. The idea that your lymph needs like 40 millimeters of mercury, like the lightest light touch of pressure. Of either compression or decompression or better yet both. Right. It's gonna be the most effective. Right. So it's a really, really light amount of pressure when you're thinking about that. And then the thing that blew my mind, well, after talking to Perry was like, I went back and I looked at where all the lymph nodes were. I was like, well, duh it's at every single. Joint space where the joint has the biggest freedom of motion. So you got the biggest freedom of motion is shoulder joint. Well, you got your aary biggest, you know, at your
Mike:hip GUIs motion. Yeah. Your hips. Yep. The back of your
Chris:knee. Right? So any joint that has the most amount of motion, it has the most density of lymph nodes, like in its just right click for me. I was like, oh my gosh, it makes so much
Mike:sense. Or, and it also makes it a lot simpler too, because now I call'em pumping stations. Totally. I think that was inspired by, by Perry as well. But it's like, listen, you got, you got about six or eight pumping stations in your body. Yeah. And if you understand how these work, you can still use your proximal to distal approach. And so I teach obviously traditional manual lymphatic drainage as part of the course like, Hey, you're a clinician. This is how you would go through a process of dual lymphatic drainage for the right leg. Let's say. And then it's like, well, what if you're not a clinician? What if you're an athlete at home? And I'm like, well, How many people, how many athletes have a percussion gun? Now raise your hand. It's like nine outta 10 people raise their hands. It's like, well, guess what? Perpendicular to potent is a great way to move fluid. Yeah. So take your percussion gun, put it on setting one, barely touch yourself with it and do little circles around your pumping stations in this order. All of a sudden it's like, holy. My range of motion improved, like doubled up in, in a 20 minute session doing it to myself. Another one that I put in that category is I call it N MES pumping. So using stem devices. Now I'm not a huge fan of stem in the way it's traditionally used, which is here's an ice bag and here's some stem and I'll be back in 20 minutes, cuz this is gonna help you heal. It's like, you're literally just saving yourself some time. And again, I know people get hot into the collar when I attack the things that they do every day. Specifically. And it's like, well, listen, like, let's be real. It's like, can that person get better without the ice and stem that you just put on them? It's like, hell, they'd probably be better off not doing it at all. But let's just say we're gonna use stem. And I think in acute care CA acute cases, this is where I do use it, which is over the counter units. To create a little fast Twitch response, right? A little bit of a fast Twitch muscle reaction, boom, non fatiguing. Right? Cause your nervous, system's not using it. And you're actually using movement and muscle activation, like you were saying in that meat in a passive way. So it's like, I that's the time and place for it. Yeah, these options
Chris:are, are important. And I think, you know, I think 10, even 15 years ago, I saw a lot of ultrasound going on in both training room, as well as clinical settings. And finally, the ultrasound stuff is almost died off, you know, thank God because that was the most passive of passive modalities. Right. And I think it's just gonna take another 10 years for some of this other stuff like ice, like, you know, passive treatments to slowly wither away. But like one of the biggest issues is like, what other things am I throwing in there? And I love that you're bringing in the stem idea of muscle pumping, you know, light and then lymphatic mobi mobility. Right. And using your hands or percussive tool. The other one I've seen really stand out in the last two years maybe has been red light therapy. Right. And so red, light's also something, when we think about cellular repair and turnover of mitochondrial ATP production, there's. Slowly evolving research, backing some of these devices out there. Talk to us, you know, maybe a minute or two about red light and how you
Mike:use it in your, I mean, for, I, I love red light and I you're a hundred percent. Right.
Arpita:Okay, so red light therapy. It's been tailored as a miracle that can slow aging, reduce wrinkles and more. But backing up the electromagnetic spectrum is a range of frequencies from low frequency, like radio waves. To super high frequency like gamma waves. Red light is a relatively low frequency. So think bigger, slower waves. As Mike talks about it in a minute, when directed at the body, it's thought to stimulate the mitochondria in the cells to improve ATB production and then stimulate that cells functions. So it's able to promote regeneration. Pretty cool
Mike:Red. Light's tough because it's so, parameter specific, you know what I mean? Like you have to have, it's not about the light specifically. It's about the dosage of energy delivered. And so you can have a, a small, I think I had a conversation with you on Instagram. We were joking about like the red light inside the newmatic. Oh yeah. The red lights on the right. You remember this conversation and, and you were like, I did the math Mike It would take you like 120 minutes of that cup to deliver the same amount of energy. That would be a clinical dose of a red light unit. Yep. And it's like, and like, you know, there's all sorts of gimmicky stuff out there that has a little red light bulb in it and call it red light therapy. But at the end of the day, it's about the amount of energy being delivered. And what you're really talking about is radiation therapy, essentially, just like you would. Energy from the sun and that's the full light spectrum. And even the nonvisible light spectrum, we can just, we're just using those two specific frequency, which is red light and near in for red light. Um, again, in the right dosing categories, we're showing exactly what you're saying. And so red light and photobiomodulation is, is really the, I think what my, what I'm using. So when I use muscle pumping and red light as a stack of therapies together in an acute scenario, that's like my ice and stem. Yeah. You know, you know, if you're going to be passive, at least let's have some type of active, uh, pathway and, or let's try to, um, augment or optimize those things as best we can. And now what we're seeing. It's funny because the company that I use, I actually got to speak to their CEO and, you know, full disclosure. I'm an affiliate platinum, L E D. I just liked their whole story. They got really big in the cannabis industry. Oh. When the cannabis industry started becoming. Recreationally and all these businesses started popping up. Yeah. All these infrastructure businesses started here. Who's creating the lights, who's creating a hydroponics, who's creating this. And so the original Genesis of them using their red light business was really them just creating, grow lights for the cannabis industry. And then I think he said it was actually a. UCLA sports medicine that reached out and said, Hey, can you create red light therapy for us because great. These are too expensive. Yeah. And he was like, absolutely, we can do that. It's the same technology. It's just a different frequency. And so they have a really great warranty, really great power for the price and a really good price point. And that's why I like, that's why I recommend them. And yeah, customer service has been good and there's a lot out there. There's so many out there, but again, there're more it's about the wa price is coming down. It's all about the wattage. Yeah.
Chris:Get the wattage on it. Just look at the wattage and you'll know whether you're getting the right amount of energy or not. Right.
Mike:And then again, if you have more Watts, you might need less time till you get to that ATP saturation point. Right. So, you know, it's all about the wattage.
Chris:Yeah. So again, options as we hit this like idea of shifting out ice, not all the time, there's a time and a place like we both have to absolutely. There's a time and a place. If I sprained my ankle in soccer today, I'm gonna put some ice on it straight away just for like, making it feel better, cuz that swollen ankle is gonna throb and it's gonna piss me off. Now if I wanna optimize it, like Mike said, you have to take a different route where you're gonna have some pain, but you have this idea of lymph mobility and you're gonna try to address some of the lymph issues that you have. You're gonna try to get muscle activation. You're gonna do lighter exercise, right? And then you're gonna do maybe some muscle pumping with some stem or maybe just some gentle active range of motion. Pass a range of motion. You have to load some things, right? You have to put some load to excite the fibroblast, to get'em to lay down the right orientation. When we talk about parallel fiber structure orientation
Mike:in, in the way that's origin and regeneration. Absolutely. Yeah. You know, I think, um, one of my favorite things of just going back to the one thing real quick is like, Every injury, minor or major has a swelling component. And sometimes we tweak stuff. We don't see swelling. And that's when your body does a really good job of actually draining that edema as it occurs. Right. So any instance of swelling, isn't a swelling problem. It's a drainage problem. Definitely. So the, so, so the, so the, the analogy I like to use is like that slow drain in your shower. Mm-hmm you know what I mean? It's just not getting the water out as fast as it's coming in and slowly you're an ankle deep, dirty water. Well, the solution isn't slow down the shower. Yeah. The solution to match the drain. The solution is open up the drain. Right. And that, I think that's where people get hung up on the whole thing. And the other fundamental question I answer is okay, like you even said, Let me throw a little bit of ice on it. Cuz it hurts. It's like, well, pain is a multifactorial process. Yeah. Multisystems process. Therefore it can be modulated by multiple systems. And so what are some other ways that we can reduce pain? That's great. Can we reduce pain promptly in the absence of using ice altogether, which is what I'm suggesting for the optimized path is I wouldn't even do that. Cuz if you look at the physiology of healing, we get about two to four minutes of vasoconstriction, right at the onset of. So if you're gonna use ice, it's gotta be in the first five minutes. how often is that really realistic? Right after that, we go through a period of vasodilation. Yeah. And that's the delivery of those immune immune factors and those, you know, like we talked about the fibroblast, the lymphocytes, the macro, I think all of it. Yeah. So we need vasodilation for that. So the, the, the actual window, as far, if you're really looking at the physiology, healing is actually very, very, very, very small. And in my mind, it basically doesn't exist. Now. Again, there's. One very important caveat to that. Vascular compromise. If you were in a high trauma, vascular compromise, we were suspecting that major blood vessels were severed or, or compromised. The example I use is Alex Smith's leg break a few years back, right. Where he had the complex fracture and an arterial compromise there. Right. Bury that thing in ice. Yeah, because at that point, the benefits outweigh the risk. So one of the saving graces to ice is that it will help cells survive a low oxygen, low nutrient environment. Yep. Just like the meat in your fridge. It preserves that meat for a longer period of time so that it doesn't start to decay. And, and again, that's what I'm trying to do is like, let's be highly specific and talk about best practices when it comes to some of these tools and, and, you know, and the reason I like red light is even if you underdose it, you're not setting somebody back. Yeah. Right. So when I look at treatment modalities, whatever it is, you have to consider downside with upside. And when you look at ice and you look at NSAIDs and immobilization, and those three things, the downside is considerable. And we just don't talk about that because the price that you're paying, you know, you're getting the downside that you're getting is at the. Oh, you feel a little bit better in the short term. It's like, is that enough? I don't know. For me, it's not enough. Yeah. You know, let me
Chris:pose this question. What do you think I've had this theory for many years now? I think the huge upswing in tendonopathy and tendonosis aspects is because we're shutting down inflammation early with SIDS and ice, and you're not getting the right healing factors. Those cytokines are not sent in the right signals to bring in the right stuff. And that tendon doesn't remodel the right way because you never let inflammation do its job. I think that's something that, yeah, I think,
Mike:I think that's, I got, I got a little addition to that. I think, you know, when you start talking about avascular tissues in general, right. Tendons and ligaments don't have as good a blood supply. And, and so therefore they get, I think their downside using ice gets worse. You know what I'm saying? Because now you're really taking away any ability for vascularization. At any level. And that's where I really think light instrument, assisted stuff, light cupping, things that strain that local tissue that can maybe pull some blood from, you know, or like get that blood actualization that pulls into the, into the, uh, inter the interstitial spaces, right? Might that's even more of a, a benefit to those types of things. And like even your school cupping. My favorite use for cupping is around thick fascial sheets and around insertional tendonopathies. Absolutely. Absolutely.
Chris:All right. I'm gonna scroll now through our Instagram questions. And I, we got a lot, there was a lot of interest in Instagram about asking you some questions and there was about three people that said, tell us your opinion, Mike, on ISAs for recovery.
Mike:That is the number one question I get, I'm sure it is. Cause they're like, oh wait, ice is everywhere right now. Like right. So ice baths for recovery, not worth it, but, but are they worth it in general as a daily practice? I think so. And, and here's the reason. So when we talk about an ice bath versus an ice pack for an injury, talking about two completely different things, um, if you're going to a cryo sauna or an ice bath on a, as a one off recovery method, you're, you're wasting your time. And, and so here's what we know that cold water immersion will actually can actually attenuate muscle growth and hypertrophy, right? So it can actually reduce your ability to get a post training muscle growth effect, which is what most of us are trying to get when we train. Now the benefit to ice baths is a hormetic effect. Yeah. And that's really, as far as the research has really confirmed at this point, which is if done consistently over time, you are basically raising the threshold point to where your nervous system spills over into fight or flight. Right? So you're making your nervous system more resilient to stress and there's lots of health benefits to that slow exposure, just like, you know, so people like, what is, well, what is hormesis? Well, it's the same way. Like a vaccine works, right? Where we're exposing you to a little bit of pathogen so that your body builds up some robust. Against it in the future, right? That's where ice baths come in. And, and that's the same thing for sauna, right? So it's like, which one do you want? Eh, whichever one you prefer. I mean, there's slight subtle differences in, you know, The the after effects. And so again, if you're gonna do an ice bath, this part, or an ice cold shower in the morning, right. To hit that, that no epinephrine and adrenaline spike is a biohack for the morning, by all means, go for it. But it's not the same thing as icing, as far as a treatment is concerned. Well, and especially
Chris:for an injury, I think a lot of the ice bath and sauna it's great healthy practice and preventative medicine for healthy bodies, not for an injured right body. And so exactly people take it and run with it again. It's blanket statements.
Mike:Cold. Right? Cause it's cold is the blanket statement. It's like, this is good. And this has to be good also. And it's not the same. It's again, that's where we're starting to talk about the nitty gritty of it. And I agree with you. Totally.
Chris:Another one that was a couple different people asked the same thing is, you know, they love this idea of meet over rice, shifting out of the ice age, going to a more progressive stance. But how do you do this? When come like communicating with your athletes, your coaches, your physicians, right? These heads of the teams that you have to work with, how are you able to negotiate? And what are some like. I think techniques or advice you have for the people trying to negotiate this shift of paradigm.
Mike:Um, I think you, you had Joe Lavaca on recently, and I think, I think when he, and he's, he's my go-to resource for things like communication, and then that's something that I'm working on in leadership and communication, because it's not about what you say, it's about how you say it. Right. We've all heard that adage. And, and I think I also pull a lesson from, 42 laws of power by Robert Green number one is never outshine the master. Right. And so what do, what did it, the whole chapter's about this idea that if you're a talented young upstart and you have somebody that's above you in a hierarchical structure, right? Like somebody who's in a leadership role over you, you don't wanna go biting that, bear on the ass too much. Right. You have to position yourself where they're the expert. And so the way that I would say is like, Hey, have you seen like, you know, I post a lot of anti I stuff. Let's say. Have you seen this? What do you think about that? Right? You, you pose that as a question to that person, that expert above you and have them tell you what you think. I'm thinking about using less ice. What do you think? We're having a conversation now that's not attacking something. And, and maybe depending on the relationship, depending on the person they're open to having that conversation about how this emerging data can shift or change how we approach these problems. If you're gonna say, Hey coach, I don't wanna do this with our guys anymore or girls anymore. This is what I I'm proposing instead. And, and when I worked in my last division one school, that's exactly what I did with my baseball coaches. And they were like, This is awesome. We love it. Go do it. Yeah. You know what I mean? Because I presented them an alternative that, that I was saying, this is gonna lead to better outcomes off, you know, on the field. And, and that's all they care about is they wanna have their athletes stay healthy. And so you have to have a well thought out plan.
Chris:It's easy when your outcomes speak for themselves a hundred percent. When you see the person three months later out shining this person that got ice and compression and immobilized for a long time and they're already doing the things that they want to do quicker. I think that shines very quickly. It's like when I got to U C S F medical school and I started bringing cups around, this is an academic. University. That's one of the top research hospitals in the world. And everybody sat on my idea of using cups. And I said, okay, let me show you what I can do with your ACL meniscus root repair and give me three months and I'll show you what's going on. And I guarantee like this is not bullshit. Six months later, the ortho docs were coming down to get treatment from me using cuffs, right? Yeah.
Mike:Because results speak louder than anything.
Chris:Hundred percent. Yeah. So your outcomes really, you know, if you're consistent and you're good with what you're doing, I think the outcomes really shine a huge light on it.
Mike:All. My, my favorite thing is to send athletes back to their surg their surgeon. Two to three weeks post up for their follow up. Yeah. With full range of motion and no swelling. Totally. And they go, what the hell did you do? So if I can get them moving better in the shortest amount of time and they have less pain as a result of it, we call that winning across the board and who wouldn't be interested in that the hardest part is getting people to accept something that might be contrary to what they've learned.
Chris:Yeah. That's been my role at, at Cal for the last 13 years is as a PT on staff with all these amazing athletic trainers, I work next to I'm the one that gets the people that just aren't getting better. It's a little more complex. You just can't solve it. It's
Mike:more time needed. Right,
Chris:right. Yeah. It's more time. Love it. It's great. It's a great place to live. But I think these communication things are so important and, and we can't emphasize enough the bio psychosocial aspect of this. All, I love that you touch on that and let's just kind of finish up with the idea of what that looks like, encompassing all this. When you think about social, what, what comes to your mind?
Mike:People are more than a meat. Yeah. You know, and, and we just have to remember that fact and, and like, you know, again, this is where I really dive into the pain conversation and the neuroscience of trauma in the course. It's like you just again, and especially for athletes and, and not to say that athletes stand out amongst, you know, right. The general population. But when you take, um, uh, an athlete, think about an athlete on a team. How am I gonna contribute to my team? What are my coaches gonna think? What if I can't come back? Am I still gonna get my scholarship? There's just so many variables and factors. And one of the studies that I reference is, um, Talking about like the neuroscience of, of pain is really the neuroscience of fear. Yeah. And how fear, anxiety and pain on a chronic level are virtually the same neuro signature virtually the same thing. Like if you looked at a functional MRI, you almost couldn't tell the difference. How can you tell the difference context? That's how you tell the difference. Yeah. And so, If, and the whole idea is if you can create a robust plan for somebody, if you can educate somebody, if you can have them buy in, understand, okay, this is what's happening. This is how we're gonna lay up your appointments. Here's what you need to do. Here's a nutrition guide. Here's a recovery guide. At least you're giving them some, you're giving them some sustainability in the fact that you're giving them back some autonomy.
Chris:I think that was the perfect 360 to come back to where we started and, and just, you have to have options that if you take the ice away, which you should, most of the time, you gotta have something else to put in place with it and say, this is gonna work and create that exact. Type of structured plan that they can digest and feel educated with. And then they're empowered. Love it, Mike. Yes, sir. Great conversation, man. And I think cool, like you said, the most important part is getting this out to everyone. Like just spread this knowledge, spread this podcast, to get out there to the surgeons, to the MDs, to the primary care sports medicine practitioners. This is really important stuff. So tell us where we can find out more. If people wanna take the deep dive with you.
Mike:Um, so there's really, there's two platforms that you can take into the ice age on, uh, I have my own platform. It's powered through think.com. So you can actually just search into the Iceage Mike St and the first link will pop up, but it's um, you could also just go to my website, uh, Mike Stella movement.com, all the links direct to the course of there.
Chris:And then your Instagram has tons of great info as well. Check'em out there. We'll we'll put it all in the show notes and liners and stuff like that. So. Awesome. Awesome man. Yeah,
Mike:man. It was great. Yeah, man. Sounds great. Yeah. Thank you for having me on it was a lot of fun chatting with you and chopping it up
Chris:Thanks so much, Mike.
Thanks for listening. This episode was produced by me, Arpita and Krista Prado. Follow us on Instagram for updates and please like subscribe and rate the podcast to keep more episodes coming. You can find mike@mikestellamovement.com and on instagram at mike stella underscore atc