Ankle tendonitis and ankle pain when running: a rehab game plan

My Achilles hurts when I run out from my house and I go out and back. Sometimes about halfway, I realize it hurts and I have to limp all the way back. Well, maybe we do a couple small loops, you know, maybe do one mile loops around the house. You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now, your host, Dr. Sebastian Gonzales. Hey, everyone. This is Dr. Sebastian Gonzales on the podcast mic today. And that was a little tiny clip of the solo podcast I'm doing today on foot and ankle stuff.

And I think the—actually, the reason why I'm doing this podcast was actually I asked my transcriber who does all the transcriptions for the podcast in case you guys have been on there and read them and so on. She's responsible for it. By the way, if you do need a good transcriber, let me know. We were back and forth a little bit on what she wanted to hear on the podcast and she really enjoys them. And she said she loved the interviews, but at the same time, she liked to hear ones where I did solos. So I'm like, well, I'll do a couple solos in here a little bit for you. And I said, what do you want to hear about?

And she said, Achilles injuries, plantar fasciitis, heel spurs. And she does CrossFit. And so she said one guy in her gym actually had surgery where they scraped off the bone on the bottom. So these are—I've actually been writing some things on foot and ankle conditions anyways. So I thought this would be a really good one to add in at this point at session 99. 99? Can you believe we're at 99? Holy crap. I never thought we'd get this far. So if you're having pain in the back of the ankle, having Achilles tendonitis, plantar fasciitis, heel spurs, if you're wondering why your ankle hurts, perhaps you've been told you have Achilles tendonitis or you have calf pain, calf muscle pain maybe, or you've experienced ankle pain after running, this is going to be a great podcast for you.

For the clinicians out there, this one will be useful, but it's going to be one that you're going to want to probably share with your patients for them to listen to directly. Now, I'm not going to say you're not going to get any good information from it. Hopefully you will. But I'm going to put this hopefully in a little bit more layman's terms and possibly go into some thought process of things that I would probably look at and address if these conditions pop up on people, not just of CrossFit, but also running. And I guess CrossFit style, I know it's kind of more of a categorization of stuff right now, but more high-intensity training, I would say.

Or perhaps we can even talk about it with Olympic lifting too, because there's a possibility that these people actually don't have these injuries to the ankle and they think they do. They feel like they have referred pain. And if you listen to the podcast with Dr. Michael Fanning, we kind of went over that. It's for IT band stuff, though. If you say you have an IT band issue, but you don't have the mileage to merit the friction syndrome, then maybe it's something else. So as lifters, you might not find IT band issues quite as much. You might not find Achilles issues or plantar fasciitis quite as much, but you could if you merit the distance to it or you had a past injury.

Now, if you guys are looking for the show notes, know that you can go into the search function on p2sportscare.com. We will have a podcast tab a little bit more updated very soon. We're going to do actually another website redesign. And I know that some of you healthcare providers are out there have already contacted me about my website. And you're like, how do you make a website like that? Well, it took a little bit of money. It took a little bit of back and forth. And it took a lot of time. It actually took just to do the design portion took about a year. But the content, I mean, there's literally 250 pages behind that main page.

So there's a lot of content behind it. So we might be changing a little bit to increase user experience. So at this point in time, when you see the search function on there, go ahead and type up your type of condition. And you might be suggested a podcast, an article, or a video. And if you're looking for this podcast in there, it's going to be foot ankle podcast, something of that nature. So it's going to be 99. Now, let me tell you a little bit about my recent ankle injury that I never, ever, ever thought I would get it from what I got it from. It was from brewing beer. So actually, this was not an overused condition.

But it was interesting to see how long this thing lasted. I was picking up, if you guys have ever brewed beer before, we've done quite a few batches before. And you kind of want it when it's cooler. You don't want it when it's like 90 degrees outside because it won't let it ferment quite as well. So we had some ingredients. We had a weekend free. We were brewing some beer. And then lo and behold, next day, it was like 95 here. Like, just a rare, like, hot streak. So we used to put it out in the garage. And it's like, well, it's not very insulated out there. It can kind of get what the ambient temperature is.

So it ferments in this glass, five-gallon water bottle called a carboy. And the carboy has always been, I've always been kind of leery about it because it's heavy. I mean, you got, like, five pounds full of liquid in there. It's probably roughly about 50 pounds. No, probably more because it's glass. Those plastic ones are, I believe, about 48 pounds with just water in it. So at this point in time, since it was so hot, I thought maybe we should insulate the area. You know, we put it in a cooler. The cooler had some water in it. So at least the water would have enough ability to keep it cooler when it was getting, like, 9,500 degrees outside.

So actually, before I move, before I actually got to this point, I thought a couple times, I should buy something to move this carboy a little bit more efficiently. And I was like, no, I don't need to do that. I'm like, but I kept thinking, well, we keep almost dropping it a couple times, and that would be kind of bad. And I'm like, no, I'll just get away with it this time, you know. So we put in this water, and another insulating tool we use is sometimes a wetsuit I have. So I was slipping into this wetsuit, and there was water on it from the water in the cooler, and it's literally about no more than six inches from the ground.

And it slipped out of one hand, and it hit the ground and just shattered. And the liquid pushed all this glass. One of them sliced my ankle right around where all the tendons go behind the bump on the inside of the bone called the medial malleoli. So basically, all the flexor groups, all the muscles that go to the toes, all the ones that go to the big toe, the little toe, the ones that support the arch. They didn't get damaged, but they actually, you could see them under the flap of skin that had already kind of come up. So I had to get stitches there, but as a result of some of the swelling from the stitches, like, I literally could not walk on this thing for about a month.

I was on crutches for easily two weeks. Just a step down on my foot felt like it was going to explode. And it's funny to see the types of things that happen when you can't use your ankle because my other hip and some of my back started to hurt. Using the crutches, my shoulders started to give me a little bit more grief than normal because it was just an increased volume of what I was having to do. So if you can't use the end of that leg, the ankle or foot, then it's a bad deal. So I rehabbed that thing actually pretty well after that, and that was not the result of doing this. It was months and months ago.

But either way, I can run now again. I can push a sled again. I can jump rope again. But it was actually, to this day, when someone gives me something in glass versus a bottle, I'm like, dude, I don't believe glass is safe anymore. Like, we should not be having this glass. And they're like, well, don't worry about it. It's just glass. I'm like, dude, do you have any idea? That little thing, what that thing could do to you? Glass is dangerous. It's the devil. So glass is the devil. Okay. So without any further ado, we're going to go into a bunch of topics and rehab as well as theory around plantar fasciitis, Achilles injuries, heels, spurs, pain in the back of the ankle, Achilles tendonitis, muscle strain of the calf, and much, much more.

So you're going to get a ton from this. Here we go. I think I've got to take a big breath before this one, get my sympathetic nervous system down. This is going to be a hard one, honestly. So podcasts are kind of tough. But here's how I plan on going through this here today. So there's three different ways I like to describe how to deal with foot ankle issues for patients. And I think this is helpful for providers as well if they need a little bit of assistance for game plan. Number one, there's a three-step game plan I like to do. And this is usually a piece of paper I give patients on day one because there's a lot of information, a lot of testing, a lot of things going on.

And they're like, well, what do I do? How do I put these things together? So that's how I kind of use that part. I will go over that in a second. Then I have made an acronym, which I don't know if I'm going to keep it 100%, but it seems to work okay for now. So I call it MAP, M-A-P. MAP is modify pain. It's activate the support system and then pattern and then eventually get to load. So map your load. And then there's a hierarchy of movement that I, how I describe to people, they're like, well, I don't know what to do with the progression of things. I don't know when I can run. I don't know when I can lift.

I don't know when I can do this. So hierarchy of movement is where I kind of go into that and I'm like, well, where are you at? And they can answer that very clearly. And then they can be able to have a little bit more autonomy to figure out what they can and can't do. Now, into this podcast, I'm going to do a little bit of, I'm going to reread here some of the stuff that my transcriber sent to me because she had that question about foot, ankle, Achilles, heel spurs, and so on. I'm going to answer a couple of these first just because I love the work that she does and I want to make sure that I'm giving back.

And I'll probably forget. So if I don't do it right now, I'll probably forget. So let me just read a little bit here for you. So I'm going to summarize things that she said. So she was asking about Achilles injuries, plantar fasciitis, heel spurs, and surgeries and so on. And she said, I'm always expecting to heal quickly, but she gets back to about 90, 95% of the way better. And then it's such a long healing process that she's afraid of reinjuring it. So she basically stopped doing things like running, box jumps, jump rope, and she does CrossFit. So she's pushing the prowler too, and there's sprint days.

So I totally understand. There is a long healing process for a lot of different types of conditions. Achilles issues definitely take a little bit of time. Foot conditions, plantar fasciitis take a little bit of time. And when I first did some reading through to see what the public was thinking about plantar fasciitis, that one in particular, I went through some forums where runners were talking about it, and it sounded depressing. I mean, it was just, you know, I've been dealing with this for two years. No one can help me. I tried orthotics. It didn't work. I stopped running. What do I do? I get it.

It's very frustrating. And coming out of the injury from that, it's very, I'd be hesitant to run as well, which is not always a good thing. But I understand the psychology of that it takes, you don't want to be back to what it was because you are afraid of not basically functioning ever again. So I totally get that. But usually when we get the area that is, if it's not a surgical case, if we get the area to desensitize some, then we can build a support system around it and movement stops being compensated. And a lot of times then we're off to the races, metaphorically and probably physically too.

And this goes for CrossFit or lifting, Olympic lifting as well. If you have a foot issue, Achilles issue, plantar fascia issue, pain on the inside or outside part of the foot, it's the same thing. It's a very simple process. It's desensitized, then you stabilize, and then we address the pain triggering activities. And I'll go into that more in a second. The last question she had was two questions actually. Number one is, what do I think about taping up ankles or feet? Honestly, I think it depends on what we're trying to do. And I remember going to a, this was, it wasn't a CrossFit Open. It was something, I think it was MPGL or Grid League or something like that.

So anyways, people were getting taped and they're like, they came in and they're like, hey, I want to get some tape on that, you know? And I'm like, why? And they're like, well, it just, that's what I want. It's what makes me feel better. I'm like, how long have you been using this tape? And they said, well, I've been using it for months. And with situations like that, like with, with like a plantar fascia issue, I wouldn't be taping it, you know? Like I, I wouldn't be taping it mainly because I don't want the tape to be the support system that allows you to do the things that are triggering the condition.

I'd rather you feel a little bit of pain and be able to realize, hey, we can desensitize that by decreasing or modifying this activity. But if you have to go out and use it that day, like if one of those people came through and they're like, well, I want some tape, this is a brand new thing today. I just want to be able to get through this and I'll deal with it responsibly. By all means, I'm down with that. But so when people are chronically using these things as crutches, I don't think it's helpful at all. Um, she had a question about cushioning, cushioning wraps or padding for the bottom of the foot at the heel.

Um, I had on, uh, Dr. Thomas Michaud and we talked about this a little bit. Um, orthotics, he's been in the orthotic industry a lot, uh, a long, long time. I think it's a family business for him. Um, and he put it a really good way. He said that, uh, orthotics are really just intended to, um, what they really do is they disperse load. So if there's a focal pain on the bottom of the heel, um, and even whether you believe it's for a, from a bone spur or a calcaneal fat pad or whatever, it's just disperses the load and lets it, lets it repair itself a little bit. Um, he said, if you pronate with, uh, without orthotics and you're going to pronate with orthotics and it doesn't really change your contact points quite that much.

Um, so it's not really a big issue. Um, I can support, I can, I, uh, if you're, if you're interested in all the research on that, uh, human locomotion is the book that he put out that is, it's, it's really intensive. And if you're a patient, I wouldn't read it. Um, I would read it if you're a clinician. It's really complicated if you're a patient. And even I had to put it down quite a few times and just take a deep breath. And I even told him, I was like, dude, you should write in a book that is like consumer based. It'd be great. Um, he wasn't doing it yet. So that's the reason why I'm, I'm making this a manual because I, I hear enough people out there who are having foot ankle conditions that just are not getting better.

And a book like his is amazing, but it's not digested in a way that consumers can kind of use. So, um, this one is written in a way that consumers and athletes can get a little bit handle, more of a handle on the thing. Um, and now the last question she had was, uh, bone spurs, are bone spurs the cause of pain with Achilles issues and plantar fascia, uh, plantar fasciitis? And it could be, but in my experience, most of the time, not, um, in multiple different types of joints with the back with degenerated, degeneration conditions or osteoarthritis or old age arthritis or any of this stuff. It's, um, a lot of times it's not in my opinion, because I've seen enough people who have had it on their imaging and they're not in pain.

And I've seen people who are in pain, don't have it. So I think just because something's there doesn't mean it's the cause and just because you can see it on an image doesn't mean it's a cause. So bone spurs, I'd be very cautious with that. Um, don't jump too quickly on the thought that the spur is the cause of your condition. Um, and lastly, this is her last question. She got a lot of questions, as you can tell. Uh, Ronnie, I appreciate, I appreciate the questions. Actually, these are great. So she said, uh, her husband went in to talk to her about an, talk to an, uh, a, uh, a surgeon or a podiatrist surgeon, um, about her condition.

And he said, well, if you could bring in here, I might do some whittling away or do some surgery on the, uh, on the area, or she can just save herself some grief and do these exercises five times a day, two minutes a day or two minutes at a time for one to two weeks. And her symptoms will probably decrease her lesson. Um, and so she said she did those exercises and they hurt really bad. And so just my response to this was, I really like, I liked that the surgeon was, uh, giving some corrective exercises because a lot of times in my experience, and there's a reason why I'm writing this book and doing this podcast is that people can get better with corrective exercise.

They can get better with some desensitizing types of, um, activities and modifying what they're doing, uh, not forever, but for a little bit of time until we get that area to repair. Um, but here's the thing is that I don't, I mean, I usually when I have someone in my clinic and we're like testing something out, like, Hey, let's try a wall wed, just try a forward lean, let's try a squat. How does this feel on your foot? Oh, it makes it worse. So usually what we'll do is we'll do a slight modification. Let's just say if it hurt in the Achilles area with a squat, I would, I would tell them to load into their toes partially or rock into their toes.

How'd that feel? Well, it feels better. Good. So their, their exercise or the corrective exercise in that regard would not be to do painful squats. It would be to get every squat to be pain-free. So we're trying to build a movement pattern right here or to, uh, rebuild a pathway and to do it painfully every single time is, uh, is not productive. And, um, this is kind of the, the, the one issue where people will ask, what is the best exercise for plantar fasciitis? What is the best exercise for peroneal tendonitis? What's the best exercise for a past ankle sprain? We don't know. I mean, it's very dependent upon the person, but also too, you have to do it right.

So, um, I think there's a lot of understanding that needs to happen on the person's part on the patient's part. Um, and just do some due diligence and be, be willing to test, be willing to AB test. Does this feel better? Does that feel better? Okay. So just because that hurts, maybe I should do it this way. And, um, what we find is that we, as we start to load the foot ankle and, um, that whole complex properly, we see calf strains or calf tightness start to decrease. We see loading of the Achilles tendon to start to decrease. We see the plantar fascia start to, um, chill out a little bit. Um, and a lot of times it's just foot loading, but it can be a lot of other things too.

So, um, as I go into some systems right here that I, that I've created the, I've kind of alluded to some of them, um, the number one thing, and this goes along the lines of a lot of different conditions that I see. And, uh, I, I got this idea from reading, uh, Dr. Stuart McGill's back mechanic, as well as his low back disorders book. Um, he kind of deals with the spine and the disc is in the same way. And I started realizing that all of these, uh, conditions can be dealt with this exact same way if they're going to respond. And the first thing we got to do is decrease the amount of sensitizing triggers or activities.

Second thing that we have to do is that if you do happen to sensitize it, what do you have to do? What can you do right now to make it decrease? Because we want it to decrease as quick as it came so that we can desensitize the entire system. Because it's very exhausting to have, um, to have pain and you think about it and you fixate on it. And so actually right now, as I'm doing this podcast, for some reason, I got this pimple on my face. I haven't had one in this spot for a long time, but it feels like it's, I mean, it feels like it's just hot. It feels like it's, uh, like kind of pulsating there, how those ones do.

It feels like they're, it's ready to go. So I'm thinking about it, you know? And, uh, so it's just sensitive. And so if we can get it down, the sensitivity down, uh, ideally by, by a movement correction or some type of, uh, passive care, then I think we're on the right track. Uh, the third is that once we got the triggers down, we got the sensitivity down, now we can lay in more of a support system. And this is way, uh, where we get the other spots of the body to assist with the ankle. We find that there's, um, a correlation with hip and torso with it. We find that the, um, that the foot overall can, uh, the structures of the foot or the, or the, uh, the toes can be a big correlating factor to the other types of injuries of the foot and ankle.

Um, there's a lot of things that we need to consider. And as I alluded to earlier, or as I talked about earlier was that sometimes improving loading the foot can desensitize someone immediately as well. So the crossover here, which I haven't made the clear division yet to people is that the desensitizing things, the things that you can do to get it to feel better is sometimes building the support system. So those ones kind of blend a little bit. So let me go into those three again right now. So let's just, uh, I thought the best way to kind of go through this would be to talk about, uh, a different type of foot, ankle, calf strain in correlation to, uh, these systems that I'm laying out here.

Um, so in this regard, we're going to talk about the Achilles tendon or Achilles tendonitis or Achilles tendinosis. So let's think about all the things that are irritating to, uh, Ronnie here. She put onto her thing. So she said, uh, pushing the prowler, sprinting, run, uh, running, jumping boxes, jump rope. Um, so what I'm hearing is a lot of landing, um, and higher than body weight landing. So there's a possibility that we need to modify those a little bit. And there's, there's a mental and, um, there's a, there's a mental thing sometimes people have with, uh, or barriers to success with these, uh, reducing their sensitivity triggers.

And the first thing is, um, and I'm hearing that she's in a group class. So a lot of times the competitiveness of the group class doesn't make it easy to modify and, um, modification of these activities doesn't have to be forever. It just has to be for a period of time. So we let the mother nature do her thing to repair the Achilles tendon. So perhaps running, we might make a correction and she can probably row, um, box jumps. Perhaps we do step ups and step downs, um, jump rope. Uh, this might be a little bit tougher, uh, but maybe just going up onto her toes a little bit up and down, up and down.

Um, and pushing the prowler, uh, I, I usually find that people that they're pushing them tend to go very quickly with it and they're not very mindful of their positions and postures with it. So when I rehab people with, with Achilles tendonitis, a lot of times I'll put them onto a sled. I'll load it really lightly and I'll say, push it so slow that you have a glass of wine on your back and it's not spilling on my white carpet. So they got to go super slow and they have to keep their pressure and they can't deviate, um, from having central stabilization. So a lot of times that decreases their pain.

Um, and they're surprised most of the time. They're like, wow, that felt a lot better. And, um, there's, they're thinking it's going to be painful. And I actually was just with a, with a friend a couple of months ago, uh, Dr. Richard Hanson, and we were talking about, uh, I think he wrote an article on, uh, I think it was a metatarsalgia or Morton's, uh, uh, Morton's neuroma. I forget which, but he sees a lot of, um, track athletes up in Boulder and we're driving the car and he's like, I get so much traffic on this one page. Um, it's, it's, uh, it's surprising that there's that many people reading it.

And I'm like, well, there's a lot of people with that problem. Like, why can't we just push them on a sled and call it a day? And he's like, yeah, you know, you're kind of right. So we start loading into the toes. A lot of times we, we solve a lot of issues. Um, so back to the thing, anyways, desensitizing triggers, a couple of mental thing, um, a mental thing that can be a hangup for, for people to remedy. This is in the running community. They will say, well, I have a Saturday run or Sunday run with a group and we go out and I like to hang with these people. These are my running partners and I have to stick with them.

I don't want to lose them. What's the point in going? I'm like, well, that's a great point. So if you're doing an out and back, maybe they're going to go, uh, 10 miles out, 10 miles back. We don't know. Perhaps you run out five and you walk like two or three or whatever it takes for them to turn around. And then you turn around, you meet them back at the five mile mark again, you run back with them. So you still get the camaraderie of going on a run with them. You can still eat breakfast with them, um, and hang out with them after, but you're not damaging yourself for the sake of just having camaraderie.

Um, also too, um, if you're running alone, you might say, well, my Achilles hurts when I run out from my house and I go out and back and I come back half, sometimes about halfway, I realize that it hurts and I have to limp all the way back. Well, maybe we do a couple of small loops, you know, maybe do one mile loops around the house. You know, there's that way, if you get into trouble, there's not that far. You have to go to really, uh, get back, get back and do some desensitizing things. So there's a lot of things to consider with this. Um, just because your running group goes where, uh, runs on concrete doesn't mean you have to.

Um, so I've, I've met people even that have added in some trail work have been much better. So there's, there's a lot of things to consider. Um, now with the, one thing to think about too, with desensitizing, uh, activities is that if you are a lifter such as her, um, we have to consider the possibility that if you don't have the volume of eccentric or lengthening contraction for the Achilles, um, to become irritated, then there's a possibility that actually the Achilles is not an issue of the Achilles. And I had a girl come in just the other day that we, we just, uh, we basically did a little bit of a test of what we call dermal traction.

And so I lifted the skin around the area of the Achilles, um, kind of where the nerves are going that come from a different area and it took her pain away and I had a run and the pain was gone and we left the suction cup on there. And, um, she's like, well, why is that working? And I said, well, we, we got to look a little higher. So, um, a while ago I did a podcast with Dr. Justin Dean. We talked about, uh, basically false or, or pseudo plantar fasciitis. And he said that you'd be surprised how many people come in with thinking they have arch pain or plantar fascia pain, but it's actually a neurological pressure.

You're pressuring a nerve and it's creating pain in that region. So they think it's that because that's all I read about. So in that regard, if it, that does improve it, um, we have to figure out if there, is there postural changes or loads of the spine, which can be affecting it because the nerves of the, that come out of the spine, if they're sensitized, the entire track of the nerve can be sensitized as well. So in this case, it might present as Achilles pain or plantar fascia pain or foot pain in general. Next, we get into the second part, which is our things that desensitize and, um, just reiterate, the first thing is things that you do, which create pain.

But then after, after the pain starts, how do you get it to go away rather than just limp around all day? And, um, this is a little bit of trial and error and it really comes down to, uh, a good examination or just taking shots in the dark. And I've noticed that some people, just like what I mentioned with that last girl was that she found that dermal traction and lifting the skin around the area of the Achilles took her pain away, uh, um, took her pain away really, really well. Um, is about halfway gone. So later in that exam, we, uh, I found that I needed to improve her frontal plane, uh, uh, stabilization in her torso and in her hip.

So we did, uh, side bridges and I had to run around after that about five reps of both. And we found that her pain was completely gone. And so in that regard, she could do, uh, uh, lateral wedges or side bridges when her pain gets worse. She can possibly do things like, um, uh, increase of intra-abdominal pressure or we say sipping soup. Dr. McGill says sipping soup, like the air is soupy, like you're in Florida and it's just wet. So something like that. And then holding the pressure inside the abdominal area seems to stabilize the torso, which then improves the area of the nerve root as it's coming out, which then decreases the amount of irritation to the Achilles.

In other cases, if the problem is toe loading, let's just say, which is another common one that, uh, Dr. Masha goes over a bunch is that if we load into the toes and we found that like a valet forward lean would improve it, then just do 10 reps of that. It's not exhausting at all. You just kind of load into the toes and all the way, boom, it feels better. Miraculous, right? So these things are so, uh, low loads that you can do them a lot in the day. And I like to have people desensitize the area before it becomes sensitized. So it just take about, you know, 10, 12 times during the day, start desensitizing it before it gets like that.

And then all of a sudden their system is, uh, prepped for a stabilization, uh, project to be, uh, improving. So the last part is building the stabilization system. And this one is, I do have a lot of people who, who ask like, well, how do all these exercises fall into play? Where are we, what are we working out here? What am I supposed to be feeling? What are, what are we doing? Um, and the easiest way to describe it is the body is one unit. We can't separate systems and we can try, we can do like ankle raises and toe raises and things like that. But it really, um, even then you have to have a little bit of, uh, hip engagement and leg engagement and torso engagement to do it, but to do it well, to link all the systems together, we need to rehab them together.

And, um, I had a, I had a patient that came in recently. He's a, he's a mathematician. He's an interesting guy. And, uh, we were talking about how to educate students on math. And he said, well, people come in and they, uh, like there was a, I forget what the type of math, let's just say it was stat. And, uh, he said, so they were really bad at this one type, there was about this one type of stat, but all it is is basically, um, a little bit of trig and algebra within it. And they're really good at those two things. They just, they, they did really poorly at the overall stat problem. And, uh, he said, I said, well, how'd you fix that?

And he's like, well, um, I brought their attention to the fact that there was, uh, algebra as well as trig in there, and then they got it all better. Um, so framing it and just realizing this is part of a big picture. So just because you're doing side bridges or wall wedges or valet forward lean, um, it, it doesn't mean those are going to be part of your rehab forever. You, you build a whole process and the valet forward lean, if you look at it, we're basically just moving like a plank of wood. And it's very similar to, um, pushing a sled. And I know patients have, they think I'm joking with this, but I, I, when it's, when they're ready for it, I tell them to, to take their smallest car they own, put the e-brake on lightly, very lightly and push it across a flat street down the neighborhood.

And they're like, no, I'm not going to do that. I'm like, yeah, you're, you're paying to come here to push a sled. The car is going to get some momentum. So it won't be super hard. Just drive through the toes, lean in, plank into it and push, you know? So it's, uh, that, that works a lot of things. And if we're going to say it works an overhead press, an isometric overhead press or a forward overhead press, um, it develops torso stiffness. It does, uh, basically it's a plank. Uh, it does breathing work. It teaches you how to sip air. It teaches you how to drive off of one leg. Um, it teaches you how to load into the toes.

And there's a lot of different parts and we can take 13 different exercises to make that one car push, but pushing a car might be when the easiest, quickest, most efficient things that people could do. Um, or even going to a home depot and getting a, a wheelbarrow and cutting the legs off it. I mean, you can push it across the lawn or pull it across the lawn. Those are all options for people, but building the support system is, um, it doesn't have to be super complicated. But in the beginning, when we're working on decreasing the amount of pain in the Achilles area with this, then we have to, uh, consider what the person can tolerate the time.

Um, I do have more on this in that book, by the way. So if you guys are interested in the book, by the way, I don't mean to keep pitching it, but this is a, this is a, these are comments that, uh, these are questions that come up a lot. So I'm realizing that I can help a lot of people with this. Um, I, I've taken phone calls. I took one a couple of days ago where a lady was talking about, she was from Seattle and she was talking about, um, some of the problems she was having. And I was, I was like, look, I, you're in Seattle. I'm in Huntington Beach. I can't help you. You know, like I can refer you to someone who might practice the same way, but I can't help you.

And so we talked for a bit and I never really told her about what I, what I thought our problem could be because I can't do it over the phone. I got an examiner, but it was still a 10 minute phone call and I was glad to help, but I can't take those phone calls all the time. So I figured by writing these books would be most helpful to people. So, um, although, um, so I don't want to, I don't want to be bashful about having you guys go and look at it. Even clinicians will get something from this. So, um, it's about 50 pages long and there's going to be, I think close to 15 videos and it may be 20 videos on some of the stuff that I'm referencing.

Now, um, within that book, uh, I talked about, this is one of the first books that I, that I made where I talked about mapping your load. So MAP, so this kind of falls from that three-step process. If you can just think about map, modify pain, activate support, and then pattern. And what this basically goes through is number one, that if, if something hurts, let's reduce the pain, but it doesn't mean we stopped there. And this is where a lot of people tend to get into trouble. They're like, well, uh, sorry, in, in this, in this, uh, framework, I'm going to talk about plantar fasciitis. So I'll skip gears a little bit here.

So if your plantar fascia hurts, the bottom of your foot hurts, we need to figure out what we can make it decrease pain within the shortest amount of time. And this is where we go into, you know, passive care. If, if it works, if it doesn't work, don't keep trying, but just because it does work doesn't mean it stops there. You need to activate the support system and then pattern a movement and then possibly load it. So MAP your load. Now the plantar fascia, some things that might work is number one, we talked about, um, the possibility that it's neurological. So maybe we do some dermal traction.

Maybe we do some toe loading. Maybe we do some ice, maybe some heat, maybe some adjustments will work. Maybe injections work. I don't know. Um, by the way, passive care, the, the categorization for this is, is things that do not take you really much effort to do, um, or someone does to you. So massage would be in there as well. I guess surgery would be a passive care because you don't really do anything. You're asleep. Um, so all these things are there. I don't want you to think that I I'm hating on them. They're just a small part of the puzzle and you find getting someone to the point where they can modify their own pain is really, really important.

And it's super empowering for the person. Um, but then after that, a lot of times people will forget about their pain because their pain is gone. So I would suggest doing that pause, that, that passive or active pain modifier and then activate the support system around it. So we're locking that thing in patterning a movement is, um, so if we're talking about plantar fasciitis, say it hurts to, um, walk upstairs. Well, now that we know how to load into the toes, then we might walk a handful of stairs and before it becomes painful, we stop. So if you know it takes about 30 steps to become painful, then maybe we do 29 and we do this a handful of times throughout the day.

So we're building a pattern of movement. Um, adding load would then maybe doing it with a backpack over your, over your back or, um, something of that nature. So, um, I forget who made the actual quote, but I thought it was a good one. It's, uh, they say that load, uh, tells the body to hit the save button. And once we've modified pain and built the support, built the endurance of the support system and then pattern of movement doesn't mean that we've hit the save button because the next day we could go back to the same crappy movement and the same pain and the same, uh, well, the support system's still building because it takes a little bit of time to build that volume.

But why not hit the save button and then start up on your work the next day? So, um, with plantar fasciitis, again, some, uh, uh, you, you might find that, um, running is painful. Well, maybe we start with a light, maybe we start with a walk. Maybe we'll find that box jumps are painful. Maybe just do five of them only to the point to before you're fatigued and then you pause and take a little break. So just because the rest of the class is doing it doesn't mean you have to. And just because you're pain free at five reps doesn't mean you're going to be pain free at six reps. So we're building, we're building a human here.

Um, and Rome was not built in a day and to restore that movement, we have to make sure that we're, um, being very mindful of what triggers it, what supports it, what patterns we need to build because those movements have been painful and we can, then we can load it. Now into the next part, um, this is something I actually got from, I think I got it from mainly Exos, but I've modified it quite a bit. Um, the, I call the hierarchy of human movement and this is something that I've written on the board many times and I have this in this huge article that I wrote, um, because I want people to understand what, what I'm asking of them before they can move to the next step because they'll ask, when can I run?

When can I do this? When can I do that? In this one, I'll talk about, uh, peroneal tendinitis as like a central reference point. So the four points that we need to consider are number one is if you, or actually first is if you can't do one thing in this, if you can't do number one, you can't do two. If you can't do two, you can't do three. If you can't do three, you can't do four. If you can't do one, you can't do four. So if you can't do anything below the one, uh, or the, or if you can't do the precursor step, then you can't do the other one. So, um, if you do, there's just a high, high reward, low risk or high reward, high risk, low reward possibility for you.

Uh, and I think this is where people who say have peroneal tendinitis, they, they start to go running and running quickly for a long period of time, or they'll do high intensity movements or, uh, um, hits training. And then they realize that, oh, I'm having pain. Well, you chose to take step four before step one. So step one is can you hold position and pressure? Okay. Let me say that again, position and pressure. So if we're attempting to get the foot to be pain-free due to peroneal tendinitis, then possibly, um, uh, rotation of the foot or on the stance leg, let's say the right foot hurts on the outer part of the foot.

Um, let's say turn, uh, twisting over that foot is a little painful, uh, or changing directions. Well, maybe we just find a certain position there and then we build pressure and the pressure is in reference to, uh, intra-abdominal pressure or central stabilization. Uh, we have this concept of, uh, if you Google this term, um, uh, proximal stabilization for, for distal mobility, it basically means that, uh, you only move as well as your stable part from the center. So, and I've, I've played this game with quite a few people. I have, have them sit on the table and lift their feet up off the ground and I say, push me with your left hand.

Um, do it with your feet on the ground first, actually. And I say, push me with all your might. So they push me. And then after that, I tell them to try to do it, put your other hand on the belly, keep your feet on the ground. And I want you to do it without activating any part of your torso. And so they can't do it. I said, uh, well, let's recap on that. So your torso has to work for you to push me. So their torso has a correlation with the shoulder and the hand and the wrist and the elbow. And the same thing happens with the lower extremity too, is that if we are not keeping pressure and position of the torso, then we keep, can't keep position of the foot to be in a pain-free position.

All right. So in general terms, I say, if you can't hold position, then you don't deserve to move because step two is moving movement or pattern. So if you're going through a movement and it starts to hurt, but it didn't hurt as we are doing static holds or non-movement holds, um, then there's a possibility that you're having a transitional problem. We see this a lot with people who have lower back pain. They wake up and their back feels amazing. And as soon as they roll out of their bed and stand up, their back hurts. So the problem was not the position of laying in bed. The problem was not standing up or standing.

The problem was how they got from one position to another. So movement is similar to that in this, in this step two, we need to make sure that path has the correct pressure and position behind it. Third is load. So I wouldn't move anything heavy if you couldn't do it with your own body weight, right? That's pretty simple. Fourth is doing it quickly. I wouldn't move quickly if I couldn't move slowly. So if we bring this to back to peroneal tendonitis, a lot of people have this when they run. So if you have it with walking or have it with standing, why would we go jogging, right? So just consider that how many times, if you can't stand on one leg without having pain, then how do you expect to stand on one leg and push off of it while under exhaustion 7,000 times in a run?

It's ridiculous, right? And I don't have a problem with running at all. I don't have a problem with plyometrics. It's just that are we prepared for it? And I interviewed Michael Ban recently, and he brought up a lot of these points, and he said it's just he didn't have a problem with or it's Coach Michael Ban, Ban, double N. So he didn't have a problem with this either. It's just does your body have the proper support systems for it? Have we conditioned the person or the human or the joint to be able to tolerate those loads? Just because it's body weight and running doesn't mean that it's the least risky thing that you can possibly do.

Now, those are the major kind of systems or analogies or frameworks that I typically use. And within the book, I put some other things that I thought would be helpful for everyone to understand as well is that just some general theories of why an ankle hurts in the first place. Number one, I know a lot of people jump to stretching and rest and so on, but there's a possibility that the joint is actually too loose. Let's just speak in a very general term. So number one, is your joint too loose? Number two, is your joint too tight? And why? Why are these things tight? Number three, your joint is busted.

And number four, is your joint is not the painful thing at all. So let's just cover these really quickly. So is the joint too loose? Because I know a lot of people jump to stretching with this. If your joint's too loose, let's just say that you haven't had proper support around it. Say you tore a ligament. Say you had past damage. You had past ankle sprains. Why are we trying to loosen this anymore? You know, like I understand the feeling of tight, but is it actually tight? And we have tests that we can do in the clinic where we figure out if this ankle or foot is more or less lax than the other, let's just say.

Because laxity, I think, is relative and it could be normal to you but not normal to somebody else. So I think generalizing and saying that we're going to do some stretches on something, why would we loosen if it's already too loose? Perhaps this joint or this foot, ankle, Achilles, calf pain might be an issue of not enough stiffness. So in that point, we improve some stiffness around the area to solidify it up. And an analogy I've used with this is we've, I wish I had this thing in my office, but it's, if you guys ever play Jenga, Jenga's that block game. But Jenga is like, I mean, it's pretty solid.

Like if you stack that thing up from the start and if you stood on it, like you would, you'd be fine, right? I'd feel confident going single leg on it. I can drink a cup of coffee while I'm on that single leg. It's all good and fine. But it's also really hard at that point if I was standing on it for anyone to push any of the other bricks out because I'm compressing it down. So compression across the joint actually stabilizes it, which is not a bad thing. People think compression, that's bad. It's not always bad. It's supportive sometimes and therapeutic. Loosening would, me getting off that Jenga block or Jenga stack would actually make it easier for those things to slide through.

So I had a girl recently where she felt like every time when she was playing soccer with a plant leg, it felt like the ankle slid. And I was like, slid off the grass? She's like, no, it just feels like it's loose inside her. She explained it very unique, a unique way. I'm like, so it's not painful. She's like, no, it just feels kind of sloppy. And so we did some toe strengthening exercise over the course of a week and it started to feel better. So in that case, we might not loosen anything because it's already loose or at least it feels loose. It didn't really test that loose in testing, but we got to go off what the person says too.

Now, the second is, is it joint too tight? So if it's too tight, why is it tight? What is protecting it? What is being so contracted or so fixated that what is it, number one? And like, why is it doing it second? Because we do have the possibility that the tightness of one area is one muscle or tendon overworking to support the Jenga block that is not being supported by the other sides. So if you had that Jenga block tower and if I duct taped it on one side, just because that duct tape is tight doesn't mean that we have complete support. So we might want to have the duct tape around the second side or the all four sides or whatever, which makes it more supportive as well.

So there is a possibility, though, that if something does need to be loosened, it's, it's, or sorry, if it's too tight, it could feel tight and pinchy within a certain range of motion because you actually are, in fact, pinching something. So you can pinch the fat pad in front. You can pinch a bone spur. It can feel tight on the backside when you're trying to stretch it because a muscle is too tight, but is it too tight from a neurological aspect? Is the electricity going to that muscle of the calf and telling it to contract, to hold on for dear life, because if it goes too far, it's going to be worse?

So a lot of reasons it could be too tight, but generally speaking, if it's too tight, maybe we want to use that MAP type of protocol. We decrease the amount of, uh, modify pain or modify sensation, modify how it feels, and then we start to support it and then we start to pattern it and does it feel better after that? That's kind of how I take that. Number three is a joint busted. And a lot of people don't think about this. Rips, tears, fractures. Um, these are things that they could be, um, they could be trauma or not trauma. Uh, fractures in the foot, metatarsal stress fractures, a lot of times associated with the toes not loading because now you load the metatarsal too much rather than disperse the load amongst the toes.

So in that case, um, sure there's a fracture, but we might treat that a very, a certain way by unloading it just like, um, just like we talked about in the first framework is that we desensitize the tissue. So in that case, we might not walk on it, might cast or boot it, uh, rips and tears. Those would usually result in some type of, um, swelling or bruising. And that's important to realize because I know a lot of people freak out about like, well, did I tear or rip something? Well, maybe, but, uh, at least the general category, categorization is there's a bunch of, uh, type one tears, but type twos generally have a little bit of bruising, uh, and swelling and type three are complete detachments.

So, um, in those cases, those type two and three might treat them a little bit differently, but type ones are usually, uh, um, I wouldn't consider it in the busted range. I would consider it something else. Um, and number four is your, is your joint pain, is your ankle pain, is your Achilles pain, your plantar fascia pain, or your parent peroneal tendonitis, is it from something else and not that tissue at all? Um, so lumbar spine nerve root irritation is one, uh, lumbar spine, disc injury, peripheral nerve entrapments, uh, central nervous system disorders, or, uh, I never liked to bring this one up, but it could be two.

Is it in your head? Um, uh, I'd never tell people that it's in their head. Um, but there's a possibility that, um, I mean, we have people who are hypochondriacs and the brain is extremely powerful and we have those conditions like, um, which I'm not well versed in, but let's say phantom pain syndrome or phantom limb syndrome, I think, whereas we don't have a foot and the foot hurts. So the brain is extremely powerful and we would, uh, address those a little bit of a different way. Now I'm just kind of skimming through this, uh, this book that I have just to make sure I'm addressing as much as I possibly can in this podcast, um, without, um, I don't want to say not revealing things in the book because the whole point is to share.

Um, but some of them are, can't be really demonstrated on a podcast, but, um, for clinicians out there, the things that you might be interested in and also, uh, really interested patients might want to want to know this too. Is that, so these are, I, I wrote down some theories of testing or clinical reasoning that I typically go through with, um, foot, ankle pain, calf pain, and so on. Um, is that I, at first I thought I went into four theories and I, I kind of make these up on a fly when I start working with people and I just kind of follow the, I follow the path that they present. Um, so if they, they show me that their, their, their Achilles hurts or their calf hurts as they bend forward, then I am chasing, uh, one rabbit.

I don't really want to chase a bunch of rabbits. So I just kind of figure out which general path would go into, and then I start to address it and see if it bears fruit. Uh, the first theory is that the, the foot or ankle is unhealthy because it's improperly loading. So I have a handful of ways that I would typically test that theory. Um, I mentioned one earlier, the valet forward lean is an amazing one. And so our lateral wedge, crossover wedge, front wedge. Um, and usually, uh, if we cue the person correctly, um, if this is the problem, it'll start to bear fruit and the person will say, wow, my pain's really cut in half.

Uh, or, um, it's important to realize in the beginning, before you do this, you need to have the person demonstrate what starts to trigger their pain. Perhaps they jog around the office, perhaps they, um, go up on the toes, perhaps they, um, dance. I had a lady that danced the other day and that was, that was kind of interesting and fun. So we, we went through the dance process with her and I, I acted as her partner. And, uh, so, uh, I was able to coach her into having a pain-free dance by some of the things that we did through, through that movement and testing that theory. So theory two, the foot or ankle is unhealthy because the toe strength is low.

So, and this is one that I picked up from Dr. Tom Machado again, um, there is, there's quite a few ways to, to test this as well. But, um, after speaking with him on the podcast, I realized how, how amazingly smart he is and how, how much research he's done. Or, um, uh, I saw that he had a product called the toe pro and I'm like, I think since we spoke, I think I've sent about four people over, five people over to, uh, his website just to buy that. And, uh, it's currently at the time of the podcast, at the time I bought it, $45 and I think shipping's free. So, and I know people are like, well, do I really have to buy this product?

And I'm like, you know, you don't have to, but I'm like, here's a, uh, I'm like, here's your options. You want, do you want the most efficient way? Do you want the cheapest way? Do you want the most, uh, complicated way? You're like, well, I want the best way. Good. Well, you'd be happy to know that actually that the most effective way is actually one of the cheapest ways. And, um, I'm like, you can try to make this little, the foam device, but it's going to cost you just as much. And it's going to be, uh, less, uh, it's, it's going to be subpar and you're going to realize that you just destroyed something and you might not have made it, um, correctly anyways.

So you might as well just buy the thing for 45 bucks, super steel. So go on to, uh, Thomas Shad's website and look up the toe pro. It's pretty, pretty legit. Um, the third theory is the foot ankle is unhealthy because the torso and hip stiffness is unhealthy. And, um, after speaking with him about this, he said that usually high level runners or high level athletes have hip, their hip and torso is usually okay, but the toe strength is usually something to seriously consider. But in a, in a, in a, in an unconditioned or, um, on a high level athletes, then we have to consider the hip and torso a little bit more.

Um, just because they typically don't have the time to do to the decon to do the conditioning and strength worth, strength worth needed to have those healthy in the first place. And I would fall into this category too. I'm definitely not a high level athlete and I work all week and I do podcasts and so on. And I don't always have time to strength train or do my work. So, um, this is always subject in there. So if you're looking at, uh, not professional athletes, but athletic professionals, then, or you are one, then you have to consider this, that, and there's a possibility that the work that you're doing with your trainer or by yourself or with your doc is not the best.

So, um, maybe you need to consider the possibility that, um, your work is in the wrong direction and it can just be improved a little bit is all. Now, uh, I did a subgroup on this is theory 3.1 is test anti-rotation as the reason for the unhealthy hip and torso. And I found this a lot with runners, um, anti-rotational drills, such as, uh, Paloff press, um, or torsional buttress are really good ones to use. Um, sometimes we find that the person clears up, uh, very quickly, 50%. On this, uh, 3.2 theory is, uh, test poor hip centration as the unhealthy reason. So just cause the torso is strong doesn't mean the hip moves well in the socket or it's not centrally located and able to do the rotation that it needs.

Because if the hip does not do the rotation and movement and flexion and extension that it needs, it, it affects loading process of the foot. And you can test this if you're seated right now, if you're walking, um, kind of move your knee inward and that brings the hip inward. And then it also moves the arch of the foot inward or collapses it. And then we have change of contact, uh, change of ground contact, which then can affect the, uh, ankle and foot. Now, um, the last one is, is the foot and ankle pain really, uh, referred pain. And I mentioned that earlier. And I think that's really important to understand.

I actually did a, um, uh, I did a study that it was not peer reviewed or actually it was peer reviewed, but it wasn't published because the sample size was too small. But the purpose of the study was to see the effectiveness or the accuracy of patient self-diagnosis. And I actually went to a running group on this and I, and I just stood out in front of a bunch of about a hundred runners. And I said, look, I'm doing an ultrasound study on Achilles tendonitis and how well, or if you have it or not. And some guy raised his hand and he said, what is Achilles tendonitis? And I said, that's a great question.

I can't tell you. So I'm like, you can literally point at your shoulder and say, I have Achilles tendonitis. And I will still image your ankle and tell you yes or no. And again, the point is to see whether people can diagnose something very simple on their own. And here's what we found. And the reason why, again, it wasn't published, um, or it wasn't, I guess it wasn't considered significant was because my sample size was way too small, which affects and skews the results. But it was very, it was looking very promising. And I can tell you from an examination standpoint that most people were not right.

And I think it was roughly about 45% were wrong, um, or 45% were right, actually. So I think we only tested 13, 14 people. Um, but they actually, of those people, only 45% were right. And my, my reasoning on this, my thought with this is the, the Achilles tendon is a very general term. Achilles tendonitis is an extremely common thing that people should be familiar with if they're in a athletic population. And it's, you can see it, you can feel it. You should, you should be able to get it right. Um, but they didn't, which leads me to believe that the more complicated conditions, things that you can't actually feel or that you've maybe never heard of before.

It's really hard to diagnose that on yourself and get it right. So let's just say a heart attack, you got arm pain. Should you self-diagnose that? Probably not. You know, plantar fasciitis is there's multiple, multiple layers of things in the foot. Should you diagnose it yourself? Probably not. And probably the Achilles, you shouldn't either. Um, and although I wrote this book, I still think people should go in and have a legit test and a legit test or a legit exam of the foot, ankle, and the entire body. It encompasses more than five minutes. I cannot stress that enough. If your doc or your PT or your therapist or, um, whoever you have, uh, maybe even your medical doctor is, is not really examining it for more than five minutes.

It's really hard to tell. Um, yeah, and you, you need to have a better exam. And now I'm not saying that you can't tell a lot just by looking at a person because you can. And I told a guy this over the phone the other day, he's talked about his knee. Um, he was wondering like, well, what are you going to do in the office? And I said, well, um, well, what's your concerns? And he's like, well, I had surgery before and I don't know if I'm going to need it again and blah, blah, blah. And I'm like, I can, I can tell, but just by you looking in the office, whether you're a surgical case or not on your knee.

And here's the rationale behind that is, is because if you, if you're limping or you're, you're walking like a peg leg, then there's a higher probability you're going to need it. Cause you might have a bucket handle tear, but the, the knee being such a, it's a circuit breaker of the leg. We need to look around it anyways. We need to look at the hip, we look at the foot, the ankle, the torso, the other leg, how you load it. We need to look at all these things, but I can tell you overall that, um, if you can walk in, then I'm going to, I'm going to be rehabbing you or at least examining you for a long period of time.

And I can do a hip exam in about five minutes, but I certainly cannot do a movement exam and dynamic exam. So if I was to sit here and just act like you're a, like you're a cow or like you're a, you know, a livestock or something, like I wouldn't have to talk to you or explain anything to you. But if you have questions and concerns and so on, and, um, that's our due diligence, that's our, that's our, that's our responsibility. Um, that's our responsibility to you as a patient is to educate you and make you feel calm and make sure that we can, um, get to the root of your problem. Um, so that's the number one thing.

Testing you takes a little bit longer and then documenting it takes even longer than that. So, um, if you are attempting to diagnose yourself, please go see somebody. Um, you will be super impressed. Um, our fee schedule is, is higher than a lot of people's, but I can tell you for whatever you're spending on and nothing against personal trainers, but I know people will spend like $175 on a personal trainer for an hour. That's great. I love that you're with a trainer, but at the same time, you can probably get a ton of information about your problem and just, uh, your trainer's gonna be so excited that you, you got an examination and then now they can get to, uh, work with you and help you load better.

And you'll get, you'll, you'll improve how you feel with leaps and bounds. So it's, it's a trade off there, but just realize that, um, you can't get it done in five minutes and anyone who's going in and applying something, applying a treatment or a suggestion, um, without looking, then they, they could be suggesting the wrong thing or at least something that's not extremely effective. So if you want the most effective thing, you need to be well-versed in what your body is doing, how it feels, how it loads, what improves it, what doesn't improve it, and so on. So, um, that is the conclusion of, uh, me talking about foot and ankle stuff.

And I really hope that anyone, um, actually, you know, I don't know if I should conclude that yet because this is one that I'm going to send all my patients that have foot ankle problems. Um, I guess I should include any common questions, uh, that I get. So, um, number one, can plantar fascia get better? Yes, it can. Can Achilles tendonitis get better? Yes, it can. How long does it take? It depends on the person. It depends on how long. Uh, I would usually say that plantar fascia, I would give it about, um, you, you're going to feel less pain in, uh, significant less pain in well less than a month.

Um, but you might not be back to your full activity, uh, within a month because, uh, you, you might have been deconditioned and we might be, we might, we might be addressing other things, building a support system and improving how you move, patterning it or mapping it. Um, and for, do you need an x-ray? If there's trauma, an x-ray is nice to have. If you're concerned about larger problems in there, such as, um, bone, uh, bone cancer or tears and rips and so on, x-rays and MRIs are great to have. But also too, when you're looking at those, don't be freaked out by the terminology, the medical terminology that are used.

I can't stress that enough. Um, I've had patients come in with, um, uh, foot problems and they look through there and they're like, holy crap. Like, I didn't realize there's so much wrong with me. And I'm like, well, there's not a lot wrong with you. It's just, those are just normal variants for you. They're not painful, but over here is the thing that's creating pain in this location. And now we just, are you feeling better? Yeah, I am. Good. Okay. So let's ignore this stuff. Uh, let me, let me tell you when these things are going to be significant. We need to worry about them. But for the most part, I would trade ankles with you any day.

And I've seen a lot of people with the findings on imaging that you have, uh, that are pain-free. So does that address your problem? Does that address your concern? Yeah, it does. Cool. Let's, let's get back to what we're doing again. Let's get back to doing your homework. Let's go back to decreasing the amount of sensitizing triggers. Let's get, let's get back to building the support system and realizing that you are in complete control of this thing. Um, I'm here to help. And, uh, I think that's all the major questions that I get. Now I'll close out that part of the podcast and we'll go into the outro.

Okay, everyone. That was the Maya solo on foot ankle stuff. If you're looking for the show notes on that, it is session 99. By the way, share this with a friend. Share this with a friend who has, um, foot ankle Achilles issues that they have been dealing with for years. And they just think it's a normal aging process because it's probably not. A lot of them aren't. Some are. Some aren't. Anyways, if you're looking for the show notes on this, go onto the website and type up foot ankle. You're going to find probably the show notes for this, the full length podcast, as well as a great article that I wrote on, uh, this was mainly for runners.

This was the six most common, uh, reasons for ankle pain while running. Um, on that page, by the way, as well, uh, there's going to be some suggestions for the mini course, which I created some mini courses that are very close to being live. Uh, we have foot, uh, foot ankle, we have knee and we have low back. And, um, when they're live, they're going to be promoted on that page. So you might have a fly in that comes in and says, Hey, you want to do the mini course? Or, Hey, you want to buy the course? Um, and the reason why I made these things was because I, I do have a fair amount of people. Like I had a friend who he lives in San Diego and he texts me and he's like, Hey, I got this, I got this back problem.

What do I do? I'm like, that's, that's a big, that's a big question, man. Like I, I'd love to help right now, but once you come up and like, well, I don't have any time. And it's like, okay, great. So I can send you someone in there and they're like, Oh, they're in my network and blah, blah, blah. So there's all these other little hangups. I'm like, dude, I want to help you. I do really do want to help you, but this is going to take probably more time than I could, I could do right now on an individual basis to share videos, share articles and so on. And literally everything is on the website right now.

Literally it's all there, um, or on the YouTube channel. So what I decided to do for these things, though, some of the things I get the most commonly, uh, asked about is low back, foot, ankle, knee, and I need to do shoulder. Um, so you're going to see the foot, ankle one suggested on there. And it's mainly, it's a seven, it's going to be a seven day email course. Uh, we don't know if it's going to be free or not yet, but either way, it's going to be very nominal price. Um, mainly the price is because, uh, if we do the price, it's because we're back and forth on the possibility that when people get something for free, they don't do it.

And the whole point is not to give someone like something that took me hours to write and just not have them do it. We want them to do it. So I want them to get better. So maybe just a nominal fee on that. Um, but the ebook after is full of a bunch of corrective exercises, full of a bunch of strategies and, um, theories that we use with rehabbing foot, ankle, and calf conditions, especially in endurance populations. Um, the main target for that book, um, in a lot of things I write, for foot, ankle is female recreational runners who have under two years experience, who have had aches and pains throughout that career.

So when we go into this ebook, which, um, I wrote this thing literally with everything I know about foot, ankle conditions and ones that can create referred pain into foot, ankle areas. So there might be a slight tangent in there, but we go into foot, ankle anatomy, we go into foot, ankle biomechanics, we go into torso, hip ground contact and how, how it, what it has to do with that stuff. We go into the theory and clinical reasoning of how to correct, um, provide corrective exercise for unhealthy foot, ankle, uh, can, uh, people, um, as well as I think at this point, we're up to 15 videos of corrective exercises that we use based upon the case.

So, um, and actually doing there, uh, I was headed to write this, but I said, if I had to gamble on the best rehab program, it would be because the hard thing with this is that everyone has very different cases. Um, but I guess if I had to gamble and someone said they had, you know, plantar fascia pain, I can guess what I think might work, but realistically it could be wrong. I wouldn't bet every dollar I have on it. Um, but when it comes to these, these, uh, books and the reason I'm bringing up, bringing them up is because I really want to make a change in the healthcare profession here. And I want patients to better understand the reasons why they're experiencing their, what they're experiencing.

And there's a lot of misinformation, old information out there on the internet that I think we can improve on. So these courses are basically designed to take care of that. And if you imagine me hanging out with a doc at a bar and you're behind us and you have a foot ankle condition, you're good friends of both of us. We're not going to just leave you out in the dust and talk about, uh, things that you don't know and don't understand. We're going to explain them a little bit. So think of it as that. So the healthcare providers are going to get something from this. Also to the patients will get something from this.

So it will be written in a way where everyone will understand and the videos will be, uh, comprehensive enough to where the cues are really, really good. So you guys can reach out by going to the search function function on the site. If there's anything that you guys want to hear about, anyone you want me to interview, any topic you want me to cover, just tell me, just email me info at p2sportscare.com. I'm here for, um, building education for the public and the profession. And I'm not going to say I know everything cause I don't. I spoke with a, with a doc who knows a lot more than me the other day on the phone.

Um, but either way, if I can, if I can help some people, some understand some stuff, then I, uh, uh, I want to do that for them. So, uh, as always be good to each other and it's not what you take is what you leave. Talk to you later. Bye.