Explorez tous les épisodes du podcast Live Aligned with Dr. Brent

You breathe about 20,000 times a day without thinking — but what if that automatic act could be trained to lower your blood pressure, sharpen your thinking, and even strengthen your heart? Dr. Lawrence Cahalin, clinical professor of physical therapy at the University of Miami and a Fellow of the American Physical Therapy Association and the American Heart Association, has spent his career studying exactly that. His research on respiratory muscle training is revealing just how much the breath influences nearly every system in the body.

In this conversation, Dr. Cahalin joins Dr. Brent Anderson to explore the science behind training your breathing muscles — not just for lung health, but for cognitive performance, cardiovascular function, and healthy aging. They discuss why a slightly irregular heartbeat during deep breathing is actually a sign of a healthy nervous system, how weak breathing muscles can literally steal blood flow from your legs, and what everyday breath training tools look like for patients and athletes alike. They also explore the emerging research on Wim Hof breathing, the connection between breath and sleep quality, and why ancient practices like Pilates, yoga, and qigong may have been onto something science is only now catching up to.

In this episode:

• How heart rate variability and sinus arrhythmia signal autonomic nervous system health

• The respiratory metaboreflex — why weak breathing muscles reduce walking ability in people with heart and lung disease

• Research on inspiratory muscle training improving blood pressure, mitochondrial metabolism, and cognition

• Devices for respiratory muscle training at home, including the PowerBreathe, threshold trainers, and a DIY sphygmomanometer hack

• The science behind Wim Hof breathing and intermittent hypoxia

• How breath pressure gradients affect blood flow to and from the brain

• The connection between better breathing, self-efficacy, and quality of life

Resources mentioned:

• Research by Dr. Doug Seals, University of Colorado Boulder (high-intensity inspiratory muscle training)

  • Seals Lab — Integrative Physiology of Aging Laboratory

  • CU Boulder: "Could Focused Breathing Be a Key to Better Health?" (2023)

  • CU Boulder: "5-Minute Breathing Workout Lowers Blood Pressure" (2021)

• Pro2 respiratory training device

• PowerBreathe device

• University of Miami Department of Physical Therapy

Chronic pain affects one in four people worldwide — and most of us don't understand why. In this episode, Dr. Brent Anderson sits down with Dr. Adriaan Louw, physical therapist, author, and co-founder of Evidence in Motion, to break down the science of pain in plain language.

Dr. Louw explains the three types of pain — nociceptive, neuropathic, and nociplastic — and why understanding the difference matters for treatment. Together, they explore why pain exists as a protective mechanism, why tissue damage and pain intensity don't always correlate, and how the nervous system can become sensitized over time, leading to persistent and widespread pain conditions like fibromyalgia.

The conversation covers the role of movement, sleep, nutrition, and education in managing chronic pain, the science of neuroplasticity and desensitization, and how positive movement experiences can literally rewire the brain's pain response. Dr. Louw also shares his thoughts on the current pharmacological options with the strongest evidence behind them and leaves listeners with an important message: chronic pain can get better.

IN THIS EPISODE:

• The difference between acute, neuropathic, and nociplastic pain
• Why pain is a protection mechanism — not a punishment
• How the nervous system becomes sensitized in chronic pain
• Fibromyalgia, central sensitization, and what actually helps
• The role of movement (including Pilates) in pain rehabilitation
• Finding hope and qualified providers in the chronic pain space

RESOURCES MENTIONED:

• whyyouhurt.com — free patient education videos and provider directory
• Evidence in Motion — evidenceinmotion.com

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Hosted by Dr. Brent Anderson, this podcast draws on more than 35 years of clinical practice, research, and teaching. He is a doctor of physical therapy, professor, founder of Polestar Pilates, and pathokinesiologist. Dr. Brent has long been fascinated by the dynamic relationship between movement and pathology, and how understanding that relationship can help people move better, feel better, and live more aligned lives.

Each episode features conversations with special guests, colleagues, and friends who are making meaningful contributions across healthcare, movement science, wellness, and education. Together, we explore how movement shapes not only our bodies, but how we relate to ourselves, to others, and to the world.

Live Aligned is about curiosity, compassion, and clarity, inviting practitioners, students, and lifelong movers alike to think more deeply, move more intentionally, and be kind along the way.

More info at: https://drbrentanderson.com/podcast/

For millions of people, being "really flexible" was never just a party trick — it was the first sign of something far more complex. Ehlers-Danlos syndrome and hypermobility spectrum disorders affect not just joints, but the cardiovascular system, the nervous system, digestion, and more — often going undiagnosed for years. Dr. Brent Anderson is joined by Dr. Marcia Perretto, a doctor of physical therapy, founder and CEO of Actify Physiotherapy and Wellness in Boca Raton, Florida, and a nationally recognized expert in hypermobility-informed care.

Dr. Perretto — who lives with hypermobile EDS herself — breaks down the difference between hypermobility and a clinical diagnosis, explains how collagen dysfunction affects the whole body, and offers a clear framework for building toward safe, successful movement. Together, she and Dr. Brent explore why fear can amplify pain, how the nervous system gets caught in a downward spiral, and what it actually takes to interrupt that cycle and get people moving again — without making things worse.

IN THIS EPISODE:

• What Ehlers-Danlos syndrome is and how the 13 subtypes fall under the broader connective tissue umbrella
• Why hypermobility and hEDS are not the same thing — and how to tell the difference
• How collagen dysfunction affects the heart, gut, skin, nervous system, and more
• The role of fear and the amygdala in amplifying chronic pain for hypermobile patients
• Why the nervous system needs "predictable movement" to begin rewiring toward safety
• How to stage a graded return to movement — from proprioceptive awareness to strength
• Why consistent small successes beat occasional big efforts for this population

RESOURCES MENTIONED:

• Dr. Marcia Perretto — Actify Physiotherapy and Wellness: actifypt.com
• Unlocking the Secrets to the Hypermobility Puzzle — book by Dr. Marcia Perretto
• The Beighton Hypermobility Score — referenced as a standard screening tool
• 2017 International Classification of hEDS — the updated criteria discussed in the episode
• Panjabi and Comerford's neutral zone concept — referenced in the movement staging discussion
• Paul Hodges and Carolyn Richardson (University of Queensland) — foundational research on spine stabilization referenced by Dr. Brent

SOURCES AND CITATIONS:

• Malfait F, et al. The 2017 international classification of the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet. 2017;175(1):8-26.
• Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population. Ann Rheum Dis. 1973;32(5):413-418.
• Panjabi MM. The stabilizing system of the spine. Part I: Function, dysfunction, adaptation, and enhancement. J Spinal Disord. 1992;5(4):383-389.
• Comerford MJ, Mottram SL. Functional stability re-training: principles and strategies for managing mechanical dysfunction. Man Ther. 2001;6(1):3-14.
• Hodges PW, Richardson CA. Feedforward contraction of transversus abdominis is not influenced by the direction of arm movement. Exp Brain Res. 1997;114(2):362-370.

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It can feel like Parkinson's disease is everywhere — a parent, a friend, a colleague — and with that familiarity often comes fear. But the story we've been told about Parkinson's is changing fast. Dr. Brent Anderson is joined by Dr. Andrew Lerman, a double board-certified neurologist and epileptologist and the founder and medical director of Grove Neurology in Miami, Florida, who has led more than 35 clinical trials investigating new treatments for Parkinson's, Alzheimer's, and other neurodegenerative disorders.

Dr. Lerman — a passionate advocate for movement, including Pilates, as medicine for the brain — explains why early diagnosis is reshaping the outlook for patients, what the first signs actually look like, and how exercise may be one of the most powerful interventions available. Together, he and Dr. Brent explore how to counsel patients with hope rather than fear, why community and family support change outcomes, and the emerging research suggesting that staying active can tap into the brain's own dopamine reserves — without the disease having the final word.

IN THIS EPISODE:

• Why earlier diagnosis and new tools (DAT scans, MRI, skin biopsy, CSF labs) are changing the Parkinson's outlook
• The early signs worth paying attention to — tremor, small handwriting, a softer voice, and changes in gait
• The difference between rigidity and spasticity, explained in plain language
• How aerobic exercise, strength training, Pilates, boxing, and dance can slow progression and reduce the need to escalate medication
• The truth about the "starting medication starts the clock" myth
• What deep brain stimulation, FDA-approved focused ultrasound, and GLP-1 research mean for the future
• Why community, connection, and consistent movement may matter as much as any prescription

RESOURCES MENTIONED:

• Dr. Andrew Lerman — Grove Neurology, Miami, FL
• Rock Steady Boxing — group exercise program for people with Parkinson's
• Power of Parkinson's — online library of at-home exercise routines and resources
• Dr. Brent's community Pilates documentary — his 10-year Coral Gables program for a Parkinson's support group (available on YouTube)
• Miami / St. Augustine University Physical Therapy program — Rock Steady (Dr. Miguel Garcia) and fall-prevention (Gabriel Somariba)
• Argentine tango research for Parkinson's — referenced in the episode for its effects on balance, falls, and disease progression
• Pilates and fall-prevention research (Peggy Roller, California) — referenced in the episode
• The Anxious Generation by Jonathan Haidt — referenced on Gen Z mental health and the value of unstructured, active play

SOURCES AND CITATIONS:

• van der Kolk NM, de Vries NM, Kessels RPC, et al. Effectiveness of home-based and remotely supervised aerobic exercise in Parkinson's disease: a double-blind, randomised controlled trial (Park-in-Shape). Lancet Neurol. 2019;18(11):998-1008.
• Schenkman M, Moore CG, Kohrt WM, et al. Effect of high-intensity treadmill exercise on motor symptoms in patients with de novo Parkinson disease: a phase 2 randomized clinical trial (SPARX). JAMA Neurol. 2018;75(2):219-226.
• Xu Q, Park Y, Huang X, et al. Physical activities and future risk of Parkinson disease. Neurology. 2010;75(4):341-348.
• Fang X, Han D, Cheng Q, et al. Association of levels of physical activity with risk of Parkinson disease: a systematic review and meta-analysis. JAMA Netw Open. 2018;1(5):e182421.
• Meissner WG, Remy P, Maltête D, et al. Trial of lixisenatide in early Parkinson's disease. N Engl J Med. 2024;390(13):1176-1185.

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Imagine spending your whole life mastering an instrument — and then, one day, your hand simply stops obeying you. The fingers curl, stick to the keys, or pull away on their own. For the small number of musicians who develop focal hand dystonia, it can feel like the end of a career and an identity. But the story of this condition — once dismissed as "all in your head" — has changed dramatically. Dr. Brent Anderson is joined by his mentor of nearly 40 years, Dr. Nancy Byl, professor and chair emeritus at UC San Francisco, who helped transform our understanding of focal dystonia from a psychological mystery into a trainable brain disorder.

Dr. Nancy Byl — a pioneer of neuroplasticity research and longtime collaborator of neuroscientist Michael Merzenich — explains how rapid, repetitive fine-motor movement can literally "smudge" the brain's sensory map, and why that map can be redrawn. Together, she and Dr. Brent explore why perfectionism and type-A drive raise the risk, how foreign environments and novel sensory inputs unlock recovery, and why belief in the brain's ability to change is essential to getting better. Above all, their conversation is a message of hope — the same brain that learned the dysfunction can be retrained out of it.

IN THIS EPISODE:

• What focal dystonia actually is — and why it's the third most common movement disorder
• The famous primate experiments that proved the sensory cortex remaps under repetitive strain
• Why perfectionism and a driven, type-A temperament raise the risk
• How foreign environments — a saxophone played lying down, an inversion table, painting on bone — restore coordinated movement
• The roles of mental imagery, dual-tasking, and reading Braille in retraining the brain
• Why education and a belief in neuroplasticity matter as much as any single technique
• Other forms worth knowing — runner's dystonia, drummer's dystonia, and the Parkinson's connection

RESOURCES MENTIONED:

• Dr. Nancy Byl — professor and chair emeritus, UC San Francisco Department of Physical Therapy and Rehabilitation Science
• Michael Merzenich, PhD — neuroscientist and "father of neuroplasticity," Dr. Byl's longtime research collaborator
• Journal of Performing Arts Medicine — peer-reviewed journal where Dr. Byl has served as editor
• Society for Neuroscience — where the paradigm-shifting focal dystonia findings were first presented
• Carol Davis, PT, EdD — her work on having patients tell their own story as part of healing

SOURCES AND CITATIONS:

• Byl NN, Merzenich MM, Jenkins WM. A primate genesis model of focal dystonia and repetitive strain injury: I. Learning-induced dedifferentiation of the representation of the hand in the primary somatosensory cortex in adult monkeys. Neurology. 1996;47(2):508-520.
• Byl NN, Merzenich MM, Cheung S, Bedenbaugh P, Nagarajan SS, Jenkins WM. A primate model for studying focal dystonia and repetitive strain injury: effects on the primary somatosensory cortex. Phys Ther. 1997;77(3):269-284

If you're over 50 and you've had an x-ray, chances are someone has pointed to it and said the words "bone on bone." But does that picture on the screen actually tell the whole story? Dr. Juan C. Suarez is an orthopedic surgeon specializing in hip and knee joint replacement at Baptist Hospital in Miami — and, as host Dr. Brent Anderson can personally attest, he's also the surgeon who replaced both of Dr. Brent's hips with outstanding results.

In this episode, Dr. Brent and Dr. Suarez take you inside the entire joint replacement journey: what actually causes hip degeneration, why x-rays don't always predict when surgery is needed, and how the threshold for replacement has shifted with better implants and improved techniques. They dive into the difference between anterior and posterior surgical approaches, what robotics actually does (and doesn't do) in the operating room, and what recovery really looks like in the weeks after surgery. Along the way, they bust some persistent myths — including the eye-opening statistic that 80% of hip arthroscopies performed after age 50 lead to a full hip replacement within two years.

IN THIS EPISODE:

• Why hip cartilage degenerates — from wear and tear to trauma to autoimmune disease
• The 80% statistic: why hip arthroscopy after 50 is rarely the right answer
• How surgeons determine when a replacement is truly indicated — and when it's not
• Anterior vs. posterior approach: why over 60% of surgeons are now choosing anterior
• What robotics contributes to precision in hip replacement (and what it doesn't do)
• Hardware choices: ceramic heads, polyethylene liners, and why metal-on-metal was abandoned
• Post-op recovery: why going slow early leads to better outcomes

RESOURCES MENTIONED:

• Baptist Hospital Miami / Dr. Suarez's practice: baptisthealth.net
• American Association of Hip and Knee Surgeons: aahks.org
• Arthroplasty Today (journal where Dr. Suarez serves on editorial board)
• The Lancet — cited the hip replacement as "operation of the century"
• Journavx (suzetrigine) — new non-opioid FDA-approved pain medication discussed in episode

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Why does knee pain so often start somewhere other than the knee? For decades, clinicians treated the knee in isolation — until dynamic imaging research revealed the real story: it's often the femur moving under the kneecap, not the kneecap tracking poorly, that drives the pain. Dr. Brent Anderson sits down with Dr. Christopher Powers, professor and associate chair in the Division of Biokinesiology and Physical Therapy at USC, to unpack what that discovery means for how we understand and treat the knee.

Dr. Powers has spent his career studying the hip's role in knee health, and in this conversation he explains "glute amnesia" — the surprisingly common phenomenon where patients simply can't activate their glute muscles, even when they want to. He and Dr. Brent trace the connection from sedentary lifestyles and lost childhood movement patterns all the way to a troubling rise in ACL injuries among kids as young as ten. Along the way, they make the case for prevention, screening, and looking at movement — not just strength — as the real key to lasting knee health.

In this episode:

• How dynamic imaging changed our understanding of patellar tracking and hip-knee mechanics

• What "glute amnesia" is and why so many patients can't activate their glutes

• Three activation exercises shown to improve neural connection to the glutes

• Why ACL injuries are showing up in children as young as ten years old

• The link between hip strength and future ACL injury risk

• Gender differences in movement patterns and injury risk

• Why movement strategy, not isolated strength, is the real key to prevention

Definitions:

• Glute amnesia — A reduced ability of the brain to activate the gluteal muscles, often from disuse, making it hard to strengthen them until activation is restored first.

• Arthrogenic inhibition — A reflex where pain or swelling in a joint causes the surrounding muscles to shut down or weaken.

• Valgus — An inward collapse of the knee, often seen during walking, running, or squatting, that signals poor hip control.

• Patellofemoral joint — The joint where the kneecap (patella) meets the thighbone (femur); problems here are a common source of knee pain.

• Neuroplasticity — The brain's ability to change its connections to muscles over time, for better or worse, based on how often those muscles are used.

"My sciatica is killing me" — it's one of the most common complaints in healthcare, and one of the most misunderstood. For the millions who experience burning, shooting pain down the leg, the real obstacle often isn't the injury itself — it's the fear, confusion, and outdated messaging that come with it. Dr. Brent Anderson sits down with his longtime mentor and friend Dr. John Sievert, a Fellow of the American Academy of Orthopedic Manual Therapy with over 40 years of clinical experience, to set the record straight.

Together they unpack what sciatica actually is (a description of symptoms, not a diagnosis) and why the language clinicians use can either deepen fear or restore confidence. Drawing on real patient stories, they explore why imaging findings are so often misread as verdicts rather than clues, why 90% of these cases resolve with movement and education rather than surgery, and how a strong therapeutic alliance changes outcomes as much as any hands-on technique. It's a conversation about replacing fear with hope — and understanding that, as John puts it, movement is medicine.

In this episode:

• Why "sciatica" describes a symptom pattern, not a medical diagnosis
• The difference between radicular pain and true radiculopathy
• How MRI and imaging findings are frequently over-interpreted and can increase fear and disability
• Real patient stories showing how catastrophizing language slows recovery
• The role of therapeutic alliance and motivational interviewing in patient outcomes
• Red-flag symptoms that mean it's time to seek emergency care
• Practical home-care strategies for calming an irritated nerve and returning to movement

Resources mentioned:

• Body Logic Physical Therapy — johnsievert@bodylogicphysicaltherapy.com
• Instagram: @Sievert.John (photography)
• Evidence in Motion (EIM)
• Kaiser Permanente Northern California Orthopedic Residency Program
• Motivational Interviewing Network of Trainers (MINT)

For anyone who's ever been told their spine is "degenerating" or that they're a millimeter from paralysis, the fear can feel as debilitating as the condition itself. In this episode, Dr. Brent sits down with his own neurosurgeon, Dr. Allan Levi — Chairman of Neurological Surgery at the University of Miami Miller School of Medicine and Chief of Neurosurgery at Jackson Memorial Hospital — for a full-disclosure conversation about lumbar spinal stenosis, one year after Dr. Levi performed the surgery that gave Dr. Brent his leg back.

Dr. Levi breaks down what stenosis actually is, why imaging findings so often don't match a patient's symptoms, and why some people walk around with "severe" degenerative changes on MRI and no pain at all. Together they trace the full continuum of care, from physical therapy and diagnostic epidural injections to the decision points around laminectomy versus fusion, and what recovery really looks like at each stage. It's a candid, myth-busting conversation for anyone facing a stenosis diagnosis or supporting a patient through one.

IN THIS EPISODE:

• What lumbar spinal stenosis is and how degenerative versus congenital stenosis differ

• Why MRI findings alone don't tell the whole story, and how symptoms guide treatment

• The role of epidural injections as both a diagnostic and therapeutic tool

• How surgeons decide between a laminectomy and a spinal fusion

• What recovery timelines and movement restrictions look like after each procedure

• Why waiting too long for surgery can lead to worse outcomes — and why urgency isn't always warranted

• How to find the right spine specialist and know when a second opinion is worth seeking

RESOURCES MENTIONED:

• University of Miami Miller School of Medicine, Department of Neurological Surgery

• Jackson Memorial Hospital

DEFINITIONS:

• Lumbar spinal stenosis — Narrowing of the spinal canal in the lower back, usually from a combination of enlarged facet joints and bulging discs, which can compress the nerve roots.

• Neurogenic claudication — The pattern of back, buttock, and leg pain triggered by walking or standing and relieved by sitting, caused by nerve compression from stenosis.

• Spondylolisthesis — A condition where one vertebra slides forward relative to the one below it; often described by patients as a "slip."

• Laminectomy — A surgical procedure that removes the lamina (back part of the vertebra) to create more space for compressed nerve roots, without fusing the spine.

• Spinal fusion — A surgical procedure that joins two or more vertebrae together with bone growth and hardware, typically used when the spine is unstable.

SOURCES & CITATIONS:

• Machado GC, Ferreira PH, Yoo RIJ, Harris IA, Pinheiro MB, Koes BW, van Tulder MW, Rzewuska M, Maher CG, Ferreira ML. Surgical options for lumbar spinal stenosis. Cochrane Database of Systematic Reviews. 2016;11:CD012421. doi:10.1002/14651858.CD012421.

• Machado GC, Ferreira PH, Harris IA, Pinheiro MB, Koes BW, van Tulder M, Rzewuska M, Maher CG, Ferreira ML. Effectiveness of Surgery for Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis. PLoS ONE. 2015;10(3):e0122800. doi:10.1371/journal.pone.0122800.

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A scoliosis diagnosis can feel like a verdict — especially for a parent watching their child's spine curve, or an adult told their pain is "just" asymmetry. But what does that diagnosis actually mean, and what can be done about it? Dr. Brent Anderson sits down with Dr. Lise Stolze, a doctor of science in orthopedic physical therapy, Schroth educator, and owner of Stolze Therapies in Denver, Colorado, to unpack the real story behind scoliosis.

Dr. Stolze breaks down the difference between structural (idiopathic) and functional scoliosis, explains how Cobb angle and vertebral rotation determine diagnosis and progression risk, and reveals why the curve you can't see from behind — the loss of lumbar lordosis in the sagittal plane — often matters more than the one you can. She and Dr. Brent walk through what parents should watch for during growth spurts, how bracing combined with the Schroth method changes outcomes for adolescents, and why postmenopausal women make up so much of her adult caseload. They also dig into surgical options like vertebral tethering and spinal fusion, and how people with significant curves can still run marathons, play golf, and live full, active lives.

IN THIS EPISODE:

• The difference between structural and functional scoliosis, and why it matters for treatment
• How Cobb angle, vertebral rotation, and wedging are used to diagnose and stage scoliosis
• Why sagittal plane posture and lumbar lordosis loss predict disability more than the visible curve
• The evidence behind combining bracing with Schroth therapy for adolescents
• What causes adult-onset scoliosis and why postmenopausal women are especially at risk
• The core principles of the Schroth method: axial elongation, decompression, and rotational breathing
• How to weigh sport and activity participation against curve progression risk

RESOURCES MENTIONED:

• Stolze Therapies, Scoliosis, Spine and Movement Arts (Denver, CO)
• Pilates Adaptations for People with Scoliosis, a course by Dr. Lise Stolze and Hagit Bedeshevsky, offered through Polestar Pilates
• SSOL Schroth educator training

SOURCES & CITATIONS:

• Weinstein SL, et al. BrAIST (Bracing in Adolescent Idiopathic Scoliosis Trial), referenced by Dr. Stolze as a landmark study on bracing effectiveness in adolescents. 
• Schwab F, et al. Retrospective study of approximately 600–800 adult scoliosis patients identifying sagittal plane alignment, lumbar curve presence, and trunk shift as predictors of surgical need, referenced by Dr. Stolze.

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