Kim Vopni (00:01.784)
Hi, Anthony. Welcome to the podcast. Nice to see you. We met in person, I guess about a year ago in San Diego when I was teaching a course and you brought one of your products in. And so it's always nice to meet people in real life. IRL as they say. I appreciate you joining me. We're going to talk about pain, chronic pain today. I know that's an area of expertise for you, but if we can start out with having you tell us who you are, how you got into
Anthony Carey (00:17.161)
I accept it.
Kim Vopni (00:31.746)
this work of working with chronic pain and also then developing the product that you created.
Anthony Carey (00:38.279)
Sure.
Almost exclusively, I've been working with people with chronic pain for over 30 years now. Did my graduate work in biomechanics and athletic training. Kind of learned a lot of the traditional ways that you would approach pathologies and injuries. But that tended to be a little bit more on the acute side. Early on in my career, I was introduced to a gentleman and started to work for a gentleman named Peter Goske. A lot of people might be familiar with him. I worked for him for a couple of years, was his director of education. I wrote his training manual, trained all his incoming
therapist at the time. But then we thought we could build a better mousetrap and branched off in 1994 and started Function First. again, we've had the opportunity to work with people from all over the world who have come to see us in San Diego. Our sort of process has evolved as the literature has evolved over the years. you know, exercises don't dramatically change. Really what changes more is a little bit the narrative behind why you're doing certain things.
and also the education along with that narrative that you would share and coach your clients through. So that's always just been a big passion of mine because it's every person is unique and individual as you know and the ability to sort of troubleshoot, problem solve, you know, from this abundance of things that we can do for people to narrow it down to what's going to be most effective for that individual. Not doing a bunch of generic things across the board that although some will work for some people, the more challenging folks they don't.
And then my passion to just sort of impact as many lives as I can through movement is what led me to eventually produce cortex and then later on cortex sit. So the combination of all that is sort of where my professional and life mission is all about is improving the quality of life through the quality of movement.
Kim Vopni (02:30.946)
Mm-hmm. Mm-hmm. Yeah, I love that. Something you said and I wrote it down because I want to make sure that I said it correctly, but you wrote in an email to me when we were talking about speaking points, pain is an experience, not a sensation. Can you like, what does that mean? And how, why do you, why do you say that? How would you explain that to somebody?
Anthony Carey (02:53.265)
Well, traditionally all of us think of pain as something that physically we're experiencing that is responsible for.
the other words, if I step on a nail, right, we say, so the pain was a result of the nail, which is true because it does some damage to the free nerve endings and all the real receptors and it sends data, you know, up to the spinal cord, up to the brain. But what really happens is the brain has to determine whether or not that's dangerous, it's a threat, it's harmful. And at that point, we experience pain. So there's literally delay. If you've ever bumped your head coming up from underneath
your desk or your table right?
first thing you do is you don't feel pain. There's the sense of all the input, the vibration of the head and everything. And then we might feel something and then we'll rub it. Right? So there's a sequence of events. It's happening at light speed practically, but there's still a process that goes on from there. when each of us experience what we would describe as pain, the underlying experience behind that is completely unique to each individual. And so there's all these different inputs that contribute to that.
Kim Vopni (03:49.966)
Yeah.
Anthony Carey (04:08.303)
especially relevant to anybody that has chronic pain. Because chronic pain is defined as anything that's been three months consistent or six months or more intermittent. So if you're experiencing that kind of pain, there's adaptations to the nervous system. if I may, one of the examples I often use when I speak and share this with, if you and I and all your listeners together were able to describe love for somebody that's, whether it's, know, any way we want to describe love,
point in our life and you used words that communicated that to me about exactly what that person meant and then I would hear words that would be very familiar. Oh they make me feel safe right and they make I feel this joy around them. I feel hope for the future whatever it is. All those words would resonate with me we understand the definitions however the experience behind those words are completely different right. So they can be based on obviously some physiological experiences we have butterflies in our stomach or you know sense of warmth.
but it can also be how our experience with other people would be or our expectations of what love is supposed to be like or what the social pressures are for my family to find somebody to be in love with, right? All those things, so.
You know, technically pain in itself is looked at now through a lens of three different lenses, which would be the bio psychosocial lenses. And the bio is everything that all of us are always familiar with. And that can be your, your inflammation. That can be the, that can be the degeneration in the joints. That can be the micro trauma or tears to the tissue, right? That could be the hypertension in the muscles. That's all the bio stuff and that's all still there. But now we look at through a psychological lens as well. And that can be.
Our attitudes about healing that can be relative to our past history and experiences Depression all of these things will also play into it and then there's also social aspects of it. So there's social pressures or social expectations certain ethnic backgrounds feel like it's their job to carry this physical burden that their martyrs or a parent may feel that they're supposed to take on all the suffering and the family or job obligations may
Anthony Carey (06:20.207)
make me feel like I have to stand all the time, right? So any of this, all of this together are literally three legs in a stool that sometimes they're, it's a wobbly stool because one leg is a little bit more influential than the other, but at the end of the day all of those contribute to all of our experiences.
Kim Vopni (06:35.916)
Okay so taking a bio psychosocial approach to healing is going to be important is there one would you know it's a three legged stool and you can't look at that and say this is number one leg and what order so is there a specific order that you would follow in terms of optimal healing or is it person dependent and I think my mind goes to I'm a movement person as well so I think of
stretching and changing postures and looking at habitual habits that somebody might do and how can we change that? Is that a good place to start or do we want to look more at the psychological perspective and think about our beliefs about that first to make movement more successful? Curious of your thoughts on that.
Anthony Carey (07:21.341)
Yeah, well, as a movement person too, right? That's our vehicle for success with everybody that we work with, and that's the major tool in our toolbox. And obviously, me as movement fitness professional, offering psychological advice would be outside my scope of practice. Acting as a sociologist would be outside of my scope of practice. However,
What we do and what has worked for us very well as we've evolved with the science is people are coming to me for exercise, right? People are coming to you for exercise and they know that ahead of time But if we share some of this information with them up front so they have a better understanding of the different levers that they can pull throughout the day, right or at least If they if they have a general understanding of it, they realize that okay It's not just because my hips are doing this or my shoulders are doing that or my mom had had this same situation
or whatever, they understand that there's multiple contributing factors. Now they're not gonna be able to control all of them, but just the insight into that, excuse me, can be very beneficial. And then, as movement professionals, what we get to do is we get to create this change in their brain chemistry through what we're doing with exercise and movement, right?
So if we give them what I describe as strategic exercises, right? So again, that's very much personalizing not just based on their movement, but also what their readiness is for exercise, right? So for example, if you and I see a client come in and we both agree 100 % through a movement assessment, this is what they need. But then we step aside and we go over their health history and we have conversations with them about what the fears they have from previous experiences with either other coaches.
or other physios or whatever and then we understand that you know they've actually never been an exercise in their life we've got to dial all that in to match that movement assessment right we can't just say well your hips don't do this your ankle is not doing that we need to do this better it still has to match up so but when we do that right if we do that in an effective way that changes the brain chemistry and now all of a sudden we're giving them hope
Anthony Carey (09:32.218)
And they're starting to see, okay, this can work for me. Then that influences, again, their expectations, their attitude about healing, et cetera, et cetera.
Kim Vopni (09:40.6)
Got it, yeah, so kind of attach it, attacking the other two, the psychosocial piece indirectly with beliefs and attitudes that are created through the movement that we're guiding people through. And my mind's going also to, I think about a client who I had many years ago when I was early on into this world of pelvic floor and diastasis, and this particular client was doing an exercise and I remember filming her to show,
what was happening in her body in this particular movement and then wanting to use that as a way to illustrate the strategy she was using was not necessarily producing the results she wanted. So how could we tweak it? But her interpretation of me filming that was that she that she was failing at that exercise. And so she took it away as that that's I'm bad. I'm not doing well. And so it makes you think of the like
I was approaching it in a way that I felt would be helpful, however the interpretation of it was not successful for her and ended up creating more fear around some movement, which was certainly not my goal.
Anthony Carey (10:44.103)
Yes.
Anthony Carey (10:54.525)
You know that brings up a great point Kim in that
Kim Vopni (10:54.669)
Yeah.
Anthony Carey (10:59.247)
What we have to be super careful of is the language that we use, right? Because we can, the things that we say, even meaning well, can be interpreted completely different by the individual. you know, there's even the, there's, your listeners, we may be familiar with the term placebo, right? Where people see a benefit, where there may not be a direct intervention that should be responsible for that, but their expectation led to the benefit. Well, the opposite of that is a no-see.
bow, right, where we imply that, you know, your pelvic floor is been blasted and can't heal or your low back is fragile and you can't ever pick up anything over 10 pounds again or even our facial expressions and all of those things literally impact the experience that that individual is going to have in front of us as we're trying to do the right thing and unaware of the potential damage that we're doing with the language that we use and even our facial expressions, like I said.
Kim Vopni (11:58.04)
Yeah, yeah, yeah, it's super fascinating. I'm I and I work now in groups. So I'm speaking globally on a zoom call with many different people and sometimes answering a question that somebody's posted where I'm not actually even interacting with them directly. They're on the call listening, but there's there's many as it in zoom. There's many screens. So I don't even know if that person necessarily on the screen that I'm looking at. But so I'm sensitive to that as well where
some of the language I'm using where it's now in a public forum. Now they've chosen to be there. They know it's public. They recognize that people can read the comments and what have you. But I think that adds a whole other layer where you're not one-on-one with somebody creating what you could consider a safe environment. I do my best to do that in a group setting. it's food for thought. so I have to really be careful with what I'm saying. So from a pelvic.
Anthony Carey (12:41.725)
Yeah.
Kim Vopni (12:55.502)
pelvic pain perspective, what I could list off many different pelvic pains. There's there's so many and it could be both like skeleton related. It can be muscle related. It could be, you know, even just the tissues around the vulva. We can go into all sorts of them. But from your population of who you worked with, what are the more common pain conditions specific to the pelvis that you've seen and what do you see as?
First, let's go with the bio and then talk about the psycho and the social, kind of the three influences on those types of pain.
Anthony Carey (13:33.467)
Sure. The folks that come with, know, I always describe the pelvis as sort of the mechanical center of the body. so.
It can affect everything above and everything below. And that's just one of the ways we can also look at it from the ground up, right? So certain things with foot and ankle. And then we also talk about, we can also have descending stuff based on the eyes, the inner ears, and even the muscles in the neck, which have four times the receptors of the other skeletal muscles. it could be coming from all that, but mechanically, it's always, know, the pelvis is a great place to start. So.
Kim Vopni (14:07.192)
I think it's the center of the universe, yep.
Anthony Carey (14:08.965)
Sure. And then having pain there, of course, sort of makes us have to be a little bit more sensitive or approach proceed with caution, as you might say. But early on, you know, I was a huge proponent of posture, even my book that I wrote many years ago was based a lot on postural malalignment. And I still believe in posture, although we can't make a direct correlation.
literature doesn't support that because your pelvis is anteriorly tilted that you're going to have low back pain. We just can't do that. the way that we would approach it and we think is most beneficial is number one, let's look at how we change the mechanical stressors to the body from an exercise standpoint, So somebody may have an anterior tilt that may also be now mapped to their pain in their brain, right? So their pelvis is this way. And then if somebody, Meaning Well, a long time ago said you have pelvic
pain because you're anteriorly tilted, well, what does that mean to them? One of the common interpretations with that, well, if I can't get rid of that anterior tilt, then I can't get rid of my pain, right? Now that's a slippery slope to go down, right? So obviously we want to be able to influence them to be able to reduce that mechanical stress through the right interventions with the exercises that we do. So we'll come out at a lot of different ways, of course, depending on the uniqueness of the individual, what they have going on. I think one of the, as it relates to pain and it relates
to any part of the body, including the pelvis, one of the things that we stay away from is provoking that pain through exercise, right? So, you know, physios may do that in a lot of circumstances. And one of the reasons they can do that is because within their bag of tools, they have a lot of passive modalities that they can reduce the response afterwards, right? So if they really flared somebody or something, they have all these other things that they'll do. If we want our clients to go home and do what we ask them to do on their own independently so that they can get
that progress and we want compliance, if we hurt them with the exercises, they're probably not going to do it. But the other thing that it does, it also reinforces the expectations and even the neurological connection to the brain that what they're doing is part of what's supposed to happen. They're supposed to have this pain here, so to speak. And then our exercises start to map to their brain. We start to map to their brain with something that's provocative. we're going to do a global assessment. We are going to look nose to toes. So anything that we see in the pelvis, is it being influenced?
Anthony Carey (16:38.435)
from other places, even though the exercises are still going to be, or part of the pelvis is still going to be relative to the exercises that we're going to do. And we'll know without doing, certainly not being within any kind of internal assessments, right? We'll expect them to bring that to us. And knowing sort of what their diagnosis is. Then we have our red flags. What do we want to stay away from so that we're not provoking anything again or we're not exacerbating any kind of any situations that they have. But giving them
We have a saying, function first that we say, let's ask, don't tell the body what to do. Right? So if somebody goes into a hundred percent into an exercise, they've just told the body that they're going to do that. Right? Especially if it's, if it's kind of an aggressive exercise. And so what we like to do is creep up on it and get permission from the nervous system to be able to do what we're doing. And then once that lowers the threshold of resistance and threat, and then we can get sort of the output that we're looking for from that particular exercise.
Kim Vopni (17:39.35)
I love that. I hear so often, so women who come into my community, many of them feel that they, many of them have potentially been suffering for years. Many of them have felt let down by other care providers maybe, and they often feel a sense of desperation. They just want this to be fixed. And so an interpretation that I think a lot of people have is,
Anthony Carey (17:45.181)
you
Kim Vopni (18:04.618)
Okay you've given me an exercise if i do more of this exercise it's going to be better and it will work faster and i will hear from people that you know i i overdid it is it okay for me to do this three times a day as opposed to just the one time and so they they have interpretation of more and i absolutely love the way that you've worded that my my recommendation is always let rest is just as if not more important from an integration perspective
Compared to the work and we need time for the body to settle into interpret what we are doing and I think the approach that you just explained is is such a beautiful way to do that.
Anthony Carey (18:43.805)
Yeah, it's almost a necessity based on somebody in pain. Because otherwise, their body interprets so much as a threat, and they don't even know it, right? Even if it's not 100 % related to what their pathology is or what their symptomology is, their body is still going to present it, or their nervous system is still going to interpret it as a threat, which then elicits all that same response, even if it's not a threat.
Kim Vopni (19:10.892)
Yeah. And that's another interesting point too, because people will also message me, is this exercise quote unquote safe for my pelvic floor? So they have their own feeling about if a movement is safe or not. they're not necessarily, they don't maybe consciously know, but their nervous system is also going to be interpreting something as safe or not or threatening or not.
And I try to get away from labeling exercises as good or bad or safe or not safe for the pelvic floor. And it's more about the person's execution of an exercise. It's, I don't use the term, but I really should start the biopsychosocial approach in movement as well. Whether or not that's going to be safe. Like I try to get away from that languaging.
Are there other words that you would use or do you use the word safer as a way to help encourage people from a nervous system perspective?
Anthony Carey (20:07.569)
Well, safe is, I think is a great word as well because they love to hear that. But that's the same as saying, and I get similar questions about, is this a bad exercise? Right? Is this a wrong exercise? And my kind of go-to response is, especially if it comes from other folks in our field and not necessarily clients, I'll say, for whom? For what? And when? Right?
Kim Vopni (20:16.13)
Yeah.
Kim Vopni (20:28.558)
Mmm.
Anthony Carey (20:29.469)
So somebody day one with me, that may be a bad exercise. Somebody day 90 with me, it may be a great exercise. Somebody with a history of this, it may be a horrible exercise for them forever. So for whom, for what, and when is a question that...
I suggest we ask ourselves when we're labeling exercises, which fitness pros are notorious for doing, right? But I think that safe or another term that we use often is creates movement confidence, right? And those two will go hand in hand. Safety and movement confidence will go hand in hand. And then the next step in that is does it feel like it's an authentic movement for you?
Kim Vopni (20:54.968)
Yep.
Anthony Carey (21:15.261)
So, and if I could share with you again, one of the other pieces of feedback that we have with a client, like when they're doing an exercise, right, I'll ask them, is it a positive, a negative, or neutral to you? That simple. I don't need zero to 10. I don't need anything like that. Is your interpretation of it positive, negative, or neutral? And if it's positive or neutral, and I gave it to it for a reason because of what we're trying to accomplish, we keep it. If they say, ah, this is kind of, or if they even hesitate, I just change to a different.
exercise. And that's based on their internal interpretation of what they're actually executing at the time.
Kim Vopni (21:51.128)
Yeah, yeah. Something else that you had said, which aligns very much with what I always say avoidance doesn't build resilience. And you had mentioned that movement variability is key to resilience, which, and I use the term movement diversity. I stole that from the gut diversity side of things, but trying to, especially women with pelvic floor dysfunction, they often will get into very rigid patterns of movement.
Based on symptoms are based on what they think is safe and they're often afraid to explore beyond that but in terms of building true resilience and allowing the pelvic floor to. Experience a stimulus that could potentially help it move past what they are current with the limitations of their currently and i think is important so what sort of. Like it let's think of a side joint pain that something that is very common in.
in my population and I know that you would have seen a lot of that. where would you start with somebody and how do you, I'm assuming your answer is gonna be there's no timeline, but what is the general progression to increasing variability when you're working with, we're talking specific to SI joint?
Anthony Carey (23:09.937)
Well, SI joint, just like everything from our perspective, it's chronic at this point as the person I'm going to see. Most people with SI joint pain, it is chronic, right? They develop that laxity. So with that context, we're going to look at the whole body again, right? And the reason why we do that, Kim, is because if you've had SI joint pain for nine months, a year,
Kim Vopni (23:19.15)
Mm-hmm.
Anthony Carey (23:36.719)
longer like a lot of people will and more common in women than men is what ends up happening is everything about your movement, your apprehension, the caution that you use when you move is all now mapped together. It's all actually in a neuro representation in your brain, right? So if Anthony could come along and wave his magic, his corrective exercise wand, and suddenly the SI joint became stable, the rest of the system is still behaving as if it's got that limitation, right? So if we don't do things
beyond the sight of pain or dysfunction or diagnosis or whatever you want to describe, the entire nervous system is still mapped to that. So the body moves, the brain behaves as if that's still there until we provide it with credible evidence, we provide the nervous system with credible evidence that it is safe. So the SI joint is going to be lax. They're going to have symptoms associated with that. They're going to have secondary guarding.
lower back, probably into the hip muscles as well, the piriformis might be locked up, all those things. The last thing that we're going to do is immediately make them feel something in their SI joint, right? And so speaking of variability, the cousin to variability is novelty, right?
So if we introduce novelty, which means that their body has to do something different, right? So what we would do, let's just say I put together this exercise program after two weeks, we would literally change up the entire exercise program and not because the objectives have changed, not because they've maxed out the value of the exercise. It's because we want to introduce novelty and the result of them figuring out the novelty of how to execute this exercise comes with variability.
And so we build that into the system that way. what we would describe as grade.
Anthony Carey (25:33.531)
the exercises within a given program. So we might start with them on the ground doing something very simple and then we strategically escalate the exercise so that by the time they're finished with us, they're doing something that's fully integrated. that now that there's their complete motor system, their neurophysiology, their brain recognizes that here's all the pieces put together that way. And again, it doesn't mean that they maxed out what we did for them on week one. It just means that we want to introduce that novelty so that they're nervous.
Kim Vopni (25:36.622)
Mm-hmm.
Anthony Carey (26:03.455)
system is continually given problems to solve, right? If I do everything lying on my bed with my knees bent, my feet on the bed, I get really good at what I'm doing on the bed. I get great at it. But now I'm outside and I'm about to catch something that's going to fall off the countertop. Where's the relationship there? There's a huge gap in my body's ability to figure out how to solve that problem, that movement problem.
Kim Vopni (26:13.816)
Yeah.
Kim Vopni (26:31.074)
One of the words that you just use there was guarding and something that I see a lot of is tension and tension in the pelvic floor and guarding that happens because of fear of leaking or fear the vulnerability from prolapse or fear that this movement isn't safe and they need extra protection. So there is a lot of guarding potentially on an already restricted tight group of muscles. How often do you see tension as a
major contributor to pain.
Anthony Carey (27:04.733)
pretty much with everybody and whether it's an underlying cause or it's a secondary response, by the time it becomes chronic, that differentiation doesn't really make that much of a difference because it is present and it is part of the map again.
Kim Vopni (27:06.978)
Yeah.
Anthony Carey (27:24.931)
exactly how that the nervous system has associated everything that's going on as one program, a pain program that it's running. And so that obviously influences a little bit the strategies that we come after it. So everybody that comes in that describes that they have something tight doesn't mean that we're stretching it, number one, right?
That's not our first go to, we're not foam rolling something automatically because they describe it as being very tight. The follow up question to that is, well why is it tight? And then we could say part of it is driven by expectation and fear that's coming from conscious thought.
most likely that's contributing to it as well for anybody that's had stuff. Secondary could be what is the neural input, right? What is the message that those muscles are getting from surrounding joints and surrounding structures that are contributing to that tone as well, right? And so sometimes from our understanding of the literature and our experience, sometimes doing something either manually or with a foam roller for lack of a better word, there's many ways you can describe that, creates a window of opportunity.
Meaning that the manual intervention of the foam roller is enough to sort of influence what the nervous system is interpreting. And therefore we can take a proactive step following that. I've never felt that any kind of self-myofascial release in and of itself should be grouped as an exercise. It is what it is, but exercise comes from something being proactively done with the motor system, not something passive, a passive input that way.
Kim Vopni (29:03.81)
Yeah, I hear a lot from people with tightness in their pelvic floor that they have been directed to not do kegels. So the voluntary activation and relaxation of the pelvic floor. My, my message back is typically kind of like what you just said, we have to understand why something is tight in the first place. We can use different modalities to, you know, release tension, but tight is also
Anthony Carey (29:06.076)
you
Kim Vopni (29:33.398)
week and we do need to take muscles through the range of motion and apply load and strengthen that muscle as well. do you have a again I don't think that there's ever really a magic timeline for everybody but how quickly would you go to the motor system as opposed to just trying to release and release and release which is it's not just as easy as okay we'll just really just relax pelvic floor.
Anthony Carey (30:00.455)
Right, right, right. I personally, and again this is through our experience and we know that the body is capable of this, is that these types of responses can be almost immediate, right? If the input's accurate, right, which would be the exercise or the direction that we're putting things, where we're putting force or removing force.
the response can be accurate. Now it's not permanent. I'm sorry, it could be immediate and acute, but it's not permanent. But what you know by the result of what you're doing and auditing your intervention, then you know that you're on the right track. And then it becomes something they continue with as part of their homework. If you audit and you have the opposite response, then you know, okay, we need to change directions. But for example, using the pelvic floor, a tight pelvic floor as an example,
We might see it somewhere, we might see it in peer-reformers as well and all that being sort part of the same profile of what's going on with the person.
There's also a motor strategy called a post isometric relaxation that is beneficial to people. So if this is the status quo of my pelvic floor all the time, right? That's the norm, right? That's the baseline. And it becomes background. It's secondary. I'm not aware of it. It's like I'm not aware of the pressure on my butt on the chair right now, right? But if all of a sudden you get me to tighten that a little bit more and then relax, suddenly now I have a point of reference, right? And then I can track some
and then I relax a little bit more and I contract a little bit more and then I relax a little bit more and so that we're not as interested in the contraction as we are in the relaxation and how that influences the Golgi tendon organs which sends that response you know to the spindles and then we have the ability to sort of have a little bit more awareness in there and that would be sort of a level A or beginning exercise for somebody but it has value because they if they can sense that release right now that's just completely disrupted or scrambled
Anthony Carey (32:05.023)
the status quo for what their pelvic floor thinks is supposed to be a level of tone.
Kim Vopni (32:10.446)
Yeah there was an interesting piece of research that that was talking similar to what you're saying and it was it was looking at provoked believe it was provoked vestibulodynia. And having the people do a max voluntary contraction help to elicit a greater relaxation response afterwards and that is opposite to what you would typically tell that population to do it would always be like just relax just relax no no contraction no activation but sometimes as you say especially from a nervous system perspective giving that.
the input of what it feels like when they may not have been able to because they're just in that static statically held position is important. So yeah, I love that. love that. Yeah.
Anthony Carey (32:49.979)
it becomes a reference point, right? It points to different location that they can start to sense a little bit.
Kim Vopni (32:54.636)
Yeah and you said the movement doesn't movement changes the brain and it doesn't need to be perfect is something else that i think was an important point that you made where especially as fitness professionals i remember. Play back in the day i think this is like thirty years ago but i you want to be the best personal trainer and you you you are taught form and we have to have perfect form and where i am now is.
Life is not perfect form and we need to train in the variability and the diversity for for the times where it's not perfect. But that is something also that helps us build that resilience and confidence in the nervous system is where we are exploring something that isn't perfect form. Would you agree with that? I'm interpreting it. Yeah. Yeah. We're on the same page. You had also mentioned something about intrinsic.
Anthony Carey (33:41.277)
100%. 100%. Yeah. Yeah.
Kim Vopni (33:52.342)
So I want to kind of distinguish between intrinsic versus extrinsic. And what do you mean by that? And do you always want to start from an intrinsic perspective before going extrinsic?
Anthony Carey (34:04.311)
well...
I would look at intrinsic typically the way we associate it and well let's just maybe define it real quickly. Intrinsic is where we're either ourselves or we're asking our client to think within themselves of what they're experiencing and what they're feeling right and so you know pelvic floor exercises are a perfect example of that right because you're asking them to feel, sense, experience what's going on in the pelvic floor. It could be the same when we do things with the transverse abdominis. It could be things when we're further
glutes sometimes we're doing that sort of thing as well right so the awareness is comes from within so you would typically associate that was with the more remedial or beginning type exercises right because it there's there's less distraction we have the objective of the exercise in part is for the person to bring awareness and conscious thought to what they're doing with that particular exercise right
Extrinsic focus would be where now the directions, the cues, the thought process for the client is outside of their body.
And with that means that the goal, objective, whatever we're describing to them, the metaphor that we're using for movement is not where they're thinking about it inside them. The value in that now when we move more to the extrinsic aspect and it's typically more comprehensive exercise. It doesn't have to be super comprehensive, but there's going to be movement. There's going to be some stability requirements. There's going to be probably more than one joint involved in it at that time. But what that does is it allows the movement
Anthony Carey (35:40.275)
to become more authentic from the nervous system standpoint, right? So if you're telling, if you have people doing lunges and what you're describing to them is squeeze your glutes, right? That's not, that is conscious interference with the way that our software wants to sequence that movement, right? So we actually either over contract or under contract or we're late or early or whatever it is. But it's not the way the nervous system would do it based on the proprioceptive feedback from the ground and the joints as they
move, right? So instead we say, what I want you to do is I want you to step forward and reach forward with your hands towards this cone, right? And then I want you to push the earth away as you come back. Or know, something like that would be an extrinsic cue so that they're not thinking about squeeze this tight and that relaxed that sort of thing. So there's a, again, that's kind of a scale in that matches with the types of exercises that you're giving to a person. But
using the pelvic floor again as example or anything related to the SI joint. If you're telling people to contract or relax while they're doing like a three-dimensional multi-joint movement around their pelvic floor, that's not the end game I would assume, right?
Kim Vopni (36:50.83)
Yeah, yeah, yeah, and that's a as you're talking is exactly people will often say, you know, when we when I'm first teaching them what I call the core breath, which is an interpretation of kegels, I guess. They're usually they're seated on a ball or a chair or they're lying down on their back or they're in a wide leg child's pose. So they're in a static position. They often gravity neutral or they you know, they can feel things and they're very connected and then we get them upright and standing that changes things then we have it.
They're bringing it into a squat and initially there's a four week kind of build up process, I guess, where they're adding voluntary activation, but they will nine time. I would say even 10 times say out of 10, I can't feel it when I'm doing my squat or I don't feel my pelvic floor like I did when I'm doing lunges, like I did when I was lying on the back for this exact point.
The way that I explain is yes, there's a lot of other things going on and your brain needs to your nervous system needs to control a lot of things you don't you're not bringing your awareness there. But also, as you just said, this is not we shouldn't have to think about okay, voluntarily activate and now relax my pelvic floor and everything we do for the rest of our life. This is a retraining process we go through to build capacity and resilience so that you can do all the other things later on with
floor that's responding at the right time using the right amount of force that kind of thing but yeah yeah so that's a really good explanation with the intrinsic extrinsic side of things so what i want to i want to go into what brought you to creating the cortex and then the cortex sit which i had an opportunity when we were in san diego last year teaching you came and dropped a couple off and i have it right here i i sit on it quite quite frequently i really like the movement i don't sit on it when i'm talking otherwise i would be
Anthony Carey (38:16.538)
Awesome, yep.
Anthony Carey (38:39.207)
you
Kim Vopni (38:40.718)
over the screen. But can you tell us a little bit about what led you to develop that, the two versions?
Anthony Carey (38:47.677)
Yes, so the larger one that you can, you know, it's 30 inches in diameter, so you can do a lot more on it. the again, you know, what we started with in the conversation was my goal was to improve as many lives as I can through movement. And I can only do so much one on one. I can only do so much in groups. I teach and hopefully that. the other thing was, can I create a product that also introduces an environment for people to do a lot of different things and particularly driven by the concept of variability? Right. So any
unstable environment, whether it's a BOSU or a Wobble Ball, by its nature produces variability, right? And what we wanted to do is introduce something a little bit more in terms of what that environment can do for you in different ways. So it's not squishy like a BOSU, it's a firm hard surface. So it's like the floor doing a lot of different things. the idea first came, I was literally standing in a squat rack and kind of warming up and thinking, here I am going to do another linear movement, know, straight up and down.
playing stuff and that's not what I would normally do outside of the gym. So I started thinking, how can I make my body do some different stuff without me consciously creating that, right? So I could create all this three-dimensional movement but I'm still through conscious thought, right? I'm like doing this. But if I get on something that creates a response just by a slight subtle shift in my center of gravity and then I have to react to that and then it responds to me, then we're on to this ongoing pitch and catch, right?
that is a continual degree of variability, meaning different stressors to the tissue in the joints. I'm not loading the same structures over and over again. And at the same time, going back to that kind of problem solving analogy for the software, every time I do something different, my software has to figure out something or else I'm either going to hurt myself or I'm going to fall off. And of course, we have a handrail for progressing the learning, but we expose our tissue and our joints to all these different positive stressors. You know, there's guardrails.
on it, right? And metaphorically there's guardrails on what we would do. Same thing going back to our coaching cues and being, you know, drilling down to perfection. We put guardrails on but we got to let the body figure out and solve that problem in between. So the environment of the cortex was that when my wife had our second daughter and spending a lot of time sitting and our first child was a c-section, our second child was a natural birth but all of it was the feeding
Anthony Carey (41:17.277)
and that and felt that her body, you know, as so many of your listeners can relate to, was not what it was prior to birth. And she started sitting on the bigger product and kind of doing things, feeding the baby, rocking the baby, but using her abs in all these different directional positions. That eventually led to the idea of coming up with the Cortex Sit, which was a smaller, but also now making the top a little bit convex so that there was a little upward pressure on the perineum. And then there's also less pressure on the caustics and the
sit bones can kind of be on there and we can feel that. So the underlying premise again was creating introducing variability to the system by default, as a result of the environment we're in without us consciously or purposefully having to think about it.
Kim Vopni (41:59.566)
Mm hmm. Mm hmm. Yeah, I loved sitting on it and I was actually now that you've explained it, I initially it was harder than I thought it would be because I'd watched you online for a period of time. So when I actually sat on it the first time it was harder. But the way that you've explained that to me, I like that. And I also I've forever talked about the benefit of having something pressing up the roundness pressing up into the perineum to give good feedback, especially when we're interpreting the relationship of the breath. So I really love that.
the like it's it moves in all ways and it's my mind's also going because I'm now becoming obsessed with aging and balance and reducing fall risk, partly because I'm now post menopause. So I'm paying attention, but I'm also witnessing my parents who want my father is is is his mobility has gone downhill and he is very much at.
high fall risk now and just watching this generation and what can we do earlier in life to help us so i think of that even though it's sitting. I still feel like that something that's giving us giving our body that the messaging of those quick motions that we need to control it was that a good interpretation.
Anthony Carey (43:16.029)
Absolutely, we actually have cortex it is in a lot of active aging and senior living homes as well. Yeah, because if you think about it, we're the human body is really an inverted pendulum where we're heavier on top and lighter on the bottom. So if we can't control this big mass, we describe as a head, and trunk the hat. If you can't control that in space.
Kim Vopni (43:21.368)
it is amazing.
Anthony Carey (43:37.413)
You're at a disadvantage, right? So by teaching people to control that in a seated environment, it's a progression to more dynamic balance, right? Because unfortunately, so much of what's considered contemporary balance, whether this, and this is often applied to our active agers and our seniors is stillness, right? Balance is equated with stillness. Can you stand on one leg or can you stand in tandem but don't move, right? Well, actually what you need to be able to do is react to a change and
Kim Vopni (43:43.63)
Mmm.
Kim Vopni (44:04.622)
Mm-hmm.
Anthony Carey (44:05.563)
and have your nervous system create a response quickly enough so that that center of gravity doesn't get outside your base of support and boom. So if we learn to control it in a sitting environment, this heavy mass of the head, arms, and trunk in a dynamic environment, that's a great leadway into what you would do then standing and then adding some dynamic stuff once you're standing. So yeah.
Kim Vopni (44:26.882)
Yeah, with the cortex, the original one you mentioned, it's bigger. So is it something that somebody would, would you stand on it or is it still also to be used in a seated position? You can, okay.
Anthony Carey (44:36.989)
Yeah, yeah, there's a lot of extra it comes with that handrail or two handrails we have two handrails because some is in rehab and for seniors as well or one handrail on it, but it 30 inches in diameter is pretty big. So you can stand on it. do a lot of things that are standing on it, but you can also and we do a lot of mobility stuff with it using those motions to introduce different abilities to hit the tissue different ways with the different vectors that it creates. Lots of core stuff you can do with your hands on it as well and you can
Kim Vopni (44:50.403)
Yeah.
Anthony Carey (45:07.103)
It's big enough to kneel on, you could do bird dogs on it, all kinds of stuff like that.
Kim Vopni (45:11.246)
Okay, I need one of those toys. All right, where can people find you? And you learn more, potentially purchase their own Cortex or Cortex-SIT. What are all your details?
Anthony Carey (45:23.239)
Function First, which is the company that we've had for over 30 years now working with chronic pain, is functionfirst.com. First is all spelled out. And then Cortex, which is spelled with the C-O-R-E-T-E-X, is at Cortexfitness.com. And there's plenty of free information on both sites too, in terms of just people exposing themselves to these ideas a little bit more if they wanted to. And if there's any fitness professionals that are listening, we also have an educational website, which is Function First.
Kim Vopni (45:33.986)
Yes.
Anthony Carey (45:53.303)
ed.com. We have a curriculum that we've developed similar to yourself for fit pros to be able to bring this content and these approaches to those with chronic pain.
Kim Vopni (46:05.134)
Amazing. Thank you for your work and the products that you've created. Thank you for joining. yeah, it was a really, really cool conversation. And we're coming back to San Diego. We're revamping the course. And once it's all done, we'll be coming back to San Diego. So I'll let you know when we're back in town.
Anthony Carey (46:08.975)
Thank you.
Anthony Carey (46:21.629)
Can I can I make a comment about what I appreciated what you've done as well? About this is you know you I think what I've really appreciated what actually initially drew me to your work was that you've taken the stigma away from the whole idea of what's going on with women's health there, and I think that
Kim Vopni (46:27.82)
Yeah, please, thank you.
Kim Vopni (46:42.126)
Mm-hmm.
Anthony Carey (46:44.625)
that you've probably directly and indirectly opened the door to tens, if not hundreds of thousands of women who can see that there's hope and possibility and you your t-shirts and your, and the name of your podcast and everything is fantastic. And so thank you for that because I think that in and of itself is probably moved a needle dramatically for the field. So thank you.
Kim Vopni (46:58.176)
You
Kim Vopni (47:09.71)
Well, thank you very much. appreciate that. And yeah, it's never easy being being the first one talking about especially really awkward conversations. But yeah, I think I've definitely seen the needle move. There was somebody many years ago, a pelvic physio, and I don't know who started this, but they used when Twitter first came out, which is now acts and they we had hashtags, we had to learn what hashtags meant. And they said pelvic mafia. And I feel like I'm part of this pelvic mafia that we're out there trying to
to educate the world. So I appreciate your kind words. Thank you.
Anthony Carey (47:42.439)
Great job, great job.
