Speaker 1 (00:00:01):
Welcome everyone. This is Dr. Shirin Towfigh here for another episode of Hernia Talk Live our q and A every Tuesday. Many of you, you know me, I’m a hernia and laparoscopic surgery specialist. You can follow me on Twitter and Instagram at Hernia doc on Facebook. Many of you are joining us live at Dr. Towfigh, and at the end of this episode, we will make sure that you have full access to this and previous episodes. Today’s guest panelist is someone that I know very well. Her name is Marcy Jina. She is a functional movement specialist. I got to know her because I’m a surgeon and I need help with my movements because surgery really messes up your body a lot. And Marcy, it has been great. You can follow her at move with MJ on all different social media platforms, including Facebook, Instagram, and Twitter. So without further ado, hi Marcy.
Speaker 2 (00:00:59):
Speaker 1 (00:01:00):
Thanks for joining me.
Speaker 2 (00:01:02):
Yeah, thanks for having me.
Speaker 1 (00:01:05):
So full disclosure, Marcy has saved my life multiple times. Lots of prevention.
Speaker 2 (00:01:12):
Mean not your life, but your body.
Speaker 1 (00:01:15):
Definitely my body, my neck, my back, my shoulders. I come to her and I was like, oh, I did three cases yesterday, or it was a long day operating, and somehow she knows exactly what procedures I need to do at her kind of gym session thing, and she just fixes me. I don’t know how you do it, but I’m not the only surgeon that you treat. So
Speaker 2 (00:01:48):
That’s correct. Yes, I have experience with surgeons and the way that they move their bodies and the way their bodies need to move. It’s just like any other individual, an athlete, a painter, a tech person.
Speaker 1 (00:02:06):
So why are we always so injured
Speaker 2 (00:02:09):
Surgeons? Because you are standing over an operating table all day and you are giving 99% of your energy to other literal bodies.
Speaker 1 (00:02:21):
I know that’s true. Plus it’s not just like it’s laparoscopic surgery, it’s open surgery, it’s even robotic surgery sometimes can be a problem. So I feel like no matter what we do, there’s something that’s going to injur us.
Speaker 2 (00:02:39):
And I mean, that’s true with any walk of life. That’s not, but unfortunately that is not exclusive to you surgeons.
Speaker 1 (00:02:47):
So what other people do you see having so much occupational related nurses? Probably a lot of occupationally related injuries.
Speaker 2 (00:02:56):
Honestly. I see occupational related, I don’t want to say injuries, but I see developments in that habitual movement pattern in constant states in all of my clients and in my own body from just working with other bodies. So right now, my posture is not really, I know
Speaker 1 (00:03:16):
My posture too.
Speaker 2 (00:03:18):
I’m also looking at the computer screen, so I’m going to give myself this much.
Speaker 1 (00:03:22):
Do you feel like once I hit 40, it’s all downhill? Lyse?
Speaker 2 (00:03:26):
I haven’t hit 40 yet,
Speaker 1 (00:03:28):
But once 1 30, 40,
Speaker 2 (00:03:29):
But the closer I get, yeah, I feel like the whole, oh, when you hit 30, that was a lie. But the second 31 hit, it was like, wait.
Speaker 1 (00:03:37):
Speaker 2 (00:03:38):
Wasn’t. I agree. They just also gave you 30. They were a year early.
Speaker 1 (00:03:42):
Yeah. Yeah. I don’t know. I feel like the body, I used to be on call and doing 18, 20 hour works, no problem. My feet would hurt maybe, but it wasn’t neck or back or soreness or I could kind of bounce back the next day without a problem when I was younger. And man, now, I mean, thank God I have much better control over my schedule, but surgery is a very demanding on the body,
Speaker 2 (00:04:08):
And I think that’s true. Again, just with anything, as we’re younger and we have more energy, think about it as a battery. When you’re a new battery, you have all this juice and you can go, you can go and you can kind of recharge. But as the battery gets older, a car battery, right? So as the battery gets older in the car, eventually you’re going to have to change that battery. But luckily as living, breathing beings, we have ways to self recharge and to take care of ourselves. And that’s why it’s so important to make these good patterns and these good habits for ourselves so that they can integrate into your everyday life. So that I totally agree.
Speaker 1 (00:04:50):
I totally agree. So what I do for a living, and we’ve talked about patients before, and you always had such great insight on people that have hernias or diastasis recti or had surgery before and understand how to tailor their needs with different abdominal and core kind of instabilities or things that kind of destroy your core. And you understand anatomy really, really well, which is why I brought you on today because I feel that it’s great to talk about Mesh and non Mesh and all these to surgeons, but sometimes you just need to sit back and be like, okay, let’s be very proud.
Speaker 2 (00:05:35):
How do the civilians talk?
Speaker 1 (00:05:38):
How do civilians,
Speaker 2 (00:05:39):
I, so I grew up as a dancer, and so whenever I, not even so much dancer, non dancers anymore, but just mover, professional mover in some regard versus non-professional mover, I always refer to them as civilians. So for whatever it is, if it’s your area of expertise and your area of this, and then there’s the people that are unrelated. So they’re the civilians in my vocab. And I think what is really important is to, like you said, it’s different for every case because every individual is different. Every individual started somewhere else when they acquired this injury. And everybody’s injury has different levels of severity, so they’re going to also come out of the other side. So it’s not just a let’s,
Speaker 1 (00:06:36):
Yeah, let’s get some of that lingo out. We have a lot of questions that have been pre-submitted, so I’m really excited to get those answered. But let’s start with some core questions. What are core? What is the core and what do we mean when we talk about core exercises?
Speaker 2 (00:06:54):
So for me, I have extensive background in Pilates. And so core, for those who are familiar with Pilates, is a huge, and see, it’s probably the biggest focus in Pilates, and it’s your abdominal muscles, but it also includes your pelvic floor, it includes your back muscles, that whole central area that is holding the center of your body together.
Speaker 1 (00:07:27):
Yeah, your diaphragm,
Speaker 2 (00:07:28):
Your diaphragm, top bottom side to side. Yeah, right back.
Speaker 1 (00:07:33):
Yeah. When we draw the core on our notes, it’s like a picture of a hexagon. So the two Rives, the sides, the pelvic, and then,
Speaker 2 (00:07:44):
But then you got to turn it around because you got to take the 360 angle. You can’t just do the right front on.
Speaker 1 (00:07:52):
And then let’s talk about Pilates, because I love Pilates. I don’t like yoga, and I feel like when I try to do yoga that was a bit more higher level than I should’ve, I got injured. So I don’t like yoga, but there are tons of people that like yoga. So what’s the difference from a core standpoint, if for someone who has a hernia or may have a hernia or has had surgery, how should they look at yoga and Pilates differently?
Speaker 2 (00:08:19):
So I want to disclaimer these next comments with, I am completely biased again, because I come from a very heavy Pilates background. I practiced yoga for several years. I had several in instructors that I loved and that I followed their practice. For me, it is a physical practice, but for me, I got more out of the mental part of it. And I think that there are definitely benefits to both. What I noticed when I was practicing is that it was very upper body dominant, and I think that comes from the fact that yoga was originally designed and created for the monks that were men. And men tend to carry their strength in their upper body. Women, we carry, women carry our strength in our lower body. So I think that that’s why I was messing up my shoulders, feeling it in my neck, getting a lot of strain on my wrist.
Speaker 2 (00:09:24):
And I think too, again, in the original creation of yoga, it, it’s a physical practice, but there is a lot of focus on that mental and that mind body connection. So it’s not necessarily geared towards getting you to focus on muscle groups, which isn’t how I necessarily train either. But I think that a lot of times when people aren’t being mindful, they might not protect themselves or give that proper relationship or that attention to the parts of their body that needs it. And so then injuries, and this could totally work in the reverse too. It can work if somebody that is doing a similar thing for Pilates or weightlifting or running, it just takes one moment of mind, mindlessness and just injury happens.
Speaker 1 (00:10:24):
And you’re also an expert in Gyrotonic. That’s a very specific trademarked kind of fitness instruction. Can you explain what Gyrotonic is?
Speaker 2 (00:10:35):
So gyro that it’s such a loaded question. I mean, it’s like everything else. So yes, I’m a Gyrotonic pre-train, also a gyro Kinesis trainer. So if you are familiar with Pilates, Pilates machines have the reformers, the Cadillac, all those, that’s sort of what Gyrotonic would be. It has machine applications, and then gyro kenesis would be the matte stool version. So you don’t necessarily need, you
Speaker 1 (00:11:02):
Speaker 2 (00:11:02):
At home the equipment, but not to say that you need equipment to do Gyrotonic either. I mean, there are ways to adapt around it, but the equipment is what is giving you that support and that accessibility. But it is a modality that tries to focus on connecting your skeletal body, your muscular body, and your nervous system altogether. Yeah. So very, for me, in my opinion, it’s a very complete system. And it also is, it’s completely about movement. It’s not about a position, it’s not about an engagement of one muscle. It’s about the relationships that happen in your body. Because I could lift my arm, but that’s not just my hand, that’s not just my elbow. And then it’s not just the muscles, it’s the bones, the brain telling my arm to lift it. So it gets very in depth, but also there’s like everything else, there’s a way to break it down or to translate it for someone else that needs to hear it differently. So
Speaker 1 (00:12:15):
Yeah, you’ve worked with me on the Gyrotonic machine and I love it. I think without stressing you out, it forces you to stretch your shoulder girdle in a way that I don’t think you can really do anywhere else.
Speaker 2 (00:12:30):
Yeah, that’s my biggest thing with it is I feel like with my shoulder specifically, it’s helped me rediscover the relationship and the functionality of my shoulder girdle and also just my entire spine. It creates elongation and space in the body where a lot of our times, our bodies want to be like this because we all live very stressful life. But it reminds you that you are a living, breathing, being, and so your body needs to live and breathe and expand and move.
Speaker 1 (00:13:04):
It seems to me like it’s kind of undoing the reverse of everything else. We tend to hunch over. We tend to kind of cal forward and it does elongate and stretch and move your body in ways it, it’s not normal to do during a normal like workday.
Speaker 2 (00:13:23):
So the picture that was always painted for me that I really like with Gyrotonic is Julia, the creator, very much still alive, very fortunate to still have him here creating and feeding us information as trainers, but he pictures the spine as the support system for your entire body, which it completely is. It’s your shock absorber, all these things. But when your spine isn’t healthy alignment and functionality, it’s moving. Then everything else can, if it’s like a coat hanger, all the coats can hang on it and all the coats can reach off of it. It’s That’s true. The base of the tree, the, it’s the trunk, everything can reach out. So
Speaker 1 (00:14:05):
We have tons of live questions, so I’m really excited about it.
Speaker 2 (00:14:08):
Oh, we do.
Speaker 1 (00:14:08):
They’re very specific questions. So if you can help expand on it. So the first question is, I had inguinal surgery with Mesh five months ago and have recently started doing planks for core workouts. But I’m afraid to do crunches or leg lifts, should I worry about doing any specific core exercises?
Speaker 2 (00:14:29):
So again, in a very general sense, it have to listen to your body not there. I’m sure there’s a generalized time that your PT will give you, you wait this long to do this, you wait this long to do that. And I don’t want to give these five months
Speaker 1 (00:14:47):
Is fine. Yeah, five months after surgery, al surgery.
Speaker 2 (00:14:50):
But if you’re at five months and you don’t feel like you’re there yet, yeah, I definitely wouldn’t push it. I would err on the side of caution because you had something surgically sewn back together. So yeah, you’ve got to give, even though that is the typical, you’ve got to give your body enough time to do what it needs to do and understand that your body isn’t the same as a B or C’S body. But then at the same time, you need to be in enough connection with your body to know that the difference between that fear and actual safety because, well, you don’t want to baby things. You want to try
Speaker 1 (00:15:35):
A plank. Planks are pretty good, is there’s
Speaker 2 (00:15:39):
My favorite. Yourself.
Speaker 1 (00:15:41):
Planks are great and they’re different ways of doing them. Is there any way to injure someone? Can someone injure themselves doing a plank?
Speaker 2 (00:15:48):
Oh, you can injure yourself doing anything. Oh my god. But yeah, I would definitely start with modifications. Start with elbow. Yeah, start with Quadra pad. Start with quadrat. Just you’re on hands and knees and you just engage your transfers. No, no, no, no. Not even on your elbows yet. Find the stability in your back to wrap around and support your ribcage. And then use that support to engage your core. Keep your back nice and long. Keep your head in line with your spine. Yes, the second your head drops down, everything’s curving over. You’ve already put yourself into a state of fluxion. Even if it’s minuscule, you want to get all that out.
Speaker 1 (00:16:32):
So head needs to be in line with the spine,
Speaker 2 (00:16:34):
Head in line with the spine. That is the most common correction that I give. And I teach planks every day to almost every client and in every class. Cause it is my favorite exercise. And
Speaker 1 (00:16:47):
The shoulders need to be relaxed. People do
Speaker 2 (00:16:49):
Lot of this, I wouldn’t say relaxed, because you want your shoulders to engage down. You want your scapulas to draw down. Basically, plank is a full body exercise. Your entire body should be engaged, your back should be working. Your neck should be long, your neck can be relaxed, but there’s still the back of your neck has those extensor muscles that need to be engaged to keep your head in line. And if it’s too much having gravity with you on the floor and quadro pad, then you start with wall sits and you just pull into the wall.
Speaker 1 (00:17:23):
Okay. And then no going, saying on the plank, someone else wrote that I was planking for physical therapy when I felt the worst hernia pain and that I had bilateral angle hernia, Mesh, I’m so nervous to do any core following Mesh and Mesh removal. Now, even though I’m a mover, how do I start back? So I think place, so are place good. If you have a diastasis, does that involve the transverses?
Speaker 2 (00:17:54):
Yes. I mean, everything has to involve your transverse, because your transverse is for a lack of a better description, your corset or your girdle, and it’s going to hold everything together. So when you have the diastasis, if these are your two sides of your abdominal wall and it’s splitting like this, if your transverse is engaged, it’s going to pull it back together. And then, let’s see, I have a pen here. So if you have a hernia and it’s pushing through somewhere, if your transverse is connecting together, it’s going to pull it back and try to hold it in place. So
Speaker 1 (00:18:24):
Yeah, we’re going to talk about the transverses a lot today because that’s the key to safety for all hernia. Anything. What about crunches and leg lifts? Tell me about sit-ups. 5 million different ways of doing sit-ups.
Speaker 2 (00:18:42):
I mean, well there, there’s one true way to do a real thing.
Speaker 1 (00:18:46):
I need to hear this.
Speaker 2 (00:18:48):
A lot of creative variations that people will come up with to cheat around actually activating their abdominals. Wow. I think if you’re dealing with an abdominal injury, I would X the crunching because again, that forward flexion is going to put that pressure down. And when you put, I wish I had better props for this, I’m like, you’ll use this little cord, so if you put that pressure down this way, this is going to want to pop up. So if this is your head and it’s coming forward, this is going to want to pop up and we want to keep this really flat, which is the goal. It would be that you keep this flat as you’re had up and around. But again, until you can get that connection with your transverse and that feeling of holding in, it’ll, it’ll be really challenging. So I would do diaphragmatic breathing where you’re laying on the floor and you’re just letting your ribcage expand and then engaging it back together. I would do, like I said, just quadriped. And then, because once you have it on the floor and gravity’s helping push it down for you, then you work against gravity and you flip yourself onto all fours and you keep your Rives and your abs pulled up. And then again, I’m just a really big, let’s play with the effective gravity because we’re not always in one
Speaker 1 (00:20:13):
Position, less injury.
Speaker 2 (00:20:15):
So if you want to sit on a ball against a wall, let everything relax and then pull it all up and together and try to engage.
Speaker 1 (00:20:21):
Okay, can you talk about this transverse abdominus? Because even for sit up, some people think it’s all about the rectus and also the guys love having that six pack, but really
Speaker 2 (00:20:31):
All of the sits they’re going to do is give you a six pack. But have you ever seen those people walking down the beach and they’ve got the six pack, but it’s hanging out. It’s not, they don’t have that nice flat.
Speaker 1 (00:20:44):
Yeah, it’s not a flat.
Speaker 2 (00:20:46):
And I’m not one for doing things to make you look a certain way. I understand people have their own reasons for why they want to work out, but I’m all about functional, healthy movement and bodies. Yes. So when I see that, I just see zero engagement in their core. They just, all they do is sit ups and reverse crunches. Those Roman chair lifts. And so they’ve worked their rectus, which your rectus, do you have a picture of the rectus Sean? We should have talked about pictures.
Speaker 1 (00:21:14):
I’ll bring a picture while you do that. Sure.
Speaker 2 (00:21:16):
Yeah. So basically your transverse is the girdle, and then your rectus sits right in front of here, and that’s where your six pack is. So all you’re doing is crunching your rectus, but you’re transverse is just pushing out, pushing out, pushing out. So from the side, you’re just getting more and more lax. So until you can keep this engagement, this isn’t all your rectus does is pull your body forward. It doesn’t, doesn’t provide support. It. Yeah, we got
Speaker 1 (00:21:43):
To let go
Speaker 2 (00:21:44):
The rectus yourself up. It’s not that it’s not important, it’s just that I would say that it is minuscule important in comparison to how important your transverse is. Aha,
Speaker 1 (00:21:57):
Rectus. So rectus is what’s in red right here. It’s, it’s your six pack. And people love it. They’re actually surgeons that carve out on rectus with liposuction.
Speaker 2 (00:22:07):
Oh my gosh.
Speaker 1 (00:22:08):
Looks like you have a six-pack or whatever. It’s pretty cool, actually. I’ve seen
Speaker 2 (00:22:11):
It dog a spray hand then don’t be carving out.
Speaker 1 (00:22:14):
But if you look deeper, are there other muscles And deep to the rectus muscle is this muscle that you were talking about. We call it the inner girdle. It’s the only muscle that grabs around a hundred percent all the way around. Whereas
Speaker 2 (00:22:30):
Electric, that’s fine around the front.
Speaker 1 (00:22:32):
Yes. So when you tighten that, that’s what flattens out your belly.
Speaker 2 (00:22:36):
Correct? Right. And yes. And in more importantly, yeah, like yes, it’ll give you that flatter stomach, but more importantly, it will hold everything in. You will be supported. You will have, if your transverse is strong and connected, you will have less back pain. You will have less, probably less lower leg tightness because you have less tightness in your lower back. And you have that abdominal strength. Your legs can move freer underneath you. Your shoulders can connect down better because they’re not lifting everything up. It’s the center of your body, literally.
Speaker 1 (00:23:09):
Yeah, this is an ugly picture, but no one loves to have a beautiful transverses because it doesn’t look good. It’s just like round muscle. But once you tighten that, it sucks everything in and gives you this flatter abdomen on the inside. So on that note, I have no idea how to do a transverses of dominus engagement, but to do a right, correct. Planks or leg lifts or correct crunches. If you focus not so much on the rectus, but on the transverses of dominus, then you shouldn’t any pain. In fact, I’ll tell you this. So I’ve quoted this study before, medical students were studied as normal patients to see if they do certain exercises. How will that affect abdominal pressure, assuming that increases in abdominal pressure are bad for hernias and crunches were considered totally fine. And everyone’s like, how is that possible crunch my belly pooches out? Like, well, you’re doing incorrectly. When you do a crunch, your belly should be engaged and go inward because that’s a transverse is pulling in.
Speaker 2 (00:24:19):
Yes, a hundred percent.
Speaker 1 (00:24:20):
Do you have any tricks on how to engage a transverse?
Speaker 2 (00:24:29):
Lemme see. Give me one second. I’m going to scoot back and try to grab the actual prop,
Speaker 1 (00:24:36):
Because I’ve learned that it’s very difficult and most people don’t really think that much about it. And so they work on their six back instead. Okay.
Speaker 2 (00:24:47):
So I have a TheraBand here. If you don’t have a TheraBand, you can use a scarf, you can use a towel, you can use a yoga strap, you can use a tie. You just need something long because we’re not going to push hard here. But you wrap it around your rib cage and then you would just breathe in and you want to kind of push out to the sides. And then as you exhale, pull your abs in and let this gently squeeze. So you should be able to tighten on the TheraBand.
Speaker 1 (00:25:18):
Are you on your Rives or you’re below your Rives?
Speaker 2 (00:25:21):
You start on your Rives and then you would work your way down depending on how wide you can get it. But what you don’t want to do, angle this down a little bit. What you don’t want to do is you don’t want to just squeeze the band, because that’s not going to do anything. You want to just keep the band engaged and then pull away from it,
Speaker 1 (00:25:42):
Pull your belly towards your back,
Speaker 2 (00:25:44):
Pull your belly towards your back. Even think about pulling your back towards your belly. So you’re literally engaging on all sides besides all pulling in. So if your Rives are kind of like a birdcage, you’re pulling the contents of the birdcage away from the actual steel frame,
Speaker 1 (00:26:01):
Which the metal frame, which would be able to make, tighten that scarf for TheraBand,
Speaker 2 (00:26:06):
Right? Yeah. And so you should be able to tighten it, but you don’t want to just squeeze it. Yeah. Because again, it’s not an external effort. It’s an internal effort. Okay. So it’s about pulling away from the band.
Speaker 1 (00:26:19):
Have you heard of the top technique we talk
Speaker 2 (00:26:23):
About top? No, it sounds familiar.
Speaker 1 (00:26:26):
Butler I didn’t talk to you about. I believe she’s a nurse. So her career is purely based on diastasis recti reversal prevention and treatment in women. She has a whole tupler technique, which she’s trademarked and she has books and videos.
Speaker 2 (00:26:45):
I’ve definitely, I’ve heard of this. I’m not super familiar with it, but I’ve absolutely heard of this. Yes.
Speaker 1 (00:26:51):
So a lot of what she does is transverse abdominal engagement as well as binding and taping. So the goal is to reverse diastasis recti. I believe she recently has presented her data that actually works because there’s very little that truly works to reverse diastasis without a tummy tucker surgery
Speaker 2 (00:27:17):
To physically sew it back together
Speaker 1 (00:27:19):
Physically, the rectus muscles back together again. But I do believe, I think if you initiate early after a pregnancy, it’s a better option. Let me ask you another question. Also live. What are some specific exercises that are beneficial for lower back pain and tightness is, I think Pilates is great, honestly, because it strengthens the corn and that tends to reduce.
Speaker 2 (00:27:49):
Speaker 1 (00:27:50):
Speaker 2 (00:27:52):
Yeah, the plus, that’s such a loaded question because there are so many things that could make your lower back feel better.
Speaker 2 (00:28:02):
And I think the biggest thing, first of all, is you have to find a modality that you resonate with. So for me, it’s Pilates and Gyrotonic and functional movement training. But for a lot of people, I, I’ve had people try Pilates and they hate it. And I’ve had people try and they hate it. And it’s not my job to make you love a modality. It’s my job to give you as much information as I can. But if you don’t like what you’re doing, first of all, you’re not going to stick with it long enough to see a result from it.
Speaker 1 (00:28:41):
Speaker 2 (00:28:42):
You’re just not. And second of all, not going to, even if you did force yourself to stick to it, you probably won’t connect with the work. If not, you hear me. No. If you’re not connecting with it, you’re not going to receive the information that the work is trying to give to you. Yeah.
Speaker 1 (00:29:08):
So what do you think of these belts when you go to Home Depot? People are wearing belts the best. Does that work?
Speaker 2 (00:29:15):
The back support brace?
Speaker 1 (00:29:16):
Speaker 2 (00:29:18):
So have, first of all, again, I think this is not a one size fits all question. I think that they are great for adding support. They do not do the job for you. So those workers at Home Depot or on a construction side or around your house, if you’re wearing it, wearing this back brace or this lumbar support, it’s great. And it’s wonderful. It’s going to give you that extra reminder.
Speaker 1 (00:29:52):
And yeah, it’s
Speaker 2 (00:29:53):
More of a reminder feedback, but it’s not going to do the job for you. You still need to engage in your core muscles. You still need to make sure you’re lifting with your legs. You still need to do all the work. Still, there is no quick fix for these things.
Speaker 1 (00:30:09):
And then can we discuss weightlifting also? Is weightlifting considered core workout?
Speaker 2 (00:30:17):
I mean, yeah, you can absolutely do core workouts with weights. Again, like I said, if weightlifting is something that resonates you, I think it’s all about finding functional movement patterns and building up strength in complimentary and oppositional form. So you’re not like, you wouldn’t just do bicep curls and never do tricep curls. That’s like the most basic way I can explain it. Don’t just do leg presses and never do hamstring curls. So for your core, don’t just do crunches and never do planks. Don’t just don’t. Just do the reverse lift, but never do anything for your obliques or the rotation. You have to do all the things. You don’t want to be guy at the gym that has the giant upper body and the skinny, skinny legs. And first of all, that doesn’t look
Speaker 1 (00:31:22):
That so for a
Speaker 2 (00:31:23):
While, but functionally, that man could fall over and he’s building. And also when you build those kinds of imbalance, this is going on another topic, but when you build those kinds of imbalances in your body, your fascia gets all messed up. And you could actually create bigger problems for yourself.
Speaker 1 (00:31:40):
I see tears.
Speaker 2 (00:31:41):
Yeah. Yeah, exactly.
Speaker 1 (00:31:44):
Speaker 2 (00:31:44):
And pulmonary stuff can build up It. Just be balanced guys. Whatever it’s be doing, do things that are balanced.
Speaker 1 (00:31:52):
I had a patient, there’s like this new fad now where you wear these wetsuit type outfits that have these electrodes and you crank it up.
Speaker 2 (00:32:01):
Oh yes, I’ve seen these. What’s
Speaker 1 (00:32:03):
That called? I
Speaker 2 (00:32:04):
Don’t even know. I don’t know. I’ve seen it on Instagram and stuff. Cause
Speaker 1 (00:32:10):
It contracts your muscle. I dunno. A thousand
Speaker 2 (00:32:13):
Speaker 1 (00:32:13):
Yeah, for you.
Speaker 2 (00:32:15):
But again, I have a great example for this. Yes. So I have a client on this. I, I’ve never used these electrode things because I’m always trying to get my clients too self engaged. Yes. I don’t want somebody, I don’t give them a shortcut, but I am a big fan of the vibration plates.
Speaker 2 (00:32:35):
And I have clients that have them. And I have one client that loves it much, and they always want to use it. And I tell them, you cannot use this every time because you need to be able to find these connections and these workings in your body without it. So it’s like, you know, don’t just do the same thing every day. You know, can’t live on, I mean, I’m half Mexican. I wish I could live on rice and beans and that’s it, but I have to eat some vegetables. I have to eat some chicken or some protein, whatever it is for variety is the spice of life. And it’s also what keeps diversity, keeps everything running. And that works in your body too. You ever want your muscles to get to the point where they’re just habitually working because they’ll stop engaging. I can do this with my arm and I’m not doing anything to my bicep, even though technically my bicep is working to bed my elbow, but if I squeeze my bicep, that’s a different thing. So I can’t just do my bicep this way. I have to sometimes do pushups. I have to sometimes find other ways to engage it. So
Speaker 1 (00:33:48):
He was doing this and then he got sharpen and a hernia, whatever. So he had a hernia. This is the thing, he had a hernia. It had nothing to
Speaker 2 (00:33:56):
Do with trainer.
Speaker 1 (00:33:57):
He didn’t know that he had a hernia and that. Oh,
Speaker 2 (00:34:00):
Speaker 1 (00:34:01):
But I think all that contraction in the belly area really pinched the hernia more and made it more inflamed. But when I operated on him, he had all these little micro tears in the fascia. And sometimes I wonder if contracting your muscle a thousand times a minute is not good because you can get little micro injuries of be,
Speaker 2 (00:34:25):
I think if you were to do it occasionally, because that’s essentially what lifting and all of these strength training type things do. Making little tear so your muscle can rebuild. But when you’re doing that, again, if that’s your habitual state is to breakdown, breakdown, breakdown. This is why recovery days are so important for people that strength train. Oh, okay. You have to give your body that time to recover.
Speaker 1 (00:34:49):
Speaker 2 (00:34:50):
Otherwise you’re just always breaking down.
Speaker 1 (00:34:53):
Yeah. Yeah. There was a moment, as you know that I was a member of Golds Jam. For those of you who may not know
Speaker 2 (00:35:00):
Speaker 1 (00:35:01):
If the Mecca, it’s, it’s where Arnold Schwar, it’s owned by Arnold Schwarzenegger, muscle
Speaker 2 (00:35:07):
Speaker 1 (00:35:08):
You got Venice Beach in California that has Muscle Beach. What is affiliated with, it’s the beach version of Gold’s Gym. And I’m the only normal person there. Everyone else is super buff and hyper muscled out. But my trainer is one of those guy, he’s a very well known in the field and he shows me and he see what these guys are doing. These men they love, they’re big chests. So they do all this chest workout and then they end up being this hunched over look.
Speaker 2 (00:35:44):
Yeah. They physically, they don’t have the accessibility in their back to pull their shoulders. Exactly. It’s frightening. Yes. Because then you are also pushing your spine forward. Yes. And if my spine is here, if my head weighs eight to 12 pounds, yes. Think about how much pressure I’m putting in front of my spinal cord. I’m just Yes.
Speaker 1 (00:36:03):
Speaker 2 (00:36:04):
Yeah. You need a disc all over your neck, man. Yeah,
Speaker 1 (00:36:07):
Absolutely. Absolutely. Okay, let’s do some more questions. Actually, one person’s asking you, do you zoom with patients?
Speaker 2 (00:36:14):
I do. I have some little patients. I’m not a doctor. I have clients with your clients. All my doctor clients and surgeon clients, they all ask me about my patients. I’m like, I don’t have patients. Yes, I do have clients that I do zoom sessions. I do in-person sessions. It’s with proper covid compliant.
Speaker 1 (00:36:36):
Speaker 2 (00:36:37):
Obviously. But yeah, I do zoom at
Speaker 1 (00:36:40):
Move with mj. It’s the best during covid. I was on your website because you had a great website for all these different things you can do at home. You can do Pilates at home. I didn’t know you can do that.
Speaker 2 (00:36:51):
And you don’t need equipment. I have Gyro K classes on there. And granted all of my current on demand stuff is for generalized population. But if that’s something people were interested in, I could make on demand things for specific case for scenarios.
Speaker 1 (00:37:11):
We should do a hernia one
Speaker 2 (00:37:12):
Together. I could do a hernia one
Speaker 1 (00:37:15):
And a diastasis one separate.
Speaker 2 (00:37:17):
Could, yeah, we could definitely do. I mean, I would love that. They’d be very similar. I feel like we could just make it, we could probably do three and it’s just a little series for people.
Speaker 1 (00:37:26):
Yeah. So at move with mj. Yes. Or move with mj.com.
Speaker 2 (00:37:33):
It’s all on there. Yeah, let’s go there.
Speaker 1 (00:37:36):
Okay. Question. My core got weak from surgery and I have constant lower back pain, which is in conduction with the abdominal wall pressure. What is the treatment for pain that comes from the core back pain and abdominal wall tension? It hurts with application of pressure and laying down hurts. Okay. So let’s say you have someone who’s ill or has a lot of a big hernia or core problem. Obviously they’re not going to be doing any extreme exercises, but is
Speaker 2 (00:38:05):
Structure, functional movement comes in all forms, it. So what’s the word? Minuscule and irrelevant. But the tiniest little movements can make such a huge difference if you’re do versus doing nothing and absolutely nothing. I’m a big believer in stagnation is death. I think once you stop moving, you’re slowly dialing. So whether it be like your muff die, if you don’t use it, you lose it. That’s a real thing. So look at all professional athletes. If they don’t continue to train, they’re not going to stay at their competitive levels. And that goes for everything. That goes for your brain, that goes for,
Speaker 1 (00:39:01):
Okay. Well that’s a really good transition to this other question which I had, which I hope that you can help answer, which is, how do you find the right instructor? You don’t want some guys straight out of high school that calls himself a trainer. Right. How do you find the right fitness instructor? Are there certain things they should be doing or certain well, training or years or affiliations? Is there a society?
Speaker 2 (00:39:34):
So again, this is not, there is no universal answer to this because we were all first day trainers at some point. I think again, you need to find someone that you are resonating with, whether it be their style, whether it be the way that they communicate their information. Because if you don’t like your trainer, you’re not going to Oh yeah. Go back. Yeah. I mean, unless you’re just a total masochist and
Speaker 1 (00:40:11):
No, I dunno. My first trainer, I got straight out of a gym, I think it was 24 fitness. And
Speaker 2 (00:40:18):
Then with listen
Speaker 1 (00:40:19):
To this guy, I feel like I’m listening to someone that has no clue what he is talking about. Why am I listening to him?
Speaker 2 (00:40:27):
And then I’ll come back to that. But the other blanket statement I want to make is, if you are coming at this from a post-op situation, you don’t want that first day person.
Speaker 1 (00:40:41):
Speaker 2 (00:40:41):
You know, want someone with experience and knowledge, or at least a very, very, not at least, but at minimum a very, very credited certification behind them. So I don’t want to say because it, it’s not that you need to be the longest-standing trainer to be a good trainer, watched people be excellent trainers right off the bat, because everybody comes from a different background. Like I said, I was a dancer. I have friends that were triathletes, I have colleagues that were professional college players or doctors or lawyers and everybody has something to bring. But if you’re looking just, so first of all, if you’re coming from a post-op, try to get somebody that has experience with what you’re working with because that will make you comfortable. That will. And not to say if they don’t have experience that you can’t work with them. Because again, everybody’s got to start someone.
Speaker 1 (00:41:48):
But I, maybe that’s why so many get physical therapy sessions because there is some kind of formalized standard that physical therapists follow. But I had to go to physical therapy and I thought my physical therapist was great, but I got much more out of you. But I’m lucky I have someone like you available to do that. I think there are people out there that can replace a physical therapist that’ll kind of integrate.
Speaker 2 (00:42:20):
Well, a good trainer will take what you, so if you’re going to physical therapy, cause you should go to physical therapy, you should do the exercises that are given to you and all those things. But you should also, either with the physical therapy or after the physical therapy, you should continue your investment in your health and your movement because your body is the only one you have. But you should take that information to your trainer and that a good trainer will take the information that you’re giving them and they will incorporate it and they will integrate it into what they’re giving you back.
Speaker 1 (00:42:59):
Yeah, I totally agree. So for this patient, I would say number one, be active. And number two, find someone that can help you show you how you can be active safely. Because when you’re in pain, you really need someone to understands what’s what is inappropriate pain. And then go very slowly
Speaker 2 (00:43:21):
And communicate with that person as much as you are comfortable with. Obviously you know, don’t have to overshare things that you don’t feel are appropriate. And some trainers don’t want to know too much information, but as far as your physical state, you need to give them as much as you can so that they can come back to you with that information giving you appropriate choices for your workout and your sessions.
Speaker 1 (00:43:50):
Next question’s a little bit surgical, but you may be able to help too. Answer part of it. After Mesh implant and removal, I got this painful depression kind of scooped out area on my rectus abdominus area and it’s sensitive and always hurts. Is this fibrosis, what is the likely cause of this? It’s a nagging ache and then does not improve. Did not improve with Mesh removal. How could I treat this and who do I see for this? So Mesh removal of the abdominal wall usually is not caused nerve pain. So I can’t say it’s nerve related, but it does take away a little bit of tissue. You may have a repair that involves the fascia. The fascia may be tearing depending on how sutures are placed, that can be tearing through the areas. But a lot of these questions like this one and the one before, if you lose weight, you take a much more tension off the abdominal wall. If you learn how to engage your core. Marcy was explaining that also takes tension off your hernia repair and the abdominal core. And so those are all two things you can work on to help reduce that. And then maybe we can talk about scars as well. What do you think, Marcy?
Speaker 2 (00:45:06):
I mean, that sounds very surgical. I don’t like to pretend to know things that I don’t know. Yeah.
Speaker 1 (00:45:14):
Who do for scars? Do you have people that have painful scars that you roll it out or something like you roll out stuff?
Speaker 2 (00:45:22):
Yeah. Well, because again, this is kind of a surgical thing, but in my experience, my personal experience with scars and my experience with my clients with scars, the scarring and the scar tissue under it, if you can break up that fascial hardness, it tends to relieve some of the pain. But again, I don’t want to say as a generalized thing that that’s okay to do because you’re saying, what if there’s a nerve thing? What if there’s a suture that’s still in there? I don’t want to make generalizations, but I mean, I think that it’s important to break up the lactic acid that builds up in your body
Speaker 1 (00:46:09):
And massaging out scars has been shown to make you take some of the inflammation away and also encourages more remodeling of the scar and increases blood flow to the area to help remodel the scar.
Speaker 2 (00:46:25):
Right. Well cause blood flow to the area generally in terms of rejuvenation is ideal, right? That’s your blood flow is what provides the body with the things it needs to rebuild. So
Speaker 1 (00:46:37):
Yes. Yeah, exactly. Let’s talk about gluteal bridges or a pelvic bridge. Sure. I believe I tore my hernia parent doing a gluteal bridge. What muscles are being loaded and how can I injure myself with the bridge? What is a gluteal bridge? It’s become a very fad thing lately I feel.
Speaker 2 (00:46:57):
Okay, so bridging is a hip hinge and I mean
Speaker 1 (00:47:03):
Speaker 2 (00:47:03):
Speaker 2 (00:47:04):
Hip hinge, when you engage your glutes and you hinge up from your hips, you extend at your hip. Okay, you do these, you do these. I like it. Yeah, no, I dunno why I do. It’s important because glut, you do it, you do them. Glute strength is really important because a lot of times when you don’t engage your glutes and you’re just thrusting your bones up, you’re your two a ssis S up to the ceiling, you’re going to extend through your abdominal. You’re going to not engage through your transverse. Everything’s going to spill out through the top. Your Rives are going to slay open and you’re going to cause pressure and you’re going to cause. So I feel like that’s my best guess as to maybe how they tore their hernia repair.
Speaker 1 (00:47:53):
I think. So I have a
Speaker 2 (00:47:54):
Patient without having seen them do the exercise and knowing where their injury was and things like that, I can’t,
Speaker 1 (00:48:01):
Speaker 2 (00:48:02):
Speaker 1 (00:48:03):
The gluteal bridge is, as a term mentioned, it’s a gluteal contraction.
Speaker 2 (00:48:08):
So you would engage your glutes, the knee, mens to lift up your hips so your glutes would squeeze, your butt would lift, your hips would go up. So you would extend through the front of your hips and ideally you would keep your transverse and your abdominals engaged so that you would be, for me, I like to do my bridging it straight line knee through the hip to the shoulder because then I know that everything is extending, elongating, engaging, there’s room for everything. I know that in a lot of yoga practice, they like to arch their back, which is not that, that’s something else, but especially from a post-op kind of rehabilitative standpoint, I would really keep that nice and level.
Speaker 1 (00:49:09):
And some people put a weight over their,
Speaker 2 (00:49:13):
On their hips. So I mean, again, if you’re coming right out of op, I wouldn’t do that. As your glutes get stronger, you can put a weight on the front of your hips to to increase the load for your glutes. But a lot of times people do that before they’ve even learned how to engage their glutes. So until you’re really feeling it and firing in your glutes and also in your hamstrings, in the backside of your thighs, all of your entire posterior chain needs to engage before you can add any kind of load to the front.
Speaker 1 (00:49:48):
So I had a young female who did that. She’s very fit, almost like a bodybuilder type, but not the slim bodybuilder. She’s thick
Speaker 2 (00:50:00):
An Olympic bodybuilder
Speaker 1 (00:50:03):
Then, but she’s short. So then she was putting heavy weights over her hip. And I think a lot of people, they do these pelvic bridges with lifts, with the weights. It’s not a glu, they don’t do the gluteal activation. It’s all at the,
Speaker 2 (00:50:22):
They’re just throwing their back out is what they’re doing. It’s very scary. I generally can’t watch most people just at the gym, not necessarily working with any, but just these people on their, I try to have tunnel vision if I’m going into the gym because I can’t fix everybody. And also
Speaker 1 (00:50:41):
They let their back arch down and then they pull the weight up then so she actually tore, she had a sports injury. She had a sports hernia. So it’s because you try and overcorrect
Speaker 2 (00:50:52):
And then it’ll
Speaker 1 (00:50:54):
Tearing or your adductor off of the bone and doing so because you’re overcorrecting instead of remaining in line with your spine, you’re kind of doing beyond. So yeah, there’s a term called gluteal amnesia. I don’t know if you’ve heard of that. I may have talked to you about it.
Speaker 2 (00:51:13):
Gluteal amnesia. This sounds familiar.
Speaker 1 (00:51:14):
Yeah, it’s pretty interesting. It’s like an old idea, but people forget that they have a butt and so they end up, for example, they’ll go hiking or up a hill and they’re using
Speaker 2 (00:51:25):
Their knees. Oh yes. And then their knees. Yeah, a hundred percent. You have to, when you’re hiking uphill, you have got to squeeze your butt and push from the back of your leg. Yes. When you are riding a bike, you have got to pull up from the back of your leg. Yes. You cannot just push down, down, down. You will wear up all of your joints, wear out your knee, your ankle, and you’ll mess up your hip.
Speaker 1 (00:51:48):
So everyone out there, I’m going to give you this task when you’re going, you’re at your house or wherever you’re at when you’re going up the stairs, don’t use your knees to go up the stairs. Use your buttock muscle to engage, to pull you up the stairs. It’s a huge difference.
Speaker 2 (00:52:06):
Speaker 1 (00:52:07):
Yeah. Okay. I just want to bring that up because I love that word gluteal and me.
Speaker 2 (00:52:12):
Yeah, that’s fun.
Speaker 1 (00:52:14):
Yeah. Okay, next question. Okay. Well I guess it’s kind of at the core of what we’re discussing, which is decor, fitness exercises decrease hernia formation. That’s why we’re here, right?
Speaker 2 (00:52:28):
Yeah. I mean, so the stronger your core, the more that it can do its job. The actual core you’re transverse, the more it can do its job, the less things will want to push out in places they don’t belong. So I mean, in my opinion, yes, it’s not going to necessarily fix your hernia, it’s not going to pull it back completely. But if everything is engaging on top, it will keep it in line more. It won’t keep it from pushing back out if you get lazy and you start throwing your hips up and not engaging your glutes and not,
Speaker 1 (00:53:08):
So there’s a study as older study, I think it’s from, it’s a Danish study. It’s a population study looked at women, actually, it’s one of very few studies that looks at women and they followed them over years and found that women that exercise are more, are less likely to have than women that don’t exercise, which to me says exercise is protective of hernias, even though hernias are very much a genetic predisposition. But just because you’re predisposed to getting a hernia genetically doesn’t mean you will get one. And if you maintain core strength, either you won’t get a hernia that’s relevant, or if you do, it’s very well controlled. It’s not going to be painful, it’s not going to be big. And I see of many patients who get hernias, they go to their doctor, oh, you have a hernia, don’t lift anything. Stop your exercises.
Speaker 1 (00:53:59):
And they gain weight and their hernia gets bigger and becomes more painful. Then they set ’em to me, here, go fix this hernia. And I have a discussion with the patient and I learned this story where they used to be fit and now they’re not. And they’ve gained the weight and they have a larger and worse pain with their hernia. And I say, Hey, why do you need surgery? Go back, work on your fitness, reduce the weight. Focus on your core. If you can get all the surrounding muscles to support this hole, it won’t cure your hernia. But if we’ve done the job to make it so that you don’t have pain and your hernia’s no longer visible, why fix it? And many patients can work it backwards and or pay it forward by maintaining a core strength from the get go.
Speaker 2 (00:54:52):
Definitely. I think that kind of goes along with my topic of there is no shortcut. You can’t just buy the next level thing. You know, you have to go back and you have to put in the work. If you’re an active person and you get this hernia, it’s not about doing anything active anymore. It’s about retraining, how to do it smarter, how to do it better. It’s about evolving with what your body body is now.
Speaker 1 (00:55:22):
Okay, here’s my favorite question. What do you think of CrossFit?
Speaker 2 (00:55:25):
Oh, CrossFit. Okay. CrossFit. I listen, I have several friends that love CrossFit that swear by it up and down. It is everything is their end all. Be all and y. Great. I’m so glad you found something that you love, that makes you happy, that gives you X, Y, and Z in a positive nature. Please do something to cross train and keep your body healthy. Yes. Yeah, because the actual motions of CrossFit. CrossFit is not functional movement. CrossFit is a sport. CrossFit is not good point. You know, are doing it to get to a next level. You are not doing it to create a healthier body. What about, sure. Could you lose weight from it? Absolutely. Could you get stronger muscles from it? Absolutely. Are you going to do all that in a balanced nature? 0% chance.
Speaker 1 (00:56:25):
Wow. What about p90x? And those are the kind of branded exercises.
Speaker 2 (00:56:31):
So truth be told, I’ve only, I’ve never done p90x. I’ve kind of watched some of the promos for it because I know everybody’s super crazy insanity and all those
Speaker 1 (00:56:41):
Speaker 2 (00:56:43):
And I think that the reason that they get so much hype is you market to people that go from doing absolutely nothing to throwing themselves into high intensity intervals. Of course you’re going to see crazy results because they were doing nothing. But then, and again, if it bringing you joy and happiness and things you want to see happen in your body, that’s great. But then make sure that if you start feeling pain, if you start feeling achy that you start doing things as you get more connected to your body, as you get more into an active lifestyle, that you start to make choices that are going to give you longevity with it too. Not just for today, but for tomorrow. Because you can look like a supermodel, but if you can’t get out of bed, what does it matter?
Speaker 1 (00:57:35):
Oh my God,
Speaker 2 (00:57:36):
If you, if you put your knees over the bed and you can’t stand up, it doesn’t matter you. Yeah. Nobody gets to see you if you can’t walk out the door.
Speaker 1 (00:57:43):
I have had a couple of patients that came to me had serious injuries after a P90X and insanity workout. Like sports hernias. Yeah. Yeah. It’s
Speaker 2 (00:57:52):
Not fun. That’s with anything. And again, it can be done in any modality. I don’t want to name names, but there are certain Pilates type places that have set me several clients post-injury destruction because they’re just doing it to feel the burn or whatever. I
Speaker 1 (00:58:20):
Yeah, I know it tries. It’s more like to motivate, I think. But I can motivate just seeing you. Honestly. I love my sessions with you. It’s been through a lot and you’ve taken me through so much of it in a positive way. So I do appreciate Can we end on diastasis? RDI is a question. Yeah. So what is it? We know it’s very genetic. Not everyone gets it. What exercises should they definitely not do? Because I’m told, for example, don’t get out of bed moving forward in a
Speaker 2 (00:58:57):
Forward, yeah. Turn to your side
Speaker 1 (00:59:00):
And so on. But crunches also, tell me a little bit more about your planks. Consider not safe. What do you think about diastasis recti and some of those exercises?
Speaker 2 (00:59:11):
So if you’re in the beginning of it and it’s extremely painful and you can’t control it, and then it’s sort of the things as if you were just do a powder, a hernia repair, you would want to just work on that transverse. You want to keep everything in a long supported state transverse. You don’t want to do the flu, you don’t want to do the extension because for diastasis popping, either way is going to, it’s going to cause the issues. Yeah. It’s because it’s like you’re going to break. You don’t want it to split open that way. And you don’t want it to push back the other way.
Speaker 1 (00:59:49):
Speaker 2 (00:59:50):
So think about those old-fashioned coin. I’m going to date myself right now. Those old-fashioned coin purses that had the split in the middle. Yeah. Platinums closed it up. It’s going to split open this way. If you push it down, it’s going to split open that way. You got to keep it flat. So nobody knows what I’m talking about, but
Speaker 1 (01:00:06):
Are there, okay, so when someone comes to you in maybe early postpartum, or are there certain ways that you change your training with them? This will be my last question because I don’t want to take up too much more. Your time
Speaker 2 (01:00:22):
Mean, yeah. Everybody that comes to me does something different because I don’t have two bodies that are the same. I don’t have the same body and more than one person. But when you’re postpartum, I have had clients that have had diastasis recti split. And with their diastasis, it’s all about how do I move with keeping this Condon controlled? How do I move my arms without flaring out my Rives? How do I move my legs without arching my back? How do you keep the center controlled but still have your range of motion around? So once you can get that then, and eventually just because you have it, if you get really strong in that transverse, it’s not saying you can never do a crunch again. It’s not saying you can never do a plank again. You can do all these things when you’re ready and when you get to those points, there is no, but there’s no set time on when that is. There’s no no end all be all thing.
Speaker 1 (01:01:26):
Yeah. The takeaway from today is if you have a hernia or plan to have a hernia surgery or your post-op from hernia surgery, number one, the transverse of dominance is the most important muscle in your body and learn how to engage it.
Speaker 2 (01:01:37):
That’s not just if you have nuts for a lot of people, that’s
Speaker 1 (01:01:40):
True for everyone too. And number two, absolutely do exercises. Do not,
Speaker 2 (01:01:48):
Do not do nothing. Do not do nothing. Do not do nothing. Stagnation is death.
Speaker 1 (01:01:54):
Stagnation is death. I should make a t-shirt.
Speaker 2 (01:01:57):
I, yeah, I would happily put a bumper sticker on my truck.
Speaker 1 (01:01:59):
Stagnation is death. All right. Well, that’s it. We’re done. This is the most amazing hour we had so many questions. Thanks to everyone who participated. That’s the end. I’ve heard you talk today. We’re going to have another session again next week on Tuesday with another amazing guest. I think you’ll really enjoy it. But I love Marcy. I think she’s the best fitness instructor. She’s a specialist in movement and knows the ins and outs about your abdominal wall, especially at your core Gera Pilates so much. You can, I already posted up her website, it’s move with mj.com. She’ll do private sessions with you. There are tons of courses on her website to work on different parts of your body that are safe. I promise you, we will work on something that’s hernia related so that maybe we can kind of focus on that because she knows so much. And I hope you watch this again and share it with your friends. I’ll post it on YouTube. And thanks for everyone for following me on Twitter and Instagram at hernia and on Facebook Live for all of you that join and asked those lovely questions at Dr. Tophi. And again, thanks for your time, Marcie. Yeah, thanks for having me. Friday. Bye. Hi. Okay, bye. Thank you so much. Bye.