Controversy: Imaging, is it helping your patient or wallet?
When diagnosing the culprit of lower back pain, many clinicians rely on diagnostic imaging (i.e.: x-ray, MRI, CT). Lumbar pain is reassuringly benign, 85-90% of the time. Lumbar pain involving nerve compression comprises 10% of lumbar pain patients. Sinister or serious disease make up the remaining 2% of lumbar pain patients. The great news is that these ‘sinister’ conditions are ruled out by a proper history and exam. However, many clinicians still seem to be ordering imaging during the initial exam. The question often raised is
“structural pathology is often evident in images, so why wouldn’t we (the clinician) want to identify such abnormalities?”
While structural pathologies do have there place in medicine, they usually have little to do with lower back pain. In fact, most lumbar pain patients do not have a structural pathology that can be precisely identified as being a cause of their symptoms. McGuirk et-al found that 1.4% of lumbar pain patients had serious causes as a result of their lumbar pain, but they were suspected from the initial exam and history.
What about disc herniation?
Because the false positive rates are so high, in identifying a herniated disc, it makes imaging inappropriate as a screening procedure. Moreover, it can lead to labelling thus allowing the patient to assume a sick role or cause the doctor to prescribe unnecessary treatment. In a study performed by Bonenstein et-al, 67 asymptomatic individuals received MRI’s. The results were staggering, in that, 31% of them showed abnormality of the disc or spinal canal. Moreover, additional studies showed that these abnormalities didn’t predict a greater chance of future problems. Multiple studies have also shown that common “positive” findings are present in 28% to 50% of people with no pain at all! Disc herniations have a tendency to resolve in a natural process without surgery. But, what about the herniations that require surgery? The Danish guidelines show the following as being surgical indicators for herniated discs. 1: No improvement after 4-6 weeks 2: Progressive weakness in the leg 3: Leg symptom remains severe despite treatment and medication 4: There is a positive correlation between clinical findings and imaging reports. What about spinal degeneration (decay)? Again this is a term that instils fear into a patient. Disc degeneration is demonstrated with equal properties between those with and without pain. The prevalence of disc degeneration in people without pain and in their middle ages ranges from 46% to 93%! Therefore there is little correlation between radiological signs of degeneration and clinical symptoms.
When is imaging appropriate?
Most acute lumbar pain patients resolve quickly and with little intervention. In fact, It has been shown time and time again that reassurance, simple pain relief and staying active, is the best strategy for managing active lumbar pain. If there are red flags (sinister conditions) present, they should be picked up during the initial history and exam. Red flags of the serious disease are as follows: Mri of the back 1: Age younger than 20, older than 50 2: Trauma 3: History of cancer 4: Night pain (unremitting) 5: Fevers 6: Weight loss (unexplained)\ 7: IV drug use 8: Cortico steroid use 9: Recent infection 10: Cavda Eqvina 11: Generalised Systemic Disease (diabetes) 12: Saddle Anesthesia 13: Motor weakness of lower limbs 14: Sphincter Disturbance 15: Failure of 4 weeks conservative care Given these guidelines we are able to form a simple strategy. If there are no red flags, consider: 1: Reassuring the patient no serious disease is present 2: Relieve and reduce pain (simple analgesics, manipulation) 3: Reactivation (stay active, no bed rest) If there are red flags present consider the following: 1: Imaging 2: Lab work 3: Referral Informing your patient that you are able to rule out sinister conditions, even though an exact cause of their pain may not be identified, will register as very reassuring news. Craig Leibenson gives a wonderful analogy for simple back pain:
“liken the pain to a common cold or the pain experienced from gardening for the first time after a long winter”.
Conclusion
In a study by Kendrick, patients who received x-rays were likely to report a longer duration and greater severity of pain. Why reinforce a patient’s belief that they are unwell and cause them to limit their activities and in essence promote a more negative outlook? Yes patient satisfaction may be higher but the patient must be educated on why radiography is unable to improve therapy, decision making, or outcomes. If after 4-6 weeks there is no sign of improved function or red flags are identified from the patients history and exam, then consider (imaging or appropriate refferal). But always remember, a picture of a car doesn’t mean its running.
References. Leibenson C, Rehabilitiation of the spine. 2nd edition: 2007 Bonenstein DG, et-al. The value of MRI of the lumbar spine to predict lumbar pain in asymptomatic subjects. J Bone and Joint Surg 2001:83-A:1306-1311. Boden SD, abnormal MRI of the lumbar spine in people without back pain. N engl J med 1994;2:69. Kendrick D, Radiography of the lumber spine in primary care patients with lower back pain: Randomised controlled trial. BMJ 2001; 322: 400-405. Jaruik JG, the longitudinal assessment of imaging and disability of the back study. Spine 2001; 26:1158-1166.
Dr. Liebenson has authored over 100 articles and three books. He is an internationally known speaker and a great teacher. Dr. Liebenson re-sparked my interest in my profession at the time I needed it most. When I thought all was lost, I stumbled onto a copy of Dr. Liebenson’s book Rehabilitation of the Spine which opened a new door to my practice. Thanks for taking the time to do the interview Dr. Liebenson.
AC:
Tell us about you background. How and when did you decide to do what you are doing now?
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CL:
Anthony,
Let me start by saying I have always been into athletics. From a young age I was playing the usual sports – baseball, tennis, football, basketball. When I decided to enter chiropractic college I did it to promote a healthy lifestyle, not to limit my practice to adjustments. Ironically, in the early 80’s it became apparent that even though manipulation was gaining traction as an evidence-based treatment that all passive care was being acknoweldged as less effective than an active care approach.
I was very fortunate to come into chiropractic college without a chiropractic “belief”. The evidence has guided me and I was lucky to have as teachers some of the greats such as Dr Karel Lewit, Pr. Vladimir Janda, and orthopaedic surgeons Dr’s WH Kirkaldy-Willis and Gordon Waddell – all strong proponents of an active approach.
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AC:
What prompted you to edit Rehabilitation of the Spine?
—- CL:
You have to realize in the mid-1980’s most exercise approaches were influenced by bodybuilding strength training approaches. Pr Janda was an early pioneer trailblazing for a motor control approach. Also, Dennis Morgan DC, PT & Michael Moore, PT were teaching in Folsom, CA spine stabilization exercises but none of these individuals had put their work together in a textbook. Even, Dr Lewit’s book, now called Manipulative Therapy focused more on manipulation than exercise. I needed a guide to learn from myself and none existed, so I asked my teachers to contribute chapters and I collected them, filled in the gaps where needed and came out with my text.
I assume that getting multiple authors to collaborate on the book was difficult. How did you go about doing that without having the authority you have now? What was the biggest challenge to the first edition?
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CL:
Amazingly they were all excited about the project because the paradigm was switching at that time. I was fortunate to have dialogued and met most of my contributers and we all shared a common passion for promoting a functional approach.
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AC:
What was your biggest mistake in life and what did you learn from it?
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CL:
Too many to name! I guess I regret not doing more research. I would have really liked to have left my comfortable American life behind and spent a few years with Pr Janda helping him to do more rigorous scientific study of his movement patterns and gait analysis. What did I learn? Get off your ass and get on with it. I have a lot of friends in the musculoskeletal medicine field and hope to continue my ongoing work w/ Pr McGill and with John Miller, PT, PhD’s help at Penn State University study in greater detail the clinical value of functional testing.
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AC:
How do you deal with patients that do a no show or are late?
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CL:
I am not much of a business person. That is something my office takes care of.
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AC:
If you could live anywhere else in the world, would you?
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CL:
Italy. Without a doubt.
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AC:
What area of spinal rehabilitation interested you the most at the moment? What is getting you excited in regards to research?
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CL:
Finally, functional assessment has grabbed the imagination of health care professionals. Gray Cook’s program has struck a cord with PTs, S & C coaches, & DCs. Pr Janda always taught “time spent in assessment will save time in treatment”. And, Dr Lewit said, “I don’t begin treatment until I have examined everything. I must see a picture… and find the “key link” that is causing the trouble.”
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AC:
Tell me about your new book.
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CL:
It is called The Functional Training Handbook and will come with 3 new DVDs – Yoga, Posture & Ergonomics; Core Stability Training; & Functional-Performance Training. The contributers represent the broadest possible swath of experts from sports such as Mike Boyle, Greg Rose, Stuart McGill, Pavel Kolar, Ken Crenshaw, Eric Cressey, Sue Falsone, Mike Reinold, and others. It is about functional training and bridging the gap from rehabilitation to sport specific skill. Each chapter has a developmental emphasis and the book takes great pains to address the needs the young, weekend warrior, or elite athelete.
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AC:
What would be some of your best advice for a new doctor of chiropractic or physical therapy?
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CL:
Learn the difference between pain management, rehab & performance training. Study the brain, psychology & biomechanics. Learn from everyone because we are just beginning on this journey and everyone is a student.
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AC:
I heard you like Tool and you got to meet their drummer. How cool is that?
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CL:
Wow! What a creative band. They are out there, but I love their shows.
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AC:
What’s next for you? Are there any upcoming events or seminars?
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CL:
I’m always in the clinic trying to see what works and what doesn’t. Writing all the time for Leon Chaitow’s JBMT and now a bit for my new blog – www.craigliebenson.com. And, of course teaching. I will be in Seattle soon for Jim Kurtz who is now the team chiropractor for the NFL Seattle Seahawks. And, I look forward to my upcoming visit to Athlete’s Performance in AZ to host a DNS-A & DNS-B course led by my friend Pavel Kolar.
Dr. Liebenson received his Bachelors degree from the University of Colorado and chiropractic degree from the Los Angeles College of Chiropractic. He is an Adjunct Professor in the School of Chiropractic, Division of Health Sciences at Murdoch University and a member of the International Association for the Study of Pain and the American Pain Society.
Dr. Liebenson is the organizer of the Los Angeles College of Chiropractic and Scandinavian College of Chiropractic Rehabilitation Diplomate Courses. He is also consultant and lead faculty for the Murdoch University and Anglo-European Chiropractic College M.Sc. programs in Chiropractic Rehabilitation. Dr. Liebenson treats many world-class elite athletes and serves as a consultant for the Arizona Diamondbacks MLB baseball team, and Athlete’s Performance International.
The first ever chiropractic member of the McKenzie Institute (U.S.) Board of Directors he has been a frequent lecturer at national and international multidisciplinary meetings. Dr. Liebenson has published extensively in numerous journals and books on the subjects of rehabilitation and chronic pain.
He maintains a private practice specializing in rehabilitation in Los Angeles and is the author of patient education books on both the neck and low back and editor of the multidisciplinary text Rehabilitation of the Spine: A Practitioner’s Manual published by Lippincott/Williams and Wilkins in 1996 and the videotape series Rehabilitation of the Spine – clinician and patient versions published in 1998. His books have been translated into Spanish, Japanese, and Korean.
He currently is in private practice in Los Angeles, at L.A. Sports and Spine, where he works collaboratively with neurosurgeons, physiatrists and other specialists in the musculoskeletal field. His practice specializes in acute and chronic musculoskeletal pain including sports medicine and post-operative rehabilitation.
One man I look up to more than any other man in business is Dr. Dawson. I originally was interested in helping Dr. Dawson implement traction protocols within his highly successful clinic in Jakarta, Indonesia. After a few trips back and forth to Indonesia and a few life changing experiences later, this man has solidified himself in my mind as one of the most influential, pioneering men I have had the pleasure to work with. This is the man that brought Chiropractic to Indonesia. This is the man that revolutionized the healthcare of Indonesia. This is the man that is healing people that would have never been healed in the country of Indonesia. In short, Dr. Dawson is the man. Dr. Dawson, thanks for taking the time out of your busy schedule to be interviewed.
AC:
Many say you don’t choose Chiropractic, Chiropractic chooses you. Dr. Dawson, how did you get involved in the Chiropractic profession?
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AD:
It was a strangely fated experience. In the 70’s my father brought me to Bali and I had a Déjà vu at a palace in Ubud. I thought I had been there before but my father said I hadn’t. The village head who heard the story went off to the priest who said I would “one day return and bring great knowledge” and gave my father a medical lontar (book) 400 years old. My father was seeing the local healer in bali for his backache at the time. At 13 my father who also suffered chronic migraines, backaches, heart disease and was addicted to morphine, started Chiropractic care with Dr Don Cannon. It changed our lives. Soon all the family was under care and by 15 I knew I wanted to be a Chiropractor. Whatever the case Chiropractic is the only profession I could get truly passionate about. It ticked my boxes.
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AC:
After you completed your schooling did you head straight to Indonesia? What took you to Indonesia?
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AD: I finished at Palmer in 1990 and had dreams of Italy with two of my best friends. I had been there 3 times during my studies. My father called me up and told me he had set aside a clinic space in a building and was terribly persuasive. I even had a new Toshiba X-ray machine. He persuaded me to buy the building a year later. I didn’t know much about interest rates and taxes and was a million dollars in debt at the end of year one. I would never do that again as it took 10 years and 12 plus hours a day to pay it all off. Came year 10 I wanted to go surfing for a year in Bali after I sold the practice and building. I took time out with my young family in our Bali home. By month 6 in Bali I had 20 people a day popping over to the villa for an adjustment and my wife said I had to find an office. It was an instant hit and Indonesia’s first chiropractic office.
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AC:
What was the hardest part of this? What did you struggle with in establishing a new profession in Indonesia? How did you overcome this?
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AD:
The hardest part and is still a challenge are the legal’s. This is a really sticky point. I have endeavored to be legal all the way which meant initially working around the system as there wasn’t one. I’m not one to be told “no” easily so I formed a Wellness Spa Company that practiced Chiropractic. After being arrested and being accused of practicing medicine without a license and interrogated for a couple of days I was let go and allowed to practice under a “Tourist Services” license. In 2002 just before the Bali bombing I started in Jakarta as we had 30 people a week flying down to Bali for Chiropractic from Jakarta.
In Jakarta a new law was passed allowing Indonesia to accept the “World Health Organisation” charter for standards which meant we now had the ability to open “Chiropractic” offices. We got the first chiropractic clinic license really easily. After that the fun began with power over the profession trying to be exerted by new Chiropractor’s blinded by promises of assisting MD’s that the chiropractors could “control the profession”.
It’s still contentious now with two associations. “Perchirindo” with its “back up” because it was first and is under the “alternative medicine department ” and is legally able to give recommendations for licensing for Chiropractors but has a medical doctor at its head. The other group ACI, who thought they could self control and have the backing of the WCA. In the end they were lied to and ACI still had to be under general control of a medical doctor if it is was give to give recommendation’s. They decided not to as it would have destroyed the whole point of the organization. But it does have the backing of the chiropractors.
So it’s a typical chiropractic disaster. The association with the power to grant recommendation’s being outweighed in volume of membership by the association that is run by chiropractors but has no power. We had one chance to get Chiropractic right but the egotists and in fighting has put us back 20 years if not more. I have not been a part of it for over 5 years. Still I am able to practice legally which is the most important point. We have all our clinic and doctors licenced including Physiotherapy and Podiatry.
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AC:
In your life what was one of your most negative experiences and how did you overcome it?
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AD
My father’s 5 heart attacks and his personal anger at himself which he then let off at everyone else in the family was a nightmare. On his 5th heart attack he changed internally and let go becoming a quite different person. This led to Nutrition, Chiropractic,Massage, Vibrational healing, self responsibility and the journey that led him to live another 25 years in good health. As a result I met healers and doctors from all professions and people who had self worth and took responsibility for all things in their life. Anthony Robbins, Deepak Chopra, Mark Victor Hanson and many of the Chiropractic greats have all made my life a joy by letting me understand the true concept of “No Limits” living.
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AC:
You are a leader. I want to know, from your perspective, what makes a great leader?
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AD:
Passion about what you do is number one. Having passion and knowledge for what you do means you don’t give up at the 1st 2nd or 100th object life puts in your way. In my case it’s probably the 1000th. Being passionate and determined allows people to feel comfortable about being influenced with the right intention. Experience certainly counts and an understanding that it’s not about only ones self interest but the interest of the group, the team the vision and the family that’s important. Kids make one realize its not all about “ME” and we gratefully give when we have kids. That feeling and attitude extended to all aspects of life is when we get grateful about leading.
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AC:
When you started your business, what was it like? Obviously, it wasn’t a major empire overnight. I am looking for the “I was sleeping on the floor, eating with food stamps” type of story here.
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AD:
I took Whitney Management 3 times over the years at Palmer. Whitney helped me to launch very well with a large checklist of “to do’s” and a party where I invited everyone I had ever known to the new office. It was 1990 and a recession of the worst kind in Geelong with Pyramid, our building society, just gone down in flames and nearly everyone’s savings had gone. Amazingly it didn’t stop people seeking out care and I realized Chiropractic is really bullet proof. When people are in greatest need they need chiropractic to help them get through.
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AC:
What has been your biggest achievement in life?
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AD:
Family wise having 4 healthy and balanced children that have their mothers good looks. Having an amazing and unlimited life was always a goal and this choice takes me around the world exploring wonderful and extreme places. Last month was pretty neat, deserts islands one day and diving to 29 meters in Komodo National Park off my own ship followed by downhill skiing a day later in Victoria was sure pushing limits and I loved it. Business wise I am yet to rest my laurels on any one thing but introducing Chiropractic to Indonesia as an independent health profession has to be the biggest event.
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AC:
Its tough to beat a month like that. What are looking forward to in the next decade in relation to your business and the profession?
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AD
In Chiropractic it is expanding the business and locations in Jakarta. We have 6 full time and 2 part time doctors and around 20 physios at last count and a small office in Bali. With enormous opportunities to expand we are looking for doctors for our new offices.
My next largish venture is a 125 room resort hotel on the island of Belitung half way between Singapore and Jakarta. Its beach front with a golf course behind it. We plan to run health and wellness programs during the week with golf players expected to take up most rooms on the weekends.
I am selling it as a Condotel lifestyle/investment. It sits on pristine white unspoilt and unpolluted beaches with 28 small islands out the front and a golf course out the back. It’s a passionate project but I have no intention of running it. I leave that up to the professionals.
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AC:
Hard work, beaches, boating, successful business, solid investments… This is a major motivation to me, I am sure others will agree. I would like to know who has influenced you the most in your career?
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AD:
Career wise my current business partner Nick has shown me how to be a balanced leader in a company full of individuals.
To set up good contract’s and employ proper general managers and legal professionals and tax strategists and accountants. Without his assistance I would have been far more happy being a single practitioner as its very difficult to expand into multi practitioner and multi discipline practices without a good head office that takes care of the details and manage the doctors and staff. I am simply another doctor in my operation. So much better. We have 10 people in our head office, taking care of Legals 2 HR 1 Accounts 3 General Management 1 Staff training 1 secretary 1 and cleaner 1.. its adds up. Overall we have about 50 staff in the company.
Skills wise I learnt how too adjust from Dr John Faye who taught motion palpation and after some time with him you can really adjust.
Too many students leave school with all the brains but no ability to adjust competently (which patients can feel).
His courses are online at chiropracticmentor.com and his concepts of functional chiropractic.
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AC:
Lastly, what would be your best advice to a new graduate in any health care profession?
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AD
Find a place you can work with without the stress of doing it all on your own. Work under a mentor whose advice you respect.
Don’t be impatient and realize that success is not a given. You have to work for it.
Anthony K. Dawson, D.C. is the founder of Chiropractic Indonesia. He established Chiropractic Indonesia by applying the principles of Chiropractic and using the establishes models from around the world that are subluxation-based and have save adjustment technique.
Anthony K. Dawson, D.C. graduated from Palmer College of Chiropractic in 1990. He had been in private practices in Melbourne and Geelong, Australia until late 1999.
In 1999, Dawson D.C. moved to Bali, Indonesia with his family. He opened the first chiropractic in Bali in 2000. This was Indonesia’s first chiropractic only clinic.
Dawson, D.C. is now practicing in Jakarta since 2003 and is currently the principal chiropractor of Chiropractic Indonesia and lives in Jakarta with his wife and 4 children.
Insights Interview: Sailing, Chainsaws, and Tissue Tolerance
AC:
Dr. Stuart McGill a name that will inevitably live on forever as being one of the most influential researchers of spinal biomechanics and its applications. Dr. McGill has shaped my understanding of the lumbar spine in a way the scholastic system (at that time) couldn’t. Moreover, he helped me of ongoing lumbar pain though simple instruction and habit changing (avoiding repeated flexion during the treating of my patients). Really there aren’t enough words to say regarding this man and the impact he has made and will continue to make on humanity. Thanks Dr. McGill for your excellence in both work ethic and on a personal level. Your hospitality to my questions is much appreciated.
AC:
Spinal biomechanics isn’t something the typical college matriculate would say they want to study. Dr. McGill please explain how you became so interested in spinal biomechanics.
SM:
A series of chance events. I was starting my PhD in Systems Engineering and met a professor who was just starting spine research and I switched to his lab. His name was Bob Norman. He was a mentor to me in many components of life.
AC:
When I was watching your first DVD I noticed you had a boat. It looks like a pretty nice boat. Is that one of your hobbies?
SM: I love to sail and that sequence was on a trip where we chartered a boat in the Virgin islands. I built a small wooden boat last winter and currently have a canoe under construction.
AC:
Moving into academia now, your research has sparked more controversy in health and fitness than personally anyone else I have read (and I read a lot). Extremes will always exist but what do you think people are missing when you come under fire regarding topics such as lumbar flexion during movement and exercise?
SM:
Several principles but here are a couple.
Tissues have a finite number of cycles of load, and particularly bending under load, until they break.
Bone, muscle adapt but discs accumulate fatigue loading. So it is important to use the number of bends wisely. Further, with so many people spending so much time sitting, bending the discs uses up even more capacity. There is usually little need to train more bending. Also posture – posture determines a tissues ability to survive load and usually flexion reduces disc strength. Choice of exercise is also so important to spare the spine – optimal choice allows a greater volume of training pain-free. Removing the cause of the offending motion/posture/load as well is a major key.
AC:
Considering this, how do you deal with people who criticize your work?
SM: Most of it I have to ignore as they rarely have a full understanding. They may pick on one facet of our work not realizing that we have done work on spine tissues, back pain patients, athletes and use virtually all imaging and diagnostic techniques. We have several hundred scientific publications. For example this past weekend I was at a conference and one delegate stated that our work on TvA used surface electrodes and was not valid (only intramuscular electrodes are valid). I suppose he had read only one of our papers. I had to point out that had he read our complete work I was one of the first people in the world to have intramuscular electrodes implanted into my TvA and many other deep spine muscles too. This was published years ago. But having stated that sometimes their criticism is correct.
AC:
When you work on patients clinically do you ever have those patients who just don’t follow through with treatment or fail to improve? If you do, how do you personally deal with that?
SM:
First I don’t see the average painful back – only those who have failed to get better after seeing several other clinicians. So these are the difficult patients and that is our specialty. So, Yes I have patients who fail. We then try a different approach to see if we can get some improvement. But if they have better and worse days we rarely fail to find out the mechanisms that cause this and
from there we help to create more pain-free days. Then we try to modify the progression to keep building more success. As well, people have to pay out of their pockets to see me – that motivates them I think. Yet there are still those who don’t follow through which is their choice. And any clinical failure bothers me. And then there is the category of those who may have substantial pathology and I fail. They may have had several surgeries and they have little tissue left that is able to bear load or they may have been hit by a bus.
AC:
I have to ask this one. When was the last time you hurt your back?
SM:
I fell on ice this past winter and really cracked my pelvis – it took a while to get over that one.
AC:
Where do you see the future of spinal biomechanics? Whats exciting you at the moment?
SM:
Several avenues: developing more provocative tests to detect the painful tissues and learn more ways to remove the offending mechanism and pain. Learning the mechanisms that great athletes employ to enhance performance and perfecting more physical based treatments.
AC:
In your book there was a picture of you working with the wonderful Dr. Vladimir Janda. Which leads me to ask, who has influenced you?
SM:
Virtually all of the great experts: Janda, Sahrmann, Skaggs, Erhard, Kirkaldy-Willis, Farfan, Bogduk, to name just a few together with some of the great training pioneers: Siff, Santana, Kazmaier, and many other great coaches.
AC:
Lastly and probably the most personal. Whats something not many people know regarding your life?
SM:
I try to do heavy physical labour every day – my favorite tools are a chain saw and a heavy splitting maul. It is good therapy.
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Dr. Stuart M. McGill is a professor of spine biomechanics at the University of Waterloo (Waterloo, ON, Canada). His advice is often sought by governments, corporations, legal experts and elite athletes and teams from around the world. Difficult back cases are regularly referred to him for consultation. Dr. McGill’s research at the Spine Biomechanics Laboratory has three objectives: to understand how the low back functions; to understand how it becomes injured; and, knowing this, formulate and investigate hypotheses related to prevention of injury and optimal rehabilitation of the injured back, and ultimate performance of the athletic back.
They have two separate laboratory approaches – one which examines intact humans which utilizes a rather unique approach that monitors spine motion and body segment position, muscle activation, ligament involvement and modelling tissue loading in each individual subject; and a second approach where they examine the mechanical behaviour of low back tissues and spine specimens. His graduate students have been involved in several issues such as investigating the load tolerance of the spine under various types of load, assessment of spine stability, examination of devices such as abdominal belts, examination of various injury mechanisms and determining the safest methods of achieving performance in the back, to name a few.
This work has been recognized with many awards including the R. Tait McKenzie Award 2005, the CSB Career Award 2004, the Stow visiting lectureship from the Ohio State University College of Medicine 2002, the Steven Rose Lectureship from the Washington University School of Medicine 2001, to name a few.
Insights Interview: The Underworld, The BIG controversy, and Being a Family Man
AC:
Firstly, JC it is important for me to thank you for doing this interview. You have been a major influence in my life both directly and indirectly. Directly, you have been a great friend and someone who I can trust. You respond to emails quickly, you are keen on helping, and you always have great words of advice. Indirectly, people you influence continue to influence me, these people are many. JC:
Thank you for the kind words Anthony. It is words like these that allow me to do my work willingly, happily, and often. No one can ask for a better scenario to make a living. At the end of the day, it’s not what you take with you that counts (which isn’t very much) it’s what you leave behind that defines your history. If I touch people and they touch people, then, my history will be told one day and it will be a good one.
AC:
How did you get started into the “industry”? Give me some details and stuff not so commonly known.
JC:
I guess I have always been “in the industry”. As a child my super heroes were strong men like Hercules, Samson, Tarzan, etc. I was never into the “Sci-fi, Superman, Batman, figures because they were not Men Like enough for me. I always loved MOVEMENT and HUMAN ABILITY, not necessarily sports. Thus, my super heroes fought animals, battled army’s, swung from trees, and picked up heavy stuff (LOL).
My formal entry into the Industry was back in 1973-1974, when I formally had the keys to Brodie’s Gym. I was called a manager at 14 because a ‘manager’ opened, closed, cleaned, collected money for membership ($10/month), sold protein bars and apple cider. I did that and I did it well. That is when I learned a TON from bodybuilders, police officers, military and para-military officers who took me under their wings due to my maturity.
At 12 I stated studying a slew of martial arts and that has not stopped. I did not care about the history or the belts; I cared about how they worked and what worked. As soon as I started the martial arts I started training for performance, NEVER FOR LOOKS! I wanted to break boards, jump high, win tournaments, and basically have the ability kick people’s asses (Although I have never been in a major fight in my life). I’m not a bad ass – but I can take care of myself enough to not have to back down or take any shit from anyone!
I have studies immensity (academic) and worked in multiple professions. I have studied and worked in the engineering, medical, and music industry. I have toured with my own band, owned and operated a bar/liquor store, and owned and managed fitness clubs. I’m a dissertation short of a PhD, and have produce over 70 DVDs and written 14 books.
I have also had my history of the fast life, which many in the industry may not know but all of my friends do. If you have heard tales about my life from the 1980s and early 1990s, I hate to tell you it is most likely true, or at least based on some truth. Yeap – from wining and dining with the underworld of Miami, to ending up in the middle of flying bullets with the same crew – it’s all true. So my journey has been a movie with several sequels. So know this – I’ve done everything twice and loved it all.
How about that for something you may not know!
AC:
You just got back from training with the Bartendaz, in NY I believe. Tell me about that experience.
JC:
I have been disgusted with fitness for some time now, that is why I don’t do anymore shows (they have become circuses and whorehouses – all in one). I have actually become disgusted with our society. We have become lazy, soft, full of excuses, and without accountability.
I have been looking for a return to the basics: to see the complex in simplicity, to see the elite in the basics, to get back to basic principles and values. The BARTENDAZ are a prime example of all of that. We don’t see basic human movement as sexy, moreover, we don’t see what can be done with hard work. Instead, we jump on the latest and greatest to keep our attention (from stability balls, to bands, to vibration, to all of he diets and gadgets you have seen). The Bartendaz experience is a re-connect for me to something that is real, basic but yet extremely advanced. So it is a perfect example of how powerful the basics can be.
We film in a couple of days and this is as excited as I have been about a project in a long time.
AC:
Very true JC! I am excited to see what you and the BARTENDAZ produce. Now, moving into choppy waters. There has been some major controversy going on between the NSCA (which you are on the board) and Mike Boyle. What is the outcome of this? What is hype and what is fact?
JC:
This is what I sent out to people who contacted me on this issue. These people were blindly contacting the Board of Directors (BOD) and sending in form letters without thinking, asking, or knowing ANY facts.
Your email was sent to me so I will offer you a long but accurate account of the situation.
I think before you assume you know or take sides on an issue, you should at least hear both sides; for nothing it what it seems here.
We have only received around 15 emails on this issue. This is NOT the big deal it is being made out to be. That is the nonsense of dealing with these VERY PERSONAL ISSUES through a public forum like Facebook, which I find totally immature, unprofessional on the part of Mike Boyle. I’m very surprised at this behavior coming from a 50+ yr old ‘man’.
Since you sent this to me, I will answer you personally. JUST man to man. Now this is just my opinion and has nothing to do with my NSCA involvement. I roll off the BOD (Board of Directors) in July after which I will much more open on these types of issues.
First – The BOD has nothing to do with the selection of speakers, or Conference Committee policies, procedures, etc. That is how we keep the NSCA clean, independent, and NOT being a BOY’s Club. For Mike to send all of his friends to write to the NSCA BOD clearly shows he has absolutely no idea about how we run the organization. This is totally immature and unprofessional. He could have and should have taken it up with Dave Sandler (Conference Committee Chair), who made the decision along with other conference committee members (INDEPENDENT OF THE BOD – that is the way it is operated exactly for these reasons). I informed Mike of this personally – so I know he knows what the deal is. Why he has done what he has done and said what he has said clearly shows he is NOT interested in the truth, the organization, or even uniting the industry – this is all self promotion.
Second – Mike was UNINVITED by the Conf Committee, NOT BANNED. He was also not uninvited because he was controversial. I suspect that the reason the Conference Committee has decided to uninvited Mike to this year’s conference is because of slanderous comments Mike has repeatedly made about the NSCA (some in my presence – so he can’t say he has not!). Frankly – if it would have been up to me, I would un-invite any presenter that slanders me to my conference, wouldn’t you? I don’t mind respectful criticism of the NSCA –that is how it grows. NOBODY HAS CRITICIZED THE NSCA MORE THAN I – but I have done it with respect. (editors note: There is a BIG difference between slander and criticizing, one of those difference being of the legal sort)
Mike Boyle has (In front of me on more than one occasion) defamed the NSCA publically and in an unprofessional manner. That should not be mistaken for disagreeing or constructive criticism – which we all advocate! However, after talking all sorts of garbage about the NSCA (without really knowing the facts because he has NEVER done anything with or for the NSCA), Mike always asks to present at the NSCA conference. By the way all of this done under the “Skirt” of Perform Better (PB); through PB’s endorsement/sponsorship relationship with the NSCA. He will tell you he never asks to present, PB asks him to present at the NSCA and that he is hired by PB and not the NSCA – that is an outright lie! The NSCA always has presenters sign contracts – remember I was in Mike’s shoes for many years!
Thirdly, much of this comes from an axe Mike has been grinding with Jay Hoffman for almost 3 years now but Mike won’t talk about that!! If Mike Boyle has an axe to grind against Jay Hoffman or someone else then this should be taken up one to one – like real men do. Not in a public forum like some 14 yr old boy breaking up with is girlfriend through text messaging. For the love of mankind, I truly feel like a dinosaur in these times. Where have the men gone in this world?
In my opinion, if you are an honorable MAN and stand by your convictions and opinions, then you will not present for any organization you don’t feel is up to your standards (which is the way I operate). However, Mike does not want to do that, neither does Perform Better, due to the Money and Brand Recognition they get from being involved with the NSCA! I find that extremely hypocritical, don’t you?
I no longer support many fitness conferences because they have sold out (the NSCA is the only one that still stands for something – with ALL of its problems). So what do I do? I DO NOT present at the conferences I don’t feel are up to my standards. I do this at great financial sacrifice but I will not sell out and I do not hide behind any forum, company, or third-party endorsement. Also, I do not call out each and every company, or presenters spreading crap for that matter it is NOT professional. If anyone wants to mud sling, I’ll do it but I will not start it (especially in a public forum).
I think if more men had real balls and stood behind their convictions, this profession, and this world. It would all be a better place. But it seems that the fashion now is to use the Internet to mud sling and talk the crap that would never be said to someone face to face. It takes no courage to take things into Internet forums, chat lines, and text instead of handling business through up-close and personal processes! This is the sad the state of affairs of today’s generation. I expected more from Mike and the rest of the PB management. They [Mike Boyle/PB Management] have shown a childish way of handling business.
AC: Hearing both side of the story is so important. Many people haven’t had a chance to do that, so I thank you for being open regarding the NSCA vs. Boyle controversy. Moving on (and its a great transition) how do you deal with the haters?
JC:
I wish I could tell you I’m mature and I live and let live but I don’t all the time. Sometimes I’m able to ignore them. But Sometimes I tear them a new asshole, in private, in public , verbally, physically – anyway it needs to get done. I hope to God I get better because one day I might end up in jail for beating an asshole an inch from his/her life.
People have become so disrespectful these days, someone needs to do something. I don’t want to be that somebody and I hope I can control myself but sometimes I just can’t. That’s the honest truth.
AC:
I struggle sometimes with the same stuff JC. Again, thank you for being open. We all have our 15 minutes of fame. Some people capitalize on that 15 minutes to make it a lifetime and some people don’t. Obviously, you capitalized. What was your “big” break and what has been your “big” trial/tribulation?
JC:
I owe my break to Lee Brown (The NSCA’s former President). Lee was the one who suggested and insisted that I write an article and do a presentation for the NSCA. After my first presentation I was invited back to a standing room only. From there the rest is history. So my BIG BREAK was the NSCA Annual Conference, 1997, in Vegas.
My biggest challenge has been to maintain a balance with all of my work, my family, and my private life. The balance of being a family man (with ALL of its responsibilities), staying at the top of my industry, and having time for me (e.g. my own personal development) is very hard. I do it fairly well and have fun doing it. So it is not too bad.
AC:
As you mentioned JC, you are a dad, business owner, and international speaker. How do you manage your life?
JC:
I’m very disciplined and a hard worker. I have to be because I don’t have any natural talents to speak of. I have a very strong character that keeps me real, grounded, and focused. I make sure I do all that is necessary daily, from giving my family love and safety, to dealing with issues at IHP, to training and getting rest. Some days I do better than others but at the end of the month I take inventory and get most of it in. I do that month in and month out. Because I’m well balanced like that I’m able to stay happy and creative. It’s not easy but I get it done.
I’m very hard to live with if you are not with the program and don’t give me space so I’m blessed with a very understanding wife that is very supportive and gives me the freedom a person like me needs! TRUST ME, I’m good at what I do, I’m all man and take care of my family but I’m no prize. It’s a package deal with me; you want to ride and show off the stallion, no problems, but you better leave your spurs at home. You spur me once and I impale you on the first low-lying branch I find (LOL). As a matter of fact, when my wife is giving me a little more “BIZNESS” than I’m willing to take, I tell her, “you’re spurring me”. Then she knows she needs to back off and give me room. We
are great together and laugh a ton at ourselves THAT IS WHAT KEEPS ME GROUNDED AND BALANCED.
AC: Many people think that all the sudden you just became internationally known but we know it took years of work. What is the best advice you have for people wanting to lecture internationally?
JC:
10,000 hours or 10 years OF DELIBERATE PRACTICE (not to be confused for pure repetition)! Get out the clock and calculator and get ready to pay the piper; that is what it takes for anyone to accomplish world-class excellence at ANYTHING.
READ TALENT IS OVER RATED.
These new guys and gals all want to do it through a web site, pictures opps, and e-books! They all attempt to cheat the 10,000 hours/10 yrs, but they won’t be able to. What is happening is the BAR IS DROPPING in all aspects of entry criteria into various fields of work (from armed forces, to professional schools, to presenting at conferences). Just look at the Internet claimed experts and new conference presenters – who the hell are most of these people? They are artificial and market driven figures who usually have only accomplished half of what they claim and only have a third of the knowledge needed to be who they say they are! Much less the ability to possess WORLD-CLASS EXPERTISE. This is why I don’t do conferences anymore (except with the NSCA).
AC:
Your expertise and hard work has paid off and you inspire people daily JC. That is an amazing talent. Are you able to give readers (and me) some pointers on being a great teacher?
JC:
Thank you for your kind compliment. Frankly, I can’t believe I have had the success I have had. ALL I wanted was to be a great coach but when you are a great coach, you inspire people, that is what coach does. I made a mistake in thinking that a personal trainer needed to know about exercise to be able to do their job. We ARE NOT THERAPIST’S OR EXERCISE PHYSIOLOGISTS, we are coaches.
We inspire people to make behavioral changes and make better choices and those choices may start with exercise but they (positive choices) penetrate EVERY ASPECT of people’s lives.
All I can tell you is that to teach you have to inspire people to learn. To illicit change you have to inspire people to work for what they want. To inspire you have to be real, honest, grounded, and perfectly imperfect – so people can see you work through your own challenges. People learn in part my imitation so role modeling is huge. You have to live what you preach.
DO NOT take yourself too seriously – you are going to screw up and fixing it is half the fun of life.
AC:
What is your biggest advice to new trainers?
JC:
“Do unto others as you would have them do on to you” is an all time favorite.
Here is mine…….
“Work like you will live forever, live like you will die tomorrow”
That’s about it brother – no secret, no rare words of wisdom, no complicate paradigms – there aren’t any. The answers to most questions are usually right in front of us and simple.
Juan Carlos “JC” Santana is a world-renowned authority in the area of performance enhancement and is one of the most prolific speakers in the fitness industry. JC has been published extensively and has produced many videos on the subject of performance enhancement. His educational resources bring the most innovative and cutting edge training methodology to fitness professionals around the world.
JC is a proud graduate of Florida Atlantic University (FAU), where he received his BS and MEd degrees in Exercise Science. While at FAU he served as an adjunct professor of Weight Training Systems and Sports Training Systems.
JC is a member and a certified Health Fitness Instructor with the ACSM, and a member and Certified Strength and Conditioning Specialist (CSCS) with the National Strength and Conditioning Association (NSCA). He is a certified Senior Coach and Club Coach Course Instructor with the USAWF, and a LEVEL I coach with the US Track and Field Association. JC has served as the Chairman for the NSCA’s Sport Specific Conference (1999-2000), an NSCA Conference Committee member (1998-2001) and was the NSCA’s Florida State Director (1997-2001).
JC has always believed in practicing what he preaches. This is why you can find him at IHP everyday training his diverse clientele. You will also see him giving back to the community through the many hours he volunteers to local athletes, particularly the Spanish River Wrestling Team where he is on his 4th year as their strength and conditioning coach.
JC is the director of his consulting company, Optimum Performance Systems (OPS), which is based out of IHP. OPS provides: Consulting for equipment manufactures, fitness organizations, fitness professionals and major sports teams, athletic development camps, education for fitness professionals and internships for graduates in the allied health professions.
In spite of his professional accomplishments, JC feels his highest achievement has been his family and the bond they share. His wife of 9 years, Debbie and his three children, Rio (14), Caila (5), Dante (3), Mia (newborn) remain his top priority. JC pledges to pass on the legacy to his children that his parents passed on to him; family first, then everything else.
Insights Interview: Forecasting, Silver Linings, and Sales Techniques
AC:
Hi Ish, I want to thank you for your time and effort in making the interview happen because I know how much you hate writing. You have been a driving force being multiple companies. Firstly, you have been the superpower behind much of cooperate giant, LES MILLS, personal training business seminars and education. Secondly, you run ishcheyne.com which is pumping out some amazing podcasts and client information. So as usual, tell me how old you were when you started becoming interested in the field and also what your background is.
IC: I got in to the fitness industry when I was 18 completely by accident. I am a qualified Chef and I had an address given to me for a job interview but when I turned up at the address it was a Gym not a Restaurant. So I said I really want a job and the guy said can you sell gym memberships, I said sure (not that I had any idea if I could or not, I had never even been to a gym before) so I started the next day, fell in love with the fitness industry and the rest just kind of happened
AC:
Many people often get, “tall poppy” syndrome (where the person tries to cut another down for their own gain). I am sure this happens to you at some time or another but what do you do to keep your mind focused away from this sort of stuff?
IC: I spend as much time as I can adding value to people’s lives by building positive relationships. Help someone get what they want and you then get what you want. Don’t worry about the dickheads.
AC:
How do you, Ish Cheyne, motivate the unmotivated? How do you make someone who is in denial about their health to come to terms with themselves?
IC: I just tell it like it is, to many people have a cross your fingers attitude to health and fitness and say things like, I hope I don’t get cancer, I hope I don’t get fat, I hope I don’t get sick. It’s better that they can prevent it before it happens rather than living in reaction. I just give them the options then if they’re smart they make a good decision
AC:
Thats a straight forward attitude. Its true that prevention is always better treating the problem after the fact. Speaking of motivation, you are very skilled in marketing and sales, how do you handle hesitations (regarding a sale)?
IC: The best line I ever learnt was, “so aside from….blar blar…is this something you would like to do” So if the person says it’s too expensive, you just say. Ok so aside from price is Personal Training something you would like to do” if they say yes, then say “well you know yourself best how much could you put towards it per week” then work it all out from there. If they say No, then they don’t see the value in what you are offering…either that or they think you’re a dick and it’s pretty much over
AC:
Okay so we know that if you are a d**k then motivation is not an option. However, who is the one person who has motivated you the most in your field?
IC: It’s not just one person; it’s Les Mills as a company. They have changed my life. The businesses innovation and the people that work in the company are amazing
AC:
You have been in the game for a bit now, where do you see the gym and fitness industry heading? What will be the next big step for the fitness industry?
IC: Small group training and membership options for people who don’t want to join or commit to a contract
AC:
If you could train anyone who would it be?
IC:
Chuck Norris!!
AC:
What’s your biggest advice for a new student or trainer?
For those that like it long: Ish Cheyne is one of New Zealand’s top personal trainers (2008 South Island Personal Trainer of the year) and with over 15 years of experience working across the Health and Fitness industry, Ish is internationally recognized as a leader, educator, and visionary.
As a leading presenter, Ish is highly regarded for his dynamic, motivational and informative seminars. Through radio interviews, television shows and international speaking engagements, Ish’s expertise and knowledge have become well-known and highly valued. Ish is the National Facilitator for Les Mills and teaches all aspects of exercise prescription, business, marketing, sales and customer service.
Les Mills International has contracted Ish to assist in the area of training development. He is one of the best facilitators in the world and has written and delivered education DVDs now seen by over 80,000 instructors in over 70 countries.
Through mediums such as television, radio, speaking events, pod casts, blogs and e-books, Ish is a key solution provider in the areas of personal training, fitness, sales and staff performance. Blar Blar Blar….. (Told you it was long)
Insights Interview: Silver Linings and Forecasting of the Industry
AC:
Hi Bret, I want to thank you for your time and effort in making the interview happen. I have looked up to many great people in the health and fitness industry over the last 15 years and one name that I keep seeing more and more of is yours. Tell me how old you were when you started becoming interested in the field and also what your background is.
BC: Hey Anthony, first of all I want to thank you for allowing me to do this interview. To answer your question, at fifteen years old I started reading every muscle mag I could get my hands on and training using bodypart splits. At twenty-four I stumbled upon HIT training. Before that I seriously didn’t know there were other “methods” out there other than HVT. Shortly after that, I stumbled upon sport-specific training and never looked back. Over the years I’ve taken a hard look at nearly every method, system, and style imaginable. I’m a 33 year-old CSCS with a master’s degree and a background as a high school mathematics teacher.
AC:
We all go through tribulation and trial and if you haven’t you will. When you first started doing your job and focusing on your work, what were some of your biggest let downs, failures, and/or rejections? What did you do to overcome this negativity?
BC: The most difficult struggle I ever went through professionally was when I had to let go of the idea that my invention was going to make me a lot of money one day. In late 2006, I invented a glute-apparatus called the Skorcher. I thought it would take off especially considering the compelling EMG experiments that were conducted showing it’s effectiveness. However, the world wasn’t ready for the invention, the economy plummeted right around the time I was able to raise money to launch the product, and my dreams of “making it big” came to a screeching halt a couple of years ago. I became quite bitter and distrustful after this experience and am not sure if I’ll ever fully “recover” from the let down. I was lied to and taken advantage of by unscrupulous investors.
As time goes on, it becomes easier to see that everything happens for a reason. I gleaned some great business lessons and learned an awful lot about what type of person I never want to become. Best of all, I own one of the few Skorchers out there and can use it in my own training! Here’s my friend Keats Snideman using the Skorcher to do a single leg hip thrust.
AC:
Many people often get, “tall poppy” syndrome (where the person tries to cut another down for their own gain). I am sure this happens to you at some time or another but what do you do to keep your mind focused away from this sort of stuff?
BC: Tim Ferriss wrote an excellent blog about “dealing with haters. Here’s the link:
1. The more popular your work, the more haters you’ll likely develop
2. The more cutting edge and innovative your work, the more haters you’ll likely develop
3. The Strength & Conditioning profession is male dominated and often ego-driven. Getting hated on comes with the territory and many don’t like “newcomers”
4. All publicity is good publicity
5. If you put yourself out there and your stuff works, you’re going to positively impact thousands of people. I’m one of the few trainers I know of who have invented and popularized exercises and created terminology that “caught on” in the industry. Focus on the good you’re doing and resist the temptation to get enraged by comments written on blogs and forum threads
6. Strength training attracts a lot of “meatheads” who love to pick fights on forums and say horrible things. Once again, getting hated on comes with the territory.
7. All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident. – Arthur Schopenhauer 1788-1860
8. Nobody likes a negative person. If you can’t learn to deal with adversity and be positive most of the time, then doors aren’t going to open up for you and you’re not going to be able to spread your message and positively impact nearly as many people as you could if you were a happier person.
9. Our profession needs critical individuals who aren’t afraid to call it like they see it. Learn to appreciate these highly critical and opinionated folks as they’re a natural “checks and balances” system for our profession
10. Every negative situation that occurs is an opportunity for you to display your positivity, professionalism, adversity, and determination
I find that after considering these thoughts I’m able to calm down and not be deterred by haters.
AC:
How do you, Bret Contreras, motivate the unmotivated? How do you make someone who is in denial about their health to come to terms with themselves?
BC: First of all, it’s important to realize that you can’t motivate everyone. As a young personal trainer I used to give discounts and train so many people for free to the point where I went overboard in my quest to “save the world.” Now I reserve trying to “motivate the unmotivated” mostly to family members and dear friends. For these people, I try every angle imaginable. I beg, plead, bargain, write simple programs, print articles, email links to journal study abstracts, and try to find an “angle” that will do the trick. Sometimes you just have to accept that a person isn’t ready to care about their health and be proud of the fact that you may be “planting seeds” that will sprout later on down the road. Just never give up!
AC:
Who is the one person who has motivated you the most in your direct family? How about in your field?
BC:
Although I have the greatest Mom and Dad in the world, I have to go with my Gramps on this one. He was an engineer and always bought me all kinds of math and physics books when I was in high school and college. I was probably the only kid in my high school who read Steven Hawking books and understood the theory of relativity. He would give me his Discover Magazines and talk to me about science all the time. This affected the way I approach everything in life.
As to my greatest influence in the field…that’s really tough. I’m a very unique trainer and don’t always follow the norm. I’ve been heavily influenced by Louie Simmons, Charlie Francis, Mike Boyle,Christian Thibaudeau, and Gray Cook. However, my training and methods are quite different than theirs. My number one influence would have to be Mel Siff (although I didn’t read his book until after he died so his influence on me occurred post-mortem). He was in my opinion the brightest guy to ever care about fitness. Although I’ll never come close, I aspire to think like him on a daily basis.
AC:
Where do you see the gym and fitness industry heading? What will be the next big step for the fitness industry?
BC: I thought long and hard about this one and have realized that I’m no prophet. My friend Carl Valle offered some insightful opinions on this topic. Here’s the link:
I’m curious to see if our profession ever enacts stringent licensing procedures for personal trainers. I’m curious to see if gyms keep becoming “fruitier” or if “manly” gyms will be resurrected. I look forward to the time when our profession has a better understanding of what “functional training” entails, as well as what best practices are for assessment/screening, gaining mobility/flexibility, maximizing transfer of training, and optimizing core training. I look forward to the time when we have a better understanding of program design as it pertains to manipulating training variables for various populations. As the different fields of Physiology, Biomechanics, Physical Therapy, and Psychology converge, we’ll gain a much better understanding of the “Big Picture.”
AC:
If you could train anyone who would it be?
BC:
Definitely Usain Bolt! I would love to conduct all sorts of analyses, experiments, and studies on him in hopes to figure out exactly what makes him so special. I would also love to see if I could help make him even faster. It’s easy to make a novice better. But getting the best in the world to be even better takes someone who really knows what they’re doing.
AC:
What’s your biggest advice for a new student or trainer?
BC: As Rob Panariello, one of the brightest minds in the fitness and physical therapy fields likes to say, “Know the difference between fact and opinion.” Strength & Conditioning is an arte scienza. It’s a blend between art and science. There are too many variables to ever allow us to boil it down to an exact science. Much of what we do is based on opinion. No expert has all the answers. In fact, no expert even comes close. Many roads lead to Rome and there are many methods that can lead to success. Learn from all the experts via books, textbooks, articles, blogs, DVD’s, journals, seminars, college courses, and internships. Have respect for those who know what they’re doing but don’t put them on a pedestal. No matter how smart you think they are, they don’t have all the answers. We don’t have much figured out so always remain open-minded yet at the same time be highly skeptical. Try to be evidenced-based while also remaining innovative and staying on the cusp on scientific advancement. Don’t be afraid to try new methods as that’s how we learn. Don’t be afraid to fail. Develop your own philosophy based on evidence, theory, anecdotes, and opinions. Always err on the side of safety. Learn from a variety of fields as that sparks creativity. Make friends in the profession. Never stop training yourself!
That’s awesome advice Bret. Thank you Bret for your time and input, I am really excited to keep following your work. Although I have been through a decade or so of school, I am really new to the field and like everyone, I am always learning. I am really inspired by your drive and work ethic and applaud you for your effort. Thanks Bret, I appreciate you.
-Anthony Close
Thank you very much Anthony! I appreciate those words very much. It’s very nice to know that I’m inspiring others. Excellent and unique interview questions. Thanks again!
What about spinal degeneration (decay)? Again this is a term that instils fear into a patient. Disc degeneration is demonstrated with equal properties between those with and without pain. The prevalence of disc degeneration in people without pain and in their middle ages ranges from 46% to 93%! Therefore there is little correlation between radiological signs of degeneration and clinical symptoms. 
