Common terms your doctor uses in injury treatment, explained

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 didn't understand at your appointment. And now, your host, Dr. Sebastian Gonzales. Hey, it's Dr. Sebastian Gonzales with Performance Place Sports Care. And this is going to be a podcast on common terms that we see that we need you guys to understand as patients to really communicate well with you. So, this is part of actually a course curriculum that I have for new patients, but also, too, we're going to have this on the Performance Place Sports Care podcast, which you can find on iTunes.

And the course is actually, if you are a new patient and you're looking for it, it is on teachable.com. But you can find a link to it on our p2sportscare.com site or our other site, which we've been working on, which is performanceplacehb.com, and just find it under courses. So, before we get really into the meat of any course or any treatment plan, we really think it's, or I think it's beneficial to know some of the terms that I'm going to use, that any other type of medical staff is going to use, a physical therapist, an MD, DO, or so on, because it's really about communicating well. And I remember there was a patient probably about five years ago or so. It was definitely a lack of communication, and it just startled me. It took me by surprise, because about 10 minutes in, I was assessing this girl's ankle, and it was a ligament sprain is what it was.

And she was looking at me, and when I said this, just in complete confusion, and I said, do you understand what's going on? And she says, no. I'm like, well, the joint could be, it could be loose, it could be unstable. And she says, a joint? And I realized at that moment, she had no idea what a joint was, let alone a ligament or the ATFL or the specific ligament that I'm looking at. So it kind of threw me back, and I thought, what do I need to do to get this person, to get this girl to stay, so I can use something helpful for her? Because obviously letting her go, she might go somewhere where either they might not give good care, or they might do something that is not good for her at that point in time, because it was a pretty fresh one.

So I basically defaulted to, I think your bone is broken. And I know that wasn't right, it wasn't the right diagnosis or whatnot, but sometimes what the idea is that we need to do in a rehab setting is we need to get this person to do something productive during a certain period of time. And realistically, what I needed her to do, she was not comprehending. So the best course of action was kind of just to get her to stay. She didn't come back after that, needless to say. But for the most part, I realized that common terminology is not known to everybody. And I've gotten tons of feedback on my videos as well as podcasts that even some of my close friends, they tell me, we can't understand what you're talking about.

Like 90% of what you're talking about, we have no idea. So this podcast is my remedy. This common term podcast hopefully should address the basic stuff that we would go through in the course of a rehab setting or treatment plan. So if this is common knowledge to you, please keep it in context and realize the intention of this podcast because it's intended to get everyone up to speed. And it's not specific to any certain injury. It's just mainly specific to the body and the definitions. So don't worry, we have more advanced courses on the Teachable site, which again, you can find at performanceplacehb.com.

But here we go. We're just going to go into some terms. So the first term we're going to go into is bone, then joint, ligament, cartilage, tendon, muscle, bursa. And then we're going into movements because I realize that some people don't realize what movements are of the body. And this would apply to any joint, although they would change slightly. So the first one is flexion, extension, rotation, lateral flexion, abduction, that's A-B, and then adduction, that's A-D, as in dog. And those two last ones are actually ones that we oftentimes get confused. I don't know why they put them together like that.

But they are—I'll get to them when I get to them. But the first bunch is mainly structures of the body. So what is a bone? A bone is basically a very hard structure, which makes up the human skeleton. They come in many different shapes and sizes. And a fun fact about them is that the human foot actually holds 26 bones, or actually one-fourth of all the bones in the body. The next one's a joint. This is the point where two bones come together. And it is there mainly for motion, almost like a hinge at a door. So you have the—I guess in this analogy, it would be the door would be a bone, and the door frame would be another bone, and the hinge is basically the joint.

So they come in many forms. There's ball and socket joints, just like the shoulder and the hip, or the GH joint and the hip. There's swivel joints, there's hinge joints, kind of like the door analogy, and so on. I won't go too much into this since it's not going to get—it's going to get deeper and deeper and deeper, and I don't want to tangent too much from the basic definitions. The knee is an example of a joint that you might know, which is pretty much like a hinge joint, although it does move a little bit in different directions. A fun fact about the foot, again, with joints, is that there are 33 joints in the foot alone.

A ligament, this is tissue that surrounds the joint and keeps it mainly from falling apart. They are very hard and resistant to stretch, and when damaged, they leave the joint looser than normal because, again, their job was to keep the joint together. The ACL of the knee is an example of a ligament you might know, and a lot of times with people that have ACL injuries, their knee becomes unstable. And actually, and I guess it's not a fun fact, but I think the American College of Sports Medicine says that within about five years, 95% of these people with ACL tears have evidence of osteoarthritis or arthritic conditions in the knee, which wasn't found in the other knee.

What is a cartilage? This is a softer tissue, and it can be flexible, but we still don't want it to tear, which is why it's a very unique structure because it's very pliable in some cases. There's a few different types, which we will not go into yet. That is a deeper hole. There's examples of cartilages that you might know. The ear and the nose are some, and if you feel them, you can feel the knee, or sorry, the ear, you can really smash around quite a bit and nothing happens to it. The nose is a little bit denser, but notice how they bend, but they're firm, they keep shape when you stop messing with them.

So they're very interesting structures, and they don't really have a lot of blood vessels to them, which is part of the issue when you have an injury to them. A tendon is pretty much an extension of a muscle, and we call a muscle and tendon together as a unit. It's really hard to separate them unless we're talking about from an anatomical standpoint, but as a unit, they function together. So a tendon is an extension of the muscle, which attaches the muscle directly to the joint, so the joint can move with the contraction of the muscle. It's easy to feel a tendon on yourself. A famous one is down at the ankle.

It's the Achilles tendon, which is on the backside, so you can squeeze it. Hopefully, it's not too tender for you because they do become tender when there's issues with them. This tendon in particular connects the calf muscles to the heel, so basically we can walk. A muscle, this is basically your standard piece of meat that you'd eat if you're not a vegetarian or vegan. A steak or chicken breast is an example of this. Actually, you can probably see within the chicken breast, sometimes you'll get the tendon in there, and this is an example of that whole complex. It's a part of the body that when it contracts, it shortens, and it bends the joint.

If you flex your arm, the bicep is the one that is doing the flexing, and you can see your hand will come close to your face since the elbow is actually bending because the bicep is doing work and shortening. A bursa is next, and funny, a bursa is one that actually a lot of people don't know, and it's funny that they relate to a bursa as a condition. So bursitis is something which typically goes, it is the inflammation of a bursa, but the bursa itself is a normal structure. It's there all the time. It's totally normal. And just think of it like a water balloon, and the inside, or there's liquid on the inside, and it's basically like a flexible container.

It's encapsulated, or we say. Note this structure is a normal one of the body, and it functions almost like a pulley, or to like grease something that's going over a bone. And the only way I've thought of it in the past, I guess, is that, you know, when you see those movies that someone's got a rope hanging over a ledge, and someone's on the other line, and they're pulling it up, and the rope's slowly starting to fray. If it had a pulley there, or a bursa, it probably wouldn't be fraying. It would just kind of come up. So I just want to mention it because most people do think it is an abnormal structure, and they think it's a big issue when there's a bursa there, but it's normal.

Bursitis is just irritation to that sac of fluid. The fluid is mainly a function to decrease friction, so you don't wear out all your parts, mainly. The next few we're going through are the anatomical references of direction of a joint, or limb motion. So these can apply to any joint, and in fact, when you read the scholarly journals, or things on PubMed, or Medscape, on research of these types of injuries, and rehabbing them, these are the types of terms they're going to use. So I think if you really understand them, you're going to understand how to rehab these better, and you can even ask people like me, or your other healthcare providers, whoever you're using, to elaborate a little bit.

And when you have these common terms down with us, it's really easy for us to explain even deeper. So the first two we're going to put together are flexion and extension. And it's really easy to talk extension with people because most people can relate. It's mostly in relationship to the spine or the knee. So extending the knee, it straightens it. Extending the spine, it straightens it or extends you, I guess, backwards, almost like you're looking. I guess extending your neck would be looking over your head behind your head. Flexing is the opposite direction. And I do plan to have, by the way, because I know it's going to be hard to explain these with words, because to explain extending, I've already said extending a few times.

We are going to have some infographics available, and I will put them in a link description below. And they will be something you can share with your friends and family so they can understand better as well without hearing me talk in a podcast. For hip, for extending the hip, it's basically putting, it's contracting your butt cheek, and this will pull you into extension. Flexion is the other way. It's like most people understand their hip flexor. So contracting their hip flexor will bring their knee closer to their face or their chest, and this is flexing the hip. Rotation, I would strongly encourage thinking about it as a top, or think of spinning, almost like you're a ballerina spinning around in circles and circles and circles.

Imagine a ceiling fan, even. If you're standing underneath it, the rotation of the ceiling fan is basically what we're looking at in relationship to the spine. If you stand just underneath it, and you're right on the axis of the center, when you spin around, it is basically simulating spinal rotation. For the shoulder, though, it's a little bit different. For the knee, it's different in its relationship to the center axis of rotation. So if you have your arm extended in front of you, like you're trying to give someone a high five, when you put your, let's see, when you put your palm down, your shoulder will probably internally rotate with the elbow.

And you put your palm to the sky, like you're looking for someone to hit your high five, I guess, a low five? Low five. So that's externally rotating. And that is in relationship to a few different things, which we won't go into, but for the most part, intellectual rotations are like spinning a pen or spinning a top. Lateral flexion, let's use the spine as a reference because it's the easiest to talk about it there. It's the motion that the spine takes when you slide your hand down the side of your thigh towards the ground. It's almost like you're trying to reach deep, deep into your hip pocket or trying to get down to your knee.

And this can take, there's left and right lateral flexion. Abduction and adduction are a little bit harder to explain. And I will talk about it in relationship to the arm because it's probably the easiest. So the arm or the shoulder, when your hand is by your side, it is adducted. So AD. When it's up in the air and you're reaching up like you have a question, that is abducted. And I've looked at a, I looked up a couple, remember, ways to remember it on forums before I started this podcast because I remember it in a different way. I think of, actually don't go into what I think of because I don't think it makes sense to most people.

But this is what most people use. When a child is abducted, she is taken away from her parents. I guess in this analogy, the parents is going to be the rest of the body. So when your arm is being abducted or it is being taken away from the rest. And when you add something, you are putting them together. So ADD means that you are bringing the arm back together. And this would also go in relationship to the hip. Now the last two things I'm going to go into are, it might not be the last we might ever talk about on the teachable site, but it's going to be the last one for this podcast, is loading a joint and hypertrophy.

And I'll start with hypertrophy because it is something I talk about a lot when we get into resistance training. And people might wonder why we are talking about hypertrophy. And hypertrophy is basically the increase, the definition is the increase of a cross-sectional area of a structure and increase in size. And hypertrophy, if we're talking about muscles, think about Arnold Schwarzenegger or a huge buff guy, they're huge. And they are basically hypertrophy out the wazoo. They are the extreme example of hypertrophy. Now, typically when I bring that up, people say, ah, you know, I don't want to get big.

I don't want to get like that. But that's not the goal. Hypertrophy, actually, it takes a long time to develop. And one study I saw, I believe it was about, it was four times a week of resistance training. And I won't get into what type because that'll tangent us again. Four times a week of resistance training for, I believe it was nine weeks, only had minor, minor signs of muscular growth. So just think about that. When is the last time that you spent four times a week resistance training for nine weeks? And I'd say majority of people say probably never because America loves cardio and cardio doesn't count for this.

So a lot of times it's hard to get hypertrophy because you don't have time or so on. And I can tell you in all honesty, the amount of lifting that I do outweighs the cardio and I'm only as big as I am. So when you meet me, you're going to see that I'm only as big as I am and I try to get bigger. So hypertrophy, the purpose of it for your rehab is because we need to have a sizable amount of muscle to stabilize a joint and also increase strength of a joint. So it spares a lot of the other things which might be injured on you. An example would be hip strength or hypertrophy of the hip muscles. We're looking to increase the strength of the hip so the back or knee doesn't suffer the consequences.

Now, when we're showing exercises, loading a joint, we say loading, loading, loading. And we might say load that hip, load that heel, load the arm. Loading is, I've talked to a few people about how I should translate this because loading a structure to me means putting weight on it. Or it doesn't have to be weight. Like, you could just be contracting an area and compacting a joint. But for the most part, the most understandable way I can probably say it is when we say load a joint, let's just say you're standing there and you're doing, we want you to do a squat with two feet on the ground. But we're trying to push you to get most of your weight onto one heel.

We'll probably tell you to load one side. And an example of this further would be you can't do a single leg squat if you have two feet on the ground. You need to put 100% of your weight or load on that one foot. So that is loading that foot. And if we tell you to switch sides, we are then loading the other foot. And when we talk about squatting, we might tell you to load the hips. And you'll probably recognize the amount of pressure you get from the ground by doing a single leg squat on the foot. But there's different ways of feeling it by loading a hip, say. Or loading a shoulder. And we will coach you through this type of thing.

It's the type of thing you have to feel. And once you remember it, you won't forget it. Now, I hope this was helpful. If you have suggestions of things that you want to hear in regards to common terminology that we go through either in person with you that you don't quite understand. Or if you're listening to this on the actual Performance Place Sports Care podcast, just suggest things. You can suggest things on our website, p2sportscare.com. There should be a link there with we have SpeakPipe there, which you can ask a question on. Just send a voicemail straight through, and we'll listen to your stuff.

We'll try to make this as most informational as you possibly can. And also on the Performance Place HB site, you can go there, and there will be a SpeakPipe voicemail there as well. I hope this was helpful to you guys, and I'll see you in the next episode. Thank you.