Testicular Tightness With Hip and Low Back Pain: What to Consider

Hey guys, before we start the show, I wanted to introduce the premium version of the podcast. If you've not taken advantage of it, you really should. If you're a clinician, this is not for lay public, okay? So scroll down in your podcast player and you'll find a button that says premium version. It's very cheap and it's a monthly fee. You can stop whenever you want, but what you'll get in this is more specific case presentations and things that I wish I could have done better and things that I think that need to be said. And, you know, I'm a little bit more frank and direct on that one. And so what you'll get is more so what I talk to my interns about and kind of like internal office discussions.

Obviously, patient privacy is there. I think we all need to start learning from each other and I'll help you learn from my successes and my mistakes. And that's the pure intention of that premium podcast. It's about 10, 15 minutes every week. It releases on Mondays. Again, you can stop whenever you like, but I don't think you will because I think you'll like it. Now on to the show. You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now your host, Dr. Sebastian Gonzales.

Hey guys, this is Sebastian, your host with the Restoring Human Movement podcast. Thanks for joining the Movement Movement. This is your first time in the show. Welcome. This has been a long time coming. You've been here. You should have been here a long time ago. We've been doing this for about 100, 225, 30 episodes now, probably. If you don't know the general format, the general format is it's partly clinical, partly educational for clients, patients, lay public, if you will. I try not to make the topics too complicated, unless we really need to. And so if you're a clinician looking to dig in deep into the research, this is not the right podcast for you.

There's other ones that are great. Jeff Langman has a really good one called The Evidence-Based Chiropractor. And I'm sure there's other sports medicine ones out there. However, today is going to be one of the versions which is a little bit more, I'm just going to brainstorm and stuff here because we've had a lot of people come in with testicular as well as hip pain. And there has been a lot of consideration that these are either testicular problems or sport hernias or FAI, hip impingement, and so on. And so there's a lot of unknown, I guess I would say, when these people have this problem, and I totally get it.

Like, I would freak out a little bit too. But I thought I would discuss a little bit today of what I see when we see these types of people and things that maybe you guys can consider doing. I guess if you're dealing with this, then maybe things that you should consider doing and really now before, you know, kind of get all your ducks in a row, if you will. Obviously, this is not medical information that I'm not treating you. And so just be aware. This is just good general educational information, kind of like your WebMD, if you will. Okay. If you're a clinician out there, and if you, hopefully, you think these are more thought-provoking podcasts, at least the one today, I'm not, I'm reserving the right to change my mind on some of these topics.

But, you know, there's not a lot of information out there on this. So this is just the best of my knowledge at this point in time. We do have a good success rate with helping people with this type of problem. But at the same time, it's always, there's always a couple things in the back of my mind that I would like to make sure that they're figuring out before they actually come to me. By the way, if you're looking for the old podcast, just scroll all the way down. We have lots in the archives, which are really, really good. I've added on some great industry experts for low back pain, some hips, some shoulders.

We've covered a variety of topics over the years. And I feel like this podcast has made me better and better as a clinician. And I think my patients benefit from it. So I'm still working on improving some of my speaking skills. So we are going to first cover what are things that you might want to rule out. And the first thing is, actually, I should go backwards a little bit here. People will have different distribution patterns with things like testicular or hip pain or even low back pain, SI joint pain, associated with problems in this area. And not everybody's going to be cookie cutter. Not everybody's going to be your quote-unquote stereotype textbook sports hernia.

And because of that, everybody's treatment is going to be a little different. And the way you arrive at the right treatment for you is going to be different as well. So just remember that you're not all going to be alike. And some of this might resonate very strongly, pinpoint to you. And other things are like, well, I have that and not that and so on. It's okay. You know, this is, again, good general information. So the thing that I first kind of look at when people come in with some testicular, we'll call it tightness. It's not always pain. Is I consider, is there anything else going on with this person?

Is there anything that can increase or decrease their pain, such as bending forward, bending backwards? Do they have hip pain as well, like in the front? Do they have gluteal pain in the back? Do they have lower back pain? Have they had this before? Is there anything visually protruding out of the area? Does it increase when they bear down? And basically, does it change with posture, position, and so on? Is it activity dependent? So these are all things that are, will help give information about what we're really dealing with here. Obviously, there's, I mean, there's things that have come into our office that are not things that we can help you with.

There's, we, we would, we would refer out for testicular examination for ultrasounds. We'd also refer out for ultrasounds of things like direct and indirect hernias too. By the way, it's important to note that sports hernias, inguinal hernias, or other types of hernias where the abdominal conscience is protruding out are actually different. The sports hernia is, is kind of like a, they say it's like a frame of the aporosis or some of the fascia into the area versus actually stuff protruding out of the abdominal cavity. And so if you're looking at the abdominal cavity protrusion ones, those are ones that I remember back in high school football, they would check you for, you know, it's just part of a, of a general physical.

Now, there are ones that you can't necessarily see either, or even really feel that well. And you might need a dynamic image to give you a better idea of what's going on, such as like a musculoskeletal ultrasound is a really nice thing to do. Uh, and that'll give you good information about whether you have your abdominal contents kind of, uh, I don't want to say protrude. It sounds scary when it's like that. It's just, it's, there's like insufficiency in the abdominal wall. It's not containing the contents. Uh, and, and from what I understand, the danger with that is that, um, you can have some of your food contents or stuff you've eaten kind of get stuck within the outpocketing.

And so that's obviously something we won't be addressing in full detail today. And those are things that I usually refer out for, for examination. Also too, um, um, I'm obviously everybody should be doing their own testicular examination. All right. Uh, we learned at an early age that you should probably be self-examining. Um, I'd say once every couple, two weeks, three weeks, a month, you know, the kind of the same general thing as, um, um, self-examination. For women, uh, for just for breast health as well. Um, you want to make sure that you can do that and know how to do that. I'm sure there's some references online to teach you how to do that, but it really comes down to kind of figuring out a baseline.

You know, um, is there something that you've had for a long time down there that, which isn't growing and isn't changing? You know, you wouldn't really know that you had anything in the first place until you look. And a lot of times people don't even know they have pain or, um, like bumps in certain areas. Um, I'm not even talking about testicles at this point. Let's just say like with your low back, like people feel their low back and they're like, well, there's that little bump under the divot. And so that thing right there, that bump, I don't know if, you know, if I was always there, like people generally don't always feel an area or aware of the structures and bumps and divots in areas of their body until they actually look or feel it.

And until then you don't have a baseline, the same thing happens with like, um, skin inspection for dermatology and, um, you know, uh, skin cancers and so on is you don't really notice until you notice. And so just getting a good, a baseline is probably the best thing to do. Um, we've had people reach out to us who have been really concerned about, um, they, they will call it testicular pain. Some call it testicular tightness. Other ones can't really fully describe it as kind of say like, it just, it just, it just feels different, you know? And, um, they've had full workups. They've been to a urologist.

They, they've had an ultrasound in the area, uh, and they've, they've talked to specialists about what's going on in the area. And there's still people that there is no positive findings in that realm. And so it's, it's kind of confusing a lot about what to do next or what it could be. And so that's what I'm going to present on the possibility of today. Obviously, I think everybody should go get examined and do their due diligence to rule out the big, bad, and scaries first. I mean, I believe in having a, I call them the big boy conversations. Like, you know, people are like, well, you know, maybe I could just do a little exercise or movement.

And, you know, this, this pain will go away. It's, I mean, the fact of the matter is it's in an area that I kind of think you probably want to deal with, you know, soon, or at least rule out all the red flags. Cause it's a little bit of an atypical presentation. Um, obviously musculoskeletal pain or just general things can refer into that area. But, uh, I know if I, if I was having this problem, I'd want to do a self-inspection. I probably want to have, um, a professional look at it as well. Cause again, they've felt a lot of, uh, normal and abnormal. Uh, and I'd want to look to see if there's anything there.

Obviously doing general things like blood work every year is very nice. Having a physical is really nice. Uh, and just having someone to a skilled eye or a skilled professional to create a baseline for you. All right. If you're not doing at least that stuff, you're not being a big boy. You're not being a big girl. You're not being responsible. Okay. And I know this is a tough love conversation, but everybody has the ability to do that. And you have responsibility to yourself to do that. Okay. Uh, I don't like getting blood work done. I'm scared of needles. Um, but you know, I, I at least do it once every two years.

Um, I want to do it once every year, but it's just, it's, it's tough. You know, it's about the time of year actually for me too. I'm should probably just schedule it now that I'm trying to be a big boy. Um, but anyways, uh, do yourself a favor and give yourself a fighting chance. Cause if you go into someone like us or, you know, your local, um, sports medicine doctor or whoever you decide to take the next look at it, having all those ducks in a row and knowing that there's nothing else going on down there that they need to refer you out for is actually really helpful. It gives us the ability to give you a better idea of what to do next, um, versus sending you out for, you know, um, you know, uh, urinalysis or blood work or an ultrasound or an examination.

Okay. Um, uh, I'll be honest with you. Uh, we don't examine down there in our office. Okay. We learned a little bit in school, just a little bit. If I was going to do a percentage based, um, a percentage base of how many times we spend other things in school, spend time doing other things in school versus doing this, this is well under 1% of any, of anything, you know? And so go to an expert, go to an expert on that. Once you ruled it out, then you can consider what we're going to talk about next. So, uh, the next thing is that when someone is kind of ruled out for all that internal stuff, we got to consider the possibility of what is still going on there.

And I first kind of go down the route of what we call associated symptoms. Um, obviously that's the main concern, but upon looking a little further and asking people, sometimes these people have front of hip pain and they've had it for a little bit of time. Sometimes they've had low back pain. Sometimes they have stiffness in their back or hip that they would consider normal for them in their age. Um, if you, if you ask them to, they, they might feel like their whole leg or that side of the body is tight. Now, um, these give us insight of other things that could be related to the area. Um, that whole area kind of functions as one big unit.

Um, it's really hard to separate the low back from the hip area. And obviously we're talking about some testicular aspects here. It might be useful to kind of say, we're going to, we're going to graduate the conversation to talking about the region. Okay. The region in there, uh, works together and you have responsibility to treat it together. Typically when someone has low back pain or stiffness or something that is different than the other side, I'll start there. I'll start there to see if there's any easy wins and if there's anything that will reduce the sensation and issues they're having into their hip or the testicular area.

Um, it's probably important, important at this point to note, um, sports hernias as well. Um, it's, it's kind of funny. Uh, I wrote this big article on our website and you can go through and search, um, on our little search bar sports hernia and you'll find it. Um, it's long, it's really long. And I wrote it and I updated it, I want to say about two years ago. Um, but I wrote it about four years ago and, uh, kind of did some touch points over time. By the way, the website is p2sportscare.com and, um, it's, it's funny because sports hernias are, it's kind of like a unicorn, you know, you don't really see a lot of them.

If you call some clinics around and you say, Hey, do you treat sports hernias? They're like, like, you'll get this voicey washing answer from them. Um, and there's nothing to say wrong about them, but like there's clinics that only work with shoulders. There's clinics that only work with low backs. And then it's like sports hernias, testicular, you know, yeah, sure. Come on in. Like it's, I mean, you kind of want to go to a place that has, um, has this had some good experience in the region. It can tell you beyond reasonable doubt. Yes, you know, we can help you. And it's common apparently for men to have testicular tightness in the presentation of a sports hernia.

They also find it's hard to pinpoint. They also find, uh, that it's, it's funny that they rest it. It goes away. They go back into the sport. It comes back. And then, um, kind of the definition, if I can recall off the top of my head is, uh, groin pain that is unresponsive to rehabilitation. Kind of vague, right? I mean, you could just say that maybe it was bad rehabilitation or it was the wrong rehabilitation for the problem. And so sports hernias are a little bit of enigma, but if we kind of roll this back a little bit and, and break it down a little bit more, we can see that there's a possibility that some of the sports hernia cases are actually low back referred cases.

I'll tell you why right now. So, um, I'm looking at Wikipedia right now just to give you some baseline of, of some of the area. And I want to make sure that all of the anatomy, um, the anatomy people out there who might just tear me apart for getting something wrong. I'm just going to read from this. Uh, the general femoral nerves refers to a nerve is just that is found in the abdominal, abdominal area. It branches, it's branches, the general branch and the femoral branch supply sensation to the upper anterior thigh. For everyone, uh, not, um, medical that's upper front of the thigh. Think about kind of like high thigh in the front as well as the skin around the anterior scrotum in males in mons pubis and females.

So mons pubis and females is like kind of like the, you say the, the, like the mound, right? The femoral branch is different from the, from the femoral nerve, which is also arises from the lumbar plexus. So lumbar means low back plexus is there's like a collection that all the little nerve roots become like a intermixed twine of, of nerves of bigger nerves, and then move out to other areas and branch off again. So the genital femoral nerve originates from upper, from the upper low back, which is L1 and L2 segments of the lumbar plexus. It passes down, pierces the psoas major muscle and emerges from its anterior surface in front surface.

The nerve divides into two branches, the genital branch and the lumbar inguinal nerve, also known as the femoral branch, which then, uh, which, uh, both of which then continue down and downward immediately into the inguinal femoral canal respectively. And so that kind of goes down into, let's just call the inguinal area, the groin. All right. It's like that crease in the front of the hip. Okay. The genital branch passes through the deep inguinal ring and enters into the inguinal canal. In men, the genital branch supplies the cramasteric muscle and the scrotal skin. Cramasteric is the, um, muscle that elevates the testes up and down, um, with temperature or voluntary.

And the scrotum is obviously the, um, you know, the sack. And so it supplies the skin for women. Uh, the genital branch, uh, accompanies the round ligament of the uterus terminating in and innervating the skin of the mons pubis and labia majora. So what we're seeing here is that, uh, the reason I'm bringing this, this topic up is because if there's a possibility that people are dealing with something that is in a testicular pain or testicular tightness or testicular sensations that are abnormal and they've ruled out all of the other things that could be there, big, bad, and scary. And there's nothing physically wrong with the testicle nor the scrotum or anything in the region.

And in the absence of having anything like an actual hernia, what are we looking at? And so there's a possibility that maybe the feeling of tightness or the feeling of pain is just a feeling that's being sent to the brain via the electrical impulses that do that. And so there's a possibility that this genital femoral nerve is something which is being irritated by what that, then that comes down to how you treat it really. Um, I've thought about this before that there was, um, someone that I've worked with that they had, I believe they did have a, a, a hernia coming through the canal in the canal.

There's, um, obviously there's stuff that goes to the testes, um, such as like ducks and things like that, but there's also the nerve in there. There's this genital femoral, uh, this, uh, genital branch of the genital femoral nerve. And so if nerve don't like pressure and there's extra contents in the canal and the canals of finite size, maybe that's creating pressure, which is creating that sensation. And although the, uh, obviously in this scenario, the, the problem would be the hernia itself. That might be one aspect of maybe how they might mechanically get some of these sensations in there without actually visually seeing any herniation, uh, sorry, um, um, uh, abdominal contents coming through, you know, maybe then ultrasound would see that a little bit better.

However, we can also take the approach of just considering that the nerves are one cell and we do have the scenario. A lot of times when, when someone has say like low back pain, uh, that is oftentimes you can have some pressure onto the S1 or L5 nerve root via whatever, that's a whole different conversation. Then they can have, um, problems into the areas where those nerves innervate with motor or sensation. And obviously this is, uh, this is something I, uh, people might disagree with me on. Okay. And, uh, I, I have, I'm not any, I'm not a research nerd, but I'm just observing what I see in my clinic.

Okay. People feel, uh, we kind of see that if someone has a compromise of one nerve root, say S1, well, we might see a loss of motor strength of the nerves or the muscles that they innervate. We also might have just general pain in some of the muscles that they innervate. And we might have a change of sensation in the area of the skin that it goes to. Okay. So we're talking about motor, which is kind of like, you know, muscle contraction. And then there's a feeling, which is input. So we have input to a nerve and then we have output. Output is what it does for the muscles down there, I guess. And input is how it gets its information like sensation.

And so say we're talking about this L1 S1 area, we can say, I mean, so it goes motor to the muscles of the testicles, but it also has sensation ability too. And so maybe that what you're feeling is not necessarily actual tightness or, or, or, sorry, let me rephrase that. You might just be feeling the feeling of tightness, or you might just be feeling pain because that nerve has some pressure on it, maybe. And could that be from what's coming through the canal? Maybe. But it can also be from where the nerve is being pressurized somewhere else. And so there's been a lot of talk over the years about the femoral nerve or the genital femoral nerve being created, having some pressure on it from, as it pierces the iliopsoas muscle, or what we might know as the hip flexor.

And yeah, that could be as well. But also too, it could just be as it comes out of the spine, which would be a hole, which is called a foramen, which is the hole where it exits, or it could be a disc, which is really common in the low back, a little less common in the upper low back, because this is the higher low back we're talking about. But yeah, it could be any of them. My point is, I think that we can kind of go back and consider where we've come in this discussion about this problem, which seems like a big enigma, you know? And obviously, these aren't cut and dry cases for us either. We still have to consider a lot of things.

But once we kind of roll out the big, bad, scaries, we got to consider maybe, is this really a problem with structure down there or not? It seems like it's not, because the images are pretty sound. You know, like I think we kind of, we've put a lot of weight on images over the years about, well, I don't see anything, so nothing's wrong, right? And these are very sensitive images. And I think if we are going that route logically, we can say, well, if there's nothing physically wrong there, then maybe it's not even a problem there. It's just, it's a problem from referral. And in that case, we have to chase this, this nerve up possibly and see if it's being compromised elsewhere.

And a lot of times we treat this from a low back first, because it seems like it's the most common spot, especially if somebody has some stiffness in that area. I personally have some stiffness around like the kind of bony aspects. It feels a little deep. I can almost, it, for me, it feels like almost like when I bend forward a little bit at that area in the high, low back, it feels like it's almost like a band-aid about to slowly rip off my skin. It's just not really painful. It's just stiff in that area. And once I'm kind of rounded into the position a little bit more and longer and I breathe and do something like frog breathing for it, it actually feels much better.

And that stiffness goes away. And so with that being said, you could be creating, I could be creating some pressure on the nerve at that area. And so we find that the highest probability of dealing with these things and getting them to go away in the absence of having any big, bad scaries is starting at the spine and then considering maybe the hip flexor. If the hip flexor is a problem, maybe something's telling the hip flexor to be tight protectively or maybe just the musculature around the area is not helping or off. There is kind of this theory that's been around where, you know, something works too hard and something's not working.

And in order to shut that one down, you got to get the other one to work its share. I think the verbiage used associated with that is kind of, it kind of butchers things, which, you know, it puts it in a, it butchers things, but I'm okay with it. I'll put it that way. Because although, you know, from a clinical aspect, like you never really shut the muscle down. There is no muscle that's really off. What we really need is the people, the patients, the clients just to do the work. And so if I say the hip flexor is working too hard, we need to get the glutes to work harder. Let's work the glutes and they do the work.

Does it, it doesn't really matter. It doesn't really matter the semantics of it. The outcome is, is still what we need and what we need to test. And by the way, this doesn't work for everybody. Um, so it's important to note too, that maybe a timeline, because I've noticed a lot of people will, there are a lot of patients will have a misconception of what to expect from successful intervention. Um, now I, I know everybody's a little different with this because everybody has different problems with different severities for different times. Uh, however, I do think there's some merit to saying that, um, spending about three weeks of doing a single intervention, whatever that might be.

And if you notice like a 50% reduction of, I'll say, I'll say symptoms at this point. Uh, I think that's pretty on par and it's very reasonable. And what I, when I say symptoms, I say that because some people feel pain, some people feel tightness, some people feel other things, you know, um, there's a gentleman that comes in that he, he talks about it as it's, it's not pain. It's just an uneasiness. It's like a storm, if you will. And so some people describe things as colors, you know? And so whatever that feeling is, and if we're talking about, you know, groin pain or low back or any of that stuff, like it usually within three weeks is a good enough timeframe to figure out if the intervention you're picking is actually, uh, going to be working or not.

Now, to be clear, when you're reducing pain or symptoms, it doesn't restore function. And the longer you've had something, the more ingrained some of these motor patterns are in compensations that you might've had. Um, and it's just harder to break. It just takes a little time. Um, but these are called motor engrams and it's where the body has the kind of the software patterns, kind of like, uh, uh, Neo and Matrix. It's like, Oh, I know, I know judo now, you know? Um, you don't have to think about judo. I know when I throw a baseball, I don't have to think about throwing a baseball. It's a pattern that's ingrained in me, right?

And it's hard to break some of these patterns without some good coaching. And so function and strength doesn't return, but the ability to attain it does, especially if we can get rid of some of the pain and maybe reasons for movement compensations. Um, so let me, let me reiterate that one more time. I think three weeks is fair to see a good 50% reduction of whatever's going on. And then later take the advantage of actually feeling better to actually restore function. Because if you don't restore function, then I would gamble and say, it's going to come back. You know, I think there's a reason why a lot of people will have reoccurring problems throughout their life.

Um, it's like, ah, it's, it's my bum knee. It's like, well, it's because a lot of people just manage pain and there's nothing wrong with managing pain. It's just, that's all you're doing. Like you're not restoring function. You're not restoring the, I guess, bulletproofness of the knee and you're not helping out with mitigating, uh, return of, of that problem again. So, um, just consider that by the way, I should, I should regress back a little bit to, um, associated symptoms with this because, um, it's really common for people to want different things or divide things up in, in partitions. Um, I spoke with Andy Galpin one time and he had a really good saying about how, how humans like organization and how in the universe, there is no Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, and so on.

There's, there's none of that. And so, but we really like it because it organizes our, our life and our thoughts. And so when we've kind of gone down this route of creating like diagnosis, if you notice, you might be given a diagnosis, like three different diagnosis. Um, and then, so some people are like, well, I need, so I have hip flexor tightness too. And I also have this tech to testicular tightness. And then my back hurts a little bit too. Can I get something for all of these? Remember, these are all probably the same thing. Okay. Because if we, if we go backwards again in this scenario, which again, not everybody's textbook, and this is not even as simple as it is when, when people come see us for this.

Um, if we have some stiffness at L1, L2, the mid back area, and that's the area that the nerve comes out of before it creates that cluster of nerves, before it goes into the hip flexor, before it goes into the canal, into the, into the test, the, the, the, the scrotum, um, that's all kind of the same thing, you know? And so they have a intimate connection with each other. And so I think to separate these things into different, um, scenarios, I think it'd be very, uh, I think it'd be hard on not only the patient, um, but it would also be, I think inefficient. I think if we just halt this from whatever is the root cause, I think a lot of the other stuff will just naturally go away on its own.

Um, an example with this is it's really hard to refute the concept of general physical preparedness and how people feel physically, um, with their aches and pains associated with aging when they just actually do something. And so, um, uh, we, we have, uh, I know somebody who, who, um, they just started working out three months ago. Um, he's probably about 60, 80 pounds overweight, um, about 50 years old or so. And so he's like, well, you know, I, I was really surprised just by working out all the things I thought age related pain that were going on, they're like all gone. My knee pain's gone. My back feels better, you know, and this is just generally becoming physically prepared.

And so just sometimes doing stuff that is helpful generically can really help out by un-mudding the water with a lot of the other things that you might be dealing with. Now, obviously there's a lot, there's very much a time in place for specific care. There is, okay, but some people just respond really well to general programming. If they've been lacking general programming, what I mean is that if somebody generally doesn't walk and they sit all day, just have them walk, they'll probably feel better. And so, and that goes for head, neck, shoulders, mid back, knees. It'll probably feel better with a lot of things.

And, um, people who don't lift any weights at all, you put a little load on them, they'll generally probably feel better to people who don't do any flexibility at all. Like any stretching or that you do a little bit of that, they generally feel better. And so there's obviously a need for specific care. And in this case, I would give specific care because, um, uh, that I think there is, I think it would respond really well. But at the same time, if I want to take the long approach with somebody and they say this person was, you know, 50, 60 pounds overweight, they weren't physically active at all.

I think if we just got them to move a little bit, I think they would probably knock out half their problems, but they still might have a little bit of groin pain and a little bit of back pain still. Um, so obviously I'm not giving specifics of what to do in this case, because quite honestly, the, the suggestions are, the interventions are unique based upon your unique circumstances. If you're, if you're a professional athlete, I don't need to, we don't need to give you general physical preparedness. You're probably physically prepared enough. And so it's based upon you, your symptom patterns, what you've tried, are you clear of the big, bad, and scaries?

Um, and what are your goals? And so, um, I think if you get all those ducks in a row and you have a good idea of, of ruling out your red flags and you have a good team, I think most people will probably overcome this again. Um, I'm not doing this podcast because I want everybody with testicular tightness to come in. I really don't. Um, and I was really hesitant on doing this podcast because it's a, it's a subject that, um, I mean, I think about, I kind of tell my interns, like I want to sleep well at night because I do think about some cases that are unique and, um, ways that I can improve. And, um, did, were we, are we going to be able to get this person out of the weeds and help them?

And to be honest with you, like when there's cases that are going really well, when they just slam dunks, like they're easy, like low backs, shoulder blade, easy, most of the time they're really, I don't want to see, I hate saying easy because it means that it's like, I kind of think it's like demeaning because everyone's like, oh, everyone should know it. Um, it's simple. It's simple. The person just has to do the work and I feel good because they're getting better and I sleep well. Okay. But unique cases for me, I lose a little sleep over and I like sleeping. I value my sleep. I'm 38. I like, I like my sleep.

I feel good when I sleep. And so by all means, I'm not, I'm not saying everybody coming with testicular pain to us. Uh, I'm just saying this is a topic that has not been addressed. Um, a lot of places. And I think the conversation can be more comprehensive, such as, such as this, obviously there's going to be parts that I've missed and I'm hoping someone else can pick up, you know, the, this conversation and put it on their podcast or their YouTube videos or whatever and help educate the public a little bit more about what the possibilities are. Cause there's people suffering with this. Um, I remember when I first started practice, somebody suffered with coccyx pain.

There was like, I think I know what I would do now. I really do think I would, I think I can help them, but it was sad to see, like they went through so many people that were sitting on a donut. Um, they couldn't even go to dinner without standing up every couple minutes. Um, and it's unfortunate because I think when, if we're really trying to improve ourself as a profession and get our patients to, um, feel better, you know, when we start helping people through more things, I think we have to share the information we know at hand and then the next generation can improve on it. So I'm hoping that at least accomplished, accomplished this.

And if there's patients listening or clinicians listening, obviously I dodged and weaved between, you know, kind of conversing with both of you. Um, but do your best, be a big boy, big girl, be responsible for your own health. And, um, if all that's clear, go find someone, go find someone else. Okay. There's probably a solution. There's a solution out there for a lot of people. You just have to find the right solution for the right problem at the right time. So, uh, I hope you enjoyed this podcast. Please subscribe if you enjoyed it and, um, share with a friend. Okay. The only way this podcast continues to grow is if you share it.

I, we have zero marketing dollars. We don't promote this podcast really any other way. Um, cause we have an office to run. So, um, but yeah, share it. Uh, and I'd love to see it grow and continue to learn more over the years. Thanks for being part of the movement. See you next time.