Four clinic cases: sciatica, back pain, a hitter's knee and a shoulder

She said, no, no one's ever touched me. And I'm like, you are kidding. You are kidding. That is blasphemy. How do we not touch our patients? It blew me away. So it was crazy to me to think. I'm like, this is standard. You can't even test a rotator cuff without touching it. You have to touch someone to do some resistance testing. You got to screen stuff out. And I said, no one really touched you? Like, not in a creepy way, but no one touched you? You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery.

And now, your host, Dr. Sebastian Gonzales. What's up, what's up, what's up? Hey, it's Dr. Sebastian Gonzales again with the Restoring Human Movement podcast. This is session number 101. And I thought I would start out this time with trying to correct something I think I've been doing over the last month that really drives me insane when I'm listening to these podcasts. And I don't know if you guys have listened and heard this part or not, but I've noticed that I've done a couple things which drove me a little bit insane. So I'm going to work on one today. And the first one is all of the ums. I've noticed that when I'm doing solo podcasts, and I have to think about a little bit more of what I'm saying.

I do a lot of ums, and it drives me a little bit crazy. But also, too, when I'm at the end of a talking point, I tend to go... So it drives me a little bit crazy. So what I thought I would do today is actually go through some fun patient encounters, which is probably going to be great for clinicians as well as patients. So I thought to break the mold out of this little um thing that I've been doing, I thought I would tell some good stories, stories that I've told quite a few times before, so I'm a little bit more well-versed with them, and I don't have to think about really too much technical with it.

So if you're on with me on this, give me a good thumbs up on that. So the first thing in regards to housework, or sorry, what is it called? Cleanup? No, housekeeping. Housekeeping for the year is, first off, I do have some good guests. Did I say year? So this is going to be, I guess my year starts around, when's this going to be released here? This is going to be August 22nd. So apparently August 22nd is my centennial year, and then it's going to be 100 days from that. So a little house clean first is that we have some great guests coming on. I'm going to attempt to get Andy Alpin, soon in the future.

I hope, I really hope. We've been in communication a little bit about it. I want to have our guest from session 91, which is Michael Shacklock. I want to have him speak with Dr. Stuart McGill. And I thought it would be amazing because Dr. Shacklock, doctor? Physiotherapy Shacklock, Mr. Shacklock, is really good with peripheral neurology, with everything out of the IVF, or everything out of the spine, and going further, Dr. McGill is really known for spine biomechanics. So I thought putting them together would be really exciting. And I know that Dr. Stuart McGill has spoken with Greg Cook before, the physical therapist.

So that was really popular for everyone to listen to. And I think they even put it on like videos and DVDs and so on, and they're selling them. And this one, I thought you'd want to hear it here first. So I'm going to attempt to make that happen. I just have to make sure that everyone knows what we're going to be kind of talking about, or at least on their end. So hopefully it's going to happen. So I have some exciting things coming on for the next hundred. So first, the story then, the story for the day is actually how I attacked my friend. And I don't, I don't know if I said this one already, but it's definitely worth, definitely worth retelling, I think.

So I have this friend who, I've actually talked about him a couple of times in the show before. I have this friend who he really, he had cats growing up. And so we're, we're camping one time and he's just, we're on this campfire and he's talking about, you know, so I think I, I think I kind of want a dog, but we don't have a yard. So I'm going to get a cat. I'm like, that doesn't make any sense. Why would you want to, why would you want a cat if you want a dog? They're completely opposite. He's like, well, we just don't have room for a dog. So I think I'll get a cat. I'm like, you don't want a cat.

No, you don't want a cat. But if you want a cat, I'll buy you a big box of kittens and leave them on your doorstep. Put about seven of them there and you won't want to get rid of your cats. You want cats? I'll get you cats. And he's like, no, I just, maybe, maybe a cat, you know? So anyways, so around Christmas time comes around and me and a couple of friends go over to his house. And little does he know that we have about seven, eight, maybe pictures of these ugly, ugly cats. And we were actually going to make stickers, make them colored and all that kind of jazz, but they're actually black and white.

We print them out of a printer and cut their faces out. So we put all these cat, cat faces all over the house. And so we put them on the Christmas tree because it was Christmas time. We put them in picture frames. We put them, uh, there was one in the mailbox. There was one in the ice dispenser. There was one in a salad spinner, which took him a very long time to find. I think that's what I maybe spoke about on the podcast before. It took him, I think easily six months to find that. Uh, and I think there was, uh, some in some, I don't know if he found this last one yet, so I don't know if I can reveal it, but it's in an area way high that typically you wouldn't find or you wouldn't look for unless you had people over.

So we know they haven't been doing much entertaining, but anyways, so we could tack the hell out of his house. So every time he found one, he texts us a picture. He's like, I got attacked, right? Cat attacked. You got cat attacked. Uh, but I know that salad spinner thing is that I firmly believe that salad spinners are a complete waste of time as well as majority of single use kitchen items. Just a complete waste. Don't even waste your money. So we threw that thing in the salad spinner. I think it took him six months to do it. I told him, by the way, you never find a picture on Google of a man holding a salad spinner and you Google around and you probably look, you're going to find a man's hands holding the salad spinner, but you won't actually find anyone, any male holding a salad spinner.

So I challenge you to make that picture. So as we go through these things today, uh, first, a little bit of, um, the things that I've gone through in the last couple of podcasts I've talked about. Uh, no, am I doing that? Um, thing that was, uh, that one doesn't count. So there was a couple of things that I went through in the, in the last couple of podcasts. That were, uh, courses based. So I have an ankle course that we're, we're, that we're going to be putting out. There's an, uh, last time we talked about the oblique. No, it wasn't the last time. It was a few times ago. We talked about the oblique strain.

I think it was number 98. Last time we went over some highlights, but so I've been putting some courses together and I want to highlight this because, uh, I want to, I want people to go through them and test them really. And I have had a few people through them and you go, by the way, you go onto my website, p2sportscare.com, go under courses. At the top, there's going to be, uh, right now there's currently three, there's low back pain, there's hip pinching, which by the way is not a hip flexor thing. But if you think it's a hip flexor thing, which is a common misdiagnosis with your hip, go through there because it's probably going to be femoral acetabular impingement.

And that's what these things are kind of revolving around misdiagnosis and then trying these wow factor things, which might or might not help you. If they do help you continue down the path and you're going to learn a lot more about these conditions and resolving them than you ever did with, uh, your, your frustrating path so far through other docs or clinics that haven't figured it out is all. And I'm not saying they're bad. They just maybe took the wrong path. And so there's low back, there's hip impingement or pinching in the front side of the hip. And there's chronic hamstring tightness, which actually if clinicians are listening, that is actually, we're looking into radiculopathy.

So we're going to do side glides and some McKinsey extension based stuff on there. So go through those. What happens is, and I'm, and I'm hoping this helps out a lot with, uh, my clinical practice because people call and they're like, Hey, uh, how much does it cost for an exam? I'm like, Oh, a bit. And they're like, Whoa, that is a bit. Why don't I go to the guy down the street who just gives away free x-rays and then treats me for free for three months? Well, you could do that, but you might not get any better, very quicker, very quickly. So I'll tell you what, go through, there's a courses thing on my page.

It's a five day free course. I got this idea from Ryan DeBell. Thanks, Ryan. Uh, it's a five day free course and it goes through literally what they're going to get and probably the first two to three sessions, but it's all, it's automated and it's organized. And a lot of the YouTube videos that I put out, people say like, well, I don't know which one to go to next. And I have to send them direct links. This is all laid out. This is obviously there's disclaimers on there. You need to go see somebody. But here's my thought with it is that I would rather, I would rather someone go through my educational process than go to someone who is not going to be able to help them.

So my attempt, so my attempt, this is what I'm testing. I want to see if it works. Give me some feedback. If you go through is I want people to go through there for free to hopefully get better free content than they got from me, them getting from me than what they paid for other people for within there. So there are upsells and purchases of things that they could try. There's some stiffness work, which is needed in a lot of cases. Low back, obviously we need a couple stiffness work things. And then there's progressions of that. And what I'm hoping for is that it's a, it's called a value ladder.

You get free. You might pay seven bucks for something else. You might pay $50 for something else, but at some point you're going to realize that my exam that cost a bit is worth it. So I'm trying to show people that my exams in my care, my, my one-on-one care is worth it. So go through and do that. And I would, I would love to have your feedback now into some cases. These are a couple of fun cases that I have had over the years that I've told stories about. And I actually tell these stories to patients a lot of times to let them know that they're, they're, they're not alone and that I've had cases similar to them.

And these are the things that worked with them. And it's funny. That's kind of what I go through in a lot of these online free courses is that obviously I can't examine these people. So I tell stories of things that happened in other people's cases. Obviously privacy laws are in effect and I don't share any names. But there, so I had this guy here. He was, he came over the last year or so. And it was funny. Like he was actually, he was an awesome, he was an awesome patient to work with. He was a fun guy. He actually, he came in the first time he came in, he walked in through the door or he barely walked in through the door.

He came in with a friend and he literally laid down on the ground face down no more than about five feet from the door. And he had his hands on his forehead and he had Syrian sciatica pain or pain down to the leg and low back pain. And this is how we spent the first 30 minutes that he was in my office. So it was kind of funny. It was one of the first times that I've had someone come in where I couldn't really do a complete exam because they were so severe. So I had to pick and choose the things that I really wanted to try. And the first thing is obviously we can't have a casual conversation if he's wincing and groaning and grabbing and stuff like that.

So the first thing I did was go over and I put my hands upon his hips and I pressed them together. And then I said, how are you feeling? And he said, oh, my, my leg pain is getting better. So it started creeping up his leg and it finally got into the point where he started to feel normal. He said he had a one out of 10 when he was at pass. He said eight or 10 or eight or nine out of 10. So I took my hands off and then he's like, ah, it's coming back. So I put my hands on again. So probably for the first 30 minutes, I butt my butt my leg up against one thigh and I held the other one. I kind of like squeezed them together so we can have a conversation about what happened.

And, um, it was very, it was, it was fun for me knowing that, uh, actually I took a good gambled route in the beginning and I was able to reduce his pain with at least one strategy. So I know that he's not technically broken. I know that we can, that I can help him. I just have to figure out the other parts. Create a data point, create all these data points to figure out what I can do with him first. Now, eventually he left that day and he came back. Um, I want to say a couple of days later, maybe it was less than a week later, I think. So he comes back and he's doing better. He doesn't lay down on the ground.

And actually this time, what I did before he actually came in, I'm like, oh, this, this guy's coming in right now. I'm like, he, he kind of got to the closest spot that he could and then just relaxed. So what I did this time was I actually put a table out in the middle of the weight room, which is probably about now 20 feet from the door. Cause I didn't want to do all of it right. But he was literally by a window and, uh, it wasn't, it wasn't easy to get to the other side of him. So I put this table right out in the middle of the room. And as soon as he walked in the door, I'm like, walk to that table.

Cause I knew once I got him, uh, once he stopped walking, then he wasn't, he was going to stay where he was at. So I'm like, walk to that table, sit down right there. So we got all the way, way to the table. He sat down right there. Eventually he get down to the ground. We were on the ground for about an hour again. So the process was, I'm like, I got to get this guy to, to do some normal things. So he's going to be sitting, he's going to be standing, he's going to be walking. He's got to be able to get off the ground. These are some basic activities of the day of living. He's going to have to do.

Let's just work with that first. So, and I'm like, I had a real, I want to get him to the table so I can actually figure out other parts of his case. I need to figure out if we're looking at a disc, are we looking at mainly nerve root impingement? Are we looking at, does he have flexion tolerance, extension tolerance? I guess, but I really wanted to test. Is he, is he compression intolerant? Is he rotationally intolerant? Does he have sheer intolerance? Kind of all the McGill stuff I really want to go through because I want to, I know a lot of times when I start with a case, I don't always go back and restart this exam.

So I want to have all my points at the beginning, but at the same time, this is about him, you know, so I know he's not going to want to care about all these provocative, provocative tests that I do, and he's probably going to get more irritated than I'm doing them. But again, he's a cheerful guy. So I mean, we laughed, like we laughed multiple times throughout the first couple of sessions. And he, um, I, I can't say it about everybody because it's, it's, it's really hard to be in pain that long and that severe. So what we did this time is I finally, finally got him to the, to the exam table. And when I got him to the exam table, he was sitting there and we then worked on posture with sitting.

And he's like, well, I can't sit here that long. It's going to hurt. I'm like, well, I just wait. Let's, let's, let's see if we can stack these things together. And so we figured out that rounding forward was worse, arching backwards better, but that arching backwards too much wasn't good. So we found somewhere in the middle. And I said, you, let's find this point. Let's stick it. So we worked with this thing for maybe a 30 minutes or so. So at this point, he'd already been in the hour, uh, office for about an hour or so. And he was still sitting on the table. I didn't get any exam really done, but he was responding well.

So I tried a couple exams in there a little bit. He was getting worse. So I, then, uh, we went back to the ADL thing and I, I kind of saw the writing on the wall and, and my next patient was going to be showing up really quickly. So I was like, well, I know what's going to happen. He's going to be, he's going to be here for a while and I need to make sure that I can get him to walk. And actually, I forgot to mention. So the first time, uh, my first exam was actually about an hour and a half, two hours. Depends if I have more free time or not. So I'm okay with, with being with someone that long, uh, and figuring out their stuff and troubleshooting and so on.

Cause that's what it's all about, you know, make sure and should make sure they have some control and making sure they understand what they can do at home to reduce or reduce their pain when it comes on. So they don't start popping meds and drink a beer and so on. So this first time, that first time he was in for almost four hours. He was in for a long time, um, which he was getting better with. And finally, when he, when he was able to get out, get out the door, he was feeling better. But this time I couldn't, he, he wasn't walking. So I thought, well, this ain't going to happen again because last time I had to, I had to manage him as well as another person.

I wanted to give them their one-on-one time, but then also too, I realized he's a super severe and, but he's well past his time that I can spend with him. So this time I'm like, well, this ain't going to happen. Like I'm going to, I'm going to get, we got to get him to walk. We got to get him to the car and then we'll see him again. So I got him like, let's just stand. I coached him in how to stand and he stood there. And he had to sit down again. I'm like, what's going on? He's like, well, I can't stand for that long because it hurts. I said, okay, cool. Let's get it. Let's get you to standing.

You can see this is a long, it was a long process, but it was fun. It was so fun. And the best part is yet to come really. So eventually I got him to stand about three, four times and he'd last no more than five seconds before he had to sit down again and take a little break. And a couple of times he went down on the floor because he needed to break again, again, laying face down. We got him back up to the table, got him back up to standing. And this time I had to use the approach of the arm swing or torso stiffness. And because bracing was working with him. So I said, look, this time when you stand up, I want you to move your arms furiously.

It's going to stiffen your torso. And let's see how long you can stand there. Drive your head straight through the ceiling. Look out to the horizon. Swing those arms. So he did. And he was up there for about 15 seconds. It was kind of like one of those things where like someone rides their bike for the first time and they look over at their mom. They're like, mom, I'm doing it. Right? So he's like, it's good. It's good. And finally he slowed it down and went down to the chair again. And at this point, my other patient was already here. So he got a good show with this. So I said, okay, look, here's what we're going to do.

I'm going to go over there and open this door. And I want you to, when you stand, we're going to do everything the same. I want you to start swinging your arms, stiffen your torso, look straight out where you're going. And I want you to walk with decisiveness out to your car. And then we're going to the point where he can wedge. So I want you to wedge up on the car and pause there. So I said, ready? Okay. One, two, three, go. Starts swinging his arms. He stands up. He's able to walk out the door and he gets to the car. And then we, we bump fist at the end there because he's like, yeah, that was good.

But that's the most creative way I've ever kicked anyone out of my office. So it was, it was, it was definitely a lot of fun. But that's something that I actually, I never, I never had to do before. So I was, I was winging it the whole time with that. But we take bits and part, bits and pieces of other things to, to see if you can get this person to respond. So that is a case number one. That's a fun one. That was a low back case with sciatica, which it was disc related that I had to creatively try to kick him out of the office. So the next one I thought would be kind of fun is there was a, there was a guy that came in a couple months ago.

He actually was low back case too. He was about my age. He's about 35 or so. And he had had back pain for about 10 years. He had a lot of decreased activity. He was overall very cheerful again. So I, and I really enjoyed working with him and we had a good time. The first time we found a lot of success, but it was kind of funny. The interaction that happened when we started going through the process of things. So he, he really wanted to start running again and being active. And, uh, he has some kid, he has a kid. So I think he saw the writing on the wall and he's like, I can't let this thing go on.

Like it's, I have a friend who's, who was being treated by someone that I know and in a very similar way. And they're like, dude, the homeboy started taking pictures of like him running and stuff. Like that's, that's unheard of, you know, like I just didn't expect that to happen. He's like, I want to be that. So when he came in and we did an exam, we figured out his tolerances and so on. Um, but we were, we're sitting there at the table in the exam room and he was able to walk in. It wasn't a super severe case. It was just a low grade dull ache that just kept coming on and just never really went away.

So we're sitting there and I was like, Hey, what, what makes it hurt? And he's like, well, it always hurts. Every, everything hurts. And this is kind of the part too, which I know I've talked about in the past. I don't think people should manage their own injuries because logic kind of goes out the door. And I'm, I'm no exception to that rule because you just forget. And it takes getting those good reps in before you actually start to realize the things that you're like, Oh, I can control this thing. No big deal. Then you just have to make sure that you don't trigger it. So he was sitting there on the table and I said, so everything hurts, right?

And he's like, yeah. He's like, it never goes away. So I just went up behind him and I kind of put my hand around like his low back. And I just kind of like, I'm just going to nudge you forward a little bit. Just go with me right there. And I said, how's that? And he's like, Oh, it's all gone. So, so all we did was we changed his stacking pattern basically. And we took a little bit of the round out of his back with sitting. And from that point forward, it was, it was great. We did some rehab. We did some stiffness work. I got him to deadlift the first day, which he hadn't done in years. He hasn't really done any work at all in a long time.

But the fun part was, was actually went outside and we did some walking because walking is part of rehab. So we're walking around out of there and he, I'd already taught him how to sit, get out of a chair, how to get off the ground, how to roll out of bed, just some ways to reduce his pain as he's recovering a little bit. And we're walking around out there. We're doing an arm swing together and walking up and down the alleyway. And this is a good opportunity for me to have a conversation with people. Cause once you coach a couple of things there, we're just walking and just kind of sticking, sticking stuff together.

So we're, we're bullshitting and everything. And then finally he says, he's like, do, do people ever feel stupid after, after these, after their initial thing? And I said, what do you mean? He's like, uh, well, I like, I feel like a complete idiot. Like I've been dealing with this thing for like 10 years and it was such a simple thing. And you're teaching me how to do basic crap. And I said, well, no, I don't, I mean, I don't, no one's ever mentioned that. They don't ever say, they feel stupid, but I, but I can see what you mean. So it was enlightening to me. It was just kind of fun just to see like the light bulb go off.

And he's like, damn. And I had, I had this, uh, type of, uh, incident when I had, I co-managed someone with a colleague and I brought her, I brought her into his office and I said, look, can you, I'm missing something. And I know, I know it. And then we found what, what, what was missing. And I saw the exam exam happen and I thought, holy shit, I'm so stupid. You know, like, how did I miss that? So, but it's, um, it was, it was fun. So it was fun to have that, that awakening period with this guy. That was a real quick one. Okay. Next one is, I don't know why I keep getting back cases on this, but I'm going to say this one's actually a back case.

Uh, it was a husband and wife team and I've had the opportunity to work with a wife for a while. And finally I get in the husband and I've been hearing about the husband and his major back issues that just don't go away and so on. And they're just, they're fun pairs. So sometimes they'll come in tandem and I've given the husband some, some cues of things to do in daily life and activities. It's that are going to decrease his sensitivity and so on. But I, I don't know if he's doing them or not. So, uh, he, he's very, he's cool. And I say temperamental in the way that like a lot of times the, the back will tend to not respond as quickly as I want it to.

But I, so I question whether the, the homework and the technique are being applied. So to show me that they're doing it right, actually. So the wife would then take videos of the guy doing it. One of them actually was, uh, sitting into a car chair because I know sitting into a chair is a big trigger for people, uh, getting into the car, but also setting up into the car. So I usually come up with the odd, the odd cues to make sure that they, that they remember it. And for some reason, like they draw some really good cues out of me. I don't, I don't remember all the ones that I've, I've used in the past with them, but they reminded me when they took this video.

So the first one was they were, they were sitting in traffic. And so the guy took off his seatbelt and he got wedged into the chair the way I told him to do. And so he's basically, he's reciting all the things off, uh, verbally the cues to go through. Cause he remembers the ridiculous ones. So the first part is, so he takes his, he takes his, uh, seatbelt off. He puts his ass halfway up onto the chair. And then the, the girl's like, wipe that ass on that chair. So he slides his butt down into the wedge of the chair. And he's like, yeah, I'm wiping the ass on that chair. So we, we say that because I wanted to push back so deep into the chair that they actually are supported by the lumbar support.

Another one there is like, oh, eating the shorts. You can tell when you do it right, the shorts start to wedge up into your crotch. So eat those shorts, wipe that ass, eat those shorts. So I got a whole bit, I got a video on that. Uh, they texted to me. That was fun. Uh, so I know it was being done. And, uh, the next one, the next one they sent me, actually, this one took, uh, took a little over the top. So they were, uh, assume like you're having a party or something. So it looked like there was a, what is that? It's not a hefty container. It wasn't, it wasn't an ice chest, but it was something, uh, similar.

I bet there was much ice and beer in it and so on. But he had a handle of rum or vodka. No, I think it was rum because it was, uh, reddish. It was a handle of rum in, in his left hand. So it was one of those big, uh, jugs. So he goes, through basically the, uh, I show a bastardized lifter's wedge cause I haven't taken Brian Carroll or Stuart McGill's course, uh, on that. So, but basically I show lifter's wedge as, as shown to me by somebody else. So I teach him how to lift stuff. So I said, Hey, you're going to go out and probably have some parties or something. You're going to probably encounter stuff that you got to lift.

So let's just teach you a wedge. So I got this video of him just walking up to this, uh, ice chesty thingy. Left hand had a handle of rum in it. So you hear him reciting again. He's like, crush the oranges, break the quarter between the ass, make five nickels, sip the air, spread the floor. So it was kind of fun to see. Uh, I really wish, I want, I want to start writing down some of these ridiculous cues. I know that the last time he came in, uh, he has a tendency to squat and I'm trying to get him to hinge. Uh, so I want to teach him that hinge or, or a deadlift just to make sure that he has command of the movement.

So he keeps dropping the real low into a, into a squat to get down. So a high chest, proud chest, ass low. Um, so I say, Hey man, you, uh, let's do some stripper squats. Like, what's that? I'm like, well, you, when you're, when your hips are back, that's when you make the money, right? So he, it resonated well with him. He did it pretty well after that. Uh, but he, he has a tendency of reciting these things still when he's doing it. Cause he's, uh, obviously trying to impress me. Fun dude. The, uh, but I told him like, look, I, you know, like I, I want to be like, if you're lifting a Mack truck, if you're going to pick that thing up, you're not going to be speaking at all.

And you're not going to be reciting these cues. You can do them in your head, but don't start telling me all these cues. Like I can kind of tell if you're going through a mental checklist, but just by looking at you. So here's what I want you to do. I want you to do a five circumcision reps. And he's like, well, what's that? Where are you going with this? And I said, well, circumcisions. Do you ever mess them up? Does anyone ever want to mess them up? No. Okay, good. These reps are called circumcision reps. I want you to say, pay so much attention, be so absolute precise that you're proud of your work.

Okay. Don't screw up anyone's life, including yourself. So circumcision reps, give me five, take a break between, because you just don't assemble the line. These circumcisions, you, what, you take a break, you go out, you drink some water, you come back, you do it again. So that was the, that was kind of his story on that. He is getting better. He's a work in progress. And this is just the attention that, well, this is, this is the, I like the dedication that he's doing. And I don't want people to overthink too much of their movements, but for the most part, perfect practice is perfect. I believe you do more circumcision reps.

You'll probably be really good at your lifter's wedge. And you'll probably start doing less pain targeting movements. And then we're off the races. We're going to get these things a lot better. Okay. So the next case was actually a baseball players. It was really fun to work with because I, I actually surprised myself. I'm, I am a student of the process and I am just following trails kind of like a, like a drug dog. I'm just looking for stuff throughout these cases. So I don't know what's going to happen. And this one actually surprised me of what we ended up doing. And I'm really glad my intern was there to, to see it because it was something that we really don't honestly teach in school.

And I didn't know I was going to do it until we actually went for it, but it was just kind of like looking at and seeing the process and seeing what we need to do to offload the structure. So it can self repair. So a guy came in with a knee injury. It was the backside leg in swinging. So if he's a right-handed hitter was the right name. Okay. So he had a major concern that this was a patellar tendon problem. He's like, Hey, is this going to need surgery? It's been happening for about three, two to three months now. And it's just not getting any better. It seems like it's getting worse. I'm freaking out.

Right. So I said, okay, so the first thing is, is you're concerned this thing's going to tear up and it's going to be a surgical case. Great. Let's check that out. So I'm lucky enough to have a diagnostic ultrasound in my office that I administer myself. Love doing it when, when, when needed, by the way, it's not really great for spine. So if anyone's given you some spinal ones, tell them to go blow smoke, blow sand, kick sand. I'll figure what it is. Pound sand. There you go. So they're, they were not useful for seeing disc. So don't even waste your time, but it was great for, for, for peripheral joints, shoulders, elbows, wrists, knees, hips, little iffy, but still see the stuff we need to see ankles and feet.

So it, by the way, I don't know if I'm, I have two podcasts about this. Musculoskeletal ultrasound is fricking amazing. So if you're looking at x-rays and you're like, I don't see anything. There's nothing there. And you're looking at it and you want to get an MRI and like it's never being done because insurance is just a tool. They don't want to give it to you and they want you to do X, Y, and Z before doing it, or I want to make sure that your, your feet are basically numb and not working before they do it. A musculoskeletal ultrasound is a really great way to investigate some things to rule in, rule out what you're going to be looking for or what you're going to be working with.

So they're pretty cheap and it's, it's, it's really cool actually with knees. I think in the age of 30 or 35, I forget which, but basically there is a, there is a study they did where they compared, MRI findings to ultrasound findings. And literally they were about the same, very, very sensitive to be able to see the things they had to see, especially for meniscal injuries and patellar tendons. But when you get a little bit deeper, the ACLs, PCLs, things inside, you're not going to see really that as much because they're guarded by bone. But either way, I think the, the outcome with that was like, look, if you're of this age group and you have a knee condition, you're worried about it.

If you took an ultrasound and it looks positive, there is literally no reason to do an MRI because you're not going to find anything different. Over the age of that, you might find a little bit more, but I mean, I've had people come in with ACL injuries that you can clearly see on an ultrasound. You're like, dude, there is a ton of fluid coming out of that joint. So we know that something's going on within the joint. If there's smoke, there's a fire. So if you're having issues with knee stuff and you're freaking out like this guy was, just do an ultrasound. They're cheap. They're quick. And if you're already paying for x-rays and you don't want to pay for an MRI, then this is your way to go.

Totally good. So anyways, he came into the office. We all sounded the knee and I didn't see anything. Nothing noteworthy. And the patellar tendon looked symmetrical on both sides. It was not swollen. There was no adenomous findings around it. There was no swelling. There was no hypervascularity. There was nothing abnormal looking. I didn't see any jumpers knee. I didn't see patellar tendonitis. I saw a little bit of sign of maybe condomalous patellar or some cartilage softening, which is usually from an abnormal wear pattern or making an area work too much. So I thought, okay, so this is normal.

So I told him, look, this thing will not explode. We're going to be fine. Let's just see how we can unload the area. Because actually, I don't know if you guys know, I had this conversation recently with Crystal. You might've heard Crystal, I think around 26 or 27, that episode. She used to work for me. Now she's no longer. But she had an issue and we had to talk about the grading system of muscles, muscle injuries. So actually, I don't know if you guys know. And for the clinicians out there, there's a consensus statement of 2012. I have it somewhere on my page that basically says grade one, grade two, grade three is no longer the standard.

So grade two and above is partial tears and full tears, obviously. Grade two and above is going to have a positive ultrasound and a positive MRI. There's going to be a finding. Below that, then we're looking into, let's just say DOMS. DOMS is now in type one, type one muscle injury, which is not going to find a positive ultrasound and not going to find a positive MRI. Just not going to find it. And it's going to self-resolve and you're going to be fine. But there's other things in there too, which are nerve derived and fatigue based and things like that. So basically, when this guy came in, we're looking at this tendon area and muscle area.

It's like, well, nothing was really positive. So maybe you're a grade one. Maybe you're nerve derived. Maybe you're something else, right? Either way though, there's nothing to repair. So you're not a surgical case. It's not a structural problem. It's a functional problem probably. So he was concerned with swinging as well as a couple of things. He couldn't slow down with running, but he could run. It wasn't comfortable, but slowing down was like murder. Damn, there's a big ass. I'm right there, huh? So he couldn't swing the bat, but he could duplicate pain with swinging a bat in the office. I thought, oh, this is so cool.

Like I have a bat in my office because I play baseball. I have probably three bats in my office. So I have this one. Then I'm like, hey, just take this bat. I want you to swing, duplicate the pain, and let's just play with it. So he was able to swing partway. He said, yeah, that hurts the back leg, especially when I'm into the downswing portion or at least halfway. And I thought, cool, great. So why don't we then, since the knee doesn't like a bunch of load with rotation, why don't we just try, why don't, why don't we, why don't we try to lighten that foot in the back? Because with swing mechanics or rotational power, we're basically transferring weight from one side to the other side.

And at some point you're going to post up onto the front side leg. Mainly the front side leg is really the one which creates the power. It's kind of like a wave crashing. The wave will not form and create nor crash. If there's no sandbar static point, it has to pivot it over. So with a baseball swing for a front side leg, got to have a solid post. And if your brain doesn't trust that post, perhaps you create one 75% post and one shitty 25% post. So perhaps that back leg was a shitty 25% post, which didn't need to really be there. We can lighten it up some. And we've seen sometimes in the majors with some of, I think it was Harper.

There was a, there was a while back where people, maybe five years ago where people were like, dude, I'm going to swing just like this guy. He takes his back leg off the ground as he actually starts to impact the ball and follow through. It's just kind of like a tap. So I followed that process right there a little bit. Why don't we transfer the weight into the front leg and see what happens? So we did that. He was, it was still painful. I'm like, okay, cool. Let's just, let's just work a little bit more on this. Let's get now. Maybe he's not physically able to do that because the brain doesn't trust it.

So that's the next process we're going to take. First off is that when I had him, we tested planes of swing. So I said, swing at a high ball, swing at a medium ball, one right down the cock, swing at one low and in the dirt, swing at one inside. And the top one didn't hurt. The inside one didn't hurt. The other two did. So what we had him do then was we started to build a, a mind mapping and a little bit of tone into the left hip. So we did a couple different exercises to facilitate that. I won't go into exacts right now. It's just probably a huge tangent as I've already done the story. It's the longest story so far, isn't it?

So after we've loaded that hip and it only took about two minutes, we have him swing again. He's like, Oh, it's about halfway better. I said, great, cool. So we're building that front side post. And my intern's like, what are we doing here? Like, why are we, why are we working on the left hip when he has a right knee problem? I'm like, dude, you're only as good as your point of, uh, you're only good as good. You're only good as your, is your point of contact. All right. You cannot produce movement if you don't have a stable point to move on. So let's just see how this goes because apparently there's nothing wrong with the right knee.

So let's not mess with it too much. And he's not presenting with any back pain or symptoms of really, uh, neurological. So let's just, let's just play with it and see where it goes. So the next thing I thought, maybe we can improve the posting by improving proximal stiffness, belly stiffness. So I looked at him and I was like, Hey, why don't we, I'm like, you know, tennis, you watch girls tennis. He's like, yeah, sometimes. And I said, cool. why don't we try to simulate Serena Williams or maybe it's Venus. One of the Williams. So I'm like, you know how they go. He's like, yeah. I said, when you swing, I want to hear it.

So he did. I'm like, swing as hard as you want to, but make sure I want to hear the grunts. I want to hear it in the, in the, in the office next door. I want to hear it down the street. So he swang. He's like, Oh, it's no pain. I said, try it. Try about five more times. Ah, no pain. So that one was a fun one because it was interesting to see in a rotational athlete, you build the posts and you take a lot of the other things away. And I can almost guarantee that if we had not played with it like that, and if I didn't have the time, I might be looking a little bit more at the knee. And if I didn't have the ultrasound, I, I would investigate the knee a little bit more because actually, uh, that is, that's a huge problem.

I think in, in sports rehab and healthcare is that a lot of times we don't investigate the, the post way, how affect the, how they affect the other, uh, the areas of major complaint. Okay. The last story I really want to share. This one actually was someone who did not come in. Um, I hope she comes in one day. I would like to see this lady and actually learn more about her experience through her injury. And so she had a shoulder problem. Actually, she was a phone call. And so I was lucky enough to pick up a phone on this one. And so she was telling me about her story and so on. And she had had this problem.

She had the solar problem for, uh, I think it was about, it sounded like it was a long time. It sounded like five to 10 years. It was, it was a while. And so she was looking for some answers and she had found some of my articles or videos and she was calling up and questioning. I said, great, cool. Let's just do this. Just come on in. And she was like, well, so what do you, what are you going to do? What is, what is it? Uh, what are we going to do when we're there? Because actually most people, most people ask this because they're, I tell them, Hey, look, insurance does not cover this. Actually insurance might cover this, but we're not going to build them for you.

We're going to charge you cash first time. And that's all you have to do with us and just pay us cash each time. And that's it. Cash, check, credit, whatever. And so she was like, okay, so it costs money. And all of a sudden she was asking about what, what we're going to do. And I, I was, I don't know what, I don't know what it was. I was on that day, but I, but I actually told her, I'm like, look, I'm going to be just direct with you. Do you care? Do you care what we're going to do? Because I mean, I can already tell you from talking on the phone that I feel that I can be of help to you. And she's, she was kind of taken aback with that.

She's like, yeah, I kind of want to know. Cause I'm always actually, I'm always at the thought that I don't think people really care. Some people don't care. Many people don't care. Some people want to know like the engineers and all the people who are interested in how the body works. They, they want to know and they want to know if they're doing, if we're going to be doing something different. But other people, it's like, dude, if I was going to wiggle my finger over you and make you feel better, do you care? Like just, just that, that's it, right? That's that you just want to feel better. So she said, okay, well, I really want to know.

I said, okay, great. So I'll tell you. I said, well, so usually we'll go through all the history taking. I'll learn about your injury. Like I am reading a novel. Consider that you've had this injury for about five to 10 years and I have not read any of this book. So I got to catch up. So a lot of it is history taking in the beginning, but also we're going to do all the orthopedic testing to make sure that your shoulder is intact and it's not a repairable one. And we're going to check all the joints around it, check the spine, and we're going to do some neurological testing, some orthopedic testing, some movement testing, and we're going to do some corrective exercise or tissue work or adjusting as needed.

And she says, neurological. I, I don't want to do that. I don't want to do that again. And I said, well, why not? I'm like, I, I have to do it. I got to check to see if there's any neurological aspect to your condition. She said, well, cause it hurt. I'm like, hurt. Well, I'm like, what did you, what'd you do? And she said, I don't, I don't want to do that zappy test again. I'm like, oh, you had a conduction test probably. So it was interesting on my end to see that. I'm like, oh, the, her interpretation of neurological testing was actually use of machine. So I said, no, no. Our, our exam, my exam is not, it's, not machine based.

Uh, I don't use any machine unless I have to do an ultrasound and check it, check something. And if you need other imaging and testing, I'll send you out and we'll do it. So, uh, someone else will do it. But I actually, I'll just, it's manual testing. I'll put my hands on you. She, and she says, oh, so you're actually going to touch me. And I said, yeah. And she's like, over the past five years or so, or with this injury, I've never had anyone touch me in the exam. And I said, you're full of shit. You're full of shit. She said, no, no one's ever touched me. And I'm like, you, you are kidding. You are kidding.

That is blast to me. How do we, how do we not touch our patients? It blew me away. So it was, it was crazy to me to think. I'm like, this is standard. This is standard. You can't even test a rotator cuff without touching it. You have to touch someone to do some resistance testing. You got to screen stuff out. And I said, no one, no one really touched you. Like not in a creepy way, but no one touched you. She's like, no, no one's ever touched me. I'm like, you need, you need to come in. If you don't come in to see me, go in to see someone else for some touching exam. Cause it has to be done. It blew me away.

So we were on the phone for about 15 minutes or so. And she was waiting on her. She was going to do an image. I think she was doing an MRI or something and she was going to have someone review it. And I felt very, I felt very comfortable with her at that point because we've already kind of gotten through a lot of things. And I wanted to use this as a learning experience because in quite, in quite honestly, when people call, they don't always, they don't always come in. So this might be the only interaction I have with this person. So I kind of want to learn something. I want to better myself as a clinician and learn about what their experience is and figure out why this person might, might or might not come in.

What did I say right or wrong? Am I listening to them? Am I communicating well with them? What needs to happen? So I, she said that she was going to have her, have her image taken, go review it with the person who'd seen her previously and decide what to do. And I said, look, like, let me be honest with you. I've talked to you on the phone for 15 minutes already. Do you feel like I know more or less than that person who spent or who did not touch you during the exam? And didn't spend any time listening to you. How long was that exam? And they said about five minutes or sorry, how long was your experience?

They said about five minutes. I said, do you feel like I know more or less? And she said, you know a lot more. And I said, whose judgment are you going to trust now? And she said, well, I'm going to go see this guy. And I'm like, and after I got off the phone, I thought, hmm, I wonder if patients really, or general public, lay public think that not touching during the exam is standard. And do they want to be touched during the exam? Does it help? So I thought about from a marketing perspective on that, I thought maybe I should just write up a little thing that says, we, sports injuries, we actually touch you during our exam.

You know, something like that. Just to let people know that like, you need to be touched during your exam. And what I learned from Bobby, maybe it was in session number 98, is that you need to listen to them. And you need to be able to build a rapport with them, not just do the exams that you want to do. So I thought I did everything right on that. I don't think I have a lady's number anymore. I'd love to call her back. But I think that there's something missing there. I think there's something, maybe I didn't close that thing right. I didn't close it to have her come in. Perhaps I need to do the follow up.

And I do believe actually with sales and marketing and getting patients to come in your door to help them has to do with a lot of times with follow up. And that's where I fall apart, honestly. But I think there might be a disconnect with patients don't always realize what is needed to know all of the fundamental things to help them. Nerve conduction test. Great. Cool. MRIs. Great. Cool. Only part of the puzzle. Part of the puzzle. Majority of the stuff we learn is in history taking. And if we can reduce your symptoms with a movement-based correction, we are on track. I strongly believe that. I have no problem with doing adjustments and electrotherapies and stretching and tissue work.

I got no problem with that. And I do some of it. But I always want to see if I can reduce their pain with a movement-based correction first and get them that locus of control, then I know that we're on the right track. And then I know I can do a lot more other things to decrease their pain later, which might not be something they can control and do on their own. So I thought that was a really interesting and informative one to me anyway, is just learning that apparently people don't get touched during their exam. Who'd have thought? Crazy stuff. So if you want to be touched during your exam, come see me.

Now, I think that's all I want to go through in this podcast here. This was session 101. And can you please let me know if this one was more fun, more informative, or less useful than the past ones? And I know I've done three straight in a row where I'm basically doing the majority of the talking and solo podcast. Again, I promise I'm going to have better... Not better. It's hard to get better than the last few interviews. I'm like, those guests are amazing. I'm going to have other people. I'm going to have great people coming on. And I might have some repeats because I feel like I could have done better in some of these interviews and dug a lot deeper.

So subscribe to this podcast. If you're a clinician, share with a patient. If you're a patient, go through and start reading the material on my website. Those courses are there for your entertainment and for your education. The disclaimer, which we had made, is that you need to be examined. Okay, I'm not saying that I'm going to fix anything or help anybody that does not have the diagnosis that they should have. You need to be examined. But I firmly believe that there's a ton of books out there and there's a ton of crap on social media and YouTube that why not? I mean, they're very liberal with what they do on theirs and showing crap.

I might as well show some good. So I'm hoping that that's the last impression that I can leave. But again, if you have not been seen, you are being negligent. You need to be examined and checked out first. Find those courses on my website, p2sportscare.com. It's on the big ass tab, courses. If you're on your iPhone, it's the little hamburger right there. Courses, right there, simple. There are paid courses in there as well. Those are the things where I elaborate a little bit more and actually go more into the process of how I teach things in my office. The first stuff is just basically steps one through three.

First one is how to desensitize structures. Second is how do you modify postures, loads, and positions. Third is working on some torso stiffness. But really, we've got to build the engine. We've got to build the engines of the body. And we need to make sure that those carry over to the sport that you want and make sure we have the linkage involved. So those are parts that I choose not to give for free because I've already given enough for free on those things. Better, still better information than you're probably going to get from someone else who makes you pay for it. So I hope this was informative.

Hope you guys like this style. And I'm going to try to be a little bit more open and liberal with my delivery in the next few podcasts. So give me feedback. Email me, info at p2sportscare.com. If you want the transcript, it's on p2sportscare.com. Just go through and type up session or just type up 101. It's going to pop up. And as always, leave each other better than how you found them. If you're a girl, go date an Eagle Scout. They're badass. Talk to you later.