Victory Friday | Issue 140
Orthopedic Insights: Highway Speeds • Three (Bizarre) Ball Strategies for Back Pain • Cross-Training Keeping You Crippled? • Lessons from 17 Years of Physio
“You can’t solve a courage problem with more intelligence.” ~ Jay Yang
Victory Friday is a weekly digest of reflections, insights, and tools from the world of functional manual and performance medicine. It is a free weekly publication. To support Victory Friday with a paid subscription, click below:
Happy Friday, all! This week: why your “new” hip pain might actually be a 20-year-old highway-speed misalignment, three bizarre (but brilliant) ball tricks for back relief, the sneaky way your beloved elliptical might be sabotaging your running comeback, and the hard-won secrets that have kept me loving this job after 17 years as a PT. Buckle up — it’s equal parts revelation, reset, and celebration.
What I’m Into: Highway Speeds. I had a conversation with a client with hip pain today.
He’s middle-aged and relatively new to endurance training and racing — marathons and triathlons.
What I told him was something like this:
Many of us carry longstanding movement imbalances — in the legs, hips, spine, or shoulders — that have existed for years, if not decades.
These dysfunctions often went unnoticed because we simply weren’t active enough. We never moved those areas far enough, fast enough, hard enough, or long enough to provoke symptoms.
But once we increase our activity level, these hidden imbalances begin to surface. What feels like a new problem is usually the result of deep-rooted, longstanding dysfunction.
I added:
It’s like driving a car with a subtle misalignment: everything feels fine on short, low-speed drives around town. But hop on the interstate and push it to highway speeds, and the shake becomes obvious (and problematic).
The same principle applies here. It’s not that higher-intensity or higher-volume activities — running, hiking, lifting, or pickleball — are inherently bad or intolerable. It simply means there are underlying inefficiencies or imbalances that daily life never exposed, and that now require targeted correction.
This concept is a good reminder — for athlete and clinician, alike — to be patient, yet persistent, with movement imbalance correction. They’ve probably been around longer than you realize, and maximal correction may be the key to peak performance and aches and pains prevention!
Cool Exercises I Like. Three (Bizarre) Ball Strategies for Back Pain. Long-time readers of Victory Friday know that we promote a systems-based approach to both rapid pain relief and performance optimization.
And our favorite way of doing that?
We seek out and share the most effective, whole-body fascial strategies
that deliver the highest ROI and biggest bang for your buck improvement in mobility, strength, efficiency and pain relief and prevention.
Ironically, many of these strategies…are hiding in plain sight and easy to do!
From yogi and movement educator Shelby (@calibrateyoga), an easy-and-powerful trio of under-utilized, full-body fascial moves!
Shelby demos three moves with a massage ball:
Diaphragm. The powerful diaphragm fascia connects to both the lumbar spine and sacrum, and the pelvis. Readers will know how impactful a stiff diaphragm can be on hip and back pain1 (in addition to the shoulders and neck2)!
Psoas (& viscera). While her intention may be psoas — a powerful hip flexor connects the lumbar spine to the femur — ball work to the abdomen also supplies much-needed visceral organ mobilization, too — which is also crucial for both back mobility gains and core stability activation!
Plantar foot. Believe it or not, the fascial in our feet is connected to our hips, pelvis and spine — powerfully! Mobilizing the plantar fascia helps free structures, far above3!
Joe’s Articles. Cross-Training Keeping You Crippled? Avid runners live for the run. When injury strikes, we reluctantly turn to cross-training to stay fit — yet we hate every minute of it.
But the only thing worse than dealing with an injury and cross-training...is when that very cross-training is quietly keeping you injured!
I see this every so often in my clinical practice (including just recently4) — but I suspect it happens often, unbeknownst to many injured runners!
Is your cross-training routine keeping you injured?
From iRunFar.com,
Cross-Training Sabotage: Breaking the Hidden Injury Orbit
TL;DR:
Hidden Cross-Training Stressors. Low-impact cross-training is typically low or no pain. Yet these sessions — especially if high-volume and repetitive — may impose enough tissue load to maintain irritation in connective tissues and keep them sensitive.
Then, when it is time to run, the higher-load running triggers significant pain. Yet it is often the cross-training that is the real culprit in maintaining the injury orbit.
Types of Subtle Tissue Overload
Focal Mechanical Overload: Specific modalities stress unique areas differently than running:
• cycling hits knees and hip flexors
• elliptical loads calves and lower legs relentlessly
• swimming can strain hips, hamstrings, and low back.Unnatural Movement Overload: Many activities eliminate running’s reciprocal loading/unloading rhythm, causing sustained tension in hip flexors (cycling) or constant plantarflexion (elliptical).
Chemical Overload: High-intensity efforts on bike, elliptical, or pool create metabolic/hormonal stress that delays healing.
Cross-Training Modalities and Risks
Elliptical: Constant plantarflexion irritates plantar fascia, Achilles, and calves.
Cycling: Overloads knees (quad-dominant) and hip flexors.
Swimming/Aqua Jogging: Aggravates low back and hip flexors.
Stair Climber/Incline Treadmill: Stresses anterior knees and Achilles/calf complex.
Four Possible Signs Cross-Training Is Prolonging Injury:
Persistent soreness after sessions with no daily/weekly improvement
Inability to progress running despite minimal daily symptoms
Doing everything else right (mobility, strength) but progress is still stalled
High-volume same-modality training day after day.
Best Practices for Effective Cross-Training
Less is More: Cut cross-training volume and intensity, especially acutely, to allow real tissue rest.
Diversify: Rotate modalities to spread load and avoid sensitizing one area.
When in Doubt, Stop: Reduce or pause aerobic cross-training; prioritize mobility and strength work for faster reset and healing.
Victory Friday. Lessons from 17 Years of Physio. Just this week I crossed my license physio anniversary: 17 years. (And if you include the beginning of PT school, twenty!).
I can’t believe how much I still love and enjoy my job. I can’t believe how lucky I am that I found a profession where:
• I’m really good at it
• I truly love it
• It pays me (relatively) a lot of money.
That’s the professional holy grail: mastery of an in-demand helping profession, daily joy, and strong financial reward.
As the years add up, two things weigh on me more and more:
• how to better promote our profession (and the way I practice it) and mentor the next generation, and
• how to keep doing this physically and mentally demanding, high-skill work sustainably while protecting my own body.
With that in mind, I’ve put together a list: the practices that got me here, and the principles that will help me keep going strong for another 17 years:
Get Great Mentorship. Seek out the best mentors early in your career, then continue finding new ones as you evolve. Choose mentors who excel in different areas — not just clinical and hands-on skills, but also business management, practice ownership, and the art of balancing professional demands with health, family, and community life.
I was so lucky to have outstanding mentors, early on in my career! I wouldn’t be the clinician — or person — without them5.
Stay Strong. Consistent strength training is non-negotiable for protecting your own body. Get skilled at using your whole body efficiently when performing hands-on assessments and treatments, so you can deliver high-quality care without wearing yourself down.
I have done some sort of strength training, on average, three times per week for 17 years6. It’s been crucial to both my effectiveness, resilience, and longevity.
Stay Fit. Prioritize daily exercise and take care of your body in every way: smart nutrition, quality sleep, and effective stress management. A holistically healthy therapist is a more effective, resilient therapist.
Exercise at Lunch. Leave the office during your lunch break. Walk, jog, or lift weights. Give your brain a true reset by getting blood flowing and stepping away from the treatment room.
In 17 years, I have exercised during a “lunch break” about 98% of those days7.
Avoid Burnout. Protect your energy by limiting your weekly hours and client load (aim for sustainability, not volume). Going solo often allows you to make more money while seeing fewer people. Develop healthy boundaries so you can leave emotional weight at the office and truly recharge.
Next month marks ten years as a solo practitioner! A huge reason I have made it this long is the fact that I rarely see more than 25-28 client-hours per week.
(Hardly) Never Take Paperwork Home. Make it a goal to finish all clinical documentation before you leave for the day — ideally zero work brought home. Get efficient with in-session charting so that when the last client walks out, your workday is truly done.
My first mentor taught me the art form of sneaking to the computer to quickly chart in-between interventions. These little spurts — often 30 seconds or less — can add up to hours by day’s end.
Get Good Enough for Cash. Build elite clinical skills and strong people skills (including sales and marketing) so you can confidently run an independent, cash-based practice. Even if ownership isn’t immediate, this peak skill set will serve you anywhere — and give you the freedom to go solo successfully when the time is right.
I met my first cash-practitioner in my second year. That became the gold standard for my skill level, and that ultimately gave me the courage to go through with it.
Leverage Boredom & Frustration. I’ve always said I’m as good as I am because “I get bored and frustrated easily.” When a patient isn’t improving, that impatience drives me to try something new, learn a fresh technique, or innovate on the spot. Turn that restlessness into a treatment-room laboratory: never stop running your own N=1 experiments.
Chase the Magic. A wise colleague says, “Today’s magic is tomorrow’s evidence-based science.” Actively pursue innovative, unconventional, even esoteric tools that reliably get people better. Many of the most powerful techniques aren’t yet backed by large studies — don’t let the lack of publications stop you from mastering what works in real life.
Early in my career I took 3-5 classes per year. That has slowed down a bit, but my learning is also more self-guided now. But that classwork is also higher-skill and challenge: truly learning magic tricks.
Find Your People. As your skills and reputation grow, your ideal clients — the right conditions, cases, and personalities — will start seeking you out. Focus your energy on those who truly connect with you and value your approach. This work is demanding; surround yourself with people who align with your personality, energy, and philosophy. You’ll enjoy it more and get better results.
Become a Mentor. Start mentoring as soon as you possibly can. I took my first PT student just two years out of school, and it forced me to clarify and articulate everything I did. Teaching is one of the fastest ways to refine your own knowledge and skills. No matter your age or experience level, there’s always someone you can help — and that process will level up your own game in return.
Here’s to 17 years, and, with any hope, to 17 more!
Issue 140 is complete!
Help people move, function and feel better: please share this publication!
Thanks for reading, and have a great weekend,
Issue 40. Diaphragm Dysfunctions Hindering Hips. Diaphragm (and thoracic cage) mobility loss can restrict hip and pelvic mobility and alignment. Two cases presented with restricted hips, pelvic rotations or torsions, and failed to maintain mobility or neutral alignment despite direct treatments. Comprehensive three-dimensional diaphragm treatment freed and/or unlocked pelvic and hip mobility. The diaphragm’s fascial connections profoundly affect hip function beyond breathing and core stability, so thoracic mobility and diaphragm assessment are essential for lower quarter clients.
Issue 17: Gregg’s Gems. Effect of diaphragmatic breathing, respiratory muscle stretch gymnastics and conventional physiotherapy on chest expansion, pulmonary function and pain in patients with mechanical neck pain: A single group pre pretest-posttest quasi-experimental pilot study. A study on patients with neck pain found that daily diaphragmatic breathing (only 10 breaths) combined with respiratory muscle stretch gymnastics significantly improved chest expansion, reduced pain and dramatically lowered neck disability scores. This adds support for addressing thoracic mobility and breathing mechanics in cervical care, likely through fascial connections.
Issue 74: Toe Spreaders & Sock Pulls! A superficial fascial treatment approach for the lower leg, which improves both myo- and neuro-fascial mobility. These hands-only techniques deliver targeted mobilization to the plantar fascia (via toe gapping, traction, and multi-plane motion) and lower-leg crural/aponeurotic fascia (via upward/downward “sock-pull” glides), unlocking local foot/ankle mobility plus powerful upstream gains in hip and low-back function.
Issue 137: Cross-Training Culprit in Chronic Pain? A client with plantar fascial strain improved on her original heel pain after months off running, PRP injection and exercise. Yet ongoing medial arch/ankle symptoms — and latent soreness after calf/foot strength — pointed to overload of the medial shin/ankle tendons. The culprit: 60–90 min of daily elliptical, with constant plantarflexor tension and no unloading. Stopping the elliptical, adding rest, and switching to uphill treadmill hiking quickly eased symptoms and cleared the path back to running. This represents a case of cross-training prolonging the very injury it was meant to help.
And for the past 5 years, it’s been closer to 5 or more days per week.
One of the toughest parts of my fellowship year were the working lunches. Although I was grateful to talk with colleagues about various topics and cases, the freeing physical activity was sorely missed.