Counterstrain for Injury Prevention, Recovery, and Performance Enhancement for Professional Dancers with Dr. Miho Urisaka

Welcome to the CounterStrain Movement, a podcast where we talk about a little-known physical medicine and manual therapy technique that is widely revolutionizing how people approach recovery from injury, illness, disease, and trauma. It's called "facial counterstrain." I'm your season one host, Fiora Mench, and together we'll explore where a counterstrain comes from, how it works, the many conditions it can treat, and whether it can help you. Thank you for tuning in today, let's dive in! Hi, Mijo, thank you so much for joining me today, as always, can we start with you taking a little bit of time to introduce yourself to our listeners? Yeah, it's great to be here, thanks for having me, Fiora. My name is Mijo Ursaca, I'm a physical therapist out of New York City. I have been doing counterstrain since 2014, and in that time my focus has been really on doing counterstrain for dancers and the dance population. I have been working with the Albanyl American Dance Theater for quite some time. I originally started off as a therapist for both their company and their students, and now I'm in more of a role of treating their more difficult cases and/or their concussion and a little bit more central nervous system type treatments. Inside of them, my practice has both counterstrain and other movement, disciplines that really focus on proprioception and really the quality of movement, the specificity of movement, and really learning about your body. Your description perfectly teases up for what I wanted to chat with you a little bit about today that we've talked about before recording, which is really looking at counterstrain yes through the lens of injury recovery, but the implications of that on athletic performance and athletic enhancement before we dig in a little deeper. So were you a practicing PT for a while before counterstrain sort of intercepted your flot trajectory? Yeah, yeah. So I was, I graduated University of Southern California, it was a great school. I worked with some research on dancers working on pedanopathy and dancers at the time, and I had really great influences both in the PT world and then research world coming out of PT school. I was working as what you would call a standard PT for about three or four years coming out of school, and that was exactly the time where I started to notice, like, you know, let's say somebody has comes in with a minuscule tear like a knee injury, and I'd be doing the textbook thing, you know, figuring out how to work on their biomechanics, figuring out how to teach them their exercise, and some patients would get better, and some patients wouldn't get better. And on top of that, my pal patient skills were developing, and so I was, you know, touching a muscle, and some muscle would release, and some muscles wouldn't release. And obviously, you know, my skillset didn't change from patient to patient within a day. And so that was right about the time where I started seeing to myself, like, what am I missing, what is going on, where it's not only the treatment protocol that I'm giving that is, you know, hit or miss, but it's even just on the second by second palpitory sensation where I'm just like, this muscle isn't going to release, like, why not? And that's when I encountered countershing. And this was the visceral class that Brian was teaching back in Paris. And he started talking about how the internal organs can create a little spasm, or can have a spasm that then creates a neuroprotective spasm in the muscle, muscle tissue. And so if you're not addressing the thing that the body is trying to protect, then the protection, the muscle, is going to release. And I was like, oh, this makes a lot of sense. And that's how I started diving deep into the curriculum. I was filling in those blanks of those open-ended questions that you haven't found the answers yet. Exactly. The why. And so you're practicing as a physical therapist, were you already working with the dancing clinic when countershtrain started entering your sort of the patchwork of modalities that you use when you treat people? Yeah. Yeah. I got into the treating dancers right after PT school. So I was already doing ballroom dancing. I've done amateur competition in the ballroom world, both Latin and standard. And so I was already interested in the dance community through PT school. And then after graduating, I did immediately start working with the dance population. And were you able to apply what you were learning at the clinic right away? Yeah. Yeah. The thing about dancers to begin with is countershtrain is a very gentle technique. And so a lot of patients will come in saying, like, I don't really feel anything or I don't know what you're doing. But the dancers, you know, the minute I came in with my new technique, they would start saying, oh, my gosh. Like, what is that? I feel like an ocean wave going through me. So they were really perceptive to countershtrain releases, even for me, as a novice practitioner. I think as they spend so much time, like, witnessing and observing their body as it's their tool of expression and profession. Exactly. Exactly. So self-aware. That's really interesting. I never would have, I never would have occurred to me. And that was great for my confidence building too, you know, like, I don't know if I'm releasing this tender point correctly, but the dancer would tell me, like, oh, that feels so different. So that was a great start. That's amazing. And so I'm imagining as it started out, right, you're seeing people who have complaints that are impacting their ability to compete as a dancer or work as a dancer. You had a few case studies that I thought I really wanted you to share with folks. Can you start off with the dancer that came in with a knee complaint? Yeah. So this patient had been complaining about her knee for quite a few years already. She was, you know, performing, doing everything professionally. It wasn't limiting her from doing her work, but it was a persisting issue that was getting worse over time. And so the first thing that I found on her was her T89, so her thoracic spine, just under the shoulder blades, I found that her T89 was restricted and it wouldn't go into extension. And so when you think about biomechanics, when you go into a squat, the correct way to do a squat, you know, just in regular PT world is to pull your hips back so that your knees aren't going through your toes, right? But that is not just hip mobility. You have to think about spinal mobility. Your spine has to move into extension for you to get into that squat form. And so for her, her T89 segment was stuck in a flexed position, like a forward flexed position, as a result of the nerves and a little bit of bony restrictions, periostial restrictions at that level. And so what we first started with her was we unlock that T89 segment. And so we were able to create some extension in her spine. And then once you did the squat or the lunge again, now her hip was pulling backwards properly and it was no longer putting pressure on her knee. Do you, so I think this is such a classic counter strain example where the complaint we come in, like you mentioned, is actually where we're feeling the guard. But it's not actually the cause, like it's a downstream symptom. And I'm curious, like how, and maybe you can't quantify this, but how often do people come in and they're like, it's my, I something going on with my shoulder. And then you're like, actually, it's in your neck or, or like in your wrist and actually it's part of your cervical spine or, you know, those sorts of things. That is all the time. All the time. And honestly, that might be because of my patient population. You know, the people who come to see me, usually I'm not their first round of therapy, right? I see the, I tend to see the failed cases. So maybe it's because they've already had it, you know, if it's a knee person, maybe they've already had it, their knee treated out. And that was a defective. And that's why they end up seeing me. So maybe it's biased towards my patient population. I would say every single patient that has walked into my door, I have not done just a knee treatment on a knee patient. And one of the great things about connoisseur, and one of the great things about the body is that it's truly telling you what it needs, you know, you just have to learn to listen. And so the, the way I found that T89 restriction in her body is we have a diagnostic process in learning counter strain, where we do a mobility test on the spine on the spinal cord to see what section of the spinal cord is the most restricted. And from there, we associate that restriction to a problem that they have. And so in this case, you would do something called an inhibition where you would temporarily disengage the problem at T89. And you would see if there's a change that happens in the knee. And so that, that's sort of neurological connection from the symptom site to the problem site is what we have as a diagnostic pathway to discover what we need to treat for that patient. And so they received this process that, you know, I found the T89 was most restricted. I was like, okay, maybe that has to do with it. Maybe that doesn't have to do it. I don't know. But then we go into this process where we inhibit the problem area to see if it resolves our symptom area and we get a clear yes. And so then you go into the treatment. And then you can go into educating the patient about why that connection occurred. Hmm. Amazing. One of the other case studies you mentioned beforehand was working with a dancer who, I mean, she concussion earlier, who during a performance actually hit her head on the floor and suffered a concussion. And for her, the symptoms were impacting her ability to work. We talked a little bit about her experience, what she would, I love a picture of what was happening when she came to you and then the, the after. Yeah. So this particular patient within the performance, she was just moving really quickly. Uh, her head was moving really quickly down towards the floor and, you know, with her flexibility. And, you know, this also had to do with some partner work that she was doing. She hit her forehead on the floor at full speed as if she was like doing a cartwheel. But, you know, it was her head, not her hands hitting the floor. And so she was suffering from like headaches, fatigue, brain fog, the next couple of days, like the week after the concussion. And one of the things that they, the company sends me the patients for is their ability to tolerate large amounts of exercise. So at the time, she would go on a treadmill and become nauseous. Um, obviously things that like spinning like pirouettes would cause her to become disoriented. Just even the day-to-day, like you could feel, you know, these dancers being really perceptive to their bodies, like on a day-to-day, they can feel that they're not accurate in their movements. They can feel that their brain is in operating at the speed that they, that it needs to, you know, have the endurance for the entire day of rehearsal to learn choreography. Um, even from an emotional standpoint, you know, this person who's generally like a really calm, happy person is feeling a little bit more depressed, these are all various symptoms of concussion. And so that's what she started with, um, what she came in to see me. And the treatment process for that, it's, it's a lot of different kinds of treatments. You know, we do treatments to drain the brain, so we're helping to improve the circulation to the brain to the neural tissue so that more healing can occur. We also treat the dural restrictions. So the dura is like the skin covering of the brain that, um, that kind of holds the brain in place to speak. If there's a tightness in that, there's going to be different kinds of pull on the brain tissue itself. And so these are all components of treating a concussion. But outside of that, I want to bring attention to, so this specific case study, I just want to, she had a lot of treatments. I want to just bring up one specific day of treatment that she had. Um, she was already doing a lot better by this, by this time, but every time she would whip her head in a piece, um, she would have neck pain and she would also get a headache. And if she did the piece, if she rehearsed the piece too many times, then she would also get nauseous and fatigue the next day. And so, you know, again, we can tell that that was concussion related. But, um, part of the pathway for draining the brain, the fluid from the head from the brain has to go travel down your neck, through your, um, thoracic inlet, which is the area right behind your clavicles. And it all goes back into the heart, which then brings a blood back into circulation. If there's any sort of restriction in that pathway, then the brain does train, tend to drain a little bit slower. And so, that particular piece was causing her, was having her whip her head because that's what the choreography is. And it's causing the neck pain because of a local issue, but more importantly for our treatment, it was causing her brain circulation to slow down after rehearsing that piece. And so, what we ended up treating on her was her mesentary at T1-T2. So the mesentary is a layer of fascia that, um, encompasses your organs. And so, at the level of T1-T2, which is just at the base of your neck, that covers your organs like the top of your lungs, it covers your trachea, it covers your esophagus. And so, when that gets tight, it also creates a compression on your venous system. And then, again, if it doesn't stretch, then, of course, she has neck pain, but also, if it's compressing on the hose that's bringing the blood out of your brain, then that's going to exacerbate concussion symptoms. And so, for her, the treatment for that day was to release the visceral and mesentary structures around that T1-T2, so that her thoracic inlet can open up so that her brain can drain itself the fluid of the waste that's being produced. And, um, have you spoken with her since, well, so I'm guessing in treating that, you were able to relieve the nausea and fatigue the next day as well as the neck pain? Yeah, absolutely. I mean, that happens immediately, that's one of our assessments going into treatment, right? Like, I have her show me the piece, I have her show me the choreography that's bothering her, and then I go through my counter strain assessment at the end of the session. We have her rehearse that piece, you know, I have her go, you know, not full out because she's not warmed up, but I have her go at 70% intensity going into that choreography, whipping her head to see if she's able to do it. And the answer is yes, like the headache goes away during the treatment, and then she's able to whip her head right at the end of the treatment. So I know that she's safe to go into rehearsal the next day. I think something that I didn't think of before, but when I'm hearing you recount these two case studies, which is, um, with the first person for the knee complaint, it was a pretty, it sounds like, and you correct me if I'm wrong, but it was almost like a very straightforward sort of one and done treatment. And then with the concussion patient, it, there was a stack, there was more of a stack of things to address in order to restore health to all of the systems and components involved. And I think sometimes people say, like, how long does counter strain take? And trying to explain that what really depends on what's going on in the body, it might be a super straightforward one and done treatment, or if it's a complex injury or and, uh, something that happened a long time ago in the body has stacked all these compensatory, all these compensations on top of it that sort of affect the way that wear and tear happens on systems and asymmetric ways. Um, that might take longer. Um, but I, but I, but in both cases, it's really interesting how counter strain was able to ultimately help those tissues drain inflammation and heal to them provide relief and restored function to both dancers. Mm hmm. Yeah. One of the things that's really cool about watching and treating dancers is, um, so within counter strain, you are always peeling off the layers. And one of the nice things about counter strain is a body tells you which layer to peel off first, right? So the way I like to explain it to my patients is imagine you're an Eskimo, right? And you have your outdoors and you have your fur coat on and everything. And you say, I need you to take off your underpants. Well, you can't take off the underpants without taking off your fur coat, without taking off your first layer of snow pants, without taking off your second layer regularly, right? Like, there's an order of operations that need to happen for your underpants to come off. And so that's the way it is with the body. Um, when a destruction happened a long time ago, like, you know, I got this injury 20 years ago and then your body had layered and layered and layered compensations on top of it. You're going to have to peel back those layers in a sequential order to get back to that root source of how your body developed this, you know, pattern of dysfunction to begin with. But what's great about seeing dancers and I've seen this in professional athletes of other sports as well, you know, I see this in professional tennis players, I've seen this in professional rock climbers are a great example. But one of person has been working on their body professionally and by professionally, I mean, you know, they're going out of their way to eat, right? They're going out of the way to sleep, right? They're moving their bodies, they're stretching their strength training. When they've been doing all of this throughout their entire life, there's always fewer layers to peel. Yeah, cause right, like they're, they're fostering a healthier, they're a multi, all the systems are healthier. Yeah. And so they're going to be more responsive than maybe a system that isn't, isn't has it doesn't have as many healthy inputs, exactly, exactly. So when you talk about, you know, how many sessions does it take, honestly, it's sometimes so much easier to treat a dancer or a professional athlete than it is to treat somebody who has, who developed a chronic shoulder injury that doesn't have a reason why. Because then if it's a compensatory injury, it's just like years and years and years of more posture for eating, everything that we need to unravel off of their body. Because actually you said something, again, as we, when we were first sort of preparing for this conversation, which was, and I think it said, Eric connects well with what you just shared, which is counter strain, one tends to enter the picture, but also two helps out when an individual's putting in the work and not seeing the changes they should be seeing based on what we know, right? Like if you're doing strength training and you still have weakness or you like can't, the strength, the ROI is not matching the effort being put in. You said that sounds like a counter strain issue. Yeah. Yeah. So I'm going to go back a little bit just to speak about dancers and dance training, just to highlight the importance of specificity. So when I first got into dance medicine, this was before I learned counter strain, one of the issues that we would often run into with dancers and non-dance trained professionals is talking about normal range of motion. So, you know, for example, normal hip range of motion, hip flexion range of motion is considered 120 degrees. So I've had so many people come into my clinic and say, you know, my other PT said that I have normal hip range of motion. So I'm fine. Meanwhile, the spell A dancer who needs to have their leg, you know, at 180 degrees from the floor, they're having issues in their hamstring and they're having tightness and they're having pain, but being told that there's nothing wrong with them because their hip is quote unquote normal in what would be listed in the physical therapy textbook. And so when you go into something so specific in terms of just in terms of range of motion, you have to have some sort of assessment tool beyond assessment tool of what the body is capable of, not what's in normal standard, right? Because I would say by any standard dancers excel in all ranges of motion in every joint in the body and that's required. Yeah. And so when you talk about the specificity of range of motion, it's not just range of motion, it's actually the quality of motion that I look at the most in a patient. And so when I talk about the quality of motion, we call it end feels and physical therapy. You have something like a hard end feel where you're like knocking on a table. That's considered a hard table where you just like have a hard stop versus a springy or soft end feel. It's like you're pushing into pillow. You're pushing into like a temporary feeding mattress where you still stop, you know, you still can't push anymore past a certain point. But the quality of that end feel is just like soft and springy where you almost feel like you can push more into it. And that's the sign of healthy tissue for anybody, not just for dancers. And so when you start talking about end feels if a ballet dancer has that full hip flexion to be able to bring their leg, you know, past their ear. If that leg has a hard end feel, a lot of times people talk about pinching in the front of their hips, that's already going to be a source of injury for that person. And so what we're trying to recreate in the body is that springy end feel when you're testing for hip flexibility. And so going back into now the professional athlete side, outside of dancers, we're still looking at that quality of end feel for injury prevention, but also for their ability to create spring in their motion. You know, if you have a hard end feel no matter how flexible your ankle is, if you have a hard end feel on that ankle, you're not jumping high or you're not landing well. There's going to be some sort of injury that occurs as a result of that. And I think that's oftentimes what's missed in standard practices. Would that, so when, would that hard end, and I might be oversimplifying, but would that hard end feel potentially suggest that there's already guarding present, whereas that softer end feel would suggest that the tissues are healthy, is that the distinction? Absolutely, absolutely. Okay. And this, there was one other case that you talked about, which was less about injury recovery and more about what does every competitive athlete want, which is optimization, like performance enhancement. And you actually have created this with, or have created this with quite a few dancers with regards to their, I think it's called turnout. Obviously, I'm not a dance girl. Yeah. Yeah. Tell us a little bit about either one or more patients that you've worked with, what you saw, or what you saw, right, through your counter-stream lens that was going in their body, what they thought was going on, and then what was the outcome you were able to create together? Yeah. So one of the coolest things in counter-strain for dancers, so counter-strain is split up in terms of course work as a practitioner. Counter-strain is split up into different modules based off the anatomy. So you have a class for the arteries. You have a class to treat the nerves. You have a class to treat the organs, or we call it the viscera. But we have a class to treat the periostea, which is the bone. And I think that is the coolest module for dancers, and for any dance professional like PT or somebody to take, because I don't think there's many modalities out there that are treating the bone. And so what we're talking about with the bone, again, everyone, you know, everyone to some extent treats the bone, sorry, the muscles. Everyone treats the nervous systems. But the bone itself is also a flexible structure. So, you know, we think about bones as this hard thing, and they are hard. But we're talking about the stiffness or the hardness between comparing like a wooden floor to a steel floor. Like, would you rather cook and stand on a soft wood floor for three hours, or would you want to stand on a steel floor barefoot for three hours? Like, you can, you know that causes some sort of back pain and fatigue in your body, right? Yeah. And so bones are also this hard, but flexible piece of anatomy. They also are responsible for creating that soft end feel that we were talking about. And so, you know, dancers are always trying to get more turnout, more hyper extension in their knees, more point in their feet and ankles to create that beautiful line, because dance is not only about performance and the athleticism, but it's also the visual, the artistic component. And so, to be able to create that artistic component, you just need more mobility. And so, treating the periosteum, treating the bone of the pelvis so that your hip socket can open more without restriction, treating the individual bones of the foot so that every single joint and bone itself is able to move. You're getting that um, do you like the last bit of range that your body is able to produce? You know, when we, when they talk about like swimming, Olympic swimming, it's like milliseconds that differentiates the top person from the bottom person, right? That's the same thing in dance works that like, it's the little like one one hundredth of a millimeter of mobility that we can get out of your bone to help then create a different kind of end feel for your hip to go into a turnout or external rotation of the hip that allows them to, you know, do a um, get into a prettier position if you will. Well, form is so important in dancing. Like you said, um, when it's judged, especially like in ballroom, right? Like, it's very much judged on the form that you are creating with your body. I think what's really exciting as somebody that's mostly watched a dance movies, right, is like, well, watching people force their bodies in really painful ways, yeah, presenting this incredibly gentle, almost collaborative way of like, there's a, there's a degree of optimization that's available to you that's actually of service to your body and that's, um, it supports it in a healthy way to expand the form expression available to you, um, rather than, yeah, just grin and bear it and, yeah, and force your body to do something that is giving you a lot of language that it does not want to do or can't do. The CounterStrain Movement is produced by The Bridge Back Project, a 501C3 organization on a mission to bring facial counterstrain to the world to address the impact of trauma, promote healing, and restore hope. This educational podcast is made possible by the generous support of donors, former program participants, and listeners like you. Please consider making a donation today to support our life changing programs. Learn more about the impact of our work and how you can help on our website at www.bridgeback.org. Yeah, and that's actually a, really, um, you touched a little bit on a really important concept to where they're trying to do something. If your body isn't going to do something, but you need it to do that, let's just say pointing your foot, right? If you need to point your foot for this particular piece, but you're, you don't have the mobility to do so, you're expanding effort, the, whether it's the calf muscles or the toe muscles, you're extending effort to create that form of a pointed foot. That means your muscles are being overused. That means that's more opportunity for fatigue. That's more opportunity for attending pathology because you're overusing that muscle because that muscle is fighting against the restriction in your bone to create that form. Whereas if you were to be able to create that mobility, that freedom of movement, then your muscles can relax because now your skeletal structure is in that position, and your muscles are then available to do something else. So if you're talking about pointing and then coming down from a point, landing from a jump, your muscles are going to be in a more relaxed position to help you, um, take that shock absorption, take that impact from the jump. And again, going back into injury prevention, now that your calf and foot muscles aren't fighting to maintain that point shape, they're absorbing the land, you're having, you're putting less impact through your knees, through your hips, through your back, all the way up to your spine. I mean, we're talking about the levels of fatigue that you're encountering within that task that you're doing too. Yeah, you're reducing your risk of injury. When I did, when I did Olympic weight lifting for a little while, they talked about like being careful of not borrowing from other areas. So like, when you do a squat and you're holding a lot, they're like, don't borrow from your back, you want to make sure that your, your form is correct so that you're, you're using the muscles you're trying to use, rather than dumping into other areas and relying on strength somewhere else to brace you, when really you want that strength and function to be in a very intentional place in your body. That's exactly it. So I'm sitting here listening to what you say, and there are, and I asked you to talk about this, which is, again, people find counter strain, usually when they try to bunch of other stuff that hasn't worked, like you said, and Brian mentioned this term as well, failed cases. So people that have gone to multiple healthcare providers or specialists, and I was a failed case, not as like a professional anything, but where it's just like, yeah, I guess you're just going to have to kind of live with this. And, and especially for people who's lack livelihoods or quality of life, right? Just somebody who, somebody can be a hobbyist, and let's say dance could be a really, really integral part of, I know someone who commutes to one of the other islands near where I live, like three days a week so she can go dance, because she's part of this like modern dance collective, right? And so it's so core to like her community and her self-expression and her movement and keeping herself healthy. And as we lose, or if that is compromised, it's not just, oh, I might not be able to hold this job, but it has ramifications on community and mental health and physical confidence self-esteem, just far reaching. I see counter strain, as yes, it can help with injury recovery, but you've talked about all of all of these other forms of enhancement. And I'm wondering, when you imagine applying counter strain at a, at a greater scale for athletics, at sort of every point of an athlete, like maintenance and recovery and enhancement, what's your envision for how counter strain my impact athletics in a variety of ways? Yeah, so even to start, I think, everyone should be going into athletics with a clear body, as clear as it can be, right? And so you don't want to go into whether it's professional or recreational, you don't want to go into something with some sort of problem to start with, like you would never go into dance if you're, if you're already starting with a knee injury, right? But that's happening at the micro level. And I think a lot of times what we don't see is how those, you know, compensations are already stacking in our bodies. We're not even there to fix an injury when we call it, when we, when you say the word injury, that means there's a cognitive, like awareness that there's a pain or problem going on with your body. But I tell all my patients, like you bring me somebody who's perfect, I can find a problem. Yeah. So we are all walking around with this, um, dysfunction prior to injury. And the more you can get that worked out, the more you are going to be preventing actual problems in the future. But beyond that, so I forgot to actually answer your question earlier about lactose and training. When you are, again, going back to dance just because it's the, the population that I understand, when you are stretching and warming up and working out and you're improving, right? You're getting better and strength or you're getting better and flexibility. If you're stretching a muscle and it's time over time, improving in length, you know, this could be over the course of a year. As long as you see improvement, that's normal progression. That's normal remodeling of the body's tissues. But oftentimes you'll see that people always say, you know, I always stretch my hamstrings, but my hamstrings are so tight I can never get them to release. That's a problem. That's an injury. That's a dysfunction. That's a time to come in for counter strain. Yeah. Yeah. So it's that it's that like the math isn't mapping. Exactly. You stretch and that should lead to better flexibility when you're doing it safely. If you stretch and it's not leading to flexibility, then there's something there's something structural or within the system. There's some sort of dysfunction that is preventing that math from mapping. And that goes for anything that goes for stretching, which is an easy example that goes for strengthening. You know, you're going to have your plateaus and strengthen in strength gains. But if you have a long plateau, then there might be some neurological inhibitions that is telling your muscle to not fire with all pistons. And so that could be why you're not, you know, your quad strength isn't improving or something. You know, Brian shows Brian the the developer of counter strain. He shows in our periosteal class an immediate strength change in quadriceps contractuality after one release in the femur of the femoral bone itself. And so again, that neurological inhibition from the brain saying, hey, quad, there's a problem that we're trying to protect. So please don't contract as strong. That's all that's also going on in the body too. So, you know, from stretching, from strengthening, VO2 max and endurance, you know, what does breath affect it affects your endurance and day to day endurance that affects your your cardiovascular endurance from a one point in time, like a performance base. These are all things like if you're running, let's say that's your choice, that's your method of choice for cardiovascular improvement. If you're running, your cardiovascular health should be improving. If it's not, or if running just absolutely sucks, there's probably something to work out there. Yeah. I just made a connection where, I mean, I've been doing yoga since I was 16 and you probably know this, but just in case anyone's listening, there's a chaturango, which is sort of, it's like the yoga push up where you slowly lower yourself down to the floor. And I think up until about three years ago, I just was never strong enough to do it. And I just thought, okay, I gotta get stronger, I gotta get stronger. And then I remember I'm getting treated by a counter strainer in Seattle who had me do the whatever those those sort of like counter tests are to test nerve, whether or not your nerves are firing to your muscles correctly. And we're like, okay, hold this and I'm going to push your arm down. And you know, you should be able to hold it up because I'm not going to play that much pressure. And I was watching your arm go down. What in the heck? Like I'm trying to hold it up so hard. And then getting that worked on. And then ever since that I've been able to do chaturanga. And it wasn't that I didn't actually have the muscle strength or or maybe I didn't. But anyway, there was something going on in the nerves of that that chain of systems that wasn't allowing me to exert the full strength to do something that I should have been able to do having been like being I'm having that a hall light bulb moment. I should have been able to do having practice yoga pretty regularly for 20 years. Yeah. Yeah. You know, and the time component is really important. So you were saying like three years of not being able to do a chaturanga like 20 years. Yeah. And then I mean having it treated and now being able to do it for the last three years ever since that treatment. Okay, go ahead. The general timeframe of muscle strength is about six weeks, right? So every six weeks or so you should be seeing some sort of muscle strength gains whether it's with ability to lift more weights or be able to do a chaturanga. You know, if you can't do a full chaturanga, you should be able to do a half on your knees. And then as you progress like a year is enough time for you to be able to do a push up, right? That is that is actually way too long for somebody to work on a push up and not get it. So I would say if you're a relatively healthy person that is doing putting the work in, right? You're going to work out three to four times a week. You're eating right, like you're sleeping right? You're doing quote unquote all the correct things. You should be seeing again in six weeks if not two months. If it's if you're working on something for two months and you know you're doing all the right things, that's already a counter strain problem. Yeah, when in doubt, try counter strain. That's my personal philosophy because it's so gentle, right? Yeah, rather than like going surgery first because I can't can't undo a cut. You know, sometimes it's it's necessary, but we've also seen just really incredible stuff where the stress circulation to extremities and those sorts of things, relieving fibromyalgia that people have had for close to a decade, all kinds of incredible things that quote seem out of the blue, but if you have the the comprehensive counter strain lens, like the how and the other counter strainers I've interviewed is like they they have all the oh, I'm just having a flash of like all the layers of like a Polaris map is you know, like you can like I think about Google Maps, right? You can look at like it looks like an animated street where you can like overlay the satellite photo. Yeah, you can then overlay traffic, like all of those are layers of information and you all sort of have that for like the systems of the body. Yeah, you can you can dig into them individually. Yeah, I feel like one of the things that I'm just understanding about this world and you know talking to physicians who haven't heard of counter strain is that it's just a layer that we're missing. It's not that not necessarily that counter strain is special. For example, it's just that it's the layer that nobody's looking at, you know? So for example, if you have a patient who's doing counter strain, eating right, but is in bed rest and doesn't exercise ever, that person's also not going to get better, right? But within our common culture like nutrition, diet, sleep, exercise, these are all things that are already commonly given as advice and how to improve yourself. And counter strain is just a piece of like, okay, well, you need to have specific mechanical mobilization of your of your tissues for your fascia to operate correctly. That's just a piece that's like completely missing from our vocabulary right now. Yeah, and specifically inflammation within that, that sort of unscanable layer. Yeah, right. Yeah, right. I talked about that a little bit with Brian when he came on to speak, which was Sony people get these scans, right? Like get the scan of the knee that's been hurting for 15 years. And they're like, yeah, nothing's wrong. Or like you said, well, it's all within normal range is like, well, yeah, but dancers aren't using their bodies within the normal range of expectation. They're using it in like a hyper specialized way. And so they need a more specialized perspective understanding. Like I will say about imaging and MRIs is that, you know, we come in a lot of my patients come in saying, well, this MRI, we're going to take this MRI of my shoulder and it's going to like tell us everything. The accuracy or the specificity of the MRI technologically, we aren't there yet in terms of imaging. And so, you know, you think of an MRI as this like beautiful iPhone 16 or whatever is out there that can that can take like super high definition high def resolution photos. And that's not the case with MRIs, you know, endometriosis, for example, is it's a condition where the gold standard is still opening somebody up like an MRI isn't able to catch and then material lining problems that you can see with a camera by opening somebody up. Like the resolution on our current imaging technology is just not something that can pick up what Brian was talking about inflammation in the interstitial spaces. And even in terms of tears, like even for meniscal tears, it's sometimes an MRI catches a tear, but sometimes it doesn't. I don't think people understand how blurry MRI images are, you know, in the 1800s or whenever photography was developed, like people sat still for an hour and they did an hour long exposure to take a photo. Like that's kind of what I'm comparing it to where you're not getting this beautiful iPhone 16 like high def resolution photo. You're getting this like photo that kind of internal scanning. Yeah, you have these movement artifacts. Like if you move in an MRI, like a 20 minute MRI, then then the radiologist can't see what's going on in that joint. Again, it's like a photograph taken over the span of 20 minutes, like it's going to be blurry as hell. Yeah, yeah. The last thing I wanted to ask was how I'm going to go back to working with the dancers. I'm curious to know if there are dancers seeing you for that sort of ongoing sustaining of health or if people usually come into response to an acute event and then they you don't see them again unless something else gets hurt. What are some of the ways that you're watching dancers use counter strain in their, you know, personal health or wellness practice? Yeah. So unfortunately, I would say this is 100% of financial issue. And so I see dancers when they get hurt. Outside of that, I don't get to see very many dancers that often. Once they do get hurt, we bring them back to not only, you know, where they were before their injury, but also helping to explain like, okay, these are the things that we're going on with your spine that resulted in this knee problem or, you know, we'll go into that type of education. But for the most part, I would say, you know, art isn't really tough field financially. Like people don't have the funds to be able to come in and get the care that I believe that they need. I do have one older dancer. She's retired, you know, and so she's doing ballroom dance recreationally. And so she started seeing me for shoulder pain, but then recognized the value of counter strain. And so now we're working with her on a biweekly basis. And the way we work with her is so much fun because I say, okay, what does your coach say to you? Like, your coach wants you to take on her steps or the, you know, she does standard ballroom dancing. So that requires a really big hold of the shoulder and really a lot of extension. And so we go with what the coach is requesting of her. And so that then because I have my background in ballroom dance, I show her, I ask her to show me the pose or show me, show me what the coach wants her to do. And then I take a look at, oh, you know, it's your, it's your heart. It's the restrictions in your paracardium that's limiting your ability to do this thing that this coach is asking you to do. So let's create more motion in your heart. Let's create more motion in a thoracic slide. Now try to do the thing that the coach was asking you to do. So again, going back into what you can and can't do. Sometimes the coach tells you to do something like squeeze your glutes when you're coming up from a squat and you're like, okay, squeeze your glutes and it's better. That's normal, right? But then when a coach says like, um, squeeze your glutes from a squat and you're, you're saying, like, okay, I can squeeze my left glute, but I can't squeeze the right one. I can't find my right glute. I can't figure out where it is. That's the definition of a problem that we can potentially look at. And so what we're doing with this patient is literally week by week just saying, like, okay, what is your coach trying to achieve with you? And then we support the coach in resolving whatever issue that her body has that's making it difficult for her to fulfill the dance lesson. It's making, I mean, it just sounds kind of like, like, you're the secret weapon. You know, like, I'm like, man, this dance company is so clever to have you on speed dial. And I can't remember who I talked about with this, but which was, which was, oh, it was a professional soccer coach. And she was like, yeah, not only is it, but she was like, money talks, right? Like, not only is it important for the players, but also the business behind sports of like, what if your, you know, your best forward is out for six weeks due to an injury and can't play five games. And one of them is against your biggest competitor, like how, and then you, I mean, that impacts the coaches career that impacts the athlete's career and impact. I mean, but that loss has an effect on every other person on the team. And she was talking about just how beneficial it would be to fold counter strain into the same way that you have people after a game helping players cool down and and stretch and those sorts of recut, a game to game recovery practices. What if you had a counter strainer that was helping their body flush toxins and address the guard that was just starting rather than, you know, after the attendance torn, maybe adding five years to that player's career or, you know, is right? It, so it seems like the secret weapon that I think is going to be interesting to watch how it, how when the sports business leaders kind of get wise to how this could give their players and teams edges. Yeah, yeah, absolutely. You know, again, our hands can see what nothing else can see. You can't see this in imaging as we've discussed. You can't see this with any kind of blood test or whatever that we have available out there. Our hands can see so many things to improve that person's situation more than any forms of testing that we have out there right now. That is a powerful note for us to end on. Nihau, if someone's been listening to this and they'd like to get in touch with you or your clinic, what are the best ways for people to reach out? Yeah, so we are sort of active on Instagram. You can find my clinic at OMPTNY. My clinic name is orthopedic movement physical therapy, New York. And I also have an Instagram on my own. It's dr.miho.bbt. I have a couple of case studies on my Instagram right now. And would you like to share about your project that you've been working on? Yeah, so we have. I'm really excited to share. We have a new website called fasciacasestudies.com where me and some other colleagues are talking about case studies like real case studies of our patients of how we were able to resolve something in our patients. So, you know, the one that I talked about today with the thoracic spine helping a knee injury is going to be on there. But we are going to be listing things like changing blood pressure with counter strain. We're going to be talking about the weird stuff that we're seeing on a day-to-day basis that can hopefully find, you know, a person out there who is looking for whether it's a patient or a clinician looking for answers into why something is not improving with everything that they're doing. And so you can go to fasciacasestudies.com and learn a little bit more about how really integral our facial system is to injury and disease and illness. Wonderful. Yeah, so go check out miho and her clinic on Instagram. And if you want to read some real-world examples of before and after having counter strain, go check out her new case study website. Thank you so much miho. This is really, really wonderful and illuminating. Thanks so much there. It was a lot of fun. Thank you for tuning in today and we hope you learned something new. If you'd like to continue learning alongside us and hear more real stories of healing and recovery, please take two minutes to subscribe and then leave a five-star review. Those two minutes will help someone out there who is looking for a new way forward to find us so that we can introduce them to new possibilities that could help them recover their health lives and hope. The counter strain movement is an educational podcast produced by the Bridgeback Project. The Bridgeback Project is a 501(c)(3) nonprofit on a mission to bring the facial counter strain to the world to address the impact of trauma, promote healing, and restore hope. They do this by sponsoring research directly funding counter strain treatment and developing educational initiatives that build public awareness about counter strain's ability to treat a wide array of conditions so that people living with chronic symptoms can return to living healthy, fulfilling lives. I'm your host, Fiora Mench, and you've been listening to The Counter-Strain Movement.