Muscle Injury Classification and the Negative MRI

This is session number 46 of the Performance Place Sports Care Podcast. Welcome to the Performance Place Sports Care Podcast, where you can learn about sports injury theory, rehab, diagnosis, and how to understand the doctor lingo you do. Didn't understand at your appointment. And now, your host, Dr. Sebastian Gonzales. Hey everyone, it's Dr. Sebastian Gonzales again with the Performance Place Sports Care Podcast. And if you heard the intro this time, you're going to only recognize it if you're probably under, what, 30 years old, 25 years old. So if you're a kid of the 80s and 90s, you'll recognize that pretty quickly because you sat there for a long time listening to the sound thinking, hurry up.

Hurry the heck up. I want to do something else. But you had to go through it. So actually, I thought maybe the next couple episodes or so, we'd kind of mess around with the sounds of the 80s and 90s. And these are probably more 90s than anything else, or early 90s. So, you know, if you know what they are, then why don't you just go on to the Instagram page, since that's where I look mostly. Look at at Performance HB. And when you see the post come up for this podcast here, just type in the sound that you heard. Tell me what it reminded you of. For me, it just reminds me, I was upstairs at my parents' house, just sitting there, just waiting, waiting, waiting, waiting, waiting.

So you'll probably know right off the bat. But anyway, so we'll do that the next couple times, maybe make that kind of fun. But yeah, so this time we are going through a topic, which is one that I wanted to do for quite a while. It is in relationship to muscle tears. And what spurred me to do it this time was because I had put up a YouTube video. And if you guys follow me at all on social media, especially YouTube, you'll see that I put up a video every week. And I try to do the best I can to make it really comprehensive. But the funny thing is, the shorter they are, the more people actually watch the entire thing.

Because if you're like me, you have a really low attention span, unless it's for something like Lost or How I Met Your Mother. Then you'll watch the entire thing. But if there's something more educational, you're like, I got to take a little break here. So sometimes I don't make the small ones. I don't go into complete detail on everything. So some of the parts are missing. So I had a comment today where someone said, well, this one on the hamstring one is, it's not right. This is not how we find hamstring tears and so on. And I said, yeah, I completely agree. There's a lot more to it. So with that being said, I at least drew the attention to the most current stuff we have for muscle tears, which actually, I don't think a lot of people actually know it.

And the reason actually why they did this one, this is actually a consensus statement that it in 2012. And it's interesting how we're grading muscle injuries now. So the reason why you should all listen to this podcast, by the way, is if you ever had a negative MRI and your muscles still hurts, then you're going to wonder what the heck. Like the MRI is negative and MRIs are really accurate and sure they are, as well as our ultrasounds, by the way, if you haven't heard of ultrasound yet. But musculoskeletal ultrasound is really accurate as well. But a lot of times these will be negative on conditions of muscle tightness, as well as some other types of muscular disorders.

And you might wonder what the heck, like, why, how can, is this a strain? Is it a tear? Like, how big is it? And so on. And so this is what this consensus statement was targeting back in 2012. So they actually went through and they paneled a bunch of physicians, I don't know of what discipline, but they found that there was no clear definitions of muscular injury terminology. And so for that reason, they broke it down into functional and structural. Let's all explain in a couple minutes here. But basically, so they went through and I'll just read off here a little bit. But so there was, there was definitions that some of the docs used that was hypertonus, muscle hardening, muscle strain, muscle tear, bundle fiber tear, lacerations.

And it was really inconsistent, especially for muscle strains. So they found that actually, I think it's 16% of the experts considered a strain, a functional muscle injury, whereas 0% thought it was a tear. There was also inconsistencies all across the board in regards to people's definition of an actual strain. So the point of this study, or sorry, the point of this consensus statement was to say, look, we need a clear definition here. If we have a clear definition, we know how to treat these things better. And we also know how to better relate and tell patients and athletes what their risk reward is and what's normal, what's abnormal, why, and if they need to sit out and so on.

So I thought I would go with that today. And first thing we have to realize is, so this will be correlated to hamstring tears, calf strains, quad strains. I guess you won't get them as much in the forearms, but, or the shoulders. But a lot of times, well, first off, realize that MRIs and imaging, they do find tears. But there's not always, if you've listened to all my other podcasts before about, about imaging, a lot of times we have what we call incidental findings. If you don't have an, or if you have an MRI with a finding on it, you can also have that same finding and not be in pain at all.

So when you have an MRI and you find something and it correlates clinically, testing-wise, and sounds like in history, that it's related to your injury, it's a higher probability that that is related. But if you have been to like a movement specialist or someone who can kind of modify how you move your body, a lot of times it's amazing to see that you can get dramatic improvements just by improving movement. And I actually had a person the other day that she was, and this was for a back pain case, she said it was a muscular strain. So I'm like, okay, can you, can you make it hurt? So she bends down the way she does it.

I mean, it doesn't look, it doesn't look like any way I'd recommend. So I corrected her a little bit and we went into a squatting pattern. I said, does this bother you? And she went down to the bottom and she had a little bit of a subtle deviation from what I would like at the bottom. And she said, yeah, that hurts. I said, okay, why don't we re-correct it this way? And I kind of cued her into a proper motion. She's like, oh, that's so much better. So with that being said, if we would have looked at her MRI and seen that there was a structural, like something actually broken, damaged, and so on, does it really correlate?

Because we improved the way she feels and the way she moves just by improving positional changes. So with that being said, I'll go into some of the classifications here, and I'll do a rough breakdown first. So in the past, we had grade one, grade two, grade three. Grade one was kind of like a strain, minor muscle tear. It wasn't bruising. And usually a lot of the definition for classification two was bruising or having some type of, you know, a discoloration come along to the skin, mainly meaning that the tissue had been bleeding or had been torn enough to really bleed out and get to the skin surface.

A three was a full rupture or detachment. So we've kind of changed this a little bit here. So now we have classification of direct and indirect, number one. A direct muscle injury is one where you've been hit, you've been stabbed, you've been cut. So contusions or lacerations, we call it. And these are things that I would consider are more of, they're not really things that I treat much in my facility here, mainly because, I mean, other than contusions maybe, but it's not like it was the movement of the athlete or the person's fault. It was just kind of like someone hit them, they bumped into something, they fell off a cliff, they were in a car accident.

These are the kind of things that it's kind of like, like, boom, and you end up tearing a muscle or you end up getting some type of muscular injury. The indirect ones are a little bit more fun to work with, and they're probably what majority of people have, mainly because, again, they're not trauma related. They're not a contusion, a laceration, a slip and a fall. You know, someone hits you from the side. So there are things that it's like, oh, shoot, I woke up with it. Hey, I just started running and my Achilles started hurting. Hey, I started squatting and my quads started to become painful and tight, but it wasn't beforehand and I stopped and now it isn't too.

It feels better now. So, again, these are indirect muscle disorders or injuries. And now we break this down into two more categories. Functional and structural, which is really going to be the focal point of what we talk about mostly today. So functional is kind of like how I said with that one lady that came in and the way she was moving created pain and then we improved the way she moved so it got rid of it. So functionally is more of like, I guess, I don't know if I can agree on the definition of functional. I know that they use a lot with exercise now and they talk about how it's a functional exercise and so on.

But really, I think it's, I'm going to go with how, the way we're using something. Like, actually, I used to give the example back years ago. I had a bunch of these pens that someone gave me and so when people came in, they're like, well, I don't know why this area of my body is hurting. So I'd grab the pen and I would turn it like I was writing on my, the palm of my hand. Except for now, I'd start pressing into my hand from the very top of the pen. Kind of like I'm stabbing my hand. So I said, if I press this and keep going with it and I put my hand on the table, I'm like, if I keep pressing here, what's going to happen to my hand?

They're like, well, that's going to puncture your hand. It's going to hurt your hand. It's going to stab your hand, whatever, you know. So I'm like, yeah, you're right. So then I would turn it 90 degrees and I would break it like a stick. And a lot of times these pens, like they weren't really good quality pens. I would seriously just kind of flex them and they would bust, you know, and the pen, the ink stick would go flying across the room. And it was funny how quickly they always broke. But from the other position, you could put so much force into them. And I explained this, the reason of this is because functionally the pen is used or that shape, according to geometry, cylinders are meant to be compressed.

And I've talked about this before with the knee and other types of bones or long bones. We're looking for them to be compressed because that's what they're good at. You take that, even a fraction of the amount of force the other way, and it starts to break and bust in and fall apart. So functionally, if muscles, tendons, ligaments, and joints even if we're using them in a way they're not intended to use, then they're going to get destroyed and become painful and start talking to you and so on. So this is kind of that functional breakdown. Now, consider that, so those under the indirect muscle injury, again, there's that functional and structural breakdown.

Let's go into structural now since we just talked about functional. So structural muscular injuries are the ones that we've talked about or the ones that we kind of talked about that three, that three category that we had back in the day. And that's going to be more of muscle strains or what we have in there. There's two groups. So there's partial tears or partial muscle tears, and there's subpartial and total tears. So that's kind of like what we typically think of and what most people, athletes, think of when they think of a muscular injury. They think something's torn, something's frayed, something's detached.

And in this category, you're going to have a lot of bruising and a lot severe lack of function. And within this structural tear and malformation category, you're going to have positive MRI findings. And all above that, in the functional range, we don't. And like I said in the beginning, if you've had an injury and your MRI is negative and you're wondering what the heck's going on, you're within that functional range. And looking within that functional range, there's quite a few things that we need to rule in and rule out so we can improve the way you move. Because the fact of the matter is, if it's not a structural injury showing positive on an MRI, showing like a partial tear or full tear or rupture and a lot of damage to the actual structures, then you're really probably in really good shape.

And there's a lot of things that we can do that will improve how you feel. But we have to take into consideration of what will happen over time if we don't deal with these functional muscle disorders. And I'm sure you've heard the other podcast, or if you haven't already, you should, is with Dr. Megan Helwig. I think it was session 36, I believe. We talk about hip conditions and she's talking about femoral acetabular impingement or hip impingement and how it can eventually become a labral tear. And she said she had a labral tear and she just has to be very careful of how she squats, how she runs, how she moves to make sure all those symptoms don't come back and the progression of her injury doesn't increase.

And unfortunately, she was actually in the category because she said she got hit by a car. It was in that category of the direct muscle injury. So she got the impact. But she still has to watch out for it getting worse and worse and worse. And the reason why I bring this up is because functional disorders can very quickly become structural disorders of muscles, which when you get into the structural category, that is when we get into areas where if something's partially torn, if it's totally torn, then you need something to rebuild it, which could be like a PRP, a stem cell, prolotherapy, I heard works okay.

Or even you can do a procedure. You can do a surgery. You can do other types of injections. So, but this is where people get really frustrated in there. They're like, well, I haven't been improving in rehab. You know, I've had this for, you know, eight months and I've gone to rehab three times a day or sorry, three times a week. I'm getting really frustrated with it. What could it be? You know, like, so, but a lot of times there are things that we could have done all along the way. And when you find out that you have a structural muscular disorder, then we need to deal with it. And we need to not ignore it because a lot of times that negative image, negative MRI and ultrasound will make people feel like, well, I can just keep going.

And granted, I typically let people go a little bit, but I make them very aware that these are the things that we need to improve on if we're going to decrease the chance of you having an actual tear in the future. Okay. Let me say that again. You have to deal with a functional muscle disorder before it comes a structural muscle disorder. Now, going into the actual breakdown again, I will, by the way, if everyone's getting confused or not, I'm going to keep going through the breakdown, the classification, the order verbally here, but also too, I will have this in my notes on the Performance Place Sports Care Podcast, or I saw on the P2 Sports Care website.

So again, that's p2sportscare.com slash podcast. And you'll find the show notes for this and I'll make this available to you. By the way, I do strongly suggest that if you are interested in what I'm talking about here, then you should read the consensus statement since it's public. It's there. A lot of these research articles, you have to actually buy for like $40, $50. And this one's just on there. So it's a really interesting one to look at. So let's go to the breakdown again first. So first we have in the first category, which eventually they break down to others. We have the direct and indirect, like I said.

The direct is the, oh no, I slipped and fell. I got hit by a car, by a person. I got cut with a knife. I fell on a rock. You know, those are the direct muscle injuries. In my opinion, it's really bad luck. Indirect muscle disorders are ones that we can prevent from going further. And those break down into two categories, functional and structural. Again, structural are ones that will see positive MRI findings on and ultrasound findings. And the functional ones, we won't. Now the functional ones, we didn't go into yet, but there's a few different types there. So there's type 1 and type 2. Type, I will start with type 1, but mainly go into, there's two types of type 1.

So type 1A, type 1B. But the reason why I'm going to go into type 1B first rather than type A is because everyone's probably really familiar with this and it's going to really resonate, I think, for the remainder of the functional disorders, what we talk about, where you'll really understand what I'm talking about. So type 1B, which is, again, a functional, overexertional muscle-related disorder, is called DOMS. D-O-M-S. It's an acronym. And DOMS means delayed onset muscle soreness. And if you're an athlete, if you've lifted, if you've run, and you got so sore that you could not move for like three, four days, this is DOMS.

And it's funny, like the first few times it happened to someone, you're like, gosh, like that's, is this normal? You know, but you realize over time that it just kind of starts going away. And it's expected if there is a large amount of volume when your body's not actually accustomed to it yet. And if you talk to people who work out, lift, run, and do a certain activity every day, they oftentimes don't get a lot of DOMS anymore. They don't get a lot of muscle soreness. But mainly, everyone kind of agrees that these are going to go away. Like, it's uncomfortable. There's a lot of swelling. There's stiffness.

There's loss of range of motion. There's pain when the muscles contract. Stretching seems to help. But for the most part, we all kind of know it goes away. And it's through the entire length of the muscle a lot of times. And sometimes it's a little bit more acute. But for the most part, it's the entire range of the muscle. So this is actually, it's an acute inflammatory pain more so. It's very general. But for the most part, it comes from a lot of eccentric motion or deceleration motions. I won't go too much into that part. I probably shouldn't even go too far there because it'll confuse you guys.

But for the most part, remember that. Remember that DOMS is a functional one. It is something that, I mean, it's not ideal to get all the time. And I personally think that when we are working out and lifting, I don't think it's an indicator of a good lift. I think it's more of an indication that there's not the greatest programming. Granted, there are times when you have to bump things up based upon where you're at in your program. But for the most part, the goal should not be to get dominated and just crushed every single time you work out. A lot of times you need to recover. And realistically, your body should be repairing itself quicker than that to be able to be accustomed to these big bouts of exercise so they don't get sore all the time.

Now let's go into type 1A, since we already talked about type 1B. And I won't spend too much time on this. And this is a fatigue-induced muscular disorder. And fatigue-induced, the reason why it's important to recognize is because it's been shown to be a a predisposition for injury and fatigue-induced muscles actually demonstrate increased stiffness, which has been shown to put you at a higher risk of an injury. And I usually tell people that, you know, the reason why we warm up is to decrease the probability of stiffness. So the importance of warm-up really is to get the blood into the area to increase some elasticity to make it so we don't continue to injure ourselves with increased stiffness, basically.

So that is a fatigue-induced injury. I won't spend too much time on that again because the other ones are a little bit more important. And since that one kind of is the bottom rung and even below DOMS, then I think we spend a little bit more time on the type 2. Type 2 is a neuromuscular muscle disorder. And I will break it up again and go back into make sure we talk about, make sure that we get down into understanding where these things fall in the category. So there's type 1. There was the exertional-related muscle disorder, which was made up of two types. Fatigue-induced, which I just spoke about.

And type 1B was DOMS. Now we have type 2, which breaks down into type 2A and type 2B. Type 2A is spine-related neuromuscular disorders. Type 2B is muscle-related neuromuscular disorders. So again, type 2A is spine-related. Type 2B is muscle-related. And actually, these two are the ones that a lot of sports physicians, chiropractors, and PTs, even ACCs, probably have to deal with the most, I'd say, in regards to troubleshooting. And I'll talk about the spine-related one first, mainly because it's one that probably a lot of people don't think about or athletes don't think about. Because a lot of times you think it's the muscle.

Because I'm going to venture and say that the reason why we go towards things like foam rolling tissue work and so on as like a first knee-jerk reaction, a lot of times is because we're thinking muscle. Spine-related ones, actually a lot of times it focuses a little bit more around working areas, not 100% right around the area where you're feeling things. An example would be a L4, L5, and L5-S1 level lumbar spine or spinal issue. And mainly what we're looking at here is the nerve roots, when they come out, they become irritated and they present as a hamstring or a calf injury or pain. And a lot of times we call those ridiculous symptoms.

So they're symptoms which go down the leg, but really they're related mostly to the spine. And typically what we do in these types of conditions is we want to push the pain or the discomfort up into the spine again. We call it centralization. So a lot of times my remedies anyways, and there might be different types of techniques out there which do things differently, a lot of times I'll focus on, I'll completely ignore the area down into the calf and the hamstring in these conditions. And I'll just, I'll see if we can make some changes in the pelvis and the trunk area. And a lot of times you can.

And like I said before, with, with that patient who was squatting down and we did a minor correction, I cued her into the, uh, a different position. If we can make a change right then and there by not even touching the spot where the person's feeling the, the tightness, the ache, the dull, uh, the dull pain, then I think we're, I think we're going the right direction there. And a lot of times this indicates that it's more of an instability is what a lot, a lot of times what I see. I mean, granted there could be other, uh, it could be too tight as well, but a lot of times I see that if we stabilize the trunk and the pelvis, a lot of times these things improve.

So an example, another example of a spine related condition, which would then create or mimic muscular injury is say a spondylolisthesis, um, is, or this is a slippage of the vertebral bodies, one on top of another. And a lot of times it'll pinch the nerve root off. Um, but there are other types of things that can create these types of symptoms as well. But the concept of what we kind of see in these spine related conditions is there's mainly increase in muscle tone. It might not make it. So like I said in the, in the beginning that these functional ones don't have positive imaging findings, no MRI, no ultrasound findings of that actual muscle.

There's really nothing really wrong too much with the muscle. I mean, there might be minor things here and there and also incidental findings when we go through the image, but it's really not that much. It's not like a huge outlier and it's mainly again, an increase in muscle tone. So that muscle tone, it comes from the nerve root being irritated. Also sometimes it can be skin sensitivity, uh, like a defensive reaction, uh, of the muscle to stretching. Um, there's pain with pressure. Sometimes a lot of times stretching can provide relief though, but a lot of times pressure is painful and this can feel like it's achy.

It's a gradual increase in muscle firmness or tension. And also can feel kind of like a cramping pain. Now let's move on to, uh, you know, actually I'm going to retract on that one too. Um, a lot of times it feels like aching, like the muscles aching in firmness. Um, and a lot of times it's not pain, pain at rest. So, um, let's go on to now the muscle related, which is again, type two B and I'll retract one more time to make sure that, uh, we're getting all the breakdown. So we have indirect and direct direct was the, that's too bad. You got hit indirect is, Hey, we can do something about it. It breaks down into two parts, functional and structural structural, which we talked about in the very beginning was a tear, a sub, a subtotal tear or a total tear.

Then, so there's functional, which breaks down into two types, overexertion and neuromuscular overexertion we talked about with DOMS and the other type type two, which are breaking down now, which we talked about neuromuscular, there's spine related and there's muscle related. Now muscle related disorders or that type two B, the way I like to look at it is a, we treat more within the actual region of the muscle and joint locally down there. An example would be that if we have an issue with the calf, then we would look in a and run the knee, the ankle and the hip. Um, but I really wouldn't look as much in the spine.

I mean, I would definitely check it. And usually when I go through, uh, examining people like this, I like to see if there is a functional or structural disorder, mainly at the very beginning. And from, from that part, it's kind of like a breakdown process. And this is why rehab is so individualized. Um, those type one or the, sorry, those, those type two A and type two B or spine related and muscle related really take a little bit of skill to be able to program for. And this is why we have a lot of tools in our tool basket in regards to rehab. We have core strengthening. We have, um, functional neurology.

We have tissue work. We have stretching. We have, uh, tissue, uh, soft tissue mobilization with tools. We have adjustments. There's mobilization of joints. There's, there's tons of stuff we can have people do. And it's really dependent upon the reason why the area is acting up. So those two type twos are the main thing that goes into the art of rehab. Now you might wonder that, I mean, so we went through a lot of information there and I'll probably stop talking about the consensus statement probably from mainly here on out. And we'll talk a little bit more of just theory, but those, the consensus statement really, I think is important for you guys to read and realize what you're working with, with your injury.

And I've talked about it before on the, there was, there was a podcast, I believe it was 35, 34. It was the one where there was a frustrated caller about a sports hernia. And, uh, at the end I talked to him about, there's a YouTube video that I put out in early 2017, I believe it was in like, uh, January or February. And if you go through YouTube and search performance place sports care, and then you end up finding one that says get control of your injuries. This is basically in the thumbnail is just kind of my hand and a piece of paper, but this is kind of how I break things down for people. And when you realize what you have and what it can tolerate, then you start to get a little bit of control, a little more control than an understanding of how you can deal with it, how you can rehab it.

What activities can you do? Can you jump? Can you run? Can you swim? Can you bike? Can you walk? Can you sleep? Should you rest it? I mean, these are all things that people ask a lot. And my answer is always depends. And I can't tell you how many, I remember this one, there's one lady, she came in with a, uh, let's see, she had a, she had a back and hip related condition. She asked, can I do burpees? And I said, depends. And we, we actually go to the gym together and, uh, she's like, Oh, how come you're always doing burpees that way? I'm like, well, cause I know my risk reward, you know, like I don't care enough to, uh, go quickly.

I go care. I care enough to get, uh, enough to where I'm breathing really hard and, and don't, I don't want you guys to think that I don't try when I'm working out. Cause I do. I mean, I go, I go balls to wall on like the rower and I do with running, but when it comes to burpees, I don't, I do a bunch of pull-ups cause I know that, uh, I have really, really good control of what I'm doing with it. I have no problem with squatting, deadlifting, cleans. Um, I'm a little bit more, uh, sketch when it comes to snatches. I don't have a problem, problem with jerks. And it really just, again, it depends on what I'm trying to, uh, risk reward on it.

So if you get a chance, which actually I take that back, make yourself a chance and go to that video again on YouTube, look for how to control or to get control of your injury. And we go over how to break down, uh, on a piece of paper, what you can do, what you can't do. And then in the middle is, I have no idea. And a lot of times, let's just say we didn't, cause we didn't talk much about actual muscle tears in this, but so you have a structural injury or a, a partial injury, like a, it's, it's, or a total tear of, let's say the calf. Can you jump? No, not at all. Not at all. Like, can you run?

No. Cause it's impact related. Can you swim? Well, maybe if it's a partial, you know, can you push off the wall when you're swimming? Maybe depends on what you present like in history and how severe it is. And you know, can you, can you squat? Like I would say, I'd say yes. Can you squat a bunch of weight with a partial tear? Maybe. Again, depends. This is all very, very, this is all very based upon like how bad it is. But if it's just like a small, tiny little tear, like squatting, like you could squat 300 pounds and still not jumping. You know, it's not like we're doing box jumps, plyos, and like running for, and sprinting for hours and hours.

So it's, it's a little bit different, uh, loading on the area. Yeah. Can they bike? Maybe. Depends. Um, so the same thing goes with hamstring injuries, you know, like, it's funny. Like when I had mine, um, I mean, it bruised at that point it would be. So if I had to classify this now, since it was years and years ago, I'd say, well, it's not functional because nothing I could do would make it better. And it was not DOMS because I felt a quick incident where it felt like someone shot me. So it didn't come the day after because DOMS is delayed onset. Was it spinal related? Uh, I mean, I guess it could have been maybe.

I bet there, I actually bet there was stuff going on with the spine area that would make it so that one hamstring tore and the other one didn't at that time. So there's a possibility. Uh, it was something I didn't look at, uh, during that time, but I was more into the structural type three injury. So it hurt to run downstairs to get the mail. Like I would look forward to that every morning to just see if it felt better. And it didn't, um, you know, at some point it didn't hurt to walk, but it hurt to run. And actually, you know, it's, uh, another case of a hamstring I had come in this year was, this was a good one.

I actually, I was actually kind of frustrated at myself about how I managed this one. Not that it was wrong. I just forgot the direction I was going in with it. Um, but with, with this hamstring injury, I'd seen this, this, uh, high school player, um, the following or the prior year for hamstring condition. And I got him for a couple months and improved a lot. He got to play the season and it was good. And all of a sudden back right before season, about a month before season again, he hurt it again. And we didn't actually do an MRI the second time and mainly because it didn't bruise. He started improving it at a, uh, at a expected rate.

And he didn't really, um, I mean, he was okay with not playing at the time. Uh, so he was open to taking time off. So there was no reason to scare them, scare him or show him that there was a partial or a very, very small tear. Cause that's probably what it was. Um, but the interesting thing is that, so after we got about a month in the season or a couple of weeks into the season, it actually, it flared up again, which I always tell people with hamstring conditions. Um, if you didn't have a flare up yet, you should expect one. And it happens to almost everybody. And it's funny when you, when I, when I've noticed, I've told people expect to flare up and it happens, they don't, they're not quite as afraid of it.

But when you don't tell them, they freak out and think the world's going to end. And I mean, it's rightly, rightly so they are, they're thinking that it's something more severe than what it is. So what happened in this case was that flare up happened. And all of a sudden, lo and behold, uh, the dad wanted to do an MRI and have an ortho console and all this other stuff. And I said, yeah, sure. Go ahead. You know, it won't, it won't hurt at all. So he did the MRI and I actually expected to see like a little partial tear in there and there was nothing. It was a non-eventful MRI for the most part.

Uh, I mean, there was a little bit of findings here and there in regards to some edema, but it wasn't, it wasn't really torn. So it was just, it's interesting to see sometimes these things, um, because he's more in the category of, again, functional or, uh, or he's in the functional category. So the reason why I would beat myself up about it actually was that, so with functional, functional disorders, especially with a hamstring, I like to, um, um, uh, start to slowly increase the eccentric load on it, which is a lengthening contraction. So we have a couple of ways of doing that squats, deadlifts, uh, RDLs, Nordic hamstring exercise are ones that we eventually get to after we stabilize the spine a lot of times, or make sure that we find out the reason why this hamstring is so, uh, intolerant to load or what's going on.

Maybe it's form, maybe it's his inability to turn. And actually what we found was, and this is where his second flare have happened was that it seemed like, so the first one came when he was going through first base and he turned cause there was a pass ball and he was looking to go to the second, this to second base. So it was the turning mechanism and slowing down, which made it happen the first time this year or that year anyways. And on the flare up, it was when he was going to back up a base and he started turning again. So I remember thinking the first time, cause, uh, baseball is really a rotational sport.

Um, a lot of the power comes from rotation, throwing, hitting, uh, is a rotation change of direction. A lot of times, um, now a lot of times training and especially, uh, strength training doesn't really happen as much in the other directions, rotation and, uh, lateral movement. So I wanted to make sure to hammer on that and focus on that, um, during that period of time. And what I found was with this first go through with his first like month, he was improving such a, such a good rate that I thought, Hey, this is great. I want, I want to bump him up to cleans now. You know, I want to bump him up to these other things, which are a little bit more fun.

Um, and when that flare up happened, I remember thinking, ah, dang it. Like I really, I wanted to go the rotational route. I wanted to go the lateral motion route and I had started on it, but I ditched it because I saw that the other stuff was way more fun for him. So the next go around, uh, we actually, in, I stuck to my guns on it. We added rotational squats, uh, lateral squats, um, crossovers and so on. And it improved a lot. He didn't have a flare up again through the remainder of the season. And it felt really, really good. We actually did some cone drills as well in, uh, just outside my office, um, that I told him to use as a warmup and also do it for different, uh, different times in the week.

So we can get the body used to slowing and turning and so on. And especially a lot of times with baseball, when, uh, especially if you're an outfielder like I am, um, I remember having, there's times, uh, this season already where I was tracking a ball and then wind caught it or had a little bit of a spin on it. So it was going the wrong direction on my head. So I had to turn and flip around and I had hip conditions that came out of that out of my right hip. So now when I warm up, I actually prep those motions first. So I do them slow first, just work on footwork. And then I go about half speed, 75% and then full speed.

So I'm not just jumping into a game and turning and all that kind of stuff. So I know I'm getting a little bit away from the, uh, muscle strain and, uh, muscle injury type of thing. Um, so we'll jump back in there one more time before we, uh, finished up the podcast. But so I want you guys to really understand muscular injuries and I think I'll, I'll probably do a written style or I will end up doing a, uh, I'll do a diagram or some type of like illustration of these different classifications really soon. Um, I, it's going to take a little bit of thinking to be able to, to make it so it's easy for you guys to understand, but I will put a link to it, um, in the show notes, it'll probably be a YouTube video or some type of graphic that will be helpful for you guys to understand muscle injuries.

But I strongly encourage you to, I'm sure that if you're active and you have teammates who have the same, they're like, Oh, I tore this and this is strained and so on. Like they should look this stuff up. They should know it. I mean, there's avoidance of activity, especially the entire week. If you're a weekend warrior, like I am in regards to baseball anyways, uh, I do like to think I do enough prep work during the week to, to be semi-responsible. But if you are a weekend warrior and you just save yourself to the weekend to play again, which I know like a lot of my friends do softball tournaments that are like that.

And you get to work a lot during the week. It's, this is something you need to know because you need to know where you stand. You need to know your risk. You need to know what you can and can't do for longterm. And if you listen to the podcast by Dr. Robert Silverman that we had on, uh, we're talking about how, um, uh, arthritis happens and arthritis used to be a wear and tear old age type of, uh, thing, or actually osteoarthritis was because that's only one type of arthritis. Um, basically we see that the progress through these acute muscular injuries, which eventually turn into chronic ones and it just irritated for 10 years.

And all of a sudden, lo and behold, you got knee arthritis, you got hip arthritis. Like these are things you can prevent. So you should know about them. So if you leave these things alone, eventually you'll have joint issues and, and maybe not today, maybe not 10 years down the road, but if you're, you know, mid thirties, like I am, and you want to be 55 at 20, you know, 20 years from now. Then you're going to probably want that hip and knee to work well. And same thing goes with the ankle and all the other joints. So, uh, I will put all these notes onto the podcast, uh, website again, that's p2sportscare.com slash podcast.

Um, I hope these ones are information for informational to you guys. Uh, I, I realized that some of them are a little bit more of a boring topic and I think it's a little bit more fun to have, uh, people I'm interviewing on it, but, um, this is not one where I had actually, so anyone to interview on it. So I thought I need to put that information out there sooner than later. Um, so you guys can get it, um, and listen to this podcast a few times. Um, but if you have an actual question, again, if you've heard one of the podcasts where we start answering the questions that you guys leave on to the p2 sports care site.

Um, I mean, I have quite a few that I've gotten, but it's not, they're not always the best. So I'm looking for a case that is interesting. I don't, I don't want to say interesting one that you give me a lot of details of. It bothers me when this, and it happened like this, and I'm roughly around this age and I've tried this and this and this, and I'm frustrated. And what do I do? And like, that's what I'm looking for. I want you guys to drop your story onto the p2 sports care, uh, site. There is a voicemail button right there in the center of the, I think it's every page now, but I need to talk to my web person and try to get it down to one page, the opening page.

That'd be nice. Um, but leave your story on there. And, uh, I think it'd be interesting. It helps everybody. I mean, usually when you go through these things, someone else has to, and I really think what the future of healthcare is going to hold for all of us is that with insurances, not paying docs what, um, what they used to, and not that they get paid a lot or too little, but I mean, I've had friends actually that they've gotten seriously checks from the insurance company for less than a dollar to treat someone for 30 minutes. So what's going to happen eventually one day is that people are going to start realizing that they're not getting the care that they want and the insurance doesn't cover the care that they want.

So they're going to have to learn and they're going to have to come to the table with an education and some know-how about how to rehab that injury so they can get the most bang for their buck from their docs. And I strongly, strongly encourage people learn all this stuff on their own. So again, suggest some topics to me, tell me your stories, and I will talk to you next time on the Performance Place Sports Care Podcast. It's been fun so far, guys. Talk to you soon.