Review the Everyday Anatomy Discussion:

Clara: Welcome to part one of a three-part discussion with my friend, Dr. Paul Ochoa. Here is a little background on Dr. Ochoa. He’s a fellow of the American Academy of Orthopaedic Manual Physical Therapists—a big one—with a specialty in orthopaedic injuries. 

He founded his physiotherapy practice in New York City, F Squared Physical Therapy, and he’s had it for almost 10 years. I’ve known Paul since we were teenagers. I took this time with him and these three discussions to share his thoughts on movement, how we can assist our movers and shakers in our classes, and some myth busters.

I would love for you to share your journey with our community. 

Paul: I’ve always been in the healthcare field in some capacity, whether in emergency medicine, as a massage therapist, or now as a physical therapist.

So, movement, one-on-one, and in-personal ways have been part of my life.

I deal with folks who come in with issues. That’s the cleanest answer if someone comes in with an issue and has preconceived answers and notions about why they are experiencing pain and what might be causing it.

And, so, a lot of my work is about education and facilitating movement, helping with any fear avoidance that might come from that. So, I love being in this because I get to work with many different parts of a person. 

Clara: What is your relationship to movement in terms of your own body? 

Paul: I love moving fast, picking heavy things up, and putting heavy things down. That brings me incredible joy. I’m a trapeze flyer. I practice Muay Thai and have done It for many years.

I also do lifts and resistance training, and those are my favorite things to do. My relationship to movement or movement in general is that it is a part of my life. It’s a priority. It’s not something I leave for as an afterthought, like an after-work thing, or I try to squeeze it in.

Clara: And do you move every day? 

Paul: I don’t work out every day.

My workouts are sometimes so intense that I need a recovery day if I don’t. If I worked at an office where I sat or stared at a screen for hours and hours a day, I would probably want to have some level of movement daily to get my blood flowing and get out of that one position I’ve been in all day.

My life is about walking, picking up weights, handing them to people, moving, and doing little things—things and teaching people how to do certain exercises. So I have some movement every day, thankfully. But I don’t choose to work out every day.  I mean, possibly if you’re training for something specific, but I don’t think that’s a sustainable thing for most people, including myself.

Clara: What is a sustainable amount of workouts in a week? 

Paul: I work out five times a week. I’ve put that into my schedule, so it feels really good. Sometimes, I move those workouts to weekends, and sometimes, I keep them during the week. So there are absolute weekends.

If you have a goal or question about how many times a week you want to work out and how many times a week you want to move, start where you are. So if you have two nights a week or two days a week, whatever it is to move, that makes it easy. 

Don’t start in a place where, you know, you’re going to immediately have some pressure to have to shift something because you’re starting something new, trying to develop habits at the same time, kind of a little bit of an uphill battle with your schedule is just that you’re setting yourself up for disappoint.

Clara: Are there any factors or tips we should consider regarding caring for our bodies as we age?

Paul: So this is a ubiquitous question I get not only with folks in their midlife or later on in life. Also, younger people who I’ve just noticed, at least in my part of the world, that younger folks are exercising less. And maybe that has to do with the pandemic.

Whether you consider it the bare minimum or the most, it is undoubtedly the first thing to consider when it comes to longevity or continuing in some movement for as long as possible.

If you find that every phone has a health tracker now, so our step count, you can always look at that. So, bare minimum walking is something you should do for as long as you can. And if we break down what is good for good areas to work with to maintain walking speed.

The first thing that comes to mind is your Achilles tendon and your ability to planar flex. Plantar flexion is when you stand up and come up onto the balls of your feet, pointing your point, your feet.

If we want to be able to do heel raises, even weighted heel raises, I always get folks to do them. So, I still get a lot of runners to do that. And the older we get, you start to have a shuffle in your gate. That’s not your Achilles tendon, and your ability to plantar flex is not the only thing that will impact, you know, that is attributed to that.

When we get into more compound, complex exercises like squats and deadlifts, they will also facilitate maintaining the speed and quality of walking emulation, which sort of bridges into another part of longevity: bone and joint health.

Clara: What does it mean to decompress a joint? 

Paul: I hear it a lot. You know, I have to decompress my spine. Elongate my spine. But let’s step back and look at how we’ve gotten here. Our bodies have evolved to tolerate gravity. And so, what does gravity do?

Gravity compresses us. It pulls us down. Our bodies have muscles and joints, which have evolved so that joint compression is how a joint gets nourishment, expels waste products, and receives new blood.

So, compression is a fantastic compression of joints. It’s why running is amazing. That’s why lifting weights is good for you. It helps you build healthier, stronger joints, joint surfaces, and bone density in general. We should dispel the fact that we must decompress. Elongating is increasing muscle contraction.

What does the muscle do when it contracts? Well, it can either do an isometric contraction, so it doesn’t change shape, or a concentric contraction, so it gets smaller. And so it reduces the space between those two bones, or it eccentrically contracts.

That means it elongates as it contracts. Now, will you do just that one type of contraction with every type of muscle? You’re not. You’ll do all three with different kinds of muscles, depending on what you’re doing. 

Clara: I asked you about the transverse abdominis and our deep core muscles. As you said, we no longer talk about them in terms of engaging them. 

Paul: Yeah. TA, or transverse abdominus, is one of your abdominal muscles; it’s in the name of trans versus your abdominal cavity. And it’s very important for many things. It was considered the group’s lead singer for a while. 

Clara: I was talking about how it just naturally wants to contract. If we imagine that we’re softening it, we can get the deeper core muscles to engage so everybody’s engaged. Not that the rectus abdominis will go offline, but ideally, it won’t do all the work. And so I found that revolutionary in my practice of softening in and imagining that I’m hugging the whole corset.

Versus like this kind of action, like hugging in and then moving, like hugging everything in towards the center and then moving from that place. And I felt like the languaging around it was imagining your corset, your TA, like hugging in. 

I love talking to you because every time I talk to you, things are evolving and changing as we are evolving and changing.

And so, what would you recommend in terms of languaging? Many people will be watching this teaching movement to get our students or ourselves as practitioners to get everybody on board. Let’s get the whole band. Let’s get the whole band on board of our abdominals.

Paul: The more we talk about something, the better it is. Let’s get into a more open conversation about fitness. Let’s go about your practice. You said that was revolutionizing how you maybe felt, how you practiced, how you initiated movement, and things like that.

You became more skilled at doing something. And so if you took someone off the street. And you had them and had to take a yoga class, right? Or you had them start to do back squats with a barbell or a deadlift or anything; that person would need to be more skilled. Again, their coordination, movement, muscle recruitment, timing—everything would be off ultimately through practice. 

So if someone queued you into engaging your transverse abdominus and, the way they explained it to you, intended to essentially bring more awareness to the lower half of your body, maybe your pelvis, what is your pelvis doing? How are you feeling muscled and contracted around your pelvis? Does that mean you engaged your TA? It was a good verbal cue that someone gave you that allowed you to acquire a new skill and coordination in something you’ve been practicing and ongoing. 

But again, if we go into the science of it contracting your transverse abdominus, which was thought to be the key that unlocked lower back pain and lumbar stabilization, you know, all these things. It’s, it’s not; there is no key. 

Clara: What’s the key? 

Paul: There is no key to unlock anything. 

Suppose we lean into back pain for a second. It’s one of the most common issues people come to their doctors with, whether their doctor is a physical therapist, primary care physician, or orthopaedic.

There is so much research out there about what back pain is and identifying the different types of back pain. Now, the most common type of back pain is nonspecific. That is the most common type of back pain. And what that means is someone is coming in with back pain. Maybe it’s their right side. It could be on the left side. They don’t have significant symptoms down my leg. 

It’s just generalized back pain and discomfort. The literature agrees that nonspecific back pain can be multifaceted. It’s not just about biomechanics. There’s more to it than just a biomechanical issue. As a manual therapist, I’ll have a little background. I’m a fellow of the American Academy of Orthopaedic Manual Therapists.

I spent many years continuing my education on specific manual therapy techniques because, in all honesty, I wanted to feed that part of my ego that felt like I could heal someone with these hyper-specific techniques. And one of the best things I learned in that program wasn’t about the specificity of monotherapy but more clinical reasoning.

We sometimes need to find out why. It also has to do with dealing with stress in your life. How are you managing stress? How are you sleeping? There may be a hydration issue or a nutrition issue. What other systems in play in or around this area might contribute to lower back pain?

There are many things to consider. Again, it’s not about “Here are the top three stretches you can do to help with lower back pain.” If you oversimplify something like that, you ask for an incomplete solution.

Clara: Based on your extensive research on people’s bodies and movements, do you have any tips for teaching movements or feedback?

Paul: Focus on the movement. And that could mean lots of different things. Let’s say you’re lying on the ground. You have all your people lying on the ground with their knees bent.

Maybe you want them to flatten their backs on the ground. Teach him how to do that pelvic tilting and stuff like that, but don’t emphasize it. I need you to think about this muscle because, first of all, most people don’t know what it is.

It’s just the movement that you want them to do. Right. So who cares if it is flat back, arched back, neutral spine, not neutral spine, or curved spine? It doesn’t matter. It’s whatever you want it to be, right?

Focus a lot on the movement, and when giving feedback, look at the person doing the movement and see where they could improve.

Clara: In my years of teaching, I noticed that getting people to take action is way more effective than telling them to engage in something. 

Paul: Another thing I recommend for movement is taught to your teach to your audience.

The same cues you give someone a bit more advanced may only work for some people who are. If you are teaching someone a specific way you want their body to be, a downward dog, you might need different cues for someone in a much more advanced place.

They will be more fine motor, whereas someone in a beginner area will have more gross motor movements. When teaching a newbie, because you might lose them, let them be happy with getting to know you and reaching smaller goals.