Maverick Spine: The Physical & Mental Costs of Military Aviation w/ Dr. Daphne Ryan

What if high G-force maneuvers could destroy a pilot's spine? Tune in as we explore the severe physical and mental challenges faced by fighter pilots during extreme aerial maneuvers. We tackle the critical issue of spine health, examining how intense compression and strain impact the cervical and lumbar regions. We also discuss the stark differences between older and newer aircraft designs that attempt to mitigate these effects. Our conversation ties in John Boyd's OODA loop, focusing on how pilots juggle the balance between mission focus and their physical well-being.

This episode features a compelling discussion with a specialized physical therapist who works as a contractor for the Navy and Marines. We delve into the intricate relationship between ergonomics, aviation, and physical therapy, highlighting the physical toll that high-performance aircraft can have on the human body. Our guest shares their journey from studying neurophysiology to specializing in spinal issues, emphasizing the urgent need for ergonomic seat designs and the integration of engineering with medical expertise to enhance the quality of life for aviators. We also touch upon the substantial strain faced by ground soldiers, advocating for a holistic approach to human performance in extreme environments.

From the science of stretching and pain to the neurological effects of joint manipulation, we cover it all. We critique traditional beliefs about stretching, emphasizing stability and strength over outdated methods. The discussion also covers the significance of proper diagnosis and comprehensive care for service-related injuries. Highlighting the brain's role in processing pain, especially for those with PTSD or chronic stress, we underscore the need for medical professionals to respect and accurately diagnose pain. This episode is a must-listen for anyone interested in the multifaceted challenges faced by military personnel and the innovative solutions aimed at improving their health and longevity.

Dr. Daphne Ryan on LinkedIn
SmartBacX Labs

AGLX Confidence in Complexity short commercial 

Stay in the Loop. Don't have time to listen to the podcast? Want to make some snowmobiles? Subscribe to our weekly newsletter to receive deeper insights on current and past episodes.

Want to develop your organization’s capacity for free and independent action (Organic Success)? Learn more and follow us at:
https://www.aglx.com/
https://www.youtube.com/@AGLXConsulting
https://www.linkedin.com/company/aglx-consulting-llc/
https://www.linkedin.com/in/briandrivera
https://www.linkedin.com/in/markjmcgrath1
https://www.linkedin.com/in/stevemccrone


Recent podcasts where you’ll also find Mark and Ponch:

Acta Non Verba – with Marcus Aurelius Anderson
Eddy Network Podcast Ep 56 – with Ed Brenegar
The School of War Ep 84 – with Aaron MacLean
Spatial Web AI Podcast – with Denise Holt
OODAcast Ep 113 – with Bob Gourley
No Fallen Heroes – with Whiz Buckley
Salience...

Transcript

Brian "Ponch" Rivera: 0:56

I decided to sit for this one. I'm in my ready room chair. I've got my top gun pens in the background. So I'm going to screw things up, like you read about today.

Dr. Daphne Ryan: 1:05

Look what I got yesterday.

Brian "Ponch" Rivera: 1:07

Never seen that before. What is that?

Dr. Daphne Ryan: 1:10

What you don't want to. Yeah, the team signed it. I know, isn't that nice.

Brian "Ponch" Rivera: 1:16

Good stuff. Yeah, they were nice. So much to talk about today. Thanks for being here. I've got a ton of personal questions, but we can save that for the end. It has to do with the cervical spine, lumbar spine, compression in the neck, everything.

Dr. Daphne Ryan: 1:34

Pilot spine.

Brian "Ponch" Rivera: 1:35

Yeah, yeah, actually that's not a bad place to start. So everybody's familiar with the movie Top Gun Maverick. They got to see some really fantastic flight scenes much better than what I grew up with in 1986, you know where the bunch of guys sitting in the cockpit pretending like they're flying, with a mask hanging off, which is still cool. So what people don't know is that that pilots are at the edge of consciousness when they're flying. Sometimes we're pulling G's six, seven Gs the blood rushes out of the body. We're straining to fight that back, to remain conscious so we can fight and win, and at the same time our spine. What's happening to our spine there?

Dr. Daphne Ryan: 2:10

Yeah, you're getting compressed. You have 138 Gs at your neck with your helmet and mask on at sorry 138 pounds in your spine of load when you're hitting seven and a half seven Gs and that's with it. If we estimated it right. That's with you straight up and down, not tipped or in a check six or any booking anywhere. So the human spine, it has something called what's known as follower load and it's kind of a Jenga block stack, if it's just so everything stays balanced and it can endure 250 newtons of load when it's in neutral or straight up and down and no pilot or air crew is ever straight up and down whether it's gear, the seat tactical maneuver, just looking at your left foot in a helicopter and hovering for an hour or so when you guys come out of that follower load position or neutral, you can hold 10 to maybe 40 newtons of load.

Dr. Daphne Ryan: 3:12

So it goes from 250 newtons when a spine is just doing life on land, and then you go to maybe 10 to 40 newtons of capacity, and then you guys are hitting 138, so you're really blowing through any kind of limits oh, wow so I'm wondering.

Brian "Ponch" Rivera: 3:29

You know we talk about aviation quite a bit on this uh podcast. Uh, there's connections from john boyd to the loop back to the f86 and things like that dog fighting. You know a lot of people associate observable right to side act to the cockpit. We know, know that's not true. It's actually more about neuroscience, biology, physics and other things that are out there. So having a discussion about this kind of I want to get people's, our listeners, in the right frame of mind. If you're going to associate John Boyd's Observer-Oriented Side Act loop with fighter aviation, let's talk about what it's like to be at that edge of consciousness, what it feels like to be, you know, 30 years later when you have back problems. That's where I am right now and I think you're kind of framing this the right way. On the neuro, I don't know if there's a neuroscience level here or not, but can you talk about what happens in the body as far as decision making when you're under those G's and stress loads? Have you noticed, or can you talk about that?

Dr. Daphne Ryan: 4:27

You know, when I was in the jet, I was focused on the mission. There was no way that I was thinking about what position my spines in and how to not have back pain. So when I read the article saying pilots should attempt to stay in neutral spine as much as possible, that's just not going to happen. You can't F-35 and F-16 have a 30 degree recline or more of a recline, and that is very helpful to the neck and spine. It keeps it more in a neutral position and unloaded. So that's a nice aspect of those different airframes. But when you're in a mission and you're trying to focus on something that is consistently changing, taking a new input, your spine position is going to get put towards the bottom of the pile on those in that situation. So it's really interesting that the ergonomic world thinks that that's even something that can happen.

Dr. Daphne Ryan: 5:28

Yeah, yeah, it doesn't even happen at a desk on land. You know, we don't even do it at our computers, let alone in a jet on a mission or a helicopter.

Brian "Ponch" Rivera: 5:37

I flew in the NACC and the F-14D. I think they're. They're very similar in the newer 18s right now and I don't think any. You know it's not ergonomically designed to support the back. You know it's horrible. It's a very expensive chair to get you out of the aircraft if needed.

Dr. Daphne Ryan: 5:56

Agreed and I was chatting with someone last week and I've had this conversation a few times. For 99% of the time you're in a position that aggravates your spine, makes it worse for that 1% chance that you might eject or if you eject, whereas if you could recline for 99.9% of the time F-35 and F-16 were able to recline a little bit and apparently they're safe enough to fly. So we just need to start partnering with engineers and aviators and just kind of getting everybody to the table to find ways through the equipment, the gear and the human, to give you guys a longer life in the seat and a better life when you get out.

Brian "Ponch" Rivera: 6:42

Well, speaking of life, let's go back and rewind a little bit and go back to your background. I went to the University of Colorado and they had this kinesiology department there and I didn't know anything about it. Walk us through how you got into this world so our listeners can understand a little bit more of your background.

Dr. Daphne Ryan: 7:01

Yeah. So I did my undergrad and then my master's in neurophysiology at the University of Colorado at Boulder, and then I went on to get my doctorate at Regis. Yeah, go Buffs, let's go Buffs. I think we have a flyover arranged coming up, so we'll see how this season goes.

Dr. Daphne Ryan: 7:20

And then I had been a physical therapist for about five years, moved up to Washington and then found my mentor in spine at the Peace Health Therapy and Spine Clinic, keith Klein. And for 10 years I had over-the-shoulder mentoring of cervical fusion, cervical spine, lumbar pain, pain down the leg, pain that looks like a calf strain but really it's your S1, plantar fasciitis. But you're getting it because you don't have your L5, tennis elbow, that's really your C6. I mean, it just goes on and on. And so when I decided to change from that, when our clinic merged, I ended up at Naval Air Station, whidbey Island as an embedded contractor physical therapist.

Dr. Daphne Ryan: 8:05

And when I brought my spine skill set to the aviation medical department, they couldn't get enough. We were getting people better in one visit. It was just something simple for me. I had done the training, it was my wheelhouse, it was exactly what they needed. They like to say lightning struck. It was just.

Dr. Daphne Ryan: 8:25

They didn't even know what I was doing. I said it was orthopedic manual therapy and it was spine therapy versus stretching and pulling and trying to think that we can pull on a joint to change its range of motion, where we'll never be able to do that, the nerve will say stop, before we can ever get to a ligament in a joint or change a range of motion in a joint, and yeah. So then they wanted to get me in the jet. So Airboss Whitesell approved Project Specialist VTOP's designation and as far as we know I'm the only contractor from the medical side that's been given that designation in the Navy A medical contractor to have the ability to then go in all airframes of the Navy and Marines. So I got my all-qual, went in the dunker, got in the search and rescue helicopters, got an F-18, flew the Top Gun 2 route low level.

Dr. Daphne Ryan: 9:22

That was my low level. Yeah, so Whidbey has been my. I cut my teeth with Whidbey and they have been nothing but wonderful and kind to me there and they're still some of my favorites. So, and then after that I've been able to when the contract changed, went to Luke Air Force Base for a little bit. They're changing that contract, so I got out of contracts and started my own business for aviation and pilots and yeah, that's what's happened. And here I am and now I'm hired as a guest lecturer for people for commands, and so I have a few different commands that I'm treating um are going to coming up.

Brian "Ponch" Rivera: 10:03

So all right uh I was just looking, I was looking, you want the your the name of your company. By the way, we like any company that has a letter x, letter x in it so something right yeah, it is something, and it has to do with an awakening or something like that.

Brian "Ponch" Rivera: 10:17

I'll figure that out in a second. So we're talking about human performance in extreme environments right, that's how I look at fighter aviation. And our podcast is really about how do you max perform as an individual, as an organization, as a government, as a planet, as a universe, right? So this fits right into that. I want to make sure there's a nice connection there. I'll see if Mark has anything for you right now, mark.

Mark McGrath: 10:43

Yeah well, don't forget about us ground pounders. You know, I can think back to my time wearing a you know four-and-a-half-pound helmet on my head.

Dr. Daphne Ryan: 10:53

Seventy-pound pack.

Mark McGrath: 10:55

Yeah, well, and also fragmentation vest was required. Load-bearing vest, that's right. Your load can be any number of things. Back then I left active duty in 04, but back then the boots were not as ergonomic as they are now. It was a different kind of, different type of combat boot and I can tell you that everybody that was in my epoch even guys that were in for you know, six, seven years got out, got out whatever. All of them almost immediately back and neck problems that pursue lots of chiropractic visits. You learn words like neuralgia then. Yeah, I learned that word the hard way. When you say c6 and c5, like I know exactly what, I know exactly what you're talking about. So I, of course I look, I would look at your website. I'm going to plan on coming out to Colorado.

Dr. Daphne Ryan: 11:43

Yeah, come on out.

Mark McGrath: 11:44

But you know, I think that there's another. You know, a lot of our listeners are Marines. That have been out in the cockpit and they can relate to a lot of the physical damage that they've experienced, and even in training. I mean, you know the jumping, climbing, falling, you know, um, doing all kinds of things. Um, and, like I said, it's almost like it's, it's almost like a persistent, chronic thing that happens almost almost immediately.

Dr. Daphne Ryan: 12:13

Agreed. Um, there are, when I treat spine patients, the interventions I was taught and I teach for spine work on acute and chronic. And so I actually had a Sergeant Major from the Army who was in artillery for 20 years and he was one of my patients recently in Colorado and he is just fantastic. He's been working out for 20 years but he's had severe back pain and he's in his seventies and we got his pain to go away. And so for him to say I've tried all of these different things stretching, dry needling, tens unit, something pulling on me, someone just sells you some snake oil, and not because they're malicious, they do think they've been told it should work. But we're not asking questions of clarity and questions of curiosity and kind of going back to the science to find some things. That Is that really what happens? Is that really the science? Are we pairing spine biomechanics with how a hip and a knee work? And they are different, they are separate. So for, for instance, you talk about neuroscience and human performance, there is a body of research that is over two decades old now, on don't stretch, and the reason is um, the probably the one I'm most familiar with and I think is preeminent, is Thomas Heimberg and he's at the University of Copenhagen. He has his PhD and he's been researching the thermodynamics of nerves for over 22 years. So I have my 22 years and his 22 years and we just can't even do an email without getting curious between us and, oh, tell me more and what's going on. And he has seen that when you pull a nerve it flatlines. That's why the stretch position feels good.

Dr. Daphne Ryan: 14:06

It can't send a pain signal and it also can't send an action potential to the muscle, which is how we give power to the muscle. The brain fires, goes down, the spinal cord gets sent out, the nerve jumps off the motor end plate and the muscle and makes it contract. The nerve after being pulled on, the membrane changes. It does not allow for an action potential to happen after a stretch and it cannot generate that for up to 40 minutes. So when you stretch you've made yourself weaker for 40 minutes. That's the guy who's pretty fit, who goes and does a hamstring stretch at command dodgeball and pulses Achilles or tears his Achilles. Or you go and you do the PRT and you're not great at pushups and then you kind of you stretch and then you don't have power. The CDC even has an article from 2004 saying we haven't seen anything really effective about stretching. Other articles show that anything you would do that would change a muscle lasts five seconds.

Dr. Daphne Ryan: 15:05

Your muscle is not meant to contract and be springy. The tension you feel is not muscle, it's nerve. Your nervous system picks up any tension in your body before a muscle ever will. So when people think, oh, I've been stretching and pulling, yeah N nerves, don't like it, hey doc and so I think you're forgetting something here that's really important.

Brian "Ponch" Rivera: 15:27

Um, science is settled right, so you can't yeah I don't know science.

Dr. Daphne Ryan: 15:32

Who knew right?

Brian "Ponch" Rivera: 15:34

it doesn't change right. So okay, this is amazing because this is a new um it's a mind right it's an organic I'm saying don't stretch.

Dr. Daphne Ryan: 15:43

You know, father of naval medicine tried to get people to take vitamin c for scurvy on the boat. 42 years it took them to say, well, maybe he's on to something. 42 years to just fight scurvy from something simple. And then father of hand washing they were doing autopsies, not washing their hands, going to deliver babies. Women were dying. That took 50 years to get him to be taken seriously and women did not die. And here we are giving the science of stretching and it is mind-blowing. And I I was there when my mentor said why are you stretching the leg?

Mark McGrath: 16:22

well, because that's what I was taught in school yeah, do you see, like so again, someone with with herniated discs and things and and and neuralgia, you know, periodically, um, these, I found that things, I'm a I'm a distance swimmer, so I do math okay, and I've also done the barbell program, starting strength and things like modification of diet, intermittent fasting and other things. I've always found those sort of interventions to be better than anything that was a drug or a pharmaceutical, because what ends up happening? I think you get reliant on those things and they address symptoms and they don't get to the core. Is that even even chiropractic? I'd love to get your feedback on the you know chiropractic, does that?

Dr. Daphne Ryan: 17:07

make sense. Yeah, so I'll set it up with some science from the spine. So at each vertebrae there is what we call a facet. A vertebrae to another vertebrae makes a joint in the spine. It forms an opening that the nerve can come out In that joint and from that spinal nerve root there's a nerve back to the disc into the muscle at that level. So when you pull on your spine and try to open it or have it in a prolonged elongated position for a while, you're making the muscles of the spine weaker because you pulled the nerve that turns muscle on. So pulling and doing this knees to the side and chest rotation. So there's a spine science to it.

Dr. Daphne Ryan: 17:51

David Butler and Laura Murr Mosley wrote a book called Explain Pain and I would agree with you, moose, that it's of how much pain does our body have to manage If my brain is constantly in fight or flight, or inflammation or stress, or I haven't eaten enough or my organs aren't able to metabolize things? I give it, then yeah, I'm going to have problems at the brain level of just even calming down the system or being able to metabolize things. I give it, then yeah, I'm going to have problems at the brain level of just even calming down the system or being able to manage pain. The other piece to that that I've seen is people will use kind of toxic positivity over pain. They'll say, oh, you know, just don't think positive. Or you know, mind over matter. Well, you know what A disc is. A disc is a disc. It hurts. You wouldn't say that to someone with a third degree burn. You wouldn't say that to someone with their arm cut off. You wouldn't say so it's. We need to kind of face what hurts. Well, when it comes to stretching and pain, one thing I'll share with pilots is I'll share this example If you have the skin on the back of your hand and you kind of grab it and pull it, we wouldn't say, oh man, my eyeball or my hair feels pulled.

Dr. Daphne Ryan: 19:14

Let me stretch it more to get rid of that pinch. You know, we know we need to unload it. We know we need to let it go or put slack in the system Like, oh, something's pinching me, I gotta shift my weight or move around a little bit. So when you have that skin, pull. We all know that more of that to get rid of the tightness won't help.

Dr. Daphne Ryan: 19:47

So what we want to do is unload it or slack the system from the side and you won't feel that pain kind of takes three hands. You got to be able to. You do it to a friend, and then a friend do it to you, and you'll see what I mean. Um and when I help patients, and then the last seven years, pilots and air crew and maintainers get stability and strength matching the 30 years of research that the spine needs the multifidus and the deep core to turn on on to stabilize the spine. So it doesn't hurt. When I've done that, they've gotten better and that's how I was mentored and that's how I was taught in spine. So when you see people stretching to get rid of back pain, we need to change that paradigm so.

Mark McGrath: 20:40

So then, so chiropractic, you know where they're, where they're, where they're doing a lot of forceful releases and popping and and and movements. What do you? What do you?

Dr. Daphne Ryan: 20:46

do. I do that. It's a bigger, broader picture would be orthopedic, manual therapy, chiropractic. They've been really great with marketing and you know, everybody knows you go and you get cracked or someone will say, gentle chiro. A few comments would be we in the spine center. We would see a few things happen. People would have hypermobile joints where the joint now moved too much, like if you crack your knuckle, it almost kind of aches for a while.

Dr. Daphne Ryan: 21:19

Other things that happen on EMG. There's some research that shows that when you manipulate or get a crack or a cavitation, the nerve at that joint shuts off for 20 minutes, similar to what happens with stretching, and you feel relief, but you get a dopamine release as well. So now you're wanting to crack the neck again, crack the back crack, crack, crack. If you can crack it where you can self-manipulate, our world would say that joint is hypermobile or you move too much. What that joint really wants is stability and there may be something that's stiff or not wanting to move on the other side above or below that level. But cracking it without turning on the neurological control of the joint is where you get addicted to the crack Right and I need to get, I need to have that crack again and again Pun intended yeah.

Dr. Daphne Ryan: 22:06

Addicted to the crack, I've been manipulated and it's changed. But I it was one time and it was by a professional and it was my, my mentor's mentor, and I was having um, um in the upper neck. You can get feedback to a lot of the cranial nerves and this is this is mind-blowing to medical professionals it's called trigeminal nucleus symptoms of cervical spine origin. So what the listeners can take home is if your neck moves over your spinal cord, C4 or above in weird ways whether it's whiplash, snowboarding, fall, slipped on the ice, I was in a jet that will feed back to the cranial nerve system and we've seen racing heart, We've seen ocular migraines, wavy eye headaches.

Mark McGrath: 22:57

Suicide Trigeminal neuralgia is considered the suicide disease.

Dr. Daphne Ryan: 23:02

Trigeminal neuralgia is the nerve here.

Mark McGrath: 23:05

Yeah.

Dr. Daphne Ryan: 23:07

Whereas trigeminal nucleus comes down from the brainstem to C4 in your spinal cord. So the trigeminal nucleus is different from the trigeminal nerve. Oh okay, both are horrible. Like you know, you're kind of. I can't tell you how many people have said thank you, doc, for telling me. I'm not crazy.

Dr. Daphne Ryan: 23:26

And you know I say oh yeah it's this, it's your C2, 3, or 4, you know, and this is how we're going to get it better and we're going to give you stability. After you're manipulated, you go back to Cairo. After you're manipulated, you have 60% more blood flow to the midbrain. That's when you want to retrain it and do the human performance piece and then, once you go back to you know, human performance. What kind of got all this started? Was three air crew did BFM at VAQ 132, and I had already trained them in the workshop interventions. They came in. They said I have neck pain, I have low back pain, and then what I did is I said, okay, if you have neck pain, you want to do these three interventions. And they had already been trained, so I was able to stay hands off.

Dr. Daphne Ryan: 24:13

We were testing the self-management of their pain after a BFM flight. And then I said, oh, low back pain, try these three. And five out of six left with zero out of 10 pain during popcorn time, before the debrief. So one we turned the muscles back on, we stabilized them. We did not stretch them, we did it quickly, but this also works chronically and they had more stability to fight what gravity had done on them and undo physics on the spine. That happens in the jet during BFM versus. Hey, your only option is ergonomics and stay still. Well, that's not going to happen. So what are we doing when you get out of the jet? Is ergonomics?

Brian "Ponch" Rivera: 24:58

and stay still.

Dr. Daphne Ryan: 24:58

Well, that's not going to happen. So what are we doing when you get out of the jet and it works? I had a BFM pilot Key West a few months ago and we did an online workshop virtually, and I asked him a week later I said how are you doing? He's like, oh fantastic, I don't hurt, and I'm doing three or four flights a day, or three flights a day some days and he's like I do this and then I do that and he has his plan.

Dr. Daphne Ryan: 25:20

And pilots need one session. You just need information, because they're so stinking smart and anybody in the military is familiar with their body, like my artillery guy at 70. He got better.

Brian "Ponch" Rivera: 25:32

We didn't change his x-ray, but he got better so I wonder uh, I got a couple like ideas or paths I want to go down. First one is exacted practices. So in the past we've learned a lot about team science from fighter aviation, commercial aviation, and that's an exacted thing that we can bring over to industry From the extreme environments we're in with these horrible seats that we fly in. Let's take these practices and ideas to a Fortune 50 company where everybody's sitting all day in their chairs, either at home or at work. Can you bring these practices over to that environment?

Dr. Daphne Ryan: 26:08

Yeah, that's where I started. You know we had the work comp environment up in Washington. You know we would see clients from Boeing machinists, anybody from the refinery. We had two refineries close to where I was, actually three, and the spine is a spine is a spine, whether you're you know. One example of the desk and the jet and how they kind of are, you know, cousins to each other is if you're sitting up straight, your head is has a relative 12 pound load to your C7 area. If you look down at a screen, whether in the jet, your computer, looking at your phone, that's a 70 pound load to your C7, exponentially.

Brian "Ponch" Rivera: 26:52

What we're talking about is when you put your head down right and you're looking at your iPhone, which happens 352 times a day right now.

Dr. Daphne Ryan: 26:59

They're calling it tech's neck.

Brian "Ponch" Rivera: 27:01

Okay.

Dr. Daphne Ryan: 27:02

Wow. So we have to realize what the spine wants to happen to it, what we have been telling it we're going to give it, and there's a mismatch. And then what our world does to the spine we were never meant to do. Our spine wasn't made for over-the-handle mountain bike crashes, tack air check, six hard landings carrying 70 pounds with your head cheering forward um, yes, it was. The brain and spinal cord are meant to be housed in the skull and spine, and then the arms and legs are supposed to do the movement. So, like I had somebody say well, what about the women in africa carrying the big pots on their head?

Dr. Daphne Ryan: 27:41

right, they're in neutral, they can handle 250 newtons yeah, yeah but the helmets and the forward load of a jet, or even helmet with night vision goggles and a you know rotary aircraft, or even at a desk yeah or in a car truck drivers. It's the same.

Brian "Ponch" Rivera: 27:59

I wonder if you can help me explore, or help us explore, a few things. So, uh, veterans administration claims, veterans administration claims. So we have a lot of pilots that have gone on to commercial airlines that may not be doing their claims. Uh, we know that there's a connection to uh anxiety, depression, ptsd, with with the spine and with spine injuries. Um, can you walk us through? Okay, let's. Let's say we're talking to uh former aviators, military officers or military personnel that are trying to go to a VA claim and try to make a connection back to a back injury or something that happened 20 years ago. What?

Dr. Daphne Ryan: 28:34

research is out there that can help us do that. Yeah, that is one of my pet projects and passion projects that I'm trying to load up on my website articles that they could use for that. And I do try to write nexus letters and help them with that. I would say a few things Before you get out list as much as you can and use the resources of people who are specialized in citing oh, this, this, this and this.

Brian "Ponch" Rivera: 29:03

Let's pause on that for a second, because let's talk about this and you're in the naval environment now. Naval aviation environment now.

Dr. Daphne Ryan: 29:11

Oh yeah. Okay, let's talk about I wouldn't go to medical.

Brian "Ponch" Rivera: 29:13

Right. Well, there's many reasons why we wouldn't do that potentially Right. Okay, so in that culture and remember it's been a while since I've been removed from that culture of fighter aviation it is in your best interest to hide how you feel right, or it was mentally and physically, mentally and physically, getting to that mental wellness.

Brian "Ponch" Rivera: 29:38

Right, right. So I will not go tell a flight surgeon that I have a cold because I want to go fly, right, and this happens all the time. So are you walk us through what you see in the culture, where it's a suppression of medical, uh, wellness?

Dr. Daphne Ryan: 29:49

oh, that's all right, that's like part two, all right, yeah. So what? So a few things.

Mark McGrath: 29:55

It's a yeah, it's an orientation thing. Yeah, like you're oriented to, not like I. Real, real c story. I I had a kidney stone and I just thought my back hurt for days yeah, because they they, they cause each other.

Dr. Daphne Ryan: 30:09

Yeah, you know it's like heart attack, don't be a wimp.

Mark McGrath: 30:11

Get out there moose, come on. It's just a kidney, you know just. But your back hurts. So what? We ran, we ran this week, so why just keep going, you know?

Dr. Daphne Ryan: 30:17

yeah, yeah I would say there I'll do 30 000 and 10 500 foot view of your question because it really is the question right. It should be if you serve, it should be presumptive. Neck and back pain.

Brian "Ponch" Rivera: 30:30

There you go.

Dr. Daphne Ryan: 30:30

I am not quite sure how we can have presumptive on some things. And we have the articles and research showing that even just one or two whiplash incidents can change the spine three, four, five, 10, 20 years out. Incidents can change the spine three, four, five, ten, twenty years out. So, um, at a high level, I think, human nature and the safety and the fight or flight of the brain, the amygdala we all want safety, so we will stick with the familiar fear before we do a change. Part of that is that we don't trust the care that we would get if we asked for help. So I like to say there's the pain of growth and there's the pain of regret. I'm willing, as a pilot, to go and get help for my pain because I think I'll grow and get better. Oh wait, now I get someone who gives me a down shit ends my career. Now I'm stuck with the pain of regret because I went and got help. That help should be helpful.

Dr. Daphne Ryan: 31:31

And so what worked with me is I was very familiar with the spine and we would have flight surgeons say we have three days before this guy has to leave, they need him or they can't do this mission, which then they can't deploy, which then they can't do this. And we did spine care for them and we got them to the mission and it was cervical pain. It was can't turn my head, can't load my leg, back pain. So the help has to help. So I kind of throw that into the mix and then I look at the NATOP waiver guide and for low back pain I think it's time to look at it again. And anybody I know in NAMI and flight surgeons and AMSOs, they love learning. I teach them a class and they are always reaching out and they're so helpful, always reaching out and they're so helpful. But they reach out and then we figure out something that helps. They're not just Googling anything, you know they're not. They're not winging it. They have a subject matter expert they come to for their pilots and air crew. So then when you look at the guide, lumbar pain, for example, says someone will have a positive response to traction, will have a positive response to traction.

Dr. Daphne Ryan: 32:44

Yet in the research, dan Roan, phd, dpt, doctorate of science. He has three doctorates and he assesses care in military medicine as a physical therapist and he saw that if you got traction for low back pain, your care escalated and you got worse. You needed a shot, you needed an injection. Don't stretch this stuff. A disc is a ligament between two bones. So now we have a guide that says do something that the other research says is harmful. So you need to do that. How's that ever going to work? You need to have a positive response to something that's harmful. Yeah, and so now I have pilots. That one, I don't blame them, I wouldn't go. I guess the equivalent in the civilian world would would be going to HR to complain about a toxic work environment and they fire you. Right, that's kind of that.

Dr. Daphne Ryan: 33:40

Yeah, so with our pilots, what we're, what's come to mind now is that the veterans, those who are out, they're the ones that can advocate for the people still in. Yeah, I'm encouraged by what I'm seeing, with the focus on mental wellness. What is the difference between me needing a rest after a marathon and me needing a rest or a massage or someone to vent to after a mental marathon?

Mark McGrath: 34:09

Yeah, right.

Dr. Daphne Ryan: 34:10

So why do we put the stigma on it? Mental fitness, physical fitness we both need rests, we both need recalibration Right. So I had a pilot recently and he said what about the blend codes when you have a hard landing right?

Dr. Daphne Ryan: 34:23

903 and 904. I was like about the blend codes, when you have a hard landing right, 903 and 904 I was like, oh, that's genius. And so what they could do and what I'm, what I'm advocating and I don't know if you know the va would care or listen, because they just go by the guide, you know, and the cnp guide. But if your jet had a hard landing, your spine had a hard landing. Okay, lots of. Now you can say on march 23rd to you know, 2004, I had a hard landing. Here you go, yeah, and you could try it.

Brian "Ponch" Rivera: 34:51

I think okay, so the research is clear so you guys have a harder time yeah, so the presumptive care, so a bunch of aviators get out. We. We don't talk about our backs. Uh, we look back at our flight log. There's 500 carrier arrests or 500 landings on aircraft carrier, which is what? Three and a half gs, four Gs every landing right.

Dr. Daphne Ryan: 35:09

Is that a hard?

Brian "Ponch" Rivera: 35:10

landing. By the way, ooh, does it pop the blink code? Well, I don't know. You tell me how many Gs is a hard landing.

Mark McGrath: 35:17

I was going to ask. As a non-aviation guy, I was going to say isn't every naval landing a hard landing?

Dr. Daphne Ryan: 35:22

Yeah, I would say being in the jet and pulling Gs is hard, Like you don't even have to land it right.

Brian "Ponch" Rivera: 35:29

Right, right. So now you have those 400, 500 aggressive landings, and I flew the air show in the F-14. So down low, 18 minutes of just max pain, and doing that multiple times a day. I'm sure there's nothing wrong with my back right? No, no, that's not true. I'm a little bit shorter now and actually I'm a little bit more handsome than I was years ago. So that's another story.

Brian "Ponch" Rivera: 35:49

That's right, that's right, at least I tell myself that and my wife says that's not true either. Okay, so presumptive care. Back to that, and I think you can help a lot of veterans with this, and I know I don't, you know this. This may not apply to a lot of folks that are outside of the military, but I think this is important and it's a good discussion to have Hard landings, pulling Gs, not reporting this to the medical. You know the doctors, the flight surgeons, put it in your medical record Leave in the military, and there's a danger of that back pain causing anxiety depression in doing that too. Danger of that back pain causing, uh, anxiety depression in doing that too. So there's a danger to um civilians who are flying on commercial airlines that the pilot in the front seat has back injuries, right. So let's, let's make this everybody's problem yeah, how can we talked with united and delta.

Brian "Ponch" Rivera: 36:37

Yeah, yeah, so this is. This is a problem. You have a potential aviator in the front of the aircraft that's flying your United or American flight who has these back pains that they were hiding because that's what they needed to do in order to get the next job and that's causing some potential anxiety, triggering some depression, and that's okay with everybody, right and the answer is no, that can't not be okay.

Dr. Daphne Ryan: 37:00

Well, it's good enough because we haven't changed it right, right right.

Brian "Ponch" Rivera: 37:04

Yeah. So what's going on when nothing's going on in your organization? It's horrible to think about. Walk back to the presumptive care. I have plenty of brothers and sisters out there that want your help. So what can they do right now to go back and have their medical records reviewed and maybe look at their back and connect to aviation?

Dr. Daphne Ryan: 37:26

reviewed and then maybe look at their back and connect it to aviation. I don't know. I am not familiar enough with the VA C&P system to say you need to file this form or do this. My limited knowledge on that I help and I write letters but at the same time it's the review and I am more than happy to provide articles and research. And well, this is pretty close to cervicogenic dizziness and that's wonkiness from your concussions and special forces and you know like I work with return to duty and they're all about helping special forces and with spine care, getting you good spine care.

Dr. Daphne Ryan: 38:03

If you're trying to get a VA claim changed, I would help. I would look for people who are well versed at that and doing appeals and that kind of thing. If you're kind of in that last one or two years, you know I would be getting the imaging. I had one guy he said he had been seen by a chiropractor throughout his care. I had one guy he said he had been seen by a chiropractor throughout his care. So he came and dumped the 800 pages of his care into a C&P evaluation and he did get 100 percent. The hard part is oh no, no.

Brian "Ponch" Rivera: 38:37

This is. This is great. So I think the bottom line is go to your website. You can help with the research and point people in the right direction. You can help with the research and point people in the right direction. In my view, you are the specialist in this that has probably the most knowledge as far as where to access the right information, so veterans can go ahead and do that. I don't want to spend too much time on that because I think that we might lose some of that One example, I'll throw this out.

Dr. Daphne Ryan: 38:59

There is an article I posted on my LinkedIn page and anyone's more than welcome to follow and I try to share that on my LinkedIn page and anyone's more than welcome to follow and I try to um share that. But there is an article that showed fighter pilots, compared to normal population, had more degeneration of C6 and C7. And you may not see that degeneration from one hard landing right. You don't see the degeneration in an ankle joint because you sprained it 10 times in collegiate soccer. It's. I can't walk on it when I'm 30, 40, and 50 because I lost the ligament stability. Now the bones degenerate, they can tolerate it. It's called exhaustive adaptive potential Earl Petman, who's a fellow in spine. He and his team coined that.

Dr. Daphne Ryan: 39:38

You break down over time so to say, oh, it didn't happen right then, like I didn't break my femur. We all know what you know a sprain or a tear or a pull that doesn't show up on imaging feels like, and it's just kind of coming back to the middle of the table and going. There's a middle reality that we're trying to dismiss and I think if we can do that we'll come to something that's beneficial for the service member and that makes sense for military overall. But it also will address retention and livelihood. My pilots leave because they can't help their kid take a bath or they can't hug and be with their kids or they can't sit at the baseball game because their leg hurts so bad.

Dr. Daphne Ryan: 40:25

That's the retention piece. They're like I'm getting out. And then they go to the commercial side. Now my Navy pilots flying for Delta or United and they're sitting down looking at screens for prolonged periods of time and they're not supposed to leave the cockpit and they're hurting. And you know what I was told it's not the cadre of problem for some commercial aviation companies, because the pilots still don't report it commercially Right.

Brian "Ponch" Rivera: 40:50

Yeah, there's some interesting things happening there with the FAA and access to VA. We can talk about that some other time. There's some ugliness going on there. I want to shift gears a little bit and go towards the mental health. We talk about mental health on the podcast quite a bit. It's not's not. It's not a mental health, it's not. It's the holistic you know. It's everything right.

Dr. Daphne Ryan: 41:08

It's that fitness right. Mental fitness is what I like to say.

Brian "Ponch" Rivera: 41:11

Right, right. So working out is important for the brain, eating is important for the brain. Walk us through how important the spine is for the brain, or?

Dr. Daphne Ryan: 41:20

the connection. Okay, yeah, um, you know I really do like huberman huberman's lab and podcast. He's great out of stanford um time out we gotta talk about eight.

Brian "Ponch" Rivera: 41:30

We gotta talk about ag1 right now. Okay, ag1, you need to go by ag1. Okay, back to the okay, uh, yeah, yeah, so uh, so part of that your brain dry.

Dr. Daphne Ryan: 41:40

If you didn't have a brain, you wouldn't have pain, and that's david Butler and Laura Mosley. The brain translates pain, so that's part of it. But at the same time, if you're in fight or flight and you're in your lizard brain and you're constantly looking for safety and seeing if your world is safe, a normal regulated brain scans their environment six times a second. One that's in fight or flight or PTSD or stress or high functioning environment, it's 20 times a second. So now you have the brain that can't manage other things, trying to manage safety, and now we have some pain somewhere. So now everybody it's like everybody just has a megaphone in the body and they're just screaming, like the shoulder screaming, the neck screaming, the body screaming, the brain screaming. So we need to respect pain.

Dr. Daphne Ryan: 42:33

When I respect someone's pain and I look for a cause for it or I think it needs more help, more stability, we get rid of the spine pain when I dismiss it or I say nah, maybe you're imagining it, or maybe you're five out of 10, it's really zero. I think you just had a stressful day. I have never seen stress that causes spine pain that isn't also partnered with a mechanical issue like, well, you're shrugging your shoulders so you're pinching the nerves at your neck, or there is something we can change. And I feel sometimes the medical world will dismiss pain with the use of stress and I would agree that it plays into it. But I would also agree that maybe we the medical world, our spine world and PT world needs to get better at looking at what the spine wants.

Mark McGrath: 43:32

You know platinum rule of the body give the body what the body wants, not what we think it needs that are a direct effect of trauma, of seeing horrific things and being on maybe some kind of psychotropic or something like that about the ecological impact of what I've observed, what I've witnessed, what I've experienced, and I'm wondering I mean, I'm sure there's no way to pinpoint exactly, but I'm wondering how many suicides are, or could we assume that many of the suicides are actually related to physical pain that creates problems. That was not necessarily something, you know, psychological or PTSD. That was actually something physically impacted me or whoever.

Mark McGrath: 44:24

And it's the pain, that pain, and then maybe they get hooked on opiates and maybe they overdose on opiates. We see that a lot.

Dr. Daphne Ryan: 44:32

My example is well big answer is if you're told your pain that is unbearable is in your head, the next thing is to get rid of your head or commit suicide. Right, I mean, that's the answer If 10 doctors that are supposed to be my specialists, that are supposed to be my source of help, say that what's left. And so I remember in Seattle I went by a tent city and I saw a gentleman fatigued in a wheelchair and I just thought, oh, I get it, I get it now. I get where it's too much. I've tried everything, I've gone to the VA, I've asked for help, and part of that isn't that the VA doesn't care. It's that, for instance, I had a 10-year mentorship with people that were in the research and were inquisitive and had time and weren't off to deployment and weren't off to war and had time and weren't off to deployment and weren't off to war Military.

Dr. Daphne Ryan: 45:27

You get out of school, you join, you're in it, this is your career. You know, when do you get the chance to get mentored? Well, now we have the residency. Well, the person that's teaching you have a chance to get mentored, you know. So, just to be fair, you know it's not everybody gets to do the specialty stuff and we look for that. Dr Amin with his interventions for Marines with PTSD, because he does. Blood flow scans of the brain is wonderful. Let's look at the blood flow of the brain before we start throwing pills at it. Suicide, what is it? 28 veterans a day commit suicide. It's horrible.

Brian "Ponch" Rivera: 46:03

Yeah, it's between 22 and 44.

Dr. Daphne Ryan: 46:05

Yeah right, you're like oh great, it's horrible.

Brian "Ponch" Rivera: 46:06

Yeah, it's between 22 and 44.

Dr. Daphne Ryan: 46:07

Yeah, right, you know like oh great, so my, my, my example that broke my, that kind of broke me was I had a ensign. He had instant pain on a ship. He was in a squadron. He always had outstanding on his PRT. He was a river rafting guide and I would watch. He came to me. He was in physical therapy. They had him on a bike. He had cord signs. He was shaking like this. You could see the spinal cord was irritated somewhere.

Dr. Daphne Ryan: 46:36

They got him out of aviation medicine. They put him in what I was told Um well, you know, it's kind of what happens as you go to the. You know he was in the barracks. He was shaking and stuttering because there was something at his core, that kind of a syrinx, and he also ended up having chiari malformation, which is the tonsils of the brain coming through the skull. The brain doesn't like its fluid being cut off or pressure. It will change its function. I was told by doctors that he had anxiety, that when he wasn't anxious he stopped having difficulty breathing and trying to catch air. When he stopped talking and didn't need air, yeah, he didn't need that much air. That wasn't his problem. He was not anxious, he wanted help.

Dr. Daphne Ryan: 47:28

A year in the barracks they wouldn't do a humanitarian expedited med board to get him home. His parents lived near Stamper. Two years later I get a text from him and he said you caught it. The neurologist didn't catch it. It was during COVID. So the neurosurgeon saw his imaging but didn't see his presentation. He did a phone interview. The neurologist told him it was a conversion disorder because she wasn't familiar with spine.

Dr. Daphne Ryan: 47:59

The neurosurgeon at Stanford said yeah, you have Chiari formation, you have a sac on your spinal cord. It's causing your trouble breathing. At least he had an advocate saying he's not crazy and that here's your medical reason. That doesn't happen for everybody. And that kind of drives my passion with pilots Like oh, it's just stress, no, it's not, it's your L5. Do this stuff? No, it's not, it's your l5. Do this stuff? No, it's not your c5. The pain down your arm. If you draw down your arm, that's nerve. Don't stretch it. Oh well, instagram told me to stretch it. Nope, stop, you know. So just giving them something. And I'm out of the medical world, so I do wellness coaching, so I don't have access to their medical records yeah but when we talk and we do coaching sessions, no one has access to those sessions either.

Dr. Daphne Ryan: 48:50

So it's a nice circle of trust.

Brian "Ponch" Rivera: 48:53

I want to share a story of a very famous aviator with you. A couple of ejections in there. First thing that we know is his father was lost behind enemy lines during the Vietnam War, grows up, ends up putting on his wings without his mother there His mom passed away prior to that Goes on and flies in a multi-seat aircraft and loses his NFL and then has multiple relationships, struggles with alcohol, oh yeah, life continues. And then comes back and ejects later on behind enemy lines, pulling lots of g's, fighting somebody. Now, the person I'm talking about is maverick here. Right, this is, this is pete mitchell. That's it, that's the one. That's true. But there's nothing wrong with pete mitchell, right, there's nothing. He's absolutely fine, and that's that's hard to believe, right? Uh, I, I know folks that actually ejected. I've known we I'm here in virginia beach. We have officers, uh, friends, uh, retirees, that that, veterans that take their lives every day, right, I think we have an opportunity here with the maverick story, to talk about what's actually happening.

Brian "Ponch" Rivera: 50:00

You know, ejecting twice, landing on carriers for over 20 years. Test pilot, uh, actually ejected three times. That I think that I know of right, yeah, yeah, one with goose, one in that crazy aircraft and one in the f-18 over enemy lines. Those are three ejections. Um, do you know anybody in the?

Dr. Daphne Ryan: 50:16

military talking to and gum. So yeah, and he's fine, but that's bs.

Brian "Ponch" Rivera: 50:20

There's right, um, and this is okay. This is what we want to talk about. What we've been talking about on the show lately is um, uh, ptsd tbi is real. Uh, I've had a talk 100 at the naval safety center when he had physiological episodes in the aircraft t30 I can't remember the t45s, uh, f18s, uh, they. They look like tbi, right, and I've talked to doctors about this and there are ways to overcome this. And I'm not going to get into psychedelics right now. That's for another show.

Dr. Daphne Ryan: 50:48

We have plenty of those shows on this Even with a concussion, the bladder acts like a spinal cord bladder with a concussion, really. And that's Captain Christine Sears. She's a urologist and she was recently at Jacksonville. Now she's at Whidbey, but we don't know what we don't know.

Brian "Ponch" Rivera: 51:03

Yeah, yeah, yeah. So my point behind all this is it's all right to reach out for help, right, that's right.

Brian "Ponch" Rivera: 51:09

Yeah, it's again 22 to 44 veterans are taking their lives every day and we have an opportunity to do something. I think that's what's really appealed to me is your background in this as well is it's not one thing, it's not experiencing one horrible thing in your life, it's multiple things. Right, it's? It's the experience of flying a jet, the fear of landing and, by the way, talk about how scary it is to land on an aircraft carrier, if you, if you don't mind, if you have any studies on that.

Dr. Daphne Ryan: 51:39

We know what happens with one or two whiplashes in cars. So you know, kind of that aircraft carrier repeated four Newtons decelerating, that's a whiplash. And we have the patch which is kind of like yeah, I did it, your spine isn't thrilled about that, you know, your spine doesn't care about the patch. And so to say that that is not service related, I have a buddy called Simon Chops.

Dr. Daphne Ryan: 52:09

Some of you may know him but he's hilarious because he says hmm well, if the data to the right of the retirement ceremony is silent and we're trying to collect more data to get people to report it, collect more data to get people to report it, but then after the retirement ceremony it's copious and you know, just exorbitantly, like thousands of pages of data of what happened to me in service, well, and none of that is service related and I have neck pain and back pain and this and that. That must have been some retirement ceremony to cause all that damage.

Brian "Ponch" Rivera: 52:45

Yeah, yeah.

Dr. Daphne Ryan: 52:50

You know, and nothing happened on the carrier and nothing happened in a jet. You know you can see the load in whiplash research of just sitting slumped, let alone the four Gs of a carrier landing, let alone for hours, let alone. So I'm actually working with a group to try to create a model. They've done the hard landing and they've done the ejection out of an ejection seat aircraft of what happens to the spine. They've done it with helmets the helmet, this helmet. There's no impact to the spine, this helmet or no helmet. Look at what happens. Because they've mapped the tension of all the tissues of the spine and all the tissues of the body and the brain. The brain has different densities of tissue, right, Think of it that way. So now you're going to have a greater TBI or greater concussion, or repeated concussions. Even if you don't hit your head against something, you get the neuronal shearing. And now it's that flat effect and that flat kind of oh, what's happening? Emdr is a great strategy to kind of recalibrate the prefrontal cortex to the lizard brain and now they can help mitigate and calibrate each other.

Dr. Daphne Ryan: 53:52

There's so many things out there now that are standard of care. I was speaking with the special forces. Guy, purple heart recipient, bronze star with valor, fusion from T12 to S1, replacement for both shoulder replacement surgeries, both sides and revisions. And he said EMDR saved my life because his buddies had been in an explosion and now we're working on his spine pain. But this gentleman is 74 at this point. He's experiencing what happened to him 10, 20, and 30 years ago.

Dr. Daphne Ryan: 54:33

So for us to connect the dots and say these three things that are service-related are never going to be a problem for the aviator outside of service. That's not what we see in the civilian world. But the civilian world doesn't have a dog in that fight. Right Like we have a patient, come in, we treat it. Oh yeah, you have a finding on MRI when it's almost like the military standard of care is you don't image everything because the image may not show it. So that does match. But then you get the VA. That's like I don't see it. There's nothing on imaging. Whoopsie, oh, in my mind I'm thinking pay for your own mri when you enter and pay for your own mri when you get out and put that on the table like just save up and do it I, I don't know, there's not one answer and I don't think people are malicious and you know we do need to support each other.

Dr. Daphne Ryan: 55:24

But yeah, there's, we can do better. I'm I will say that we can do better no, this is fantastic uh yeah, I definitely want to talk to you afterwards.

Brian "Ponch" Rivera: 55:34

Yeah, my discs in my neck are just tingling, thinking about somebody, so yeah, and you know, in the last week I've had two mris where on my back I had shoulder and uh, oh, I spent my time in there meditating.

Dr. Daphne Ryan: 55:49

It was awesome, it was really cool for that reason the hum hum man, it gets everybody to hum.

Brian "Ponch" Rivera: 55:54

Oh, it's awesome when you do it right. So I'm shocked at all the back pain that we have now, or I have now, you know, putting this helmet on. I wasn't wearing it, we wore our MVGs quite a bit. Yeah, the newer helmets, you know. I know Smurf I don't know if you know his story about ejecting it out of an f-18 here off the coast of norfolk, virginia beach um, his story is phenomenal. Um with uh, he had to do her helmet on, ejected out, had to escape some sharks, a lot of damage to the body. Uh, recovered from that, went flying again, uh later and then had some damage. You know, couldn't remember the flight, he just went on and we'll grab him on the show.

Dr. Daphne Ryan: 56:42

Oh, I'd love to chat. Yeah, I was just out at Carrier Air Wing 7 and working with one and I love Norfolk and Oceana and HSC-5. Hsc-5. I love when I can tell aircrew pilots or maintainers you have what the civilian world looks at as a bad neck, like a C-5 or a C-6. But if we get you stability against the spine, you won't have your symptoms. I know I see the x-ray, I see the MRI, but there's a symptom management strategy that does not involve pulling your head and bending it against force. Please do not make a double chin. If a PT tells you to do that, you're pulling the skull back on C2. That's kind of a thing to strengthen your deep neck flexors. That's not how it's supposed to be done. Don't pull your head to the side. You will never get down to any joints because your upper trap and nerves will tighten and you're going to think you're at the end of your stretch before you even change. You just can't do it. Just stop, stop, stop the madness.

Mark McGrath: 57:50

We're learning these things now with the medical science and research that's available now. I wonder if anybody's ever gone back and tried to construct or reconstruct veterans of World War II, for example, that died early or committed suicide or died young you mean like look at what their spine looked like. Yeah, like wonder if it wasn't just uh, what we're? They're called shell shock or ptsd that there could have been some kind of physical relation to spine my interest, moose.

Dr. Daphne Ryan: 58:22

Hey, that is something I would like to see. I I treat enough patients where they say I was told this 10 years ago. I've been doing it every day. We change it up and we do the spine stuff and they leave without pain. It's like I, I I've been looking for this for however long, and they've been telling me to pull on stuff and and so I would not be. My initial answer is yes, hands down, I bet so. I bet so yeah that's interesting. Yeah, I appreciate that history majors thinking no, but that's it right.

Dr. Daphne Ryan: 58:57

The hand washing always gets me. Oh how in the world could we do autopsies in the morning and not wash our hands and deliver babies?

Mark McGrath: 59:04

and maybe a germ would get inside a woman and she would die two days after blood-borne pathogen well, I wonder if there's enough vietnam vets still around that you know, because they would do a 12-month tour. You know of constantly jumping out of helicopters, andets, world War II TAC air veterans rotary veterans, artillery, you know boot pounder veterans and just get a catalog of spines. Hey, you heard it here first on no Way Out, yeah.

Mark McGrath: 59:46

I know this is what we do. We develop ideas and things. I mean, I wonder what John Boyd you know. Think of John Boyd, with all the fighter plane hours he had and all the maneuvers that he did. You know what condition his spine. He died of prostate cancer. But you wonder what his spine was like.

Dr. Daphne Ryan: 1:00:00

Well, and there's things called the anatomy project where they've taken cadavers and done like millimeter cross sections of every tissue in the body and that's how we're able to model now. But then at the same time, we have those studies where I want to do that with a model because they have the tissue tensegrity measured, where I can say you did this, this is what your spine will be like in 5, 10, 20 years. It's in the works of having nonprofits pay for it, so it's available for veterans and service members. You know, because I don't. The goal for me would be to have a standard human performance care and strategy for neck and back pain for pilots and military, and don't do this, do this and you teach them when they come in and you have it available midway, just through the whole spectrum of their military service. When I have been at some of the highly funded projects in Arizona, I have seen not spine care but CrossFit or what you would do to strengthen a hip, and I would watch them give stretches and I'm thinking you have this program fully funded and yet they and they have access, but it's access to the wrong thing. Right, you can be sincere, but sincerely wrong. And so being getting the science and getting those specialists. But you have to match it with the commitment, with the passion and get it to the people that need it. Right, I just want to. You know it's like I have it.

Dr. Daphne Ryan: 1:01:41

I spent 22 years figuring out how to help spine and then, when I got to the line it was, I just want to give it to you. I had you know here, just take it, I don't care, you know. And so, yeah, I'm really curious, moose, like I wouldn't, you know, in doing the committee work, right? Well, I don't know, is it you know? Should we go that route? Do we have enough information where we can just get it done Because we've measured the tissues? It's there, we have it, it's in the vaults, it's in the library, it's in the research groups. I don't know. That's a good question. And then now you don't think you're crazy when you have neck pain, because dr ryan gives you this article that says, yeah, you do have more degeneration at c6 and 7 for your neck than control populations when you're a fighter pilot, rotary pilot, and you're right, I mean it could go for just wearing a 70 pound pack. It doesn't have to be a jet, right, it's?

Brian "Ponch" Rivera: 1:02:37

military it's low.

Dr. Daphne Ryan: 1:02:38

They beat you guys up, you know.

Brian "Ponch" Rivera: 1:02:43

Absolutely. Wow. This has been an amazing conversation, good reorientation on so many things yeah.

Mark McGrath: 1:02:48

Thanks for this. This has really been no thanks for the invite.

Mark McGrath: 1:02:55

This got me thinking, you know I love it when people that's the goal of the podcast doc I mean honestly, I mean we're we're trying to develop and and, uh, advance these ideas and these things are. You know, a lot of veterans listen, but then a lot of people who bear loads and a lot of people that have, you know, physical and mental things that, um, this is yeah, and I would just encourage anyone in the military and your listeners to know that there's help, that does help.

Dr. Daphne Ryan: 1:03:18

And if your PT is sounded like stretching and pulling, and well, I guess that's about all we can do. There's some other things that I think could be of help. I don't want to be as bold as to promise Nothing, is you know I would you know you've run percentages right, like well for 75% of people. Promise Nothing is you know I would you know you've run percentages right, like well for 75% of people. This should work, you know. And yeah, then there is surgery. But even with surgery, if you don't turn those multifidi muscles back on, you're going to have pain. The surgery makes you able to heal and it gives you the right mechanics, like now, you're fused and you're not sliding too much into a nerve or the spinal cord. If it's a fusion, usually you don't need the fusion, but if you're really unstable from an injury, we want to give you that so that we don't go to a second back surgery and a third back surgery or a failed surgery. Now you just suffer the same way you were suffering before.

Mark McGrath: 1:04:11

What's the best way you would have our listeners follow? You mentioned LinkedIn, and then you're also on your website.

Dr. Daphne Ryan: 1:04:17

I do. I had um. I'm building the website. We're trying. I'm trying to have it, have um, a nice case study and research page that's in front of any membership. I have a newsletter that I'm going to be working on and that's like my second job. I have a day job at the hospital in Denver where I treat patients, but I see patients Monday through Thursday at the hospital and then I reserve what I really want to do for Thursday mornings and Fridays and sometimes even on weekends. But I'll be out at San Diego this coming week at the Naval Helicopter Association Conference and so, and then after that, yeah, I'm hoping to help, I'm hoping to get into the commercial air and I'm hoping to get into law enforcement and helping veterans more.

Dr. Daphne Ryan: 1:05:08

I think veterans have a freedom now that they can seek care. That helps. You know they're not behind, you know they're not on a job, so they can where they think they might get downed. So they have more of a freedom to reach out and I've helped a few of them get to the right type of care in their state. That's hands-on. That was kind of rewarding he thought he had. He was just dizzy and it's probably his upper neck, so we got him to someone that could do more direct treatment. So, yeah, there's a lot of help. Yeah, I would just ask your listeners to reach out, and they're not crazy, I'd say 80% of the time there's not a mental component to it, and even if there is, their pain is still valid.

Brian "Ponch" Rivera: 1:05:49

Is this the same book you have behind you?

Dr. Daphne Ryan: 1:05:51

Yes, it is. Ah, there's a lot of uh. I have some pictures in here. We can do that some other time but uh, you have pictures in here.

Brian "Ponch" Rivera: 1:06:03

I'm, I'm that old, yeah. Yeah, oh, you are old. I thought you were like sort of old. No, no, I'm 51, I'm a retired navy captain, so, uh, what's that mean boy.

Dr. Daphne Ryan: 1:06:07

Yeah, oh, hey, I love this one. I gotta find it now. One of my favorite patients that got me started in aviation was an f4 marine fighter pilot and he has a picture um over ho chi minh trail before we're supposed to be there?

Mark McGrath: 1:06:24

was it bull meachum?

Brian "Ponch" Rivera: 1:06:25

oh that, I was just looking at that picture. By the way, that's the one.

Dr. Daphne Ryan: 1:06:28

Yeah, yeah, my favorite was the dunker. When I did the dunker at.

Dr. Daphne Ryan: 1:06:33

Whitney, I tell you that was the. I have never seen or heard teaching like a safety center. They give you one command. If you can't do it, they give you the second command. It's not well, try this and try this and try that and then maybe think about this. That is a good, that's good feedback for your brain being able to handle multiple commands and multiple tasks. In the jet they said ma'am, you got to do this and this. I was like okay, I can do two things and I had to go. I got out of all the seats in the dunker blindfolded, did the rebreather. You know, it's kind of funny when I hear that cast of Top Gun 2 and Maverick saying well, we had to go in the dunker once.

Mark McGrath: 1:07:15

Oh, you know it's going to kill you and I was like once you gotta be kidding the reference point on hook, yeah.

Dr. Daphne Ryan: 1:07:18

So I am so short, I'm five, three, and you know how you have to have three points of contact before you can release your seatbelt. I cannot get to the seat behind. I was behind the passenger I'm. I could not get there.

Dr. Daphne Ryan: 1:07:37

And so after six times in that seat, they came over and they said all right ma'am, forget, this is the last time, yeah, and I was like I am not losing my all qual for this and I just waited and all of a sudden I kind of did like a little extra reach and I could feel it and I was out like all I needed was that it's do or die and I did it.

Dr. Daphne Ryan: 1:07:58

So it's been fun because I've gotten to fly with rotary and tack air because, yeah, we knew what we were doing. We knew we wanted to put the pain of the provider through the pain of the aviator. Sorry, put the provider through the pain of the aviator to provide better interventions. So I learned their pain and learned to identify with it. A headache for three days in NVG, sitting in the crew chief seat in the back of the helicopter at Lemoore yeah, and we expect people not to do that. If you walk sideways on a sprained ankle, we would all go. Oh, yeah, I bet that hurt you. Oh, but turning your head for an hour to fly, that cannot be something that would cause pain. I just don't get it.

Brian "Ponch" Rivera: 1:08:36

We've learned some phenomenal lessons from Naval Aviation. Again going back to team science and things like that, the Naval Safety Center, seriously aviation crew resource. I need that t-shirt yeah, aviation crew resource management is the foundation of team science, which is pretty powerful, and we use that in the flow system. I spent some time at the Naval Safety Center there.

Dr. Daphne Ryan: 1:08:55

That's a good friend from SEAT.

Brian "Ponch" Rivera: 1:08:57

Yeah, and the things we're looking at were advancing naval safety with complexity theory, which is really powerful. How do you capture some of these things that are happening in your organization through narrative, through quantitative and qualitative data? So my point behind all this is don't feel bad for what's happening here. I mean, we all signed up for this. We wanted to serve our country, but we're bringing things from our service that are so powerful, including our conversation today, that can be applied to anything, really anything, and that's a key message here and the same thing with Boyd's work is don't look at it as just some cocktail napkin thing that somebody threw together. It's not that.

Brian "Ponch" Rivera: 1:09:40

It's bigger than that, and that's where we're going with this, but Doc Poole, it's people.

Dr. Daphne Ryan: 1:09:47

You can't put people in a box, right, you can't do it.

Brian "Ponch" Rivera: 1:09:51

There's no, there's no average human being out there. You know, we know that from ergonomics right yeah, yeah.

Dr. Daphne Ryan: 1:09:56

I love this study of like, oh they did, you know 5 000 averages and there's never been an average, you know, for uniforms in the military it's like oh, no one fits the average, so yeah, no, fantastic conversation pretty pretty well in seat you mentioned seat at cvwp.

Dr. Daphne Ryan: 1:10:09

They put neck and back pain on the asap questionnaire and we had at least 30 percent of people after every flight had neck and back pain like and ASAP questionnaire and we had at least 30% of people after every flight had neck and back pain like and that was anonymous and in in service. So you know. The articles show 89, 54 to 89% of rotary pilots have pain after every flight. The rotary research is actually a little more meaty and concrete than what we have for TAC air, but we're getting there.

Brian "Ponch" Rivera: 1:10:35

I haven't. I haven't met a helicopter where I haven't fallen asleep in it. So that's, that's a jet guy.

Dr. Daphne Ryan: 1:10:41

Oh, not fast enough.

Brian "Ponch" Rivera: 1:10:42

It just vibrates. You're like, oh, I'm going to fall asleep in here.

Dr. Daphne Ryan: 1:10:45

That's me on the plane. Just me to sleep. Yeah, yeah, no, this is amazing.

Brian "Ponch" Rivera: 1:10:49

I appreciate your time.

Dr. Daphne Ryan: 1:10:50

Yeah.