83. Expert Insights: Breath Work in Pain Management with Jill Miller

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Welcome back every bendy body. This is the Bendy Bodies podcast and I'm your host and founder, Dr. Linda Bluestein the Hypermobility MD. This is going to be a great episode, so be sure to stick around until the very end so you won't miss any of our special hypermobility hacks.

Linda Bluestein, MD (00:26.398)

As always, this information is for educational purposes only and is not a substitute for personalized medical advice. Today, I am so excited to have Jill Miller with me. Jill Miller has 30 years of corrective movement expertise that forges the links between the worlds of yoga, massage, athletics, and pain management. Her signature self-care fitness programs, Yoga Tune Up and the Role Model, are found at gyms, yoga studios, hospitals, athletic training facilities, and corporations worldwide.

Jill is the former Anatomy columnist for Yoga Journal and has been featured in New York Times, Wall Street Journal, Shape, Women's Health, "O" the Today Show, and is a contributing expert on the Oprah Winfrey Network. She is the author of The Role Model, a step-by-step guide to erase pain, improve mobility, and live better in your body, and a contributing author on self-myofascial release in the textbook, Fascia, Function, and Medical Applications.Myers and Walking Well. She is the creator of dozens of instructional DVDs, including Rolling Along the Anatomy Trains with Tom Myers and Walking Well with Katie Bowman and Treat While You Train with Kelly Sturrett, DPT. Her new bestselling book is Body by Breath, the science and practice of physical and emotional resilience. A couple of seasons ago, co-host Jennifer Milner and I interviewed Jill in an extremely popular episode, number 30, Focusing on Fascia. So be sure to listen to that episode as well.

Jill, hello and welcome back to Bendy Bodies.

jill (03:01.732)

I'm so happy to be here, Linda. Thank you for having me back.

Linda Bluestein, MD (03:04.426)

Of course, I'm so excited to chat about your latest book, which, which I have to. This is an amazing book. It's also available in Kindle, right? So people can like get it that way too. This is an incredible. Yeah. This is an incredible book. Um, so this book, body by Breath the science and practice of physical and emotional resilience, this is a beast. This book has, I think you could spend such an amount of time.

jill (03:17.518)

Yes.

Linda Bluestein, MD (03:32.63)

going through the exercises, reading through all the different things. There's the QR codes to do further exercises. It's just an incredible resource. What inspired you to write this book?

jill (03:44.484)

Yeah, the book is a very large book. It ended up becoming 480 pages. Believe it or not, Linda, when we were finishing up the first draft, we ended up cutting about 380 pages more from the book. So there were dozens and dozens of client testimonials and first case stories that we ended up.

Linda Bluestein, MD (03:59.649)

Oh.

jill (04:12.476)

deleting from the book because we didn't want it to become larger than it ended up being already. So how did it come about? There are many different tributaries to the formation of the book. This is really my life's work and much of this work is my own healing journey of going through my body to deal with my own mental health challenges.

that ended up being corrective work for soft tissue imbalances, that ended up being emotional self-regulation strategies. So there are many, many different areas of health and wellness and complementary medicine that this book fits into, which I'm really happy about. I'm sure we'll discuss on the podcast. But technically how it came about, about a dozen years ago, I was doing a webinar with my friend, Dr. Kelly Starrett.

He's a physical therapist. He's the founder of something called Mobility WOD. He's basically a, he's a God in the CrossFit space at the time. And he had a webinar on a platform called Creative Live and he was a good friend of mine. He and I had been collaborating on some YouTube videos that he had a very popular YouTube channel. I introduced him to my approach to self-myofascia release and breath based self-corrective work using my tools, the role model balls.

Linda Bluestein, MD (05:34.244)

Mm.

jill (05:36.06)

things that we talked about, maybe we talked about on the last podcast, but I introduced him specifically to a mobilization for the gut and the diaphragm using a soft, squishy, pliable, gorgeous ball, which is one of my tools. And I didn't know at the time when I introduced this to him that he is an asthmatic. And he was so blown away by what happened to him. This was

Linda Bluestein, MD (05:45.712)

Hmm.

jill (06:03.388)

during the videotaping. And what I'm talking about, like a three minute YouTube video. And by the way, when you're filming, you're under performance pressure. There's like this whole other stress that's going on, but he was so impacted and affected by what happened to him with this very, very simple self-treatment. And that is his mission. We have a shared mission of giving people permission to treat themselves. And anyway, long story short, that was part of the genesis of our friendship. He ended up bringing me onto this webinar.

to present on breath and to present on fascia. And I did two one-hour lectures on this webinar that was seen around the world. And the next day I got an email from his publisher. So his publisher, Victory Bell Publishing, they published his New York Times bestselling book, Becoming a Supple Leopard. And they reached out to me and they said, hey, we'd like to publish your book. And I wrote back, I don't have a book. And then they wrote back, write one and we will publish it.

And which is a gift, as you know, because you are also an author, it is not easy to secure a publishing deal. And I had this incredible opportunity to be able to share something with the world. It was so open ended, like write one. And so I really thought I wanted to write this book. I wanted to write my this gut based approach to self healing. I wanted to talk about breathing. But again, this was 12.

Linda Bluestein, MD (07:14.814)

Ha ha ha!

jill (07:28.484)

13 years ago and in the greater wellness and fitness space, breath was not trending. Breath wasn't interesting to anybody except for the yogis, the martial artists and movement professionals. Like, excuse me, not movement professionals, performing arts professionals like singers, dancers, instrumentalists who know they need to use their breath strategically, but it was not the thing. So I ended up...

Linda Bluestein, MD (07:35.01)

Mm.

jill (07:57.188)

deciding I would share my self-myofascial release approach with the world because I knew that rolling was a rising trend and I knew I had something very significant to share about that. So I wrote the Roll Model which you shared out in the intro. And I was hoping that it would go well because if it went well, maybe I would get the opportunity to write the book that I have really been wanting to write, which is Body By Breath. And this is, I mean, this is almost...

20 something years of writings that I've been doing on the topic of self myofascial lease, of emotional regulation, of breath-based strategies for health. And another eight years, I mean, they offered me a contract about eight years ago for this second book. And it took me that long to write it. There were a lot of things in the way, including having my second child, having a total hip replacement. And oh, by the way, there was a pandemic.

All of these things really gave me a significant writer's block. I would start and stop and start and stop, but I finally finished it. And in February, the book has been published and it's been an absolutely incredible book release and experience ever since then.

Linda Bluestein, MD (09:11.766)

Wow, so this is 20 years of work really in this book, but eight years of actually working on it.

jill (09:15.412)

Easy.

jill (09:19.436)

Yeah, more than, more easily more than 20 because I started, I started discovering this, the work that's embedded in the book. I started performing it on myself as a co-ed at Northwestern University. Um, when I was 19 years old or 18 or 19 years old is when I started to discover this approach or this experimentation that is now pervasive throughout the book and, um, is throughout my pedagogy.

Linda Bluestein, MD (09:47.794)

Amazing. And can you explain to us a little bit about how the book is organized?

jill (09:52.288)

Yes. Oh, thank you for asking. So the, I'm going to grab the book. So the book is, is heavy. It's 480 pages, but it's beautiful. It's a beautiful hardback. The first 200 pages are the how, why, and why bother. And it breaks down many different aspects of respiration. It breaks down the mechanics of respiration. It breaks down fascist science. It breaks down

Linda Bluestein, MD (10:09.366)

Mm.

jill (10:20.972)

aspects of the vagus nerve and influences on performance, the role of breath and performance. So all of the physiology and the science and the research, that's upfront. However, within the upfrontness, I understand how people can only take in so much. And there are off-ramps throughout the first part of the book that take you to QR code. So you can head to YouTube and I'll re-explain it for you more magazine style.

I'll re-explain things, I'll take you into body excursions. You can actually embed the experiences that I'm trying to describe in your body. And then the second part of the book are four different chapters of techniques. And the categories that help one with creating a body by breath are breathe, of course, breathe, roll, move, and non-sleep deep rest, also known as yoga nidra.

Linda Bluestein, MD (10:50.561)

Mm.

jill (11:19.928)

So those are the techniques, those are in the back of the book, or the second part of the book, rather. And then the very back of the book, there's two addendums, two appendixes that were frequently asked of me, constantly asked of me, actually. One is on scars and the other is on diastasis recti. So they didn't really belong into the interior of the book, but I wanted to be able to share strategies and somehow why and why bothers for that. And those are at the back.

Linda Bluestein, MD (11:35.898)

Mm.

Linda Bluestein, MD (11:45.99)

Okay, so this is really actually a combination of a book and a course, it seems like. Almost.

jill (11:53.28)

Yes, self-practice. Yeah, I mean we actually have a course so if people like want to be led Led more concretely and be able to easily create a programming paradigm around this. Of course, we have a course But yes people Who are more book learners will find that if they go through this and I give them strategies of how to you know Approach their own stuff their own Strategies

they can find ways within the book to be, to do self-guided work. We're also creating an app, because I understand there are so many people that are not book learners, they're more kinesthetic learners or auditory learners. So that app, which will live on our website first before we create the app, is coming soon. We've been editing it for the last couple of months.

Linda Bluestein, MD (12:40.77)

That's really exciting, because I feel like a lot of people like to learn in snippets. And maybe they might have the book in one part of their house or one location, and maybe the app. Yeah, we always have our phone on us. So I think that's going to be a really cool addition to all of your incredible offerings. So that's going to be an exciting thing also to watch for.

jill (13:03.208)

Oh, for sure. And it's over a hundred different exercises. So there are, there are so many things to get out of it. And you can really create your own compound pharmacy to induce the relaxation response, which this is really, really geared towards you being able to tolerate a parasympathetic state as a help towards your own embodied resilience.

Linda Bluestein, MD (13:30.03)

Mm-hmm. Yeah, and I wanna make sure we can dig into all of what you just said. So hold that thought while we talk a little bit about why bendy bodies should care about fascia. I feel like we should back up and start there as we start to get a little bit more into some of the details about this topic.

jill (13:50.884)

Great, well, I hope that your listeners do go back into the archive and listen to our first episode together. I re-listen to it in preparation for connecting with you. But the reason we should care about fascia is because collagen is our most pervasive molecule in our body, in the body, in terms of the formation of all structures in our body. And if your collagen is the...

um, afflicted bit of your being because of your diagnosis, then we need to pay attention to really all parts of the body. But your fascial tissues are the organizing tissue of the entire body. It is the structural scaffolding that gives every organ its ability to have form and shape. And that includes your muscles. That includes your liver.

Doesn't include your brain. Brain is very special. But all the other parts are collagen-based tissues. And so understanding the reliance of our mobility and our stability from collagen that has good integrity, it's imperative that we look at how are we impacting, first of all, how's our fascia impacting us and how are we trying to impact our fascia in the way that we move

train and move our bodies through space or stillness.

Linda Bluestein, MD (15:23.034)

And obviously we did talk in the other episode, my recollection is we talked for sure about self mobilization and some of the techniques that you teach. If someone has a limited budget and they want to get the book and they want to get some props and things, where do you recommend that they start?

jill (15:40.468)

Well, obviously the book is a great resource, but if resources are limited, go to your library. Don't worry about buying the book. Go to your local library and request it. Request it multiple times. They'll get it. It should be offered for free to the public. I actually obviously need to pay for my own life here also, but we can take advantage of public resources in that way.

Obviously, I'm also an entrepreneur. I will always encourage people to get the tools that I provide, but you can use tools that you might have around your house as long as they are pliable. We can talk about why that's important and have a bit of grip and aren't injurious to your tissue. I think there's one tool that seems like almost everybody at this point in time has or has been gifted, and that is just a simple yoga mat. If you roll up a yoga mat or an exercise mat, the...

the front or back of a yoga mat has a ton of grip and you can roll the mat up to a cylinder shape that has just enough density that you're able to use it for a point-based massage into different parts of your body that may be ailing. So while I am a soft tissue, excuse me, while I am a self myofascial researcher, in addition to being an entrepreneur,

This should not, you shouldn't, you don't need only these tools and you don't need only this book. There are free resources. YouTube is a free resource where I've put many, many videos. Our website has many articles that detail the how, why, wherefore of self-myothosha release. So I encourage people to not be discouraged by a financial wall that might feel it blockades you from

these self-treatments. They are available for free if you can be clever about it. So that's where you can start. But if you are willing, if you have the finances to invest, go to Amazon, get the role model, go to Amazon, get Body by Breath and head to our website. And you would get something called the, the role model starter kit. The role model starter kit gives you all of the balls that we, that we, that we sell.

jill (18:00.356)

Um, and I always encourage people to get a second Coregeous ball because frankly, um, there are a number of different spinal decompression exercises that are throughout body by breath, not in any other, they're not, there are no place else, except for my online library. I teach these spinal decompression exercises that are not just for decompressing the spine, but what they do is they are. Profound at adjusting autonomic tone. Um, and that is very important for a bendy body.

to be able to have a reliable input that can take you out of a highly anxious state and help you ground into your body, help you feel at home in your structure, give you a place to land. And so that's one of the reasons why the tools in general are so helpful, but there are specific exercises in the book that I typically highlight when I'm being interviewed, because I think

They're helpful for all bodies, whether you're bendy or whether you're physical, um, that will immediately change autonomic tone. And they are, these are so important for our ability to think clearly, to be able to make decisions and frankly, to just relax, to be able to chill.

Linda Bluestein, MD (19:02.692)

Yeah.

Linda Bluestein, MD (19:16.678)

And I'm so glad you just said that about whether you're bendy or stiff as a board, because I think sometimes it is confusing that you can be bendy and stiff within the same body, right? So I think that some of these tools are particularly helpful for that. So I used to be very hypermobile when I was younger, but because I went through a period where I didn't stretch at all and I just got like tighter and tighter, now I have mostly things that are tight.

jill (19:43.812)

Right.

Linda Bluestein, MD (19:44.214)

So I think that's an important point for the listeners that we call this the Bendy Bodies podcast recognizing that some people have more historical bendiness and they're not bendy anymore. So could you talk a little bit about if someone has like a mixed picture like that and what they might be beneficial for them?

jill (20:07.64)

Yeah, it seems like a paradox, but it really makes a lot of sense. And I get this question, let me put my book down. I get this question every time I post something about hypermobility. I get a lot of people that are afraid because they've heard, okay, I'm too bendy. I shouldn't stretch and I probably shouldn't roll because rolling equals stretching. Let me just dispel that myth right away. And I think if you probably listened to my friend, Libby Hinsley, you guys interviewed her as well.

Linda Bluestein, MD (20:29.122)

What?

Linda Bluestein, MD (20:37.579)

Yep.

jill (20:38.308)

for Bendy Bodies. She explains this so beautifully in her book. And also I'm pretty sure I'm listening to the podcast that you did with her as well. There will be parts of your body that I call bully muscles. There are going to be tissues that do the work for the rest of the guys because it's like, I'll handle it. My upper trap, my upper trap and levator, I'll handle this neck instability for all the other lax ligaments that are not coming online.

So something has to take control so that your body doesn't feel like it's gonna fall apart all the time. And this is not your conscious doing, this is your brain deciding which tissues are going to be hypertonic in order for you to not fall into a puddle on the floor. I'm obviously exaggerating. You're not gonna fall into a puddle on the floor. But in order to maintain your posture against gravity, something's gotta support you. And if it's not gonna be the deep intrinsic muscles, which should be doing their job,

It's going to be these more superficial ones that are like full of knots and kinks and tension. But that's also not, if you listen to the work of Tina Wang, also she'll talk about this also. I love Tina's work and have encountered her via the Fascia Research Congress. So you can look up that podcast too. I am like a Rolodex for your podcast. I share your podcast all the time. So you're welcome. So what I need to do.

Linda Bluestein, MD (21:59.895)

Oh, thank you so much.

jill (22:03.74)

do is I need to help my body and my brain to no longer feel like it has to be on guard in order to treat those tissues that are hypertonic. If I'm not treating those tissues that are hypertonic, my exercise practice more than likely is going to bypass them because a muscle that is locked continuously in contraction isn't really going to contract well anymore.

So I need to figure out different ways, different strategies to reduce the bracing response throughout the body. And that muscle bracing response, also known as resting tone, right? So my, my resting tone is not restful. It is extremely metabolically expensive to me day in and day out. And so that is one of the reasons why body by breath type of work.

is so helpful for a bendy body, because it addresses holistically your entire autonomic tone. It switches off that gatekeeper that's telling your upper trap, your left psoas, your right soleus to stay on guard and tight all the time. Then once I reduce that miserable resting tone, by the way, you're going to feel even looser than before. That's when I can

Linda Bluestein, MD (23:25.742)

I'm gonna go.

jill (23:27.684)

then use an implement to roll those areas that tend to be hot spots. And then, then do exercise protocols based on whatever you like to do. You know, whether it's, you know, Pilates or gerotonics or it's isometrics or yoga tune up or, you know, whatever, or weightlifting, whatever is the strategy that helps you to feel put back together again. But then you're going to have more available tissues to both lengthen and contract through their entire.

entire movement cycle so that over time I can continuously remodel this body and this brain, this brain overriding resting tone challenges that typically bendy bodies face. And that really is the protocol. It's not just, oh, just relax. Yes, relax so that we can turn off this guard dog that is always on guard and then massage him or her.

Linda Bluestein, MD (24:16.558)

Thanks for watching!

Linda Bluestein, MD (24:21.966)

I'm sorry.

jill (24:26.6)

let those tissues and the fascial tissues that accompany it and also the unfortunate abundant logjam of inflammatory cytokines that might be in that area from the tonicity. And I can flush that stuff out through rolling and then I can start to retrain those tissues to learn a new behavior pattern. And that's going to be a lifelong process. What I tell my Bendy people

Don't go after your joint junctions the way your Viking neighbor would. Stick to the center, stick to the muscle bellies more so. So that would be the big differentiator of rolling strategies if I'm working with different hypermobile populations is let's not focus so much on joint junctions, but let's focus on the muscle bellies more so than on Golgi tendon and myotendinous junction regions because of the risk of dislocating.

also use softer tools. There's no, you know, the softer the tool, the safer it is in and around a joint junction. So if I'm using a hard foam roller or lacrosse balls, I really do risk overstretching delicate tissues, creating bruising, irritation, further overstretching or dislocates. But it like the yoga tuna balls are so gummy and chewy.

Linda Bluestein, MD (25:51.436)

Ha!

jill (25:53.326)

and have this amazing grip that they're able to receive the bony prominence without further punching at it or irritating that region.

Linda Bluestein, MD (26:06.862)

And I love as you're describing this because this is exactly why I am not a fan of muscle relaxants. Muscle relaxants, the biggest benefit that people get generally from them is it makes them sleepy. So it kind of relaxes them that way and kind of will generally relax muscle tone. But then of course that may, like you said, increase someone's risk of subluxation, dislocation, et cetera. It's not doing anything for the actual...

jill (26:13.784)

Mmm.

Linda Bluestein, MD (26:33.342)

local hypertonicity that you said is trying to compensate for other things. And I love that bullying muscle concept. A lot of my colleagues, that's one of the first things they do is they prescribe muscle relaxants because tight muscles are painful muscles, right? But really what you need to do is address the root of the problem and not just put a bandaid on it.

jill (26:56.012)

Yeah, it also the muscle relaxant doesn't address the irritants local in the tissue because of the tissue congestion, because of the stagnation of lack of movement. That needs to be moved out. You can call that movement of lymphatics. I'm talking about movement of the extracellular matrix and the inability for the vesicles to decongest.

And what's in that area, when I have a muscle that's in chronic contraction or a number of fascicles within a muscle that are in chronic contraction, you get a backup of cell death, frankly, which is what I call the poo and pee of the cells. And we need to flush it out of the toilet. And the therapy ball movement, the therapy ball rolling, the pressure of it, gentle pressure, as well as then...

doing correct contractions after, that's what really is going to move that stuff out.

Linda Bluestein, MD (27:53.162)

Yeah, that makes a lot of sense. And besides working towards the middle of the muscle, working with softer tools, etc., as you just described, are there other certain exercises that you think are most helpful for bendy bodies?

jill (28:07.48)

Well, yeah, so many. Oh my goodness, where do I start? I think, I think what we're, like there's a million. What I, what the, excuse me, mistake.

Linda Bluestein, MD (28:08.831)

I'm sorry.

Linda Bluestein, MD (28:15.585)

Ha!

jill (28:29.932)

I'd like to just cycle back or refer back to something I mentioned earlier, which are these spinal decompression exercises using two Coregeous balls. And maybe let me describe that in detail. But before I describe that, I want to reemphasize that the bendy body may have...

pervasive challenges in tension in so many different parts of the body. So we talked about this resting tone, not being restful. Also that resting tone, not being restful recycles this anxiety that end bodies are known to already have higher rates of anxiety than other bodies. And so this tension begets tension.

So the first thing is we wanna be able to do movements effectively that address our emotional tone, that address our state. And in the book, I outlined something called the five P's of the parasympathetic nervous system. And if I can do exercises that take advantage of these five P's, then I'm almost...

guaranteed that no matter what thing I choose in the book or what exercise I choose that I found on YouTube, you know, from our output is going to be beneficial to me. Should I describe the five P's and then I'll get into the double cord? Okay. So the five P's are the first P is perspective. Remember, these are five P's of the parasympathetic nervous system. We're trying to do things that allow us to first let go of.

Linda Bluestein, MD (30:07.502)

Sure.

jill (30:21.02)

tensions, both known and unknown. So the first P is perspective, and perspective has to do with mindset. And the mindset is about allowing your embodied experience to occur. Now, when we start to go into deep relaxation states, often what happens is we get uncomfortable, further uncomfortable, great, emotional, right? We can start to experience

the disappointment that we might have about our pain or other emotional disturbances that tend to rock a highly sensitive, bendy body person, maybe a little more than the next person. So we wanna make sure that all of this is allowed, that our body is a safe place for the experience of our body to take place. So the one I'm currently working with in terms of perspective is all of me is welcome here.

All of me is welcome here. Yeah, it feels good, right? That, especially like if I'm nervous before doing a podcast on the Bendy Bodies podcast, and I know I'm gonna say a lot of goofy things, I might misspeak, you know what? That's just a part of my humanness and how fast my brain works. All of me is welcome here, that's fine. And that really helps me to allow whatever's gonna transpire to transpire. So whatever your mindset is, I think it's good to frame it for yourself.

Linda Bluestein, MD (31:19.067)

Ugh.

Linda Bluestein, MD (31:22.207)

Love that.

Linda Bluestein, MD (31:27.094)

Hahaha!

jill (31:48.28)

so that you can welcome the experience that's coming up ahead. Another one that's really good and generic is, I embody my body. That seems to be one that most people can, I'll take that one on. All right, so the second P is place. And the place must be safe. For a body to truly relax, you have to feel like you can let go. So take that into account. I mean, I have a studio and this is also my workplace.

That really helps me to chill out. But hopefully maybe it's the bathroom floor for you, maybe it's a closet, maybe it's your bed. Find yourself in a place that's safe. The third P is position.

When we bring position into the relaxation stew, it allows us to take advantage of the baroreceptor reflex. Now, comma, I know for the bendy people, you're like, but I have orthostatic intolerance. I get super dizzy. Or I might have a heart condition. Like laying down is challenging for me. Let me just say in a body where

that is not an issue. Typically, if the heart is slightly higher than the head, the bare receptor reflex kicks in, which is that essentially your brain can only handle so much blood. And if you're just a little bit upside down, like say you put your pelvis on a couple of blocks, on a yoga block or a gorgeous ball or a stack of books, then you have a gentle slope in your body. And what that gentle slope does is your blood starts to rush towards your brain. And then the...

the stretch sensors in the side of the neck that are mediated by the vagus nerve, they start to sense too much fill happening in those vessels and there's a very quick reflex arc that happens in the brainstem, which basically slows down the heart rate and narrows all the blood vessels. And so that slowing down to the heart rate and slowing down to the breath pace is an inherent implicit relaxation response built into your body, comma, my bendy body. People.

jill (33:57.552)

Please know your own tolerance for an incline like that or a decline, a slope like that and proceed accordingly. So for some of you, it might just be, let me just lay down in my bed. I don't necessarily need to prop my pelvis up, but we wanna take advantage of that for the relaxation response. And of course, when you come back up right later, just take your sweet, sweet time and apply precautions there. All right, so we've got position is

Get grounded. Let gravity help you. That's the short story of position. So we have perspective, place, position. All right. Number four is pace of breath. This is where the breath part comes in. We haven't even talked about breathing. Oh my gosh, Linda, we are all the way to the spot. We haven't talked about breathing. What's the point? Like there's a diaphragm in there. And I'm not gonna go into a huge long lecture about breathing. I'm gonna keep this really short. In terms of the relaxation response,

Linda Bluestein, MD (34:42.648)

I know.

Ah!

jill (34:56.088)

Extended exhales typically are the thing that helps you to downregulate. But here's the other thing that helps you to downregulate. Breathe slowly and not like you usually do. Meaning just change your breath pattern so that you are breathing more slowly and you're breathing at that pace consistently for three to five minutes. And when you look at all the research on breathing, it's like fast breathing is going to pep you up. Um.

But bottom line, dive into a new breathing pattern that's lower than usual and try to make your exhales a little longer, and that's going to enhance your relaxation response. All right. So that's the fourth P. What's the fifth P? Palpation. How do we do palpation in body by breath? We can do it with balls. We can do it with hands. We can do it with objects that are strategically placed to mitigate.

that unconscious muscle bracing and or to go into certain portals of tissue within the body that are known to enhance the relaxation response. So any questions about that before I get into like this decompression exercise that I keep teasing?

Linda Bluestein, MD (36:14.98)

The only question I have is if you have any of the balls to be able to show us, we will put this up on YouTube at the same time that the audio goes out. And I think it would be helpful for people to see if you have any of those props nearby.

jill (36:26.468)

I sure do, I always do. So this is the Cordus ball. It's about the size of my, well, I have a very long head, but if I had a long head, that's the size of a Cordus ball. And it's made from a grippy pliable air-filled rubber, and you can always modulate the film. So it can have less air in it if you don't like to have that much displacement in your structure. And then we have a variety of

Linda Bluestein, MD (36:34.73)

Ah!

jill (36:55.092)

solid rubber balls that are made from a grippy pliable rubber in three different sizes. So right now I'm holding up the lime green ball is called the yoga tuna ball and the this is smaller than a tennis ball. The therapy ball plus is the medium size. It's slightly larger than a tennis ball and then the alpha ball is slightly smaller than a soft ball but all of them are made from a squishy pliable rubber and they have a ton of grip so

when it takes a hold of tissue, I'm putting this on my chest right now for people that are listening and I'm turning it. And as I'm turning it, it's twisting my tissue into a vortex that's grabbing the skin, grabbing the fatty layer, grabbing superficial fascia, transmitting stretch all the way to deep fascia muscle, all the way down to the skin of the bone, all the way down to creating stretch upon the periosteum. And so that grip is really important for exciting the many, many different sensory neurons.

that are pervasive throughout your fascial tissues. And that's another really important aspect of the rolling is that while it's affecting all these autonomic aspects, that's really the emphasis of body by breath, it's also affecting the proprioceptors, the mechanosensors in those tissue, so that when you do roll, it helps your brain know how to locate those tissues in your body, and then they're better able.

to contract and you're better able to sense those contractions. So that's a really big bonus that has been shown in the research that rolling enhances force production and it also enhances proprioception. Those are two big wins for a bendy body that trips and is inelegant unless they're doing their sport or their dance. Right?

Linda Bluestein, MD (38:34.306)

Mm-hmm.

Linda Bluestein, MD (38:42.014)

Yeah. And it's so common for people to not be able to feel their knees go into hyperextension or their elbows going to hyperextension. It's hard to avoid something if you can't feel it. And I love what you just described about as you were showing it on your chest and the stickiness of it. Dr. Helen Langvian, I'm not sure if I'm pronounced.

jill (39:01.718)

Longevin. Mm-hmm.

Linda Bluestein, MD (39:02.678)

Blangevin, yes. She talks a lot about the stretch of tissues and that's how acupuncture works, right? They put the needle in and then they twist. And so when we think of stretch, sometimes we think of big stretches. We don't think about just, it's just this small amount of stretch that we need. But when we move less and less, we don't get that kind of...

jill (39:09.637)

Yes.

Linda Bluestein, MD (39:22.926)

little bit of stretching and so we get more inflamed, we get more tension and a lot of other problems like you said, inflammatory cytokines and all kinds of bad things happening in the body and I love what you said about the muscle poop and pee too, accumulating.

jill (39:38.052)

Yeah, I try to keep it simple.

Yeah, those local arousal of areas of tissue to enhance proprioception, it really is profound for a bendy body because it gives you a sense of place in your structure. It gives you an end feel, and that is something that is so missing. I really like to have those palpation, those tactile elements.

to give the biofeedback, but also the benefit of that versus a muscle relaxant is it propagates better force production and better force control of those areas that are rolled. That is such a benefit. No weary side effect. You're not going to be weary and leery and groggy. Your body's going to be more alert in the best possible way. So we keep teasing this exercise.

Linda Bluestein, MD (40:38.562)

Hahaha.

jill (40:41.664)

This exercise I like to call, oh my gosh, it's the worst title of an exercise. I don't even think I can say the whole, it's so long. It's low back decompression via the lateral raft. Great. It's a tragedy that I named it that, but it's so important. I have it in the book twice. I have it in the early pages of the book, and I also have it even further detailed in the back of the book, and I have it as a QR code.

Linda Bluestein, MD (40:53.288)

Oh my.

jill (41:10.424)

want people to do this exercise, not to make you more mobile bendy body people, but to enhance your ability to sense your, to sense your low back, to sense your rib cage, to sense your pelvis and to be able to sense the, the profound interrelationship of your respiratory diaphragm to everything from pelvic floor to face. This, this one exercise, I'm going to sell it all to you and give you the relaxation response. It takes advantage of all five P's as I...

Linda Bluestein, MD (41:34.91)

Hahaha.

jill (41:40.104)

described before. But where do you put the balls? We have to do a link in the podcast notes to the link on YouTube. All right. And we can do it. I have one on Instagram and I have it on YouTube. It's that important. And if you don't, by the way, if you don't have two gorgeous balls, like I'm showing you right now, you can use two rolled up yoga mats or you can use one yoga mat and one, you know, you don't have two yoga mats.

Linda Bluestein, MD (41:47.15)

Are you sure? Yes, we will for sure.

jill (42:08.204)

you roll up a towel or you fold a pillow. It's not gonna be as effective, I'll tell you right now, because you wanna have the grip. Okay, but where the ball goes, looks like I'm taking off my pants, but I'm not revealing my low back. I just hide my shirt. Didn't expect to show you anything here. Okay, I'm also tethered by this cord. Turn this way.

Linda Bluestein, MD (42:20.564)

Hahaha

jill (42:33.58)

Okay, so the two balls are placed on the sides of your low back, to put it simply. What they're looking for is a connective tissue aponeurosis, a fascial aponeurosis called the thoracolumbar aponeurosis. And this is like a terrible view because I can't walk further away. But the balls are together on your low back. They're not going to be on the sides of your waist, but they're going to be just

Linda Bluestein, MD (42:57.054)

Ah!

jill (43:02.752)

inland from the waist towards the low back. And then you lay on the ground and it feels like your low back is resting in a hammock that stretches your low back from side to side. So when you lay down your sacrum will be actually firmly on the ground. Your low back will be tractioned across. So it feels like there's two massage therapists with a four-handed massage.

pulling your tissue laterally instead of vertically. So when people see balls, they're like, oh, roll up, down, up, down, up, down. They always wanna roll up and down their spine, but this doesn't even touch the spine. What it does is it will lay there and you'll breathe for many, many minutes, not feeling, you don't wanna feel like you're in hyperextension of the low back. You don't wanna feel like you're in a back bend. Shouldn't feel like you're in a back bend.

The rib cage is also on the ground and the head is on the ground. And so the first few minutes is just breathing into the right and left balls and moving your breathing into the perception of movement in your back body. Um, the time under

The time under, I call this intention, not time under tension, but the time under intention here, of course, with your perspective in place, is to get a sense of the excursion of these lower ribs into the ball, the balls. And this is an experience of the movement of your respiratory diaphragm, which, first of all, you can't really sense your diaphragm because it doesn't have mechanosensors that tell you where it is in space.

It's really, really profound to be able to feel its impact here in your low back. And in the meantime, this is also tractioning the sacrum, fourth, third, second, first, and the thoracolumbar junction as well. So places where bendy bodies tend to, and all bodies tend to have extreme hypermobility, but usually the treatments on the back are not these horizontal strokes. So you'll have an.

jill (45:16.316)

incredible sense of length and decompression, this traction experience. Within that, I start to have people do tiny pelvic tucks and untucks, and that creates an undulation-like movement. So then you'll start to create little tiny movements, spinal undulations, that will have a ripple effect from sacrum to skull in tandem with the breathing. So we add up all of the five P's.

Linda Bluestein, MD (45:28.483)

Mm.

jill (45:45.564)

together here with the palpation, with the perspective, the position, the pace of breath, and a little bit of movement in there to increase this palpation experience. Then you take the therapy balls out after two to five minutes, and you will have flipped, what I call, flipped on your off switch. So this will change resting tone.

And then from there, this is one of the things that I do when I'm really spun out, but it's also something that I like to do before I do core training. Because now I know I no longer have muscles that are gripping unconsciously throughout my spine. Maybe it's your left QL, maybe it's your right psoas, maybe it's your multicellular in your mid thoracic. Who knows what it is? There's so many, there's such a per...

profound pervasive relaxation response that happens throughout here. And now you can try to control the muscles, turn on muscles you want to turn on and slowly rebuild your core strength, which is a great place for bendy bodies, bendy people to start from. So I think that might be a good recipe.

Linda Bluestein, MD (46:52.33)

That sounds like a fabulous one and people who are in chronic pain tend to breathe very shut.

Linda Bluestein, MD (47:03.384)

Mistake.

Linda Bluestein, MD (47:08.212)

Oh my gosh.

jill (47:10.616)

It's dry where you are.

Linda Bluestein, MD (47:13.194)

It is incredibly dry. And I struggle more in the morning than I do later in the day.

Probably my coffee doesn't help. I love that exercise so much. And especially as I'm thinking about people in chronic pain and how so often once we get into chronic pain, and I know I've done this a lot myself, we start to breathe more and more shallowly. Because I think some of the things that at least I've struggled with as an anesthesiologist, who I put people to sleep, I control their breathing, I've been breathing my whole life. And so then I hear things about breath, and I'm like, well, but we just do that.

right? But we could be doing it in a way that is not serving us, is the point.

jill (47:56.22)

Oh my gosh, can we talk about breath now? Oh my gosh, at this point, the book is called Body by Breath. So this exercise is, all the things you just said is so helpful because it pours our attention into what I call zone one of respiration. And that is the stuff below the rib cage to try to improve the excursion of the diaphragm into and upon the tissues

Linda Bluestein, MD (47:59.147)

Yes.

jill (48:26.1)

that it rests atop of, which are all your different abdominal layers, all of these organs, obviously the pelvic floor as the basement membrane of diaphragmatic impact. So it attunes us to being able to improve this zone one range of motion for breathing. And when we get into zone one breathing, again, which is this area below the diaphragm, it's

It's happy place is parasympathetic dominant state. So it's going to turn on a relaxation response. A body in a high pain response is typically going to be in either a zone two, which I'll describe, or worse, a zone three. So zone two breathing occurs in, and by the way, this is my model. I have this modeled out in the book. It's not medical. It's just a helpful model in terms of, well, how are we going to treat these different myofascial tissues?

throughout the trunk, head, neck, and face based on somebody's pain, movement, and breathing patterns. So the zone two occurs within the rib cage itself. And that is an important area to breathe. That is our area of breathing for sport. That is when the intercostals and diaphragm collaborate to allow for the ribs to upwardly rotate on inhale and downwardly rotate on exhale. This is the area that we breathe in when we're excited, when we're hype.

When we're lifting heavy loads, we should not be breathing in our gut area. When we're lifting heavy loads, we should be bracing there and having the mobility of breathing happen in our zone two. But we don't get as much saturation if we're exclusively a zone two breather. And often what happens if we tend to be a zone two breather day in and day out, we don't tend to have good exhale capacity. We don't tend to really get all the air out.

And what can happen is that can deflect us into zone three. And zone three is when we use muscles of the face, neck and shoulders to get there in, right? And you can see that in the panther, you can see that in the body in fear or shock or even quick bursts of delight, like orgasm, typically is some zone three breathing in there. So this is not always diabolical to be a zone three breather.

Linda Bluestein, MD (50:25.795)

Hmm.

jill (50:46.836)

But it is, if that's your consistent way of breathing, it's truly harmful because it's so metabolically costly to use your scalenes and your sternocleidomastoid and your trapezius and your levator scapula to get breath into your life. We want to use them in case of emergency only. And so this model for me of the zone one, zone two, zone three really helps. I think it relates to the pain model.

It relates to movement models and it does help people to be able to map their emotional state models because it's going to map with state. You're going to be in a high stress state if you're zone three. You're going to be in a more sympathetic dominant state if you're in zone two, and you're going to be in a parasympathetic dominant state if you're in zone one. What's ideal? A blend of zone one, zone two, and then zone three sparingly in case of emergency.

Linda Bluestein, MD (51:41.934)

And so if someone is listening to this and says, wow, I think I must spend a lot of time in zone two and three, and I want to learn how to get more into zone one, what can they do?

jill (51:52.78)

Listen to the podcast again and do all the things, do all the things in body by breath and jump over to my feed and just find so many different, you know, free posts that describe how one can turn on their off switch and co mingle these five P's and these principles that can allow you to stay present in a parasympathetic state longer and longer. Cause it can be.

Linda Bluestein, MD (51:54.338)

Ha ha ha!

jill (52:21.476)

It can be pretty scary. And I think that when I say scary, it's because when people start to let down their guard, they start to have their feelings, right? The feelings that we've been running from or the feelings that we've been avoiding or the feelings we'd rather not experience. And so that is part of enduring the relaxation response. And that's why having the first P, the perspective is important. And then of course,

Linda Bluestein, MD (52:33.62)

Mm-hmm.

jill (52:49.308)

You want to make sure that you're communicating your feelings with paper as in journaling or providers. That's another P. Oh my goodness. Or people's that you love. Right? So find your people to share this experience of your own, this developmental reach for you.

Linda Bluestein, MD (52:59.298)

Two peas, two more peas.

Linda Bluestein, MD (53:12.694)

You just added three more P's to your five P's. I love it, it's like me with the B's, you know. This is always adding more. So I love it, that's fantastic.

jill (53:14.236)

Mm-hmm. That works.

jill (53:23.96)

we can have a new podcast called The Alliteration Sisters.

Linda Bluestein, MD (53:27.174)

Right, right, exactly. I love alliteration. So we may have already covered this and if so, that's totally fine. But are there other self-fascial treatments that can help hypermobile bodies breathe better?

jill (53:43.084)

To breathe better. Yeah, so I think one, so we did this deep gut thing. You can also do that similarly in the ribs. You can you know, attune the tools, obviously, to your stretch, your pressure tolerance. So for many people, if you're like, I'm afraid I might dislocate, go to the wall, lean against the wall. Like, use the smaller firmer balls, lean against the wall. There are neck things that are really helpful for the hypermobile person and I don't have time to describe all of that, but

A really short, easy thing that I think can be very helpful for zone three, hypertonicity, is just a finger massage on the cheeks, the forehead, plucking on your own sternocleidomastoid. It's not illegal to do that. So right now, you can see I've got a very prominent one. Everyone's like, your sternocleidomastoid is so tight. I'm like, no, no. It's...

I, you can see every piece of my anatomy because of my mobility. You can see through me, like a translucent, um, uh, muscle. Um, so this is a very nicely compliant SEM. I'm not concerned about my SEM. Um, but anyway, you can pluck on that and, uh, you can also take your fingers right onto, this is really helpful for my TMJ people too, like the front of your, your chompers, your front of your masseter, like you had a horse bit and you could just, uh,

Linda Bluestein, MD (54:39.997)

Ah!

Linda Bluestein, MD (54:44.022)

haha

jill (55:06.192)

do some pressure against your masseter. How do I know I'm on the masseter? Just try to clench your teeth and you'll feel the front border of that muscle pop in. I don't need to go on my jaw joint, but I can just latch there. And I can also use my, sort of the ant chubby cheek technique and pinch that muscle and pluck it out. And if you're like, I don't want to touch the muscle, you know what? You can pinch the skin of the face and traction it away.

Allow yourself to breathe. That's really great to actually decondress the maxillary sinus. I'm doing all of this on camera. That's why I sound funky, folks. So I can do skin rolling along the face. And it's so accessible. You can also, of course, do this with the Ogatuna balls. But when I say skin roll, it's pinch and walk your fingers all around the mask of your face. Because these muscles, many of these muscles are floating superficially.

Linda Bluestein, MD (55:41.454)

Ha ha ha!

jill (56:02.128)

very close to the surface. And so I can access them. Why are these muscles? These muscles are, many of them are innervated by the facial nerve, some of them trigeminal, but the facial nerve and the trigeminal nerve, by the way, share source nuclei with the vagus nerve. And so just by doing face-based massage, it can slow down, it can slow down my stress response. It can alter the high heart rate.

So I can slow down my heart rate, I can slow down my breath pace. And this is all just like right here at your face. Wash your hands first, especially if you're going anywhere around the eye, I have to say that, with soap and water. But the face is a great, easy target. And you can do this while you're, you know, I don't want to say you should multitask, but if computer work is stressing you out, give yourself another input. Roll your face while you're doing the other computer stuff so that at least you have this other option of

of making a shift.

Linda Bluestein, MD (57:05.266)

And that's a great little break that you can take too from doing your computer work. So maybe you're not, I agree with you about the multitasking and I tend to do it a lot. So it's, yeah. But you can also do this pretty easily and quickly in a little mini break from your computer work. So I love that. And I think you get asked this question a lot, but how do you manage your own hypermobility symptoms?

jill (57:29.896)

Oh, rolling one and strength training. I love doing strength based work. And I added that strength based work into my world, you know, resistance training. Gosh. It's been it's been well over 20 years. I think working with weights, but also my the program yoga tune-up that I created.

many, many years ago. That's probably older than 20 years also. This work is in general been very helpful for keeping me stable and mobile as well and being able to continuously stay awake to my end ranges and not to blow past them. So it's a combination of mobility work, disassembling yoga poses, prioritizing healthy movement.

rolling, strength training, you know, and that all embedded within that is breath-based work. I don't like to call it breath work. That is the buzzword, but I breathe strategically in anything that I do. How's that?

Linda Bluestein, MD (58:48.086)

I was going to ask you what we should call this episode. I think Breathing Strategically might be a good title. Do you have any other ideas? Because when you said that, I thought that would be a cool.

jill (58:59.744)

Oh gosh. Yeah, I don't think that's really a zinger. It doesn't sound very zingy.

Linda Bluestein, MD (59:08.299)

Yeah, we need to think of a zingy, a zingy title. It's always hard to come up with that.

jill (59:11.34)

Maybe I think that this is about, the body by breath is about using, breathing is a body wide experience. It is not a nose to lungs trip. And that's one of the many things that the book is trying to help emphasize is what this blast radius of breathing on every cell and system of your body.

is something that we can account for, improve, and harness its virtues for our health and well-being. So I think this is like improving your breath smartness. I don't have a title for you. I'm usually pretty good, but you also have a specific audience that you're speaking with. The other ways that I deal with my hypermobility is,

I know that I am not injury proof and I'd love to be injury proof as all of us would. I know that injuries are going to come. So I think of a lot of the work that I do as preventative on a constant preventative measure. I'm not waiting for the next accident to happen. I know it's going to happen. And so one of the tools that I...

Linda Bluestein, MD (01:00:24.407)

Mm-hmm.

jill (01:00:36.536)

really have come to rely on when I start to experience acute pain that's not going away, that I can't seem to roll away or exercise away, is extracorporeal shockwave therapy. I am such a zealot and proponent of this tech. Have you used it, Linda?

Linda Bluestein, MD (01:00:49.069)

Mmm.

Linda Bluestein, MD (01:00:55.286)

Mm-mm. Yeah.

jill (01:00:57.816)

I just finally did a reel about it. I did a reel about it yesterday. I've been wanting to do it for five years, but I didn't have a cameraman in the room until my son, my seven-year-old son, and my daughter, actually, she didn't do the video, but my son took a wonderful video while I was at my chiro on Saturday. And so I could finally show people this amazing treatment that I get when I have acute spells that are also

Uh, not showing up in any type of testing. So even muscle did not show, did not even the muscle. I failed the muscle. Like the muscle tests were all fine, but I'm like, no, I have pain near my bicipital groove and I'm not sure what it's from, um, blah, blah. Anyway, the extracorporeal shockwave therapy sends acoustic waves into your body.

Linda Bluestein, MD (01:01:31.234)

Right.

jill (01:01:51.912)

and finds areas of calcification within connective tissues, within ligaments, within tendons, within nerve sheaths, epineurium. It's an adaptation or adaptation of lithography. Help me, the kidneys, say the word.

Linda Bluestein, MD (01:02:11.495)

lithography? Is that what you're trying to? I'm not sure. My husband is a urologist and did lithotripsy his entire lithotripsy?

jill (01:02:13.348)

RV? Ugh.

jill (01:02:21.636)

Right, so that's the protocol where they're sending these shock waves to bust up the stone in your body so they're not having to cut you open and do invasive work. So this is a non-invasive technique that they then readapted because they noticed that the people that were getting this treatment, their back pain went away and it wasn't necessarily related to the kidney stones. And so they're like, well, this must be doing something to other tissues. And so they've adapted this tech for connective tissue or for musculoskeletal.

you know, tissues or myofascial tissues. And the most pervasive research has been on plantar fasciitis, very high success rate, but it works on any area of the body that has, you know, muscles and fascia, ligaments and tendons. So that has been for me very helpful because it also reduces inflammation. So maybe you aren't calcified, but when there's suddenly this acute blowup, like, I don't know what I did, did I over train? The...

it can even help with acute flare ups and it takes, it's a very low cost intervention relative to pills or surgery or MRIs or what have you. So I'm a huge fan of that.

Linda Bluestein, MD (01:03:35.482)

I do have a neighbor who has had that done several times and has said that it was very, very helpful. I've just never done it personally myself. So, but that's great to know about.

jill (01:03:44.276)

Yeah. Yes. And I mean, if people are like, well, where do you find this? Usually it's physical therapists or chiropractors would have the unit. In Germany, they are, I think every orthopedist office has one. Like these are, it is a very common tech in Germany, but in, in the US, it's not FDA approved. It's still, you know, on the outskirts. I just think every

Linda Bluestein, MD (01:03:57.954)

Mm.

Linda Bluestein, MD (01:04:12.084)

Ah!

jill (01:04:14.032)

It's like an electric toothbrush for your connective tissues.

Linda Bluestein, MD (01:04:17.531)

Oh my gosh, that's brilliant. An electric toothbrush for your connective tissues. I love that.

jill (01:04:24.496)

But also, Carla Stecco who's one of my fascia research heroes, if she hasn't been mentioned on your podcast before, let me be the first. But Carla Stecco also recently did some research on mechanism and what she found, she and her team, including Katarina Thede over in Padua, found that the electroshock therapy upon fibroblasts was the fibroblast, dormant fibroblast, started to spurt out higher Hyaluronan within an hour.

of the stimulation and kept doing it for up to 24 hours. So it's altering the extracellular matrix and that's that decalcification process, right? Deagglomerating connective tissues that have become stuck and immobile within the body. So it's really brings tissues back to life in a way that basic friction with massage or rolling cannot. And so that's why I'm so thrilled to find a treatment for.

You know, who knows why you got this thing or that thing or the other thing, but you got it. And if exercise and massage and physical therapy and this treatment and that treatment are not working, try this. See if it works. It's working for my mom and her adhesive capsulitis. If you go to my Instagram page today and you can see the number of people like, oh my gosh, this totally solved this problem I was having here, there, the other way. So check it out.

Linda Bluestein, MD (01:05:34.221)

Mm-hmm.

Linda Bluestein, MD (01:05:48.886)

That's, that's especially interesting to me because I am currently dealing with bilateral adhesive capsulitis and I just had MRIs of both of my shoulders and I have, you know, arthritis and some cysts and subacromial cysts and various different things. I definitely, uh, and rotator cuff tendinopathy, et cetera, et cetera. Yeah. The, the, the impressions was like very, very long, but, but no frank tear, nothing that's probably.

jill (01:06:07.672)

Oh, gosh, Linda, I'm so sorry to hear that.

Linda Bluestein, MD (01:06:16.874)

you know, surgical or anything. And even if there was a surgery for that, like effusion, how are they gonna get rid of the fluid? So I am going to try that. I am going to try that and I will report back.

jill (01:06:18.938)

Yeah.

jill (01:06:30.384)

Please do, and do you know who has a unit near you?

Linda Bluestein, MD (01:06:33.898)

I do. I'm going to go to the person that my neighbor recommended.

jill (01:06:36.676)

I'm so excited for you, Linda. I mean, I just sent one of my, obviously this is not all gonna go on the podcast. I just sent one of my longtime clients who had a knee replacement and he had persistent chronic pain going on in his rectus femoris. It just would not go away no matter what he did. The massage, the PT, the dah, dah. I said, just go see Dr. Tosh, get a treatment and within one treatment, the pain he had for a year and a half.

gone. Plus, I mean, if they, if they're able to, he just found it had, he had calcified at his articulars genu. So that's just the superior, you know, superior aspect of the joint capsule of the knee. Come on. That's where the catch was.

Linda Bluestein, MD (01:07:07.232)

Really?

Linda Bluestein, MD (01:07:23.414)

Wow.

Right, right. Fascinating.

jill (01:07:29.753)

You can't deagglomerate that amount of thickening, but this tech can.

Linda Bluestein, MD (01:07:33.23)

Mm-hmm. Right. And what I love about that is so often, people that have hypermobility, if we have surgery, we end up with all kinds of complications. And it didn't address the root problem anyway. So.

jill (01:07:42.61)

Mm-hmm.

Linda Bluestein, MD (01:07:48.798)

I think if we can have as many tools as possible to try to avoid surgery and try to improve function. And like you said, there's a lot of other things, obviously trying all the different techniques that you've mentioned, physical therapy, massage therapy. You know, there's, oh, of course. Yeah. There's. Yeah.

jill (01:08:04.632)

nutrition, psychedelics, whatever, you know, all the things. It was like, there was one thing I was like, I am ready to try psychedelics. Like I am so much pain around this one thing. And then it was like, oh, all I had to do was shockwave and I don't have to do the psychedelic, great. Because then you're blaming yourself. You get into that game. You know, you know what I'm talking about. You get into the game with your pain and...

Linda Bluestein, MD (01:08:22.378)

Yeah, yeah.

Linda Bluestein, MD (01:08:27.139)

Oh yes I do.

jill (01:08:31.64)

And I'm just, you know, I'm here for the long haul and I know that I have the hypermobility and I think I do pretty well staying pretty pain-free for the most part. But when stuff comes up, I'm really happy to have this tech and for them to find, you know, to keep doing more research on it, to figure out what is this mechanism? Why is this working this way?

Linda Bluestein, MD (01:08:56.43)

Yeah, definitely. Well, I will give it a try and like I said, report back. So do you have a favorite hypermobility hack? This is how I like to end every episode by getting some good collection of hypermobility hacks.

jill (01:09:10.18)

My favorite hypermobility hack is...

jill (01:09:20.624)

My favorite hypermobility hack. Well, this is gonna sound crazy, but I do like talking to people about my hypermobility, like amongst friends. I do like community, and that is a really big thing. In my DMs, the different other professional, movement professionals that are part of my community, I do really get a lot of strength in community. And it's also one of the reasons why I...

It's like going back to you, why I do love your podcast. Um, in terms of the health, I do think the community part is a huge part of my health. In terms of the health, the first thing that really comes to mind is dead lifts.

Linda Bluestein, MD (01:10:04.435)

Interesting.

jill (01:10:08.596)

I love the type of strength that I get from doing deadlifts on a regular basis. And that, when I say that, that's about once a week that I'll, I'll try to do, um, pretty heavyweight with deadlift.

Linda Bluestein, MD (01:10:24.458)

Wow, that's really incredible. And when you say community, I think an important thing to point out is if you wouldn't mind sharing your thoughts on support groups, pros and cons, because I think they can be wonderful things, but have you experienced or heard of people having different experiences that might be helpful at times, but also sometimes kind of get you too much into your own head and...

can increase that anxiety.

jill (01:10:56.556)

Linda, I haven't, I don't have experience with support groups around this per se. And I don't have any clients that have reported anything to me. So I really have nothing to give you there. Um, I realized I left out one category of movement that I do on a regular basis. May I add that to my list of things? So there's one other category of movement that after I had my total hip replacement that I started to introduce very.

Linda Bluestein, MD (01:11:15.667)

Yes, please do.

jill (01:11:26.936)

with great amount of fear and a great amount of reluctance. And that was high intensity interval training. As prior to having my hip replaced, doing high intensity interval type of work would leave me in pain or injured. Something new would get injured. So I really had hesitancy to do it. And I remember about six months into PT, my physical therapist was like, you need to push yourself. You need to go run up hills.

Linda Bluestein, MD (01:11:33.333)

Mmm.

jill (01:11:55.16)

You need to do high intensity intervals Like you need to, she was just like listing off. Like you're not going to adapt or change anymore unless you push this hip. And so I ended up finding a woman on Instagram named Doc Jen Fit. Her name is Doc Jen Fibroni is her name. And I did one of her challenges on Instagram. It was like a 12 minute hit challenge but she's a physical therapist. And I felt the way she cued was very approachable and very safe.

And I could only do about eight minutes of the hit, but I understood completely what my assignment was from that point on. Anyway, long story short, I have included healthy hit into my movement practice ever since then. And even Jen and I created a program called Roll into Hit, Adapting Intensity for Every Body. And one of the things we do address within the context of the hit is adaptations for

Linda Bluestein, MD (01:12:43.387)

Ugh.

jill (01:12:51.728)

people with joint replacements or hypermobile bodies and whatnot, and how important it is to make sure to include and why it's important to include this type of variability for your health and adaptation and wellbeing. So I just wanted to make sure that I gave a shout out to those of you who may have joint replacements or are approaching hit with great hesitancy.

Linda Bluestein, MD (01:13:20.874)

Mm-hmm.

jill (01:13:20.912)

There is a safe place for you now. And our program was specifically designed with these, you know, with this type of cohort in mind.

Linda Bluestein, MD (01:13:31.458)

Yeah, that's really fantastic because that doing HIIT, high intensity interval training, is the best way to increase aerobic capacity too, right? Which is critical for the functioning of your autonomic nervous system. And it's, I think what often happens is, you know, we kind of fall down the EDS hole or hit the EDS wall, however you want to say it, and kind of inactivity leads to other problems. We get that kinesophobia. I definitely had that.

More than a decade ago, I was so afraid to move because it seemed like every time I moved, I hurt myself. So I just, yeah. Yeah.

jill (01:14:07.241)

You know, like going into the ocean, like, oh God, forget it. Danger, danger. Yeah, but to be able to build strength, to be able to tolerate high heart rate intervals, I mean, for me, it's like a miracle. And what it's done for my spirit and for my soul and for, oh my gosh, for the hedonic tone in my body, right? The ability to tolerate pleasure.

It's been amazing. So I've been very, very grateful to her and to my physical therapist for telling me you need to move, you need to push yourself.

Linda Bluestein, MD (01:14:45.278)

That's honestly shocking though to hear.

jill (01:14:48.304)

Well, look, she's a very progressive, amazing local in LA, Dr. Leffel McCurdy, and she happens to have a robust client list full of hypermobile dancers. It's supposed to be her subspecialty, and I was blessed to end up getting assigned to her through my insurance back when she took insurance, and it was really a blessing.

Linda Bluestein, MD (01:14:59.936)

Mm.

Linda Bluestein, MD (01:15:10.698)

Wow, that's incredible. And we'll have links in the show notes too, as many of these things as we possibly can that you've mentioned. Yeah, definitely.

jill (01:15:16.976)

Great, I would love for her to have, yes, she's been sent your podcasts by me before.

Linda Bluestein, MD (01:15:24.15)

Fabulous. I love it. I love it. Where can people find you online?

jill (01:15:28.872)

My website is TuneUp Fitness. So you can head to TuneUp Fitness and find all these long articles on fascia, on rolling. We have one right now on recovery, muscle recovery. My gosh, so tuneupfitness.com is the website. You can find me on Instagram at The Jill Miller and also on Instagram at TuneUp Fitness. That's our brand page. And then we're on Facebook at TuneUp Fitness and.

I think I'm on Facebook. I'm not on Facebook as much anymore. I'm kind of always on Instagram following your posts and mine, I mean, you know, not following my posts, but I'm posting.

Linda Bluestein, MD (01:16:02.402)

Ha ha ha.

Linda Bluestein, MD (01:16:06.59)

Yes, yes, I love it. And we will definitely have a link to your YouTube channel as well. And is that, would people be able to find that by searching TuneUp Fitness? Or how would they best find that?

jill (01:16:16.432)

How would they find? Oh, you can tell. Yeah, sure. I mean, if you go to the website, all those links are there, but yeah.

Linda Bluestein, MD (01:16:18.71)

your YouTube channel. We'll link it in the show notes.

Linda Bluestein, MD (01:16:24.446)

Okay, perfect. Okay, excellent. Well, Jill, I can't thank you enough for coming on the Bendy Bodies podcast today and sharing your incredible knowledge and wisdom with us. This has been such a great conversation. I mark little clips that I think are particularly quote worthy. And I think I marked more clips during this conversation than any other that I've done in the past considerable while Yeah.

Yeah, there were so many different things that I think are just going to be so helpful for people. So I can't thank you enough for taking the time to chat with me and share your wisdom with the audience.

jill (01:17:03.076)

Thank you, Linda. I appreciate you. Appreciate what you do. Let's get the information out there.

Linda Bluestein, MD (01:17:08.362)

Most definitely. Well, you've been listening to the Bendy Bodies podcast today and our guest has been Jill Miller. And thank you so much for listening and we will catch you next time.