Common Hip Pain Questions: Arthritis, Labral Tears and More

You're listening to the Restoring Human Movement podcast. Thanks for joining the movement, movement. I'm Sebastian Gonzales, show curator and head clinician at Performance Play Sports Care in Southern California. This show's for active people, those who refuse to let pain and injury get in the way of their life and how they want to live it. Trails and trips, fields and courts, whatever moves you. Each episode features rotating host, expert guest, and real clinical conversations that help you move better and trust your body again. Here we go. This is going to be about 45 minutes today, and I'm going to have on Dawne Costantino, who is going to help me talk about...

We're going to cover some common question answers with hip pain today. Say hello, Dawne Costantino. Hello, hello. Okay, we're sharing a microphone today, so we're going to do our best to make the audio perfect, but we don't know if it'll happen. So we're going to play a little... I'm going to answer the question, you're going to answer the question back and forth. We've done this before. So do you want to be first or second? I'm going to be patient first because I don't like this one. All right, Doc. So my hip, do you think it's arthritis? My mom has it. Your mom has your hip? She's got arthritis in her hip.

Is it genetic? Okay, so I think the first thing to cover on this is that arthritis is sometimes hereditary. I don't think we can refute that possibility. I think I want to change the microphone to the other way. You like that way? Okay, so I'm going to do a microphone swap. Let's see here. How does that sound? Let's go here. Talk to me. Talking to you. Okay, okay. So let's just... No, I like the other way. Let's do the other way. Okay, sorry. We used to have this official podcast studio and then we moved offices. So then now it's a little less. Okay, so yeah. So sometimes arthritis is hereditary and there's many different types of arthritis.

I think we should probably mention that first. Rheumatoid, I don't think it goes to the hip, does it? I'm sure it can. It does, like a little bit. I don't know if it's like a primary spot though. Okay. Osteo doesn't really, which is the most common one. It goes to the hip, but it's not really hereditary. And then there's like psoriatic and enteropathic and reactive and there's all these different types. So if you're generally like a old age arthritis, I'd say, no, this is probably not because your mother has it. Your mom used her hip in a certain way over the years and that's just your mom's hip, not your hip.

Yeah, no, I agree. Okay. Do you have any questions, Dawne Costantino? So you're saying just because my mom didn't have it, that maybe potentially that's not then what's going on with me. So then is this just arthritis for me primarily? So we would need to look and physically examine you a little bit. We can't just tell with talking to you. Usually people with arthritic hips will lose the, what's the sign? I don't know how to call it. When they try to bring their knee to their chest. Drummond sign? Drummond. Dremond sign. How do you spell Dremond? I think it's D-R-E-H-A-N-N. Okay. So I don't think they had that sign when I was in school, but it was an observation.

It was like, you bring the knee up and it drifts out. Like I remember this guy rode a bike behind him. He was riding a bike. And every time you'd see his knee poke out to the side, almost like it was going to hit the mirror of a car. And so that would be maybe something that would be arthritic hip, maybe for arthritis. But usually a good physical exam can tell you. But there's a definitive feel. It's like there's, you can't find that range. It doesn't hurt. It's just not there. Yeah. No, I think that's the biggest thing too, is a lot of times people blame some of their pain on arthritis as well.

Just because you have arthritis in your hip or it's shown on your images doesn't necessarily mean that's the cause of your pain. Yes. Right on. Good. So we are going to switch roles then. And I'm going to ask you the question. It's painful to stretch my hip. Should I be stretching my hip? No. Okay, moving right along. No, I'm just kidding. Stretching is a big topic of concern for a lot of people. They think tightness. Along with tightness comes wanting to stretch, wanting to release some of that tightness. But if you're noticing in your hip that stretching it is making it worse, we have just a very simple rule here.

Stay away from the things that bother it and do the things that make it feel good. So stretching at the time is something that's bugging it. Then let's try not to stretch. If you want to stretch, then we can make that a goal of yours. But we're going to have to come back to it. Right now, let's stay away from the things that are negative for it. But I've been told that stretching is good, though. Sometimes. It depends. Some people respond really well to stretching of the hip. Maybe we find a different way to stretch if you want to stick to that. But because it's making you worse, you've been doing it for a while and you're not getting better and now you're here, we're probably going to try to not stretch.

Okay. Yeah, I think actually I've noticed too that sometimes people will stretch and they'll talk about pain in the area where the stretch kind of encloses on. The example would be if you're trying to stretch your knee to your chest to stretch your glute, you feel pain in the front of the hip, which doesn't really make any sense because everything there is laxed. So you're actually pinching something. But if you're stretching the back of the hip or you felt like a stretch type of feeling back there, then that would make sense. If you're stretching your hip flexor, but you feel pain under your buttocks area, that doesn't make any sense because it's a pinchy point thing.

Yeah. I mean, overall, if you feel a benefit afterwards after stretching, then keep it. I think there's nothing wrong with that. But if what you're asking here is it doesn't seem to make you feel good, then let's not do it. Okay. So I think you answered the next question. Stretching feels good. Should I stretch? Yes. Okay. Stretching doesn't always mean that that's an end-all be-all. There's some times where we find a certain stretch for people that feels really good, and maybe it's really that simple. We just build up strength around it, and we go from there. But there's times where people, they'll only find that temporary relief with stretching, and it keeps coming back.

So let's keep it. Since it feels good, that can be a pain reliever for you. But let's add something more to it if stretching is all you're doing right now. I feel like you've answered all my stretching questions. Thank you, Doc. Wonderful. All right. Your turn. It hurts when – oh, no, no, no. I'm sorry. Is it okay to walk? Is it okay to walk on your painful hip? Yeah. Does it hurt to walk? Let's go with yes. Got it. Okay. Well, you're going to have to walk at some point, right? Yes. So can you walk a few steps? I would say I could probably maybe walk around the house a little bit. I can do things around the house.

But I'd like to be able to go for walks as a form of activity, and I can't go for very long. Why do you want to go outside the house anyways? Like, is there something out there you're looking for? Yeah, some mental health stuff. So there's this thing called a Segway. You can purchase one. They have tours even. They're great. There's always something with you, Doc. Oh, the Segway. Who invented that thing anyway? Who knows? It's cool, though. Wait. So have you ridden one? No, that's the one with the handles, right? Have you seen the ones without the handles now? Those are hoverboards, which are just...

They're supposed to be... So they came out the same year that Back to the Future was supposed to be, 2020 or whatever. They don't even look close to the real hoverboard. I saw one. It's like a single big wheel now. Oh, yeah. Your feet are on each side of it. And somebody was wearing a motorcycle helmet with it, just flying down the crosswalk. Yeah, they go like 40, don't they? Yeah, those things are insane. Yeah, that's like... I've always thought riding a unicycle would be cool. Yeah, it would be cool. And playing a harmonica, because most people don't do it. At the same time. I mean, if you're a master, you can do both.

This is true. So if you're able to... If it hurts to walk, but not around the house, but it hurts to walk outside, you might be getting past maybe your walking capacity. Let's just say if you're going to do 30 steps, and you're fine, but you do 31 and you're not fine. Maybe you hit 30 steps multiple times a day and just take a little bit of a break. There's some people that have pain that will reduce with doing like a little bit of a pause in the middle. Say you walk, this is probably why there's park benches, by the way. You sit on the park bench, it feels better. And then you walk again, and it's almost like a reset button for you.

You ever see those workout places like around, like it's like there's a pull-up station, and then there's like a dip station. So you can almost do it like... So I would gamble to say they're spread out just enough to where like you can walk to the next one. So maybe go do something like that, and you'll build your walking capacity. Because for you, we might not know, you're just generally physically unprepared. So you lack GPP, general physical preparedness. And so, yeah, we can work up and build a little bit of general physical preparedness. Okay, so let's go with the route of walking is okay.

Then go ahead and walk. I have no problem with you walking. Perfect. Don't you want mental health? Go outside a little bit. So it's not going to hurt me then, walking on this hip. That bugs me a lot. Oh, no. I mean, if it feels good, and it doesn't have any negative repercussions of after walking or during walking, then go ahead and walk. Not everything is going to bother your hip. It's not like it's a ticking time bomb. It's going to just explode. And so usually you would know if there's a mechanical aspect to it, you would know if that movement or activity is bothersome to it during it'll hurt or after it'll hurt worse.

Okay. Sounds good to me. It hurts when I sit too long in my hip, right in the front. Okay. Go away pretty quickly after standing up? Well, I walk around a little bit around the house, and it's okay. And then I go outside to look for mental health, and it starts to hurt again. You always do this to me on the podcast. You just pick on me for one thing I said. Always bring it back the entire time. Honestly, the answer to this is very similar to the walking one. So let's find a threshold where it's okay. So sitting for too long, what is too long? Let's establish a timeline, right? And then maybe we just set an alarm and have you get up, move around a little bit, make it feel better, and then sit back down.

Kind of reset that alarm again. Maybe we pair some exercises to go with it so that maybe that time before the pain comes on will improve more. So that's something that we're going to work on. If you want to sit longer than 30 minutes, maybe you want to get through an entire movie without the hip hurting, then we'll keep that in mind, and we'll pair some things with it. I was just going to say, who really wants to sit longer? I feel like everyone just doesn't like sitting. Honestly, if I could sit without pain, I would probably find myself sitting a very long time. There's always these little alarm systems that are just like, gosh dang it, I got to get up.

I use pain as my alarm. Do you have pain with sitting? Yeah. Look at me right now. Of course I do. No, it just looks like you're contorting or something. I think I have pain with sitting because of the way I sit, to be honest. I can't sit like a normal human. I don't think I've seen you sit the same way twice. Nope, always find myself in weird positions, that's for sure. Do you want to trade me chairs or something? Will that keep you confined a little bit? No, you're going to find me in a weird thing on that too. Maybe we'll just put like two, like maybe benches next to you so you can't get out, you know?

So you're stuck to the actual chair, like make the chair do some work. Yeah. Oh, that's it? Okay. Yeah, it hurts when I sit too long. So you're saying just maybe do some exercises, sit a little bit longer. I think sitting is a skill. I think it takes a little bit of know-how how to do it. And then, yeah, some people sit longer than others. I had some back pain when sitting and watching. Oh, we were watching a movie. I think it was Jurassic Park. And we were like in the third row because we were late. And movie theaters have decided at this point that everybody should have these big lazy boy chairs.

Incredible. Addition to the movie theaters. It was terrible for me. I was like on the edge, just kind of like, but I couldn't look up either really, you know? So. Oh my gosh. I actually found myself in one of those older movie theaters the other day and they didn't have the recliner. It was actually, and we were in the very last row up against the wall. And so the chair was straight, it was straight and straight up and no cushion. And I was like, wow, this is so, this is totally how it used to be. This is very uncomfortable. Yeah, it's great. Yeah, it is. Did the things go up, the little arm thingies?

No. Nothing moved. You were just stuck with that one piece of wood to sit on. Would you rather eat something off the floor of an old movie theater or an airplane? Oh, that's a hard one. I was going to go airplane. Now, airplane pre-COVID or after COVID? Oh yeah, not eating anything off floors anymore. Yeah, they started, they started cleaning airplanes all of a sudden. That's true. Yeah. I don't know. What about you? That's a hard one. I've always had this thing against airplanes and airports. So I would go up movie theater. Yeah. I have like all these excuses that are popping in my head like, well, maybe I'd choose this one because of this.

And I'm like, no, that doesn't make sense. Well, movie theaters, you can sit in the front row where most people don't go. That's true. Or like at least movie theaters close. Like airlines are just like, they're always flying around. There's always like feet down there and stuff. And then how many times, you ever put your bag down there and it comes up wet? Well, I put, I collect, I put my airplane pillow on my bag and realize how many times it put my bag on the floor as before I get on the plane. I started to realize this and was like, oh, okay, I probably shouldn't do this anymore. So, so one of my, like the worst things like that is, I just hate it.

So you go through TSA, right? And so you have this, there's like the little machine that x-rays you or whatever it does. And there's the little yellow feet. And so everybody going through the little airport line, like they have a little dirty feet and stuff like that. And you see some people doing their tippy toes and walk on the sides of their feet and stuff. They're like, they clearly don't like this, but I'm just like, I'm just going to wear some socks. I'm good. I'll, I'll, I'll tolerate it. But I'm like, I get through the yellow feet and I'm like, I'm just going to go a little bit outside or inside of the feet.

Step yourself in the yellow feet, Seb. Yeah, sir. Can you put your feet on the yellow feet where everyone else put their feet? Yep. I was a barefoot person in the airport for a while too. And then you realize you shouldn't be. Kind of weird. Yeah. You're that person. Okay. It hurts when I see who, who did the sitting one or you answered it, right? So I don't know if I, anything else you would want to add to sitting. No, I think you covered it. Okay. Let's see here. Do you think that my hip pain is a labral tear? I'd have to ask you some questions. Okay. Does it click and pop? Yes. Does it hurt when you do so?

No. Okay. Then maybe not. I don't know, but probably not. Usually it's associated with a painful click and pop, but that can't be the only data point, right? Is there any other data points that you think? I think they usually look, they usually look like, like hip impingement. They'll show some positive hip orthopedic tests, like scours, circumduction for bears, for deers. Like there's a cluster of tests that we can do to figure out if it looks like some type of capsular cartilage problem, but a labral tear is pretty like, it's usually the painful click and pop. Okay. So if I have popping and clicking and it's not painful, don't worry about it.

I mean, yeah, my hip, my hip pops. I don't really, I mean, you know, one that one exercise, it kind of bothers me whenever I do it is like a dead bug is my leg goes too far and it does this clunk. There's, so there's something called snapping hip syndrome. You heard that one. And what do you think about that one? I don't think that's anything to worry about, but it snaps. It's almost not painful. Sometimes people don't, like for me, I have the popping, clicking, snapping kind of in different joints and it's not painful. So it doesn't bother me. But sometimes when you're doing a certain exercise and it's like clunk, clunk, clunk, like you're doing the dead bug every single time.

It's like, this is just annoying though. Can we work around it or can we fix this? So there's probably ways that we can modify and move the joint and put it in different positions. So you don't feel it all the time. But if it's not painful, then we're not worried about anything too crazy going on in here. As far as diagnosis. But I'm worried about it. Okay. Well, let's find a way to decrease your worries. Let's go for a walk and find some mental health. Let's find some mental health. Yeah. I thought you could say that. Okay. Well. Wait, I got a question for you though. There's something that popped into my head.

Oh, I can't wait. So I'm going like when you think spondy, right? Spondylolisthesis. And there's certain sports that will pair with that, that you think about. Is there anything like labral that you'll pick a sport with? Never really thought about that before. Well, I think it'll be the sports that go along with impingement. So hip impingement, like it's kind of like a, a progression of it could become labral pathology. We'll say because phrase tears, whatever, but kind of the thought is that the impingement can become that similar with shoulders. It's like impingement can become cup tears or partial tears or whatever.

But so weightlifting can be, but usually here's soccer quite a bit. Dancers have a lot of hip problems, but I've heard some stories of some of the colleges having strength conditioning programs where their football players have hip pain. And then they do something called Clark's test, which they figure out which people have like cam deformities. So cam deformities are like this oblong shaped part of the femur neck head area that makes it so you don't have a lot of hip range within certain like the thigh slots. So forcing these people into certain squatting depths and patterns can create some impingement and possibly tears.

Never know. But I see, I feel like a lot of dancers complain of hips, a lot of soccer complains of hips, you know, so are the impingement or tears or not? Who knows, you know, but there's a lot of people experiencing hip pain that don't play any sports at all. And they just come up out of nowhere, which we should probably mention that hip pain can be referred as well. They can be in the joint, outside the joint, or referred to the joint and they can be coming from different things. So a lot of times if there's no mechanism for the actual tear, like I squatted down, I had 500 pounds on my back.

I pushed up out of the hole and I felt the pop like, okay. And it's a painful clicking and popping. Okay. Like maybe we're, but it's like, I woke up with it probably not like probably looking at maybe some referred somebody on the chair. Does that answer your question? Do you have any thoughts? Yeah, you made other questions pop up as you were saying that. Oh, good. Okay. Is it about mental health and going for a walk? One, I just wanted to state, I think that's cool that they're testing that in strength and conditioning programs. I didn't know that they were doing that. No, I don't think they are.

Oh, I thought you said they were. No, I think this one, they brought, they brought somebody in from what I understand. They brought somebody in, they did some Clark's test. They said, these two or three people are higher risk of having this hip issue. Let's change their strength and conditioning. Nice. Oh, you're saying they should though. Yeah. Okay. And we can do tests like that. They're not hard. Or you just find a slot that doesn't like, generally if the listeners are like, well, I don't know. I don't know how to do that test. Just, it shouldn't hurt the squat in your hip. Stop forcing through it.

And the other one that popped up was, it might even be a question here that we might get to, but let's answer it now. Does the labral issue actually need surgery? I'd say no. It's goal dependent probably. I've met people that have had pretty bad labral tears and, you know, years later they return back to full function. Their hip still pops. They have a little bit of issues here and there, but they're fine. Yeah. You know, general physical activity is fine. They're not trying to be professional athletes. They're just normal everyday people. So I think if that's the goal, then probably, you know, that's a good question.

I don't know all the parts of that. No, that's exactly the way I would answer it. Usually it's goal oriented. It's like, well, let's try these things first, as long as we're not like on a deadline and you're not an NFL player who's got to get back by tomorrow kind of thing. So yeah, 100%. That's why we just can't, just don't see NFL players or anybody who has a timeline. It's harder. Okay. So I think I'm asking you, I was told I may need a hip replacement and someone told me that I should probably, I'll probably get it done before I'm 30. Yikes. I know, I know a couple of people that have this story.

I've heard this too. So I've, I've tried to work around the, let's stay away from those people answer because we can't actually predetermine anything. Most of the time we'll keep it in mind. Let's see, let's, let's take note of things you've tried. What have you tried? What haven't you tried? Let's see if, do you want a hip replacement? Number one, do you think this is something where you want to go? Yes. I love hip replacements. Okay. Well then you know what? Schedule it. Let's get it done. Right. But most of the time, obviously people don't want to have to go through that. And so let's take inventory of what you've tried.

Let's try some other things. Let's do a little program. Give it some time and we can kind of go from there. So I'll circle back to a couple thoughts that I feel like it kind of goes like this sometimes, but my x-ray showed that I have arthritis. So what do you mean? I won't, I mean, it's just going to get worse, right? Not necessarily. How so? I think coming right to the conclusion of you need a hip replacement because we're finding arthritic symptoms in your imaging is a very big jump. I don't really know what else to say besides let's just try some things. Because I'm very confident that it's probably not your actual destination of where you're headed.

What's the word I was looking for? Oh, like a choose your own. You might be too young for the choose your own ending books. Are you? Yeah, I guess so. So there was books that you would take. Let me educate you about history. Please do. So there was these books that you would like start out with, you know, you read chapter one and it says, Hey, there's door. You can go through the woods or you can go through the ocean. Which way do you want to go? And so it says, you went through the ocean. So go to page 72. And then she just flipped around this book and you'd end up dead or alive or whatever. It sounds like Bandersnatch on Netflix.

I hate that, by the way. That's the new version of what you're talking about. So I just got chills. I saw that one and I had nightmares about Bandersnatching. I never actually, I liked the black mirror until that and I stopped. Super creative thing though. Oh yeah. It's yeah. But you have a choice in the book. Okay. Not in Bandersnatch. I get what you're saying. So does that answer that question though? I feel like there's a better way to word it. I think I did a terrible job. I can't, I can't think. I'm just thinking about Bandersnatching. What did you say to your people who told you that? I said, let's just about the arthritis and the hip replacement.

Yeah. The hip replacement by the time you're 30. See, I totally forgot the Bandersnatch. No, I said, let's just try stuff, you know, similar to you. I just said like, you're right. Maybe, I don't know. Yeah. Once you try something, like if you, if you, if you want to get it done, you can. But do you want to? No. Let's try something. What's the problem? The key thing there is you're like, I don't know. I mean, we don't know. So for anybody who's saying that that's your, that's what's going to happen to you, that sounds insane to me. Yeah. You can't really predict injury. You can't predict injury.

You can't predict the future. Or else we would have predicted that you would have been talking about walks and mental health today. And I would have beat you to the punch. Now for a quick pause before we keep going. Hey everybody, it's Sebastian. If what we've been describing in the show so far sounds very familiar, and you've been dealing with some ache, pain, or stiffness that keeps coming back no matter what you do, and no matter what you try, we're offering a free discovery call today where we brainstorm with you what has been working for you, what hasn't been working, and we also try to unravel what is a critical part of the puzzle that you've actually been missing that's keeping you from full recovery and getting back to full activity.

The link's in the description. It only takes a few minutes to fill out the form. Okay, back to the show. Correct. So, but yeah, like basically at the end, I started, the book is actually on low back and hip pain. And so after going through it a bit, I started listing all of these tonic and phasic muscles. And so the phasic ones are the ones that are quote unquote off, tonic ones that are quote unquote on like the piriformis. And then I found myself kind of listing like upper trap, lower trap, middle trap, like just ones that weren't around the area just because I was going through. And so I got to lower trap, middle trap, and I'm like, like parentheses, typically what you rehab when you're looking at shoulder and neck.

And then you look at glutes, typically what you rehab when you're, you, when you're looking at hip piriformis or back and you, and so on. And so usually the program will look different, but kind of, you just target a lot of the phasics at some point and it just becomes like a really good strength conditioning program, but it has to be coached well. So, but it's the same thing. Same idea is not necessarily like here is the, you know, cookie cutter program for you, right? It's more just like, well, we're going to rehab around the area. We're going to focus on these things, but the specific exercises are different for everyone depending on who's in here.

Yeah. And there's, there's, there's slight variations. Like we use probably, I'd have to guess 20, 25 different exercises. We're talking about low back or hip. And then there's like little minor variations on it. Like, like a different spin, like sit this way, but turn that way. You know, like it's slight variations, which are hard for people to do on their own because then they have to think about how to dissect in, in turn. I don't want, we don't want them internalize their problem, but that's why the value of having someone not really attached to the problem, but looking from an objective perspective that you can see like, Oh, maybe we try this.

Let's try that. How's that feel? Oh, it's better. Perfect. It's not your piriformis. So, well, we came very far from, I guess we can't really have it hot with the piriformis. We can't have a hip podcast without talking about the piriformis, I guess. And you can't talk, you can't do it without hip flexor either. So it's not on the list, but let's do, I, my, is my issue, my hip flexor? Probably not. If we were to put a blindfold on you and we were turning around. How can you test for it then? Because I think that would be, it's very convincing that it's the muscles, right? I've actually shot myself in the foot with this before because it's like, well, then let's test the hip flexor.

Then it ends up producing the hip flexor pain. But then you treat them for the thing that refers to it and it still ends up getting better. So test the hip flexor, see if it's weak, see if it reproduces pain. What does that look like? Lay on your back, try to resist knee pressure downward. You can poke and prod it if you want to. Um, I don't know. What else would you do? What about? I've just never seen a true hip flexor before. I'm trying to think if I have. Like if there hasn't been trauma to the area, right? If you didn't have a misstep, if you didn't see bruising, swelling in the area, this is like one of those muscle strain things that we're talking about, right?

Yeah. There's, well, there's sometimes procedures will go in and do like, like around the tendon. They'll do like a sleeve, almost like that to decrease friction. Uh, I don't, I remember, I remember I read about this case or there was, or if I actually had it on, maybe it was years ago, but, but yeah, there's, I haven't really found one either. Like we've found a lot of people with hip flexor pain and tightness, but not truly the root cause. So I guess another way to maybe test is, so you're talking about ruling out, maybe rule in, did you talk about knee to chest? I zoned out. I said knee resistance.

What about just knee to chest and it hurts in the hip flexor region, but passively. So you're bringing it right now, Dawne Costantino's sitting here, sitting all weird. And so she's putting her knee to her chest, using her hands as the effort that piece is not the hip flexor. And you're saying it creates it. That's true hip flexor. No, no, no. It creates pain there. So it's not a true hip flexor. Oh, okay. Cause you're not activating the actual muscle. Right. Cause it's passive test. So we're doing things like, that's why things like scours and for bears, for deers, those rule, those rule in impingement or labrum, but it also rules out hip flexor.

Yeah, no, I was, I guess what I was, I was trying to rule in earlier than testing resisted hip flexion would be your ruling in. What else would rule in besides history? I don't know. I think it's a diagnosis of exclusion personally. I don't think it's, so then actually we should talk about this then since the listeners might be, why are you both taking different routes to the same problem? Do you know what you're talking about? Like, why is she ruling in and you're ruling out? We do them all. Okay. Yeah. I think we're just, we're going based off of, oh, this person already said this. So let me add this in.

I think no matter what we're testing the hip and there's always these go to orthopedic exams. Like you said, that will rule in or rule out all the possible things that can contribute to pain in that area. So you have data points that collect up into looking like it's a true hip flexor or looking like it's impingement or arthritis or whatever, but we're going to go down that list of things and we're going to make sure to give you a better idea of what's the true cause here. Now, since we're on this, actually, is it my turn? Oh, it's your turn to ask. So I'm not, I'm not going to say the question then yet that I want to do.

What does that say? Try? I can't get you the little things on there. Oh my, my hamstrings are tight. Should I stretch them? I wish we both had microphones because it sounds, I'm going to trade you this, this, this thing here. So, so I'm going to go with where I, where I'm normally sitting. I'm going to level this later. So it might change, but, but as I start to get closer and so I want you to listen to yourself when you get closer to. Okay. Listening as I get closer and listening as I get further. It just sounds so much better. Further? No, closer. I like it. I like it further. Do you? I, I like to feel like they're in my head.

Actually, but back here does sound like an NFL. In here is just kind of scary that I can hear myself this way. Yeah. It's like in your head. Yeah. So the hamstrings are tight. Should I stretch them? Sure. Go ahead and try it. Does it hurt you? It's maybe kind of that like feel good, painful stretch during, but feels good after. So it helps your hips after? Temporarily. Sure. Go ahead and have a good time. I feel like anybody who's stretching gives them really long-term relief. We don't necessarily see them. Probably. We don't hear from them. A lot of times when people say that stretching feels good and gives them relief, it's usually temporary and they want something that's longer relief.

So as long as it's not hurting you and it feels good, continue to do so. I've taken it away from people who it still feels pretty good temporarily though. I have when it shows, when it's looking like we shouldn't be tensioning it. Why? Because it's that, it's that like, what do you say? That positive, negative kind of thing. Oh, the math of it. Yeah. Oh yeah, that makes sense. Because there's even those people who do specific workouts, right? They're like, no, I can do my workout the entire time and I don't have any pain and it feels good. It's always later on in the day that it hurts. So it's, well, let's start to just like rule in and rule out some contributions here of what can be putting you in that more net negative or negative than net positive.

Yeah. Am I saying that correctly? Positive, negative? Yeah. The net, the end result should be positive numbers, not negative. So you're saying that their exercise or their stretch might be contributing negative numbers to the equation and robbing your person of their positive ones. Yeah. Okay. So, well, let me say one more thing about this then. So hamstrings, why we would take stretching the hamstrings away is a lot of times we see tightness in the hamstrings isn't true muscle shortening. It's usually more nerve related and nerves most of the time do not like to be tensioned. There's a time and a place for them to be tensioned.

So we take them away in the beginning just to make sure that you're not adding in that negative that we're talking about. So you're just kind of more controlling the situation to make sure that we're not going the wrong route. Yeah. Okay. So I got a hard one for you then. I saved it. This might be the last one of the podcast. So if you guys are not subscribed, you should because we're going to do this again and again and again because we have so many more questions. So I was told I have a sports hernia. What do you think I should do? It hurts right in the front, right around my pubic bone. And yeah, no one could figure out what to do with me.

I tried a bunch of rehab stretches. Didn't work. Okay. Usually my first question is, especially with hernias, have you had any imaging done? Not that I'm going to send you to get some. Just curious if you've already had them done. I have not. Remember, oh, sports hernia. Gotcha. Okay. Just making sure you didn't hear hernia. Oh, yeah. Okay. Either way. Okay. I have not had any imaging done. Okay. Gotcha. So wait, what was your question? Do you have it? Yeah. I want to know if I have a sports hernia. This is a hard one. Well, let's test some things then. Let's see. Okay. Sports hernia though is usually one of those, we can't figure out what's going on with your hip and groin here.

So we're going to, you're distracting me. You're starting to lead me to an answer here. I'm going to answer it the way that I want to. You can add it later. But I, I, a lot of times think that the diagnosis of sports hernia is one of those that you are given because they can't actually truly figure out what's going on with you. They'll do an ultrasound. They'll do imaging. Nothing shows anything in that area. You've tried rehab. Nothing's getting better. It's just one of those just like, well, this is what you got going on. Then let's kind of go from there. There's nothing to surgically be. I've had someone come in the other day with it.

And he's just like, I was told I just got to live with it now. I'm like, well, it's unfortunate. Let's try some other things then. Did you tell him to go for a walk then? In his case, yes. Yeah. So yeah, sports hernias, you start with the imaging thing. Yeah, it should. If it's a true sports hernia, it should see something. And a diagnostic ultrasound is a really good way to go. They're not readily available or found really quickly, but most people don't need them. But we've seen a lot of people with hip pain here. And we had an ultrasound here. We were doing a lot more of them. I think I only ever found two.

And we've seen hundreds of people with groin pain right in the same area, same presentation. And yeah, I think a lot of it just comes down to failed rehabilitation or they didn't do the math of rehab right. And they're usually more highly probable impingement or referred from the back. I've never seen an osteitis pubis, have you? So I know those are another thing too. So, but yeah, I, I gamble and say no, but there are ways to test for the insufficiency of the neurosis of the abdominal wall. You can do like almost like a sit-up crunch test and you can stress test the muscles that go into the pubic bone too.

But if you really want to figure out whether it's not a musculoskeletal ultrasound, probably the way to go. What do you want to add to that? Nothing. I was looking at the dermatome chart over here to see if I can get them like to try to describe it better to them. But what we mean by referred from the back, because a lot of people don't know what that word referred means. I just think to myself, I mean, you can even look this up like dermatome patterns, Google it if you want to, and just follow some of those letters and numbers around and see which ones lead into the area of your pain. But there's certain areas, nerves from the low back that come around and supply into that groin area.

So if everyone's been treating you for your hip, your groin, whatever, and nobody's looked at that backside, maybe that's something that's going on with you. And that's what we see a lot in here. Well, I think probably the thing that I've had a lot of people ask is, why do you think it's referring from my back if my back doesn't hurt? Because we've already treated you for the hip and groin and all that stuff and it hasn't been working right. So let's go to the other thing that we haven't tried yet. You don't need back pain for it to be referred from your backside. Yeah, I would agree. There's a lot of people with numb fingers that come from the neck that don't have neck pain.

Yeah. Or their neck is just stiff. It's not painful. It's just tight. So, okay. That's probably a good one to end on. Dawne Costantino, did we forget anything? We have a lot more questions, but we can cover that on another day. Forget anything? I don't think so. I mean, if you guys like what we're saying, if you want to ask us some questions, if you want us to look at what you got going on, maybe we're speaking your lingo. We're here for you. We'd love to talk to you. If anything in today's episode resonated with you, visit the link in your podcast player. There you'll find any free resource that we mentioned in the show, any guest links, and a link for a free discovery call with us.

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