Expert Movement Specialist James Fowler on the Rapid Recovery Report
Toree: Hello. Our new and improved Rapid Recovery Report, sponsored by ROMTech, the modern technology rehabilitation. My name is Toree McGee, and it’s been a while since we’ve seen you guys last. So, we actually have a new format going on here. You will see us the last Thursday of every month. And we’ll be bringing on a variety of different experts now. So, we’ve got surgeons, we’ve got people in the field that you’ve seen. We also are bringing in those that are experts in sports med and movement, and all things health.
Expert Physical Therapist, James Fowler
So, we’re really excited to kick off our podcast return with a really special guest, a physical therapist by trade and expert movement specialist James Fowler. He’s been running James Fowler Physical Therapy in New York over the last 20 years. He’s a certified exercise specialist by the American College of Sports Medicine, and is a member of the American Physical Therapy Association.
Prior to opening his practice, James spent seven years coordinating the Motion Analysis Laboratory at Beth Israel Medical Center, where he developed an evaluative tool for the analysis of running, golfing, and throwing. His expertise in motion analysis has earned him the title of the official physical therapist for the New York Knicks – go Knicks – and the New York Liberty basketball teams, where he not only provided rehab for these teams, but also motion analysis for performance enhancements.
So, welcome to our show, James. We’re so excited to have you.
James: Well, hi Toree. Thank you so much for having me.
Toree: Yeah, we’re excited about it. This is going to be a fun time. Now, we’ve heard on our show orthopedic surgeons, physical therapists, sports med specialists, tell us though what movement science is, and what sparked your interest in this particular industry.
James: Well, I think if you ask that question to 10 or 20 different people in this profession, you’re going to get probably a different definition. But basically, what you’re going to find is that movement science is a study of movement, and within that, function and performance. And that doesn’t just really apply obviously to athletes. It applies to just the general public. We all have to move about in our day. We all use our body as the vehicle to get us from A to B. and some of us exercise, and some of us play sports, and some of us just go about our lives.
Really, what movement science to me is looking at the fundamentals of the foundation of what everything is built on. And that is especially exciting when you’re dealing with athletes, because for me, I can look at many different sports, and you can basically see the fundamentals of like how they’re going about striking a ball, throwing a ball, or whatever their activity is. You’re going to see the basic principles there. And that actually is really exciting for me, because that’s where if I see a movement fault or a positional issue related to their particular sport, I know where I can go to make some real changes.
And then my own interest in this is I’ve been working, obviously, as physical therapist for 25 years, but I’ve been playing competitive sports since I was six years old, and I played every sport under the sun. So, for me, it’s just a natural thing to look at movement from this perspective.
Toree: Yeah, absolutely, and it makes sense as the competitive athlete, that you’re competitive in physical therapy too, and coming up with the new and improved things.
Toree: So now, congrats, speaking of that on your movement lab. So, it only seems logical then, I guess, to open a movement analysis lab within your physical therapy practice. So, you’re basically teaching individuals how to optimize performance while they avoid injury, right?
James: Yeah, that’s exactly right. And I want to clarify, because there is a distinction between – well, there’s movement analysis, and there’s motion analysis, and there’s video analysis, and they’re just in terms for the viewers to understand. Motion analysis is really systems where you have infrared cameras. This is basically what you’re going to see in universities, where you’re getting into the whole biomechanics.
What we have done here is created a room. This is really like our playroom. It kind of came about making a lemonade out of lemons during the pandemic. And my landlord was very helpful for us to kind of help us with rent. And I noticed that some of space started getting empty, and there’s just one place right next to my office, right next door. And I said, that would be perfect if we could get that space, and build a movement lab, and do all our high-end dynamic activities, the jumping, the hopping, and leaping there. Not in the middle of the room with our other patients, where all sorts of different therapies are going on. I thought that will be great.
So, he was so kind actually to really provide this opportunity, because for me, it was actually a dream come true. I’ve always wanted to have a space, especially in New York, space is hard to come by. I’ve always wanted to have a space where I could take, and we could be uninhibited about what we do. We can strike, throw, kick. And the room is kind of designed for that. Then to be able to take some technology and put cameras in there, and do video analysis, now we have an educational tool. And that to me, is the real exciting part.
Toree: Gosh, that’s so cool. And I know we flipped through a couple of photos while you were talking about it, and it looks so freaking cool.
James: Really, yeah. And I’ve always been the PT practice that are built in these big massive gyms. And they walk out, and then they have this complete massive playroom. And they end up doing endless things in there. And it’s like, yeah, I just want to have that. I just want to be able to have that. So, it’s not a massive space, but it’s great. And it’s going to be a great opportunity for us to really explore.
Toree: Absolutely. I mean, every time I kind of think of physical therapy, and I’d assume most were the same, it’s, I don’t want to say boring, but it’s something that you kind of dread a little bit, because usually you’re doing physical therapy because you’re injured. It’s not fun. It’s not exciting to do any of the work that you’re supposed to be doing to like get better. And so, if you have this like motion analysis going on to keep you from getting hurt, like here is what you do to not get hurt. Here’s a brand-new thing, and it’s really exciting, and it’s explaining to you why you’re hurting, what can fix it, instead of just like, here, do these exercises.
James: Absolutely. And it’s like the other part of all this is the idea of physical therapy, because of our current situation with insurances and all that constraints that sometimes gets placed on us, we want to do more, but we sometimes are stuck to like get them just to the point where they get out the door, and maybe they can start their activities, and you kind of keep your fingers crossed, all things work. But this is another opportunity that we can take them all the way to the end.
So, exactly as you’re saying, it’s like the boring is not actually knowing where this is going to lead you, and we’re just hoping that by getting stronger or increasing the range of motion, or getting the connected tissue moving, that that’s going to work, and it worked very successfully. But to actually get you back to doing it and repeating it time and time again, to give you the confidence. And this is so important with the ACLs that we do on the reconstructions and in terms of rehab, is to get them beyond the injury mentally, and really get them to repeating their activity.
Yeah, so this is exactly it. Make it fun. Make it so that they have this, something to shoot for, and have the 100% confidence that they’re fully recovered.
Toree: Yeah, absolutely. So many of our guests that we’ve had previously on the show deal with sports injuries, surgeries and stuff that are in effect, I guess, of being injured after the facts. So, your expertise focuses on how individuals like, I mean, athlete, or just someone who’s looking how to exercise properly can do it right in the first place to avoid injuries, right?
Toree: What types of patients do you work with the most? I assume you see a lot of athletes too.
James: We see a lot of athletes. But on that, every PT practice also sees the other, from 10 to 90, we have the gamut. So, we have professional athletes, we have college athletes, high school athletes. And the key for us, and obviously in the athletic population, is that most of their injuries are coming from something that’s done over like a repetitive strain, repeated motions over and over time again. And yes, overuse is usually the definition of why these injuries occur, but what we want to do is be able to look at it from standpoint of like, well, why do they get overused? What was in the motion of the movement that led to that particular part of the body being strained repeatedly?
So, then we’re getting back to like what I was saying to like the fundamentals of movement, like the basic core foundations of how they’re using their body, how they’re using the lower half in relationship to the upper half. Where is there a break?
You told me earlier that you play golf, and this is exactly the areas where, especially as older populations want to keep playing, that their ability to understand how to keep that relationship, plus now with technology and with people involved further and further and further, you see people try to swing harder and harder, and it leads to a lot of issues. So, we want to look at efficiency. That’s our key.
Toree: Yeah, not everybody can be Tigerwoods. Sorry guys.
James: No, and you shouldn’t even try. I mean, it did great for him, but eventually he’s—
Toree: I mean, Tigerwoods couldn’t even be Tigerwoods all the time.
James: Exactly. And this is I’m telling you, you see a lot of injuries in a lot of sports, and this is probably one of the number one reason. It’s just like everyone is playing for now, and longevity is not really in the way that we’re going about it.
Toree: Right. I mean, it’s hard when you want to be able to compete with the people on TV, but you are not at the level of the people on TV. That’s what it does to you.
James: And you don’t know what they have to do in order to compete at that level too.
Toree: That’s right. So, explain to me then what a typical session of yours would look like.
A Typical PT Session with James
James: Well, first, we tell our patients you’re going to be there at least an hour. Our approach is that we’ve talked a lot about movement, but we put our time into the manual part. We believe and I personally believe that the manual therapy is so integrally connected to getting them better through the mechanics, because connected tissue, the ability to like open up the tissue in order for them to get the range of motion.
Of course, we have to deal with the acute issues. We have to deal with muscle strains, ligamentous strains, and we have to get that better. But on the manual side of it, we will spend a lot of time in order to try to get to lengthen the tissue back, and in order for them to have the range of motion to do the activities that they need to do. So, we’ll do 30 to 45 minutes of manual therapy. Then we do another 30 to 45 minutes therapy and exercises, depending on the particular diagnosis. Our ACLs are there for at least an hour and a half, maybe up to two hours. So, we want to incorporate both ends of it.
And we also deal, like on the manual side of it, this is also a way for us to give people an opportunity to sense their own bodies, and understand. So, our hands are our teaching tools to further them understanding how to use their bodies.
Toree: Yeah, okay. Now, you said it starts kind of all manually. Now, what type of equipment and technology are you using then to analyze your patients? And I’m sure it’s different for different injuries.
James: It does. From one standpoint, we’re a straight-up physical therapy practice. We’re obviously going to use our physical therapy modalities that we use to deal with pain and swelling, but we also are going to use other modalities within the gym.
We do free-weights. We have a leg press. We have a lot of the cable cone systems. We also have a yoga wall which we use, so we incorporate. Within that, we actually do a lot of our pilates work off the yoga wall, where we can do a lot of hip stabilization activities with bands.
And then we have our other equipment such as what we have in the movement lab, where we have our plyo boxes. Actually, another yoga wall in there, so we can now incorporate different bands and resistance to work different planes of movement.
So, adding the cameras in there, we use the B1 sport, which we can capture up to 240 frames per second of movement, so that’s our educational tool right there.
Toree: You sold me. I’m coming out to New York tomorrow.
Toree: This is exciting. I mean, you’re a lot cooler than I am, because you’ve been a guest on the CBS Morning Show, talking about motion analysis for golfers. So, we’ll go back to golf, as like golf, you like golf, and we have some listeners that enjoy golf as well. So, what’s the most common advice that you deliver? And if you have any pointers for our audience.
Tips for Safer Golfing
James: I do, but there has to be a disclaimer, because I’m not a golf pro, and I’m not a golf instructor. Again, the fundamentals where the golf swing is based on. And I’ll say like the number one thing that I often see, is I ask somebody, before they even swing, I say, “Tell me what a weight shift is?” Demonstrate to me a weight shift. And I know based on how they’re doing what they think a weight shift is, is basically how they’re going to swing that club. And I would say, so many times, a weight shift for too many people is just shifting their hips side to side. And that is like the death of a golf swing, because that’s when you start getting reverse pivots, and your swing, and so teaching the understanding of what a weight shift is.
So, putting your feet on a scale, two scales, and you have 50-50. And can you just move your body just like a millimeter to the right, and increase your weight to 60-40 or 70-30, or 80-20, and then reverse it to the other foot. Then we’re starting to understand that a weight shift is based on a vertical relationship, and not a side-to-side relationship.
Toree: Yeah, okay. And that will help the timing a lot too, right?
James: It will help the timing.
Toree: Timing is the magic part of golf.
James: Timing is the magic part. But you know what the magic part, when you look at now the best golfers in the world, and you see them turn, their head does not move at all. They’re rock solid. So, when they turn back, they know exactly where they started. They know where they’re going. And they’re dealing with micrometers, and in terms of how they want to contact the balls, they’re not swinging.
Active Release Techniques
Toree: Oh, yeah, huh. Not at all. Okay, that’s really interesting. So now, in regards to the physical therapy practice, we’ve been hearing a lot about active release techniques as a noninvasive way to heal different types of sports injuries. It’s my understanding that this is a treatment that’s used for soft tissue disorders. Can you describe a little bit more about how that technique works to alleviate pain?
James: The challenge when we get a patient, and they have repetitive strains as athletes – ART came from a chiropractor Dr. Leahy in Colorado, and we work with a ton triathletes. In fact, he was a triathlete himself, and they actually literally put tents or ART practitioners there actually at ironman competitions.
So, what they were looking at, and how the technique is developed is looking at adherence of tissue, and how does the adherence of tissue affect movement. So, in repetitive strain syndromes, when the tissue does not glide on itself like it needs to, then it deviates, and you end up moving differently, because you can’t move through that adherence.
So, ART is really simple in a sense. You just have to know your anatomy and know where muscle starts or where it goes, that you apply pressure at the adherence, at the adhesions, and then you have them moved through the motions of that muscle, and so you’re basically going to go muscle to muscle. And you’re always working different levels tissue, you’re always working different angles in order for you free up the motion. So, really, it’s a manual technique, but it’s also a diagnostic technique to look at overall mobility, and that’s why you see a lot with runners, and especially does a lot of work with the triathlete world, and the whole population. And it applies to everybody. It’s not just athletes.
Toree: Okay, I mean it makes sense to me. Now, what do you look for to determine if a person is a candidate for like that kind of treatment?
James: Well, you have to always do your red flags first, because not everything is in adhesion. So, you have to kind of go through and do your assessment make sure that what you’re seeing is motion inhibited by restricted tissue. So again, this will be applied to anybody. Athletes comes into play because of the repetitive activities that they do. And it’s often associated with location of pain. So, when they have pain at that particular point, that’s the area that you want to work on. So, it’s very specific to locale. And if the person has a pain in the shoulder, in this particular event, you don’t work on their hip. It’s often associated to where you find the tenderness of palpation.
Toree: Okay. And I mean, yeah, knowing anatomy and how to move, I’m sure, why we rely on you, because listen, half of us don’t even know how to pronounce kinesiology. I don’t know where everything is.
James: And they don’t know what it is actually.
Toree: Yeah, because it’s like something hurts, it hurts. Is it the bone? Is it the joint? Is it the muscle? I don’t know. It just hurts.
James: It does, and that’s the fun part of what I do and what we do as physical therapists, because this is our bread and butter. We are educators, and we need to always keep our profession alive with that idea that we need to teach people about their bodies, because nobody else is going to do that. Trainers do a wonderful job. Pilates teachers and yoga instructors, obviously, are in that same realm. We’re all educators. We’re educating the uneducated.
Toree: Yeah. It’s so funny we live in these vessels that we really know nothing about. We have to rely on other people, like you guys.
James: Exactly. It is kind of strange. I always say this. I don’t know why, but there was a never manual given to how things work, and so we have to kind of create the manual, which also kind of goes back into my physical education background is what happened to PE, physical education, because these kids are not getting educated.
Toree: No, not at all.
James: Not on the body.
Toree: This goes back to my PE teachers in school. How is running a mile going to help me learn anything I needed to know?
James: Exactly. It’s funny. This is my biggest pet peeve. In my next life, I think I’m going to try to figure out how to bring real physical education back to schools.
Toree: I love that. I would have loved that, for sure, because this is so interesting to me. I mean, I would imagine it’s interesting to everybody. Only got one of this. We all got a body that we live in.
The Movement and Sports Lab
Toree: Now, you’ve given us a ton of really great information, and like I said, I love to come see your lab in person, so I’m going to look up some videos and stuff online. But tell me, do you have any exciting like projects that we could be on look out for, or anything that you want to plug?
James: Well, I mean, I have a lot of projects. That’s kind of how I roll. Probably have too many ideas. Well, yes.
First of all, we have specifically connected to the motion lab – The Movement and Sports Lab is what we’re officially called, The Movement and Sports Lab. There’s two program we’re really building out of that. We’re building our sports analysis program where we’re using our high technology high-speed cameras for analysis of movement in sport. So, we’re trying to reach out to the young athlete, because we’re finding that even we get to like 19, 20 years old, they’re kind of hard to change their habits. We want to get to the 11 and 12, the ones who are just starting off. So, we want to be able to have a little outreach into the youth leagues, not just baseball, softball, but soccer, any sports that we can get involved with. So, that’s one part that we’re really excited about building.
And also, on our movement aspect of it is our neuro. We have a therapist, Dina Gersander, and she is a specialist in Parkinson’s and movement disorders. So, what we did also in the other side of our wall there, we did create like a movement living room, treatment room. So, that allows us to have the patient who have had neurological issues have an opportunity to do therapy in a kind of a more living room atmosphere. And that’s a big program that we’re trying to push along.
Plus, we’re working with Tamir Kfir. He does orthotics, based in Israel, and he’s a leading orthotic producer for the top 100 tennis players in the world. Djokovic is one of them, but he also works with the Dallas Mavericks. So, we have a great relationship with him, so we’re trying to build our relationship further.
Toree: Awesome. He’s got a really cool name too.
James: Tamir Kfir, yeah.
Toree: When it rhymes, it’s always a good one.
James: It’s always good.
Toree: That’s why my parents named me Toree McGee. So, where then can we find you on social media, James? I think you’re on Instagram, on Facebook?
James: Yeah, those are the areas here. And just look under James Fowler Physical Therapy from Instagram, Facebook. We’re also in LinkedIn. So, come and join us, and interact with us. We’re going to be putting out all our kind of progress reports of how our programs are going.
Toree: Perfect. Well, I’m going to go and follow you right now, because I’m really excited to see about all of it. And thank you again for taking the time to hang out with us today, and teaching us something brand new. So, thanks again. Enjoy that New York weather.
Ladies and gents, thanks for hanging out with us and watching The Rapid Recovery Report. We will be back every last Thursday of the month. Please feel free to follow and subscribe to our social links, our YouTube channel, and we’ll see you guys next month.
Thanks so much again, James. I appreciate it.
James: Thank you, Toree.
Toree: All right, bye-bye.
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