We discuss in this interview:

• Functional movement and its benefits for RA
• The case study of a 63 year old woman with RA
• The symptoms she was dealing with and the first discovery call
• How this woman was able to reduce joint swelling through simple corrections to her movement
• The importance of correct movements for inflammation
• Building strength and improving brain-muscle communication
• The role of the nervous system
• Core strengthening
• Chair exercises

Clint – Today, we’re going to look at a case study of someone with rheumatoid arthritis who has worked with a functional movement coach. Which is someone who does similar to physical therapy but works with the body in a way that it’s designed to be moved. Our guest today is Carl Reader from CarlReaderCoaching.com, and he’s a functional movement coach who works with people with not just rheumatoid arthritis, but people who’ve had sporting injuries and just problems with their physical abilities across the board. He is a coach within our support forum for our rheumatoid support members. He is today presenting a case study of a lady with rheumatoid arthritis who worked one on one with him, and the challenges that she faced with her rheumatoid arthritis, the progress that she made. Some of the epiphanies and the breakthroughs that they had together and overall, the benefits of before and after with working with him. The reason that we want to do this is that we’ll help you to see ways in which you can use physical therapy very functionally to be able to improve your symptoms, reduce inflammation, restore some range of motion, and regain some strength. So Carl, welcome back to this podcast, it’s not your first time. It’s always a pleasure to have you.

Carl – Oh, it’s great to be back, and always enjoy sharing with you guys. Thank you for having me back on again.

Clint – Hey, I’m looking forward to this one. It’s a case study, as I mentioned, so why don’t you start by saying what symptoms did your client or patient, if you like, presented with when you first started working with her? And was it face to face in person or was it over Zoom. Set us up for the sort of the scenario?

Carl – She’s a lady, she’s 63 years old. She’s been struggling with RA for over 50 years, and she actually listened to a podcast we did together on Paddison Program, and she just reached out to me. She was going through a flare-up and mentioned that she needed some assistance with some movements. So she got in contact with me and we set up the online coaching and had a discovery call to see if I can help her. She was presenting with really bad swollen knees, a stiff neck and shoulder, and sore feet. Those are her symptoms.

Clint – Yes, very interesting, so lots of common areas especially the swollen knees are going to get a lot of eyebrows to raise, a lot of interest being piqued for people who are listening or watching to this wanting to know what you did with that. In your discovery call, I don’t even know, but do you offer that for free or is there a small fee to do the discovery call?

Carl – No, it’s a 15 minutes discovery call. I just ask questions and they get to share their history. Just to see if what I do is going to be of any benefit to them and if it’s going to work. It’s great because they can get to know, like and trust me, it sort of feels that they get an idea of what I do.

Clint – Ok, so it’s a free 15-minute session. People should definitely take you up on that and find out whether or not you can help them, basically. We have a questionnaire quite similar for people in our support group. There are some people that it’s not a good fit for, and so if you’re working together closely with someone, you do want to have that sort of feel out. Like these dating apps these days, you want to both swipe right before you go on the date or it could go all wrong. What was she hoping to get out of her sessions? What were her expectations before beginning with you? Were they realistic or did you feel that you would be able to help her?

Carl – Well, it has been for 50 years, she said to me she’s tried many practitioners. She’s done many things when you exercise things. I think the big thing was just to find something different that she hadn’t tried before. And what really piqued her interest was learning how to move correctly. She hadn’t heard of or been trained to do, and she wanted to be more independent. So take charge of her own health, not having to be reliant on some sort of medications. So they would empower her, it would help her to take charge of it. She loved the idea of maybe creating new movement habits so that she could do at home. That was a big expectation, and that’s exactly down my alley, that’s what I do. It’s relying on the movements to bring the changes as opposed to just going through a set of exercises. So that is what she was really keen to get out of those sessions.

Clint – Let me just put on my sort of skeptics hat for a minute. What if people are thinking, but how can just moving my body a little bit more the way it was designed, going to reduce symptoms? It sounds overly simplistic.

Carl – Yeah, I think like anything that’s been designed, if you use it incorrectly, it just gets destroyed or broken. If you use it correctly, it’s sort of like the body we know it’s just that homeostasis it’s always seeking to bring healing and balance and restoration. So when we move in the way that we’re designed to, and especially we’re like loading. If you’re loading the body incorrectly if you launching or twisting or talking. It makes a huge difference by just getting those 5, 10% load differences or weight. Centre of gravity in the right place and positioning the body correctly. It has a huge difference for people who are struggling with the elements, or particularly RA. If you are 21 and you fit and fine and you don’t really notice the difference. But when you do have pain, you notice it very quickly.

Clint – What did you do? Obviously, you started working together after you had your short chat together. What plan did you put in place up front? I mean, what was the big picture strategy? And then we’ll get into the detail. But what was your big picture strategy?

Carl – Well, what I said is if you can’t go straight into teaching people how to move correctly because of functional movement, correct functional movements there needs to be some sort of base-level strength. So if you just take someone and you say, look I’m going to teach you how to move correctly in the first session, you’re actually going to do damage because it’s just they don’t have the strength to move functionally or even the coordination. So we want to first build your strength, we want to first also look at activating the muscles, by which means improving the brain and muscle communication through very simple movements. This just enhances the functioning of the key muscles you want to work, and then we want to build her baseline core strength, which I always do with all my clients. And then from there, we can start to actually teach you how to move functionally. That obviously resonated with her because in the past she had done movements and exercises that the body objected to. So she was also quite nervous about doing exercises so I said, look, this very step-by-step process, and we’re going to start a very easily. Before we start getting into how to climb stairs, how to get out of a chair, we’re going to actually prepare your body for movement. Build up your base level strength and then we’re going to teach you how to move, that was the plan.

Clint – Beautiful. Give us an idea of the sort of things that you might suggest to a newcomer who wants to start working with you around the call, just so we really sort of give people that sense of understanding of what would they be in for? I know each person is different, so in your case study here that you’re walking through in terms of core strength, we’re talking about the abdominal area, is that correct?

Carl – And the waist, the trunk muscles, but like you said, more specific to the abdominal area. So we all have the same nervous system. Depending on whoever I work with, I always mention that you’re nerves to the core muscles are like what we talk about T6 to T11, your mid-thoracic mid-back. So any sort of postural pain, deviation from the normal will impact those nerves, and that then has an effect on your core muscles. If you’re trying to do core strength and you haven’t got good communication through those nervous systems, then you actually end up straining the back muscles and your neck. Many of the traditional conventional sort of exercises today, look at planking and all these kind of exercises that they find and they build core strength, but they’re not always appropriate for people struggling with RA. So we look at more like very simple exercises done in the chair, resistance bands. And it’s incredible because you’re able to position people in a comfortable position where they can strengthen their core muscles without actually. If you look at doing sit ups or something, it often strains the neck and it starts to impact the back as well. So what’s great about these exercises is you can do them without straining your back, and that’s often a big complaint amongst people, in general, trying to strengthen their core as they fill their back muscles. getting hurt or their hip flexors are getting tight.

Clint – I love it. We can’t take anything for granted when you have rheumatoid arthritis, it’s almost like your entire body is guilty until proven innocent. You don’t know what’s sort of out of place not working well, inflamed, irritated, contraindications with one part of the body, and actions that could upset somewhere else. So I’m sure a thorough diagnostic is required to assess the level of a starting point.

Carl – Yeah, a lot of the core strength, though, is which is very interesting for listeners is that when we work on the core strength, we then able to then start to make postural changes and spinal changes. So I use the core as a way to decompress the spine. If you look at a lot of the mobility exercises, even in yoga I use for my yoga clients, I get them to do core strengthening first, then go do yoga because when they do the core, it actually unlocks the spine. They can get a greater range of motion mobility and that improvement in the spine then translates to better movements, better, load on the knees, it’s all connected as you know. So this is where the individual coaching comes in is like, what part of the spine am I going to look at today? Or where are we going to focus on some sort of remedial work to help you with the knees? A lot of it’s like even just helping the upper body mobility can affect the knees, so it’s very specific. But that’s where the breakthroughs come in because often people just can’t get through like they’re going to hit a roadblock or they’re stuck.

Clint – Okay, so you’ve spent some time with her working on her core, and consequently, then it works on sort of back posture and so forth.

Carl – Correct.

Clint – How long do you spend? How many sessions on this? How much homework do people have away from the sessions with you, the frequency of the meetings? Answer that, please first, and then what do you do after that?

Carl – So we start off with like 2 sessions a week for maybe 2 to 3 weeks, depending on the client’s needs. The first 2 weeks is important because you’re building the coordination, and I’m able to really look at what areas to address. Then there is homework, so they do their exercises at home, I send them pictures with all the details of what they need to do. And it’s so important for them to stick to that program because often they’ll do more or they want to accelerate the process. I know that’s quite common and end up sometimes not getting pain, but they’ll say it’s my fault. I’ve done too much. So it’s not a lot in the beginning, is to get them used to the movements. Then I usually advise a day’s rest in between, so 3 to 4 days times a week, but with a day’s rest. A lot of people like to be moving every day, so it’s been a challenge to just get them to do the basic movements every day. But the strengthening just give it a day’s rest, especially if there are flare-ups and then it tapers off to once a week. My general plan is 6 weeks of clients, but I have a lot of clients who stay with me for a year, we’re doing twice a week or once a week for a year. It depends on what they need and what they’re looking to get out of the session.

Clint – Okay. So let’s move through now to rolling out the plan for the case study. As we said, we’ve worked on the core area and balance, and so on. Then what did you do next? And talk about the specifics of what you did next and some progress and some objections and the whole interaction. Go through that process.

Carl – Well, a lot of it starts with chair exercises. So, doing the core we mentioned, and then getting out of the chair. I mean, if you’re just just getting out of a chairs like a basic like a squat. So just helping her to go from the other chair. And then we started doing weighted getting out of the chair with weights. Then a lot of the resistance band works of pulling down, like looking at strengthening your arms and the core as well. So those elastic bands are very useful to just to help with general strength. We mentioned she had a sore neck as well and shoulders, so there was a lot of mobility working through the upper back and neck. Then strengthening her shoulders using those bands. From there, I went to actually teaching her how to squat like and how to bend and how to climb stairs, how to get off the floor correctly, sort of everyday practical things that she would be doing. Gardening, lifting was a huge benefit for her as well, because that’s where the pain was coming, getting up and down the stairs. But now that we had the strength now that she felt that she was confident to move in that area, then we could then go to their climbing stairs. I don’t want to teach them climbing stairs when she hasn’t got the basic strength to do it correctly. So once she got that, then she was away.

Clint – What were some of the breakthroughs that you saw along the way?

Carl – I think the big improvement was in the neck, the range of motion, and the flexibility, and then just the significant reduction in pain and swelling in the knees, which she mentioned. A very key point here is that the confidence that she had from the strength and knowing what to do, she often would protect herself by stepping up to joints, which I think is quite common with people with RA. Just being able to have that confidence, and knowing the improvements and body awareness she was able to move the joints more freely. That obviously then translates into pain relief. And as you know, I’ve talked about this a few times, it’s so important just to get those joints moving. But when you don’t know how to move them or you haven’t got the strength and then you actually then even that whole fear of voiding pain and movement it has the opposite effect.

Clint – It does, yeah, there is a downward spiral effect where if you stop exercising to reduce inflammation or to stop feeling pain, then the sensitivity increases, and you become ultimately more and more inactive. Because your abilities go down and down. So we have to find a tolerable level of discomfort when we exercise that isn’t damaging. We have to be able to work through that level of discomfort and start with very low discomfort. But keep asking the question of that joint, can you do this? Can you maybe do this a little bit extra for me? What about yesterday you did that? Can you do this bit more? And you know what the joint tends to in most cases, respond well. As long as you’re in your world, it’s a functional movement, it’s not something like a leg extension exercise at the gym, which is completely not functional. It’s something that we’re designed to do, which is sitting and stand, sit and stand, which is a squat.

Carl – Correct, and I think that you make a good point in that pain is that a lot of the clients that I work with online struggle to differentiate between what is actually causing the pain. Is it the muscle? Is it the tendon? Is it the joint? So it’s so important, and I think that’s either one and one comes on where I’m able to just say, hang on a minute, what do you mean you’re feeling pain? Where’s the pain? That’s okay. Hang on, stop. It’s actually the joints or actually, you’re compressing your joints. Oh, I thought I was stretching. No, you’re not stretching your compressing or so I feel this and I said, actually, that’s good pain, that’s bad. So helping them in that because they don’t have that understanding. I’ve had over 20 years of working with pain, so I can quickly say, no, that’s the wrong type of pain you’re getting there. And even though it’s a bad pain, keep going, it’s getting better. The pain, it’s gone the pain. So I know when to push them through the pain or not. And I think that’s just really that sort of helping them so much because you can’t do that at home or you don’t want to just wing it when it comes to pain,

Clint – Especially when the swelling. In your case study, you’ve got swelling in the knees. And when there is swelling, it’s like a whole new card game, the rules are sort of out the window because some things that may under normal conditions, be helpful for just about everyone else. When the knees are swollen, it introduces complexity that requires great care and insight to not stir things up.

Carl – Correct.

Clint – So getting a swelling reduction in the knees from working with you is a phenomenal outcome. It’s hard to shift swelling in the knees, it is. Do you think that she was able to achieve that through the activation of those key soft tissue areas connecting to the knee? Or was it more through flexibility? Or what insights do you think and sort of best guesses are associated with that swelling reduction?

Carl – I mean, it’s complex, there are multiple things, but I mean, definitely. I mean, as you say, even the diet’s important. But when it comes to exercise, you know, the core strength is like the miracle cure I want to call it. And it’s because when you get out of a chair or on your knees, they need that support from the core otherwise you overload the knees, so that’s a huge thing. I’ve even found out just doing core strength helps people in their hands, and it’s like, how is strength in the core going to affect rheumatoid in my hands? I don’t know if it says cytokines that get released in the musculoskeletal muscles have that pro because they regulate inflammation. But other climate issues are mentioning how like my hands feel so much better and we’re doing core strength, and I was just like, I’ll be lying if I knew exactly how that worked. But there is the results are there. So the same with the knees, it’s like the general core strength is important, but also it’s just like the psychological order, the confidence, and then removing that fear of movement again has an effect on inflammation. It’s amazing how, as I said, it’s complicated the intricacies of these systems that regulate inflammation. Obviously, this has to do with the muscles as well. But my best guess is it’s actually the psychological effect that exercise that is having the confidence that the freedom to move can actually play maybe even a greater role in reducing the knee pain than actually, just the movements. does that make sense?

Clint – Yeah, there are complex mechanisms, there is no doubt about it. I have a list of suggestions in my mind that it could be as well. But the bottom line is it helps, I agree that it helps. I use to find my hands used to feel so much better when I would do upper body exercises, specifically anything for the further sort of deltoid punches. Anything that involved using the upper body, getting blood flow through the entire limb right from shoulder to fingertip. And notice that in that position, there’s no weight being held through the fingers, as I’m pushing away, all of the pressure is just back into the soft hands there’s no joint being hurt whatsoever, it’s perfectly great for you.

Carl – Then you get the mobilization of the nerves as well when you do that. So there’s a lot going on there, and I love that. In fact, the core exercises we do is it’s like the one that I’ve shown before the pulling dance, the thing, and your belly button and it’s getting the whole arm working. But as I say, it’s complex, but it’s there’s definitely that the fact that exercise, it’s not just the physiological strengthening of the tendons. Yes, that obviously plays a role and support, but it’s what that does to the mind that also is a huge tie-in as well. So she’s made great, I mean, just climbing up and down the stairs, bending, doing every day if you think about getting on the floor, up and down. These are things that we do, we talked about it before up and down the toilet, like out of a car, off a desk. It’s movements that you do every day. If you just get those right, it has a huge effect, and just knowing how to do them correctly, I think. One of the big aha moment she mentioned as well quite a few times was that you don’t have to do super difficult, complex exercises to get great results. And I think that’s saying that a lot of especially even my sports guys, they said, but your exercises are so basic. These are so basic exercises, yet they’re so effective. And I think that’s especially for RA people this is so great. You don’t have to do complicated movements and strenuous movements to get results.

Clint – It’s so true, we tend to overthink these things, especially if we go and get the assistance of, say, the local Physiotherapist who hasn’t got any experience with working with complicated or difficult cases like rheumatoid arthritis. whilst they are probably the greatest if you’re just an athlete and you’re working, trying to keep up the local soccer routine that you have going on each weekend, it might be perfect for that person. It’s so different when it comes to rheumatoid. As we said, right at the start of our conversation, every joint and every limb is sort of guilty until proven innocent.

Carl – As you said, it’s so individual. I mean, it’s like what you do with her is going to be completely different to someone else. Sometimes I start with need problems, often even start with working the shoulders. I don’t even go to the knees, because of the crossover length, the chains that we work different areas. So it’s like sorting like a problem solving this picture. As we work with this lady, you can see straight away actually where the roadblocks are or where she’s actually struggling and what’s going on and able to pivot and change direction. So it’s I mean, just exercise again I mean, you said it before, it’s such a big part of that coupled with diets and many other things, exercise as medicine. That’s the big thing, she didn’t want to rely on medicine too much Western medicine. So, you know, exercise is medicine in a sense.

Clint – Do people need to buy many things to work with you such as equipment, expensive things? Or are you able to direct them to some inexpensive resources for them to get started?

Carl – No, you just need a chair and you need there’s elastic resistance bands, preferably quiet light in the beginning. Then a lightweight like a 2 kilogram, maybe a 3-pound weight for US-based clients. It’s not heavy stuff at the moment, it’s pretty simple.

Clint – And if you sent her on her way now with a plan that you’ve been through your coaching sessions together, does she now have a maintenance plan that you’ve given her?

Carl – Yes, she’s got a maintenance plan that she does every 2 to 3 days, and I’ve given her things if she does struggle with certain pains or restrictions that she can do to loosen it up. It’s quite a sequence, an order of exercise that she goes through and then in that 6 weeks, we try and work out it’s like a recipe. So it’s not only just the exercise but what she must do when she must do it. So there’s a real, quite detailed plan that she goes through. And then I update it every 2 or 3 months, we’ll be in touch and maybe something needs to be removed or stronger exercise or different pain.

Clint – Right. Yeah, different challenges do present themselves as you go. Well, Carl, thanks very much for this. It’s been very informative and it’s really great to hear that you’ve got some, you know these you would call life-changing outcomes for people. The case study you’ve given us here is someone, as you said, who’s had rheumatoid for decades has probably got a lot of physical challenges that they’ve negotiated over the years. To get her that level of results from only a couple of months is awesome. I also just want to say to folks who are interested, Carl’s very affordable, your pricing is set up to make it accessible to a great number of people who may not be able to afford their local physical therapists slash functional movement experts. Your pricing, I believe enables that for a lot of people. So please head over to www.CarlReadercoaching.com and schedule a 15-minute call with Carl, which is completely free just to see whether or not he’ll be able to help you. And for all members of Rheumatoid Support, you’re able to log in and inside our members’ area, ask Carl as many questions as you want. All the exercises are there, all the ways of doing things are there. So if you’re not a member and you’d like to access Carl that way, it’s a very, very, very effective way of getting help from Carl. Head over to www.RheumatoidSolutions.com, where you can join up and get help from not just Carl, but all of us, myself and the team. So thank you very much Carl, and it’s always a pleasure to have you on here, I look forward to chatting with you inside our support group, probably today or tomorrow. But I hope that also this has been helpful for everyone else to be able to learn that there are ways forward, even with long-term affected joints, to be able to make significant improvements. So thanks very much.

Carl – Oh Clint, thanks. Always a pleasure.