Conquer Your Weight

Dr. Sarah Stombaugh: Before we get into the episode, I am thrilled to announce we are launching an online course, The GLP Guide. The GLP Guide is a must have resource for patients who have been prescribed any of the GLP medications such as Wegovy, Ozempic, semaglutide, Zepbound, Mounjaro, tirzepatide, Saxenda, liraglutide. There are a lot of them, and this course is available for anyone to purchase. We often hear from people who haven't been given much information about their GLP medications. No one has told them how to handle side effects, what nutrition recommendations they should follow, or what to expect in the longterm. And it can be really intimidating and simply frustrating to feel like you're alone in your weight loss journey. With The GLP Guide, you'll get access to all of the answers to the most common questions for patients using GLP medications, not sure how to use your pen, struggling with nausea, wondering how to travel with your medications. We've got you covered for only $97 for one year access. This is an opportunity you do not want to miss. The course is launching on October 1st. For more information and sign up, please visit www.sarahstombaughmd.com/glp. You don't have to be on this journey alone. We are here to guide you. And now for today's episode, this is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight podcast. Announcer: Welcome to the Conquer Your Weight podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh. Dr. Sarah Stombaugh: Hello everyone and welcome to today's episode of the Conquer Your Weight podcast. We have a repeat guest with us today. I have Caryn Ranney, health coach and personal trainer coming to join us to talk about a different topic. Last month we were talking about the role of health coaching, what a health coach is and how that can be used in a medical practice. We shared how Caryn is working with my patients and my practice, but the other thing that Caryn does, and probably one of her biggest passions is working as a personal trainer. So she is a personal trainer but focuses and specializes in pain management. And so for people who are having pain, whether that's chronic pains or acute pains, learning how to utilize those or how to support those in the setting of personal training, I'm really excited to talk about this topic today. Caryn, thank you so much for joining us again. Caryn Ranney: Yeah, thank you very much, Dr. Stombaugh. Dr. Sarah Stombaugh: So hopefully I did an all right job describing the personal training with pain management, but tell me a little bit more in your own words what that means to you and how you support people in their exercise and wellness goals. Caryn Ranney: Yeah, absolutely. So I've been working as a personal trainer for over 10 years now, and I noticed that something that would repeatedly and very commonly affect people and throw people off their programs was experiencing chronic pain. And even within a basic personal trainer certification, we are taught that there are, if someone has a muscle imbalance, we like to say, let's say that a muscle around the joint is overused and a muscle around the joint is underused, then we are taught to not make that worse. With exercise, it is possible muscle is overused and then you train it more so than it's opposite, then it can lead to becoming tight and angry and painful and even lead to injury. So it was always something that I recognized and would try to work with people on. But then as I moved forward in my career and learned more techniques and I would say even moved out of a traditional mindset of training and looked at movement from a 3D perspective instead of just single muscle bellies, so to speak, then I found that that's actually what I wanted to specifically focus in that even by just creating a, sorry, I'm stumbling around in my words because I am passionate about this. Just by creating a program in which we're strengthening the underused muscle, stretching and or releasing the overused muscle, and then also talking about the lifestyle aspects that lead up into pain. And whenever I talk about pain, I'm talking about pain. That's chronic pain, you're not sure where it came from, and it just kind of built up over time. That's what I specialize in. I can also work with people post physical therapy or even pre-physical therapy if range of motion hasn't been reduced enough. So from there, I found it really powerful because just by through a program of certain specific exercises, specific stretching or myofascia release techniques, and then talking about the lifestyle things that build up into it, I found that I was actually able to fully treat patients and they were able to leave pain-free after a certain amount of months. That's really powerful to be able to do that without medications or without surgery. That's not to say that those are very good ways of treating pain. However, I noticed that people wanted to also learn a method of treating their pain that they can do on their own, and sometimes it just takes a tennis ball just to, yeah, you can use a tennis ball for myofascia release. Dr. Sarah Stombaugh: Yeah, I love that. I think when we think about pain, a lot of it as a society is not always well understood. I think in the exercise realm, in medicine and maybe just in general culture, there's conversations like if there's any pain, don't make it worse, which of course we don't want to make it worse and stop, lay down in bed, don't do anything and wait until you can see a physical therapist, which I think we should clarify and we'll talk a little bit in a couple minutes here about the differences between what you're doing in physical therapy. Physical therapy is amazing. Physical therapy is very important, and physical therapy, while it can certainly address minor illness or minor injuries rather, or minor pain areas, physical therapy really it's an entire medical specialty dedicated to helping people recover from major injuries, surgeries, for example, like orthopedic surgeries, especially after childbirth when there's been major muscle injuries that need to be rehabbed. There's a lot of people who are living in this sort of in-between space where they have sort of aches and pains, but there's not like, oh, this one major problem that needs to be comprehensively addressed, but more just like, how do I support my general body and it's not feeling good for me. I've got some chronic low back pain or intermittently my shoulder hurts, or these different things like that. How do we support someone in that? So tell me a little bit when you think about what you do versus physical therapy, how do you explain that to people? Caryn Ranney: That's a great question. Yeah, and I always have to kind of make that discrepancy. So just like you just said, a physical therapist can absolutely treat these more severe injuries where it's say, I got into a car accident and I tore my shoulder. So they're going to be able to help support that shoulder while it's healing and also help to build in range of motion while it's healing. I think that's one of the key pieces is the while it's healing piece and then also just being a more severe injury. So whereas personal training for pain management, like you said, it kind of addresses that in between area where I don't know why, but now I'm having low back pain and this is kind of built up and there wasn't anything specific that led to this. I'm kind of not sure where it came from, and now it's here. So especially if it's something that just built up and it's not injury related. Dr. Sarah Stombaugh: Absolutely. And tell me, when someone comes to work with you, what does that look like? Give me an example of, and I'm asking this, but I know a little bit of the answer because Caryn actually did a assessment for me. But tell me, what does your initial assessment look for? What are you looking at? What are you looking for? What are you seeing and explaining with your patients or clients? Caryn Ranney: Clients? Yes, thank you. So it is an assessment that looks at the three kind of major areas of the body. We're looking at the ankles and lower body, the pelvis and mid body, and then the torso and kind of mid to upper body. So it's kind of a broad look at those general areas. And then from there I'm also looking at how they move in the three different planes of motion that being sagittal, which is typically forward, backward, frontal, which is side to side and transverse, which is our rotational plane of motion. So I'm assessing those three major parts of the body within the three major planes of motion. So we're going through motions that are within that plane of motion. And I'm just looking at is there, it's not necessarily to say that one thing is bad or not, I'm just looking at the movement efficiency. Is there a part of the body that's just kind of falling out of line from everything else? Is there a side of the body that's acting differently than the other? Is one ankle rolling inward and the other one's doing something different? I'm just looking at discrepancies or anything that I just know from education that can commonly lead to pain. One of those being if we're looking at ankle, knee and hip alignment whenever we move, is the knee dropping inward or outward? We're looking at things like that. Dr. Sarah Stombaugh: Absolutely. Well, to give a concrete example, when we think about past injuries, we think about just our day-to-day routine, maybe the jobs that we have, the roles that we play, all of those affect us in terms of movement. And so I'll talk about myself for example, when we came in or when I came into your studio and we did a movement analysis and there was noticing that my body was in balance, and you could probably maybe remember, but one side was stronger than other side. We'll just say. And as we were talking through what that looked like, it's very obvious to see as the mother of young children and especially my youngest is just getting ready to turn two and I hold her on my hip a lot. And so there's a lot of times spent holding a child, and any mother will tell you, you only have one side of your hip. People will say, oh, try to hold them on the other side until you have kids you don't know, there's only one side that you can hold them. You are completely incapable of holding your child on the opposite side. You have a dominant side, that's the side you have to hold your kid, and if you try to hold them on the other side, your hip doesn't even pop out. Your kid would just fall straight down. So I say that half jokingly, but we get into these ways. I have three kids, I've held them all in the same hip. That is my dominant side of the body, and I spend a lot of time, my daughter, my middle son could be carried around to this. My daughter loves being carried, and so I spend literal hours each day holding someone on my hip. And it's easy to imagine then how that could throw someone's body out of alignment. Caryn Ranney: Absolutely. Dr. Sarah Stombaugh: Give me some other examples like that of things, maybe just their dominant hand past injuries. What are things that end up throwing people out of alignment that you've been able to identify with people? Caryn Ranney: Yes, and I want to clarify. It's not always even just alignment in general. Sometimes it is just because I do this movement just all the time and it's one sided, then this has become just super strong compared to the opposite. And the opposite is not as strong. Something that I see all the time, all the time. And it kind of goes with, I remember, well, we were working on too, where if I'm always doing everything in front of my body and that's just how we're designed, our hands are in front of us, so we're working with our hands in front of our body or we're texting or we're typing on a keyboard, we have a mic in front of us, we're cooking, we're chopping up vegetables in front of us. Everything tends to be in front of us. And due to that, it's very common that we will start to round the back a little bit and our shoulders will start to come forward. Because if we're always doing something in front of our body, if I just put my hands in front of me, my shoulders come forward a little bit and I can feel that this muscle between this chest muscle and the anterior shoulder muscle just becomes activated just from putting my arms in front of me. And then from there, the muscle in the back then becomes lengthened and longer. And if we spend a lot of time in that position and the muscles adapt because they're made of elastin, which is similar to a rubber band so to speak, it kind of behaves similarly. So just like a rubber band, if we just stretch it, hold it stretch for days, it's going to eventually permanently lengthen, well, I won't say permanently, but it will start to chronically, maybe chronically. Then I was talking about a rubber band. I'm like, okay, bring it back to muscles, chronically lengthen. So that is a really common thing that I look at. And then it very commonly leads to shoulder pain, neck pain, pain in the front or the back of the shoulder, and even can lead to not being able to put my hand over my head as in doing an overhead press. Dr. Sarah Stombaugh: Absolutely. And so this idea of, because there's always a front and a backside, if you think about your arm or anterior, posterior, medial, lateral, there's always an opposing muscle. And so if you've got a muscle on one side of your body, there's a muscle that is balancing that out. And so learning how to get to those two things in equally strong, equally relaxed, whatever they need to be, I guess depending on the situation, working to balance those two things really goes a long way in improving the way our bodies feel and function for us. Caryn Ranney: Yeah, absolutely. And the body's not always as simple as just black or white, one side or the other side. Of course, joints can be more complicated than that, but if we boil it down to that perspective, it does work. So I guess going off of what we were just talking about with the chest then becoming shortened and the back becoming lengthened, then if the hands are in front of us all the time, then the solution then big picture do the opposite. So yeah, so if my thumbs are always turned inward because I'm texting, I'm working on something, turn the thumbs outward, and then from there, putting your hands behind your back in order to stretch the chest. And that's the Dr. Sarah Stombaugh: Big that looks, so I want to do that. It's just like, I need to stretch here. Caryn Ranney: It feels good. And so that's the kind of big picture is just like, okay, well I'm lengthening this chest muscle and now I'm actually packing my shoulder blades together in the back in order to kind of pull them together. And that's requiring me to use muscles to do that. So then from there, the prescription, let's say, because I write an exercise prescription for people to identify what is the area that we need to release. So in this situation it would be the anterior shoulder and the chest, maybe even the biceps, and it can go all the way down the arm line too. So releasing the front of the chest and stretching and lengthening, and then strengthening our pole movements, our shoulders, anything where we're pulling a weight or something towards our chest. And then from there, considering the lifestyle factors, is it because I'm always holding my kid, which means that my thumb is always turned inward and my bicep, it is always slightly contracted. I have my arm bent, I'm holding a weight. Dr. Sarah Stombaugh: Yeah, absolutely. A weight that grows every day. Yeah. Thank you. I love that explanation. And so tell me, we think about the development of chronic pain and it's easy to see where many different factors could contribute to that. But tell me a little bit, because pain, it's more than just a muscle is irritated or overused or underused. There's all of these other things that can contribute. So when we think about the bio-psychosocial model of pain, tell me a little bit about that and how that might apply to your work. Caryn Ranney: Absolutely. So the bio-psychosocial model talks about how pain doesn't necessarily come from our biology. That's a bio part of it. It can, but it doesn't always. It can also come from psychological sources. That's a bio cycle part of it, as in how we manage our stress, how we do we just push our emotions away? Do we let ourselves feel them? Are we disconnected from our emotions? Things like that. So that's the psychological side of it. So pain can actually come from our psychology. Then there's a sociology side of it. So how do our social structures affect pain? So for example, in more marginalized communities, we actually see higher pain ratings. So for example, if someone experiences racism, then they are more likely to experience pain. Dr. Sarah Stombaugh: Wow. It's really, it's amazing When we think about the biology and the body, it's amazing how much our body holds onto these stressors that we're exposed to all of the time. And whether that is psychological stressors, sociological stressors, our body holds onto those and comes out in ways that if we're not able to adequately process those, if we're exposed to them over and over again, our body can feel and experience that stress. And it often comes out in pain, but sometimes in illnesses, we see that. We know stress plays a major role in a lot of different illnesses. So thank you for sharing that. I think that's a really important piece. And so there's what is happening in the gym, and they might be getting stretches, they might be getting weightlifting routines and getting all of these things that they're working on. And I know some of what you do, even maybe combining health coaching with personal training, being able to support someone more broadly and how that impacts their overall health and wellness is significant, I imagine. Caryn Ranney: Yeah, absolutely. And yeah, like you said, that's where I'm working with somebody. The personal training side of things is more biology focused, however, in the beginning of any initial consult, if someone's coming in that has experienced pain for years, and I've seen a handful of people that have had pain for 10 years, and that's whenever I have this conversation about how pain can, that can come from biocycle and social sources. And I ask the question around, do you notice trends around when you experience pain? Sometimes it might be, I've been in a stressful day of work, I haven't gone to eat lunch, I didn't sleep well, and I'm noticing that my back is starting to ache. So I encourage people to start to consider those things so they can connect with when do they experience the pain. And then from there, if they do notice that it is often associated with something that is not biology related, then we might switch from personal training to health coaching, or I'll just start to integrate health coaching into our personal training sessions as well. Dr. Sarah Stombaugh: I love that when it's easy to see where that sort of reconnection piece with our body in general. It's so empowering to feel like you understand your body and can partner with your body to improve your health rather than feeling like you're fighting against or don't understand. And it doesn't, it's not like a light switch that just flips, it's just reestablishing or establishing a relationship sometimes it feels like for the first time, but getting to know and understand what it is my body's experiencing and how can I best support it in this situation. I love that. Caryn Ranney: Yeah, absolutely. And it is very, very common that we just become disconnected from what our body is feeling. I mean, we commonly have to do that. Imagine as a parent, you have to take care of your children and sometimes you have to shut off that you're feeling hungry for a bit or work related, we have a deadline, we can't take a break for lunch, we need to work through because I have to hit this deadline. So then if we're feeling hungry, we just kind of push it away. It's very, very common to feel to become disconnected. So I really try to help people just pay attention to just start to connect with their body again. I'll also do a posture analysis too, and that's where we, it's common to find people that they have a bit of a forward sway, and once I ask them about it, does it feel like more of your weight is on more of your toes versus your heels? And they'll be like, oh, yeah. Huh. So then we'll work at shifting it backward a little bit, so it's more in the midfoot. Dr. Sarah Stombaugh: I love that. And improving posture. How does that affect someone or help them? Caryn Ranney: Oh, I mean, posture is a thing that I'm always talking about. I mean, we spend all day in our postures. So it comes back to if you spend a lot of time in a certain position, then that's too chronically, just the muscles will adapt to it. So it's hard to kind of visualize this if you don't have a visual, but let's say that you have a forward sway, that means that your hips are coming kind of forward and you're kind of just, you're swaying your weight forward. So if you look at the big picture of the shape of the body, it becomes more of a C shape in which the posterior line or the back line of the body becomes shortened, and then the front line of the body becomes lengthened. So in the big picture of things, then it would make sense that you could experience pain anywhere along the posterior line of the body. It could show up in the neck, it could show up in the back, it could show up in the feet, and so yeah, of course posture then can affect and lead up to pain if it can lead up to muscles becoming shortened. Due to this posture that I'm always, in fact, forward sway, I have found it is very commonly associated with lower back pain. That pelvis is the center of the ish, kind of the center of our gravity. So it's going to always be trying to balance out where the rest of our body weight is. Dr. Sarah Stombaugh: I love that explanation because I think a lot of times we sort of all know that you should have good posture, but what does that really mean and what are the potential impacts of not having good posture? So thank you for that explanation. Caryn Ranney: Yeah, of course. Dr. Sarah Stombaugh: Yeah. When you think about your role and how you can support the medical field, for example, or how you partner maybe with physical therapy or other movement, what does that typically look like for how you're supporting your clients? Caryn Ranney: Well, so I don't really know of any general practice doctor that wouldn't recommend the majority of their patients to get more physical activity. And just going back to the easier said than done and people having a lot of their referencing our previous health coaching conversation and people having a bunch of different circumstances that lead up that just feed into their life. It's not always easy as just hearing that you need to exercise and then just Dr. Sarah Stombaugh: No one's like, oh, I need to exercise. Great, I'll go do that. Caryn Ranney: Let me just go and bench press a hundred pounds. It doesn't really work like that. It's like if we have all these trained professionals, personal trainers that are trained in movement, some are even trained in emotional motivational interviewing and also health coaching, then wouldn't it just be more effective if instead of just being told to do something, we're then referred to somebody that can help us get there and help us develop that havoc. Also, it's not something where you just go and do it once and that checks a box. It truly is something that becomes built into your life. It's a lifestyle change. Dr. Sarah Stombaugh: Well, and it's not intuitive. When we think about incorporating exercise, there may be things like walking or running or biking or doing crunches or pushups. These very super rudimentary exercises that we learned at some point in our lives we're like, I can do jumping jacks. We have this maybe a small arsenal of things that are taught to us that can improve our physical fitness. But when someone says, oh, you should do resistance training, weight training, and how do I hold a weight? How do I move it in a way that's not going to hurt myself, but what weight should I start? And so a lot of times there's this aspect of just like, okay, maybe I'm even super excited about exercising, but I don't know what to do. And that's where a personal trainer can be really good at, okay, let's figure out and support you in those specific goals you have. Caryn Ranney: And there's a lot of information out there. It can get kind of intimidating and overwhelming when you have zero exposure to exercise or going into a gym or something like that, or weights in general can be very intimidating. People do sometimes hurt themselves when they don't know what they're doing too, and that's not a fear factor. It's just something that does sometimes happen. So it's just helpful to have somebody who knows what they're doing and can then partner with you to also uncover what are the movements that you enjoy, what are the activities that you enjoy that you can keep doing Dr. Sarah Stombaugh: Well, that part, that enjoyment and looking for. A lot of times we think about long-term goals, and while long-term goals are super, super important for us, there also needs to be partnering with the short-term gratification or the short-term benefits that we see. And so doing movements that you really enjoy, your body enjoys moving in that way. It brings or changes your energy in a way that is supportive of your goals throughout the day. Feeling good after exercising is so important. You don't want to feel depleted. You don't want to feel like it's okay to feel a little sore. Your muscles may have some soreness and often do have some soreness when they're being worked, but not pain. So sore, I can't get out of bed. You want to feel positive physically well after your exercise and not feel like you've been hit by a train. Caryn Ranney: Yeah. Yeah. I mean I think the big picture is you're not going to keep doing something if it feels terrible. Dr. Sarah Stombaugh: Yeah, exactly. Caryn Ranney: So yeah, finding that balance of how do I start without just bulldozing myself like you just said. Yeah. And then just feeling energetic immediately. I know that I've done a good job if my client is smiling and just looks a bit brighter and happier than when they came in, and that is always my big picture goal. Dr. Sarah Stombaugh: I love that. And I think that would be something we can even encourage any listeners too, is after your exercise, how are you feeling? And just taking a moment to check in, how does your body feel? Are you feeling sort of a weight off your shoulders? Are you feeling a little bit more relaxed? Are you feeling more energized? What is it that you're feeling tap into that is so valuable? Caryn Ranney: Yeah, absolutely. And it slows us down from the fast pace of life and just anytime that, like you said, we can just flex that muscle of trying to reconnect and pay attention to what my body's telling me, the more it is going to start telling you more what it wants. It does know what it wants. Dr. Sarah Stombaugh: Absolutely. This has been so cool. Caryn, as we wrap up our conversation today, are there things I haven't asked you and you're like, oh my gosh, your listeners really need to know this. Caryn Ranney: I mean, I could just talk so much about this. I think the big picture is if you are just wanting to start exercising, just again, try to be understanding with yourself and try to do small steps instead of just trying to jump in, be understanding with yourself, be encouraging with yourself. If you did it once, then celebrate yourself. If you didn't quite hit your goal of doing twice, just remember something is better than nothing. More is better than some, and too much is hard to get. Dr. Sarah Stombaugh: Yeah, I love that. And if people are interested in learning more about you and in working with you, how can they do that? Caryn Ranney: Thanks for asking. So I have a website. It is my last name, R-A-N-N-E-Y, coaching.co, so ranneycoaching.co. And on that website, I have a form that you can fill out. If you're interested in talking to me, you can schedule a free initial consult, and from there we can talk for free. I also have an Instagram, which is also Ranney, R-A-N-N-E-Y, coaching. Dr. Sarah Stombaugh: Excellent. Thank you for sharing that. For anyone who didn't listen to our health coaching episode a couple of weeks ago, it's important to know Caryn is working with patients in our practice on their health coaching behaviors. Patients who come into our practice will work both with me and with her in order to have a comprehensive approach to support their, not just medical goals, but their really overall health and wellness goals as well. We've also recently started building out some personal training packages, and so for patients of my clinic, if that's something that they're interested in learning more about and adding on to their medical package, we can do that as well. We will put all of the links for both Caryn's practice as well as Sarah Stombaugh, MD. All of that will be in the show notes, so you can click that there. Thank you so much for joining me today, Caryn. This has been really a lot of fun. Caryn Ranney: Thank you very much, Sarah. Dr. Sarah Stombaugh: All right, everyone. Have a great week and we will see you all next week. Bye-Bye.