Focusing on Fascia with Jill Miller

[00:35] Jennifer Milner: Hello and welcome to Bendy Bodies with the Hypermobility MD, where we explore the intersection of health and hypermobility for dancers and other artistic athletes. I'm Jennifer Milner, here with co-host Dr. Linda Bluestein.

[00:49] Dr. Linda Bluestein: Before we introduce today's guest, we'd first like to remind you about how you can help us help you. First, subscribe to the Bendy Bodies podcast and leave us a review. This is helpful for raising awareness about hypermobility and associated disorders. Second, share the Bendy Bodies Podcast with your friends, family, and providers. We really appreciate you helping us grow our audience in order to make a meaningful difference. This podcast is for you.

[01:09] Jennifer Milner: Our guest today is Jill Miller, co-founder of Tune Up Fitness Worldwide and creator of the self-care fitness formats Yoga Tune Up and the Roll Model Method. She has studied extensively the links between fitness, yoga, massage, athletics, and pain management. Her unique self-care fitness programming has been adopted by global gym chains Equinox, 24 Hour Fitness, YogaWorks, and integrated into clinical practice and athletic facilities across the globe. Jill is the former anatomy columnist for Yoga Journal magazine and featured in multiple publications, including the New York Times, Wall Street Journal, O, Shape, Women's Health, and featured on the Today Show and Oprah Winfrey Network. Hi Jill, and welcome to Bendy Bodies.

[02:09] Jill Miller: Hi, thanks for having me.

[02:14] Jennifer Milner: Absolutely, we are so glad you came on to share your wisdom with us. Now you have very generously shared a lot about your own struggles in health on social media. For those listeners who are just discovering you, can you give them a little background?

[02:29] Jill Miller: I have always had a bendy body, and it's really exciting to actually be on a podcast called Bendy Bodies. So I just want to do, first of all, a reverse mega thank you for welcoming me here. I have been consuming your media for quite some time and have been extremely educated and have identified a number of times by listening to your podcast. So just thank you for being here.
[02:57] But yes, I have had a number of health struggles that all seemed to be completely unrelated to one another until I started going down the rabbit hole of the researchers that were really identifying these connective tissue traits at their origin that seem to be blooming a number of different buds. And I've got lots of buds in my body that fit into this tree.
[03:29] The most recent really is that I had an early hip replacement — a total hip replacement at age 46. Now I can't remember. 45 or 46. I think it was 45. Yeah. Early hip replacement, age 45. And I had been a yoga professional for decades prior to that. My journey with the hip replacement really puzzled me. It absolutely confounded me when I got the images, because I wasn't really living in crippling pain. I was able to move relatively well. The red herring was my tensor fasciae latae would have a recurrent spasm about once every 7 weeks, but I could usually train myself out of that pain. But because of the frequency and the repetition of this pain, I thought, well, maybe I've got a labral tear. And so I finally got imaging once I had had my second son and was about a year and a half into nursing him. I just didn't want any imaging until I knew that I had given my son as much life as I possibly could. And then when I had the imaging, they were like, well, what labrum? Because I was bone on bone, osteophytes everywhere.
[04:53] I'm looking at my bone right here, actually, because it lives on my desk. I'm that person who kept her bone.

[04:59] Dr. Linda Bluestein: Can you show it to us?

[05:00] Jill Miller: Oh, sure. Yes, it's in its little carafe.

[05:03] Dr. Linda Bluestein: Oh my gosh, we love—

[05:04] Jill Miller: We love show and tell.

[05:05] Dr. Linda Bluestein: That's awesome.

[05:09] Jill Miller: Well, thank you for appreciating.

[05:10] Dr. Linda Bluestein: I mean, it's not awesome, but you know what I mean.

[05:13] Jill Miller: Yeah, it's pretty crazy to think there's a piece of me sitting over there. And I have a really cool prosthesis that gives me a terrific range of motion with really no risk of having to do a repair at any point in my life. But I was really shocked that I had end-stage osteoarthritis and that nothing could be done.
[05:40] When I went in to my orthopedist — I got an appointment with a great orthopedist in Los Angeles who has a very novel approach called the direct superior approach — he came into the room, I laid down on the table for the exam after he said hello, and then he said, "When do you want to schedule?" Like, before he even did his assessment, just based on my images, his next words to me were, "When do you want to schedule?" And then when he did the assessment and he circumducted my hip, he just said, "Oh, there's your pre-existing condition right there." And I still get really emotional when I think about that moment, because really what he was saying is that my hypermobility was my pre-existing condition. And whereas my right hip, which also is hypermobile, wasn't arthritic and is fine. So there was a CAM deformation in that left hip, and there was probably some manner of birth defect that I certainly ran to the ground in the first 45 years of living.
[06:43] And being hypermobile gave me an advantage in the art forms that I loved, which is dance and yoga and lots of crazy types of movement. But that's a little bit about that part of the story.
[06:54] But I could have also not told the story. I have a company where part of our branding is self-care fitness. I teach fascial rolling. I'm a huge advocate for self-care healthcare and for educating people about their anatomy and doing safe mobility and all the things. And here I was succumbing to this condition that I was living with, ignorant of this whole time. One of the many things I teach people is about your body blind spots and getting to know yourself. And it's like, how could I not know I had this decrepit, falling apart body part? So there was a lot of questioning and ego-assessing, and also did I really know who I was. There were some identity issues that came up for me big time with it.
[08:00] But really one of the big stories for me is that I was living with this decrepit hip relatively pain-free for a very long time, meaning the practices that I cultivated and curated were keeping me healthy, vibrant, mobile, able to have 2 children at a late age. So I have to look at — I wanted to be able to share that what I do, my path of teaching, is not about pain avoidance. But wow, this pain mitigation work I teach, it really works.

[08:45] Jennifer Milner: That is really interesting. So if I'm hearing you correctly, you were already on this path of teaching the full body rolling, and you had done a lifelong study of yoga and sort of were already on that path, and then you had this huge thing that popped up and said, "Hey, guess what?" And you thought, well, maybe I don't know my body as well as I did. And it causes this crisis of identity, which is so common in performing artists when your body is part of your instrument. And then for you, when you've been teaching and saying, "Hey, I know these things and here are good things to do, know your body" — everything you were saying. And then this pops up and you have to kind of process through all of that. But then at the end of that, you realize that what you had been doing actually had been helping — like you said, not pain avoidance, but pain mitigation. And it sounds like that's what kind of led you to share your story, which is so important so that other people can have that same path.

[09:46] Jill Miller: And I was also concerned that I wanted the teachers that I've trained — I mean, we have 500 teachers I've licensed worldwide, and we've taught hundreds of thousands of people around the globe — I wanted them to feel secure that the techniques that I was teaching weren't the things that led me into a hip replacement condition, that the things that I'd been teaching over the last 12 years were truly a therapeutic modality.
[10:16] And I really think the things that led to the hip replacement were doing things like straddle splits where I'd hear an audible pop every day, rolling through my pelvis like I was on Solid Gold, wrapping both my legs behind my head and then interlacing my hands in between them — literally tying myself up into articulate knots via my joints and connective tissues. Living at end range is certainly a dead end, and I discovered that. I really stopped practicing that way in my early 30s and started — created this program called Yoga Tune-Up so that I would not end up disarticulating myself and disintegrating inside my own body as I was going that way.

[11:06] Dr. Linda Bluestein: It sounds like up until your surgery, you were functioning at a really pretty high level, which is amazing. A lot of people's level of activity before they have a total hip replacement declines quite dramatically. And then if they go into surgery being deconditioned and having a lot less muscle mass, their outcomes are not as good. So that's really amazing that that was able to serve as your prehab program. You didn't intend for it to be a prehab program per se, but it definitely worked as one.

[11:43] Jill Miller: Absolutely. And once I got the diagnosis and I knew I was heading towards surgery, I was extremely disciplined about making sure that I really observed my mechanics and that I kept loading the hip. I wanted to make sure I maintained as much muscle mass as possible and even grew new muscle mass going into surgery so that I'd have a shorter recovery.

[12:03] Jennifer Milner: So smart. So smart. And I want to get back to that. But first, I want to push the pause button on your personal journey and talk about one of my favorite topics: fascia. So let's geek out on this for a second. What is fascia and why is it important?

[12:27] Jill Miller: Okay, you want the 3-minute version, the 30-second version, or the 3-hour version?

Jennifer Milner: 30-hour version.

[12:36] Jill Miller: So fascia is your seam system. It is the web — which is a very highly used word in the fashion world. It is your structural web that connects all of your parts together. It is the living threads that connect bit to bit to bit and suspend all of your parts within you. It's the part of you — even though it's all of you — it's the part of you that allows for differential movement to occur.
[13:11] So I'm going to sort of shuttle this towards movers. It's the part of you that allows tissues to glide over one another and to have stretch relative to one structure relative to another. So if we think of it in terms of muscles, which is always one of the easiest ways to think about fascia, it's that whitish extensible stuff that allows muscles to shift and shimmy next to each other. But within a muscle itself, you also have moving parts — you have fascicles that also need to glide internally, and then you have muscle cells that also are wrapped in their own fascia that also allow for differential movement within the deeper and deeper structures of a muscle. So we have this constantly connecting web that goes from cell to skin, from toe to face, from organ to bone and back again.
[14:12] And your fascia is, as I mentioned, it's living, so it is constantly regenerating itself, just like all your body parts turn over. The main cell of your fascia is known as the fibroblast. And the fibroblasts tend to the web. They create collagen and elastin. They also destroy those same structures in order to maintain the loads that you place on yourself either from inside or from outside. So your web is constantly adapting to loads and environment.
[14:49] Your fascia is also extremely nerve-rich. In fact, there's new research that points to the fact that there are 250 million sensory neurons embedded in your fascial tissues. So we can say that our fascial tissues are a really important organ for us in terms of gaining proprioception and interoception. It really is a tissue that helps connect us to our nervous system's perception of ourselves.
[15:26] I believe it was A.T. Still, the founder of osteopathy, that said that fascia connects all the branches of medicine together. And so when you start to learn about fascia, you get all interested in lymph, you get all interested in vasculature, you get all interested in muscle, and of course you get interested in the nervous system and motion and movement.

[15:48] Jennifer Milner: Absolutely. It's something that I talk about in my practice a lot. I will tell my dancers, you can either consider that your body has 600 muscles, or you can consider your body has one muscle and 600 pockets. Those different pockets are within the fascia, but they are also connected with how they move — Tom Myers' Anatomy Trains and all of that. It's so interesting when you start looking at moving from a fascial perspective, and where you can get stuck up and down that line of fascia.
[16:25] When you look at the IT band before the fascia is cleaned away in the dissection and you think about how big and wide it actually is — it's not just that narrow strip that a lot of times is seen in dissection, but it is so tightly interwoven with your lateral quad and your lateral hamstring. And from a very practical movement point of view, having an understanding of fascia and being able to think of releasing your body from a fascial level before you even try to do muscular stretching is so important. So I love that you did a deep dive into that. What started you on that journey? Were you thinking, my body is so bendy, but no matter how much I stretch, I still feel tight? What else could it be? What started you down that path?

[17:14] Jill Miller: Well, my father's an infectious disease doctor, and so luckily I grew up around the language of the body, and especially the language of the diseased body and microbes. This is something that I have an insatiable passion for. Just before we got on, I was listening to yet another medical podcast about the coronavirus and its mutations. I just have an insatiable desire to hear people talk about cells and body parts, and I think it's from listening to my dad do call-out when I was a kid. So I probably heard the term fascia from him at some point because of some type of fascial disease or infection.
[18:02] But how I really started to learn about it functionally was probably around age 19 when I met my yoga teacher and bodywork mentor Glenn Black, who — and I can say this on podcast — he's a yoga recluse. He doesn't have a website. He's not the type of person that likes to get lots of emails or press. He is really a movement genius, but he's a very, very private person. I met him while I was working at the Omega Institute for Holistic Studies during college. During my summers at Northwestern, I would go out and stay and live on their property and do work study for the people coming in to take workshops with people like Deepak Chopra and Ram Dass and all those sorts of folks.
[18:50] And Glenn talked about fascia. He was a bodyworker, and I think this was also a really big theme within the Rolfing community. Glenn wasn't a Rolfer, but he studied a lot with a chiropractor as well as with his teacher, who was a physiotherapist out of Russia named Shmuel Totz, who created — he branded his form of physio here in the U.S. called Body Tuning. And actually Yoga Tune-Up pays homage to the lineage of bodywork that I came from through Glenn.
[19:31] And so Glenn would talk about fascia, and Glenn would talk about ligaments, and Glenn would talk about tendons. My embodiment started to get indoctrinated with medical terminology or clinical terminology while in practice. Part of his classes were not just yoga poses but articulations. We did a lot of articulations — now called controlled articular rotations or controlled articular movements, but we just called them articulations back then. And we would also do bodywork on each other to help with proprioception. If he wasn't really happy with how we were doing triangle pose, then he would have us get down on the ground and massage each other's quadratus lumborum or our gluteus medius. And he would take us through the anatomy with our fingers or with our heels or our elbows or whatever technique he was teaching us. And he would talk about connective tissue. So that was really my entry into that as a functional thing.
[20:39] And then fast forward years later, I ended up reading lots of materials. Of course, I read Anatomy Trains. And then I started going into the lab with Gil Headley, who is a wonderful humanist and anatomist. And so I was able to go into the lab and start to do dissections with him, and continue to study with him to this day. And I work with Tom Myers now. Tom and I have a program we're actually launching in just a couple months called Rolling Along the Anatomy Trains.
[21:15] The genesis really went from being a student of my body, getting familiar with the terminology, then letting that insatiable hunger to learn more lead me to labs. I also got involved with the fascia research community. At my first Fascia Research Congress in 2012, I was very bold and submitted a case report. They accepted my case report and I ended up presenting a poster on a student of mine who had Charcot-Marie-Tooth disease, or hereditary sensory motor neuropathy. Not EDS, but boy do they present like an EDS patient. And I really learned a lot about extreme hypermobility from this student that I worked with for 9 years. His transformation was what I submitted to the heads of the Fascia Research Congress. And that presentation really empowered me to make allies in the fascia research space and find my friends — this whole new community of fascia pioneers, researchers, and movement pros that really use fascia as an organizing principle for their work.

[22:37] Jennifer Milner: So connect the dots for me. Connective tissue, fascia, everybody has it — why should bendy bodies in particular be concerned about fascia and be looking into their fascia?

[22:50] Jill Miller: Well, this is the best question. Your fascia is adaptable, right? We bendy people, we like to stretch. We like to stretch either because it needs to be performative, or because when you stretch, there are some wonderful neurological changes that help to dampen sympathetic outflow, that help to promote a parasympathetic state. It chills our anxious minds down. And for me, the stretch really was my addiction. It was the thing I used instead of Xanax to help me downregulate. That's just a really big part of my personality. And unfortunately, I overdid it, and that's part of my legacy.
[23:42] But what the bendy body community needs to know is that your connective tissues have an end range, and that stretch barrier really needs to be respected. Unfortunately, when you have conditions within the hypermobility spectrum, you don't always get that feedback that you're blowing past a safe range or that you're moving in a way that is going to destabilize your ability to contract well and hold your body together. And so those fascial tissues and all those sensory nerve endings that I mentioned a moment ago — when they are moved beyond a certain point, they will break, they will rupture. You will create micro tears, and it becomes more and more difficult to move well the more you create these micro injuries.
[24:34] Your connective tissue does not heal fast. Muscle cells repair really quickly — they repair in about 24 hours — but your connective tissues take 2 or 3 times that. And so if you're doing this every single day, stretching beyond end range, there will be a breaking point. You have to give your body time to heal and recover unless you are mobilizing, dancing, stretching, or practicing yoga really in safe ranges for the majority of your practice. And so the more we can honor and respect that stretch barrier, the better. Our fascial tissues are there to hold us together. We may be doing ourselves harm unknowingly, and I certainly was.

[25:18] Jennifer Milner: And we talked offline right beforehand — I wish I had known certain things 25, 35 years ago, and maybe I wouldn't have thought it an achievement to put my legs behind my head.
[25:36] That was such a fantastic response. Thank you so much. There's a lot in there that I'm going to be going back to listen to again, because that was really terrific. Thank you for that.
[25:48] I know that you were a contributing author to the Fascia Function and Medical Applications book. What should our listeners know about your chapter and about the book in general?

[26:00] Jill Miller: So the book Fascia: Function and Medical Applications is a compendium of 20 chapters that David Lesondak and Dr. Anjali Akey put together for Taylor and Francis Publishing Group. There isn't a modern text on the medical application or on functional fascia applications in the medical space. And so they gathered together researchers and experts.
[26:29] I'm just going to look at the table of contents here because there are so many different topics — just to let you know what these topics range from. Some are specific applications, like Antonio Stecco and his sister Carla Stecco, who are some of the most notable fascia researchers in the world, talk about their technique called fascial manipulation. There's a chapter on scar tissue management. There is exercise and fascial movement therapy for cancer survivors. And then there are chapters on anatomy — a biotensegrity chapter, which is basically a new theory on how your fascia behaves as a tensional network in your body; the fascia in walking; innervation of fascia; fascia in the circulatory system; and hormonal effects of fascia in women.
[27:20] And then my chapter is on clinical foundations and applications for self-myofascial release with balls, rollers, and tools, because I am a self-massage expert. I wrote a chapter on the current research, which there's not a lot of, believe it or not. Really only in the last 20 years have there been just slightly over 100 papers that are peer-reviewed and in medical journals covering self-myofascial release and looking at different variables. So I covered the current state of research, produced this chapter, and learned a lot.

[28:02] Dr. Linda Bluestein: That's so interesting. I know that in the medical world people will talk about myofascial pain, but even myself — being diagnosed with myofascial pain years ago — I never thought about the fascia component of that. And it was not really explained to me either. I've had physical therapy many times and have had myofascial release in physical therapy, but the fascial part of that — first of all, there was no real teaching of how you can do this on yourself, or why this is so important. And also the regulation — like you said, I had somebody who did not respect my end range. It was kind of like, "Oh wow, look what you can do," not realizing that just because it can go there doesn't mean that it should go there. So I paid for that for a while afterwards, for sure.

[28:59] Jill Miller: Yeah. So there's so much to respond to in what you said. One thing I didn't mention when we were talking about what is fascia — one thing I think is helpful for anybody to understand, especially the bendy bodies folks, is that we have different qualities of fascia throughout our body. So we can think of fascia in layers. And by the way, using the layered approach is very controversial in the fascia space, but I find that it's very easy for people to comprehend.
[29:31] So right underneath your skin, you have a really spongy, springy layer of fascia. Most people just call this fat. This is the adipose that really gives your body its form, its shape. People identify you by this fatty layer, but these fat cells are twined and sprung and held in place by all the different collagen and elastin vectors — the fabric of the fascia. But we also have lots of lymph vessels here, we have wonderful circulation, we have nerves, and so on. The superficial fascia, which is this most superficial layer, because it is so nerve-rich, helps us with proprioception. And also when we do specific light-touch applications to the superficial fascia, it really affects our autonomic nervous system. It can be the gateway to deeply relaxing the nervous system, calming down one's heart rate, calming down the breath pace, allowing you to actually feel your feelings. So this is like one of those places where we really encounter that soft side of ourselves and our vulnerability.
[30:47] And one of my other entry points into all of this was my own hatred of that layer. So that body fat layer was something that in dance — at the time when I was in college and extremely insecure — we did not like that. And I was bulimic. So for me, this superficial layer has been really a work in process and a work in progress in being able to accept all the parts of me, including the squishy, gummy bits. Our culture maligns superficial fascia in a big way, but it doesn't call it superficial fascia — it just calls it fat. So it's interesting that nobody knows the term fascia, but they certainly know the other term.
[31:44] And then we have this transition zone of fascia between the superficial fascia and what Jennifer was describing — the IT band. The IT band is deep fascia, but it's also something more complex. It's known as an aponeurosis. It's actually a big broad tendon. Your IT band is the tendon of the gluteus maximus. It's the tendon of the tensor fasciae latae, but it also is a deeper fascial structure, and you can feel it. You can feel its strippiness. It's thin and it's tough.
[32:18] Many of our deeper fascial structures have an orientation that makes them look like what's known as a wetsuit — it form-fits to the muscles. It's not lobular and bubbly like your superficial fascia. But in between the deep and the superficial, we have this loose fascial transition zone. This transition zone is a membranous zone. Sometimes it's called a fascial interface. Sometimes it's called perifascia. The nomenclature around it is still loose, still not totally set. But a lot of the nerve endings you're talking about with myofascial pain syndrome are really peppered in this loose fascial zone, in this membranous zone. And so when we think about treatment, maybe rubbing really hard and really aggravating all these cells and all these nerves — understanding the layers helps us to decide how to apply pressure and what are best practices for our clients that are bendy.
[33:24] But also our bendy people, as you know, are going to have certain spots in their body that are holding everything together for the rest of it. And so we need to have different applications for not only the different types of fascia on our body but also the different loci that we rely on to hold it all together for us.

[33:40] Dr. Linda Bluestein: That makes sense. That's a great explanation. And in terms of your yoga work, if we can kind of transition over to that — I know sometimes people that are bendy are told that they should not be practicing yoga. Can you tell us a little bit about what yoga is and how it has influenced your health?

[34:07] Jill Miller: Well, I wouldn't say that I practice yoga either. I had to step away from the way I was practicing, and that's why I actually created Yoga Tune-Up, so that I could focus more on proprioception. I could focus more on what my joints were doing or weren't doing. Because I think yoga has best practices within it that I think any bendy body or any human can really benefit from.
[34:33] Some of the best practices that come out of yoga in general are they're so great at stoking the parasympathetic nervous system and providing relaxation and downregulation. There's really a beautiful art around their breath, different types of breathing approaches. You can see that across the spectrum in different tribes of yoga because yogas have come through many different lineages. And so not all yoga is the same.
[35:01] So it's very hard to answer your question, "What is yoga?" My favorite answer to that is — and I'm blanking on her name, it'll come to me by the end of the podcast — but a colleague that we did a lecture series with many years ago in Toronto said, "Yoga is whatever you say it is." That was how she wants people to redefine yoga. It's whatever you say it is.
[35:30] So I think yoga can be extremely dangerous for people that are hypermobile, that like to hang out in end range, that are bypassing their own proprioceptive feedback — bypassing it through overstretching, or bypassing it by using breath techniques that can really make you zone out, or bypassing it using trance-like music that can disembody you, that can help you to dissociate rather than to integrate.
[36:02] I'm coming to you, I literally come back from the dead to report this, because I think that can be a very controversial statement if I speak to — I used to be so diehard in the yoga space. To say that to me would have been extremely offensive. But there are mechanisms embedded in yoga culture that can help people to actually really grow into themselves. If used improperly, though, you can really dissociate and literally disassemble yourself from end to end if you don't have the correct anatomical education. Because a lot of the yoga clans rely on mystical anatomy and not accurate anatomy, and that's part of what I like to work on correcting.

[36:51] Dr. Linda Bluestein: Sure. Actually, I know — this is going to sound like a strange combination — he is a neurosurgeon and a functional medicine doctor and a yoga instructor.

[37:03] Jill Miller: Oh, wow. I want to take his classes.

[37:09] Dr. Linda Bluestein: He wanted to create a program for people with EDS, and he said, "Do you have a patient that I could try this out on?" And I said, "Me. Try it out on me." So he walked me through the program that he was doing, and then he gave a talk at the local hospital on yoga and medical applications of yoga. And your answer and his answer — I feel like they aligned perfectly. Maybe from slightly different perspectives, but that's what he said: it's turned into so many different things, so many different ways of practicing. So it's kind of like — if you say bread, obviously now you have gluten-free bread and wheat bread and white bread, whereas it used to be that you just had Wonder Bread. So many different practices. That's super interesting.

[38:10] Jill Miller: And I'll say one other thing about the hypermobile community in yoga: we are lauded in yoga classrooms. We're used as the example. We're used as the model. I would say that a lot of really successful yoga teachers have a certain range of mobility that is supernatural, and they may have success because of their mobility, because it looks like they're doing these geometrical poses that we see in old yoga textbooks — show-stopping and jaw-dropping and carnivalesque. And that is a tool, just like I see the arabesque behind you. There's a tool in the image that will draw in aspirational students.
[39:05] And then if you're somebody like me — there was no end to my flexibility. Teachers could just lay on top of me and I'd be doubled over in a pose called Paschimottanasana, just a forward bend. And there's just no end to the gumminess, but this is not a longevity strategy. It feels really good. It feels really fun, and you certainly get to planes of awareness — potentially because you're dissociating — that are kind of thrilling and drug-like. But would I have stopped at age 21 if someone said, "You're killing yourself"? I don't know that I would have heard that.

[39:48] Dr. Linda Bluestein: What would you like to go back and tell yourself at that age that you think would have resonated? What you just said just now was fabulous about not having longevity in that, but is there verbiage that you think would have resonated with you back at that time?

[40:06] Jill Miller: Honestly, I'll say this — if I had known as much as I know about fascia at that early age, if I had known about joint capsules, and if I had known about ligaments the way that I know about them now, I might have made some different decisions. But I just didn't know enough about those parts of my body. I mean, I knew that they stretched — those parts stretched — and then if you held them long enough, they'd stretch longer.

[40:37] Dr. Linda Bluestein: Right.

[40:38] Jill Miller: Not a longevity strategy.

[40:38] Jennifer Milner: Right. It's that tricky place of how do we word things for the next generation in a way that is going to be heard. I know there are so many things that if somebody had said something to me when I was 14 — people would say, "You gotta warm up." And I'm like, "No, I don't. I'm doing just fine." And I think if my 30-year-old self had come back and said, "You need to warm up," I would've been like, "Okay, thanks, bye." So it's giving them that education, that practical knowledge to go with it and something to show for it.
[41:15] When I talk to dancers and I teach about injury prevention, I say the only people that come to injury prevention workshops are the people who have already been injured. But if you relabel it as a performance enhancement workshop, then everybody comes. So trying to talk to the younger generation — not just "don't do that," but "hey, let's do this instead and you will feel better. You will still be a beautiful stretcher." I think so much of it is how we word it and make it applicable to who they are at that moment.

[41:46] Jill Miller: Yeah. I think about this a lot with my daughter. She's 6 and she's a budding gymnast, and I'm just seeing it now. She's so much stronger than I ever was. I mean, she can do pull-ups. I can't even do a pull-up now. And I watch her coach — I don't interfere — but her coach is very good at this point. He's just building her step by step with strength and then letting them have fun.
[42:15] But how about — I can't imagine having gone to a yoga workshop in my mid-20s titled "Strengthen Your Midrange." That's what we need to do as hypermobile people: find pleasure in those gray zones of the midrange. And so I am working on that right now as an entrepreneur, like as somebody who wants to make sure that I sell to the mainstream the education that excites them about not being at their end range, that being able to perceive themselves in their body no matter what position they're in. I think this is something we all need to tackle collectively — to really sell midrange as sexy.

[43:06] Dr. Linda Bluestein: Oh, I like that as a new quote. Midrange is sexy.

[43:11] Jill Miller: Yeah, midrange is the new sexy. You find a new edge. You're in your middle.

[43:18] Dr. Linda Bluestein: I love it. I love it.

[43:20] Jill Miller: That's awesome. Yeah.

[43:21] Dr. Linda Bluestein: And whether you're hypermobile or not, I think we tend to think that we're invincible at those ages. Like you said, you think that you can just do whatever you want to your body.

[43:31] Jill Miller: Well, I do have this bone here, so I will use this on occasion. My kids know about the scar and we talk about how I got it. And so I just hope that, living, I can be a living museum for them so that they'll make good choices as they go forward. But I'm also here to help guide that.

[43:54] Jennifer Milner: Well, and I don't think that midrange is an either/or. You don't have to say "midrange is the new sexy, this is where we're going to stay." But if you can't do something in your midrange, how can you expect to do it well and correctly in your end range? If you can't do a single pirouette, why are you pushing so hard to do 4?

Jill Miller: Exactly.

[44:15] Dr. Linda Bluestein: Exactly. So Jill, I would love to hear more about your fascial rolling. Your own health journey led you to fascial rolling and developing The Roll Model. Can you tell us about your bestselling book, The Roll Model: A Step-by-Step Guide to Erasing Pain, Improve Mobility, and Live Better in Your Body?

[44:37] Jill Miller: Yes. I love talking about balls, Linda. So I have a set of 4 different sized soft, pliable rubber balls — and let me restate that: soft, pliable rubber balls that have a ton of grip to them, that grip a hold of your skin, that help to shear these different fascial layers that we were talking about, that guide you — or that you use to guide you — towards different tissue targets for proprioceptive awareness, for improvements in mobility, for pain mitigation, for self-treatment.
[45:20] This came about because I started learning massage really early in my movement career. I started studying shiatsu when I was in college. I saw a sign for an open house at a shiatsu school, and when I was 18, I started studying shiatsu massage. And in terms of self-practice, the first deep self-massage stuff I started doing had to do with my gut and had to do with my bulimia.
[45:45] I was really struggling in Pilates classes and dance classes at my school. I was in the performing arts, and I really had a hard time with this concept of center. So I'm going to get to the book, but there's a little bit of a story here. Teachers always talked about center — "move from your center." And then of course Pilates mat classes were offered, which was amazing way back when. I had a teacher, her name was Juanita Lopez. She was with the Joffrey and her teacher was Romana. And I would go to class twice a week and I never got sore, never got sore in my core. And my roommate who was pre-med at the time would come with me to these Pilates classes and she was always dying, just in agony in her abdomen every class. And I was like, I don't know what she's doing wrong, or what I'm maybe doing wrong.
[46:42] But the bulimia that I was dealing with was allowing me to just completely bypass my middle. And I confessed to a yoga teacher at the time. I remember telling her that I couldn't feel my center, and that I was bulimic. I knew these things were connected. And so she told me to lay face down on this bean bag that looked like a hamburger bun — it was a prop from the Iyengar yoga lineage, this little bean bag. She said, "Lay face down on your belly and breathe into it." And I put the bean bag on my abdomen, on my navel, and I laid face down and I started to feel agony. I started to feel intense visceral pain. And I started to feel my emotions. I started to feel everything that I had been avoiding. I knew that part of my healing — I would have to confront directly what I'd been doing to my body and also the feelings that I was running away from in my body.
[47:45] And so I started to experiment with that on my own every day in my dorm room. I would roll up a towel and make it look like a honey bun or a hamburger bun, and I would move it around my abdomen and I would breathe. And then years later, I started experimenting not just with towels, but any little tool I could find — balls, rollers, hollow rubber.
[48:12] And eventually, very long story short, I married my husband. I was teaching a mix of yoga and Yoga Tune-Up with balls, and he said, "You should really brand this and you should teach other people to teach this." And so I used these tools both for the gut and then smaller rubber balls for the whole body to help people embody their body, improve first proprioception and mobility, manage and treat their own pain, and improve whatever movement practice it was relative to. Originally it was Yoga Tune-Up, so I was helping people tune up their yoga. But I found that the Roll Model work had no boundaries.
[48:55] And this is what took me into fascia research and took me into different branches within the clinical sphere — from mental health professionals to clinical social workers, somatic psychotherapists, trauma therapists, social workers working in group settings using the tools to help bring people into their bodies for whatever purpose they're using. Military, the police, fire service, college athletics, professional athletics. It's gone all over the world now. We're in so many different places with this application of people learning to map their body, getting to know their fascia, and using tools that really make a really big difference and don't do harm. So we call this "rubber drugs." And the balls have names. There's the CoreGes ball for the core. There's the Alpha ball, which is our largest solid rubber ball. There's the Therapy Ball Plus, and then there's the Yoga Tune-Up balls, which were the first balls that I named. So they still have the name Yoga Tune-Up, but they have nothing to do with yoga. They're just grippy, pliable rubber balls.

[50:08] Dr. Linda Bluestein: I love that. I tell people all the time that if you don't listen to your body, it's going to keep screaming louder and louder until you finally do. But you're teaching people how to tune into their bodies in a way that can help with emotional healing and physical healing. That's really amazing.

[50:30] Jill Miller: Yeah. When I did a call for stories for my book The Roll Model, which was published in 2014, I did a call to action to our community of students and teachers, or people who have used our tools. The majority of the stories that came in were not about a painful knee or back pain. The majority of stories were about emotional regulation. And I found that to be absolutely enthralling — that the biggest category that people were needing help with in terms of their suffering was their emotional stress and their emotional suffering. And that they found that the therapy balls had become a tool to help regain their sense of self. And then the byproduct was, "Oh yeah, and my back pain went away," and "Oh yeah, I sleep better at night after I roll my jaw," or "Oh, I got rid of my plantar fasciitis, but also I can go on long walks with my husband now." Just all the things.

[51:29] Dr. Linda Bluestein: That's fabulous. Because with so many things, a little bit is good, but too much can be problematic.

[51:35] Jill Miller: So this is like stretching.

[51:36] Dr. Linda Bluestein: And stretching, right? Right.

[51:39] Jill Miller: Not too much rolling either. I mean, you can overdo it.

[51:43] Dr. Linda Bluestein: Yeah, you could probably overroll, but it's kind of like you're not going to overmeditate. Probably most people are not going to overroll.

[51:51] Jill Miller: Yeah, a couple have. I do have to say — I do not advocate sleeping with your balls, but one of them is my father, and so he's a doctor, he can prescribe it. It helps him with his SI joint, so it helps him with his sciatic pain. So go for it, Dad. Whatever works.

[52:12] Jennifer Milner: Jill, I just love how your personal journey seemed to start at such an early age — trying to confront your eating disorder, having this sense from a very early time period of wanting to know more and wanting to figure it out and wanting to do it right. And that's such a blessing that that was just part of who you were.
[52:35] I mean, obviously you had issues, but then you started trying to address them and work through them. And I love how that sense of curiosity and being determined to do it right has benefited so many people. Because you were honestly moving forward doing these things, and then you were like, "Oh wait, that's not right — now I have to have a hip replacement." "Oh wait, but that actually did help me. So now I'm going to go tell more people about this." Your personal journey is helping so many other people. And we're really grateful that you're willing to share your story and the knowledge that you've gained as you've kind of researched your own way to health and stability. I love that.

[53:17] Jill Miller: Well, thank you. I've learned a lot. I've learned a lot by listening to you all too. You've added to my journey so much.

[53:28] Dr. Linda Bluestein: That's great. We love putting together all of these different disciplines. There's so many different things that can be so useful for all of us as human beings and human bodies. Was there anything else that you wanted to talk about that we didn't cover? And if you can also let people know where they can learn more about you and the work that you're doing.

[53:54] Jill Miller: Yeah, I would love to share just a couple of programs that I have that are very comprehensive — if you're really interested in learning about fascia and about rolling, I think they will really educate you at whatever level you want to take it in at.
[54:09] First of all, our website, tuneupfitness.com. We produce very robust articles that have lots of free content, interviews with experts all over the world, on different topics. There's one that's been very popular over the last year because of the pandemic, which is on the vagus nerve. This happens to be one of my most favorite topics, especially because I tie it in with respiration. I have a whole training program around that called the Breath and Bliss Immersion that will be happening in March. We do that a few times a year and we're doing it virtually now.
[54:39] There's another longevity program called Walking Well that I collaborated on with a friend of mine, Katy Bowman of Nutritious Movement. She's really in the movement spectrum — no furniture in her house, barefoot all the time kind of thing. She's just amazing. She lives out of Washington, and she's an incredible educator, especially around biomechanics. We created this program called Walking Well that really addresses the walk bit by bit — I do rollouts and she pairs those with movements. And the reason I mentioned this is that one of the things I learned in my hip recovery was that I had actually danced and yoga'd a natural walk out of my body at a very early age. My walk was very unnatural due to the hypermobility that I generated along with whatever genetic conditions might be there. We'll find out someday, right, Linda? The Walking Well program is really educational and you can enter at any level. You don't have to be an expert mover to do it. I'm hoping my mother and her friends find this as their entry point. But it's also very good for rehab if you had a knee surgery or any joint replacements.
[55:53] And then the other program that's coming up really soon, that I think would be really interesting for your clinical followers, is the Rolling Along the Anatomy Trains program with myself and Tom Myers. It's almost 9 hours of content where he does very rich, deep anatomy lectures, and then I teach movements and rollouts for each of the anatomy trains. That's launching in April.
[56:15] You can always find me on my website, tuneupfitness.com, or I'm commonly found on Instagram with the handle @yogatuneup. But we also have a brand page at Tune Up Fitness — so if you like giveaways, follow @tuneupfitness, because I don't do giveaways on @yogatuneup. You'll have to see pictures of my kids if you're on my page.

[56:36] Dr. Linda Bluestein: Well, that is fabulous. This has been such an informative episode, so much great content, and we really appreciate you sharing your personal journey and all of the incredible research that you've done and all the fabulous programs that you've created. Really great work that you're doing.

[56:59] Jill Miller: Thank you, Linda. Thank you, Jennifer. I'm excited to interact with your community, and you can just shoot me questions about fascia and rolling and all of that through either one of those places that I mentioned.

[57:12] Dr. Linda Bluestein: Sounds great. We will definitely do that.

[57:15] Jill Miller: Well, good.

[57:16] Dr. Linda Bluestein: You all have been listening to Bendy Bodies with the Hypermobility MD. Today we have been talking with Jill Miller, co-founder of Tune Up Fitness Worldwide. And Jill, we are so grateful to you for taking the time to come on the Bendy Bodies podcast and share your expertise with us today.

[57:32] Jill Miller: Thank you so much.

[57:32] Dr. Linda Bluestein: Thank you for joining us for this episode of Bendy Bodies with the Hypermobility MD, where we explore the intersection of health and hypermobility for dancers and other artistic athletes. Please leave us a review on your favorite podcast player. Remember to subscribe so you won't miss future episodes. Be sure to subscribe to the Bendy Bodies YouTube channel as well. Thank you for helping us spread the word about hypermobility and associated conditions. Visit our website www.bendybodies.org for more information.
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[58:20] The thoughts and opinions expressed on this podcast are solely of the co-hosts and their guests. They do not necessarily represent the views and opinions of any organization. The thoughts and opinions do not constitute medical advice and should not be used in any legal capacity whatsoever. This podcast is intended for general education only and does not constitute medical advice. Your own individual situation may vary. Do not make any changes without first seeking your own individual care from your physician. We'll catch you next time on the Bendy Bodies Podcast.