Listener Questions on Hip Impingement, Meniscus and Runner's Knee

This is session number 89 of the Performance Place Sports Care Podcast. Roma. 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, it's Sebastian Gonzales, Dr. Sebastian Gonzales. I'm your host for this podcast here, and we're going to go over some questions from listeners this time. This is something actually I recorded a while back, and I actually had to move it. I moved it a little bit because it was actually scheduled for number, I want to say 63, or 62, when I had Dr. Stuart McGill and Brian Carroll on. So, I really wanted to have them on. They were an amazing interview. So, this one got pushed back a little bit, so I apologize for all the people who I said some of their stories might be on the air. So, it's on the air now. So, the couple cases we're going to go over, and by the way, if you're a clinician, I'm going to go over some of the clinical reasoning and a little bit of thought process on these types of cases. If you're a general public or lay public listening in, then this is just kind of the rationale of how someone like me or a rehab professional might go through addressing some of these types of questions and so on. By the way, it's not medical advice. I want to make sure that I'm very clear about that, and everybody who's listening, obviously, this is not an exam, and you need to be seen by someone in person. All those legalese of medical. Hmm. Yeah. That's something that we, I don't know if it's a good or bad thing, but man, it definitely provides some barriers for people. I know that when we're looking at creating some e-books and manuals and stuff, that's the, that is the main barrier of putting the products out, actually, is thinking that people will do it recklessly, do the wrong thing, or implement without actually being seen. So, but a lot of times with clinic, clinicians, I think there's a lot of time misunderstanding about what good active care is, um, how to troubleshoot a case and so on. So I'm, we're trying to really help the entire population set by helping the providers as well. So the cases we're going to go into today is number one, there's going to be a quote unquote torn meniscus from exercising. The second one is going to be intense knee pain, uh, with a negative x-ray. Uh, the third is going to be, uh, some hip pinching or probably femoral acetabular impingement. We don't know. Uh, and they have lots of physical therapy. Fourth is burgeoning jujitsu knee pain. There's a lot of knee pain in here, huh? Huh? Knee and hip. Uh, fifth is, is a question on grading muscle injuries in the shoulder. And the sixth is hip flexor pain after, uh, after a hamstring injury in a runner. So those will all be kind of fun to just kind of dig through. But let me tell you about Roma. Roma did, I don't know if you guys realize this. So I went to Italy recently. Um, and I came back actually when I was over there, I, all these signs said we're going, we're in Italy. We're in, we're looking for Rome, right? Roma. And, uh, all this, all the places went to Roma. And I asked my friend there, I was like, is the name of the city Rome or Roma? And he's like, it's Roma. And I'm like, why do we call it Rome? Like, I don't understand why in America, I don't know if they do this in different countries, but why did we absolutely just take the name off? Like no one, I don't think in different languages, we changed New York city to something different, you know? So I started thinking about all the different things that, um, we encountered that actually we just blatantly just changed the name on. And I'm really just kind of curious about the history of that. So if there's any historians out there or people who are familiar with this type of, uh, change of terminology, I'd love to hear this answer actually. Um, but yeah, we went to, uh, Florence and it was for Florencia, Florencia, I think for, um, I think Venice, uh, Venice had a different name too. So it's funny, kind of funny getting off these train stops. It's like, I, I think we're in Venice. I know it's the end of the road.

Um, it starts with the V, but it doesn't look like Venice. So why the heck are we calling Venice? Why are we calling it Rome? Why don't we call it Roma? I think it's more probably, I feel like respectful for the actual country and city, honestly. So, um, I mean, Mexico, we call it Mexico. We just don't have the inflection of Mexico, you know? So I don't know, just a thought there. So, uh, yeah, that's what I'm thinking there. Okay. So as we go into these cases here, um, uh, just to recap, if you guys can go online and actually, uh, go or actually go onto the media, you're listening to it and please review this podcast. Let we know if you like it or dislike it or so on. We do plan on changing the name actually pretty soon here just for some rebranding, uh, and trying to make it a little bit more, um, uh, descriptive of what we're trying to do. Um, when I originally, when I originally started the podcast, I just named it after my clinic. So, um, but yeah, so we might change the thing anyways. So let's go into these, uh, cases and I hope everyone gets something very good from this. So the first one we're going to start with is actually on knee pain and this was done, uh, submitted actually through a, uh, a video on the Pez Ansarani, which you do have on YouTube. And by the way, if you haven't seen the YouTube videos, there's a ton of free information on there about some tips you can do, the ways to diagnose your stuff or at least help your doc do it. So here we go with a questioning series. Uh, so they say, hello doc, I tore my meniscus in 2015 exercising. I was told I need to lose weight or get a gastric bypass because it wouldn't be able to, because I wouldn't be able to lose weight fast enough. And then I was given a cortisone shot when, or it went through physical therapy twice in a year for a total of six months and the shot lasted a year. I went back to the doctor because my knee started hurting again. Uh, he just gave me another cortisone, another shot and sent me away. This last shot lasted about four months and I was back to hurting and limping. I was limping from February, 2017 until August, 2017 when my, uh, just last week when I went to a new doctor and he told me it was arthritis. He gave me a shot, but it was actually this, uh, but it was the actual side that hurts in order of physical therapy. He asked me to follow his video and stretching, but my problem is I can't bend my knee good enough to follow the stretching.

The butterfly is an, is extremely hard in anything that I have or in anything that I have to do bending my knee. My question is, do I continue stretching or should I, my question is, do I continue to stretch the best I can until I get the correct positioning? So I guess when I've read through this, uh, you know, the first thing I thought of, actually I didn't, I didn't actually see that she went to, she or he went to therapy for some reason, it sounds like a female, but I don't recall. Um, so yeah, I didn't hear that they went to therapy, but, um, so I put a little list down of things that I would probably talk about with this one. And the first one was really, you know, what was the rehab or what was the quality of rehab? Because I think that is a really important part. Um, and the goal in mind, um, I can't tell if the goal is to improve how the knee feels or to lose the weight, because if it is to lose weight, there's a lot of other means that we can do, um, to decrease weight. Uh, kind of the, the, the methodology I go by is abs are me in the kitchen, glutes are me in the gym. So dieting, if we're talking about, if we're talking about losing weight as the primary goal, there's a lot of different ways to do it. Um, and also the knee wouldn't necessarily hurt with swimming. It might not hurt with rowing because rowing has a little bit of a decrease of knee bend, but a lot of times people who are a little up there in weight, weight bearing exercise kind of bothers them. And especially things like running, um, it really bothers them because there's a high amount of impact for that joint, which can't stabilize itself anyways. And you add the weight upon it, then it even amplifies it even more. If the main goal is knee pain, then I do think that obviously losing weight is a huge factor in this. Um, there's, there's actually been patients I had in the past that, um, I was being very kind of like soft with my words about it, but they were, they were all, they were definitely overweight. And, um, the, the amount of low that the knee takes with someone with that much more weight. I mean, like I, I had to, I'd ask a friend, I was like, Hey, look, this is a really sensitive situation with this patient. Like, what should I do? And he's like, why don't you just have them carry around like a 20 pound kettlebell, even 20 pounds, have them walk it around the room for five minutes, if they can get that far and ask them what they feel. And he's like, well, they're, I'm like, he's like, well, they're going to feel like this is a lot of weight, you know, like their back's probably going to start to hurt.

The shoulders are going to get tired. Their knees are going to hurt more. And he's like, that's a good example to show them when you even have 20 more pounds on you, how much more your body starts to wear away, especially if you don't have the right joint strength to control it. So I guess with that being said, I mean, I think the physical theory was definitely one of the right things to do. Um, but I don't know what the therapy was, um, because there is, in my opinion, there's types of therapies and this is not, I'm not pigeonholing physical therapy, but a lot of other people do the same type of thing too. Chiropractors do it a lot. Massage therapists do it. Um, but you know, this, I, the ice heat or, you know, stretching this, the kind of like the passive approach with things. I think it's awesome for pain management, but really when it comes to these knee pain people, um, whether they're 50 pounds overweight, I think gastric bypass, I think you have to be, is it a hundred pounds? I think, I think there's a, actually a threshold, I forget, but if they're well overweight, I think we can spend a lot of time to at least doing floor work, you know? And I, I guess, um, to anyone who has a case like this, I think you really have to assess and talk to your therapist about, you know, is this therapy and whatever it is, say it's ice heat injections, which sounds like she has injections too, um, stretching is this making it so my knee can stabilize better or not? Because a lot of times with these knee conditions, uh, I mean, the knee is a simple hinge joint, you say, and it's stuck in the middle between two very mobile joints. And it's almost like a circuit breaker. It just doesn't, it doesn't function well. It doesn't feel well if the joints surrounding it aren't working. And one of the first areas I typically look is at someone's core or trunk strength. And, um, I did a whole nother podcast. Actually, it's, it's coming up on core, the concept of core, but I know if you've heard my other podcast, you probably heard me allude to the idea of trunk versus core. Um, but for the most part, I'll, I'll kind of dabble in that slightly since it won't come out for, uh, I think about a month now here. The, uh, the core is not just a six pack. Okay. The core is the obliques around the sides. It's the transverse abdominus, which is deeper. And if you look at these, these muscles that are, um, kind of wrapping around the trunk area or the, or like the stomach area, they're kind of like, if you look at them on anatomy, they're, they're kind of like, uh, uh, not, not poster board. God, what is it? Oh, plywood, plywood. So if you see plywood, you see like all this, these, uh, the wood kind of placed in different directions and it's kind of how it is. And it helps out dramatically with keeping the torso stiff, which then in turn does make it so the knee and hip can function better than the entire limb. Now I'm not going to just stop there.

All right. There are other parts of the core. There's the glutes are core muscles. The lats are core muscles. The pecs are core muscles. Breathing is a core, um, function. I guess the diaphragm, the pelvic floor. So there's a lot of parts to this, but for the most part, we can't just treat the body as a single section. And I guess that goes to the, uh, I guess my thought on the therapy is, was it treated as a single joint or were we looking at the entire body as a whole? Um, I think Dan John says it's the, the body is just one unit. You know, you can't, you can't separate it. Um, and I do believe that I think there's a time and place for doing local stuff like injections and tissue work and, and ice and heat and so on, but it only takes you so far because there's a reason why that joint got like that. And in this case, maybe it was the excessive weight. Maybe it was something before that. We don't know. Um, I've met people who have gained weight because their knee hurt them five years ago and that was a slow progression upwards.

So there's, there's other factors in it too. It's not always the weight. Now you guys might want, might want to know just some of the exercises that I usually do with people with knee conditions. And one of the first ones I start with is, uh, I, I start with a bird dog unless they can't bear weight on the actual knee. So if they can't bear weight on the actual knee, I'll, I'll go to a set like a side bridge or a bridge. Um, I, I do recommend planks sometimes, but I think people's general understanding of planks is not very good. Um, and they think it's a dramatic long hold time. And in cases like this, you, we should only go to the point to where they can have good form and sometimes it degrades really quickly and sometimes you can't even see it.

So just a couple of ones I like to use are bird dogs, side bridges. Um, the McGill curl up is a great one. Um, bridges, like I said, if you can tolerate double leg bridges, single leg bridges are great. And even this though, like, uh, some people do them really passively. Uh, what I mean by that is they'll drive their hips up into the air and they'll kind of sit there and like the rest of the body is just kind of chilling. You know, we, we really need to activate the muscles that are involved in a bridge. And, um, I went to a seminar recently, perform better in Long Beach, which I do recommend everyone go to if they're interested in fitness or, um, kind of the new advancements in fitness. So Dan John put on a presentation there where he was showing us all the bridge. So he had us go on the back on our back and we drove the hips into the air and he's like, who can feel their hips or their glutes turning on? You know, and people raise their hands so on. He's like, okay, let's try these two different things and let's see if it improves it at all. So one of them was, we had the other person, uh, we had partners. So the other person kind of stood over the knees and my knees, let's just say I was on the ground and they tried to drive my knees together. Okay. So my effort was to drive them out, but really I wasn't gonna, I wasn't winning though. Knees weren't moving. It was just a strong isometric contraction. And this just lit the cheeks up, which is what we want to do in this pattern, in this exercise that we're doing. Now, another correction was, was I put my hands straight in the air and I was on my back. So hands straight in the air, I put them together and the person actually put, so my palms were facing down towards my feet, but arms straight in the air. And so they would grab my hands, you know, hand in hand, and they would try to pull my arms above my head or towards the wall behind me. And I would fight them in this, geez, this really lit the cheeks up, which is what we wanted to. Uh, by the way, I can make a video for you guys to kind of see this demonstration here. I thought it was amazing. So that's an example of just things that I think we should be doing with rehab with knees, whether the person's overweight or not. Um, sometimes the habits of the person, you know, creates these knee conditions. Maybe this case, it was an eating condition. Maybe eating was a psychological thing that made her feel better. We don't know. Um, perhaps the, uh, perhaps she was, uh, had a knee condition on the other side years ago. We don't know that either. Um, which a lot of times does put weight onto that single side. So these are all things to consider with, with knee cases. Now I saw a reference to the butterfly. Um, and I, I don't know the terminology of this actual exercise, but it sounds like, um, it kind of reminds me of like a, uh, I guess, I don't know if this is politically correct, but there was a, when we grew up, it was, it was called Indian style sitting and just going to wait at recess. We'd cross our legs. So gosh, I don't know if that's PC anymore. I apologize to any Native Americans. So, um, anyway, see, we crossed our legs and this kind of creates some rotation about the knee. Um, kind of cause where the foot is on the ground and the knees kind of, or the hips kind of locked in. So the, this does typically flare people up with meniscus conditions I found. It's not as much so with like pes anserini, but, um, I know I did say this in the beginning that pes anserini in medial meniscus tears or injuries or frays kind of like go hand in hand. They, they seem like each other. And if you look at the video that I have on pes anserini on YouTube, which I will put a link to, um, you'll see that. So I do have some differentiation of palpation there and the knee joint or the actual joint line is very palpable for people, uh, unless they're actually overweight, then it's a little bit harder, but skinny people or at least middle road people can feel it pretty well. And you slide a little bit lower, like an inch lower than you have the pes anserini, which sometimes does have some overspill, but usually this rotational type of, uh, instability or pain with it, as well as the joint line tenderness is pretty classic of, uh, of meniscal injuries. And by the way, if you're wondering, well, like, I've still have no idea if I have a meniscal injury. Number one, you should go to your doctor to get tested.

But if you want to see what they're going to do, I will put a video on medial meniscus, uh, injuries. And this is how we test it, at least in my office, partially in some of the corrections we can do. Now the rotational stability, like I said, with that butterfly thing is, um, is something that, um, it could be rehabbed and trained regardless of, um, if the person has high weight or not. So some of the exercises I mentioned before, if done well, can actually guard against that rotational instability. So kind of the cascade of events that happens here is a lot of times when people have a sloppy core or a sloppy trunk, we also get a sloppy pelvis. The sloppy pelvis, it makes it so the knee or the knee kind of gets this rotational effect from the hip or the femur or the thigh bone. It kind of just spirals it down there. Um, we also have the case where people with ankle conditions, if they have a kind of like a collapsed arch, you can see that same rotational effect too. So what we want to do is we want to decrease the amount of, uh, triggering or pain trigger there really. And I know it's going to sound really dumb and simple, but if something hurts, you don't do it. And that's not to say you don't do it forever, but you do it for long enough to where until we can stabilize the air reasonably. Um, so perhaps, you know, butterfly stretching is not the right call on that because if it flares them up or maybe the butterfly stretching is okay, but maybe it's going too far.

Maybe they're just not ready for it yet. So, um, but on that note, I do see that there was a, there's, so it looks like the knee's not bending. Um, if it's not bending, there's a couple different things why maybe it's not bending. Um, number one is it could be extremely full of fluid. I personally experienced this when I had a meniscal tear and actually it was a tibial plateau fracture. I found an hour later, I thought it was a meniscal tear. Um, I, I mean the, the area was so inflated in there. It felt like there was a balloon, uh, just inside my knee and I, it felt like it was going to explode.

So I couldn't bend it the whole way. On the flip side, you can have meniscal tearing, which will also catch. So that is something to consider, um, as well. So if it is catching, sometimes that knee meniscal tear has advanced. And if it's advanced to like, say a bucket handle, I think those are more of on the orthopedic, uh, uh, side where you want to get a recommendation to maybe, uh, clean that thing out. But, um, so that's, that's something all you should probably consider. And going back to the rehab exercises, I think that it's important to state that exercises can be scaled. Okay. And if this person cannot tolerate weight on their knee, that is in a fully loaded position, plus all their gravity and the gravity and body weight. So we can go to a kneeling position, which is much easier.

Okay. It kind of loads the knee a little bit, or we can put them on their back. Okay. So they're laying on their back. So if we can put them in this, let's just say we're going into a squatting position while on their back, while on their back, and it doesn't hurt. And, or even face down like a quadruped rock, if they can do this movement without really gravity's effect, but they do, but they can't do it when they're standing. Then I think there's an issue with how the air is loading when they're standing. So some of these exercises or rehab things, we can kind of unload the person and kind of groove in new patterns and strengthen around the deficiency they have. But it doesn't mean that they just kind of stop and wait and, um, you know, get, uh, the injections will just kill the pain. Really. It's, it's not really repatterning that stuff together. So, um, on the note of, I should go back to that, why the reason it's not, uh, bending. I did a whole podcast before on, I think it was an article, maybe it was an article. Um, but it was stretching when you should stretch and when you shouldn't. And one of the major things that I tell people to figure out is if you're stretching into the, a pinch point, if it feels like it's pinching an example, if you bend your elbow, like you're doing a bicep curl in the and, and you're doing it passively, like you're using the other hand to do it for you. Um, that inside area where the bicep is, if it feels like it's kind of catching in there, you we've turned our bicep off. There's nothing going on there actively because the other hand is doing the work. That's more of a pinch point. And that's a possibility that there's an actual internal joint issue. Okay.

I don't tell people to stretch through that. There's ways to improve it, but I don't tell with regular stretching protocols. I don't tell them to do that. Now on the flip side, if that person is trying to do that same thing, but now it feels like it's tugging on the backside where the tricep is, that's a little bit more of a safe realm to do stretching. And obviously the, uh, every case is really different. Um, but for the most part, that's a better reason to push into a stretch than it would be pushing into a pinch. So really assessing the quality of, and the reason for your joint restriction is really important when it comes to recommendations of flexibility and so on. Now, last thing I guess is, uh, bracing. I should probably talk about with knees. Um, I found that there's a really good, uh, use for bracing at certain times. Um, I've had some patients with, uh, popliteal tendon injuries, which is, uh, it kind of assists in locking and unlocking the knee when we're driving the knee down to create force or driving the leg to create force. And when they get into full extension, a lot of times they just don't like it. It just seems like it takes forever to heal. So in those cases, I just kind of want to limit that pain trigger, which is full extension. I just slightly take them out of it.

So when they wear this knee brace, they can walk without pain. Um, a lot of times they can actually run. I don't tell them to run that often, but there has been times where I have people run with the brace, um, because we're not really locking the knee a ton with running. And we do with, I'm thinking about mainly with jogging. Um, and I just haven't worked on kind of their cadence. I really don't have them shoot for performance. I guess I shouldn't have gone down this route because this is a whole nother conversation. But, um, anyways, I, I'm allow, I allow them to at least walk with the brace on, um, because I want them to still load all the rest of the parts of their body. All the tendons will start to kind of, um, not remodel if we don't keep a little amount of load on them. And gravity is just enough load to at least offset that. So, but we don't want to go into the pain triggers. We don't want to keep compromising that tendon, but we want it to work slightly. So, um, a brace or an extension check brace is a good idea in that instance.

So I think I'm going to go on to patellofemoral injury next on to the next question here. So, um, keep in mind, all of those references will be, um, on the show notes at p2sportscare.com slash podcast. Okay. So the next question is from, uh, actually I can't say the name. So we'll start with it. So my, my left knee has been aching for two to three years now, but not really anything that affects my life. The other day, however, I was just sitting at a desk at work and I got this sudden, intense, excruciating, debilitating pain that will come and go for about 40 to 50 or 40 or 30 to 45 minutes. The pain level was a 10 and then disappeared. It was so intense that my body reacted with dizziness, nausea afterwards for about five hours. I'm 55 years old, used to run, but haven't in 10 years. I'm lean, I'm fit and active, but nothing more strenuous than hikes and long walks. Doctor doesn't know or doesn't seem to know what it is. We'll get an MRI, but the x-rays show nothing.

I've been stretching and rolling my thigh quads and quads and inner as the trainer told me that would help. Okay. So, um, first note on this, and again, this is not medical information. So you guys need to seek care of your primary care or someone you really, really trust in the sports injury or sports medicine world. Um, now anytime that I hear nausea and vomiting, I think systemic. Okay. And if you guys don't know what systemic means, it means internal. Okay. When you think about, let's just say a heart attack, nausea, vomiting, vomiting, sweating, referred pain, yeah, down the arm, but no one questions that. Everyone seems to be on board that left arm pain first and chest pain, like an elephant sitting on it is going to be a possible heart attack or something heart related. Okay. And then you have things like, uh, I think it's gallstones. Gallstones refer to the back. It feels like back pain, but it hurts more when you are, I think it's when you're eating, when you eat fatty foods because the gallbladder squeezes out fat or it's not fat, but, uh, um, uh, enzymes. No, I'm losing the word, but it squeezes out stuff bile. Bile, there you go.

Squeeze out bile to help digest the fats that we eat and just that squeezing effect. Sometimes there is a stone in the way. So, um, it hurts and it refers to the back. So, but that too is something what creates some type of referred pain, usually around the chest wall. Um, but still it's a visceral reason. Um, and there's a few more, I'd probably have to look them up. Um, actually I guess kidney stones is another one. It feels like it's deep inside you and I've had kidney stones and, um, it felt like someone was kicking me in the back around the kidneys and it shot through to my groin area. So it felt like it actually goes through you. Um, but I mean, if I wasn't paying attention to the shooting through, it could have felt like back pain. So yeah, maybe stretching wouldn't work in that case. So when I see nausea and vomiting, I think no matter what happened before, sure, the pain was intense, but that's, that's something that's, I mean, maybe food poisoning even. I mean, there's a lot of things. Uh, I mean, this person's 55 years old, not saying the 55 is old, but I mean, people have, um, really, uh, serious things that happen at 35, you know? So I think when we get older, we have to, to realize that there's, um, there's also a larger possibility of things that they can happen that are not just musculoskeletal related, even though it seems to be. That's why I really do stress people go to their doc because I mean, I listen to stuff like this, or I grew up listening to like Loveline. It's just, I mean, it's all, I mean, it's all cool and all it's entertainment and it helps educate people a little bit more, but realistically every per every person and every injury, um, is unique and there's no way to tell a hundred percent unless you go in and have an examination. That's why there's a history and examination as part of like your first appointment.

And, um, I've actually had people come in and they said, okay, I had an exam by another doc. I just want you to treat me. I'm like, that's not going to happen, man. Like I got to look to see what's going on or else, uh, you know, I'm not helping you. And you know, I, we're just kicking sand around. So then the next thing I see on this, and let's just say we put the dizziness and nausea aside and we just say everything else was on there. Um, this kind of reminded me of, uh, so they put it on the video for patellofemoral pain and patellofemoral pain is technically runner's knee. And if you look up my article on my website, so it's p2sportscat.com slash, I think it's at pain after knee pain after running currently, or you can just go through and you'll see if you click, uh, I'm a patient injury articles, you'll see that runner right there. Just click on their knee and you're going to find through that, there's a whole section on runner's knee. And one of the ones at the very bottom of it is movie theater sign, which when I was doing some research, I thought, Oh, that's kind of cool movie theater sign. You know, let's, uh, let's dig into this a little bit more. So movie theater sign is actually it's so the knee is in a bent, it's a bent knee position. Um, and it's interesting, I think, because a lot of people think that rest will actually make the knee feel better, but it's not necessarily the case with patellofemoral pain because the knees in this bent position, there's actually the two surfaces are contacting. So the cartilage underneath the, uh, kneecap and, uh, just below it is the femur, the femoral groove actually has cartilage on as well. They can get irritated when they rub against each other. If they're not, if they're not in the right position, I guess. Um, and this knee position again, creates more rubbing. So that's why a lot of times they'll have pain with deep squatting, though we find standing up. Um, and things like this won't always show on x-ray. Um, and I think that's an important part of, uh, this question here is that they are taking definitely necessary steps. They went to their dog. Um, the guy recommended or the guy or girl recommended x-rays, which is a great start. Um, and the MRI is really something that we'll see if there's damage later, you know, it'll actually show some things. Um, x-rays are really, they're, in my opinion, they're, they're kind of archaic. They do see stuff. Um, but when we're looking at soft tissue injury, especially in the early States, um, they're, they're not as useful, you know, they'll, they'll see things like, you know, um, bony alignment, they'll see arthritic conditions. Um, they'll see things like that, but they, they won't even show like small fractures sometimes. Like you really have to look super hard to see it. Um, and I'm not going to say I'm an expert at x-ray cause I don't, I don't see them all the time. Um, but I remember, I remember looking at that, that images with these tiny little fractures and they would put them on these tests, but just because they want to partially trick us, but they're tiny, you know, MRI is much more clear. I mean, even like a patient can see and look and say, what is that?

Why is there that spot within that area? You know? So it's a lot more apparent because we can see things in a lot more detail. Now we can see the college surface in with patellofemoral pain in an MRI, but that doesn't always mean that that is the pain generator. Usually what we'll see after when someone does an MRI, we'll see there's a report that goes along with it. Um, and it'll say, we see this, this, this here's, this is torn up. That looks okay. These look normal needs to be clinically correlated. Right? So what that means is if the person doesn't have pain, say, say we trick the radiologist when we send someone in who doesn't have any pain or problem and they say, well, there's this, this, this, and yeah, this person probably really hurt and so on, which they don't make those judgment calls by the way on it. That's just, uh, they leave it kind of to the, uh, physician with it. Um, but let's just say they did. Um, you don't, you, you can't, the, all these MRI findings and all these imaging findings aren't always painful. So sometimes the pain generator is something else. So in the exam, we really have to take that into account. But I like to oftentimes if, if there is suspect of, let's just say a bucket handle tear in the knee, say there's something, uh, say like a cyst we're looking for, say we're looking for malignancies or we're looking for fracture. You know, I like to have these images to, to confirm there's not anything more extreme going on, but a lot of times with knees that we can, we can make them a lot better if they're not too far gone with arthritis. Um, uh, even without even looking at an image. Okay. And now I guess I should probably address that is, is there a certain point where arthritis goes too far? Yeah, there is. Um, arthritis is a, is a bony growth and it's the air, the body's attempt to stabilize the joint, which is not really stable. Um, we're not functioning well as it happens over a long period of time. Arthritis doesn't happen overnight. Um, and I'm talking about osteoarthritis by the way, not the other extravagant types, because there are many types. Um, but for the most part, I mean, I see people with, with knee pain that don't have arthritis. I see people with arthritis and no knee pain. And, um, just because we see it on an x-ray doesn't always mean that it's, it's the pain generator, but when you can feel on an exam that there's actually a hard stopping point, there's a block and you think that it's correlated with all this crepitus and grinding and so on. And you look on an x-ray and you see, whoa, this thing looks like a mushroom. It doesn't even look like a knee anymore.

Yeah, that's, that's, that's probably a major thing we have to address there. Uh, and at that point, maybe it's a knee replacement, you know, or we have to consider the person's goals. Can they walk, can they do their activities daily without pain? How old are they? You know, if they're 70 years old, maybe they don't want to have any replacement because it takes a little bit of rehab to come over. Um, you know, or actually people which actually this happened to me with, with my grandfather went in the hospital and, uh, he had some dementia or Alzheimer's and he, whenever he went in the hospital, he was worse off than when he came out and it wasn't the hospital's fault, but it kind of jolts him out of his, his normal setting. And I mean, I remember one time he thought that the hospital was, he's, he's like, I, he looks at me and he's, he's like, well, I don't, you guys are doing here. I don't know why you guys live like this. I'm like, what are you talking about? And he's like, you live with all these people. I don't know how you do it. And I'm like, grandpa, I don't live here. And he's like, well, you do. I remember he said, you do or you don't, but I don't agree with it. So he was firmly convinced that we were at my house. Um, but when you get him back into a setting a little bit, like he, he regains all of his, uh, you know, is his, uh, memory or a lot of his memory and recognition, at least where he's at. So like in that case, like, are we really doing the person, um, a service by getting them a knee replacement or, or intervening in that manner and then making them worse cognitively. So that's a whole different battle there. Now I guess I should go down the route of stretching, rolling quad calf. Um, it looks quad and inner thighs that they're doing. And I don't have a problem with this, but, um, I, I, I believe that the knee is definitely, definitely affected by the core and the hip. Like you heard me say in the last example. And if we, we only have X amount of time to do that one or the other during the day, foam rolling or doing some rehab specific to improve the way those other areas function, I'd rather than do the second.

But if you have a lot of time in the day, go ahead and do both. I have no problem with that because rolling out the quad and the thigh and everything. And like, it does seem to help people with knee pain, uh, and, and runners do your condomalase patella. But, uh, I think it's a little misleading sometimes. And, and there's actually a lot of times where I have people in my office that I, I, I try to really hold back from doing any tissue work or rolling or stretching until I have a good chance of improving the condition without even doing it. And the reason why I do this is mainly a psychological approach. So if the person comes in asking for tissue work or rolling or stretching, right? If I give them to it first, their, their thought is, wow, that stretching really helped. Okay. Which I don't think is a good long-term goal, which is why I don't want to go that route yet. Yeah. It makes them make, makes them feel better. It's a good pain management approach, but I don't think it's an answer. Now, if I can make their knee feel better by making them move better, or say I give them like one core exercise, let's just say, and I'm going to go into which one because it's not important right now. So I give them one and they stand up and they squat down like, whoa, my knee feels a lot better. All of a sudden now they're interested. They're interested of why addressing that section of the body was helpful for their knee. Now I have their attention. Now I have the ability to install some new habits and I still can't have them stretch and roll, but they're open to both. So if they saw that the answer was stretching and rolling in my experience, a lot of times they stick down that route and then I don't have, I haven't really effectively helped them in the longterm. So I think that's important to realize in this case or this question. And I guess I'll just finish this one off really quickly by saying, uh, if you don't have, if you guys don't have your annual physical, you really need to. And if they're not looking at your blood work and if they're, um, not looking in detail with, uh, different aspects of your body and your function, your goals, then I, then I think you really need to, uh, you know, state your case. Cause, uh, that that's, that's an important thing. It's just like checking your oil in your car. You got to make sure that you're, you're looking in there's, there's signs, there's signs of really important things in that blood work. And sometimes you have to ask for specific panels. It's not always in a general blood work panel. So, uh, yeah, ask, tell them what it runs in your family, tell them, um, what you're concerned about. And then a lot of times they will order those tests if needed. So this next one is on FAI or femoral acetabular impingement. And this one's a long one. So I'm just going to go through and then we'll go on to some questions with it. So this, this is a verbatim again. So this came at the perfect time. They're talking about a video that I did, um, on YouTube. I will put a link.

Uh, I was just diagnosed with femoral acetabular impingement combo and refused, uh, steroid shots and no way are they going to cut off my bones. I have tons of pain in the area of my hip while squatting, walking and for sure, or sitting, walking and for sure squatting. It took several months before getting diagnosed. I actually went to physical therapy for my lower back and they said that I had posterior pelvic tilt on the right and I had no problems with my hip joint until I started doing the PT exercises for the posterior pelvic tilt. In fact, the very next day, my ankle was swollen and my whole leg was stiff. Uh, I continued, I continued to go to PT for about five more visits with my pain increasing every visit and unable to perform PT exercise without pain. About four years ago, I was, I had a burning knee pain from a kickboxing class. I went to the carpet at the gym was too rough for my toes to pivot, but my knee would. As I realized this, I stopped the kickboxing class. I used to slow down for, uh, slow down on workouts. Uh, it was a come and go pain until about a year ago when I started moving my moving, when it started moving on my leg. Note, I was working out, uh, working out much at the time due to life and pain and my job required a lot of sitting and standing. I decided in late December, 2016, it was time to get back working out and moving more or moving more. My knee pain still came back and went and working, or still came and went and working out according to the pain in how I moved. Oh, one sec here. This is going to take me a second.

Okay. I'm going to, I'm going to interpret this one. So they, they worked out according to how their knee felt. Um, and for the most part, it got better. In mid February, I was unloading groceries, completely unthinking and lifted them and twisted and all kinds of popping happened a week ago or, or later my back or on my low back on the right side started to hurt so bad. I couldn't sit, stand, sleep, or feel, feel right. I went to a chiropractor probably a year since last visit. Uh, I went to, I went to the chiropractor probably a year since the last visit. It took about six visits to start feeling better. When I, when I asked him who I'm getting tired. When I, when I asked him to do, uh, about starting doing PT, he said, sure. If you start feeling like that, if you feel like that would help, boy, I was wrong. Um, I started PT at the end of April, which led me to so many doctors and testing to find out the source of the problem. Here I am with FAI, probably atrophy and all my hip, but inner core muscles, yuck, but my knee pain was gone. I've been scouring and searching everywhere for information on how the body works. What is FAI, a surgery, uh, is the surgery really a solution, et cetera. I believe I can fix this without, uh, without it just going hard. Uh, let's see.

I believe I can fix this without it just, without surgery, I think. So just, just so hard to know where to start. Oh, they need an answer to where to start. I watched both your videos and it kept saying, and I kept saying, I wanted, I want someone to work with me like that. My PT, my PT didn't come close, not to mention I saw four different therapists due to how the facility ran their PT program. I'm really looking forward to educating myself and find a way to move and strengthen my body and live an active lifestyle without surgery. Thanks for making a wonderful video. Okay. So, whew. Thank you for submitting that. Uh, um, I'm sure it took you a long time to write it and I'm thankful that you took the time. So, um, yeah. So I think the first thing I would start on this is I, I, I hear a lot of, um, I see, I hear a lot of unsatisfied with their PT. Um, I'll first start with that. I, I guess my standpoint is I love physical therapists. I love chiropractors. I love MDs.

I love orthos, um, massage therapists, trainers. I, I think there are amazing ones everywhere. Um, but there's also some ones that are not as great and not to say these ones weren't the best, but perhaps they didn't troubleshoot enough just in the beginning to figure out where, um, where they needed to go with this person. And I know that, um, I don't think that, that I, I think that therapy and I do, I do this in my office is, uh, I, I tell people that there's, there's not going to be a one-time fix on things. Um, I'm human. Everyone's human. This is, your body is a puzzle. We have to put this thing together. And, um, actually a lot of times in my first exam, I actually had a patient like this, um, the other, the other day where I was basically troubleshooting the whole time and I'm very open about it. And I say, look, I'm going to do a couple of things with you. Some can make you feel worse. Some could make you feel better, but I'm looking for the ones that either improve your condition or keep it the same. The ones that make it worse, we're going to digest that down and figure out why. And if we can't figure out why we're not going to have you do that at home for homework.

Okay. So this person had a, uh, they actually had pinky finger numbness. Um, and it was worse with being in downward dog position and then going through like a flow to like a chaturanga. So kind of being hands underneath the shoulders. So we actually were going to start with kind of like we did a wrist exam just to see there was nothing really eventful. We did a neck exam, wasn't that eventful. And the shoulder one actually was. So we put, I put her shoulder overhead and just kind of pushed into what we call an apprehension test. I did this, uh, face up by the way, that part. Um, and it set off her, her symptoms. So what we did is we stabilized the shoulder, um, uh, first manually. So I did it for her and it improved it. So I took her out into the rehab area.

And the first thing I like to choose for that some, on some cases is a kettlebell arm bar. So we did that. I had a retest. She said, well, that's, that's, or she tested the downward dog as well as a chaturanga and it, Hey, that feels better. Good. Cool. So we didn't actually treat the wrists at all that day. So the next thing we try, thing we try was a serratus wall slide. Uh, that was given to me to, uh, by Nancy Newell. She has a podcast on here, by the way, if you guys want to check that out, I believe that's session number 60. So, uh, we use the shoulder blade to stabilize the area in front of the, uh, humeral head, which is kind of where the brachial plexus goes past or the, the ulnar nerve. And we did that and Hey, it got even better. Okay. So there, I told her there was, if there's anything that makes it worse, we don't do it that time. We didn't find anything that made it worse. So everything was still fair play. Um, but keeping that in mind in the light with this, with this question or this comment was that, uh, I perhaps they didn't get to that conclusion yet.

Um, so there are things that will cause pain when we're doing them too. Um, but I think communication is important and not to say she didn't communicate. Um, I don't know why I keep thinking this as a woman. Uh, gosh, I just, maybe it's the tone is written. Um, but either way, I think communication is important between healthcare providers and patients. So, um, if something feels like it hurts or pinches, and especially with, uh, impingement, if it pinches, you need to tell them, um, because there's ways to get around that. We can open the hip up a little bit wider. We can distract it a little bit. We can change, uh, what we're trying to do. So I don't think that the PT was necessarily bad. I think it was just need to be homed in a little bit more.

Um, in regards to diagnosis of, of, uh, femoral acetabium impingement, it's, they said it took a long time for it to be diagnosed. And that does happen a lot with this case because people tend to think it's, um, a lot of other things. Um, one of the major ones, they think it's a hip flexor condition. Um, other ones, they think it is a, uh, low back condition or a high to adductor strain. Um, but some of the tests I like to do to confirm it, or at least see if we're in the right ballpark is scours test. By the way, this is all in the video. I will put a link. Um, scours test, there's axial compression, there's circumduction test. Um, these are all ones, uh, and actually for bears as well. F a B E R. These are all tests that show if they show that in pinching on the inside part of the hip, then there's a high, higher probability of impingement. Now there are ways to decrease that, um, mainly in regards to pelvic tilt and core bracing. Um, but some people actually just have, they have the predisposition for this mainly because they were younger athletes. Um, I think I talked about it on a Reese, uh, podcast way back. We talked about, uh, how that cam deformity in the femur happens with young athletic populations when they're, when their growth plates haven't finished yet. So that's something to consider that maybe, I mean, I know people that squat a bunch that they, perhaps they just, they need to realize their proper squatting position. Not everyone can go, uh, narrow foot position. Not everyone can go below, uh, parallel. It just doesn't happen.

Now, the last thing on this one is I think we need to, um, realize the long-term effect of femoral ashtabular impingement. It probably more than likely will become a labral tear. Okay. No one wants a label tear. It's a cartilage injury. It's very hard to get rid of. It is very longstanding in regards to how it'll affect you. Um, but the pinch, you know, people just kind of blow by it, you know, and they shouldn't, they shouldn't, they shouldn't, they shouldn't, because it's something that they can really improve on. But once it becomes that label tear, oh my gosh, it's so much harder. So in the early stages like this, they really can be, um, addressed. Oh, and I should go back to diagnosis.

Uh, MRI arthrogram is really the way that you confirm it on a, on a, on an image. Um, MRI really won't show much of it. X-ray won't show, um, much, although they say crossover sign is helpful. Um, but really I think MRI arthrogram is the way to rule out the major, the labral tear. But if we can reduce it with improving the way the person moves in the office, then I don't see any point in really shooting them for a, uh, arthrogram. There's, it's expensive, it's intensive, it's, um, and I reserve that for people who are going to have a surgery, honestly. Uh, lastly, I want to, um, actually this person here that wrote this in, you're doing a good job of educating yourself. I'm really, uh, I wish there was more people like you out there because, um, you, you need to learn about your injury. You need to learn about your body. You should be the expert in the injury that you have.

There's no reason to say, oh, I didn't know. There's enough information out there and you'll be able to digest and break down the ones that are BS, the ones that are, are great. Um, uh, but yeah, so I, I think I put a lot of my videos out there because I, in podcasts, cause I, I'm hoping that people will find it. I want them to find it. Uh, and lastly, I think if you know what's going on with your, that type of diagnosis and you're a hundred percent sure it's that diagnosis because you've had, uh, confirming, uh, a lot of doctors say that it is, or a lot of therapists say that it is, perhaps they're not the white ones, the right ones to rehab for you, but they're a good one to diagnose. So you want to ask your person who's going to help you rehab it and treat it the types of questions that you know to be true. Um, so you want to make sure that they're the right therapist for you because, um, I can honestly say that I don't work well with concussions. If someone came in and said, I have a concussion, I, I, I mean, I could lie to them and say that I work well with them, but I really don't, you know, it's just, it's not my, it's not my thing. You know, I can, I can send them somewhere else who would do a better job and same thing happens for, uh, uh, FAIs. So, um, but I want to reiterate that that I don't, I don't, the PT didn't sound like it was bad. It's just, and also I don't know the quality of what they did. Um, but it sounded like they were starting down the right path anyways. So on to the next one, gosh, I've spent a lot of time on these so far, the medial meniscus. So here's a question. Thank you for your video. I injured my knee, my left knee, the quote unquote medial meniscus or peasant surrounding bursitis participating in Brazilian jiu-jitsu. I do not, or I do have leg pain when I sleep at night on the, on the inside, just below the knee joint and a knot is a knot down there. Hmm. I don't know what that is. Um, I will do recommended exercises. I, you should look into the Brazilian jiu-jitsu community to give your advice because the joint injuries suffered when, because of the joint injuries suffered when training. Thanks again. So, um, awesome. Yeah. I, uh, no, I totally agree. Brazilian jiu-jitsu.

Um, it's funny though, with, with that, with that population, the, the, the ones that I've seen, it's usually like, I'm like, Hey, how'd this happen? They're like, well, I don't know. I was getting tossed and turned and someone grabbed me. And like, I, they, there's never really like a clear mechanism of how it happened because it happened so fast. A lot of times in my experience, um, I've seen them have a lot of stingers into the shoulders. So they have a lot of neural traction injuries up there on the, around the brachial plexus. Um, but, uh, yeah, so I guess the, it sounds like he's on the right track. Um, uh, by the way, the recommended exercises, you got to make sure you get it confirmed first because, um, you don't know if there's more in there. There's always a possibility of a fracture.

And in that case, there's a whole different, um, treatment plan. Um, but the, the, the sleeping at night kind of interests me and that's just why I have this on here is that, so I know a lot of people with different types of injuries, they say like, maybe I should get a new bed, maybe get a new pillow, maybe this, maybe that. Um, I don't want to say get new because I think it'll be very short lived how long that the benefits are. Um, and yeah, I'm surprised the amount of people that with medial meniscus injuries that they get their foot caught in the bed sheet and they try to turn around in bed and all of a sudden their knee just wakes them up because their knees caught because it's that rotational force. So there might be things that you want to do prior to bedtime to make it so we're not aggravating it with getting caught in the sheets and so on. Um, taping it is one way, bracing it is another. Um, even like a, even like an ace bandage, I think, um, although I don't love them. Um, something, something that, that makes it so the knees a little bit more steady for when you kind of jump around inherently or unknowingly at night that it's protected slightly because with all these types of injuries, we need to desensitize the area and then we need to stabilize it too. And it's really hard to stabilize the area when the area is super aggravated and the person can't move, um, into the rehab and that we want. Um, and a lot of times with knee conditions, and by the way, this sounds traumatic, which is a whole different story, but the non-traumatic ones, we have to kind of give them doses of the poison. We have to make it so they are resistant to that movement that created in the first place. Okay. So I will move on from that one. Uh, but the next one, muscle grading. Okay. This was the topic I thought, uh, although this is a shoulder one, I think it would still carry to what we're talking about today. So, Hey, I was playing basketball. I lifted my arm up really quickly and now with the top of my shoulder and back slash armpit area.

Okay. I got to get a visual on that shoulder back. Okay. Has been hurting for about two weeks. It's gotten better. Uh, and I can move my arm and have no weakness, but it really hurts when I raise my arm to overhead and to the overhead position. Does it sound like a serious sprain or tear? Um, so I did a whole podcast actually on the muscle grading system. Um, and I think it was, if you go into ptsportscare.com slash podcast, it is going to be number 46. So actually if you do a ptsportscare.com slash podcast pound 46, so you'll get taken right to it. Um, but that kind of goes into muscle grading systems, uh, or, uh, uh, uh, muscle injury grading system, the most current one from 2012. And what I kind of go into there is that, um, the old grading system was, uh, type one, two, three, one is a strain, one is a partial tear, one's a full tear rupture, basically. Um, grade two and above would definitely bleed, um, and leave a bruise in the skin. Uh, one is just kind of like a no man's land. It was like so many different grades that, um, and actually didn't account also for, uh, uh, spine related, uh, muscle injuries, muscle related muscle injuries, uh, delayed onset muscle soreness, uh, and things of that nature. So for all we know for this, um, we have to consider that was this injury actually a muscle injury? Because this person obviously thinks it is because they said sprain or tear, what is it one or the other? And I, how do we know what is? And, uh, I, I talk about this a lot at work is that if someone comes in with something feeling tight, um, uh, a lady the other day that she talked about her hip, her piriform is feeling tight. So I check her range of motion, her range of motion is normal, both sides. It looks symmetrical, looks okay in the hip we're talking about. Um, but she's had back pain too. She has back pain. So she's like, how do I get this problem in the hip to go away? The back pain's not that bad. The hip pain is, is a whole different story. It's just tight and uncomfortable and so on. And I explained to her that muscles have the electrical impulses, all of them, all the muscles have electrical impulses, um, or electricity coming to them. Oops, sorry. I hit the mic coming to them from the nerve roots in the back. Um, and if they are, I guess, pulsating, we want to say generally speaking, if they're giving more electricity, the muscle has, just imagine like grabbing like an extension cord, like you, you start to contract, you know, it's just what happens. Um, so that happens with, um, when there's also compression, even like compression of a nerve as well, or irritation to a nerve. And this could be in this case, the shoulder could be in the neck. So I always like to check the, uh, neck in cases of shoulder conditions, especially if they test negative for all their cuff, um, the rotator cuff, uh, being attached. Okay. The things I like to test in rotator cuff ones are, um, I like to go down the route that Max Schenck suggested that we had him on a podcast, actually number 47. So that's pound 47 after podcast. Um, he, he had a little, uh, pyramid where basically the bottom was the very bottom. If you don't have this, you can't have proper shoulder function and shoulder injuries just don't come out of nowhere unless they're traumatic. So first is breathing and core. Do you have those two locked into place? Do they work? Okay. If they don't, then you'd work on them first. Next, you have neck and mid back function. Cause we're talking about that nerve root, uh, innervation last next is we have the shoulder blade. Does the shoulder blade hold the shoulder on to the body? Well, does it have dynamic stability? Does it hold their correct position as your arm moves through space? Lastly, we checked the rotator cuff. So, um, this person jumped a little bit soon to the rotator cuff. It looks like, um, so there's a lot of other things to check first. So I would listen to that max shank one, number 47, and I will listen to 46, which is the muscle grading system. And here's the last case right here. We have, uh, we have a hip flexor question. So here we go verbatim. So I'm a 52 year old runner, uh, and had a hamstring, had pulled ham, had a pulled hamstring about six months ago. Uh, she said that she fell running downhill after a trip, never really gained strength, regain strength. And this has felt tight since, uh, especially during hip extension while lying on her stomach. Okay. Sorry. I'm just thinking about that when we're doing, uh, and when doing heel to butt running drills, life took over and, uh, and never managed to regained or to restrengthen properly. Fast forward two months, major life stress, no time for strength training or, or Pilates, uh, any longer. And I moved to a new city, joined a new running group and ran too far too soon. Uphills, major hip or major pain in the left hip. Let's see. That was a, I guess we don't know what, uh, hamstring was injured. Uh, so major pain to the left hip, new physio, uh, new physio, not running oriented and just says, don't run and strengthen the glutes. I can't figure out exactly what the, what the issue is. I was thinking about the, I was thinking about hip socket. I guess I need a proper diagnosis first. I found smash work on YouTube and he demonstrated a band around the top of the femur, uh, stretch, which does give some relief and tried running again, did a 10 K really badly. Uh, it, or 10, 10 K really bad, came down a little and then three K, which was awful again. Sorry, this is a, um, the, a little bit harder to read. So, uh, the, there, uh, there's a weird sensation walking downhill at the hip flexor, a bit desperate to start running again, help. So my takeaway in this is that, I mean, obviously, um, I hear that, that she had moved to a new city. There was a lot going on. We don't know how long this was. Uh, it looks like it was at least months. And so, um, and it looked like she kind of recognizes she just did too much in the beginning. And I, I tend to think that, um, we need to do proper training for the sport that we're looking to do. And I think that's more of a, of, of kind of like a negligence on people's parts. And I know that a lot of people do this. Um, I've, I've definitely done this in the past as well as that, you know, you get busy during the week and then the weekend comes and you want to, you want to play, you know, you want to run, you want to play baseball, you want to cycle, you want to jump, you want to sprint, you know, but, or is your body really responsibly ready for it. If you've done the right work over the time leading up to it, then you're going to be happy about how your body feels after. If you're not, if you haven't anyways, then you're not going to feel good about it. Okay. There's always a possibility that like, you need to take some time off, like deconditioning does set in. Um, something that runners definitely need is they need core strength or sorry, core endurance. Uh, I don't want to say strength. I'm trying to get away from that because endurance and strength a little bit different. So core endurance is something that I like, um, hip, uh, uh, functionality or range of motion is important. Um, but also too, it comes down to conditioning. Like is the person ready for that speed or distance without allowing while holding off neuromuscular degrade? And I'll say that very generally here now is the per, does the person keep good gait form? Can they hold proper running form for the distance that they're doing? Um, and actually I'm, I'm about to write an article on this whole concept, uh, which, uh, I did get from Dr. Lum, um, who I will reference on this. He did a great presentation at Perform Better this year. Um, so he had the term on his presentation called functional capacity. Um, if you don't have the ability to, or let's just say we're talking about, let's just say we're talking about mileage, it'll make it the easiest. So if you have 10 miles that you're running and you haven't, let's say, uh, you know, one person in a second person, say we have two, two glasses. Okay. They're full of 10 miles. We're doing 10 miles today. That's just what's happening. You're in a group. I mean, everyone goes 10 miles in the group. No one really doesn't make it. They just do it slower or faster.

So say we have this person right here that sent this in and they can't, they can't run more than say three miles as in good form because of all this, he got busy, you know, just wasn't training, didn't prep for the sport, whatever it is. Um, they can only do three miles well. And after that, these seven miles of poor form, their body's going to, is going to start falling apart after that third mile. And then we have stress put on areas of the body, which aren't used to taking it. Okay. Now we say we have that person who's been running that group for a long time and did all of the necessary work. They're supposed to run 10 miles, just like everybody else. Say they run nine miles and then the last mile, they just hammer it, you know, and they start to fall apart a little bit.

Which one has a higher probability of getting injured? Probably the first, right? So they went the same distance, but their functional capacity is very different. So the functional capacity is the ability to keep proper position. In this case, we're talking about running form for distance for a certain duration of time, speed, um, or load. In this case, we're talking about distance again, rather than a time or a load. So that one mile or that seven miles is where they're starting to fall apart. So that's what we call the functional gap, or that's where I got from Dr. Lum. Um, I think it's an amazing theory. Okay. So we need to spend less time in that gap. Okay. If you're going to go into the gap, just go into a little bit. Sometimes you have to push into and hammer into it. And that's how we get better. That's how we make better, faster athletes. But at the same time, we don't need to be in that all the time. Okay. But we do need to flirt with the line. They call that threshold training. So I think that being able to getting this person to kind of realize what their threshold is. Um, obviously you might want to, uh, deal with the proper diagnosis of what the ball and socket hip is. Um, I think some good things to look at is look at the cartilage of the hip, look at femoral acetabular impingement, look at the actual hip. Um, you get the hip motion, uh, without active movement. And that's going to lead you to believe, is that a ligament? Is it a tendon or sorry, is a ligament? Is it cartilage? Is it the joint? Um, or you can, maybe it's an active component. Maybe it's a hip flexor. Maybe it's a high adductor. Maybe it is, um, you know, the, the tendons of them. There could be a lot of things. Maybe it's just arthritis in there. I mean, who knows? I'm not that I ever blame arthritis for a lot of stuff, but maybe, maybe it would, it's just a huge mushroom of a joint, which it should be a circle. So there's a lot of possibilities, but I think if you get down to the right diagnosis of it, then you can also find the right treatment for it. And then you can also reasonably assess your risk reward and just find your functional capacity, hit threshold every once in a while, and then start to improve your running from there. But you're going to have to make sure that your physio, um, is familiar with this type of thing so they can guide you and at least you can bounce ideas off of them.

So I hope this is helpful to everybody. And, uh, so if you, again, if you've listened to this entire podcast and you liked it, um, just submit your question in, obviously we can't give, I can't give medical information that you guys follow. Um, but I kind of go down this route here is it's kind of like, this is what I've done. This is what I've seen. Um, this is the theory of what would work. And, um, I think if everyone understands better of what their conditions are and what the, uh, current theory is for treating it, then I think we're all going to be better off. And I'd love to say that these podcasts are going to be extremely current all the time, but I mean, I can't be, I mean, I can't know everything, I guess. And that's why I have experts on. Um, but also too, when this, when I, I'll probably have to redo the same topic again in about a year or two years, because our theories change a little bit every year. And, you know, kind of what I knew when I started is not the same as what I know now. I do still hold same, still to those same principles.

Um, and a lot of what I do, it kind of is, there is still a lot of similarities, but you know, it's a, you got to refine a little bit, you have to get better. And that's why, um, you got to go to a doc, a therapist, a PT, or, or of any profession or any, um, even plumbers. Like you want to know the best plumbing that's out there. You know, you want to know who's keeping up to date. So I think it's really important to ask your doc, what's the last research article they read? Um, so if they said, well, I read one last week, great, cool. You know, it might not be the most current article, um, because maybe it was written in the 1980s, but still they're, they're keeping up on things, which I do like that. So you have to make sure you, you read some current stuff and, uh, you talk to other healthcare providers out there who are also progressively minded. So if you guys want to get ahold of me, there is the P2 sports care, uh, website, which is where I hold all the articles and the podcast on it. Um, I also have stuff within the store there, which I don't want to sound like a sales pitch, but honestly, the stuff that I recommend to you guys in some of these videos, as well as podcasts that I talk about in reference, I put links on this stuff in there because it's just easier for you to find.

I mean, I've had a lot of emails in the past where people are like, well, I, where can I find this band? Where can I find this ball? Well, it's right there on the thing. Um, it's in the, it's in the store. I mean, I don't, I don't, I don't distribute those personally. They actually go straight through Amazon. I get a small affiliate, uh, link on it. So, or affiliate fee, which I mean, it's nothing. It's like 4% of sales and you don't lose any money on it. I just, Amazon just pays me to put a link on the page. So if you guys want to help me out a little bit, if you do buy stuff on Amazon, I strongly advise you go through the store. Lastly, again, if you are a healthcare provider and you're like, yeah, yeah, I like this stuff. I'm trying to put all this type of stuff together again on those posters. And I know it's going to sound again, like a sales pitch. Realistically, when I started in my practice, I would have killed for posters like this. Okay. I'd absolutely nothing on my walls. I started with absolutely no loans. Um, or actually, so no small business loan. Um, all I had was student loans that I owed and I use stuff in my own bank account to start my own practice. So things like this, I mean, they're extremely discounted and cheap and so effective for, uh, educating patients. So if you want to look at them, go on to the shop page, it is the store on the PT sports care site and check them out. Um, they're high res, they are printable. I print them and send them right to you and we can actually customize and put your practice logo and information on it. You can actually have them for free too, by the way, you can't have the prints for free. Um, mainly because I'm kind of trying to control to make sure no one, uh, like steals them because it did take me a lot of time to make them. Um, probably each one took me easily over, over 20 hours to put together and write the information for. Um, but the, uh, but the web versions you can have for free, just go on to there, uh, the store and you will be prompted to, uh, put in your email address and then you'll get sent about seven or eight ones you can put on your social media and you can embed on your website.

So you can share with all your patients that way. And lastly, as always, don't forget to leave people a button on how you found them. Golden rule. Be good to each other. Talk to you soon. Thank you.