Dr. Matt Fontaine on the Easiest Ways to Prevent Injury & Optimize Performance

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Hey, it’s Mike. And welcome to another episode of the podcast. In this episode, I interviewed Dr. Matt Fontaine, who is a fantastic sports doctor here in the Washington DC area where I live. [00:03:00] And I’ve been seeing him. for, let’s see, I’ve probably done six or seven treatments now for a lingering bit of biceps tendonitis that has just been getting in the way of my pressing.

It started with heavy incline bench pressing several months ago, which actually started with my neck just being tight and I kind of just ignored it cause I was like, yeah, whatever tight muscles it happens. But then it was just not going away. So I backed off the, the, the heavy incline bench barbell pressing and went to flat.

And then from there, eventually my biceps tendon started to get aggravated. And I tried, you know, the, the various things that you can do at home. There it’s, it’s a tough thing to treat because a lot ties in there in that bicipital groove and what is actually causing the friction on the tendon is hard to isolate.

So I found Matt. Who has been practicing sports medicine for about 15 years now. And he has worked with everyone ranging from professional baseball players and triathletes to [00:04:00] a weekend runners and CrossFit warriors. And he has helped people through some pretty gnarly injuries and setbacks way worse than what I’m running into.

And in, in my case, he has been using a technique called ART, which you will learn about in this interview. And it has really helped loosen up the muscles in my shoulder and arm that were aggravating my biceps tendon. I mean, I wish I knew about this months ago because I had tried all kinds of things with lacrosse balls and foam rolling and stretching, and you just can’t.

Get the results that you can get with ART. It’s pretty cool. And you know, in addition to just simply getting results with me, Matt also really impressed me with the breadth and the depth of his expertise and experience. I mean, he really knows his shit, which you’ll. Quickly. See, as we get into the interview and I wanted to pick his brain on various things like finding and fixing muscle imbalances predictors of injury, the nature of soft tissue injuries, simple preventative measures that [00:05:00] you can take at home and, and more.

And I’m really. Happy with how it came out because I think he shares some really great insights and some real practical tips. And, you know, just as a side note, as I get more and more heavy weightlifting under my belt, I’ve really come to appreciate stretching and mobility work more for the purpose of preventing injury and just also maintaining optimal performance.

Because as Matt talks about in the interview, pain really is a lagging indicator. And once you’re feeling pain, you’re further down the road of dysfunction than you probably think. So this whole area of you got prehab and the stretching and mobility and maintaining healthy soft tissues is really one of Matt’s specialties.

So I think you’re going to find the interview very enlightening and helpful, and here it is. Matt, thanks for coming on the podcast. I’m excited to have you because my arm finally feels really good again. 

Matt Fontaine: Awesome, man. Well, thanks for having me. I’m I’m excited. It should be fun. 

Mike Matthews: Yeah. Yeah. So let’s start with just a, you know, a brief [00:06:00] introduction of who you are what you do, kinda what your background is, some of the, some of the feathers in your cap and so forth.

So everyone listening can you know, get a sense of how you approach things. 

Matt Fontaine: Sure. Well, I’ll give you the cliff notes. My credentials basically, I’m a doctor of chiropractic, have a clinical doctorate in chiropractic. I’ve been in practice for going on 16 years now. Primarily the majority of that has been in sports medicine.

So doing a lot with athletes and did my residency at Texas Back Institute, which is in Plano, Texas. Basically, what they do down there is they spine surgical center. And they do have a pretty good conservative management team as well. Everything from pain management to spine surgery. They do a lot of level one research there chiropractic physical therapy.

So as far as complex spinal cases, I’ve pretty much seen what’s out there and I’ve seen it in a collaborative sense through all different specialties in medicine, including chiropractic. And let’s see, I practiced in Florida for about a little over a decade. And during that time, I had the privilege to work with a couple.

[00:07:00] Major League baseball teams that made their spring training headquarters down there. And also over the last 10 years plus been a active release technique provider and started doing that in 2005, 2006. And through that was was able to work at quite a few Ironman events as part of the A RT Ironman medical team, where basically we put a RT docs up at Ironman events treating the athlete.

So did Ironman, Florida. Clearwater 7. 3 World Championships and also down in St. Pete, which is part of Ironman 5150 Olympic Series. Yeah, 

Mike Matthews: yeah. And you know, just, just to interject on that, that’s one of the reasons why just everybody listening. One, we’re going to talk about ART a little bit later in the podcast and, and.

Matt will explain what it is how it works and it has helped me a lot because if you’ve been following me and my work at all, you know that over the last several months I’ve kind of had this on again, off again, shoulder, bicep tendon, wasn’t exactly sure what it was. It would just [00:08:00] bother me when I would be.

Pressing and I would, you know, I could do additional warmups and kind of just work around it, but I had done kind of exhausted what I, the self treatment options that I knew about with myofascial release and, you know, foam rolling and, and just mobility stuff. And yeah, it sure helped a little bit, but it didn’t.

It didn’t fix it. So then I went looking for like, okay, I got to, I just got to find someone that this is what they do. So I went, my criterion, my number one criterion was I want to find someone that works with professional athletes. Cause I figured these, you know, these guys, their livelihood depends on how well their limbs are functioning.

So, you know, if, if someone can keep those people as clients, they must know how to get results. And so that’s, that’s why I originally was, was found Matt. via a friend of, a friend of his in and somebody he worked with in Clearwater. And so just, just to kind of throw that out there, and I know we’re going to talk a bit about, Matt, like, how do you find a good, a good sports doctor?

And, and, and when, when, when does [00:09:00] it make sense to go find a sports doctor? But that’s just something that I think is, is Because, because, you know, I think I’ve been, I’ve been to quite a few chiropractors over the years just for maintenance stuff and, and it’s kind of hit and miss. I would see that found that some of them were, were very much into just like coming, okay, just come every week and I’ll just you know, adjust your neck, adjust your back and kind of just forever type of thing.

And then others will be very into well, let me muscle test you on like 42 different standard process supplements and you need to be taking some, you know. You know, it just becomes where couldn’t say I noticed much of a difference one way or another. So also the fact that, that you are multidisciplinary, I think that, that’s another thing that drew me to you.

So that’s, that’s your background. Now let’s get into kind of the, the meat of the podcast and let’s start with, so you’ve worked obviously for many years with a lot of high level athletes, a lot of endurance athletes and, and now these days crossfitters, right? Like people that are I mean, well, they’re into weightlifting, but, but, you [00:10:00] know, a lot, you see a lot of CrossFit people as well.

Right? 

Matt Fontaine: We do. CrossFit makes up a pretty big chunk of our patient base, which I’ve 

Mike Matthews: heard from quite a few PTs. They’re like CrossFit has been a boon to my business. 

Matt Fontaine: Yeah. I mean you know, I, I work out with one of the the bigger gyms here in the mid Atlantic. And so I find that that helps actually.

Getting into the community and kind of find out what it’s all about is it definitely gets a bad rap in circles that maybe don’t know enough about it. You know, there’s two kinds of you know, thought processes and there’s certainly a lot of people, you know, kind of crossing over from bodybuilding ended CrossFit.

You get a lot of endurance athletes that are kind of finding CrossFit either as a way to cross train and then everything all the way up to people who are, you know, trying to get into the CrossFit games. So, you know, I think it’s, it’s a fad that’s here to stay for a while. And there’s a lot of there’s a lot of benefits to it.

Certainly does come with its risk of injuries and, and you know, that’s kind of what we see in the office and, you know, we do our best to try to keep them in the gym, keep ’em CrossFit, and maybe do it a little bit [00:11:00] safer and you know, so it’s been a lot of fun. What would, what would 

Mike Matthews: be some of your, what, what’s, what would be like some of your tips for people that are considering CrossFit or the new to CrossFit?

’cause I’ve written about it and you know, I think, I think it. Is great that it’s introducing a lot of people to barbell training and to weightlifting and resistance training. I think that there’s a lot of crazy programming out there and a lot of bad coaches, but if if you have good coaches and good programming, it makes sense.

So if you have somebody, what would you say to people that are new or considering CrossFit on how, how can they reduce their risk of injury? and stay healthy as long as possible. 

Matt Fontaine: Yeah, I think, I think you hit the nail on the head right off the bat. I mean coaching and programming make all the world of difference, right?

So I always go on the, the mode of, you know, the devil’s in the details. And so even in, in clinic, when we’re doing rehab, I don’t contraindicate exercises as much as I contraindicate. So, you know, take a deadlift or a squat, for instance, you know, really good exercise, depending on where you’re at with injury or movement might not be something you want to start out with.

[00:12:00] So what I’ve seen from my CrossFit gym and some of the other CrossFit gyms in the area, the guys that are doing it well. They have a really good baseline intro. They’ll have what they consider three months or less. So they take the time to scale workouts. They don’t just throw everybody into the fire.

Usually they try to incorporate some type of a movement screen. That’s one of the things that we’ve done at our gym because at the end of the day, and 

Mike Matthews: just to define that, so people know what that is. 

Matt Fontaine: Yeah. So, you know, technically the movement screen was developed by a physical therapist, great cook, a lot of research went, went into it.

And essentially it. It boils down to seven prime movements that the body does, starting from overhead squat straight leg raise, chest, testing out your hamstring flexibility. It looks at core stability, shoulder function. So it really kind of hits on these seven basic movements that every human structure should be able to execute.

And so what it allows us to do is to predict injury and also to basically diagnose in real time muscle imbalance. So the number one [00:13:00] predictor of injury is previous injury. The next number one predictor beyond that is muscle imbalance, right? So that’s one of the biggest patterns of movement dysfunction that we see in clinic.

And I say we, and that’s, that’s across the board. You’re an orthopedic surgeon, physical therapist, sports chiropractor, even just, you know, your standard chiropractic office will see this. And specifically in runners and just athletes in general is poor movement, right? Where people lack 

Mike Matthews: like what are the most common ones that you run into?

Most common, you know, just issues that people have with inability to move properly. 

Matt Fontaine: Yeah. So it’s really, it’s really funded on, you know, there’s kind of areas of the body that tend to have to be more stable. And areas of the body that tend to have to be more mobile. And so one of the things we see in a lot of people that move poorly, which in today’s day and age is, is most of us, right?

Because we’re not designed to sit at a desk. So if we just start from the ground up and we kind of hit the ankle, foot and ankle joint, you know, we need a good amount of mobility there. And we tend to see a lot of people have stiff, restricted ankle [00:14:00] movements, also stiff and tighten the hip. And what that ends up creating is a lot of issue in the knee because the knee is just a hinge joint.

And if you’re bleeding motion from above and below, the knee then has to compensate and the leg can kind of rotate inward or outward. It puts a lot of torque forces onto the knee. So. Moving up from the hip you need a good stable core. Basically that kind of midsection area up into the middle back.

You need to have good flexibility of your upper back in between the shoulders ability to rotate the bend backwards. The thing about most people tend to be locked in a forward position, kind of that computer posture, moving up into the shoulder. Again, it’s a very mobile joint needs to have full range of motion, but also needs to be able to.

That the body needs to be able to create stability around that highly movable joint. So those are kind of the things that we see go arise. Those areas of stability are lacking. And the areas that we tend to need mobility, particularly the hips, the ankle and the upper [00:15:00] back, we tend to see people very restricted and locked up.

Mike Matthews: Yeah. And, and so how does that play out in the gym then? Because, you know, cause you’ll hear if you just Google around a bit and read about, Oh, well, some people will say the deadlift is just a terrible exercise. It’s just going to destroy your back. And other people, and some people say the same thing about the bench press and no matter how you do it, it’s terrible for your shoulders.

And I mean, as a, as a. general rule when when you run into binary black and white thinking like that usually like for me in anything red flags kind of go up because rarely anything in life is that cut and dried, but Exactly. 

Matt Fontaine: Outside of death and taxes and like some of the laws of physics. I mean black and white thinking in a clinical setting really needs to be kind of scrutinized because it is a case by case basis So what you look at is a lot of people tend to go into the gym with some of these movement dysfunction at play.

And oftentimes multiple regions, right? And so they try to execute a deadlift on a body frame that isn’t stable [00:16:00] where it needs to be and isn’t mobile where it needs to be. So if we take the hips, if you don’t have the flexibility to get into the hips and get down deep, what will happen is you’ll end up rounding your lower back.

And if you try to pick up something heavy enough off the floor with a rounded lower back, that’s a recipe for disc herniation. Sprain injury and so forth. Same thing goes with a bench press. You know, if I have a forward protracted shoulder position, if you just think about kind of that routed shoulder, I’m already starting that movement in a dysfunctional position.

The shoulder is not in a stable position. And I’m going to execute a pressing movement, which is going to, you know, put the rotator cuff at a disadvantage mechanically. And it just sets you up for a whole slew of issues from bicep staminitis to shoulder impingement. And that can progress all the way to more significant things like rotator cuff tear, labral tears, commonly known as slap lesions.

And a whole slew of issues. So the, the biggest thing for somebody trying to get into, you know, like I said, whether it be CrossFit or any sport really is, is to start with a good movement screen. And you know, we could [00:17:00] talk more about that later, but that’s definitely something that, you know, a good clinical physical therapist, sports chiropractor should be able to take care of.

Mike Matthews: Yeah. Yeah. And, and people, you can, you can learn about it. Like, like Matt said, Gray Cook is, I mean, I, I, I’ve seen his work kind of, I’ve seen him just kind of credit as the. The real progenitor of, of mobility. I mean, obviously Starrett is known as he has made it a bit more mainstream than, than Cook, but you know, Cook’s stuff came first.

Matt Fontaine: Absolutely. And so if you look at, you know, the top strength coaches, if we just go from the professional level on down, I don’t care if it’s major league baseball, NFL, NHL the NBA, these strength coaches are, they’re movement screening. They’re they’re athletes coming into camp every year. They’re looking for where are the areas that were bleeding movement and power and strength that set us up for injury.

I mean, just like you said earlier, when you’re investing multi, multi millions of dollars into these guys. That’s their [00:18:00] livelihood. It behooves us to be able to diagnose an injury before it happens and get to it. So yeah, Kelly’s done a lot of really great work with his MWOD stuff. We use a lot of his stuff in the office.

I’ve personally met him twice at our gym. He’s come down to the mobility clinics, done a really good job of kind of getting that mindset out into the CrossFit community, which, you know, like we talked about earlier is reaching a lot of people. You have a lot of people, you know, in the cross for these days.

And so it’s at least creating an awareness. Yeah, and it’s making, 

Mike Matthews: it’s making working out popular, which is cool. Exactly. Exactly. We’re getting people off the couch. So then, okay, so let’s say you have somebody here and they’re just new to just weightlifting in general. What are some, like, I mean, obviously getting a full movement screen is great and definitely be recommended if they have somebody that they can go see and that works for them financially and so forth.

But what are a few simple things that, you know, they could test at home to know if they are should they [00:19:00] clearly be like, are they ready to really start doing a proper strength training program, for example, which is going to involve heavy bench press, heavy overhead, press, heavy squat, and heavy deadlift.

Like what are a few things, like if you can’t touch your toes, then blah, or if you can’t, you know, do this with your shoulder or do that, or if you can’t do this with your back. 

Matt Fontaine: Sure. I mean, you know, if we just take a couple things, I mean, if you have an ability to execute a fairly decent squat position and I’m not going to get too technical with that, but you know, most people can kind of tell whether, can you, can you just squat down and drop your butt between your knees without having to come up on your toes?

You know, it could be a 

Mike Matthews: break, break parallel and be stable. 

Matt Fontaine: Exactly. You know, if you just think about, you know, just a simple box or a, or a chair, can you, can you swap back into that chair without having to make some kind of grossly compensated movement? You know, I think the toe touch is slightly misleading because most people kind of think that, Hey, I’ve never been able to touch my toes.

I’m not very flexible and I have just tight [00:20:00] hamstrings. And that actually is not true for most people. Because of all the sitting we do, the sciatic nerve lends itself to being entrapped by the tightness that occurs in the muscle of the hip. So as I go to Execute a forward bend and try to touch my toes.

What happens is, is there’s tension along those muscles and that can grab onto that nerve right in the hip where you sit and not allow that nerve to slide as you make that movement and what will happen is it’ll shut the movement down and it creates a lot of tension down the back of the leg. It’s basically neural tension from the nerve being stretched and a lot of people will misinterpret that as tight hamstring and so we’ll find a clinic after we’ve done some active release.

to the hip and we can talk about that a little bit more, but some soft tissue release work to the hip. We find that it frees up that motion and we can improve their range without even doing anything to the hamstrings. So, you know, there’s some telltale things. I think, you know, for most people it depends a lot too on your background, you know, were you an athlete growing up?

Did you play sports? Do you have some experience in the weight room? Those kinds of [00:21:00] things, you know, for a lot of people jumping in to, doing a lot of these lifts the answer is no to that, right? So if I’ve come from a background of playing football and I’ve done some basic movements in the, in the gym, squat, deadlift, I’ve got some experience to draw on from that, you know one of the things we kind of look at in the gym is, is, you know, the litmus test of does that movement look athletic, right?

If it looks athletic, odds are there’s a lot of things working correctly. And if it looked horrible, you know, He kind of gleaned it from there. 

Mike Matthews: No, that’s good because people can always, and I, and I’ve recommended this to many people that reached out to me and I’ve actually asked them to send me videos.

But just like with any sport, if you want to get good at, you know, like I, I spent a few hundred hours working on my golf swing on camera, which is the only way to build a golf swing efficiently. But similarly, if you want to really see if you’re, if you’re. executing a weightlifting movement properly, video yourself get a friend and they’re, you know, yeah.

Who cares what people think? Everybody’s taking selfies and trying to [00:22:00] show off. So in this case, you’re doing it for, for useful purpose and get it, get a video of your squat from, you know, the side and, and from the back and the same thing with deadlift and saying, you know, all of your big lifts. And, and that’s a, I like that tip is just like, does that look graceful at all?

Does it look fluid? Does it look right? Go compare it to, you can find, find. Plenty of good models on, online with, with, again, with, with good strength coaches on, this is what a squat should look like. Does yours look like that? No, well, what are the, what are the, what are the big differences and how do we fix those?

You know, how do you get it more toward ideal? 

Matt Fontaine: Exactly. You know, we’ve, we’ve done a lot of work with golf pros over the years and Titleist Performance Institute has done a really good job of bringing together some of the top lines in physical medicine, whether that be strength and conditioning. Physical therapists, chiropractors golf professionals with the underlying premise of healthy golfers, golf more, right.

And there’s a lot of really good research that’s come out and they’ve done a lot with just that, you [00:23:00] know, looking at swing faults are not always a technical issue. 100 percent somebody could have a swing fault that’s related to a biomechanical issue where they lack normal structure and function of a joint.

And unless you have that looked at by a professional who’s able to actually kick that. You could be spinning your wheels with all kinds of, you know, coaching cues and techniques. So it’s the same thing. And I think looking at stuff on video, you know, in the gym, we usually will look at people and kind of evaluate their squat and they do an overhead squat.

We can glean a lot of information from that. We do the same thing with runners. Get them to shoot some running video and you can really clean a lot, especially in running as in with golf, you can slow that video down for a fraction of a second, where you’re really able to pick up a lot of distortions that you miss with the naked eye.

So, you know, there’s definitely a value for, for starting with. Hey, does that movement look remotely athletic and if not, then maybe it warrants, you know, a further look, 

Mike Matthews: right? And so on the upper body, what [00:24:00] would you say is like if you can’t do this, you shouldn’t be, you know, going heavy on your bench pressing.

You should be addressing mobility or your overhead pressing, for example. 

Matt Fontaine: Yeah. So two, two simple things are, you know, one, can you. You know, make a fit and kind of reach one arm up over your head to try to bring your hand between the shoulder blades like if you were going to scratch your back and can you bring your other arm behind the back and how close can you get those two and a normal healthy shoulder left and right like 

Mike Matthews: locking locking hands is the idea yeah 

Matt Fontaine: if you can lock hands great now reverse the position where you switch the arms the opposite arm reaching behind the back is another one on the head if you’re about even with both of those and you’re within, you know, you can kind of touch your fingers or you at least within a hand’s width, probably you have some decent shoulder mobility.

But what we find in most people is that you’ll see there’s a huge difference left to right when you switch those arms around. So and the reason for that is a lot of people lose what’s called internal rotation. So basically that [00:25:00] ability to. Reach behind your back and kind of bring your hand up the spine and how high up can you reach without doing a lot of compensated, you know, bending and twisting.

The other one you can do is do basically what we do in in a clinical setting is an exercise that’s called a wall slide. And you basically stand with your back to the wall. Can you keep your head flat and your chin kind of pulled in slightly and bring your arms up to 90 degrees? And can you reach the back of your hand and forearm to the wall?

Most people that are really tight in front they’ll find that they have difficulty doing that if you can’t get your hand all the way flat to the wall You’re probably going to have issues somewhere down the road with heavy pressing whether it be shoulder pressing bench press those kinds of things 

Mike Matthews: That’s a good point in and also something that like I this is me kind of learning this lesson in that what I have run into I’m sure would have been caught earlier.

When I was it I guess I, it first started manifest as just neck tightness when I would bench press, no pain, [00:26:00] just that my neck would just be tight. Like if I tried to turn to the right and I just was like in the beginning, I was like, yeah, whatever neck tightness. I mean, it happens sometimes your muscles get tight, but then it would progressively get a little bit worse when the next time.

And I kept on going heavy and eventually I was like, all right, I need to back off that, which I did. And then was getting it massaged and that was better. But I’m sure that I was missing. My shoulder mobility probably was not where it needed to be. And then this brings me to something that you had just mentioned that, that just in what I was running into where tissues then are, are being stuck and they’re not sliding and moving the way that they should friction, friction, friction, eventually.

It’s just the repetitive use element of it. It doesn’t, it doesn’t matter your form. And this is the important point is that your form can be great. You know, if you would have seen me bench pressing, you would have said, Hey, that he’s doing a good job. There’s, it would be hard to, you’d be hard pressed to find something.

with what the way I was doing it, but you, what you can’t see is what was going on on the inside. 

Matt Fontaine: Exactly. It’s a [00:27:00] great point. It’s a great point. So, you know, certainly if, if we know there’s these restricted movements, you’re more at risk. Like I said earlier, the number one predictor of injury is previous injury.

The second most. Common predictor is the muscle imbalance that we see. So, you know, it’s true that even with perfect technique, the basic rule you can go by is that all musculoskeletal tissues will fail at a certain Percentage of load or a certain number of repetition. That failure rate is different.

It’s on a scale. You know, it can be everything from a mild sprain strain to a really significant pair. So, you know, and it goes back to 1 of the things that people tend to. I’ll be misled by it. Hey, you know, I don’t really have any pain. I just have a lot of tightness. So 

yeah, 

Matt Fontaine: the important thing is that pain is a lagging indicator, but by the time you have pain you have incurred tissue injury.

The human brain is a very adaptive system. It’s one of the things that makes elite level [00:28:00] athletes so elite is their Compensatory mechanisms far surpassed that of the average Joe. They’re able to compensate for muscle imbalance to where it’s almost not even noticeable to the naked eye. But when they do break down and have injury, they usually do so on a much more dramatic note, 

right?

Matt Fontaine: If you look at, there was a few years ago, you had I don’t forget this, a good friend of mine, he’s in the chiropractor Jason Sehorne was a big quarterback for the New York Giants, had a knee injury. They had to do ACL reconstruction. Now, here’s a guy, top NFL player, has access to some of the best doctors going, right?

Comes back out first or second game following season and tears his hamstring. How does that happen? I mean, at some point, right, it’s a buildup of scar tissue that, you know, they obviously didn’t address, but you know, here’s a guy who has access to, like I said, some of the best training out there. And that’s just one example we see, we see all the time.

So, [00:29:00] you know, the, the true reality for most of us is that, you know, by the time you reach. the 30s and 40s, right? The compounded effects resulting from decades of basically repetitive motion, what we call hard miles and duty cycles starts to basically show up in the form of pain. The tissues become less elastic.

And so a lot of the injuries that we tend to see from tendonitis to shin splints, you know, plantar fasciitis in the foot with runners, Runner’s knee, IC band syndrome you name it. Even discal injuries in the spot tend to really have been, you know, an injury that comes on that looks acute, but it’s been in the making for five, 10, 15, 20 years, even.

And 

Matt Fontaine: that’s one of the biggest thing that’s misleading to people is that they’ll come in and say, you know, I don’t understand, I’ve been doing this, you know, whatever their sport is for X amount of years. And I’ve never had a problem. I always kind of look at them and say, well, The unfortunate thing is when someone goes to [00:30:00] the hospital to the ER, they have a massive heart attack.

They don’t get to tell the doctor, Oh, what the hell? I’ve never had any chest pain. Those issues have been developing over time. And so we kind of take that for things like cancer and diabetes and heart disease and kind of know that those are chronic that take a long time to, to kind of show their head.

It’s really no different than soft tissue. It’s due to repetitive motion. You can have great form, but if you run enough miles, sooner or later you’re going to have some soft tissue injury, and then you can get caught up in this cycle. You know, we can kind of talk a little bit more about what actually happens.

with a repetitive motion injury. It’s it’s actually pretty simple to understand, but most people haven’t really had anybody explain it to them. Yeah. Yeah. Yeah. 

Mike Matthews: Yeah. Let’s let’s just right now because I mean, it’s something that you’re, if you lift weights over a long period of time, you’re going to, you’re going to run into it to one degree or another.

It’s just inevitable. 

Matt Fontaine: That’s right. And so, you know, part of it [00:31:00] is soft tissue has always been kind of downplayed. I mean, if people get. The kind of injuries we see in orthopedics, I mean, you know, if you fracture or dislocate a bone that tends to be a little bit further on the hierarchy scale than, let’s say, a soft tissue injury.

And so we really look at the long term sequela of those soft tissue injuries. I mean, for years, those injuries were kind of like, you know, put down by the wayside like, Hey, everything looks good on the x ray. It’s just a soft tissue injury. Yeah. 

Mike Matthews: And if it’s not a real injury, it’s just kind of a thing.

Matt Fontaine: Yeah. Like, Hey, no big deal. I mean, yeah, certainly, you know compared to a lot of the other acute, if you take out all the acute sports trauma, acute sports setting injuries. You know, ACL tears, concussion, broken bones, those kinds of things. What we’re left with is the bread and butter of orthopedic sports medicine, and those are soft tissue injuries and joint dysfunction, right?

So basically over time and enough repetitive motion, the tissues will start to get tight. I [00:32:00] don’t know anybody who’s done anything repetitively. So as the tissues get tight, now they start to rub and there’s more friction, 

right? 

Matt Fontaine: So as that friction builds, we get caught in a cycle where the tissues are tight.

They’re starting to rub more, but we’re continuing to do the repetition and it can be small amount of workload. Think of like hours and hours at a computer, or it could be things like running, cycling, working out in the gym. And as the tissues get tighter and tighter. It starts to create basically a tourniquet effect.

You’re not getting enough blood flow deep into the tissue. And what we know has been proven in physiology is that decreased oxygen to the tissues, what we would call hypoxia, actually stimulates the body’s repair mechanism. And so the default for soft tissue is to lay down fibrous scar tissue. Same concept occurs in the blood vessels.

If you have high blood pressure and a lot of inflammation, the body tends to heal that with cholesterol plaquing. So most [00:33:00] people can kind of grasp what goes on with that. In the soft tissues, the body responds the same way to an acute trauma as it does to a repetitive motion, meaning it starts to lay down this fibrous tissue, which is very inelastic.

And now you have tissues that are less elastic, and as you continue to use them, their threshold for injury starts to drop, and you start seeing things like being able to lift less weight in the gym, movements that were non painful are now becoming painful. I can’t run as far, the list goes on and on.

Mike Matthews: And then, so from there like for instance, if we just kind of use my, what I was running, what I’m running into, for example, so then where does that come in, in terms of inflammation and then pain and then? 

Matt Fontaine: So it’s twofold. So most of the repetitive motion injuries do create some degree of inflammation, but Kind of under the radar.

It’s kind of a low grade inflammation. It’s there all the time. Take kind of the two extremes, you know, you sprain an ankle, it swells up real good, or you break a bone. There’s a lot of bleeding, a lot of [00:34:00] swelling. It really stimulates the body’s alarm system. With these repetitive motion injuries, the irritation and the inflammation, particularly in the beginning, but over time, are kind of on a lower level.

They’re there, but not really enough to just cause the body to go into this alert mode, right? So most people continue to You know, exercise, work out, play sport, maybe they have some tightness, maybe they’re a little bit more sore after a run, but you know, again, it’s not really preventing them from doing what they’re doing.

And it kind of goes on, you know, under the radar and it’s, it’s basically just a matter of time. 

Mike Matthews: Yeah. And I, that’s, that’s, that’s what I ran into. So then I guess, I mean, when we look at it as a whole, this is kind of inevitable, it’s just, it’s just a consequence of using our bodies and you’re going to, I mean, if it starts with muscle tightness.

Anyone who does anything remotely, physical, regularly has run into that. So what would you say is like if we look at it in terms of, okay, so there are some things we can do, [00:35:00] I’m sure to prolong the. Prolong the the, the health of our tissues and prevent injury. And then so like, it could start there with some self treatment stuff.

And then at what point would you say, does it make sense where somebody should go find someone like you and they’re just ultimately going to, you know, that, that’s what it’s good. That’s what it’s going to take for them to be healthy again. 

Matt Fontaine: Yeah. So You know, if we look at kind of like, you know, the body is very adaptive machine, right?

So, you know, over time tissues that are kind of stressed optimally, good technique, given plenty of recovery time, the adaptation will be positive in the long run, right? You get bigger, stronger, able to run faster. The big thing that a lot of people don’t recognize is that they’re not really respecting the low recovery curve.

And basically all that means is I go in the gym, I do a workout. Alright. And am I fully recovered by the time I go in the gym and do that workout again, whether it’s a long run, a ride, you know, [00:36:00] if you’re a triathlete, you know, a swim, bike run in the gym, it’s workout, the workout trauma and repetitive motion are cumulative.

So if we respect the load recovery cycle, things like sleep and nutrition come into play. I mean, that’s a whole separate podcast, but don’t think that there’s too many people out there that haven’t, at least if you’re really athletic and active. I’ve heard that, you know, hey, it’s important to get, you know, really good quality sleep because that’s when we do most of your recovery.

So, you know, over time. That’s one way to help prevent this is to kind of have a good game 

plan, 

Matt Fontaine: you know, a lot of people just don’t really have a good game plan. If maybe they’re working with a trainer and again, it comes back to programming. If they have a good programming structure with enough rest.

built into the program. You know, if you look at how professional athletes strength train, right, everything is periodization. So they’re having all these macro cycles broken down into smaller measles cycles, and they kind of target specific things. But at the end of each of these cycles is a built in D load, whether that be for week, you know, most pro [00:37:00] athletes, when they come off their season, that’s like up to a month.

Where they’re really not doing anything in terms of heavy strength training, heavy workouts, you know, you’ll find that 

Mike Matthews: you’ll find that in powerlifting as well where you’ll have guys Olympic lifting and stuff where after after a Meet or after a particular after you like they’re peaking in their training if when it’s real real heavy real strenuous I mean some Famous guys would not then touch a weight for a month.

Matt Fontaine: Yeah It’s all about letting the body get back to neutral and you know, they’re doing other things They’re doing things for recovery and you know, things like getting massaged getting in the tea, you know they’re a clinician getting some body work done and there’s all kinds of things, you know with regard to that Nutrition, obviously what your fuel in the body comes into play, you know But as far as like getting into things that people can start doing from a preventative standpoint Foam rollers, lacrosse balls, they’re, they’re pretty popular now.

We do still see people that have kind of heard of it, but aren’t really using it. And then there’s certainly people that just don’t really know what they’re for, haven’t been [00:38:00] exposed to it. So those are real simple things to use. And, you know, again, I think that, you know, even in the CrossFit community, they’ve done a really good job of, of making.

Active recovery kind of in the mainstream. 

Mm-hmm . People 

Matt Fontaine: are realizing, Hey, you know what? I just did a heavy squat workout. Maybe I should get on a FOMO and like roll out my legs. Maybe they’ll be better recovered for the next workout. So on that end, what we tend to see is that problems that really require in clinic treatment.

You ask, you know, how does somebody know, like, hey, you know, when should I go see somebody? So you’re starting to have an issue. Things are a little tight. Notice, hey, I’m just not moving that well. And you’re devoting some time to getting on the foam roller and trying to do some stretching. And a couple weeks goes by and it’s not getting any better.

That’s an indication that you need to get in and have somebody take a closer look at it. Because tightness in the will respond favorably to a foam roller. Loosen up the tissue, but if it’s an actual area of [00:39:00] scar tissue where the body has laid down those fiber spaces and glued muscles together, and we probably have some nerve entrapments through there, you know, that’s when you really need to get in and have some clinical treatment, get some active release done, 

Maybe have a little bit more instructional on how best to use these foam rollers and lacrosse balls, because again, the devil’s in the details.

Tweaks that we can do to make those have more of a maximum benefit. So those are just a couple of, of ideas to to think of. 

Mike Matthews: Yeah. And if anyone listening, if you’re not familiar with the mobility foam roller, lacrosse ball stuff at all, if you go to muscle for life and search for mobility, you’ll see a few articles I put together on, they give you some simple routines that you can do for your upper body and lower body.

Cause if you, Starrett’s book which is great. Becoming a supple leopard, you’ll, you’ll be quickly overwhelmed cause it’s very encyclopedic. So you’re going to look through it and you’re just going to wonder, you’re going to say, okay, this all looks cool, but what do I do? Like all I know is my, the neck the right side of my neck is tight or, or all I [00:40:00] know is, you know, my shoulders are tight and I can’t, I can’t do the simple stretch that it is.

that Matt was talking about. So again, if you want to get a little crash course in it, just head over to my site. And then from there, of course, there’s a lot more you can learn, but at least at least there’s a starting point of saying, Hey, do these start with these basic and that, and that’ll cover your, your big muscle groups and it’ll, it’ll, at least improve things in terms of range of motion.

And so then Matt, go ahead. 

Matt Fontaine: Yeah. I was just going to reiterate. I mean, I think the big thing is getting a sense of awareness that Hey, there are things that we can do and, you know, kind of recognizing that. Hey, I have this restricted limit limitation. And, you know, I’m going to talk about earlier. I think Kelly’s done a really good job and, and great cook.

And, and you know, the issue for a lot of people is the, the books tend to be kind of more textbook. Like, so a lot of people find themselves. You know, in a position where they’re like, Hey, I see these movements. I’m not really sure how to execute them. And that’s when, you know, you should be taking that to your coach down at your gym, or, you [00:41:00] know, if they’re not familiar with it, you know, getting in and, and getting in to see, you know, a physical therapist or, or a chiropractor who’s, you know, into doing a lot of this physical medicine.

You want somebody who’s, you know focusing on sports injuries. Yeah, 

Mike Matthews: yeah. Let’s, let’s now, let’s, let’s now just, just segue into how to find a good doctor. 

Matt Fontaine: Yeah. So you know, the, the number one thing that’s mostly on here is really these injuries need to be treated with a tri prong approach. And what I mean by that is you need to have Somebody’s looking at joint issues, restricted joint movement, response to manipulation.

You also need to be looking at soft tissue. That encompasses everything from the muscle, the fascia, nerve entrapment. Nerve entrapments probably are responsible for about 80 percent of the symptoms that we see in clinic. Numbness and tingling, pain, restricted movement. And the third component to that is the corrective exercise.

So if we look at traditional therapy that people have gone to tend to be very pop heavy on exercise. [00:42:00] And within exercise, there’s a whole slew of how best to approach it. It should always be done in a progression, starting with, are we addressing mobility issues before we’re addressing stability issues, meaning Improving range of motion, which brings us back to the joint and the soft tissue issue.

So from a clinical standpoint, most people need to be having some clinical manual therapy. And if you’re not getting somebody to put their hands on you and actually fix these problems with your structure, all the stretching and activation and strengthening exercises in the world are going to be short sighted.

They’re just not going to have the effect today. I mean, I always tell people, if you’re baking a cake. We need eggs, flour, butter, you leave one or two of those out, that cake’s not coming out right. And it’s the same thing in physical medicine. So the basic paradigm of how do we treat these things needs to be that tri pronged approach.

You know, certainly nutrition comes into play as well but now we’re talking about really optimizing recovery and stuff like that. 

Right. You 

Matt Fontaine: know I think one of the best things that people could [00:43:00] do is to go on to activerelease. com and you can click on the find a provider link, plug in your zip code, and you can search for providers that way.

Mike Matthews: Yeah, yeah, and if you want to take a minute here just to talk about ART and just because it, it has, it’s, I’ve noticed improvements in my problem after I mean, I’ve, we, I’ve seen you five times now. Is it five or six times? Yeah. And, and after each one, it’s noticeably better. And after each, after each treatment, it’s the best that it has been, you know, since it started bothering me months ago where I can actually see like there’s light at the end of this tunnel or such.

I’m not just going to have a permanently aggravated bicep tendon. So it’s been pretty cool. I can attest to it personally. 

Matt Fontaine: Yeah. So, I mean, the basic. Principal with, with ART, it’s been around for over three decades. Like I said, we’re sponsored with Ironman Medical. So, you know, again, these people are investing the better part of a year to train for a race, you know, at the pro level for sure.

And definitely at the elite and amateur [00:44:00] level. So, you know, the, the treatment is highly effective when it comes to manual therapy treatment. I mean, really ART is the gold standard. There, there really is no substitute. It treats nerve entrapment. Essentially, what it does is it restores sliding to the tissues.

We talked about how the body gets glued down, you know, if you think about what really happens when I get on a foam roller, I mean, I’m really compressing the tissue, but I’m not able to create the sliding. And so that occurs during the AR treatment where You know, the, the active release doc is actually, he or she is putting their hands on the tissue, creating some tension where the two muscles are glued together, and then through a process of active motion, we’re able to create a lengthening.

So if that. Directly in an area where the nerve is entrapped, we can create some, some movement of that nerve so that it frees up motion. So, from a soft tissue standpoint, that really is, you know, your, your go to. There’s other treatments out there. Grafton is very effective where they use these [00:45:00] stainless steel instruments.

And there’s, there’s other companies that have come out with other. Materials to basically create this kind of scraping tool. There are a lot of areas in the body that works really well. Again, I would always default to, am I going to see an ART provider because they’re going to have kind of the most well rounded toolbox, in my opinion, for taking care of these soft tissue injuries, you know, and from there, obviously manipulation is a big thing.

And so most of your acid release docs that are full body certified, they’ve got to be put in. Two to three years minimum of postgraduate training, right? They tend to have most of their practice focused on heavily in, in sports medicine because again, just in keeping with the kind of injuries that we see.

And so that being said, most of these people are going to have a pretty active functional exercise component to their practice, meaning they can teach you. Proper mobility exercises, how to use a foam roller, everything from activating and strengthening exercises to, you know, a seamless transition and getting back in the gym and actually coaching up [00:46:00] some, you know, strength and conditioning exercises, i.

1. squatting, deadlifting, 

Mike Matthews: yeah. Yep. No, that’s good. So that’s like everyone listening. You can kind of go back over that and make a list of questions that you, that you’d want to ask any potential doc that you were thinking of seeing just to get a better idea of what are they trained in? How do they go about treating things?

How comprehensive you know, is their treatment? I also personally, I mean, I, I don’t know if you, if it’d be a thing for you, Matt, but I think it’s good to see if they work with any sort of professional athletes or high level elite athletes. I mean, I always, I was initially, I was just like, I’m going to start there.

I’m going to find someone that like, what do the, what do the pro athletes, who, who, who the type of people they see, and I’m just going to go see one of those guys. I mean, 

Matt Fontaine: you know, in all fairness, I’ve seen that work on both ends. I’ve had the privilege to know a lot of really great docs. 

Yeah. Yeah. 

Matt Fontaine: Over the last 16 years.

Yes. Some of them have been at that high level. And so, you know, if you’re at that high level, it really speaks [00:47:00] to, you know, a high level skill set because they just don’t keep guys around very long unless you’re getting results on the flip side. There is a certain amount of. Being in the right place at the right time.

I was pretty lucky being down in Florida. I had some good opportunity. That doesn’t necessarily happen for everybody. There are a ton of highly qualified docs out there that are just happy running, you know, they’re practicing are treating a lot of athletes, but, you know, maybe it’s at the collegiate high school and under, and then just, you know, active individuals.

So believe me, there are plenty of docs that I know personally that haven’t. Really had the opportunity to work with some of these pro level teams that are every bit as good as a lot of docs that are working with them. So there is some political stuff. Yeah, 

Mike Matthews: that goes without saying 

Matt Fontaine: for sure. But certainly somebody who’s really been down that walk, fairly sure that’s a pretty good vetting process to know that They have a pretty high skill set.

So, you know, those are kind of the big things that I would call them. And if you find somebody on an ART website, you know, their credentials because they [00:48:00] are, she polices that. And if they’re full body, as I said, you can, you can rest assured they’re probably been doing it for at least three years, if not longer, and there’s other credentials beyond the full body.

So the more icons after their name again, it’s just somebody who really. Putting in the time to, you know, build their craft and then, you know, you call the office. You can just ask them, you know, hey you do do manipulation. If they’re a chiropractor, yes, they do. And then ask them a little bit about, do you incorporate physical therapy 

into, 

Matt Fontaine: and then you can just ask what kind of patients they tend to see.

And don’t be afraid to ask specifically for your injury. You know, hey, do you, do you treat runner’s knee or plantar fasciitis? You know, sometimes you can get a lot of information off of their website, but not everybody has a very comprehensive website. So I would say be weary of going to a website that doesn’t have a lot of information.

If, 

Matt Fontaine: Things look good on the surface, you found them on the ART website, it’s worth a call to the office. Talk to the staff. Usually staff is very knowledgeable about what the docs treat. And it can go [00:49:00] from there. 

Mike Matthews: So now what about you specifically? So if we have any listeners that are in the greater Virginia, D.

C., you know, this whole area, where can people find you? You know, where’s your website? I know you mentioned that you are going to be working on like a big upgrade in terms of content and stuff. 

Matt Fontaine: Yeah. So We we’re located in Alexandria, Virginia, just outside of D. C. Northern Virginia, Washington, D. C.

Metro. So, our website is PotomacPhysicalMedicine. com. That’s going to be the same URL. We are in transition right now to we’re getting a new web layout. We have a blog site currently. It’s Prehab4Performance. So, it’s Prehab4Performance. The number for performance. com cool that’s going to be phased out and we’re going to actually have that just all encompassed with the Potomac physical medicine.

com website. So that’s really the best place to look at stuff. There’s a bunch of good content on there and I would say within the next month or two. The blog content will be on there as well. 

Mike Matthews: Cool. I mean I think [00:50:00] that covers everything. That was great. That was very comprehensive. A lot of practical information.

It’s good because it addresses just questions that I’ve, I’ll get via email and I’ll answer privately. So a lot of those types of discussions make for good public discussions as well. So now, you know, these people, Hey, here, here’s, here’s the answer. Check this out. So I’m sure that it’s going to be well received and you may be hearing from, from people.

Matt Fontaine: Yeah, absolutely. I’ll just throw my email out there. Anybody wants to contact me directly? They can reach me at drmatfontaine at gmail drmatfontaine at gmail. com. 

Mike Matthews: Okay, cool. And Fontaine is F O N T A I N E, right? 

Matt Fontaine: That’s correct. 

Mike Matthews: Okay. Awesome. Well, that was great, Matt. Thanks for taking the time. I really appreciate it.

And I appreciate you fixing my, my arm and my shoulder. 

Matt Fontaine: Anytime, man. I’m glad we were getting it done. 

Mike Matthews: Yeah. Thank you. 

Matt Fontaine: Really appreciate you having me on. It’s been fun. 

Mike Matthews: My pleasure. Hey, it’s Mike again. Hope you like the podcast. If you did go ahead and subscribe. I put out new episodes every week or two [00:51:00] where I talk about all kinds of things related to health and fitness and general wellness.

Also head over to my website at www. muscleforlife. com where you’ll find not only past episodes of the podcast, but you’ll also find a bunch of different articles that I’ve written. I release a new one almost every day. Actually, I release kind of like four to six new articles a week. And you can also find my books and everything else that I’m involved in over at muscle for life.

com. All right. Thanks again. Bye.