Hip impingement and compression in lifters and golfers

This is session number 35 of the Performance Place Sports Care Podcast. Has everyone tried nitro coffee? 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, everyone. This is Dr. Sebastian Gonzales with Performance Place Sports Care Podcast again. We have a guest on today. This is Megan Hellwig. It is like hell with a wig on. She is a doctor of physical therapy who is going to be our hip expert, and she does a lot of treatment and rehab with people who like to lift.

So, I don't want to pigeonhole as like just CrossFit, but mainly people that lift a bunch. I know she's had a back history of working with people post-op as well, but we're going to go into some of the hip conditions today, and I think what you guys are going to get out of it is just an insight of what your rehab and your treatment is going to look like if you have a condition like this. So, when you go in, you'll have some really, really good questions. By the way, if you have not listened yet to the podcast before this, it's going to have all the boring stuff with the hip. The anatomy, the ligaments, the bones, and some basic mechanics of how it works, just so you guys can understand some of the context and some of the verbiage we're going to be using today.

So, we're going to bring on Megan. I met her actually at an active release seminar in Boston a few years back, and we studied together, and it was a good time. She's a nice person, lady, girl. I don't know how to read Megan. Anyway, so here's Megan. Tell us a little bit about yourself, Megan. Hi, thank you. Oh, sorry. Dr. Helwig, sorry. That's all right. Dr. Megan Helwig, and I actually am in northern San Diego County in California, but recently moved here from the East Coast. I was back in New Jersey when we met up at the Complex Protocol seminar, ART seminar up in Boston. Yeah, I don't think I'll ever want to do a seminar again in East Coast.

That was miserable time-wise. And it was just cold. Like, why wouldn't we be somewhere warm? I don't know. So, yeah, what are you doing here? Or here as in Southern California? So, back in New Jersey, I was actually seven years at an ortho sports clinic, working with every type of population. And before I moved out here, I had opened up my own office in Hoboken, New Jersey, above a CrossFit gym when I had started CrossFit. And I was seeing people there, but knew I wanted to be on the West Coast. And that had always been in the back of my mind for the past, like, six years. So, finally, I took that leap of faith and drove across country in September and started up my own shop out here.

What happened to all the people that you were working with over there? Did you just kind of hand them to another provider? Or did they feel like they were... They were not too happy that I was leaving. I still get emails from a lot of them. And I actually do do some virtual consults and Skyping sessions with some of my clients back east in New Jersey. And whenever any of them are visiting out here, we get sessions in when they're here. But I have a few providers that... The one practice I was at was a big practice. So, a lot of them were able to see some other practitioners. Or I referred them.

Depending on the type of treatment I was doing with them, it depended on who I would refer them to. So, yeah. So, then I came out here and I had already been affiliated with a CrossFit gym out here and had a friend that started her own business, Movement Rx, downtown. So, between starting my own gig up here and then I'm one or two days a week under my own company, but at their facility at Movement Rx. Cool. So, you're building your own right now from all those other spots. Okay, good. Just want to make sure that everyone knew. By the way, you can find her at PrimalStrengthPC.com, which we'll go over that in the end as well.

Yeah. So, first off, too, I know that we're talking about CrossFit a little bit. We're in agreeance that... I know that CrossFit always monitors these things and they... I'm scared of them. I'm scared of talking good or bad about them. I don't even want to have their word in my podcast half the time, but we're in agreeance that we're not bashing them, right? Oh, no, not at all. I am competing. I'm in the open, so hey. Okay, good. And now, since I'm old and they actually have a 35 to 39 age group, I'm considered masters. So, it's kind of fun to see where I can go up against everyone else in the world in my age group this year.

What's beyond masters, by the way? What do you mean? What's beyond 39? I don't know. We don't go there. No. But yeah, so not only do I work with... I work out of a CrossFit gym, but I also do a lot with the golf and triathlon community. So, I actually go up to Santa Barbara once a month and to a golf academy up there. And I work a lot with the golf pro and do one-on-one sessions with a lot of their clients looking at their body and is there reasons why you can get in or can't get into certain positions in the swing or why they're having certain troubles with their swing and how they're playing.

So, it's been fun with all different sports and I do a lot of stuff with my golfers in the hips and not just CrossFit and lifting. So, it's been fun starting stuff up out here. So, what do you feel like does the hip relate to other injuries? Like, why is there... Why are you working so much with hips? So, if you look at the body and my biggest thing is looking at the why. Like, why do we move a certain way? Why do we have certain symptoms? And trying to get to the bottom of it. So, if you look at our hip and the pelvis, that's part of our main foundation and our core. And if our main foundation and our core is not working, then you look at the extremities.

A lot of injuries we have down even to the knee and ankle could just be a symptom of something going on in the hip. And I find a lot of the relationships of things going on throughout the whole body come back to the center and the core. So, if we can reset and stabilize the pelvis, the hip, a lot of times things in the knee, the ankle, the back will all kind of go away without having to, like, hammer on the areas that are actually hurting. A lot of times, you know, where your pain is, it isn't. You know, a lot of times what's working really well, where your pain is, it's what's working really well.

It's working too hard and your body's telling you, you know, I need a break. And what I do is look at the body and find what's not working. If we can turn on what's not working and reactivate and, you know, get that signal to the brain to work properly, a lot of times, you know, the pain will go away. So, is this an easy concept for a lot of people to grasp as patients or athletes? I mean, they're pretty open-minded to this. It will blow a lot of people's minds because I will be totally out of the box, like, looking at, you know, something nowhere near where their pain is. But then once they see how they can feel, like, immediate changes, like, I test something and it doesn't work.

I touch something or release something or find the relationship and then all of a sudden it works. So, you can see things change, right? Once they see that change or feel that change, then they believe it. But sometimes they're like, I don't know about that. Like, my shoulder hurts on the top. Why are you looking underneath? Or my hip hurts in the back. Why are you looking at the front? So, I'm guessing you probably find as well that the – so, the area that is not working doesn't usually hurt, right? Not all the time. You know, maybe there are some cases or if there's some kind of trauma where there's damage to the tissue.

But a lot of times, is it damage to the tissue from a traumatic event or is it damage to tissue from a faulty movement pattern that was repetitive over time that finally broke down? So, something's overworking a ton and it finally broke down and got damaged where I would love to have seen them months before that when it was starting to hurt but it wasn't horrible and we could have fixed that pattern to prevent it from getting to the point where they might need surgery. So, you mentioned earlier before you even got on that I know that we should break down tissues. So, there's different types of tissues and you're mentioning different ones you thought were more important to – or at least you thought now that more important to actually treat or work on or so on.

So, when we first met and we were going at the ART course and going through a lot of stuff like ART, yes, people love it and, you know, it has amazing results and we do a lot of tissue but we also do tendon, ligament. We work on all that stuff but lately I've been working even on scars a lot. So, we think of – I almost look at it as a hierarchy where I almost put scars and ligaments and tendons above the muscles right now and I find that when I can reset those things, the muscles will kind of go back online because they're just reacting to what they either attach to or around that area. So, I've had huge results and a big part of each session with every single patient is their history, any surgery they've ever had because when they go into the body and cut in, that's trauma to the body.

Our brain registers some kind of trauma and it's going to react and when our body reacts, it's going to change our movement patterns. Any kind of, you know, abdominal surgery, any women that had C-section, tearing from giving birth naturally, anything, hernia repair, anything in that area, when they scar afterwards, you don't want to breathe down there because it hurts. You don't want to move that tissue because it hurts and we develop, you know, faulty movement patterns. As I always say, we're high-functioning, dysfunctional athletes, you know. For a good athlete, we're a good compensator and we don't want to stop so we'll just keep moving in different ways.

Yeah, it's almost like an addiction. You just kind of just get around it for a little bit. And every time we get around it, we just add on another layer or another faulty movement pattern and things might not hurt right now, but maybe two years, ten years, who knows how long down the line, moving in that little faulty pattern over time builds up. And then you're like, oh, out of nowhere, my hip just started hurting. I don't know why. But it could have been years of it building and we didn't realize it. So how do you feel about then with, I know, so people that lift and they lift a ton of weight or they're hitting a golf ball really far away and they're just like slanging people on the course.

How do you get them to, like if you find a movement disorder, you find like there's a scar in their history. How do you draw their attention to that or how do you find it? I, well, I break down. So whenever I see someone, I first ask all those questions and I'll ask multiple times. Are you sure there's no surgeries? Like any big head traumas, any big, um, even a little surgery as like removing a mole. If you removed a mole in a certain area, that could even, that could have, I've had that affect people's movement patterns as crazy as it sounds. But, you know, maybe I have them standing and I test their balance and they can't even resist me.

But then I touch the scar and then, you know, test them again and they're rock solid. You know, so you see that feedback, something's going on in the brain, giving feedback to that pattern, you know, is rewiring something. Um, so you're opening a window for your body to learn. So when I test everyone, I'll test and go through everything. But then when I'm looking for the relationships, I refer back to that history or I refer back to those common things I find. Like, so huge thing is, um, people that sit all day for work, then we want to go and work out and we expect our body to work well after sitting for eight hours.

Um, hip flexors being super tight, shutting off our glutes. We want to go and squat, but our hip flexors are like super tight and our glutes are just sound asleep. Um, and then we end up, we could be more quad dominant using lower back to get out of it, you know? So there's some common relationships that I find. And if I don't see those are working with a certain patient, then that's when I dig into their history more. But a lot of times there are some common things we can do, um, to kind of reset stuff. Yeah. I've actually noticed that there's, um, I'm sure you have too. When people come in, they're like, you know, my friend told me that this happened to him and my quads aren't working well.

And yeah, I think that's what's happening to me too. And do you, is there's, there's like, there's common situations that you find where like, you'll try a couple of things here and then all of a sudden you'll dig deeper into the history and find that past trauma that they're hiding. Mm-hmm. Oh yeah. And a lot of times, like I would love for it to be cookie cutter and say, okay, this hurts, do this. But everyone's, everyone's unique. Everyone has their history and their path and how they've gone through life. And, you know, that's going to dictate also how their body reacted and how, um, the session's going to go too, of which, what I'm going to look at.

So all my sessions are always one-on-one and very unique. And so what happened to one person could be the same as one of their friends, but then it also could be totally different. Mm-hmm. Um, going back to the, you said touch, like touching the scar or the mole. Mm-hmm. I got to, I got to touch on that. So, and you don't, you don't have to reveal too much because I know it's probably part of the magic and posterity of what you do. So explain touch, like touching the skin and like how it would, or touching the area and how it would change their balance or movements. So. I know it can get pretty deep on this one.

So I would, you probably skin the surface a little bit. Um, is there a good way to explain it to a new patient maybe? Yeah. So when I do some of the scar work, I actually use, um, I call it an indicator muscle. So, cause you can't muscle test a scar like you do like, oh, I want to test your, your quad and see how your quad or your glute tests. Um, you can't test a scar, but I will use like a surrogate almost like, so I use another body part. Um, while I do certain testing on the scar and see if it shuts that other body part I'm testing on or off to kind of see if it's an overdrive, like hyper facilitated or inhibited.

Um, so I, I'll use indicator muscles somewhere else in the body to test scars. Um, a lot of times I'll do that and then what I find I'll reset in that area and then go back and test other things in the body that were weak and they're all, now they're strong. Okay. Um, or if it's a scar to a muscle, so say, you know, after hip surgery and they did a scope and you have those little points of scars and I'll ask people, did you, how'd your scars heal? And someone be like, oh, well this one didn't heal too well or it puckered or it kind of keloided. And I'll go on the scar and try to see maybe what direction is it not moving well?

Is there a part of that that's like restricted? And I'll move into that restriction and then go and test other parts of the body and see if there is any relationship. So is this kind of, is this partly with, I know people probably heard of fascia. Is this part of like the fascial network or is this something different? Meaning the technique or the talking about the actual tissue? Um, I guess both. I guess I should probably start with, um, I know that I always, when I always do these podcasts, I try to consider that they're showing over my shoulder. I'm trying to introduce into the conversation and we went through so much in that last minute.

Um, so fascia, by the way, is like you get chicken breast and that's that slime on top basically, right? Okay. So is this similar to, so it's, it's not, I don't know if it's, does fascia have contractile properties? Well, that's like, there's a huge debate. Um, there's a big debate that there is, that there isn't, but we can make, we can make change. Um, the biggest, you think of the biggest fascia point in the back of the body, like the thoracolumbar fascia. So that whole area in the low back is super fibrous covered with a ton of tissue and fascia, um, that your lats feed into. So all the way up to the shoulders and then your glutes feed into and the pelvis, all that right there.

So a lot of times people experience that like tightness in that low back, but then it's, it's my job. And that's the fun part is, is it really coming from the hip? Is it coming from the shoulder? You know, a lot of times I'll find shoulder to opposite hip relationships. So one thing's not working and the other thing's overworking or one thing's shut down. Of course, the shoulder is going to feel funky on the opposite side of the other hip. Um, you reset one and then all of a sudden you're like, Oh, my shoulder feels better. Um, because everything, everything's connected. Um, you know, even to looking at the big toe, if you don't have good extension of your first toe, then you're not going to get full extension when you're running in the hip because you can't extend in the toe.

So you're not using your glutes. If you're not using your glutes, you're going to overuse that hip flexor. And then there that goes, that whole cycle of hip flexor getting tight, glutes shutting off. And then you get a little torsion in the pelvis because if things are a little asymmetrical, that's when things start to go off. So that hip or, that hip or back pain could actually be coming from the big toe. Um, I thought we just, I thought we'd just stretch it away. Just stretch it and it'll go away. Yeah. I don't know if I, I don't think I told you. I think I came up with it after we, uh, we started, uh, after I met you, um, I had people come in like telling me about like problems with their car and stuff.

I'm like, why don't you just stretch it? Like we talked about, I'm like, I heard it fixes everything. Yeah, exactly. Um, I, one way I heard fascia described it, at least with that cross patterning, like what you said, um, is someone had, so they tugged on my t-shirt and they said, do you feel that in your shoulder? But they tugged it down by my belly button. Exactly. Okay. Yeah. That's a good, that's a good analogy. Okay. Good. So everyone, everyone tugging their belly button right now on their, um, so we're, we're about almost 18 minutes in the podcast. I guess we haven't spoken much about the hip yet, but we should, we should speak about the hip.

Um, okay. So question for you is with these two populations, so you have golfers and lifters, um, which, what is the most common type of injury that they get? And can you explain a little bit, a little bit about what it is and what's typical presentation, how it hurts, so on. I find, so between golfers and, you know, lifters too, a lot of times people will come in complaining of, oh, it hurts. Um, and they're putting their hand kind of around their hip in a C shape. Like they're kind of, they can't pinpoint where it hurts. Um, you know, and I, when I see that they're like, oh, it kind of hurts in the front and the side and the back, you know, that I take that as more of, okay, the C sign I'm going right to, okay, their hip may be stuck in compression.

Um, so there might be some different symptoms they find in there. And as I, we touched on it for a second, if there's any instability going on, our bodies are amazing. And if our body feels unsafe, our subconscious is going to tighten up to try to protect it. We don't consciously do it, but our body will tighten up. So I see a lot of people coming in and, you know, they might have that pinching in the front of the hip, but they also say it kind of just hurts all the way around. You know, that's when I am going to start looking at, you know, compression of the hip joint. So if you want to kind of break that down, um, for people, um, if there's any instability in there, um, if there's any needy pathology going on in the hip, maybe the doctor said, oh, you have some arthritis in your hip.

Um, oh, you might have a slight tear of your labrum. You know, I, for me, I know I have a torn labrum on one side and I want to avoid that surgery at all costs. Um, so I'll do whatever I can to keep my hip stable to avoid that. But a lot of times when your hip starts to get vulnerable or, you know, think of that high velocity, um, rotation going through the hip in a golf swing, or think of the heavy load going through your hip at the bottom of a squat and coming out. If that hip's not stable, your body's protective mechanism is to kind of tighten up. So what happens when, you know, your hip is tight, tightening up?

Um, I often find, um, that you look at some of the rotators and you get your pectineus, which is a small muscle, um, in the front of the hip will kind of draw the head of the femur up into the joint more to kind of protect it because it wants to feel more stable. So instead of using some of those bigger muscles, like our glutes, the poor little rotators drawing and locking it up in there. Um, so that's when people start to feel like, oh, it kind of hurts in the front and kind of point to that area by the, um, inguinal ligament. What then I know that you spoke about, uh, the scars and whatnot and, uh, different types of tissues.

So in there, is there anything you can relate to what we passed said to this condition? Oh, so huge, huge, huge thing. So anyone that's ever had a hip surgery, um, it could have been years ago. So you think after surgery, you have trauma to the tissue in that area because they went in to operate. Um, you have swelling in the area afterwards and even a little bit of swelling in the hip is going to cause some inhibition of the muscles around there. And a lot of times your, your rectus femoris on the quad gets inhibited. Um, for some reason, after hip surgery, that muscle likes to shut down, um, and turn off.

And so often people are like, I need to get my quad working again. Um, but when that happens, that triggers that whole cycle of the hip trying to protect itself and tightening up, you know? So if I have people laying on their back and I try to, um, you know, test a straight leg raise to see how their, their rectum is working. And it's just that on me when we're right, when I had the knee condition, I think you're testing on me, right? I think I did. Yeah. Cause we were looking at, did you have, you, we maybe looked at popliteus and then I'll look at pectinus. So I'd go back and forth between the knee and the hip trying to see, cause those are the anchor points of that muscle.

Um, you know, what's going on. So a lot of times anyone that's ever had a hip surgery, that muscle is often shut down. Um, which starts that whole cycle of, you know, the pectinus wanting to draw up and pull, pull that hip in tighter to, um, to stabilize. So how do we, so how do we break that cycle then? So breaking that cycle, I found that it's great. Like, Oh, people will go and stretch. Oh, my hamstrings are tight. Let me go stretch them. But we have to ask why. So if we can find out the why or the relationship. So say for a certain patient, their quad was kind of shut down, um, and it was their pectinus that we found the relationship between the two, I would go in and do soft tissue work.

So say I do ART on their pectinus. When you do that soft tissue work, or you go in and stretch or mobilize a tissue, you're sending a signal to your brain to learn something. So it's opening up. So that, that you're sending that signal to the brain to let that tissue relax. But that tissue is working for something else. So you open that window to learn. So within 30 to 60 seconds of releasing that tissue, I am going to immediately activate your rectum or activate your quad. So a lot of times people will be in the gym or wherever they are and they'll stretch and they're talking and they're foam rolling or they're doing whatever.

And then next thing you know, like five minutes goes by and then they're like, Oh, let me do some activation exercises. You kind of miss that window to actually tell the brain to turn those tissues and the, those muscles back on. So I find when you go to the gym, you wear your beach headphones and just like sit in a corner and yes, don't talk to me and let me go here and you might see me doing silly things. No. Yeah. But those relationships. So if we can find a relationship, you have people will get better so much faster if they can pair the mobilization, the mobility, the release, the stretching with certain activations.

So for all my, my clients or my patients, when I find the certain relationships, there's kind of a hierarchy of them. And then also I will pair it and I'll make it as easy as possible because I don't want to give someone like, Oh, you need to do this hour routine every day. I'd rather give them something that they can do in like a one or two minute little segment that they can do throughout the day while they're sitting at work. Cause the more often you do it throughout the day, your body is more likely to learn that pattern and create that new habit that create that proper functional movement or a pattern.

So say, say it is the pectineus we found was kind of shutting down their quad. So even if you're sitting at your desk, I would tell a patient to, you know, get in, find that tissue and I'd show them how to do it. And a lot of times I'll video them doing it and send it to them. So they have it to refer back to, I was like, get in there for 30 seconds to a minute and work on it. And then immediately afterwards you need to do a straight leg raise or you need to do whatever active action of that muscle to activate it because you're telling your brain, I mean, turn the one thing off, turn the other thing on.

Yeah. It's interesting to say that cause I know that there is, I know a lot of people that do their own, we call it mash work, lacrosse ball, foam rolling and so on, stretching. And then they, then they're just ready to start warming up and working out or run or so on. And, uh, I know the patients that I have here, like I, I try to teach them a library of, of, of corrective exercise we want to do, but they, if they want to get work done, they have responsibility to stay and stabilize it afterwards because there is that window. Um, I don't think people understand that too much anyways. So a lot of people know like, Oh, I know my pack is super tight or I know my hip flexors are super tight.

Well, why are your hip flexors tight? If they're hip flexors are tight cause you're sitting all day, but also what also happens while you're sitting all day, your hip, you feel the hip flexors tight, but you're shutting off your glutes. Your glutes aren't stabilizing you. So if you get in and use one of those like mobility balls or lacrosse ball and you kind of roll out your hip flexors and you do that for a couple of minutes, roll over on your back immediately and do some hip thrusters or like do some quick bridges to fire up the glutes, kind of tell the brain, okay, open up those hip flexors, turn on the glutes and you'll find things will start to, you know, stick instead of you're like, why do I have to roll this out every single day?

Well, you probably have to roll it out every single day cause you're not activating something afterwards. So of course your body is going to go back to what it knows. It's going to go back to its protective mechanism and tighten up whatever was tight because either it's working too hard or it just doesn't feel safe. Well, I don't know if you get it as, as PTs as much as, as we do as chiros, but I've had quite a few people come in and they'll, whatever type of work you do on them, if it's like manual and adjustment, um, I've had people ask so many times, should I not do anything the rest of the day?

Well, why? Like, well, cause it might slip out. Well, no, you should do something. You should stabilize that area, get it to move better. So do you get that as, as a PT too, or? I mean, it depends on what they're going to go do. If they're going to go squat 300 pounds right afterwards versus going and doing some mobility and, you know, movement pattern stuff. Um, cause our bodies, if we put threat to it or we put heavy load, it's going to want to revert back to its old pattern. Um, so it depends on the threshold of what your body can handle. So if you're trying to correct a movement pattern, I'm, I'm, I'm not one to tell you, you need to go and rest.

Like that's the last thing I'm going to go do unless it's needed. Like unless there's severe trauma and you're at risk for severe injury, then I'm going to tell you, you need a rest, but most likely I'm going to give you a routine or something that I want you to do right before you go to do the activities, um, that, you know, fed into those patterns. So like say it was hip flexor to glutes, like in between sets, while you're squatting, I want you opening up that hip or I want you going in and doing a quick five second stim or release to your hip flexor, squeeze your glutes before you get up to the bar.

You know, just as a little reminder to your brain, you know, this is what's supposed to be working. Um, and I'm also going to tell people, you know, you need to use, you know, common sense and I don't want you going back for a one rep max PR. We need to start light and we need to build back up so your body can start to build a tolerance and, you know, support this new pattern. So how long does it take to recorrect a pattern like this? Cause I know that, uh, some people use, uh, tissue work and, and all that kind of stuff right before lifting or running or golfing cause they're trying to loosen things up and they just go, just go balls to wall after that.

Um, how long should, do you think they typically would expect to feel like they don't need to, I guess, quote unquote, warm up in that way anymore? Um, it all depends on how long it's been going on. Um, how complex it is, you know, is it something that was shutting people off globally, like all over their body or is it just one little pattern? Um, so it's hard to say, like, I would love to be able to give an answer. Um, cookie cutter, when this happens, this is going to be how long you're out. Like everyone's different. If some people, I tell people to do the exercises two, three times a day. Ideally, if you want to do it 10 times a day, go ahead.

That's great. I would love it. You know, you just have some patients will do it 10 times a day and you're like, okay, if you get super sore, cause you're working on that tissue too much, you need to back off. But, um, it's like any habit, you need to correct it and you need to be conscious and constantly working towards it. Um, eventually you don't have to do it all the time, but in the beginning I say, I want you doing it throughout the day as much as you can. And that's why I try to keep it simple for things where you don't need a gym. You can just do it wherever you are, um, to keep resetting that pattern.

But eventually like I'll have my patients go and do stuff during a session. Um, we'll go down and grab a bar and do something, or we'll get a golf club out and start swinging. And, um, I'll challenge them, have them do it and then get back on the table and retest those patterns to see if they, they stick. Um, sometimes they don't, and maybe I don't have the right relationship and I need to dig deeper or sometimes it's like the peeling of an onion and you know, you take away one pattern or you correct it. And then something comes up where they're like, I used to have this years ago. And it's almost like you're peeling away those patterns.

You're like, okay, I took away one dysfunctional pattern. And now we revealed what you used before that. So, um, it would make our jobs a lot easier if we could just say, if this is the problem, do this. But you know, every patient's unique and that's what I love about it. Being able to get to the bottom of the situation, um, or the, the cause of the symptoms. Yeah, I, I know it is, it's, it's a lot more complex than, uh, it definitely can't be cookie cutter. Um, but I know that, I know that people wonder, you know, they, they think it's really a simple fix. And as long as the pain goes away, like, what can I do?

What, what is this one thing I can do to make the pain go away? And it's, it's not, it's not that simple. There's a lot more to it. Yeah. So, I mean, and there, there are cases where that happens. I have a lot of patients that, you know, I see them once and I never see them again because they say they feel amazing. We revealed a few patterns. I had a cyclist who, um, she couldn't ride. She's training for Ironman and she couldn't ride more than 40 miles because her feet cramped so bad and she would have to get off the bike and take her shoes off because her feet were cramping so bad. And it ended up being all from her hips.

Her hips were fatiguing her glutes, her hip abductors, everything around her hips was shut down. But then if I would test her, like she didn't, it would test. Okay. But after 40 miles, she started fatigue and it would shut off. But I had, I, then I would test her while she would curl her toes. So if I tested her curling her toes, everything was rock solid and strong. And think of it, think of the size of your toe muscles, like your toe flexors versus the size of your glutes. She was using her toe flexors for her glutes. No wonder her feet were cramping and I was having so much pain, you know? I thought you were going to tell me that maybe you restricted her water intake so she wouldn't pee on her feet when she's riding and that fixed it all.

There you go. Simple solution. Yeah. People love to pee on their bikes like condors. Ugh. We won't go there. Luckily, uh, it was raining for Ironman Lake Placid when I did it. Oh yeah? No one could see all the stains all over the street. You don't want to stop. The clock doesn't stop. So hey, you got to keep going. Yeah, I know. I've seen pictures. Yeah. Um, what, so then moving on to like the next, I know that the, actually the last thing we talked about all, we started with, uh, uh, uh, tightening of the hip or you said compaction, right? Or a compression, compression of the hip. Um, I know that is probably a very large global situation rather than diagnosis.

Um, cause I don't know a coding for that, but if you were to, I guess sum that one up is, uh, a, a diagnosis of somewhere to look up, what do you think they would probably find with, with that, with that type of, uh, mechanism of injury, I guess. So like what I call compression could also be a, um, impingement. Okay. So hip impingement, because if the head of the femur is getting impinged, um, or stuck up higher in the joint, when they go into any kind of flexion, they start to feel that pinch in the front of the shoulder. So the femoral acetabular impingement syndrome, like we got to love those syndromes that people, uh, yeah, it's kind of like, Oh, you have these symptoms.

So we're just going to call it, you have this syndrome, but half the time that's not the issue. You know, um, that's just a symptom you get. So it's that broad diagnosis of, hi, this is the syndrome, but you know, what's the real cause? So that's, you know, if we can, like we said before, so if it was pectineus compressing the hip, you release, release the pectineus and then simply stand on a step with one foot, the hip that was compressed dangling off it. So it kind of feels like you're distracting the hip. That's decompression for the hip. So that right there is a corrective for hip compression.

Oh, so simple. Weird to get a life hack out of you. Seriously. Yeah. That's one of them. I usually tell them that, uh, like I really, really try not to, to lay down like diagnosis terminology to them. Cause I know they're probably going to look it up and find a bunch of weird stuff. Um, yeah, I, I kind of just call it, I'm like, here's the situation that's happening and just tell them a story. Yeah. I knew you liked that reference there. Yeah. From Jersey. Yeah. Come on. I was going to throw GTL somewhere in here, but I don't know if I can do it. Um, what would your next then I guess diagnosis be?

I'm sure there'd be some similar type of mechanism of injury, but what, so we got impingement in there. What else, what else do you typically see in golfers as well as, uh, lifters? Well, if you think about, um, so we could catch something. So if say they did have the compression or impingement, that's like an early stage. If they don't treat that, or if they don't take care of that, that can then lead to, um, a labral tear in the hip, you know, because if that head of the femur is just grinding away in the joint all the time because it's compressed, you know, that puts you at risk for, you know, fraying and tearing and, you know, damage in the joint capsule itself, or even down the line, if it's going on for a long period of time could be, you know, arthritis.

So osteoarthritis of the hip, you know, as we start to age and as we start to get older, if we've been grinding on our hip and these faulty patterns for years, we're going to be, you know, at risk. And then you go to the doctor or get an x-ray, they say, or, oh, you have, you know, arthritis you need, you're going to need your hip replaced eventually. Um, you know, those are the things we want to avoid, um, down the line. But of course, sometimes we can't avoid it. Sometimes it's been there where maybe, you know, congenitally the way our hips are formed, we're prone to that happening. Um, but a lot of times, so say my hip or my golfers, my hippers, my golfers, or they're, you know, lifters, they all have hips.

Um, but, uh, you know, a lot of them want to come back and do what they love. And a lot of times doctors will say after, you know, a hip replacement or labor repair, they don't want you going back to that high level. Um, but you know, that's where a lot of my scar work does come in then. So if you've actually had the surgery, you know, hip replacement or a labor repair, you need to get in there and reset those scars. You need to get in there and make sure all of the muscles are stabilizing and doing their jobs correctly. Um, so you don't, you're not at risk for, you know, further injury or injury.

A lot of times I find that history of maybe a hip surgery, their hips don't bother them that much later on, but it might be their knee or it might be their back or it might be their ankle, you know? Um, so a lot of times though that stuff will, if you don't correct and look at that stuff after, you know, a hip surgery, then you might be going to PT or you might be seeing a chiro or you might be seeing someone for knee and ankle stuff, not realizing that it's actually coming from the hip. Yeah. And it's a long process. I know that with even like back conditions, when you have, uh, uh, a surgeon in one level, then you assume the next level, I think even surgeons say the next level is going to be affected pretty soon.

Um, I don't have documentation that I probably should get some before I say it too much. But, um, but yeah, no, I, I totally agree with you. Um, the whole thing's a process. I mean, like you start with your, your, uh, gosh, I'm, I'm forgetting your terminology, compression, compaction, hip, hip compression, hip compression, then you can possibly end up where you get impingement, you end up with a possible labral tear, degenerative changes or the bone spurs with the hip or osteoarthritis. Right. I mean, I mean, those are some of the big key things, but then if we want to break it down, like every patient, I see the first thing I do after you take the history is I look at their breathing, you know, we all have to breathe.

We all breathe, but are we actually breathing properly? That, that, that could be a whole nother podcast on its own to break into that. But I also find if we've ever had pain. And a lot of times when you have hip pathology, you have surgery, you have an injury, we have pain. So that alters how we breathe because you know, that fear, that anticipation and our diaphragm, if you look at the diaphragm as a muscle attaches to the pelvis. So if our breathing's off, our pelvis could be off. So sometimes I don't even have to touch actual hip. If I work on their breathing and reset their breathing first, sometimes stuff in the hip will change.

And, you know, I've had people that can't touch the floor and you just work on breathing and then they're touching the floor. Yeah. I think, I think almost, I would say half the podcast that I've put out so far has somewhere in there. We've talked about breathing or intra-abdominal pressure. Mm hmm. Yeah. It's huge. That's like the hierarchy. Like I'm sending almost all my people home with, you know, breathing exercises. Like that's number one, usually all the time. Yeah. I think it's super important too. Like is, is there a, I asked one of the other guys that I interviewed recently. He's a, I'm your, your dynamic neuromuscular stabilization DNS.

No, I haven't taken it. I've, I've like read a bunch of stuff on it and some of my stuff might be similar, but I haven't taken one of the DNS courses yet. That's on my list. Yeah, I, I considered it, but I know they want more and more CEUs and, uh, but I have a good friend who is, uh, he teaches some of the courses with, with DNS. Uh, by the way, everyone, DNS is a type of, uh, uh, certification you can get as our professions. Um, but yeah, he was, he was all about breathing and, uh, he's been telling me about it for years and, uh, it's important. Really, really important. Really important. And a lot of people were like, I didn't realize breathing was so hard, like to actually breathe properly and actually use our diaphragm instead of using all of our accessory muscles instead.

Like our upper trap, like everyone breathes from their upper trap. They go for a big heavy lift and you see people take this huge breath in, but they're breathing from their upper trap. You're like, you just lost, there's no intra-adominal pressure there. You just filled up everything but where you needed to. Yeah. I, I actually have a, uh, I, I have balloon animals now in my office and I pump them up and I tie them off and, uh, I have them sitting there and people ask like, why is the, why are those balloon animals there? I'm like, cause they would be on the ground if they weren't, didn't have pressure inside them.

So it starts the conversation about pressure. Cause I, I, I know that in the past, like when I'm talking about breathing to people, they're like, you're nuts, you know, like I can't believe I paid money to come here and talk about breathing when I got a knee injury, you know? So it's a little bit further away than I think they, what they want to hear at least, um, from my mouth. But, uh, I know it's super important. We should just do a round table sometime about the breathing. Just have like five providers on. Oh yeah. Cause there's, and then you get everyone that's taken like the PRI stuff. Yeah.

I saw that. I haven't really looked at too much into that yet. Um, is that, have you looked into that? So I was, we just did like a little in-service, um, like a couple of weeks ago on it. And so a bunch of the girls I used to work with all do it. I don't, but it's some interesting stuff in there and looking at, um, breathing with everything else too. So that was like that and DNS were like two of the other things, um, we were going to look at the stuff like the muscle testing I do is the NKT. So the neurokinetic therapy is all the muscle testing and ligament and all that stuff. So of course, like ART, we don't get credits for it in California, but it works.

So that's why we take it. And we, you don't get, you don't get credits for it. I think we get credits, but they're, they're not complete. They're not like what you need for the entire year, which is kind of a bummer. Oh, so New Jersey and California, the PT does not accept ART because it was created by a chiropractor. Wow. I think that, so I think if, if you find a, if you find a PT that learns how to do ART in California or Jersey, they really do care. Yeah, because we're spending, I've probably spent close to what, five, 10, 10 at least grand on ART courses over the years. Oh, easily, easily, but I know it works.

That was part of the reason I became a PT is I was training for a half Ironman and I couldn't run getting off the bike. And I saw a chiropractor who did ART on me and I had no problem after four sessions, you know? So I was like, okay, I'm sold. I'm getting certified. The question, cause I know that we've, cause, cause I met you at that, at that ART seminar, which is actually at the time there, do you remember them doing that? There was a shoulder labral case. Do you remember that one? Yeah, I think. Well, so, so in these, in these courses, they, they usually present obviously some type of case there and they, we troubleshoot it and so on.

I thought there's so many more things we can do than just ART to this core, to this person. And, uh, I know that I, as I developed over the years as a provider, like I, I first, I first thought ART was everything or, or sorry, I'm not going to, I'm going to, I guess I'm going to stop saying ART because there's some tissue work, by the way, everybody, there is, so ART is a patented type of soft tissue work that PTs, chiros, massage service, doctors can all, can all do. I think ACTs as well, as long as they get certified. I do love ART. I don't want to seem like I'm bashing on them at all, but there are, there's other types of tissue work, there's Graston, tool assisted, uh, uh, gosh, even sports massage.

Um, there's, there's so many different types, but anyways, I know that I was of the thought before that when you just release these tissues, that was it. And like, this is gold, but just like you're saying now, you gotta, you release it, you tell the brain a signal and then you, then you teach it to move better, right? Oh yeah. And that, I was exactly the same as you, like ART was huge, huge part of my practice and people will come see me just for that. And I still have people that see me just for that, but I try to educate them and say, you know, my whole world changed when, and it saved my hands a ton when I incorporated the NKT with it.

So I would have to ask why, why am I going to go and release this tissue? Like, why is this tissue tight? Is it tight because it's just tight and it needs to be stretched or is it tight because it's holding on for dear life? So something can be tight and actually be really weak. And if we go and release and stretch something that's tight and weak, we're actually doing more harm than we could maybe good because you know what? You're taking away your body's protective mechanism. I've gone in for, you know, massages before and I walk out for a second and I feel great. And then all of a sudden my back went into full spasm because the masseuse was so great.

He totally, you know, unraveled every protective mechanism and compensatory pattern I was probably using. And I went into a full blown back spasm. Yeah, it is very protective. When you take that away, it hurts. So part of my whole, the way I treat now is I ask why, you know, why am I going to release this tissue? If I know why I'm releasing it, um, because you know, it's overly tight and it's working for something else. And I find that relationship great. Um, but sometimes when you go and stretch, like people that stretch their hamstrings all the time because they can't touch their toes, like your hamstrings are tight for a reason, your hamstrings might be tight because if it's a stability issue, your pelvis doesn't feel safe.

So your hamstrings kind of tighten up to say, don't go any further. I don't feel safe. But, you know, if you could stabilize your pelvis, all of a sudden your hamstrings start to let go. So you don't have to be mashing on that tissue all day. Um, you know, so the combining the different techniques has basically saved my hands. Um, and also kind of, you know, gave me a clearer picture of why am I going to release certain tissue? Yeah, I totally agree. I think that, I mean, I feel like there's, uh, when people are searching for a PT or a doctor or a chiro, whoever they're going to for these conditions, like they should, they should ask the reasons why they're, they're doing the type of technique they do.

And, um, I, I've blended techniques as well. And I think it's, it has far better results in some cases come in. I don't do any of one technique. I do all the other and so on. And it's just really independent of the case. Yeah. And it's like, it's like, we have a toolbox, like these are all the different tools in our toolbox and each patient might, um, require some different tools or different combination of how we put them all together, you know? Yeah. And that's, that's, that's the awesome part of our, our profession is that we can, you know, tailor it to each patient. You know, we're not doing the same thing over and over.

It might look like we do the same thing, but it might be a little bit different with each person. And like, it all depends on how the tissue feels. Like some tissue might feel like, like we learned this with like some of the other stuff is like super stringy versus, you know, how long has it been dysfunctional? Like you'll feel a difference in the tissue. If it's been going on for a couple of weeks versus going on for several years, there's going to be, you know, you're going to feel it. And also maybe the, how long it's going to take for things to respond. It might not change in one session. It might take, you know, a couple of sessions or a few weeks where, you know, I have some people where we're good and if they're on top of their exercises, I only see them once or twice.

Yeah. I was, I was telling them the more they do on their own, if they can do it well, the less they're going to see me. Exactly. The less they pay. But I don't think it's, I always tell them, it doesn't change my recommendation. I have, I have the mom recommendation. Mom doesn't pay. Mom lives like a mile away and she is retired. She has all the time in the world. So if I recommend a certain amount of things to her, then I want her to do all of them. She doesn't have to come and see me, but she has to do them somewhere, you know? Yeah. Um, so you gave us one life hack, but I want another one.

Um, I want, how would someone assess, uh, something that they could change in their hip or knowing that the hip, figuring out other than past history, is there another way to figure out if your hip is a problem, causing another problem? Hmm. It's a tough one, huh? Assess, assess, assess. I know. It's always assessing. Like a lot of times I'll have people, but then like, I'll have them look at single leg stance, you know, is it, that could then open up a whole nother can of worms with the ankle though. Um, yeah, it could, it could. Well, don't worry. We can throw a disclaimer in here and say, look, ignoring the ankle, assuming the ankle's good.

Here's what you would. Yeah. Or I mean, same thing when you're going into that impingement. Like if you're laying on your back on the floor and you go to hug one knee to the chest, like, do you have pain in your, in the front of your hip? Yeah, I think that's a good one. I, I don't. You know, do you have pain when you go into the bottom of the squat? Like you go down into a squat, is it pinch in the front of your hip? Okay. How deep, how deep should they be squatting or hugging their knees? Um, you want to get them below 90. So you want to get them below parallel to see what happens when they get, you know, below that.

Um, if you have, if your doctor's given you the, you know, precautions, like it's great when they say you don't want to, don't tell them not to squat anymore, but everyday life, we, we need a squat. We need to go to the bathroom. We need to do these things. We need to tie our shoes. Um, you know, um, trying to get below 90. I mean, if you, some people will get the pain, even just sitting down into a chair, you know, so if you have pain doing those things, there's something going on, but there's a simple thing you can do. Like get your fingers on the inside of your pelvis, like right inside your hip bone there where it's a lot of times it's going to be tender because it's your hip flexor and kind of push on that hip flexor in there and then do it.

Um, bring your knee to your chest. Does that take that pinch away? You know, that could be a sign that that hip flexor is overworking for something else in the, in the hip and it's hypertonic. And that's causing some of that impingement in the front. Okay. So I'm sure everyone's sitting, probably listening to this podcast right now. They're doing this. Everyone do this right now. Yeah. So if you're sitting feet flat on the floor, you kind of put your hands on your hips, like you're pouting, you know, put your hands on your hips. So you're the pads of your fingers should be right in front of your hip bones there.

You know, if you make that C shape, so thumbs are around the back, fingers are in the front. Try to draw your fingers to the inside of those hip bones there and kind of massage around. Do you find certain tender spots? Some people will jump through the roof in certain areas. You'll find little trigger points, but find a tender spot. So the more, I always tell my patients, the more specific you can get on the tissue, the better. If you can find a little tender spot, hold that spot and then go into that test again, pull that knee up to your chest. And does it still pinch? I think it's good. I'll give everyone part of a disclaimer that I think you'll want to give them to.

If you feel something pulsating, don't touch it. Yes. Or if you're pushing so hard, it's sending pain down your leg. Stop. Yeah. If there's a pulse, move aside. That's your femoral artery there. But... Well, cool. That's a good assessment. Good assessment. I like it. Oh, they're going to say something. Oh, no. Okay, so then we are approaching 50 minutes on this podcast. When's the last time you spoke for an hour on the phone? Oh, it's been a while. Yeah? Is your arm getting tired from holding the phone up? Thank goodness we have a... What do you call it? Oh, you have the headset? Yes. Or I might be treating my elbow and shoulder later if I was on the phone that long.

Or my neck. Well, is there anything that you want to add before we start to close the podcast? How can we reach you? Do you... Are you going to any events soon in case there's... I know there's some Cairo students that listen to this podcast as well. So maybe we can reach out and talk to you. Yeah, so I am in Northern County, San Diego. You can reach me even just by... My website should have a link to my email and also my phone number. So primalstrengthpt.com. Once a month, I do head up to Santa Barbara to work at a golf academy with a bunch of golfers. So I'm usually up there one weekend a month.

So sometimes I'll plan some stuff up in LA or seeing people along the way. I coordinate with that trip. And then two days a week, I'm actually downtown in downtown San Diego at Movement Rx. So... But if you just... If you want to contact me, reach out on the website or on Instagram. I'm primalstrengthdoc. And you can probably see some of my lifting. It's a lot more lifting than it is a lot of the PT stuff. It's like your personal account versus the PT stuff. It's combined both because it's out of the CrossFit gym that I train at. But you can see some content. So I like to practice what I preach or try to practice what I preach.

You know, you mentioned too, actually, I guess I never really hit on it. So you have a labral tear and you still... I mean, you still play golf. You still lift, obviously, right? Oh, yeah. So I was hit by a car three, four years ago when I was biking and tore my pectinus, tore some of my... I had abdominal hemorrhaging and a labral tear. And, you know, I was good friends with a surgeon that I saw. He worked... A bunch of the surgeons that work with some of the NFL teams in New Jersey. And we basically kind of agreed that I wasn't a candidate for the labral repair surgery because of how active I was and how limiting that surgery would be.

You know, so I deal with that. Like, when I start biking a lot and I do a lot of the repetitive motions, sometimes I'll feel that aching starting to creep back in and I'll have to take a look at things. But I have to be conscious and, you know, proactive in making sure some of the patterns you commonly see with that don't creep back in. Well, good. Yeah. Practicing what you preach. And it's good to see, actually, that you... Labral tears can be really troubling things to work with on people. I know they're really frustrating. So, just being that active is really impressive, actually. So, I'm sure you squat deeper than I do.

Ass to the ground or to the grass, as they say. Yeah. But, you know, I don't feel it at all when I do that. But it's in my technique. And I know there's all those online, what do you call it, judges or whatever they want to call. People always have comments for, you know, certain people's techniques, but they don't know people's history. And sometimes you need to do certain things a certain way, depending on how your body's, you know, functioning. But a lot of times, you know, if anything's going on, just to get looked at and know that you're doing the right thing. We call them trolls, by the way.

Yes, trolls. That's a perfect word. Yeah. Well, cool. Well, thanks for coming on. I will then close the podcast. And when we put this online, I will put some contacts of how everyone can get a hold of Dr. Helwig. And yeah, you can ask for some questions yourself. Awesome. Thank you so much, too, for having me on. It was a pleasure. Cool. Just so just just stay on while I close it and we'll talk after. OK, sounds good. OK, everyone. So thank you again for listening to the Performance Play Sports Care podcast. Go on to iTunes. Please subscribe. It helps me out a ton in so many ways. I can't even explain and review it.

If you if there's some constructive criticism or some good praise you want to give me, by all means, do that, please. So if you have questions yourself or you want to suggest somebody to be interviewed on the podcast, go to P2SportsCare.com. Again, that's P is the number or P the letter to the number sports is plural care.com. And there is a button right there on the homepage and there is a button right there on the homepage. So if you haven't read it already, I spent actually probably four months of my life just writing content for this page. I dug up so many different research articles and reference so many different places for multiple different types of conditions, hip injuries, such as ones we're talking about here and runners, golfers, baseball players and so on.

And I put all my personal experiences there with multiple injuries that I have, too. So it is it is the place where I put all of the information I can possibly think of in the most research and easy to read way. So please go on there. It'll help you out a ton. And lastly, I guess, too, I should probably start doing this to every podcast, but I apologize if any of the certifying bodies feel like we were bashing them and all that. I promise you weren't. I just want to make sure that we are playing devil's advocate a little bit just to make sure that all the patients understand the difference between the types of certifications and treatments and techniques and so on.

So everyone's working together to get the best care that they possibly can. So thanks again, everybody. Please subscribe and I will talk with you soon.