Recurring Calf and Hamstring Injuries on the Same Leg

This is session number 55 of the Performance Place Sports Care Podcast. You just thought in them baths and laughing your ass off. 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, everybody. This is Dr. Sebastian Gonzales again with the Performance Place Sports Care Podcast. And that sound clip was Tropic Thunder right there. That was Downey Jr. in the flesh. So today, I thought we'd have on a different type of podcast. And there's going to be a guest. And he's actually one of my longtime friends. And he actually doesn't work in the medical world. He doesn't know a bunch about injuries. He knows a little bit.

But the reason why I thought I'd have him on is because it's funny that we always talk about this kind of stuff like in a social setting. He's like, hey, this started happening to me. What should I do? And I'm like, I don't know. Like, we don't have enough time to really talk about it right now. So I thought we would go a little bit deeper into it today. And I said, hey, let's just do all this on a recorded line right now. And he's actually helping me do a little bit of development in regards to kind of asking people what they need for online courses and suggestions with these types of injuries.

And the difference with him is he's actually been in to me and I've examined him so I can't actually render care because I've seen what he has going on. And so I know a little bit more bits and pieces with people who are not who have not been seen by me. I can't really suggest anything. But so we're going to dig through his case today and just kind of figure out what's lacking. Talk for about 45 minutes to an hour and just see if there's any holes in what he's doing. Like, what's the most abrupt thing? What can I suggest? What kind of videos? What kind of rehab videos can he do? Is he stretching enough? Is he exercising enough? Is he rehabbing enough? Is he eating enough? Drinking enough water? And so on.

I mean, are all these little parts, all these little parts are important. So I thought we'd just dig right into it. So we're going to have a mystery guest. I'm not going to reveal his name at all. So we're just going to have him on. If you want to be someone like this, feel free to go on to the P2 Sports Care site. We've now moved the voicemail button to the podcast page only. So that's p2sportscare.com slash podcast. And now we are actually having some of the podcasts on the main page as well. So you can listen to it right there in a nice little media player. Make it easy for you guys. So if you want to contact me, go on to our contact on that.

I do get those forwarded to me. So if you have an interesting case, I'd love to talk to you. But here we go with the mystery guest. All right, everybody. So this is our mystery guest. Welcome him on. Say hi. Hey, how's it going? Oh, good. I wasn't assuming, I wasn't thinking that you would think that they would say hi because they can't say anything back. So I've kind of told them that you are, so I've known you for a while. So I can share some of your information in regards to your injury. So why don't you tell us about your injury and what's going on and how it happened and all that kind of jazz.

Sure. So my injury is a, I have a left calf injury. This injury has been, you know, on and off for, I would say, even close to like 15 years. It's always been the left calf. I'm a right-handed athlete, right-footed. And so a lot of, you know, jumping, play basketball a lot. And, you know, jumping is usually my left leg is my strong leg. So there's probably something there. It really all started. I never really cramped up much until, you know, I would say, you know, around 15 years ago when I was, I was taking creatine. And when you take creatine, you know, you, you tend to cramp up if you don't drink enough water.

And so that was really the first time my calf started cramping up. And it's always been that one since I do a lot of stretching. I roll it on a, on a baseball, um, and, uh, use a runner stick. Um, but it's one of those things where it feels like, it feels like, oh man, it's gone. It's, it's fine. I feel like I can go back out and do stuff. Um, but it, it, it always seems to tighten up. And, uh, and this, uh, this latest injury, which happened, um, two days ago was, uh, was just running around at the beach on the sand. And, and it just felt like it cramped up. And, um, but it was, it was much more than a cramp because it's still, uh, two days later, it's still a little tender and I'm still, uh, limping on it.

Um, and, uh, for the last two days since the injury happened, I, I did some pretty extensive stretching. Um, I rolled it on a, on a baseball, uh, pretty good and it felt much better, but I can tell that this is going to take, you know, potentially, you know, uh, several more days of, of stretching it out on a baseball and maybe, you know, after four or five days I might feel back to normal. Well, I think the major question is, wait, you were running on the beach. Yeah. I was, uh, I was attempting, I was attempting to run on the beach. I mean, was there a dog chasing you or something? No, there was a, there was a football being thrown at me and, uh, I had to, uh, run to catch it.

I thought you were going to say you had tried to get out of the way. No. Well, so let me ask you this then. I know, I know we're going to attribute it back to like 15 years ago as well, but what, when's the last time you sprinted besides, uh, running away from a football? Um, I would say in the last two weeks. So would you, I mean, like sprinting, like as like forward, backwards, sprinting side to side, forward, backwards. I usually, when I, when I go for runs, I'll go, uh, and just do sprints because I, I just, I don't really like running. And so I try to get the most bang for my, my running workout.

So I do sprints when I run. So like all out sprints, not just like, uh, okay. And then you take a little break in between, but you're going, you're going straight, I'm guessing. Like all out, like running from the cops sprints. I do know where you live. So that is definitely possible. Um, yeah, by the way, you said this, is that going to be your last, uh, 4th of July, 4th of July there? Are you, are you moving? Um, don't know yet. Uh, probably not. We really like it, uh, out here in Santa Monica. So probably not. Um, so then when you're playing football then, so I'm guessing that you were also going side to side and turning and spinning.

And what was, was this just like casual catch or were you like, it was just casual. It was just casual. Um, I think, uh, you know, there was a lot of walking, uh, you know, prior to all that. And, and I, I could feel that it was a little, it was a little tight. So, I don't know, I probably just, uh, didn't really think much of it until obviously, you know, either I strained it or pulled it or whatever, whatever happened. What side was that old hamstring injury on too? Left. The same side. Yep. Um, well, I was just curious, like, so like the first thing I think of, like when you're talking about sprinting, like, so most people don't, they usually don't build up to a sprint.

They don't condition themselves during the week. Like, so I played, I mean, I played baseball this weekend. I played on yesterday. Um, I, I hit a couple where I did to get, I had to get second and third. So I had to sprint, especially turning the bases more than I typically have to. Um, and I get sore the next day, but also during the week, I don't always do enough conditioning and change of direction drills and running side to side and pivoting and, you know, like how you kind of did in basketball. Um, so most people usually don't. Usually now, especially if they're doing it for a physical fitness, they'll sprint in a straight line.

But when you're playing a sport, a lot of times it's rotating or changing the direction that is not in the same vector or forward and backwards as, as you're training and you get it. Yeah. So that's just the first thing that comes to mind. Um, but also too, I think it'd be fair to say that if you hadn't sprinted before, let's just say you did, you know, say you did like a hundred pushups, right? Two weeks ago, but then you did a hundred pushups today. Do you think you'd be more or less sore from it than if you did it like every week or two times a week? Well, yeah, more because I'm not really used to it as much.

Yeah. So with sprinting, you get, they call this an eccentric load or it's a, a lengthening contraction, similar to like jumping. Like when you jump off a box, like all your muscles are, a lot of the muscles are lengthening. You can tear something or strain it. Um, so sprinting has a high amount of it. So I would think if you're going to play casual football, you should probably condition for it too. I'm sure you weren't thinking about it though, right? Yeah. I mean, to be honest, this, uh, the, the whole football thing didn't really go very far. Um, like I said, I think my calf was already feeling kind of tight, uh, leading up to it.

So, I mean, I'm talking literally like, like less than five minutes into just throwing a football around and like running around a little bit on the sand. It just got, it just got tweaked and, and I was pretty much, uh, hobbling for, you know, the next 48 hours. Okay. Um, but you're right. I, I don't like, I'll go on, I'll go, I'll do sprints. I'll go out, I'll play basketball, but it's, you know, it's not consistent. And so, um, when I do those things, I do feel very sore the next day. And when I do those things, I do go a hundred percent all the time. I don't, I don't think like, Oh, let me ease into it.

And that might be something there as well. Yeah. Like I actually started to, I don't do it every week, but I actually go to the park and put up cones on like a Wednesday and all the change of direction and starting acceleration and then slowing down or deceleration to the cone change direction. And, and open up the hips or close the hips and like, uh, change in direction from the cone in different mannerisms. Um, I mean, it's really hard. It does gash out a little bit, but I think it better conditions us to use our body as when we finally get to the sport, then our body remembers how to work. And also it has a little bit of load on it in that manner where it decreases chances of injuries like that.

Um, well then also too, what was your warmup like? Uh, there really wasn't, there wasn't any warmup. There wasn't, uh, it wasn't like I, I had stretched. I probably should have stretched cause I did, like I said, I felt it a little tight from all the walking around. Um, so no to that, no warmup, no warmup. Uh, okay. So what do you plan on doing with it right now? So right now, um, I've been vigorously, uh, stretching it with a baseball. Um, I've, I've kind of figured out, uh, with, you know, help from, you know, a lot of your videos that you do, um, how to utilize a baseball to stretch the calf.

Um, and it's, it's really the only way that I can, I can really get a good, you know, deep, um, kind of stretch. Uh, and in addition, I also just use my hands to kind of, uh, do, uh, you know, uh, at home kind of active release type of stretching. Um, and it's, uh, I, I mean, I'm, I'm doing a, I think I'm doing a good job of it because it's, it's feeling much better in two days, but, um, but that's pretty much it. I want, I want to work it out too, but I don't want to injure it any, any further. And so, uh, I was looking to, you know, get your input on, on kind of what else I should be doing besides just stretching.

Yeah, those are, they're, they're good starts. Um, but also to the, um, I think this is, I know we had talked before about like the inconsistency of video of videos and not knowing where to start. And, um, the, like, I don't even think that I would start you stretching really, because let's just say, I don't even, cause I don't even know what this thing is yet. I haven't even seen yet, but, um, let's just say if it's, it's black and blue or it has like a little bit of spot where it had a welt on it, there's a possibility. This is a, a actually structural tear. And in that case, you really don't want to be doing tissue work on it.

Um, especially too aggressively within the first like three to five days. Um, and you don't really want to be stretching it too much because if there's a gap in the tissue, like imagine you have like a rubber band that just, I mean, you're trying to let like the tour, but then you're trying to kind of put an epoxy on it and the epoxy never dries, but you keep stretching the hell out of it. Right. So like there's part of that in the play too. And at some point the epoxy does get, it does get the ability to, to bear load or to transfer load between the two sides when you stretch the rubber band.

So gauging upon, let's just say it wasn't, it wasn't that it wasn't a large tear or a grade two or anything like that. And it's just something minor. Then, uh, I think there, there is a need to load it. Um, because there's using when you remodel like a tendon or a muscle, there's, there's things that go into the area that want to rebuild it, but they're actually, they, they happen with the inflammation process. Number one, they're like naturally occurring. They come in there, but also too, you want to, uh, you want to mechanically load the area when it can tolerate it. And this is like a rough range, but they found, they found that collagen remodeling or a protein remodeling in that area happens at a higher rate when you, when you load it.

So what do you mean load it? So let's just say if it, say this was like, uh, say we're talking about a calf thing, which we are, I guess, um, maybe, um, uh, heel lowers is a common one. Um, or an isometric contraction of the, of the, uh, actually I'll make it easier on you. How about walking? I mean, walking, you, you go through normal, like a range of motion. The calf does some work, but not a ton, you know, but it's, it's gravity is the load. So it's, it's, it's like, remember, didn't like back in like biblical days, like they would cut people's Achilles and leave them in the desert or something.

I mean, cause they, cause they couldn't walk cause they didn't have the ability to transfer load between one side of the muscle or the tendon and the other. So if it has the ability to transfer load, you need to, need to let it. And the walking is one of the easiest ways. Um, or you can do things like you're actually like, say the calf machines at the gym would be another way. Squats would be a way. Biking would be a way. Um, but rest or relaxation or casting would not be a way in that case, you know? I see. So there, so there is no black and blue, you know, it doesn't, I don't think it's, I don't think it's a tear.

Um, I don't know right now in the beginning, it felt like a really bad cramp. Um, today I feel like maybe it's something else, like maybe it's a strain or something. Um, but I don't really know how to tell. And so I, I, I mean, I'm walking on it fine. If I really had to go out and run, I could probably do it. Um, but not for long and, and so, you know, I, I, I guess, uh, would you say that by loading it, like would, if I went to the gym and actually did calf lifts or, you know? Well, so you said you're hobbling the other day. So can you walk right now without pain? Um, let me, let me just make sure.

Yeah, I, I can walk without pain. Um, I can, I can feel it's there. Yeah. So, I mean, I, I mean, I would just go to, it's, it's almost like, think about, think about squatting. Like if you have a pain within certain range of motion squatting, you just don't go through that range yet. And you certainly don't load it anymore. You don't put, you know, 45 pounds extra on the bar and then you just squat it just because you want to, you want to feel normal again, you know? So, I mean, I wouldn't just, I mean, I always tell people to consider the risk reward. So the, let's just talk about walking to running in, in this case with a calf thing, if you sprinted or did plyometrics, you'd have a much higher risk.

And at this point we know that it's very fresh injury. It's very, I think a very low reward too. So you might as well pick something which is a little bit lower risk and higher reward. So we know that walking can increase the amount of, uh, uh, collagen remodeling in there, which helps it longterm. Um, and also there's very low risk of injury unless you jump off a curb or, you know, try to do parkour or something in Santa Monica. So, I mean, I would stick to something like that, but, but also too, like, again, this goes down to like the, I mean, I haven't seen you. I don't know anything what it looks like.

I don't even know if you know what the calf actually is. I mean, I'm pretty sure you do, but you could be pointing at your shoulder for all I know. Nope. It's a calf. Yeah. Well, so then we'll play this game. Is it, is it the inside or outside? Um, it is, uh, it is the inside of the left calf. Okay. Is it, are you sure it's not a bone? You sure it's a muscle? You sure it's a tendon? It's, it's the muscle. It's the main, it's the biggest muscle I can feel here. Well, I know there's not much there. Yeah. I have pretty skinny, uh, skinny legs here. Okay. Is it, is it, is it superficial or deep? It's deep.

Okay. So. I mean, I, I can feel it superficial, but when I, when I'm like putting my, my hands in there and like trying to rub it out, I'm getting like, I'm getting underneath this, I'm trying to get underneath this big muscle. Okay. And that's where I can feel, that's where I can feel the, the kind of, uh, relief when I stretch it out. Well, so when you, let's just say if you had, so you had your foot on the floor. On the ground right now that in, in your, you weren't raising really the, the pads of your, or the, uh, the balls of your feet off the ground at all when we're doing this. But if you raise your, if you raise your little toe or all your toes off the ground, or you drive your toes only into the floor, like kind of almost trying to rip the top of the floor off with the, with the, with the, does that bother it?

Nope. Not at all. And then the big toe? Um, just the big toe. Yeah. If I try to do that, nope. Well, cause there's, the reason I asked cause there's, there's multiple layers now. So there's the calf is most people consider the calf as it's called the soleus and gastrocnemius. I know you like the gastrocnemius. Didn't we talk about that thing in high school? Yeah. These, these, these terms always go, uh, over my head, but, but continue. Oh, don't worry. Don't worry. There's a, there's a whole article on this. I'm pretty sure I will attach in the show notes, everybody. All right. So it's those two muscles.

And if you know where they attach, they attach the Achilles tendon. Yep. The Achilles tendon has a pure function of pointing the toe down. I mean, in free space mainly. Sorry, of pointing what down? Like pointing the toe, like being in a dancer position, I guess. Right. Um, I mean, that's just some free space. I won't even go into the closed chain, open chain. Were you asking me to do the thing with my toes to see if the Achilles was an issue? Well, no. Well, like, cause there's the reason I'm, well, actually, let me, give me, let me do a good disclaimer real quick. Cause I know there's going to be probably some, uh, medical or rehab people, um, that are actually, I forget where we're going now, but anyway, so gastrocnemius, I'm looking at superficial layers versus deep layers.

And then we look at referred pain versus neurological and so on. That's kind of what I'm asking him. Um, so, uh, what, what, what'd you ask me again? I was asking you if the, the exercise you just asked me to do where my foot's on the ground and then you want me to dig my toes into the ground or put them like up to the sky, um, does, well, do I feel anything? And I said, no. And then you said that those motions are more connected to the Achilles. Well, so the Achilles tendon mainly points, oh, I know what I was going to say to all the PT people. We're not going to talk about closed chain. We're going to talk about open chain.

So just so they all understand that. So if you're open chain or if your foot's off the ground, the calf muscle will point the toes or point the ankle or foot, the entire foot down because the Achilles tendon attaches to the backside of, of the heel. Um, now they don't connect to the toes at all. So any, any discomfort or, uh, irritation with toe movement, big toe or small toes, say that, say you put like, you put resistance against like your, like, like your second and third toe and you drove like as hard as you could into the, like the resistance or finger or whatever you're using and that shot it off.

I mean, this has, it would have nothing really to do, uh, if we're talking about a strain where it does had nothing to do with the superficial muscles, which is what most people consider their calf. It's actually the deeper compartment. Um, now I mean, the reason I'm bringing this up is because the specificity or the specificness of each condition is really important because let's just say if you picked up a YouTube video and you started rolling out like your, your superficial muscles, then it's not going to do any good. Right. Yeah. So, and also too, we have to consider the possibility of referred pain.

How do, how do we know this isn't a, cause you can have referred pain from higher muscle groups, higher joints, um, back issues, nerve related things. I mean, there's a, there's a lot of possibilities here. Um, but typically like consider like a heart attack, like kind of the, the differentiating factor between chest pain, like a pec tear or pec injury and a heart attack, because they will feel like in the same areas. If you can palpate it and feel it, or you can increase discomfort by say, making them do like a chest press or a bench press motion, then you're probably looking at a pec injury.

But if you can't, but if you can't, that would be a superficial injury. Well, I mean, that would be a musculoskeletal injury because the other one's an organ based injury. And so, okay, good. Well, if I touch the pec on like a, on a heart attack, I, I'm, I can't increase or decrease any sensation you're feeling by touching the pec. Right. Meaning, meaning that's a referred pain. Okay. In that case, we wouldn't peck, we wouldn't roll anything. Okay. So are you saying, okay, so I want to kind of go back to this, the thing, the motion with the toes. What, if, if I move my, my toes and I dug them into the ground like that, where, like, were you looking to see if I was feeling pain on my calf by those motions?

Yeah. Not in the toes. I was trying to isolate, isolate those. It's like, we call isolated muscle testing or manual muscle testing. You're trying to, you're trying to do only one muscle at a time to, to specify or really get down to what muscle or structures involved. Yeah. So, so, and I, and I'm doing that again and I, and I get what you're saying. Um, like, so if, if I was out on a basketball court and this, you know, cramp was again, imminent. Yes. Those actions, those motions with the toes, like digging in, like pushing off pretty much pushing off the ground would, would cause the cramp. Well, so you're, you're saying pushing off the ground in a jumping manner, right?

Sure. But so then the, the calf is activated and working at that point. Yeah. So you have to differentiate the two. It's almost like you're, so we have two variables, A and B, right? You're with jumping off, you have A and B combined. I'm trying to do A or B actually C. There's three of them here. Um, anyways, that's something that could be done really. If anyone's wondering, I know this is probably, we're probably going too deep into this part, but, uh, this can seriously be done in like two minutes. Hands on. Like, like it's not even worth talking about anymore, but go ahead. No, I mean, you can, you can keep going.

This is all, this is all your thing. So. Yeah, no. Well, I guess I was, I was just, uh, trying to understand now the difference with, you know, superficial versus a deeper injury. Well, it's, it's, it's not about the depth. It's about the function or what the, what that area does. And I know we haven't even gone into yet. Like the reason why that one calf maybe is irritated all the time or that one, technically it's called the leg. It's the region's called leg. Um, why that, why that one area is irritated all the time. And it could be movement pattern based. You could have had an old injury that makes you shift to that side.

There could be a ton of things where you said that creatine thing, but from a structural standpoint, if we're trying to identify what the actual thing is, it's not about the, it's not always about the depth. The depth just tells us a higher probability. Like, like if you barely touched your, touch your calf, like on the back and you said, Oh, it's right there. Maybe, maybe it's a pimple, you know, but if it's way deeper than that and you're telling me you're trying to get way underneath it, then we have vein artery nerve. And we have muscles which, uh, control the arch as well as the toes. Okay.

So it's really just, it comes down to how can we know we're addressing anything productively if we don't know what it is? Sure. I gotcha. Okay. So what's the next step? Um, well, uh, so I would, I would go back to, wait, when did the hamstring thing happen? Um, I mean, I, I would say the hamstring kind of strain, I don't know if it was a strain, but it started happening maybe like five years ago. So that was, that wasn't, that wasn't, that wasn't trauma. You didn't slip and fall, right? Yeah. Again, it was, it was just, you know, it was playing basketball. Um, it was, it was, uh, it started with an adductor injury that was like, that felt like it was a growing injury.

And that one was pretty bad. Like I couldn't, I couldn't do stuff. And I know you had, uh, you actually fixed me there with the active release, which was amazing. Um, I've never really had that issue come up again. And, um, but, but yeah, the, the hamstring I'd say around five years ago. Okay. Um, well, I was just curious, so everyone's kind of getting an idea of, so there's this, this entire limb affected here. I don't remember which adductor it was. Is it the same time? It's all, it's all, yeah. So it's this entire limb here. Um, and it's been going on for 15 years. I mean, we, we have collateral damage is what I'm hearing.

I mean, there's, there's a lot of crap going on. Like we can get down to the nitty gritty and say like, look, let's just work on this one spot of the calf and this one spot on the hamstring and that and that and that. But I mean, these, unless you slipped and fell or someone hits you, like those would be called traumatic injuries. Like those would merit like, like, holy crap. Like there, there's like, that was just unfortunate. The muscle got torn. Let's address that one single spot. Um, but there's, there's something that what, what, how you're moving, how you're jumping, running, changing direction that is creating this left side to not function well.

So, and I'll tell everyone on the, uh, on the other side that you're, you're a bad patient. Cause I mean, how long we've been talking about this, right? I mean, I, we, have you done, how much rehab have you done? Can you count on, can you count on 10 days out of, out of 15 years? Yeah, probably less than 10 days. Okay. How much, how many days have you spent stretching? Oh, I stretch all the time. Okay. Before I go to the gym, before I play basketball, before I go for a run, any sort of, uh, athletic activity. I always stretch. Okay. In gym based stuff, are you talking about basketball or are you talking about like weight training?

Both. Okay. Machine or free weight? Both. Uh, core work or non-core work? I do both. Uh, sit-ups mainly, that kind of thing? Uh, yeah. Yeah. Sit-ups. Um, no. Okay. So I'm trying to get like the, just an overall, uh, kind of, uh, just seeing what the missing parts are. And it sounds like you've done tissue work and it's been helpful with decreasing pain or discomfort. It sounds like you, you stretch till the cows come home. So that's not missing. Yep. Unless you, unless for some reason you're not doing it properly, which I haven't seen it. Well, I'll tell you, I'll tell you this. What I, what I do a lot of with stretching is I'll use the runner stick to continually keep stretching my hamstring and my adductor.

Um, I will, I will use the baseball to stretch my hamstring and I will, I will literally, um, even go lower back. I'll try to stretch my lower back out with the tennis ball. Um, and then I'll go to glutes to my hamstring and, um, and then I'll go, I'll take it from the calf all the way down to my, the Achilles. I'll, I'll do all that. I'll stretch. Okay. Cause that's what it, that's literally what it takes for me to continually like be able to go out and be active. Well, so I would still question the, I mean, you're, you're, you seem to have dialed in and getting stretching and myofascial release into your, you know, regimen.

But I mean, I don't, I don't hear anything that is, I mean, you're going to the gym, but I, I, I've seen you, I've honestly seen you go to the gym. I, I, I got an idea of the things you're doing and I would change a lot of it. Uh, and I, I, I mean, I, and we've gone to the, how many times have we gone to the gym together? Like 30, 40? Oh yeah. Yeah. Many times. I mean, I, I mean those, those workouts that we used to do like 12, 15 years ago, you know, I'm, I'm doing still very similar workouts at the gym. Well, so, you know, I'd say I don't, I don't do any of them anymore. Really? I mean, I'm just saying like, this is just like the knowledge base that I've gotten and I'm not trying to be cocky about anything.

Like those are, those are fine for like, um, like, cause we were working on, our goal was a hypertrophy. So getting larger, bigger muscles mainly. Um, I would just, from a movement perspective, like you could still get very large and get like big muscles and move like absolute crap. Like we did, we did, I did a podcast with another guy the other day that we, I think it was probably, it was probably last, uh, I think it was 49. If people want to listen, it was with David Newton. Um, but it was, uh, we were talking about, is there any correlation with being fit, having low, um, low body fat or having large muscles?

Is there any correlation to moving well? And he's like, absolutely not. And I would completely agree, agree with it. Cause you can get all that done without ever really moving well. But if you want to decrease these injuries, I think you have to, to change a little bit. And a lot of it does start with rehabbing it and it eventually goes into, to weight room stuff. Um, cause you already got stretching down and you got myofascial release down, right? Yep. You, you eat pretty well, probably. Yeah. Okay. You drink a lot of water. Uh, most of the time. Sometimes I, I do, uh, I get really busy and I, I literally forget to drink water.

I would joke. I won't, I won't go there cause, cause this is a podcast. Um, I'll go ahead. No, I, I won't. It's entertain your listeners. No, I, no, I'm not going to go there. Okay, so anyways, the, uh, so I would, I would really figure out the rehab section like a lot, like, like the core stuff, like you talked about, like there's like sit-ups of the rectus abdominus is one of the overly, uh, over, overly trained and least beneficial, uh, areas of the core that I could probably think of. And I would, I'd probably venture to say in regards to stretching the most overly performed stretch and least needed one is a hamstring stretch and it makes people feel great.

I'm not going to say it's, it's terrible. It has its place. Both of them do, but they're, they're just overly utilized and there's so many more things to, to add into what I'm hearing that you have going on. Yeah. Um, so, so the, I mean, what would you say? I mean, beyond the core, right? Like, I mean, I, I get your, I get what you're saying with the hamstring stretch. Um, but why is that with the hamstring or with the core stuff? Yeah. Why is that the, why is that not really an efficient, you know, because I, I mean, I feel like there's like, so there's active, passive, dynamic, ballistic stretching.

And there's a bunch of different types. Okay. I won't even go into the, a lot of the other types. I'm going to go into active and passive. We'll just keep it simple. So passive range of motion. Let's just say you laid on your back and, and, uh, I pushed your leg up towards your head and we stretched your hamstring. Um, is, I don't know if that D is a rope or something. Right. Um, so in normal life, when do you ever do that motion? Uh, hurdles with, well, let me put it this way without, without, you don't do hurdles. I can tell you that already. Um, so when do you ever get your leg into driving, driving your knee to your chest without your other muscles helping, that's true.

So passive stretching, I mean, it has a time and place, but if I were you, I would add a more active component. And if you're on your back doing a hamstring stretch, if you, you drove your, your knee or your straight leg all the way up as high as you can to the ceiling, you'd have to activate your core, your hit, you do it better. You'd have more engine motion if you had your core engaged in your hip flexors doing the work. Right. So, I mean, that's just one way. I mean, there's a lot of different ways you can, uh, attack the core. I can put a bunch of, uh, references on the, uh, the, the show notes, but, um, the, the common thought right now is, um, it's, uh, we call it, I, I, I, I try to call it a torso or trunk right now because core people think of shredded six pack.

Yep. Um, but it really has to do with, if you consider like a spring, say you got a spring that's like stuck into a piece of wood, right. And it's just kind of pops straight up. So if I pushed it, it would come back to center, right? If I pushed it and let go, it would come back to center. Yeah. And it doesn't matter which direction I could, I can swap it around any direction. It's still going to come back to center. And if you imagine that as like the, the, the spine and all the surrounding components, the whole point of the front side abdominal wall, like the obliques, the transverse abdominus, the rectus abdominus, or the six pack, it's, it's function is to stop you from being pushed backwards into, uh, uh, extending your back.

Basically, it's, it's, it's not as much the function of forcefully curling you forward with 45 pounds in your chest. Right. Okay. So you can, you can train that standing ideally. Um, you can do it with things like exercise called the bird dog. There's a dead bug. There's a side plank. There's, I mean, there's a ton of different things. Um, uh, I spoke with another guy on a podcast where we were talking about side planks and he, uh, I think if everyone wants to listen, that's going to be Justin Dean's, uh, podcast. I think it's number 52. Um, so he talks about side planks and how he had, if he has someone who's a runner with a side plank or a runner with an injury and they can't do like a two minute side plank, which I tell people a minute and he says two minutes, he's like, if they can't do a two minute one, he'll basically just send them home until they can do it because there's almost no point in working on them because they're going to get injured again so quickly.

Okay. So the, the concept of rehab that over the past few years, the, the, the idea is we call it, uh, if there's a distal injury, you want proximal stabilization. I know the big words, so I'll explain them. Proximal means more towards center. The most center you can get from the lower extremity or legs is the core and the pelvis. Okay. Um, so if you don't have those functioning well, you almost have no, uh, no chance of remedying any hip, knee, calf, foot, toe injury unless, unless it was trauma. That's a whole different ball game. Got it. Yeah. You know, one thing I didn't mention is I, I, I do play golf and, um, there's obviously a lot of like, you know, hip, hip turning and, and, and motions like that.

And sometimes, um, sometimes I mean, I get like my obliques and, and, and, you know, my hips, they do kind of get sore after, you know, after too much golf. So I don't know if that has any, any impact on the kind of rest of the, the, like the, the lower, lower part of the body, but, um, you know, it can, but that's, I mean, that's golf is just, they actually do a whole, um, there's a whole, uh, there's a few groups now that, I mean, they focus on, uh, strength training, core strength, mobility, and fitness for golf too. So the, the concept is just like with any other sport, like you have, uh, you can, you can hit a ball really well, but you'll hit it better and you'll have better longevity if you actually train the motion with some resistance and make all your joints work well in unison.

It's not just about swinging the club anymore, you know? Yeah. Um, so I mean, yeah, it could have a correlation, but you've had this a long time ago. So it's like the more, whatever, whatever components missing, the, the longer it stays around, the more collateral damage you'll get. Got it. And then we're putting out fires. So basically you're saying start with the core, strengthen the core. And, uh, by doing that, you're going to, I guess, what's bring me, bring me closer to this, the connection. Is it, you know, because your core is going to be more strong, uh, stronger, it's going to be sound that you're not, you're not going to overcompensate.

You're talking about with the calf or the other calf with like my, you know, my hamstring with the calf, like kind of how this has been basically for like the past decade and it can on and off type of thing where I'll be fine and then I'll hurt it. I'll be fine and then I'll hurt it. Okay. Well, um, on and off injury, by the way, over the years, like you can have, and we talked about in the past, the, the concept of, uh, scar tissue. So, um, you can have that build up, but either way, the scar tissue has absolutely no chance of like, um, really repairing to, I mean, cause it does repair. It's a normal process.

Um, it won't hold up if, if we don't get the movements or core strength, right? So I guess the, probably the only way I can, uh, give you an example, I know you're probably, you're sitting, right? Yeah. Okay. So, um, why don't you bring one knee in towards your midline while your foot's on the ground? Okay. So what is your ankle doing? Like in relation, so foot in relationship to the ground. Wait, what do you mean? Uh, so one foot is going to be on the ground and the other foot, I'm bringing it up to my, Oh no, they're both, so both feet are on the ground, your butt's in the chair and you're just going to bring one knee over towards the midline.

Okay. And I just want you to, just want you to feel like what your ankle and foot are doing. So does by changing the position of the knee, does it somehow affect positioning of the foot and ankle? Like is, is the, is the foot and ankle like shifting around? I mean a little bit, not like it's most, mostly still flat on the ground, but. But the pressure points change, right? Yeah, a little bit. Okay. So all I'm looking for you to, to, to see is there's a relationship between knee position and foot contact points. Okay. Oh, interesting. Okay. So now do that same motion, but put your hand like kind of by your pocket on the same leg.

Okay. So you feel the movement coming from the hip, right? Yeah. Okay. So when you move your foot back or sorry, your knee back towards like center or where it started at, this would be like more of a, we call more of like a piston like position. So if you have a piston, like in an engine, you want to make sure it's just straight up and down, right? You don't want any like side to side, crazy motion, stuff like that. Cause you lose power that way. You lose efficiency. Um, and in, in this regard, uh, I'm sure you've seen people squatting terribly with their knees caving and all that stuff, right?

Yeah. So a lot of that usually is a byproduct of hip or pelvis issues. And I won't go too deep into that, but it's, let's just call it quote unquote, a muscular imbalance, or maybe they just don't know how to squat. I mean, it could be many different reasons, but either way, if you don't have proper core strength, your hips have very low probability of functioning properly, which eventually leads to lower, uh, or leg knee, uh, kind of like positional degrade. Like you lose position of that piston like thing I was talking about. So the, what I'm, I guess I'll talk about the cascade again. So if the core doesn't work, the hip doesn't work well, usually the knee caves in.

I've never seen it cave, uh, go out on anybody. When the knee caves in, it has a relationship with the foot, with the foot contact point, which you already talked about, which you already felt. And if you, I don't know if you can feel on your, I can kind of feel on myself that my Achilles right now on my shoe, on the back of my shoe, it's also changing positions too. Okay. So all I want you to see is there's a connection between, do you see there's a connection between the hip and the foot at least, right? Yeah. Okay. So is it believable that you think there's a connection between the core or the lower back area and the hip or pelvis?

For sure. Okay. So they're all connected in, in regards to, uh, movement. So if you can't move well in the upper portion, you have a very low chance of moving well in the bottom portion. So you're making, you're making things load improperly. Yeah. You're, you're forcing something to break. It's really interesting. Um, like I'm doing this where I'm moving the knee to the mid mid line here. And, um, I just, I can feel like when I put my, my hands by my hips, by the pockets, I mean, I can feel just a drastic difference with the right leg and the left leg. Uh, in, in, in regards, in regards to movements.

Yeah. Like, like my left leg, um, just the right leg is just much more free. Um, I, my entire foot is, stays flat footed on the ground when I move the knee to the midline. Whereas the left, I, um, it's a little, it's a little different. It's a little tighter. And it's also the outside of my foot kind of comes up a little bit. So I don't know if it's probably to do because my, my cap is tender right now or. Hey, it could, it could be, I mean, it could be that there's a loss of ankle range of motion there. I mean, there could be, I mean, there could be, there could be a lot of things, you know, typically when you have like a, an issue with one area, let's just say a knee, you look above and below it, um, as well as the core is always in place.

So let's say we're talking about knee. We're going to look at the ankle. We're going to look at the hip and I already told you a core has strong relationship to the hip. So I mean, you kind of got to look at them all. Yeah. Okay. But there's always a possibility that someone moves really, really well, but they just, or say they have, say they have, I don't want to say move, I guess. I don't know if you, you, you probably golf with people that don't know how to golf. Yeah. They're, they're probably, there's, some are probably in really good shape. They can squat really deep. They are really athletic, but they can't swing a damn golf club.

Yep. So that, that has to do with just them not knowing how to move there through that pattern. You're asking them, um, same thing happens with running. Um, same thing happens with changing direction for a football. Um, I mean, it could be a ton of things sprinting. I mean, how many hours do, I mean, I could probably count on one hand how many hours I spend sprinting during the week. Yeah. So I mean, it'd be ridiculous to think that I would be super efficient as someone who's actually doing it a lot. Got it. Yeah. So those are the holes I see in it. I wouldn't go down the route of tissue work as much right now because there's, I mean, if you only have like an hour free in the day, I would, I would rather you fill the holes.

Yeah. Like work on the core. Work on the core. Yeah. I mean, a good couple of things you can start with. There's, uh, um, if everyone wants to look this up, there's a article on myths of the low back. Um, there's a section there. I want to say it's the third. So if you go into p2sportscare.com, uh, and look at the injury articles and you scroll down, you look at the low back one that will have this article I'm talking about, and it'll be the third chapter. So I put some of the exercises from, uh, one of the experts in the field, his name's McGill. So I put three of his in there that he, um, typically uses.

And I use a lot with rehab here at the office. Um, those are good starting points. I mean, there's a lot more to do at beyond that, but those are, those are the things that most people get really challenged with. And it's, it's the, if they can control that, it's like the biggest win they can possibly ask for. All right. Yeah. I mean, I'm open to, you know, any sort of, uh, kind of workout regimen that you recommend for, for me moving forward. I'm definitely open to like, you know, to switching, switching things up. Um, and so, uh, yeah, I mean, I, you know, I, I, I don't, you know, historically I've never really worked out my legs that much and I try to make a more conscious effort to, to work out legs at least once a week.

But, um, you know, there's probably, there's probably a lot more of that I, I should be doing or, or maybe thinking, thinking about the workout in a more, you know, holistic way and, and focusing on areas like, like the core to help the other areas. Yeah. So, and you, you still could do like, um, like some, some leg stuff that'll be, you know, beneficial for like aesthetics and stuff if you want to. And it's, it doesn't have to all like regress back to doing rehab based stuff. But a lot of times when you add it in, like when you're taking a little bit of break from doing squats or something like that, or bicep curls, I mean, you just, you just take, you just take a little bit of time between and that's your rest period.

Anyways, you kind of need it anyways. It just makes productive gym time. But, um, what I'd say from here though, is that, um, is, do you know how to, if, so I have that article in there, which everyone probably can check out and look at there's, there's videos, there's still shots. Now it comes down to, do you feel, do you feel like you can get, like if I, if I showed you a video on how to do the Macarena, you could, could, do you think you could do it right away? Yeah. I mean, I probably have to watch it, uh, four or five times. Okay. So when it comes to trunk stabilization or core work, you're going to want to, most of the time people need a cueing from somebody.

They need to be a broad attention to the areas which are not. Sorry. I was, I was lying. I know how to do the Macarena. Yeah, I'm sure you do. You know, uh, if it's, yeah, uh, what was, what was that elbows upside to side you're pretty good at? Yeah. All of those moves. Well, you, you can do the SpongeBob. I've never seen you do that one. That's out of my, my time range. Um, well, anyway, you, you get the point. It's really hard to, for people to learn them if they don't know what they're supposed to be doing. Right. Yeah. So, you know, I'm, I'm, I'm looking forward to, you know, whatever exercises, uh, you know, rehab and other that you have for me.

And, um, you know, this is, this is definitely some, like a weird kind of lingering, you know, injury that, uh, I just can't seem to, to kick. And so I'm, I'm definitely kind of committed to figuring this out. I think it's all from having cats really from cats. Uh, well, I'll, I'll, zero cats in my life. Too, too, too many, too much exposure to cats. It's kind of like asbestos. It doesn't take much. Yeah. Uh, so, well, I'll send you some, I'll, I'll send you like the links to those things. Um, and we'll, so make those private ones is everybody, uh, I can't really give medical information without having seen someone in person.

So technically this does work since I've seen you before, but, uh, either way. Um, so yeah, so I'll send you a couple of things and when you come into my area or see you, I can cue you on them. So, okay. Yeah, I'll do, that's probably a good idea. Come down there to your office in, uh, Huntington. Yeah. And get some tacos or something. Maybe. Um, so, so yeah. Um, anything else that, uh, you know, I should, I should be thinking about? Uh, no, I mean, there's, I'm sure there's a lot more that can be found, but I think it really, um, I don't know. I always, I always think about like, if you give someone too much to do, they won't do any of it.

Um, and I remember one time I took, so I took Maggie, Maggie, Maggie, Maggie's my dog, by the way, everybody. Uh, so I took Maggie to, um, the vet and she was talking to, she had an ACL injury and the vet was very detailed for two hours. She examined Maggie and, uh, told me everything about dog ACLs and stuff. And I had to go home and just absolutely sleep. Like I was so fogged by the time I left there. I didn't want to talk to anyone. I just wanted to lay down. So sometimes you give them too much information. It's just, it's, it's not helpful. So I would say just find the major hole, which in this case, it sounds like it's core, core and pelvic stabilization.

And then once you kind of get that, some traction with that, then you start poking holes in the other stuff, you know? Yeah. Okay. Any, uh, any more questions on that or? No, no, I think I got it. It was very helpful. Oh, good. Um, okay. Um, so just, do you want to, you want to stay on and I'll, I'll, I'll tell everyone where to find the stuff real quick. Sure. Okay. All right, everyone. That was our guest, the anonymous guy. And, um, I hope that was helpful to everybody about, uh, kind of learning about the cascade of events that can happen with, um, condition to the lower extremity as well as the, uh, the core and everything like that.

And, uh, a lot of times when you dig real deep into these things, uh, I mean, if you had like a checklist, uh, oh, if you had, if you had a checklist, you'd really find, uh, holes within your lifestyle or program or movement. And, uh, those are the first things that we typically feel and, or we fill up. And a lot of times when you're in kind of emotionally attached to the injury, which I know I am when I have an injury too, you, you kind of forget about all that stuff, you know, it just kind of logic goes out the door. So sometimes you just need to get through and just get down and nitty gritty and figure out what you're missing.

And that is the major part, but a lot of times there is consistency. So, uh, if you need to find those notes again, it's p2sportscare.com slash podcast. And if you want to reach out to me, there's also contact forms on there as well. Um, we do ask that people, if they're going to give their questions, um, you can do it on the, uh, there is a podcast, uh, uh, based, what is it? It's a voicemail button. It's on the homepage. So if you go onto that, uh, you can just leave about a minute, minute, half of your own story. And I will probably use it as a question on the podcast to come. So hope you guys enjoyed that.

And I will talk to you soon.