JJ Thomas's Primal Physical Therapy Guide

A smoke alarm does not start the fire. It only tells the house something is burning. Most people, faced with a screeching alarm at 3 a.m., do not shrug and pull the battery. Yet that, says physical therapist JJ Thomas, is exactly what medicine often does with pain: it mutes the signal and calls the job finished.

Thomas runs Primal Physical Therapy outside Philadelphia and treats everyone from NBA players to forty-year-old mothers, including her friend and patient Dr. Gabrielle Lyon, who first came to her with what she assumed was a simple hamstring problem. It was not. Lyon's hamstring tear traced back to her shoulder and neck, a connection that seemed strange until Thomas explained the logic behind it.

That logic runs against how most physical therapists are actually trained. Thomas graduated physical therapy school twenty-five years ago, when the standard was to look only above and below the injured joint (03:03). Under that model, a tendon injury gets eccentric loading, a technique where a muscle lengthens under tension, such as slowly lowering the leg after a hamstring curl (04:38). The tissue often heals. But if nobody asks why the tendon tore in the first place, Thomas says, "it's gonna come right back" (06:08).

"Really, the pain is the alarm, and so what we have to figure out is what is the signal, like, what is causing that alarm to go off? Often in medicine, we keep just, just taking the batteries out of the alarm." — JJ Thomas [00:00]

The alarm, in Thomas's view, goes off because modern life has quietly erased the movement signals the body expects. Adults are sedentary six to ten hours a day (07:05), 80 percent of people are insufficiently active even if they technically get some daily steps in (07:38), and for every hour of sitting beyond seven hours, mortality risk climbs about 5 percent (08:06). Thomas sums up her fix in an acronym, MORE: treat Movement as a driver of health rather than a supplement to it, move Often throughout the day, add Resistance, and remember how the body Evolved to move in the first place (10:16). Something as small as 10 to 15 squats an hour can shift glucose uptake and hormone regulation, and 20 squats an hour can change amino acid regulation tied to protein synthesis (10:55).

Every program Thomas writes, for an Olympic athlete or a desk worker, is built around seven patterns: squat, hinge, push, pull, carry, reach, and rotate (13:43). She ties these to the milestones babies pass through between birth and roughly age three, patterns like rolling, crawling, and standing that have to be earned in order before the next one becomes possible (15:00). Skip the overhead reaching pattern, she argues, and shoulder stability never properly links to the rest of the body, including the pelvis, because the muscles involved share the same connective tissue planes (14:13).

That shoulder-to-pelvis link sounds abstract until Thomas renames the part of the body most people call the pelvic floor.

"Pelvic floor is a really poor word, because you can't have a room with only a floor. Like, the reason the pelvic floor is a thing is because there's three other walls. The top of the wall is the diaphragm." — JJ Thomas [38:54]

The side walls, she explains, are the abdominal muscles and the spinal erectors, the muscles running from tailbone to skull. A floor cannot hold weight without walls around it. That is why Thomas will prescribe scapular exercises, meaning drills for the shoulder blade's stability, to a patient asking about pelvic floor weakness or incontinence (38:35). The two systems share scaffolding.

Posture Is Not a Decision

This same logic explains why telling someone to sit up straight rarely helps. Posture, Thomas says, is not a habit so much as a readout.

"Posture is really a reflection of your underlying stability, so it's really evidence of what your stability patterns are." — JJ Thomas [34:39]

If the stability is not there, consciously straightening the spine for a minute changes nothing once attention wanders. Left alone, poor scapular position can progress to shoulder impingement, where a tendon gets pinched under the shoulder blade's bony edge (36:54), to headaches and jaw problems from a forward head position (37:50), and eventually to pelvic floor dysfunction, since the wall holding the room together has already buckled (38:35). The fix, in Thomas's clinic, usually starts on the floor: variations of tummy time, which is the same position infants use to build head and spinal control, done as an adult (22:53).

The Muscle That Fixes the Neck

Thomas extends the same thinking to a category of injuries doctors usually file as overuse.

"What people think of as overuse injuries are often underuse injuries, in my opinion." — JJ Thomas [55:03]

Take shin splints, a common complaint involving the posterior tibialis, a muscle that controls the arch of the foot (56:09). Standard advice is rest and isolated strengthening with resistance bands. Thomas instead treats what she calls relative rest: light, weight-bearing positions like a half kneel, paired with rotational or lateral loading so the muscle learns it has support from three-dimensional movement, not just its own effort (57:21). The muscle got overused, in her telling, because the muscles around it were underused and never picked up their share of the load.

Thomas uses a simple test to find these hidden culprits. She has a patient rotate the neck while sitting, then while standing. If rotation is limited only while seated, the problem usually is not the neck at all. Sitting puts tension on the posterior chain, the muscles running up the back of the body, and that tension, not the neck itself, is what restricts the turn (72:33, 73:14). One older patient reported exactly this pattern: fine neck rotation standing, stuck while seated. Thomas treated his low back and hip. His neck improved without being touched (73:55).

This is also the thinking behind dry needling, a technique using thin needles to stimulate dysfunctional muscle, which Thomas began learning in 2009, when only about 300 physical therapists in the country were certified to do it (65:30). She rarely needles the painful site first. In one early case, she needled a clinician's groin muscles and his neck rotation, previously stuck at 30 degrees instead of a normal 80, immediately normalized (67:05). She now describes the needle's effect as a structural, biochemical, and electrical reset: it releases a shortened muscle fiber, produces a measurable twitch on electrical testing, and triggers biochemical changes that support repair (74:34). After needling, she puts patients straight back into the movement pattern that was failing, so the nervous system reinforces the change immediately rather than losing it (76:18).

None of this, Thomas is careful to add, works in isolation from metabolic health. When Thomas's own blood work came back with low estrogen and an underperforming thyroid, despite years of serious training, Lyon recognized a mismatch she had seen before: patients doing everything right physically while their biochemistry quietly worked against them (79:59). Once Thomas's hormones were addressed and her protein intake rose to around 130 grams a day, close to one gram per pound of body weight, her sugar cravings dropped and, within about eight months, her body composition changed substantially (87:11, 82:08). Thomas closes on a financial image: movement throughout the day tells the body where to spend its limited energy, the way daily choices direct money in and out of a bank account (89:43). The alarm, treated as information instead of noise, turns out to be useful after all.