Gary Heshiki

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Sydney, NSW
Gary Heshiki

Sydney based Physical Therapist and American trained strength and conditioning coach.

Gary offers a variety of exercise and therapy programs to aid in your health goals. Individuals of all ages and fitness levels can benefit from improving muscle and movement quality to alleviate common aches and pains. Gary Heshiki is a Gold Coast based fitness professional bridging the gap between living and thriving.

15/02/2024

Why I don’t use what I was taught in PT school (for musculoskeletal problems). For my fellow movement professionals
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In general: focusing too much on techniques and not enough on development of a system.
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Systems vs Techniques
•Techniques primarily work off pattern recognition and may not work for everyone.
•This is where you get the good ol’ well that didn’t work, let’s go the other way. When you fall into the habit of using techniques, you begin seeing every problem as a nail since you generally only use a hammer.
•A system processes information, then interprets before acting accordingly.
•I use a combination of all the textbook knowledge I’ve accumulated to go with anecdotal experience to view problems and decide on the best way to treat a person.
•This needs to go beyond clinical reasoning which I’ve noticed in general is used as a rationalization over an informed decision.
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Treat the person then the problem.
•It sounds obvious, but too many clinicians get caught up in tests and outcome measures.
•These are important, but they don’t matter much to the person.
•My goal is always give you what you want while getting what I think you need. Anything else means this wasn’t a team decision.
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Does your therapist….

18/01/2024

Much of this was learned at the ISM I recently took. I highly recommend all the courses from FAS and hope this short carousel piques your interest.
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TL:DR
•You can’t move where you can’t move. •Make your joints do what they’re supposed to do and you’ll be better off long term .
•Could you ignore everything and fall backwards into a good outcome? Sure, but I’d rather not leave it to chance.
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Professionally I’ve always believed in this: Everyone is welcome to have a seat at the table, but not everyone gets to have a say. Sounds a bit harsh but it’s the only way to grow the field. Get better or get left behind because the profession needs to push forward.

19/12/2023

Things I Got Wrong and Why Thats a Good Thing
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As I approach the conclusion of PT school, I look back on all these beliefs and thoughts I held through the years with a more critically eye. To be frank, most of them being flat out wrong. This doesn’t mean I wasn’t getting good results, rather despite a lack of understanding I was able to back up into the right conclusion. Here are a few of my thoughts I wanted to elaborate on because after 18 years of coaching, you’re either getting better every year or you’re repeating your first year 17 more times.
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Ask any number of coaches or therapists if they think they’re both good and effective, and every single one of them would say “yep sure am”. Despite this self-aggrandized view of our capabilities, we aren’t making a dent in chronic low back pain for example. You have coaches giving out specific mobility drills and convoluted positioning for resistance work to move things back into position. Ultimately, mixed results even though we’re all “great”.
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Clickbait titles works on getting views, but what good is it if it’s not the right solution? To elaborate on this, we as a society push for a quick and low time investment solutions to our problems and pains which has resulted in the clickbait heavy content being put out. The true answer to most problems is and always will be it depends. Why? Because the circumstances that have led to your lower back or shoulder injury is not the same as anyone else’s.
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Biomechanics don’t matter (sometimes it does)
I used to pride myself in knowing how things are supposed to move and how when you deviate from it, you’re likely to get injured. Problem with this nocebo narrative is that it begins to instill fear of movement and a over-reliance on working with me (eg: only I can see whats wrong, so you have to keep coming back). I have since adopted the belief the body is adaptable and is more robust than we give it credit. When you see a coach saying they’re evidence based, who believes the body is adaptable but here are 3 moves to avoid, it’s a walking contradiction.
…continued in comments

26/06/2023

Greater Trochanteric Pain Syndrome: So you’re saying it hurts right at this one spot 🤔
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GTPS is also known as gluteal tendinopathy. While many try to paint a simple if this do that kind of solution, it really is a little more complex underneath this “easy” to diagnose problem.
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You often have pain over the side of your leg, often you can pin point it over the bump near your hips. You have trouble climbing stairs and generally experience pain when trying to stand on one leg.
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While it can be associated with glute Medius weakness, much research around this theory has proven it’s not the only driver for pain. Plinsinga et al looked at those with pain having greater hip abductor strength experience greater psychological distress. Meaning their beliefs around their movement increases pain signals without the weakness many would point to as being the issue.
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Second would be dismissing the notion just load the tendon. A clamshell or any hip abductor motion places more compressive stress on the tendon. So if we have an irritated area, how on earth would this help?!
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What to do:
-If it’s irritated, unload the area before reengaging with exercise. This doesn’t mean stop completely, but finding modifications.
-If you’re a runner who gets it after a specific mileage, what is it about this distance that triggers the pain? Could be a volume issue or as simple as increasing cadence to change the loading pattern.
-Strength is good, but it isn’t the solution if it’s introduced at the wrong time.
-Pain is an interpretation of what’s going on. The driver of the pain could be any number of things. Don’t let any charlatan on social media tell you otherwise.

19/06/2023

Patellofemoral Pain Syndrome: aka the front of my knee hurts.
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The short and sweet of this is that you have an overly sensitized knee. You could change gait or how someone Squats but this doesn’t have to be done forever.
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Enough research shows you can have a ton of knee valgus while running and still not have a lick of knee pain. Might this problematic in another person? Yes of course but there’s a variety of factors that might increase or decrease sensitivity at the knee.
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It’s not all about biomechanical factors like knee tracking or strength. The front of your knee hurts? Figure out what it requires (be it modification or load reduction) and keep moving!

17/06/2023

Today I complete my 37th trip around this globe and I got to spend it with the two people I love the most.
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This has been a challenging year to say the least. While I’m currently on the tail end of an accelerated DPT program, I find myself longing for days with my little one but more so with my wife who I miss everyday.
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If there’s anything I’ve learned this past year it’s this: All things are temporary. You can endure anything knowing difficult situations will soon pass. At the same time, also knowing to have gratitude when things are good as it won’t always be “good times”.
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These few hours are where my birthday overlaps between my two homes: Australia and Los Angeles. I miss my friends, tacos, Trader Joe’s, and Disneyland. What I wouldn’t give for an overpriced churro while running after my favorite little Mouseketeer.

13/06/2023

Knee Arthritis: Due to wear and tear?
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Not really. Does degeneration of the cartilage contribute? Sure. Is it the sole source of your pain? Nope.
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When looking at research examining one common belief that individuals with excess mass (via high BMI) they will experience more knee pain. A handful of papers looking at biochemical mediators and pain noted the same thing: decrease overall inflammation and knee pain goes down without any structural changes.
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Secondly, it’s the chemical irritation (like why a pinched nerve in your back hurts) that increases sensitivity and pain signals. When you have a chronically irritated area, like the knee, then the threshold for triggering the pain signals are much lower. Remove the irritant and you raise your threshold again. Chemical irritation is a systemic problem not a local one.
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Lastly, there are dozens of papers showing you can have minimal and major degeneration of the joint space and it’s a toss up whether or not you’ll experience pain. Meaning, it’s not just about the space change that’s contributing to your knee pain.
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What you can do:
1. Focus on getting healthier. Recovery and nutrition strategies are key.
2. Strengthen the hip, knee and ankles.
3. VMO is far less important to knee health
4. Focus on activities you love, modify accordingly and live your life.

26/02/2023

Great weekend meeting lots of likeminded people and listening to share his wisdom on keeping things simple. A few gems to share here.
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Listen to the patient and they tell you exactly what you need to be doing.
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Pain gets a seat in the car, but it doesn’t get to drive.
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Biomechanics matter for performance, the further you get from performance the less it matters.
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When examining any system or technique, take what works and run it through your framework. In the end, the goal is helping a the person in front of you. So you can always extract a positive on how to (or how not to) manage their issue.

13/01/2023

Having relocated to Australia, there’s a lot of new faces here who don’t know too much about me.
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My name is Gary Heshiki and I am an American born and raised strength coach-manual therapist. After earning my degree in Kinesiology, I applied to Bond’s Doctor of Physiotherapy program to explore my passion for helping people move and feel better.
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I previously ran my own training and therapy business in Los Angeles, CA for 16 years before relocating here with my wife, daughter and 3 cats. It was a huge change but knew that professionally it was the next progression in my development.
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I’ve was heavily influenced by the world of powerlifting and olympic weightlifting before exploring how mobility can be so much more than the current “mobility” work. In my opinion, true mobility work is strength training. When applying the same concepts behind resistance training like periodization and manipulating velocity, you quickly learn you can do a lot more for your joints than leg swings and a hip flexor stretch. If there’s one thing my clients would attest to, it’s how much more durable and infrequently they get “nagging pain” in the necks, shoulders, and/or backs.
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In between my current studies, I maintain an online presence through a coaching app where I’m able to continue training clients. Through a collaborative relationship, we decide on goals and training set-ups that work best for my clients.
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When you do what’s always been done, you’ll end up getting the same ol’ results. Life’s too busy to get sidelined because you coughed weird or woke up 30years old 😭.
If you’d like to learn more, follow the link in my profile or drop me a DM here and let’s get you back to doing the things you love.

10/08/2022

Has anyone explained how to view research quality?
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Nowadays everything is “backed by research”, so it’s hard to tell what’s legit and what’s cherry picking one sentence in a case study to sell you weight loss teas or a massage gun. Here’s a very simplified guide to see the hierarchy within research.
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Lowest form of evidence: Expert opinion.
Yep that old coach yelling about orthopedic costs or unracking weights causing back pain….lowest form of evidence. There’s an importance to experience but it in no way replaces research (and vice versa). In this case, research is what proves a modality can be used for a wide range of people vs trial and error.
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Observational studies: case study, case controlled studies and cohort studies.
All of these are great at looking into relationships and potential casualties as they are long term observations about a particular group of people. For example if we wanted to see what the relationship is between 25 years of Olympic weightlifting vs general training and developing low back pain. One might do a retrospective cohort study looking back at 2 groups of masters level lifters who competed in Olympic lifting and powerlifting and compare the rates of lower back pain.
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Randomized controlled trials
This is what you likely think of when you think of research. These are great, except when coaches use them to make statements using them as evidence for a wider range of people. One study doesn’t equal a whole population.
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Systemic reviews and meta analysis
Reviews seek to answer one question, then after sorting through thousands of randomized trials to include, draw a conclusion. A meta-analysis is just a way to use statistics to combine large data sets into something useful for you to read. When you want to figure out if something is legit, see if there are any systemic reviews first.

27/07/2022

Has anyone ever explained pain to you?
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Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
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This means that pain does not always equal tissue damage. Most people and clinicians understand pain to be a purely biological problem, something that only exists in your muscles or soft tissues. But this is only 1/3 of the solution as we understand that pain is in part constructed in the brain. Phantom limb pain is an example of that, an individual continues to perceive pain despite not having their limb.
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All pain is processed by the limbic system. This means we NEED to address cognitive, behavioral, and socio-economical causes of pain. Outside of treating the physical, an emphasis on education on how thoughts and our everyday emotions affect how pain is felt is key to chronic pain.
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•Imagine that a pain dial exists in your central nervous system.
•It functions like a volume k**b that it can be turned up or down. 3 areas that affect this dial are:
•Prefrontal cortex: Attentional processing and executive function
•Cerebral cortex: manages our thoughts
•Limbic system: emotion center of your brain
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3 factors that significantly influence pain
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Sydney, NSW
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