Musculoskeletal ultrasound: what it shows and who should scan you

This is number 27 of the Performance Place Sports Care Podcast. I'm drinking coffee. Welcome to the Performance Place Sports Care Podcast, where you can learn about sports injury theory, rehab, diagnosis, and how to understand the doctor lingo you didn't understand at your appointment. And now, your host, Dr. Sebastian Gonzales. Hey, everyone. It's Dr. Sebastian Gonzales with Performance Place Sports Care Podcast again. And we have an awesome guest today. His name is Mike Jabilon. He's actually an ultrasound sonographer. And I thought I would actually bring him on because he was one of the people who really got me into doing ultrasound diagnostics.

And I know if you probably hear the word ultrasound, you're thinking treatment, or that gel that's put on you, and someone sits there and kind of rubs it on you a little bit, and it takes about like 5 to 10 minutes. And this is different. This is basically getting an MRI or qualities of an MRI, actually, a lot of them are comparable to an MRI, without actually having to go through that clunky machine, without having to get all this authorization from your doctor and so on. Like, you can seriously come into an office, and within a minute, you can see a rotator cuff tear. It's so, so cool. So, me and Mike met, actually. He taught me how to do some of this ultrasound.

So, I shouted at him quite a few hours, and he has a lot of passion for doing it. He's been doing it for a long time. So, here's Mike. He'll tell you a little bit about himself and kind of how he became so passionate about doing ultrasound. Mike, why don't you take it here? Yes. Hi. Good morning, Sebastian. Thank you so much for having me a part of this. Morning. And, absolutely, ultrasound is more than just a job for me. It is absolutely a passion. And one of the things that I am so passionate about is the instant information that ultrasound gives. Having an idea and then looking right inside of the body and being completely safe makes it even better.

So, being able to help people quickly and get instant information on the spot gets to be very exciting, and it makes the day very enjoyable to help people. Yeah. I know that you said that, actually, one of your tags you told me, or your mottos, was, it never felt so good to know what is wrong. Is that it? Yeah, that's right. Because we find that an amazing thing happens, for better or for worse, when we diagnose a problem. That the person feels better. Even if there's a serious problem that we diagnose, somehow learning the cause of your pain is relieving in itself. Yeah, I actually had, I have a patient now that his wife actually told me, she's been gone through, she's gone through a lot of things and not knowing exactly where condition was.

It wasn't an ultrasound case, but she found out she had Ether Danlos Syndrome, and I'm like, oh, that sounds terrible. And she's like, actually, I felt really good, because she knew finally what it was. So, I know exactly what you're talking about with the ultrasound findings. So, tell me about, like, your background with ultrasound, because I know that you've had, actually, extensive, I mean, you've been around ultrasound for a long time. So, tell me about that, because I know everyone's probably wondering, is this a new field, and so on? Yeah, my background in ultrasound is unique from a lot of people, in the sense that I was raised around ultrasound.

My father was one of the early pioneers in the technology in the late 60s and early 70s. So, in most of my childhood photos and my childhood, I was surrounded with ultrasound, even to the point of early grammar school, during a show and tell, bringing a pocket Doppler and listening to the kids' carotid arteries at a very young age. So, my background in ultrasound goes back to the beginning of my life, pretty much. But as I got into my adult years and ready to pick a direction of my life, it seemed very natural to go into the field that I knew so well, ultrasound. And being from Philadelphia, where I'm from, I immediately went to the world's greatest ultrasound department, ultrasound school at Thomas Jefferson University, and began my training there.

Yeah, I think I told you I had some sonographers come through here, and they were wondering about how to do ultrasound for me, because they actually don't teach a lot of it in school, at least around here. Is that true? Yeah, it's difficult to find quality ultrasound training. And ultrasound training is broken up into two parts. There's the physics and administration, which is pretty general. And you can go to a lot of places and get that type of training. And then there's the specialty itself. So, if you're interested in looking at hearts or babies or abdominal organs and things like that, there's special training for that.

And now, if you're interested in musculoskeletal sports injuries and joint injuries, there's extra training in that department nowadays as well. So, what are some, because I know probably everyone wonders how this is going to correlate to them, what are some cool, like, interesting and common things that you typically find in an ultrasound? Well, on a daily basis, we see a little bit of everything. Something from a simple shoulder injury, patient that can't lift their arm and they're not sure what's wrong. So, we see a lot of athletic injuries of all ages. So, from young grade school kids up to professional athletes, we see all different types of knee injuries and elbow injuries.

And we also do a great deal of work in rheumatology and in arthritis. Ultrasound has become incredibly powerful for examining the condition of joints. And this information is very important in the rheumatology field, for example, to know and understand the level of joint damage that a patient has. So, a typical day for me is a wide variety of anything from pediatrics to osteoarthritis and different forms of rheumatoid arthritis. Yeah, I've seen the rheumatoid arthritis ones. Those are really colorful pictures, aren't they? Yeah, it does. And it really changes people's lives rather quickly. Yeah.

I know that you said something about a shoulder, and I know you'll remember this story, but I actually tell it quite frequently when I have shoulder cases coming into here, is that, like, remember when my mom came in and we found that full cuff tear on her? Yes. Yeah. So, it was an interesting story was my mom came in, actually. She didn't need any help. She just came in to pick up my dog, and me and Mike were, he was teaching me to do ultrasound, so I know she had a past partial rotator cuff tear. And so, we wanted to see it, and lo and behold, the complete super spinaeus muscle was just blown off of the humerus, and she can move her arm with no pain.

She had full range of motion. It was crazy, because now when people come in, they can't move their arm. I wonder, why don't we just image them first, and just, if they're a fully blown off tear, then we refer them out, you know? Yeah. I remember that day, and I talk about that often, and your mom was so sweet. She came in, and she's a tiny, tiny little lady, so it's easy to see inside of her, and instantly, in a matter of seconds, we could clearly see that tendon was gone. And I know there was a look of a bit speechless on all of our faces, like, really? That's what we're faced with right now?

But it was crystal clear. There was no question about it, that that was what was going on. Yeah, I still actually have her image saved versus the MRI she got later. And actually, when she went into, she went into an orthopedics office and had it repaired. But I went into the appointment with her, and we had the ultrasound to validate it, and she had the MRI, too. And the doctor's like, okay, have you had x-rays yet? And we said, no. And they're like, all right, let's go get a series of x-rays. I'm like, why? And maybe there's something I don't know about repairing the shoulder, but I thought it was clear as day.

Yeah, that's exciting. See, that's ultrasound right there. There's no reason not to do an ultrasound on the spot. It's completely safe, and there's no side effects. There's no radiation. So you could be around an ultrasound machine all day long, and it has no negative or side effects on the human body. Now, have you ever had, I know I've had the question from, actually, I had a kid that he was about 14. We were looking for a hip condition, which we didn't want to subject him to x-rays, so I suggest that we do an ultrasound. And he came back from another doctor and said, I don't want you to do that.

It's not safe, the radiation. So do you still find that people have a misconception about safety of the ultrasound? Yeah, that must be a misperception, because in all of my years involved with ultrasound, I've never read a reported contraindication to its use. It simply uses a high frequency of sound waves beyond the audible human range. And to modern-day science, there is no known side effect or any type of negative response that could be created from diagnostic ultrasound. There are other forms of ultrasound, such as therapeutic, that create a deep heat, and it's a much lower frequency, and that could cause some burning if you left it on the skin.

But diagnostic ultrasound has no reported contraindications that I know of. Yeah, I don't think I have found any either, and they use it on – they look for hip dysplasia on babies, I believe, with it, right? Routinely, that was one of the earliest uses of it for that. Very easy, simple thing to do. And that's an example right there on looking at an unborn fetus. Doing ultrasounds throughout the day on unborn babies is a perfect testimonial to the safety of diagnostic ultrasound. Oh, yeah. And I forgot then – so, yeah, pregnant ladies can't do – they can't do x-rays, so looking at them under ultrasound would be great.

So if you're a pregnant lady and you want to know what your condition is, ultrasound is probably one of the ways to go. Yeah, and that's one of the things that I love about it. There's so many different things I love about the technology, but the safety of it. I have a lot of friends, for example, that are radiology technicians, and their day is spent adjacent to an x-ray. And as we all know, there are a lot of red vests that the patient has to wear, that the x-ray tech has to go behind a shielded glass. There's a great deal of exposure to radiation when dealing with a simple x-ray. Yeah, I remember seeing fluoroscopy.

And the beauty of ultrasound is getting fluoroscopy as well. Yeah, they wear complete lead suits in there, it seems like. Yeah, so that's a great thing about ultrasound. It's completely straight. I know that one thing that I've been researching on a little bit lately, because it's an interesting area to me, is sports hernias. And I know that we spoke about it a little bit. Have you had experience in sports hernias? Because I know that ultrasound is supposed to be one of the higher gold standards for that, right? Yeah, sports hernias and inguinal hernias, direct or indirect hernias, are always a concern when examining hip and groin problems.

An ultrasound has always been a go-to, very readily available test to make a quick diagnosis on that. There could be other possibilities, such as an iliopsoas, tendinitis, or bursitis. There could be a hip joint issue or a labral tear in the hip. So there are a lot of differential diagnosis to hernias that need to be separated and taken off the table so you can focus on the proper diagnosis. Yeah, I think it's a good point. I know that I've had people come in with hip conditions, and the argument against doing an ultrasound on their part or what they've heard, they're like, well, can we see inside the hip?

I'm like, well, we can't see past a certain section. And they're like, well, why are we doing it? And I'm like, well, it's almost like a rule-in, rule-out game. If we know it's not the iliopsoas tendon, we know it's on a sports hernia, we know it's on a hernia itself, then sure, it leaves a lot of things that are no longer on the table anymore. Yeah, the technology has come leaps and bounds. It has really improved tremendously over the years. And nowadays, we can look into a hip joint very quickly and get a great deal of information, even looking at the quality of the joint, the condition, which is something ultrasound has never been known to be strong for.

But nowadays, with this incredible resolution, we can see the head of the femur, and we can see the acetabulum, the joint surface, and determine if there's any arthritis. You'd be amazed at how many people have a simple osteoarthritis of the hip or maybe a labral tear in the hip, and it's confused for a hernia. Sometimes you get a lot of the same groin pain symptoms into the groin that are misleading. Yeah, can you see, so we can see labral tears too, right? Yes, we get a really nice window into the anterior labrum of the hip. Okay, yeah, I was curious because there's actually a patient I have right now that the, she's actually been back and forth from surgeons looking at her back as well as, gosh, they were even looking at, they're looking at some fibroids on her ovaries or uterus or, gosh, that's not my field, but for the most part, she has hip pain, and they couldn't figure it out, and I actually had to send her for an arthrogram, which obviously includes dye.

We didn't do an ultrasound on it, but it was amazing that we found a labral tear there, which seems like she presented like she had a labral tear, and no one really looked at it. In ultrasound, it seems like it'd be such a quick way to just eval it real quick. Yeah, there's always no problem in doing an ultrasound first, and then if we need to step up the game and bring an MRI in second, and then an arthrogram, you always have to consider the test itself. An arthrogram is an incredible test for this type of a problem, but still, you're using injected dye, gadolidium. Some patients have reaction, anaphylactic reaction to dyes and things like that, so you always have to consider the aggression of technology.

Are you going to jump right to an arthrogram? But there's no reason why not to do an initial ultrasound and get a good view of the joint surface, get a good view of the labrum, and start with that. Yeah, and also too, it's more, I know that we've talked about the cost of it versus these other tests. I don't even know what the other tests cost, but I know how cheap ultrasound can be. Yeah, that's another advantage. Obviously, I'm very pro-ultrasound, but another advantage to this is the cost factor. Ultrasound is a relatively inexpensive exam to perform. In comparison to MRIs and arthrograms, especially, it could be well over $1,000.

It involves a radiologist's time, a rather long needle. It's a bit of an uncomfortable test to have, to say the least. So, yeah, ultrasound costs a fraction of the other imaging modalities. Yeah, yeah. Have you actually, I don't think I've asked you, have you had any experience doing other types of, like, have you done x-rays personally? Like, I don't know if, do you have your degree for that or anything like that? In our musculoskeletal training, it includes and requires a lot of internship and cross-training in other imaging modalities, such as x-ray and MRI and CT scan. So, we're interacting on a regular basis, and I'm fortunate at the facility I work at that we have an MRI scanner right there, and we have x-rays and every type of imaging modality under the sun.

So, we're always comparing ultrasounds to x-rays, ultrasounds to MRIs, and even ultrasounds to surgical outcomes. We work adjacent to a surgery center, and many times we do an ultrasound in the pre-op holding area. They go in and have the surgery, and we get a chance to stand in there and watch and on the spot see what we found. What does it look like in vivo? And so, we're fortunate with that. Does it look how it looked on the ultrasound? Is it how you imagine it? Yeah, it's amazing. It's really amazing to see a torn tendon ripped away from the bone with jagged edges, and then you go into the surgery and you see the same tendon torn away from the bone with the edges.

It's pretty fascinating. I don't think there's ever a day that goes by that I'm not fascinated by this technology. Yeah, you should almost play like almost like a game to see who can draw the best picture before you get in there just to see and like match it up. Oh, yeah. We're always playing games like that. We joke about things like that standing there as they're about to open a shoulder and look in. We're all taking bets on who's going to be right. Not everybody agrees on what they might find, and we've had some really remarkable intraoperative stories, a lot of exciting stories to share of our experiences in the operating room.

So how many times, because I know that people wonder about like, is this technology as good as an MRI, since everyone's heard of MRIs and so on, with certain areas, how accurate would you say they were in comparison to an MRI? You know, that's a great question, and it comes up often. And in general, I like to describe all imaging modalities as tools, and tools no different than when you sit down at a restaurant to eat your meal. You have a lineup of tools there, too. You have a spoon, you have a fork and a knife, and depending on what you're going to be eating at the moment, you'll utilize the proper utensils.

So if you're eating a bowl of soup, obviously the spoon is the best tool for that job, et cetera, et cetera. And I think the same applies in health care, especially with diagnostic technology. It depends on what you're looking for. And each of these modalities has its own place. So ultrasound does really, really well for a general initial screening. But then there are some times that we need to bring the x-ray in or bring in an MRI to provide more detail. So for example, ultrasound can't see into the bone, in the middle of the bone. It shows the outer surface of the bone beautifully, but it doesn't show within the bone.

If we rule everything out, but we still need to get a good view of how does it look within the substance of the bone, we'll send down for x-ray or we'll send over for MRI. So each has its own advantage at a different time. Yeah, I agree. Actually, there's a few times actually in here where there's been people or runners that have come in with shin splints or pain on the front side of the shin for all that you don't know. One of the possible diagnosis is a stress reaction or stress fracture. So with ultrasound, you just kind of look through and see, does the quality of all the soft tissues and everything around it look good?

And if they do, then you kind of have to assume we have to look at the bone too, right? Yeah, and ultrasound shows the surfaces of the bones in great detail. And as a side note, I'm always fascinated about how they use ultrasound outside of medicine for this purpose. In different fields of dealing with gems and diamonds and things with real delicate surfaces, they use special high-frequency ultrasound to determine if there's a crack or a chip. So ultrasound is very valuable not only in medicine but outside of medicine to examine the condition of a surface of an object. Oh, really? So if there's a crack in the surface, then it'll, well, obviously it'll show on the ultrasound, but the sound waves won't reflect back the same direction.

Is that how it would work, right? Yeah, and in basic terms, you'd see a nice, crisp line coursing across the screen. And at the site of a chip fracture or a stress fracture, you'd see a splintering pattern or like a break in that nice, smooth line that would represent the bone. So that's an example of how ultrasound would depict that. Cool. So what would then, do you have a top three maybe types of injuries that if someone was listening to this podcast, they could say, well, I have that one. Maybe I just want to get an ultrasound instead of, or initially to evaluate it and then see where you go from there.

What would be your top three that you like to see clearly? Okay. That's a, narrows it down a little bit. I'd say for sure right off the top, any shoulder injury, any type of shoulder pain or difficulty raising your arm or at nighttime pain while you're sleeping and anything like that. Ultrasound is number one for that. Same thing applies to knees. If you have an instability issue, you feel like you're buckling and giving way, if it hurts when you run or walk. Ultrasound is excellent to evaluate the joint surface and to take a look at the cartilage, the meniscus, and then any of the joints really, but we could go to the ankle.

We see a great deal of ankle injuries, including ligament tears and nerve entrapments that can go on and different forms of osteoarthritis, rheumatoid arthritis. Plantar fasciitis is very common on the heel. A lot of people have pain. When they get up in the morning, they step down. Ultrasound is great for examining plantar fasciitis. Yeah, so actually, for all you don't know, too, so ultrasound is very user-dependent, and although, so I'm a chiropractor, and it's within our scope of practice, but I can tell you in all honesty that we had absolutely no education. I didn't even know what it was until about five years out of school.

And so the quality of the examiner is really, really important, and Mike is actually one of the best ones I can ever imagine, like just calling and bouncing ideas off of you. For some of the things that I've seen, I have not been able to do with other sonography techs. And so when people are looking around for an ultrasound tech, would it be tech? Yeah, it's fine. They're different words, but that's just fine. But so you're looking around for someone to do an ultrasound on you. It's really, really important to, I think, to call and make sure it's the right person. I don't know, Mike, is there any certain red flags that you would want to ask, or that they would want to ask to make sure that it's a really good sonographer?

Because I only really know less than five, really. And we're in a huge area in Southern California here. Yeah, of all of the fields of ultrasound, musculoskeletal ultrasound, without a doubt, is the most operator-dependent. So it is very rare to find someone. And it's a skill that requires constant improvement and trial and error. So the first most important question you should ask before having a musculoskeletal ultrasound is, number one, who's going to do the test? And number two, what's their background? How much training has this person had? If they tell you that this is brand new, that they just started this a year ago, that they love it and it's great, well, that's nice.

But what you really need is somebody who can say, I have at least five to ten years' experience in musculoskeletal. I've written papers. I've presented lectures. I teach. That's really who you're looking for. This is an extremely operator-dependent test. Yeah, and I remember that I think, didn't I, I thought I sent you someone with like a groin thing, and we thought it was the pudendal nerve, or you told me a story about you had to get, so there's definitely like x-ray, there's those common views that like everyone learns how to do and they're really a little bit harder to mess up. Ultrasound is so different and, you know, have to get a glove on and get real deep into the groin area there to find a small nerve the size of probably less than fishing line is really, really hard.

I can't do that part. Mike can't. You just take some skills. You just have to get some protocols, which we've established for different areas. You definitely have to know your anatomy. So anybody who's even considering doing musculoskeletal ultrasound, they have to consider themselves or pride themselves on being an anatomist. You can't do musculoskeletal ultrasound unless you have a passion and a strong skill in understanding anatomy, because when you go to look at a groin or you go to look at a wrist or an ankle, you'll be completely overwhelmed if you don't have a full schematic in your mind of what you're about to look at.

And these get to be very complicated areas. You brought up a good point, actually, because some of the other sonographers I've talked to, and this is not bashing them, it's just I think we should, I think it's just a lacking of a little bit of education. I asked them, actually, I started with, what are the muscles of the rotator cuff? And by the way, everyone, there's only four of them. And that's where we started, and they could not name them. So how do you expect to properly eval somebody if you can't, if you don't know what you're looking at, right? Yeah, that's been our greatest setback or our greatest challenge in our business is finding people that are skilled to do this.

We have no choice but to train them and groom them from the ground up ourselves. So we start with really good anatomy experts, such as a chiropractor or physical therapist. They would be incredible candidates to learn this because, as you know better than anyone, your training entails so much anatomy. So taking a chiropractor and teaching them ultrasound is a much better job or an easier job than taking an already existing ultrasound technician that specializes in, say, cardiology or heart and trying to teach them musculoskeletal ultrasound. It doesn't work so well. They have to command the anatomy.

They have to have a strong command of anatomy to do this. Yeah, it takes a little while. I remember when I was in school, actually, I took anatomy twice and physiology twice. And the first time I was in school, I was actually a valet attendant. And between when we actually park cars and people come out, I was looking at my anatomy book the entire time. And even like when I go and lift with my friends, like I would name off all the muscles that we were using and so on. And I mean, you basically have to live it for, you know, a couple of years to really, really get it. And I honestly wouldn't expect, like, I don't have, I know that I learned a lot of internal organs and the heart and stuff like that, but I've forgotten a bit of it, you know, and I wouldn't consider myself an expert in that.

I would definitely just send them out to someone who is. So you're right. It does take time. Yep. You have to live it, like you said. And we will do that today. When we get into our office this morning, we look at those maps and schematics on the walls. We break out the anatomy of the wrist and hand and we're constantly drilling each other and challenging each other throughout the day. You know, to name the carpal bones, for example, in the wrist is not something that just anybody will just do. It takes constant practice and keeping that fresh in your mind. It depends on how important that is to you.

Yeah. But in a musculoskeletal ultrasound world that we live in, it's critical to know this stuff and you can't be fumbling around with it. You have to get right down to it and know these things right off the top of your head. Yeah. And the patient can always feel, they can feel when you don't know what you're doing, if you don't know what you're doing. Yeah. That's right. So I want to tell a story about actually, so when I came to your house actually for that oblique strain, because I thought it was really, it was enlightening to me actually. So Mike, actually, I was playing baseball and I was swinging a bat and all of a sudden I felt a pop in my left side, right up by my rib cage.

And I thought, dear God, I probably just fractured a rib. So I was freaking out, like taking like, I call it like a patient mentality because all logic goes out the door and you start wondering if you're going to die or if this is the end, that's the last injury you're going to have. So it was nice of Mike actually to, he lived fairly close to me, so I drove over to his house and he has an ultrasound machine at his house and we were able to eval it. And I don't know if you remember all the details of that exam, Mike. Do you remember parts of it? Yes, I do. I remember it very well. So it was, we took the probe up into the oblique area right as it was attaching into the ribs and we were trying to differentiate between a rib fracture and an oblique strain.

And I remember very clearly that you saw a vessel on the Doppler, which was formed within a small chip. Does that sound right, of the rib? Sort of, a little bit, but keep going. I want to follow you along. Or it was a avulsion, I forget what. But either way, I know that my end as the patient is all I, what I really wanted to get to the point of is that I felt really good knowing that I did not completely split the oblique off. Because even when I, I don't know if I told you, when I coughed, it felt like I was about to lose my intestines throughout that hole. So I was freaking, but it was nice for Mike to look at it and see that, you know, that I can calm down a little bit and there's not a ton of urgency on this.

And I was able to form a good plan of attack in regards to rehab for it. Yeah, that's, that's the part I have to share, Mike. Just the sanity. Yeah, and that's always a great example right there of being very worried and in your own mind being not sure what the problem is. And then once you come up with some answers of what it is and what it isn't, it almost makes you feel better. Even though the pain might still be there, you feel this tremendous sense of relief because, hey, I know what it is right now. And I know what it's not. And in your case, what we did was we isolated the ribs one by one by one, and we scoured them in great detail to make sure that there was no crack or that there was no abnormality involving the rib margins.

And then once we ruled that out, then we turned our attention to the surrounding muscle. And in your case, it was the abdominal obliques. And that's where we honed in on the problem. And we found that there was some interstitial or some partial tearing within the muscle right around the attachment site. And then we could see the swelling. I think what you were making reference to is we could see some hyperemia or some increased swelling and inflammation around the muscle tissue. Yes, that's what I remember. Actually, after doing that, I actually wrote a whole story up. I don't know if I told you.

I put it on. It's on my site now. If you actually scroll all the way down and you got to the point where you saw a baseball player and you saw a trunk dot, you basically click on that. And it's the entire story of the rehab process as well as the ultrasound. And I didn't have the images, which is kind of a bummer. We should have saved them. But of how that went. And I didn't realize how common oblique injuries are in baseball. Jeez. People contact me all the time now just saying they've had the same type of injury. Wow. Yeah. Go ahead. I was waiting to hear what you had to say. Oh, no. That was just the part.

I just wish we had the images for it. So, Mike, is there anything else that you would like to add? I know you have to go to work. Is there ways for people to get a hold of you? Are you Beverly Hills now? Is that where your office is? Well, we cover a lot of area. We're all the way from South Orange County, and we cover all the way up to Ventura. So, right now, today, I'm about to go in. I'm in Beverly Hills, right off of Wilshire Boulevard, and I'll be here throughout the day. But tomorrow, we'll be in Tarzana. Friday, we'll be in Thousand Oaks. Then we start over again. We go up to Oxnard. So, we have different locations.

We even go up to Bakersfield once a month. So, we have different locations throughout Southern California that provide musculoskeletal ultrasound. You can reach us directly. If anybody needs an ultrasound or would like to get one done, you can call our direct scheduling hotline. The number is 949-361-3284. And, once again, that's area code 949-361-3284. And, someone will help you schedule an appointment at a location convenient to you. Or, you can reach us online at orthopedicultrasound.net to learn more information. Yes. That's what I was going to ask you, too. Well, cool. Yeah, I think this was – we might have to do this again because I know that we can get super deep into other details of Voltstone.

We're just barely skimming the surface right now. I really appreciate you having me on. It's a great opportunity to talk about this exciting technology. And, thank you so much. Wishing you and everybody a wonderful day. And, I look forward to doing it again next time. Yeah, thank you, Mike. So, everybody else, too, before you leave the podcast, just remember, you can submit your question to be answered on air. Obviously, in public. So, just know that because usually in healthcare, there's privacy laws. But, the whole point of this podcast is to allow everyone to learn from everybody else's injuries so they have some type of sanity as well as game plan going on with their injury.

Because, most of the time, when someone has an injury, it's their first time having it or they've had it for a long time. And, it's really hard to know what you're supposed to do for it. So, the website to go to for that is p2, the number, sports, plural, care, dot com. Also, too, there is a ton of pages of content on there. Like I said, there's online courses for a couple different types of conditions. How we rehab it, how, and the education around it. The idea is that, actually, I don't know if I've said this before, is that I had a patient, actually, with a sports hernia. He was only in the country for a month.

I had him for a month. And, then, he had to go and get deployed off to Iraq. So, the goal of that month was to make it so he became his own expert because no one was going to be there to help him with it. So, we really hammered it down. And, after doing that, we developed part of these courses for that reason. So, everyone, thank you so much for listening. And, we will see you next week.