Misdiagnosed IT band, hip and elbow pain, and kettlebell rehab

This is session number 83 of the Performance Place Sports Care Podcast. It's peanut butter jelly time. 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. Where you at? Where you at? Where you at? What did that even come from? Anyways, I remember seeing it on Family Guy, I think, once, and it always had to do with a banana. Brian was in a banana suit, I think, so I don't even know what it came from. Anyways, but I don't know anyone who's passionate enough about peanut butter jelly to sing about it, except for Mike Fanning.

So Mike Fanning is going to be our guest today. He was recommended to be on this podcast by the last person that you heard. If you're going in sequence here, if you heard Dr. Tom Fletcher last week, he actually interned with him early on, and then he went to the school that I did, and went through the sports residency. And that thing is a beast of a program. It is just extremely in-depth. You spend a lot of time. You're around a lot of good people. So Tom said that he's like, you know what? You've got to have Fanning on because he's at the apex of his intelligence right now. He's like, he might not go anywhere up from this, but he might go down.

So you need to get him really early. And I said, yeah, okay, let's have him on. So Dr. Mike Fanning, I thought I would just go a little bit, I don't want to say general here, but I asked him, what do you feel passionate about? And he said, well, proper diagnosis is pretty important to me. And I'm like, you know, that'd be a cool thing, because we haven't really gone down that route too much in this podcast yet. If you don't have the right diagnosis, you go the wrong direction in your care. I can't stress that enough. So we're going to go into some concepts surrounding proper diagnosis. I also said, what else are you passionate about?

He said kettlebells and running and triathlons as well. So that's actually where Tom met him. Dr. Fletcher met him. They did triathlons up in Utah. So now, if you have not gone through it before, I want you to go through iTunes and review this podcast for me, take a screenshot, send it to my email or my podcast email. It's info at p2sportscare.com. And I'll put you in the drawing to get a soft-ass Performance Place shirt. I'm not kidding you. It's not one of those types of shirts where you're like, oh, you wear it once, you get itchy and scratchy when it's dry out. Like, no, if you live in Colorado and it's dry out, this is not your standard cotton shirt that you want to take out in the garage and veneer or a piece of wood with.

You want to wear it to the end of time. So put your email in there. Anyways, so next is if you are a student, okay? I've been talking about this weekly now. I want you to go on to the p2sportscare.com slash shop area because the patient educational posters that I've been putting together as well as the podcasts are intended for you to build your practice. They are intended for you to have the tools that I didn't have when I started. I had to have all these long conversations about proper diagnosis with people. Well, you can just have Mike Fanning, who probably a lot of you have learned from, speak about it.

So you can have Dr. Stuart McGill talk to you about or talk to your patient about low back mechanics. These are all assets to you, and you get access to them organized when you just buy some posters. So check that out, ptsportscare.com slash shop. Now, before we go into, I want to thank you all for spending your hour with me and Dr. Fanning and letting us share our knowledge with you. So without any further ado, Dr. Mike Fanning. Okay, Rowena's promise here is Dr. Mike Fanning in the flesh and live here. Good morning, Sebastian. Thank you for having me. Good morning, good morning. Or Sebastian Gonzales.

Dr. Fanning. Good Dr. Fanning. We're on video today, so if everyone wants to check this out on YouTube, this is a new test style because I'm really tired of editing two different cameras, and we're going to try just a straight-up GoPro. So if you like it, then give me a thumbs up on it. If you don't like it, give me a thumbs up still, but then say you don't like it on the comment box. Okay, so tell me about yourself. What's the deal? How did we meet anyways? We met through a mutual friend, Dr. Tom Fletcher from Salt Lake City, and I believe it's actually when I started chiropractic school down in Whittier, and he was down in for like an SFMA seminar, and we all ended up meeting up for dinner, I think, one night down in Huntington Beach.

Where did we go? I'm having trouble remembering. It was Wahoos. Went to Wahoos? Yeah. It's so long ago. That was like four or five years ago, wasn't it? It was, yeah. It's been quite a while. Yeah. How old are you now? 31. I turned 31 this past October. Oh, man. You've come so far. I know. I'm getting old. So tell everybody that, so in the intro I said that, Tom said that you're at the apex of your knowledge right now, and there's only a downward slide, because you are, because you're in the sports residency right now at, what are they calling it now? Are they calling it LACC still? It's called Southern California University of Health Sciences, because it's got, they have a PA program, acupuncture.

So tell me about the sports residency and, or actually what did you learn after school into that residency that you thought, holy shit, this is like groundbreaking? So the sports medicine residency started immediately after I graduated from LACC or SCU last December. And I don't, I wouldn't say anything groundbreaking. It's just built on the knowledge, like the fundamentals that we learned in chiropractic college, but a little bit more in depth with different orthopedic conditions. Mainly, you know, you're expected to be an expert at the spine, if you will, when you graduate from LACC. But I feel like in the residency, it was immediately thrown out into the real world, for lack of a better term, with local high schools and some local colleges working in their training room and on the sideline, and I got all this hands-on experience of seeing an actual injury and then how to manage that right there on the sideline.

So it really has nothing to do with chiropractic. It was just the thrown to the wolves and getting all this hands-on experience of real orthopedic conditions. So, yeah, I remember in school, we didn't get a ton of trauma. So you're saying you're on the sideline, you're getting, you know, the concussions, the turned ankles, the lacerations. So actually, my first basketball game, I worked at a university, or sorry, a high school up in Santa Fe Springs. A gentleman went up for a loose ball, came down, and tore his Achilles tendon. Just in half? It just, yeah. I don't know where it tore, but it was just like I went over, he was screaming, went over there, and there was like a huge bulge back there.

So immediately knew that it tore his Achilles tendon. So that was my first experience, managing a torn Achilles tendon. So that's something I never had experience with. So I guess that's more of the groundbreaking stuff is never knowing what you're going to see and not really expecting. You have to be expecting anything. So it was more of like an athletic trainer role at first, just getting your hands on and the sideline management and being able to direct the patient, hey, you need to go to the emergency room or, you know, go get an x-ray down the street or you'll be okay. So it's really different than, I've always told people that I actually don't like dealing with fresh injuries like that because the way you manage them is much different than.

Yeah, absolutely. So when you started going through those fresh conditions, then how would you explain the difference between like, you know, how to manage, say, that Achilles case, like, actually, he might have been surgical. But let's just say one year removed versus immediate. Okay. Yeah, well, yeah, because just the fundamentals of it. Because I know that with, I guess what I'm getting at is that everybody's good at different things. I'm not good at that, and I know I'm not good at that, but you're definitely good at that. I wouldn't go as far as that. Well, you're better at it. Like, I remember the first time I saw, like, so I did sideline stuff at a field hockey tournament, right?

And this kid just had, he got a stick to the face, and it's just like the goo coming out of his forehead. Awesome. And I was sitting there just kind of looking at him, and I saw him blinking and crying, and I thought, okay, well, at least he's not dying, you know? And luckily, Reynolds came over, another doc came over, and like, okay, so what have we got going on here? I'm like, he's got cut on his head. I'm going to take off now. You can manage that thing. It's just like a whole different experience, but... Oh, absolutely. Luckily for me, like, I was in the military, and I got some EMT training in there and some combat lifesavers.

So I had been exposed to some minor trauma, like, you know, falls and some blood. So I guess that stuff didn't really bother me. I also worked in a hospital, and so I saw some pretty gross things in there as well. So, like, when I see blood, it's mainly the most important thing I felt where I brought to the sports residency program is being able to, even if you have no idea what you're doing, just have the confidence and take control of the situation, because chances are you have a better idea of what's going on because of your education versus the layperson around you. So being, like, an air traffic controller, right?

So telling everyone to back off, you know, give them a test because everyone wants to help out, right? But you're basically the main guy, and, you know, just if there is blood, make sure you just control the bleeding. Get someone, get their parent down there if it's, like, an adolescent or a high school student, or at least, you know, get them off to the sideline if it's, like, a football game, and then you can, you know, everything slows down over there, and you can get a better idea of what's going on. And most of the time, I found it's pulling the person from a game, if it is football. And the very few times, fortunately, I haven't had to call emergency services, so.

When you said go into it with confidence, it just reminded me kind of like it. Thanksgiving dinner, everyone's sitting around, like, who wants to say grace? And no one speaks up except for the one person does and says, rub it up, dub, thanks for the grub. But very confidently, and everyone's like, that was good. Groundbreaking. Absolutely. So why did you want to go into chiropractic school anyways? You know, I had no idea I wanted to go into chiropractic school. I got out of the military having a great plan to get into health care, and I was thinking along the physician's assistant route. And, you know, it's a, I won't get into it too much, but it's a difficult transition going from the military sector to the private sector.

And I got kind of lost along the way, got into some endurance sports. So the point of the story is I ended up meeting our mutual friend, Dr. Tom Fletcher. And I remember him just asking me, hey, or telling me, why don't you come down and see what I do, you know, take a look and see if you like it. So I went down, checked out his office, and saw how he, his interaction with patients, and he was getting some good outcomes with his patients. So I was like, this is pretty cool. And then Tom and I, his mutual friend, Brandon, applied to chiropractic school. And so I was like, you know what, I'm going to apply too.

So this was in the spring of 2013, and then got accepted and came down to beautiful, or sunny, I don't know about beautiful, but sunny California that fall. Are you going back to Utah? My wife is from California, so that's a difficult sell for a Southern California girl to go to where it snows half the year. So the goal is we'll probably end up leaving Southern California, but weather is in just a couple years or, you know, later down the line. But I'm from New England, so my heart's back there, but I'll probably stay out on the West Coast somewhere. So only snow in half the year is fine if it's only like 30 degrees, not negative 10 or whatever.

Yeah, I don't mind. I love cold weather. I love snow. But my wife, yeah, it's, you know, it's 45 degrees and she's freezing. But, I mean, that's like everyone in Southern California. Yeah, this is the coldest day, I think, in recent history right now. I will say I was pretty cold when I woke up this morning, so I'm turning, I got that thin blood now. Yeah. So I told everyone a good reason to have you on is that we're going to go over the concept of proper diagnosis and your passion for diagnosing people properly. I don't know if you have any, do you have any stories about people that you've experienced that have kind of gone down the wrong route of treatment because of improper diagnosis and vice versa?

I've got quite a few stories, but, I mean, look, I wrote a couple things down so I didn't forget. Wow, that is a lot of notes right there. Wait, is that all for today? Yeah. Holy shit. I want to make sure it's squared away. Oh. So if you, I have, if I make a claim, I actually have a couple things to back up. Oh, good. But I want to just, you know, take my word at face value. So I think we're allowed to show that to the camera then if there's, is there something, I see you have dermatones in there. Look at that. Yes. So that's the first thing I'm going to talk about. Okay. What's a dermatone, by the way?

So a dermatone, it stems from embryological origin of when you're, you know, your cells are multiplying and you end up forming into the human being that you are. But it refers to like nerve roots. So your nerve root and the skin along that, um, a certain path is all originates from the same, um, what I believe it's a certain, uh, some might, right. Um, so when you do have say like a, um, a disc pathology, like in your low back, um, and it, um, it compresses, I guess, or it irritates a nerve root. You may have feeling or you may have irritation any little way along those, um, that, that, that path.

So for instance, um, first thing I'd like to talk about is the, um, over-diagnosed IT band syndrome. Oh yeah. That's a great one. Yeah. So, um, you know, um, I deal with athletes of all different colors, shapes, sizes, um, and backgrounds. So, you know, I don't have an issue if someone comes in as an ultra marathon runner, an Ironman athlete or marathon runner, you know, even like a competitive 5k athlete. Um, if they come in and they've been diagnosed with IT band syndrome, I don't have a problem with that. Um, when I do have an issue is when a CrossFit athlete who does not run or a, you know, a power lifter comes in and like, Oh, I have IT band syndrome.

So right there and then I know that they don't have IT band syndrome because, um, the mechanism of injury is typically repetitive stress in the sagittal plane. They, the, so running 400 meters at a time is not enough to have an IT band syndrome? Probably not. I'm not saying no, but that's why I go in and I do like a nice long, um, thorough history and exam. Um, and so I, I'm fortunate enough to work in a model where I have a two hour initial history, um, in exam. Um, so my initial history is about an hour and 15 minutes. So it's not just focused on like, you know, what's going on right now. We go back and figure out when this actually started, not like when you started, it got to the point where you wanted to come in.

So here we are. My first example of, um, a, uh, CrossFit athlete, they had IT band syndrome six months. Um, they run no more than five miles per week. Um, the most, um, provocative factors or things that exacerbate his quote unquote IT band syndrome are heavy squats and heavy deadlifts. So, and like I said, he doesn't run much. Um, so I went through the history and everything, you know, some things that stood out to me were, you know, back stiffness. He doesn't have back pain, um, but his, he has a really stiff back first thing in the morning. So as we know overnight, we have inhibition. So, you know, if the desk disc is irritated and it swells up overnight, you're going to have a little bit of a stiffness in the morning.

You know, you move around, the water gets kind of, it gets, or, um, the fluid gets pushed out of the disc. Um, and so you feel better. Well, if you do have like a disc herniation or a disc arrangement, that's irritating that L5 nerve root. A very common, if you look at the dermatome map over here. Yeah, we might have to show that one to the camera there. So if we look at the dermatome map over here, the L5 nerve root goes right along that IT band. Go a little closer on that. We got a fisheye lens. So this is going to be, all right, everyone see that? So wait, say that one more time or. So if you do have like a nerve root irritation of L5, um, the dermatome goes all the way down from the back along the glute, down along the IT band on the lateral side of the knee, all the way down to the foot.

So some person may not even, they may come in with IT band syndrome that they can't even run, um, or do anything. And this has been going on for six months. It's probably not IT band syndrome. So that's my first, um, pet peeve, I guess, is the IT band syndrome is way over, um, diagnosed. And most of the time it's usually, uh, pathology stemming from, um, the low back. So when they, let's just say, let's go down a couple things that people with IT band will say then. So they, they find on that, that they roll it, it gets better. Is that still probable, probable not IT band or is there. So some of the research that I've read is that, you know, the IT band doesn't really stretch.

My theory of course, is that when you do roll out an area that is irritated. So if it is coming from the low back, you're, I guess you're desensitizing, um, nerves. Like you're just, um, but putting Bengay on it. Yes. You're putting Bengay on it. Um, and you're just desensitizing the area. But then if you think about it, you're rolling on your side and you're actually causing, um, a lot of excess movement on that, um, lateral flexion. So you may actually be making the disc pathology worse doing that repetitive, like rolling over and kind of moving your back in a funky way. So in a way it's not, um, it's, it's actually making it worse.

Yeah. Funny you say that there was actually, uh, I sent this, there was a video I saw on Instagram where they were promoting a foam rolling, uh, device. And so they were doing it for the hamstrings and then you can see the person rolling on it. They're, they're, they're face up to using their arms and so on. And then you can see in the back that they're rounding their back. And I was like, if this is creating neural tension in the hamstrings, then isn't this kind of just reversing what you're just trying to do? Yes. But it goes back to the patient education. Like they don't know any, it's not the patient's fault.

They don't know any better. So it's on the healthcare provider to make the correct diagnosis. So, so then on ITBN ones too, let's just say when people can feel underneath like that tendon on the side or like they're going into the insertion in the knee. Is that, is that more indicative of a IT band thing or is it more still probable low back nerve? It depends. So yes, I would, if they're pointing down there, um, cause a lot of the, um, theories on IT band syndrome that I've read is that, um, it's actually some people or some of the research, um, goes in and says it may not be a friction disorder, maybe just a fat patty irritation.

Um, so if someone points down to where the typical spot for an IT band syndrome is then, and based on their history, I'm okay with diagnosing it with the IT band syndrome. But I'm always, if someone comes with IT band syndrome, even if it probably is, I'm doing a low back exam to make sure that it's not coming from the low back. There was a, there was a couple of cases that, uh, there were a few years ago, I think, but they, there's a spurt of time where I got a bunch of lateral or lateral knees or outer knee pain with people. So I had the, the diagnostic, diagnostic ultrasound, I'd image it so you can clearly see the IT band and below it.

And then the joint line, and then there's the, uh, popliteal tendon is in there really closely too. Um, I was surprised by how many times that it was not actually the IT band. There was no visible swelling. It was another related structure locally there. Sure. So that, I don't, that's my experience on the actual pinpoint down there too, but. Interesting. Yeah. Popliteal tendon. I, I wouldn't disagree with that. Like, that's just kind of, to me, when I hear IT band syndrome, it's just kind of like a garbage can term. Yeah. Unfortunately. Like, like, uh, plantar fasciitis. Yes. Like headaches. Yes.

Like headaches. Um, but you know, a lot of the therapies that are done are still going to help the patients. So it's not, I can't, I don't know. Well, so then let's go back to the, so the reason for getting the proper diagnosis with that, how would the rehab or treatment be a little different if it was like, say the back versus IT band? Well, if it's your back, I'm not going to have them roll out. I'm not going to probably touch the IT band, right? I'm probably going to do like, um, what I do is I do a lot of the, um, McKenzie, um, McKenzie therapy. So if you're not familiar with that, that is more of like preferential movement and really loading, um, uh, a disc, a preferential, um, movement pattern for your low back.

Okay. So then the idea is, um, with that, is it in a nuclear, uh, disc arrangement, meaning is it from the nucleus propulsus bulging out or is it an annular fiber, um, bulge? So the outcomes are usually better with an annular fiber type bulb versus a nuclear because the nuclear is soft. So it's harder in theory to get that nuclear, uh, the nuclear material back into the center. So explain that one more time. Cause I know that, that people might have glazed by that idea. Um, I know we have the jelly donut analogy on that. You probably, probably, probably well versed on that one now. You know, a funny story on that.

When I first started working for one of, um, these, uh, one of my mentors, um, the idea, we diagnosed her, the patient with a disc arrangement and I started talking about the jelly donut and she just ripped me apart. And I was like, why did you do that? Yeah. She's like, that's so unprofessional. Really? Yeah. So, um, I thought that was a really good idea because it's like, you're relating to the patient. You know, a lot of the patients don't know a lot about anatomy, right? And this was an older lady. Anyway. Um, so I try to, now I've been trained not to talk about the jelly donut. Really? Yeah.

It's so funny. I've never had any backlash in jelly donut, although I don't always talk about it a lot. I think it's a great analogy, but now I'm like, I had to avoid saying that for so long. I just don't, I draw a picture for the patient. Um, so the idea for, um, I can't wait. You're going to try to explain this, not jelly donut style. So I'm going to do my best. So if you imagine, um, what a disc, a disc in your low back. So you have the bones, um, your introvertebral, um, or the, um, introvertebral, uh, disc that are between, they're like cushions in between, um, your vertebra. So, um, if you were to look, get it on a helicopter and look down onto a, um, a disc, what you're going to see is basically two different discernible areas in the, and it's going to be the, um, middle portion, which is the nucleus, um, nucleus propulsus, and it's made up of a gelatinous substance.

That's your jelly. Okay. And then the outer portion, um, is your annulus fibrosis. And this is just millions of these really strong cross-sectional fibers. Okay. Um, the inner two thirds of this entire disc has no innervation at all. The outer third does, and it's innervated by the sinovertebral nerve. Okay. So what, where, what happens, what's the difference between a nuclear bulge and an annular fiber bulge? Well, the nuclear bulge would be a bulging of that nuclear material into the, um, more common than not, it's posterior lateral. So the, to one side, um, sets that jelly donut squeezing out onto one side, um, but it can also go centrally as well.

And that's the idea behind generalized low back pain. Um, then you have the annular fibers and you can get just like a, uh, a smaller bulge and just the annular fibers themselves. And that's actually an indication for, um, if manipulation is going to work very well. So the two differences are going to be an annular fiber bulge where it's just the annular fibers, the outer portion or a nuclear bulge. And that's going to be the inner portion bulging out into, um, the outer portion of the disc. Does that make sense? It makes, it makes sense. But halfway through there, I did see you say, heard you say jelly donut again.

So now let's, you read you that entire thing without saying jelly donut. Yeah. I'm not going to do that. No. Dr. Burris would be a little disappointed in me though. I, I might, I might do a correlated video and showed the jelly donut. I, cause that way, you know, I'm not throwing you under the bus. Um, but that is, I think it's a really important concept for people to understand. Um, I don't know any other way other than jelly donut. And it's a great, I think it's a great way to tell the parents. Well, I'm wondering how you got to staying on top of a helicopter looking down rather than like a skyscraper or a building or something.

Well, I love helicopters. Unfortunately, I don't have my license. Did you, did you ride helicopters in the army? Yes, I did. And I love helicopters. Uh, got to go on the Chinook CH 47 and then the Black Hawk, of course, the UH 60. Love those things. Um, they're so cool. Yeah. It's, it's so funny. The things that I think we like come into explanation such as that, like. Um, yesterday, I didn't even realize it, but apparently I was telling someone to put their hands in towards their pockets like this. And I was going to say cowboy, but I said buckaroo. And, uh, so my front office girl turned to me, she's like, did you just say that?

Cause that song was on. I'm like, what song? It's about the buckaroo. Um, so IT band is the first thing that is commonly misdiagnosed. That could be a spinal nerve root irritation of some type. Yes, sir. Okay. What is another one? Um, the next one. So I guess in general, it would be the, like a radiculopathy is underdiagnosed. And so before I move on to the next one, um, a lot of times people with a, like a cervical spine radiculopathy have that all the term of the rib out. So usually, so what I mean by the rib out, that's a common phrase in the chiropractic profession, but, um, it's just referred pain from the, um, discs in the, um, uh, in the cervical spine.

And then also you can have lateral opicondylitis is overdiagnosed and you need to do a cervical spine exam. And that's usually referred pain from C6, um, tennis elbow. Yes. Tennis elbow. Sorry. Um, yeah, that's always, if it's been going on for like a year and a half, it's probably not tennis elbow. So the next one, um, I feel is, I guess not diagnosed enough is a more acetabular impingement. Oh, I like this. So a lot of people with, um, pain in the front of their hip, um, they, you know, I don't fault, um, any of the people who suffer from this, but you go online and then the first, um, first thing that you see is, uh, iliopsoas tightness.

Um, and I'm not saying, I mean, so as is a big muscle, you know, and it is, you know, we use it when we're sitting here, we use it all the time, but, um, is that the pain generating tissue more times and, um, more times than, than, than, than so it actually is not. It's, um, uh, fomorocetabular impingement. So what a fomorocetabular impingement is, um, is you got that ball and socket joint right in your hip. Okay. Um, and so basically what happens is, um, I actually brought the, there's a Warwick agreement. Where did I put that? Um, the Warwick agreement of 2017 and the, uh, British journal of sports medicine.

And so what that is, is a whole bunch of clinicians from, um, an orthopedist, you know, osteopaths, um, different MDs, they all got together and had a consensus statement similar to the, um, concussion consensus statement, but they talked about, um, what an impingement on the hip is, um, and what's the best course of care and that type of thing. So, um, a fomorocetabular impingement is typically a bony overgrowth, either on the femoral neck so that your big, strong, um, uh, bone right there, um, uh, in your, on your thigh, um, or a bony overgrowth on your pelvis, um, or both. And so what it is, is when you do certain movements, especially hip flexion.

So when you bring your leg up, um, or when you're sitting here, um, that the bony structures are rubbing on another or another. Um, so, um, there's a quick, I mean, doing a quick hip exam should take no more than like three minutes. Um, but this is really important to figure out if the person has a fomorocetabular impingement, especially a younger patient, because it can lead to a labrum tear. And so an FAI, you can manage pretty conservatively, um, as, as a manual therapist or a PT chiropractor ATC. But, you know, if you don't diagnose it, then it's just a psoas strain, the patient's going to go through all these fact provocative, um, exercises and probably make it worse and eventually get that labrum tear.

So, um, I was told of a good study. Um, I could be wrong on this, but this is what happened apparently over at USC is, um, when Pete Carroll was the coach, he had, um, he was losing some guys to hip injuries. So he brought in, um, Mark Philippon, who's one of the leaders in, um, uh, hip surgery and he's over in, uh, Vail, Colorado. Um, so he brought, Pete Carroll brought this guy in and he had him do, um, a hip exam on every single person on the, um, on the USC football team. And he found that Mark Philippon found, Hey, these guys have an FAI. They may not be symptomatic, but you need to alter how they do things.

So, you know, for linemen who are in that, you know, they're going into a full squat, seven, you know, between 40 and 70 times per game. So they're really going to exacerbate that, that hip issue. So the idea is you're not going to be able to modify that because they're going to play, but during their training and especially during weight training, you can modify it. So they don't need to do a below 90, you know, below parallel squat. They can just do quarter or partial squats. So that's why it's important. So, you know, if you see, I don't know, a police officer with a femoral acetabular impingement and he lifts weights, well, there's no real reason for him to go below 90.

He can still work and do strength training, um, in a pain-free range of motion. And so during his daily activities or while he's working, he can still go and, you know, pursuing a subject or sitting down where he's going to have that full hip flexion. Um, it's just, it's not going like, you're not going to change his job, but you can modify his activities so you can stay in the game longer. Yeah. I heard that same study or at least experience. I don't remember if it was, I, I, I never got validation if it was true or not, but I, it sounded really good. I liked it. Um, did Dr. Horton talk about it in the diplomate class?

He might've. Cause that's who told, told me. Okay. Yeah. He might've, um, I don't know. I feel like there's, there's some people that like, when I hear it from them, I'm, I'm okay with taking their word as it happened. I probably shouldn't do that, but, uh, I just started with a grapevine so I could be completely wrong. Yeah. Well, Pete, Pete Carroll's been calling here. That never happened. But no, I, I agree with the, uh, like FAI is actually something that, that I, I, I would say a strong majority of, I don't know, it might be, it's going to be a guess of a number, but I'd say at least 25% of clinicians are not aware of it.

But like I had, uh, an ER doc come in here one time that he had, um, yeah, he had gone to a back doc. He'd gone to a hip guy. He'd gone to a bunch of people and like, he couldn't figure it out. But it, to me, it just looked like, um, we didn't have confirming imaging yet at the time, but it looked like severe FAI or a, or a small grade labral tear. Um, but it's something that I didn't learn about and probably still about three, four years ago. And it was like, holy shit, everybody has some type of FAI if they're an athletic person when they're youth. Absolutely. Yeah. And the thing is like, it's really good to, uh, it's behooves the clinician to diagnose it earlier, the better, because there's really strong correlation, uh, between, um, FAI and, um, osteoarthritis down the line.

So, um, I thought they had a study where there was, um, I want to say it was, is it was kids that were still growing. I want to say it was soccer players. Uh, I'd have to, I can probably find this one actually. Um, I remember holding it in my hand, so I think it was real. Um, but it was something along the lines of that. They, they imaged them x-ray imaging just to confirm whether they had any, uh, cam deformities or, uh, abnormal growths on the, on the femoral neck or head. And one year, and they checked with them one or two years later and they found, um, that a lot of them did then have it.

So it was a, as the growth plates were closing as when these cam deformities started to appear since they were extremely active at their age. Sure. So I feel like a lot of you who have been active kids are going to have FAI and they're going to need to know about it. Right. I agree. I'm, I got, um, I have had to modify my, a lot of my daily living, uh, activities of living, like for my weight training. I, I mean, I don't go below a certain, um, uh, my deadlifts or my squats. Um, I do from a platform. I don't go below a certain, um, certain depth. Otherwise I'm going to be hurting for a while. Yeah.

I would, I feel like there's a push right now where people are finally starting to get away from, uh, ass to grass squatting and deadlifting from the ground. I hope so. Um, I'm not too sure, honestly, that would make sense because not everyone fits into one, you know, one box, you know, so it would be smart to, you know, assess the person's hip. I think it's really important for, um, you know, personal trainers or CrossFit coaches or athletic trainers to all be able to recognize this. You may not be able to, you know, officially diagnose, but, um, when you check out the hip, then you can really, um, really coach the person on how to do a good squat.

Because not everyone can do their toes pointed forward because they've got some sort of anti-version or retroversion on the femoral, um, on the neck. So I think it's a pretty good thing to do for anyone who's dealing with athletes. I'm going to put a reference to, uh, a couple assessments. Okay. Uh, do you have any that you like or any videos you've seen? For the hip? Yeah. For, uh, to see if, cause people are probably listening to this or like, how the hell am I supposed to figure out if I have this out? Well, funny you just mentioned that. So, um. Good lead in, huh? Yeah. So I brought some of the, um, a couple of the, uh, really good tests for, uh, testing the, um, for an FAI.

And I will talk about the sensitivity and the specificity of each. So basically how reliable is that test for this condition? All right. So one thing you want to just ask the patient, um, and it's a 100% sensitivity for a labrum tear is, do you have painful clicking in the hip? So it's 100% sensitivity, 85% specificity. So what else could it be if it's not? Probably not, um, uh, as significant, but like the, there's, you always hear the snapping psoas tendon, um, less likely. Those are probably the only two that I'm really aware of that a painful pop in, um, in the hip would be. But it's, if you do have a painful click or pop, it's probably going to be that labrum.

But another one, um, I don't actually don't have the specific specificity or the sensitivity on this one, but it's the presence of Dremon sign. So what that is, I've not heard that yet. Oh, I love this one. Um, so you just like, you have the patient on their back, um, and, um, you, you're going to test say the left side. So you let them, you bend their knee, um, at 90 degrees and their hip. Um, and then you're just going to passively guide their hip up. So their hips should go all the way up until you feel end range. But if you get to about 90 degrees of hip flexion and it starts to roll out, that is a, um, that is just one.

Okay, this person may have a pin or a camera pincer type because, um, just there's something that's blocking the hip from going all the way up. Okay. So that's where I typically lead in is just doing that and then full forced flexion. So just pushing the patient, all their hip, all the way into a full hip flexion. Um, because one of the, uh, provocative things a patient will complain of is painful, like deep squat. So, um, doing just a full force flexion. If that's painful, that's two. So if those two are positive, then I'm like, okay, this person has two positive tests. Um, the next one would be flexion with adduction.

So bringing that hip across towards midline and then internal rotation of the hip. And that is 99% sensitivity with 25 specificity. So, uh, uh, I don't think we clarified what is sensitivity versus specificity so everyone can understand the gravity of these tests. Okay. So specificity is, um, is it testing what you think it's testing? Okay. And then sensitivity is if it is a positive test, it is going to be this. Okay. So for instance, so if I do that flexion, adduction, internal rotation test, um, if it is painful, there's a 99% chance that it is a hip impingement. Okay. Does that make sense?

Mm-hmm. Okay. Yeah. I, so what was, so what was the other, it was, what was the other part of it? And then specificity. So that is how specific the test is. So you could be testing a lot of different things. Okay. So it's not necessarily just, um, that's where you need to ask the patient where it's painful. So when you do that flexion, adduction, internal rotation, you may be stressing another structure. So if they're like, oh, that's painful, you need to follow up with, where is it painful? Because, you know, if they have pain on the outside of their hip, it's probably, you know, probably, you know, pulling on one of the, uh, hip muscles.

Mm-hmm. Okay. Funny, funny to say that. There was a guy one time that he came in that it was, it was the most extreme exam I've ever written. I would do, do like, say like wrist flexion. He's like, ah, like, where's that hurt? He's like, my left toe, little toe. Like he, he was like, I didn't think he was, I, I, I, I had to take him at face value because I don't think he was joking with me, but holy shit, it was the longest exam I ever wrote up because I'm like, I, okay, we got to stop because I got to keep writing these down. I'm going to forget all of them. Yeah. Oh my gosh, I'm sorry I had to deal with that.

It was kind of, it was kind of fun realizing that, that, that, that can happen. Um, the next one would be hip scour. So that is, um, you start with that flexion, adduction, internal rotation, and then you're just going to axial load the hip into the joint and then just bring it. You're basically just going to scour the whole thing. So pressing down and then you bring it through all different ranges of motion. Okay. Um, sensitivity for that is 50%. Specificity is 29. So it's not great, but if you do all those other tests with it, it's giving you a good clinical picture. Then we all know, um, Patrick's test, um, that's flexion, abduction, external rotate, rotation.

Um, and so the sensitivity of that is 81%, specificity is 25%. And those are for FAI because Patrick's tests can also cause low back pain. Um, and then it can also be, um, tell you if there's a labor pathology. Um, but one thing to keep in mind with all these tests is that you may have like a, that's why I go back and taking a good history is important is because someone with, um, a stress fracture, um, in that area, a lot of these tests are going to be positive for that as well. So, um, that's why I like to stress taking good history. So in your experience, how many, how many patients come in are familiar with impingement of the hip or labral tears or anything of that nature?

So like I said, I work in a unique model. So I only see about 15, 20 patients per week. However, I work a lot of events. Um, and I, on a given week, I have a patient interaction of depending on the week, but I'll just throw about 70 to 75 to 125, depending on the week. Um, and I would say unless someone's officially diagnosed them with it, most people have no idea. Most of the interactions I have with patients are like, oh, my psoas is strained. And the first test I do is flexion, adduction, internal rotation. And that lights them up. I'm like, it's not your psoas. Do they, since I know, I know you get them really quickly sometimes at these events, uh, how confident are you that, that, that, that new diagnosis information is going to stick with them?

So that's a, that's a tough line. I have to, uh, a walk and it's a lot of the times, Spoh, I worked a fencing event out in Kansas city and, um, I'm very careful with like getting, you know, going into someone else's lane because they're most likely never going to see me again because I'm never going to go back to Kansas city. Hopefully. Um, that, that fun, huh? Yeah. Um, so I try to give them advice, like, you know, this is what I think it could be. Um, I recommend that you go see someone who's really good at evaluating the hip. Um, there's been one case and it wasn't an FAI, but, um, it was a 16 year old female with low back pain.

Um, and 16 year olds should not have low back pain. Um, and she hadn't been getting any image or anything done. So I called the father over cause it was concerning. I want to make sure that she got some imaging for her low back for, I was suspecting a spondylolisis. Um, so I talked to the parent and told them that they need to get an image on that. Um, but most of the time I try to walk, uh, I try not to get too involved. I try to educate them and see if they're receptive to my feedback. Some people are others or not because they really trust their whoever they're seeing back home. And I get that, you know, who am I?

I'm just some random Yahoo that's walking into their life for, you know, 25 minutes. And I'm going to basically tell them that their person, their other clinicians wrong. So I just try to be diplomatic about it. And if you know me, I'm pretty outspoken and, um, pretty passionate, uh, about, um, my diagnosing. So, um, I can, I hold the reins back and, um, I just try to give them some advice. Um, and if they're receptive, I tell them if not, then I don't push it. Well, so then that brings up another question is that how do you know, actually, I guess it's, they're not really your client client or patient anymore.

So I guess it's out of your concern, but if they said, well, who's, who's good that will know hips around here? How do you, how do you, how do they find somebody? I know you're not from Kansas city. How do they find someone who's actually going to do a quality exam and know exactly what this is? So that's a good question. Um, the best I can do is I try to, uh, direct them towards a DACBSP. Um, so a diplomate and, uh, they have a diplomate from the American chiropractic board of sports physicians. And I know at the very minimum, they know how to do a pretty decent hip evaluation because of the training that we go through.

So what I will typically do is I will either go, I'll tell them to hold on a second. Um, and I'll try to look someone up that's from where they are. Um, or I'll ask because, um, there's a lot of docs I work with that have a lot more, um, they know they have a lot larger networking. Um, and so I can usually point them in the right direction. And actually I haven't had a problem now that you mentioned it. I usually find someone, uh, one person was Rhode Island where I'm actually from. And I knew there's a really good clinician up there, Don Murphy, not Dan, Dawne Costantino. Murphy. And that's really important for chiropractors to discern.

So, um, Don Murphy, um, is a really great clinician doing great things. Um, he's, this is kind of going off on a tangent, but he's the one who started the clinical reasoning in spine pain. And he's like adjunct faculty at Brown university. And, um, he does a lot of research. Um, and he's trying to create a model for chiropractors to fill the void of, um, a primary care physician for spine related problems. So how's that, how's that going? It's going really well. They're actually going to implement that, um, at the school, um, over the SCUHS. So, um, it's like a lot of, um, going back to like good proper history and exam.

And then, um, they do a lot of like the McKenzie end range loading stuff. And I love it. I studied into that model for about a year and a half and I thought it was really good at, um, uh, evaluation, um, and for a little back and neck pain. Mm-hmm. So. Oh, cool. So Don Murphy. Dawne Costantino. So Dr. Fletcher told me that he sent me a picture of you, uh, and your resistance to wearing, uh, triathlon clothing. And he wanted me to ask you what your beef was with actually wearing actual triathlon clothing and why you do everything in Speedos. So when I first moved to Salt Lake City, I didn't know anyone. And I met Tom or Dr. Fletcher on a bike ride.

Um, I went out and it was freezing cold out. Um, and I didn't have like any winter clothes. So he was nice enough to give me some warm clothing. So that's how I met him. Really nice guy. Um, but you know, we did a lot of triathlons and triathlon camps together and I did, I did a lot of racing in the Speedo because my first experience with triathlon was watching, um, one of the old Ironman championships when I was a kid. And I remember, um, there was one of the guys who finished up at the top, he was wearing a Speedo and it was, he did so well, you know, he was pretty BA. So, um, I just like, man, that's pretty cool.

Going back to the roots. So wait, did you have posters of men with Speedos on your walls to inspire you? No, but Tom has a poster of me and a Speedo in his office. I'll have to ask him for that picture. That might be the one that he sent. Yeah, go ahead. Yeah, there's one he has in the office that's me riding my bike and Speedo and I have long hair and I look like a hippie. Yeah, I think that that might be it here. Let's see. Yeah. Is this it? Oh, that's a different one. So yeah, you know, he randomly liked that yesterday and I was like, what the heck is he doing? Or this one. Oh gosh. I'm going to drop these into the, uh, into the video version.

Oh man. I thought these were a joke. Why are these things, they're like pink bloomers. Yeah. I try to get them really colorful and it was my way of having a little bit of fun. Yeah. I'm sure the people behind you were like, screw it. We're going to get in front of this guy real quickly here. Yeah. Well, some of them couldn't do that. You know, it was pretty good. Not that good, but pretty good. So as we transition away from the proper diagnosis stuff, uh, is there anything that we missed? Um, just, so the main thing, I actually have a pretty good quote that I'd like to, um, so the model that are one of my mentors right now is he follows under, um, this, uh, gentleman's model.

His name is James Siriax. He was an MD and he was a manual orthopedist. So he's funny thing is he did a lot of spinal manipulation and soft tissue work, um, and he absolutely could not stand chiropractors. So I think it's funny that there's a group of chiropractors right now following his model of how to diagnose and manage orthopedic, um, conditions conservatively. So I like to give this to my, the, some of the students I teach too, because I'm, I'm passionate about, um, you know, teaching the, uh, students as they become clinicians to really listen to, um, the patient because a lot of them aren't being heard, um, when they go see a lot of like a high volume doc, um, no matter which field they work in.

Um, so Siriax says every patient contains a truth, he will proffer the data, which the diagnosis rests. The doctor must adopt a conscious humility, not towards the patient, but towards the truth concealed within the patient. If his interpretations are regularly to prove correct. So the patient is, has all the information and you just need to get it out of them. Yeah. Just keep digging, keep digging. Cause a lot of times they're, they may be embarrassed at some things or, you know, they just don't think it's applicable, but it's the most important piece of the puzzle. Okay. I like that. I think I got to get you a non squeaky chair one day.

Sorry, I move around a lot. Yeah, you were, well, mine is too. I think I need to upgrade here. Yeah. I don't know. It's pretty nice in here. Yeah. Well, I don't know. I feel like I can finish the entire wall here. I moved all this stuff out one day cause I had like really low wifi in this corner and I was doing people on Skype and we had correlated videos. So I cut all this shit down and I put it out there in the front over there and move it all back in. So I haven't put it back together yet. But I see everyone's like when they're doing videos on how to podcasts and stuff like that, it looks so crisp and clean.

They have this little thing right here and I'm like, where the, where the hell are all their wires? This seems like just a fake, like they just took this thing off and just like a little dummy one. So what's this thing? It's called a pop filter. Actually, I was, I don't know if it's needed, but it was, if you don't have this, you're supposed to have a pop filter. Okay. Um, I think it's, I think it's supposed to address any ambient air or breathing. Oh, I see. Um, kind of, yeah, it's kind of like, you know, like those mics when you use them outside, they have the, they have the cat on it, the cat skin.

So I think it's like that. I see. Okay. And then, I don't know, I gave you a blue ball one and, uh, I like it. Yeah. I, there's, I have different colors for different days. There's a yellow one too, somewhere. Um, so Tom told me to ask you about kettlebells. Uh, I know you said they ask you, or you, you said you're, uh, passionate about kettlebells. I am. I love kettlebells. Um, so I got the, um, one of the best gifts I've ever gotten from someone was Staff Sergeant Lombardo when I was in the military. Um, I won't go off on this whole story, but, um, for about three months, um, of my life, um, I was at the, uh, the mercy of Dr. Lombardo, sorry, Staff Sergeant Lombardo, um, and from about 5 a.m. to 8 a.m., um, Monday through Friday, and basically just smoked me with kettlebells.

So Turkish getups, kettlebell swings, um, farmer carries, suitcase carries. So a lot of the stuff I actually implement on my patients here, um, he taught me back then. Um, I love kettlebells, um, because you can bring them everywhere. Um, and I really like them for, um, uh, for endurance athletes. Um, I'm an endurance athlete myself, but you know, a lot of endurance athletes don't want to put on a lot of muscle. Um, they want to get that muscular endurance down. And I think it's really important to, um, get some strength training in. So kettlebells are really great. They help a little bit out with VO2 max, not a whole lot, but really, um, you're doing a lot of that sub-threshold, um, max heart rate stuff.

So, um, with kettlebell swings, it's just, it's all body stuff. So you're working your glutes, the lateral, mainly the lateral portion, um, lateral hamstring group, the low back, um, you know, the core, you know, I know that's kind of a garbage can term. I hate that term. Yeah. So basically you're using your abdominals, um, the transverse abdominis, internal, external obliques, um, the low back, but you're engaging like, um, with some abdominal brain. So it's like a, a natural progression as far as I'm concerned from, you know, some with low back pain, you get them on diaphragmatic breathing. You get them in the McGill's big three, you know?

Um, and then once they can get up on their own, I start doing like suitcase carries, farmer's carries, get posterior chain activation. Um, and then I ended up getting the patient eventually it takes a while. Um, but to a kettlebell swing, you know, cause it's really good in the proper kettlebell swing. So you're using mainly your glutes, um, and not your low back, but it's going to get forearm strength, um, you know, scap stabilization, um, lower extremity strength. I just can't think of a better exercise than a kettlebell swing. Yeah. How long did it take people to really get there in that you've seen to responsibly have a good, safe swing?

A while. Um, it depends on their athletic background. So if it is, for instance, I have a lady who is 50 with, um, uh, with she's recovering from some low back pain. Uh, see, I actually had a, um, um, uh, L5, uh, disc herniation. Um, did she have IT bands in her? She did have IT bands in her. No, I'm kidding. Um, so it's taken her a while. Um, and when I did introduce a kettlebell, I introduced like a five pound one. And, um, but it, she's not that ready to go past that at this point. You know, you start with like the hip hinging movements with, um, so it's taken quite a while. Um, I don't even, I can't put a number of visits.

It just depends on the history of the background of the athlete or the, um, you know, their coordination and, you know, how aware of they have a lot of these movements and a lot of people are not. So it takes a while. I've noticed it with the swing that there was, I mean, I never do American. I've done Russian. Yeah, that's what I do. Yeah. I feel like with American or even like people that like, they float it rather than driving it, driving the kettlebell down through the, through the tunnel again, I feel like there's a lot of slack. It's almost like once the kettlebell like hits again, then it could trigger something or it could, um, create an injury.

So at least with American, like that thing's swinging all the way from the top there. And if you're going to throw it through the tunnel, God, that's a lot of, I don't think I would use over like to maybe 26 pounds on that. Yeah. I don't believe in kilos by the way. I don't, I like the pud, like the old, the, um, the Russian Imperial Russian measurement. Yeah. How much is a pud? A pud is 36 pounds and there's a good Russian proverb. It is, you never know a man until you've eaten a pud of salt with him. 30, 35 pounds of salt. Pretty much. Yeah. Um, so, you know, men, now they mentioned the American kettlebell swing, um, or the, the American swing versus the Russian.

I did, uh, um, some research cause I wanted to see, is there any discernible difference with like, um, activation of muscles and there was not, there was no, there like EMG studies that were done. Um, and I don't remember the, the control or like the N, um, on the study, but there really wasn't any more muscle activation for like a transverse abdominus or. The back muscles, anything you're just going to activate maybe some of your scap stabilizers, but it was very weak and there wasn't like a definitive conclusion of the study. Yeah. I wish I had brought those. I should have. That's okay. I'll give you a chance to look it over.

Oh, to, to, to send them later. Okay. So just so just to clarify on that. So the lower, I'm guessing the lower half, the, the drivers of the movement, the initial drivers, the hips. Yes. And the torso were about the same. The scapular muscles then probably did the work past about here or something. Right. And if you think about it, someone, um, if you're doing like an, a two pod or what is a 72 pound kettlebell, I don't, I would not wreck. I mean, unless you're like a, you know, a, you played for Alabama in college football, um, and you're just like a beast of a person. I don't know if that would be responsible to, um, teach someone to do that.

That's my personal opinion. Um, I used to do American style when I was in the military and I would do it with that. But now I'm thinking, I don't think that was the best idea. Luckily I was young enough, um, where it didn't really matter. But I think when your patients are a little bit older, um, or your clients, then probably stay away from that kind of stuff. Mm-hmm. Um, in regards to kettlebell swings that like I've noticed that some people, they seem to squat it. Some people hinge it. Is there a preference that you've seen or? Well, so I like the hinges, is, is the goal. That's what it is.

It's a hip hinge movement. So I try to stay away, like coach someone if they're getting too squatty. I'm like, I do squat. I'll do like some goblet squats. So that's another kettlebell exercise, um, that I think is great. Um, but then you have to be able to coach them the difference between, you know, a squat and there's two different hours. You're looking to get two different, um, outcomes from a squat versus a kettlebell swing, right? So you're looking and using different muscles. So, um, I think it's important to, um, let the, or discern or coach the patient or client that not to get too squatty because I've made, yeah.

There was, uh, I just recently made, I made a poster on deadlifting faults. And so one of the, one of the sections I did was, it was squat verse hinge. And so I put it out, actually, I put it on the, uh, the DACBSP or CCSP Facebook page. And I said, what do you guys think? Can you give me some feedback? Right. Um, one guy, I don't remember if it was on that, on that Facebook page or it was a different one, but one guy, he, he was, he was, he was vocal enough about why do we care about the difference? And so it wasn't on a swing. It was on a, on a deadlift. And I was like, okay, so this is interesting.

Can you, can you enlighten me on this? So he, he just gave some references that he was saying that if, if a couple of these, a couple of lifters, at least that he learned from, they squat their deadlift and they're very efficient at it. Why do we, why would we change that? Uh, and I think the theory was something about like you would save your, you would, you'd use your quads in the beginning off the ground to break the bar from the ground. And you'd use your hinge or you'd use the hips to, to lock out. And so I never came to the conclusion on whether that was correct or not. I've debated it with a couple of people.

I still teach them both because I want, I don't think people have the ability to know, like they just don't know the both. Good point. But I, I thought it was interesting. Um, I don't know if you've seen anything on that yet. No, I haven't, but I think that brings up a good point. Like when someone, for instance, I has an FAI, I'm going to, I like the hip hinge more because you're not going to, I don't want them going into, um, doing that full squat, especially with the kettlebell. So I actually have them pick the kettlebell up off of a surface. So they're going to start, um, from a standing position versus picking it up off the ground.

Um, so I guess for that, um, I don't need to, I guess the squat isn't as important. So I, then I go to the hip hinge cause that's my goal and how I was taught, I guess. So I guess we're really, what it comes down to is how you were taught and the gentleman that, uh, taught me and drilled it into my head was, it's all about the hip hinge. And it's as far when I've always think of a kettlebell swing, I guess I should probably do some more research on it. But when I think of a kettlebell swing, I think of hip hinge. Yeah, I do too. I see people squatting it on, on accident. It seems like, seems like beginners will, but I don't know.

I've been back and forth and whether I'll like, if, if they've gotten to the swing, if they have poor form on a hinge versus a squat, the squat seems like it's going to be a relatively less risk. And if they're not mastering it, I'll make them do like one, two, three, then put it down or something. But then I would almost rather them cheat that and not get hurt. You know, or cheat, cheat the squat. So I think it goes back to what we were talking before we started here. Um, the most important thing for you and I as professionals is to get the patient moving pain-free. So, you know, is a squatter dead versus a hip hinge for a kettlebell swing?

Is it going to hurt them? Probably not. As long as they're doing it and they're not getting hurt and you're giving them, you know, um, pain-free range of motion. I think that's probably the most important thing. So I, I guess that's a good point. Like if they can, if they're more comfortable with the squat, as long as they're not going to hurt themselves, I guess I'm okay with that. Yeah. So you said you use a lot of those, those movements or loaded movements for rehab. Um, give me some examples just so everyone can kind of just, just figure out what type of things would be rehabbed with. Say like, uh, you said, uh, loaded carries, kettlebell swings, goblet squats, Turkish get-ups.

Um, so Turkish get-up, obviously that's, I mean, that's a ball buster. So that's kind of, um, most of the patients actually won't do that. And I do that myself. Um, but that's, I guess what I would do typically on a, um, um, um, more so than, uh, the most would be carries. So whether it's a suitcase carry and a suitcase carry would be, um, you're picking up a kettlebell, um, just one kettlebell, um, and you are just going to walk with it. So, you know, you are going to make sure that your scapular, um, your scapula is set and you're going to hold it. So you're getting, um, some scapular stability.

Um, and then you're also going to be getting some, um, uh, some contralateral. So the opposite, um, low back engagement. Cause, so if you were to not engage your low back or your abdominals, then you, the idea would be fall to that side where the kettlebell is. So you're walking and you're, you're holding your scapula down. So you're getting some middle and lower trapezius engagement, some of the other scapular stabilizers. Um, and then you are, you have to engage, um, your abdominals and your opposite, um, quadratus lumborum, um, so you don't, um, fall to one side. Yeah, they, they did a, uh, I think they did a recent study on, or maybe a handful of years ago where the suitcase carry that it showed how it helped level the pelvis for people that have like, quote unquote, uh, leg leg discrepancies.

And things like that would be addressed with them. Right. Yeah. So that's a really good one. I probably use that whether they have, um, a person has a cervical spine radiculopathy or like a sick scap trying to get the upper back working. And it was really good for the low back as well. Um, the, uh, farmer's carries is basically, um, similar or it's pretty much the same thing except on both sides. So you're doing, you're getting two kettlebells. Um, you're going to make sure you like roll your shoulders back, put your shoulder blades in your back pocket and you're going to walk. So you're having to engage your core.

Um, but it's also going to, you have to stand upright. So you're getting all your erectors from your low back all the way up to your neck are going to have to be engaged. So it's really good for muscular endurance, um, the entire posterior chain, really. Um, you know, just something you need to look out for is that anterior head carriage. You don't want to put too much stress on the nerve roots. Um, well, the brachial plexus, cause I know one time I went to the fundamental capacity screening, which is a offshoot of the FMS with gray cook. And, um, we, one of the screens was a, um, a farmer's carry, uh, like 75% of your body weight and, um, that's, doesn't sound like a whole lot, but actually, um, it's quite a bit of weight.

Um, and then you're walking and I remember, um, I had really good form, but then my whole, my, you know, so much, uh, um, traction on my brachial plexus, my whole, my hands went numb. Oh, both of them did. Yeah. They're starting to tingle. So yeah, okay. That's enough. So I mean, the, the, the point of the story, I guess, would be not going too heavy or going too far at once. Yeah. And just kind of build up into it. Yeah. Um, with the kettlebell swing, depending on the ability level of the, of the patient, I liked, that's usually a gradual progression from, you know, just, um, you know, ground movements, core stability stuff.

Um, and then moving to like the hip hinge, um, I'll definitely introduce the goblet squat. So holding the, uh, the, the kettlebell in front on the chest bone and then, um, sitting down, um, and then standing back up. So once they get like that movement, like being able to initiate movement from the hip, um, really loading the spine, uh, which is, um, ultimately the goal, especially with someone with low back pain. Um, but then the kettlebell swings usually last, um, unless it's like I said, depending on the skill level. Um, but it's usually starting off pretty light and just to get that, um, that thrust.

And it's a great exercise for your, your hip stabilizers. And I like, like we were going on with the, the hip hinge. I love the hip hinge because, you know, you're going to get your hamstrings firing, you're going to get your quadriceps and you're not going to go into that deep squat movement. So you're not going to irritate your, your hip, especially if you have an FAI. So I love the kettlebell swing. No, remember it's a, uh, it's a psoas major strain. That's right. I'm sorry. Psoas major. Your psoas major strain. Yes, correct. Well, cool. I think it's, I think it's a lot. Um, so you gave some references on there.

I'm actually going to make some videos, um, correlated to, I have, I have one of the bunch of carries. I'll put it on there so everyone can take a look at it. Um, and there's all the FAI tests. So I might have to get that doc from you. Sure. Absolutely. Cool. And, uh, we will do a McKinsey video, I think too, because people are probably wondering what is this? We mentioned McKinsey a couple of times. Yeah, it's really good. Um, there is. Yeah, it's, it's definitely pretty good. It's a Robin McKinsey down in Australia. It's funny. He didn't like chiropractors either, but eventually he warmed his heart up to chiropractors and he found the, um, the, uh, the technique on accident.

Yeah. Um, but it, it's pretty good outcome measures. Um, is he alive? That's a good question. I don't know. He's probably, if he is, he's pretty old. Yeah, probably. I'm not sure. Yeah, I don't know. Yeah. I don't know. I want to figure that out. I was thinking about this actually recently that there's, um, so like a lot of the shoulder research is by Kibler, Kibler, right? Mm-hmm. And so I was like, I wonder how old Kibler is. So I looked him up and, uh, I, I found his, his, I found his site and I found a phone number and I'm like, I think I want to call Kibler before, before, like some of these guys that have done so much research, they probably have so much to share, like before, you know, I hope he didn't die soon, but like at some point they will.

Yeah. You know, like, um, it'd be nice to, Yanda's, Yanda's gone, right? Yes. Yeah. So it'd be nice to have all those people on. Yeah. I can't think of, I thought of, uh, Andrews, James Andrews. Yes. Yeah. I'll try to find McKinsey. You should. I can imagine it now. I was on the ground playing video games one day and I decided to look up and my back felt better. It's pretty easy to do. Like, yeah, it's like you wake up in the morning, just go ahead and lay on your back or lay in your stomach, cobra pose, and then go about your day. Yeah. Maybe, maybe he was mimicking or like making fun of the cobras next to him.

Ah. He was, yeah, he had a bunch of pet cobras. You know, the Aussies are an interesting group of people. Yeah. Wait, are they from, are they from British descent? Yes. They sound like Brits, right? Yeah. They used to be a part of the UK. Okay. And I have a, when I was in the service, um, I went to, um, a, a school with some Aussies, uh, out in Vegas for a few months and I remember talking on the radio with these guys and I'm like, we're speaking the same language. I have no idea what these people are saying. Yeah, I know, right? They've been Scots. It's like, I don't know what they're saying.

Yeah. The, um, the, the coffee business I told you that I had, um, my partner was, he's a, he's Australian. So I picked up a handful of things from him and I started, finally started to understand what he's saying. After about like two months, it's probably why our business didn't go well. We just didn't, we couldn't communicate with each other, but yeah, um, I think I've gotten better at it now. Um, okay. So as we start to close up here, um, what do you have for closing words for people? I know that you, you want, you have the passion for diagnosing them and making them start to do hinges. So I like the, my passion for diagnosis, it comes from, I was misdiagnosed from, um, I had a scaphoid fracture and it became a, um, it became a, um, non-unit avascular necrosis.

So the reason why I have a passion, I'm not saying I know everything I'm always learning. Um, and I'm getting better. Um, but the most important thing is I took out of that whole experience is that I went to a whole bunch of different clinicians and no one really listened to me at all. And it was very frustrating. Um, and so I think the most important thing we can do is listen to our patients because they're going to, they're going to tell you the diagnosis. Um, and that's why I got in, I think as a, as a doctor of chiropractic, it's my duty to get the correct diagnosis. That's why the patient's coming to me.

Um, and when it comes down to it, the diagnosis drives the treatment, right? So if I don't know what I'm treating, then the patient may not get, may get, may not get better. And another thing, it may not be something I can help them with. I have some of my patients, they come in and I diagnose them with, so for instance, I had a glute med avulsion person was on Cipro and he had a spontaneous avulsion of the glute med tendon. Um, I could do muscle work on that all day long if I just thought it was a glute med strain, but he needs surgery because he has an avulsion, you know? So, um, yeah. So the diagnosis drives the treatment.

So I think it's important as a doctor of chiropractic, um, and as a clinician, um, to make sure I get the patient the correct diagnosis. Good. How can everyone reach you? Um, so I do have, uh, anyone can feel free to email me. Um, it's michaelfanning at stuhs.edu. Oh, we're going to have to update that then when, uh, cause you're going to be out, out in about a year, huh? I will be, um, however, I may stay on to work with Dr. Horgan. So that's all dependent. If, if you update that, I'll update it on the show notes too. Okay. And I do have an Instagram page. Um, it is at sports underscore spine underscore MF.

I think, or is it sports and spine? I don't even know. Well, apparently, uh, Tom said you're a really fun, uh, follow taking, taking pictures with Greg Cook and wearing, uh, white or, uh, pink bloom or Speedos. Yeah, it's, uh, sports underscore spine underscore MF. All right, cool. So I will link all that in the show notes as well as your email. Um, and currently you work in, are you guys, uh, uh, Miranda Del Rey? No, I'm in, uh, I'm in Whittier right now. Um, I do work out, um, in East LA once in a while with the sheriff's department, but our clinic is, um, at, um, in Whittier. Okay, cool. Whittier, California, everybody.

All right. Well, thanks for coming on. Yeah. Thank you so much for having me. I appreciate it. It was fun. Yeah, it was good. Thanks, man. Okay, everyone. That was Dr. Michael Fanning. He is session number 83. So if you're looking for the show notes or anything we referenced as well as any of those tests, um, for those misdiagnosed conditions, then I'm going to have them at the show notes. That's p2sportscare.com slash podcast slash pound the session number, which is 83. So I, you know, just to reflect a little bit, I do agree with them completely, especially with that IT band thing. Holy crap.

I can't tell you how many people come in with these, what we call radiculopathies or referred pain into areas that commonly are misdiagnosed as IT band syndrome, plantar fasciitis, things of these nature. It's really, uh, everyone's really familiar with at least sciatica, but they're not as familiar with all these other types of, um, I guess not extreme pain. It's just a little bit of discomfort and they think it's not a nerve or a neuro related condition. So we really need to screen those out and have proper diagnosis if we're going to treat these people well. Now, so yeah, I'm, I might make a graphic on that and that would be, I think what it would probably be is something like the picture he showed.

It'd be that L4, L5, uh, related radiculopathy or presentation down the leg, as well as a pattern for IT band and maybe some hotspots of typically where you would feel pain, discomfort, loss of sensation in these two different types of conditions. So something that we can really show patients that are just handy right there on our desk or on our wall. And, um, gosh, you know, I haven't seen one on social media yet, so maybe something that we can share on social media too. So if you've not been to the patient education section of my website yet, ptsportscare.com, just go through, it'll say I'm a patient.

And there's so many articles that I've written over the last year. Last year was a content building year for me. This year is more of a, I don't want to say promotional year, but it's making people aware of the content. So, I mean, there's, I want to say each article that I've written has taken me over 20, 30, 40 hours to put together, to proofread, to have correlated videos, correlated, uh, or have infographics made. And that's kind of the inception of all the wall art and posters that I've put out for people because it was just needed for the website. So there's one on IT band stuff. There's a huge one on low back conditions.

There's a huge one on active release. There's a huge one. Diagnostic, diagnostic, diagnostic, ultrasound, as well as shoulder conditions. I mean, you name it. There's a bunch of stuff on there. If you're looking for the wall posters, docs, young docs out there, you need stuff. You need stuff for your walls. You need stuff for your patients to look at and to digest what you're saying because we all learn different ways. So if you're looking for those, ptsportscare.com slash shop. There's a bunch of them in there. And like I said earlier, if you're looking to share these type of podcasts with your patients but don't want to text them, email them individually, I'm going to have a Google calendar or sorry, Google sheet, Excel sheet with all of the podcasts in categorized for them to look at on their own.

You just have to show the Google link with them. And you get that when you actually buy a poster. So, all right. I think that's all I got for today. And I hope you guys had a great day and a great time listening to Dr. Michael Fanning. Leave everyone better than you found them. That's how we do it. See ya.