The Movement, Volume 1

Hi there, and welcome to my newsletter.

My name’s Ryan, and I specialize in helping people be active and thrive in and out of the gym. This newsletter is about challenging the status quo of healthcare and fitness and summarizes what I’m learning, thinking, and teaching.

Thanks for reading and being a part of The Movement.

If you read nothing else this week..

I want you to understand why I decided to write this newsletter.

Starting back in 2008 when I was the Head Student Athletic Trainer for my college football team, I’ve worked directly with clients, patients, and athletes of all kinds for over 15 years.

I’ve been a coach and physical therapist in 10 states throughout the U.S., ranging from Hawaii to Boston and other states in between. I’ve worked with clients ranging from the elderly to CrossFit Games competitors to Special Operations military personnel in Fort Bragg.

I’ve owned multiple private practices and am now working entirely remote with clients from around the world.

Throughout my journey, I have seen seen the shortcomings of the healthcare and fitness industries. Clinicians claim to have their patients’ best interests in mind but the value of the care they’re providing is still subpar, leaving millions of patients wanting more. Coaches and trainers believe they’re helping people through movement and exercise, but without understanding the whole person, these modalities tend to make people worse, leaving them plagued with pain and injury.

Whatever the example and problem may be, it’s my belief that knowledge is the solution.

I don’t claim to have all the answers. Very far from it. However, I’ve spent countless hours thinking, researching, and testing ways to solve the problems I see running rampant. If you’re on social media or have been a patient in our current medical industry, you know what problems I’m talking about.

So this newsletter is all about taking a stance and demanding a better way. With the knowledge and understanding you take from reading this newsletter, my hope is that you’ll become an advocate for yourself and those around you. It’s to help you realize there’s a different lens through which to look at health and wellness and to be empowered in your thoughts, actions, and decision-making and not have to rely and depend on the “experts.”

I’m grateful and honored that you’re reading this.

Thank you for being a part of “The Movement.” Sincerely.

Okay, let’s dive in!

The way we use medical imaging is all wrong.

There ’s no denying the medical marvel of imaging. Technology has dramatically altered all aspects of care — from diagnosis and treatment to surveillance and prevention.

It began with the revolutionary introduction of the computerized tomography (CT) scan in the 1970s. For the first time, physicians were provided with a 3-D view of the body’s organs, bones and other tissues, as well as tumors.

Ever since, we’ve been using imaging to diagnose and give us an insight into what’s going on inside the body. The primary purpose of imaging is to give us more information or ensure physicians are "crossing their T's and dotting their I's" if they get sued. Maybe a doctor wants to determine if there's a fracture and its severity if so. An x-ray image can give them that information.

But the problem is that more information is not always a good thing.

There's a common misconception in ordering imaging that says, "Why not? It can't hurt."

Both healthcare professionals and members of the public often want to have a scan because it might rule out serious conditions or confirm what exactly is causing the pain.

However, scans only show something significant in a minority of people with pain.

This study found there was an unnecessary ordering of imaging in 40% of patients who exhibited no indications warranting such a procedure.

Over-imaging for people with pain is a significant problem for several reasons:

Cost & resource burden - Imaging procedures, such as X-rays, CT scans, and MRIs, can be expensive and time-consuming. When unnecessary imaging is performed, it leads to increased healthcare costs and places unnecessary strain on healthcare resources.

False positives - Over-imaging can lead to the identification of incidental findings that may not be directly related to the pain we’re experiencing. These findings can result in further unnecessary testing, anxiety, and medical interventions that may not be required.

Radiation exposure - Some imaging techniques, like CT scans, involve exposure to ionizing radiation. Frequent and unnecessary imaging increases the cumulative radiation dose for patients, potentially increasing the risk of radiation-related health issues, especially in the long term.

Misdiagnosis and overtreatment - Scans don’t tell the whole story! Relying solely on imaging to diagnose pain can lead to misinterpretation of findings or the detection of normal variations that may not be the cause of the pain. This can result in unnecessary treatments, including surgeries, medications, or other interventions that may not alleviate the patient's pain or could potentially cause harm.

Neglecting non-imaging information - Pain is a complex and multifactorial experience. Over-reliance on imaging may divert attention away from exploring other essential aspects of pain management, such as physical therapy, lifestyle modifications, or psychological approaches.

Dependency on imaging results - Patients and even some healthcare providers may become overly reliant on imaging results, expecting a "quick fix" solution based solely on the images. This approach can undermine the importance of a comprehensive and patient-centered assessment of the pain condition.

Increased risk of invasive procedures - Unnecessary imaging may lead to the identification of benign conditions or age-related changes that are not the cause of the pain. This can prompt the consideration of unnecessary and potentially risky invasive procedures.

Also, we see that there can be a huge problem with catastrophization and the nocebo effect.

This is basically making things worse than they are and creating a belief that you’ll never get better without excessive medical procedures and treatment.

We begin to have negative expectations (the opposite of what a placebo effect creates) and these expectations leads to poor outcomes.

Here’s the usual sequence of events:

1. Ouch. Something hurts.

2. Let’s figure out why. Orders some imaging.

3. Images show “damage” and “degeneration.”

4. “Well, that’s not good. I better get it ‘fixed’ or else.”

5. Medical treatment and “usual care” (injections, surgery, opiates)

6. Dependency on medicalization any time there’s another “ouch. something hurts.”

You become fearful about something you didn’t even know existed, and the medical industry provides you with the solution you don’t really need.

This cartoon summarizes it perfectly.

Imaging tends to also oversimplify what’s actually going on.

We know that the body is a complex organization of different systems, organs, blood, nerves, soft tissue, etc. To look at a static picture of something and think that a small “lack of normal” is going to give us all of the answers is short-sighted and dangerous.

You are NOT your scan and it doesn’t tell the whole story.

Take pain, for example. It’s become clear that pain is not a purely mechanical problem (joint, bone, tissue, etc.) and instead a biopsychosocial one (mind, body, emotions, beliefs, social factors, etc.)

If we understand that and appreciate the research for what it is, then we need to no longer perform these “simple” surgeries and procedures that are designed to slice pain straight of the body. It doesn’t work that way!

I’ll finish by giving you some insight into what the future holds.

Whole-body imaging scans are going to be HUGE. I don’t want to admit but it’s true, and you should be prepared.

Do you wanna why there are startups offering these scans popping up across major cities in the U.S.? Because of the money.

Companies like Prenuvo and Ezra offer whole body screening to detect cancer, targeting individuals with unexplained pain, genetic predispositions, or who want “overall peace of mind.”

Insurance does not, and likely will never, cover these whole-body imaging scans without any medical indication.

There is as much evidence supporting the use of whole-body imaging for cancer screening in healthy individuals as there is evidence supporting that the 2020 election was rigged.

The American College of Preventive Medicine recommends against using whole-body scans for early tumor detection in asymptomatic individuals. There is no evidence suggesting whole-body scans in asymptomatic individuals will improve survival or likelihood of finding tumors, especially since the tumor detection rate is less than 2% in this population.

In one systematic review of whole-body MRI for preventive health screening, the authors found critical and indeterminate incidental findings in asymptomatic subjects were substantial, as were the false positive rates. This review included 12 studies with 5,400 asymptomatic adults without known disease, syndrome, or genetic mutation. The rate of critical and indeterminate incidental findings were both 13% with high variability. The false positive rate was 16%, also with high variability. While people may feel that incidental MRI findings “can save lives,” the authors conclude that physicians should not offer whole-body MRI for preventive health screening to asymptomatic individuals based on current evidence.

The high rates of incidental findings and false positives negatively impact patients’ mental, physical, and financial health:

• Incidental findings increase anxiety in patients.

• Incidental findings may warrant more invasive testing only to yield negative test results.

• Incidental findings that prompt further workup may be increasingly expensive, especially since insurance never approved the whole body scan.

Another review found that abnormal whole-body scan findings are expected in about 95% of individuals. Thirty percent of these individuals would require further investigations, but less than 2% of these findings would actually be reported as suspicious for malignant cancers.

To reiterate, I’m only talking about whole-body scans in asymptomatic individuals with no genetic predispositions. The use of whole-body imaging for cancer screening is indicated and recommended in patients with rare genetic conditions such as Li Fraumeni syndrome and constitutional mismatch repair deficiency. Also, evidence-based preventative scans like mammography are also indicated. But insurance covers these scans.

If you stare aimlessly at the night sky long enough, you’ll see a shooting star. A shooting star is a meteor 60 miles above the earth’s surface, traveling nearly 30,000 mph. Should you call NASA, freaking out? Probably not. Most meteors are small and disintegrate in the atmosphere. Large meteors that make it through the atmosphere and hit earth are extremely rare.

Similarly, if you scan your whole body without any indication—”staring aimlessly at the sky”— you’re almost certain to find something. And, since this is your body, you’re going to want to find out what that something is, leading to unnecessary anxiety, healthcare procedures, and healthcare spending. This something is highly likely to be a benign incidental finding, meaning you could’ve lived a long and healthy life without knowing of this something. This is essentially why insurance companies would never cover willy-nilly whole-body imaging scans that companies like Prenuvo and Ezra offer.

So, from a medical point of view, there is rarely an indication for a whole-body imaging scan in asymptomatic, healthy individuals. But why are these startups offering these imaging services?

It’s a lucrative business.

An MRI machine costs around $150,000 (not including maintenance). Say Prenuvo purchases one MRI machine. To break even, the company needs to perform one whole-body imaging scan on just one patient on just one-quarter of the annual number of working days. The company is likely performing more than just one scan per day, bringing in millions in annual revenue.

In summary, it doesn’t seem like the medical industry and these kinds of startups are ever going to change on their own. There’s too much incentive to keep ordering and charging for scans even if the evidence clearly shows they’re oftentimes unnecessary. So that means it’s up to the consumer to take a stance, ask questions, and understand the implications behind it.

In Volume 2, we’ll talk more about when scans and imaging ARE warranted and how you can have conversations with your physician to make sure you’re doing what’s best for you.

Dope stuff on the internet..

My buddy and BMX legend Nick Bruce posted this question so I thought I’d share my insights.

Compression boots have been shown to increase limb blood flow and have positive effects on perceived muscle soreness.

However, there’s not a ton of evidence on decreasing inflammation or helping with muscle damage.

Also, you can similar benefits of blood flow and soreness by walking in water if that’s more feasible for you.

Journal of Applied Physiology

Other notes:

Best for muscle soreness and fatigue: massage. 

Best results for inflammation: massage and cold exposure.

Frontiers Research

Fitness rec - I purchased the Kensui Fitness EZ-Vest Max V2 a few months ago and it’s been awesome. Maybe my favorite piece of fitness equipment I’ve ever owned.

1. I didn’t need to buy new plates to use with it. Instead, I can use the plates I already own.

2. It’s durable and conforms to my upper body really well, allowing for a comfortable ruck for 1-2 hours or more.

3. You can load it up to 300 lbs! What? Yea, seriously. I’ve only worked up to 50 lbs at this point but I don’t know of any other vests that can allow you to add that kind of weight. Overload FTW. Highly recommend.

Book rec - I’m pretty over reading books on productivity. That said, on a friend’s recommendation, I picked up 4000 Weeks and quite enjoyed it. It’s a book on time management and productivity that just hit different, and was much more philosophical than tactical: something I’ve been pulled towards recently.

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See yah out there,

Ryan