Listener Questions: Hip Pain, Ankle Impingement, Numbness, Pitcher Elbow

This is session number 57 of the Performance Place Sports Care Podcast. In the words of Socrates, strong minds discuss ideas, average minds discuss events, weak minds discuss people. 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, everybody, it's Dr. Sebastian Gonzales with the Performance Place Sports Care Podcast. Again, bringing you, hopefully, some good information for your sports care. I don't want to say just your treatments and your conditions, because really, we should be learning about everything that there is out there. Even if you're not a healthcare provider, I feel like this is our body, you know, like we need to know how it works. And if you are an athlete, you need to know how your body works. And you need to know that when these injuries happen to you, that there's rational ways that we can address them. So, you'll see that I'm changing the intro up a little bit there. I thought I would add a quote today from Socrates. And, you know, I really do, I've noticed that over the, I feel like over this year that I really, I really want, I desire to have conversations with people about theory of things. And I feel like on this show, I've gotten to have that with a lot of different people that, I mean, more than I ever have, especially within the healthcare realm. Because a lot of times we just kind of just exchange in passing, or, you know, we'll talk about what so and so is doing. And, and I feel like it's very like skin or surface deep conversation. I feel like when you really get down to the nitty gritty, you find some really great minds out there who are willing to talk about theory. So, just some food for thought, at least, it was interesting when I saw the post. So, today is going to be a podcast just with me. And I was going to go and give back a little bit to listeners here, and answer some of the questions that I've seen come through emails, as well as voicemails, and YouTube. So, keep in mind, as I go through these things, that I can't really give direct medical information, I'm not going to say anyone's names or anything like that. And for the most part, I'm just going to brainstorm these questions that people posed. And it's not for the lack of me wanting to help. And it's a lot of the healthcare providers will understand when they listen to this podcast, that there's a really, there's a gray area where we can't direct you to do certain things, if we haven't seen you, because we're only getting part of the puzzle. So, we're really not, we're not getting everything we need to direct you in the right direction. If we don't direct you in the right direction, then we're not doing any favors. So, what we're going to go into today is there's a couple questions. One was a cyclist with hip pain. Another was an ankle sprain, they were looking to avoid surgery. Someone asked a question about numbness of the leg. And then lastly, there was a pitcher with elbow pain. So, I thought we'd get right into it. First, with the cyclist. By the way, if you guys do have questions, one of the best ways to go is onto the YouTube channel. I do search there pretty frequently. I might miss some, so I do apologize, because for some reason, YouTube doesn't allow, they just don't feed them right to me. Sometimes I have to actually dig around a little bit to find some, I'm like, oh, I didn't see this one. It happened, you know, two months ago, and I didn't really even look at it or address it. So, YouTube's a really easy way.

Also, Instagram, that is at performancehb. So, I am on there pretty frequently. I'm not on Twitter quite as much. Or right on my website, p2sportscare.com, you can leave the voicemail right on there, too. So, let's get into it right here, okay? So, I'm just going to read these ones verbatim, and this one says, Hi Doc, I've been doing insanity four days a week for about a year, plus road cycling. A bit of running and swimming without having any issues, thank God. Now, it's been three weeks. I haven't done any sports, and I planned on starting again on next Monday, but this kind of hip pain, he's referencing a video we had on, it was rectus femoris origin strain, which you can find on YouTube if you Google that. It's one of the more popular videos, by the way. So, a hip pain just came to him today. So, he didn't hit anything, nor did anyone hit, hit. All right. So, nothing hit me, nor did I hit anything. It just came on all of a sudden.

What causes this? Thanks. So, actually, I did a recap on this video on YouTube early on in when I started redoing the podcast, and I'd venture to say that, although I didn't delete all of the old, old podcasts yet, where I was doing them like in my car, driving home, they were actually just on my iPhone through a headpiece. Now, I have an actual studio, but the one I brought up about rectus femoris origin strain, I'm pretty sure was in the, I want to say, ranges of one or two or somewhere around there. I wish I, I'm trying to look it up right now. I don't see it. Okay. So, it's under, I'm sure it's under 10. So, anyways, he asked about what causes this, and can it happen without trauma? And if you've listened to a couple of the more recent podcasts, we did hit on the concept of quote-unquote injury already, and it's really funny how when we consider injury on our side, so anything that probably you see anybody from our side, the healthcare side, or sports injury side, and they write an article or they reference an injury, even sports injuries, it does not mean always trauma. But I've come to realize that a lot of people, a lot of patients and athletes think injuries only have to happen when trauma is involved. Trauma is when someone hits you or you hit them, or a misstep and like say something actually crumbles, you know, like an ACL or like a knee, because that does happen as well. So, the injuries don't have to happen with trauma. They can develop over time. And I did a whole podcast on this already in session number 54, where we talk about the concept of injuries. They don't have to be traumatic. They are in the past, and actually sometimes currently, we do think of them as overuse, but also now we kind of consider them also movement-related conditions. Also, too, I did do a whole podcast on different types of muscle injuries, or the categorizations of injuries. So, it doesn't always have to include trauma, and I can't say that enough.

So, these things usually do build up, and you won't notice them overnight. They'll just kind of slowly creep on, and sometimes, actually, I take that back. Some do seem like they do come overnight. Some people think that it's the way they were sleeping, and so they start blaming their pillow or their mattress, but really, it's the things you do the majority of the time of the day, which will create this. So, just kind of looking over what this person was doing. I mean, they were doing four days a week of insanity is actually, it's more of a plyometrics-based jumping type of activity, which actually, when you consider some of the mechanism of injury for plyometrics or running, a lot of it comes down to what we call neuromuscular degrade, and neuromuscular degrade is where you really can't keep your form because you're hitting an exhaustion point, and it doesn't have to always be breathing exhaustion. It could, it's just the point where form starts to degrade, and it usually happens as intensity increases or duration of time increases. Now, if you've listened to some of their podcasts on functional neurology, you're going to know that there's more than just the musculoskeletal system involved, so we do have the neurological system and the brain involved in this. So, there are aspects that are a little bit higher, which I'll probably deflect to some of the other people I interview to come because they're definitely more knowledgeable in that realm than me, but for the most part, we need to get it so your body functions well so it can tolerate that jumping mechanism because that little yank over and over and over and over and over and I think it's sanity's like 45 minutes or so. I've never done it personally. It takes a toll on the area and one of the muscles which can be irritated is the rectus femoris at the origin area. Now, let's just say it's not the rectus femoris either. Let's just say the area right there with the anterior front side of hip is the thing that's being irritated. Now, what else is there? Let's consider this first. So, it could be the hip flexor tendon, which is the iliopsoas tendon, which is the main hip flexor of the area. So, you could have a hip flexor tendonitis technically. The rectus femoris is technically a hip flexor, but it's kind of a weak one. It is a two joint muscle. And the reason why I bring that up is because two joint muscles typically are a little bit more dynamic. And they're also, I consider them almost like Ferraris. Like they, they do a lot of work. They're, they're make it so we can move quickly. They're very important, but also too, they typically break down first. A hamstring, the hamstrings are a great example. They're also two joint muscles too. So, what else is there as well as deeper? We have the actual ball and socket joint, um, which you could have a impingement or also a labral injury or labral pathology there. Uh, I'll, I'll clean that up a little bit to say the labrum is a cartilage injury. It usually involves the joint. The joint is surrounded by a ligament or capsule and the joint itself, I guess we usually say it's kind of like how everything is, uh, blended together down there, but you can have a pinching pain there, which the way I typically kind of qualify with people is I have them bring their knee to their chest and I have them do it so that their entire leg is relaxed. So if they feel the symptoms happen when they bring their knee to their chest, that means that we're testing the passive components of that area, the cartilage, the joint, the ligaments, the things that don't contract really. If it doesn't seem to hurt, but you let go of the knee and then now your muscles start to activate to hold it up, it could be the tendon or the muscle.

Now, the reason why I bring all that up, and I know we're getting a little bit further away from what he was talking about, but, uh, really it comes down to isolating down to figure out exactly what the injury is locally right there. Is it a muscle, tendon, ligament, joint, cartilage, vascular structure, nerve area, referred pain. Referred pain can be from like a, uh, nerve root entrapment in the low back maybe, or within a peripheral nerve entrapment. I know it's complex. Let's not go into that, but there's a lot of reasons why it could be. And if you start chasing the pain down, I mean, you could be all the way down at the foot and just, I mean, forget about the entire hip completely. So that is all very important. Now, let me bring it back home a little bit here is that some people might say, and I agree with them, is that, you know, why do we, why do we spend so much time assessing the actual joint right there when we know that there's reasons why these joints or muscles or tendons, the area, I'll say regions, we know that they are affected, if not from trauma, they're affected by the way the body's moving. Okay. We're going back to that concept of neuromuscular degrade. The neurological, neurological and muscular system break down because we can no longer tolerate the activity anymore. And this is what happens a lot of time when people, go for broke on exercise. So we know that breathing is a component, intra-abdominal compression is a component, core strength overall, the whole hoop mechanism of the core or trunk or torso is important. The pelvis is important. The tilt of the pelvis is important. The muscles surrounding the hip are important. And even things down into the ankle, foot, knee are important. So there's a lot to come into play here. So we need to really assess how the entire limb and the entire body is working.

And if you listened to the past podcast that I had with a friend of mine, it was session 55. You're going to realize that if you're anything like him, you probably don't understand the correlation between the other parts of the body, which is completely understood. And if you listen to that podcast, he actually has a, uh, what was it? A calf condition and a hamstring one. We kind of had to break down and I did explain to him step-by-step how these things are correlated. And at the end of it all, actually, I'll tell you, after we recorded that, I emailed him all the stuff that I wanted him to do. And then he still had questions. He's like, I understand you get, you sent me these videos, but can you explain again why you're doing, why we're doing them? I said, no, I'm not going to.

And the reason is, is because I'm going to send you the whole podcast we did. We, I understand it was hard to understand the first time, which a lot of things are. That's why we study and read books multiple times because we get different things out of them. But understanding that, understanding the mechanism and why different areas of the body affect that area or the hip in this case is extremely important. And we found actually through studies that when people understand, when patients understand why they're doing something and how things are connected, they actually do it better. They get better faster. Their disability is less. Um, so overall it's a higher success rate and oftentimes it's because they take it more seriously. Okay. I don't, I don't like to say that people are making excuses for their, for their rehab or their injury, but also too, they don't understand the importance of it. You know, it's kind of like if someone were to tell you right now that you need to save it for retirement and you're 18 and you don't do it until you're 25 and at 25, you're like, God, I should have, I should have been saving up all these years. I could have had so much more interest, you know, or, uh, you know, uh, accruing of, uh, exponential growth is what my sister would say. And it's not really important at the time, but it doesn't, it doesn't meet the lack of importance really makes it so you don't follow a treatment plan. So I can't stress that enough. So I know we've gotten a way away from the question here, but he asked what causes it? I guess my answer in short here then is a lot of things.

And it could be one thing. It could be two things. It could be, um, I mean, it could just be that he's unfortunate and he was born with a terrible tendon right there and we don't know. Um, but for the most part, I think when you get checked out and you get assessed for your movements and making sure that everything's really attached and it's just, uh, you know, like if you go back to that podcast where I had on types of muscle injuries, a lot of muscles can hurt when they are actually, there's nothing physically wrong with them. They're not torn. They're not strained. And an example is delayed onset muscle soreness. You, you get sore after working out, they go away and like, five days if it's extreme versions, maybe a couple of days, you know, but no one really questions that there's any damage to the tissue, but it doesn't mean the muscle isn't hurt. It's a real injury. So I hope that helps out a little bit there. Um, and, uh, we're going to go straight into the next one then. Okay. This is another question that I got, uh, through email. So this is a 33 year old. So eight months ago I had a bad ankle sprain and by the way, this one's going to have a lot of technical language. So I might intersect a little bit. Um, I had a bad ankle sprain which led to persistent ankle anterior lateral impingement, which results in slight overpronation. I'll stop there. There's a lot more, but so ankle anterior lateral means kind of front and outer side. Impingement means kind of pinching, um, which results in overpronation, which means that kind of having, uh, less of an arch and, uh, and slight valgus heel and hence wrong gate also impaired any weight bearing activity. So basically saying he can't, uh, weight bear as much anymore and his, uh, walking and running mechanics are altered. The problem is persistent and no improvement, uh, with, sorry, I'm going verbatim, uh, with normal physical fitness or physical therapy exercises. I'm about to go for surgery for ankle, ankle arthroscopy, but I wanted to ask you if you have any new techniques that may release such ankle impingement, which is located in a very different or very difficult location inside the ankle joint. This may help me avoid surgery. He, and he had to attach a picture. Um, for the most part, it just kind of describes some, some ligaments in the area that he's, he's looking at. Um, now, uh, what he asked about was mainly that, so here's what I'm hearing from this. Uh, first off, we don't know if anything's actually torn. Um, I didn't hear anything about an image to confirm whether the, uh, one of the most commonly torn ligaments in the ankle area, especially with, uh, inversion sprains is in kind of rolling the ankle to the outside, which is the most common one.

You guys are probably doing it right now just to kind of test out the movement of it. Uh, that is the, the most commonly torn in the urtate ligament is the ATFL, which is the anterior talofibular ligament. I know it's a mouthful, uh, but for the most part, you, if you slid your, uh, fingers kind of down the bone on the side of the shin and just went a little bit in front of it when it kind of hit that ankle, there's a gully right there. And that's around the area of the ATFL. And this is the one which, again, it's most commonly torn. But at the same time, it could be a mild strain. Um, I've actually seen people who don't have ankle pain whatsoever and their ATFL is not completely ruptured, but it is definitely compromised.

Now by compromise, I just mean that it's, um, or an uncompromised, it just means that it's, it's still functioning. There's no pain, uh, or sorry, I take that back. The, the compromised ligament means is it's not in full integrity. Um, now I've seen a lot of other people too, with incidental findings on imaging too, meaning that we have people that have quote unquote tendinitis or tendinosis, which don't have pain. Uh, we have people with completely normal x-rays and MRIs and ultrasounds of the ankle and do have pain. And I remember actually a case that we had, uh, come in and it was an ankle injury that was again, pretty old like this is about eight months. It wasn't really, really old, but, um, he kind of noted the same thing and, but he, he kind of felt tightness or like pinching on that outer part, kind of where I had you palpate.

But it happened like when he had his, uh, when he was pointing his toe, his little toe, his little toes kind of to the sky. Um, sorry, I'm having to translate what I'm trying to think to you guys. So basically kind of rocking the, the foot and ankle or foot or ankle back and forth. It's not when like you're about to roll your ankle again, but it's the other way. So this is where he felt pinching at, um, at the time. And, and it was kind of interesting and it really baffled his, um, he had a podiatrist at the time. Uh, there was an MRI, which was negative and x-ray, which is negative. So there was really not much wrong with that ligament that we talked about before. And also too, when you do stress tests or, or figuring out if the ankle is, um, if it's stable, because we want to have it. So the area is not just like completely unglued, because then we're going to have all the whole different problems all in itself. Um, it was technically kind of normal. I mean, there's nothing wrong with the ligament. The stress tests were all pretty normal. And when you test that ligament, usually you do it almost like you're turning your ankle again. So the reason I bring that up is because that's not the motion that hurt him. It's the other way, which then kind of leads you to think, well, we're not really tensioning the ligament. So we're not really testing the ligament. So what the heck is getting pinched in there? Right? So what we did is we kind of, we took an ultrasound and I remember this case really specifically, uh, uh, really well, because when we saw him a couple of times and, um, he ended up getting a correction that he needed to make him feel better, but he never, he didn't follow through on rehab, which is really unfortunate because he needs to, um, this was years ago. But, uh, so we found an ultrasound that when we put him into that position, when we turned, we moved the ankle to where the pinching happened, we saw a bunch of fluid come out of that region of the ankle. And what happens is when you're, when you're approximating the ankle like that, and when you're moving the two bones kind of together or the two regions together, this area of fluid came out and you could tell it was fluid because it was black and it just started coming straight out of joint and it was getting pinched. So it's almost like a water balloon, which was between two joints and it was just getting smashed.

So it created pain. Now what the fluid was coming from in this case was the inside of the joint itself. Now what was causing it? Um, I would imagine it was from some type of, uh, light instability. It wasn't like the, the thing was, um, grossly unstable. It's not like he wasn't able to walk. It was just that it wasn't perfect. And this is, this is what happens a lot of times from past injuries. You end up getting like chronic inflammation in the area and it just goes on and on and on. And eventually you get arthritic conditions or degenerative changes or the cartilage breaks down and you know, the tendons get irritated and things like that in the area. But for the most part, that region of pinching was his major issue. Now what we ended up doing was I told him to go back to his podiatrist and we just said, I said, look, I don't have the, I don't have the means to get that out. We just, we can't pierce the skin in my profession. But I would be curious to see if we had a pain generator in that. If we got rid of that fluid, if you stuck a needle in, sucked it out, move the ankle. If it would go away, that would lead me to believe that we've identified the pain generator. Cause it made it, cause pretty much the major issue. And it sounds like this guy's having the same problem is that they don't know what it is because they're willing to go in and, and look around and just see, you know, but in my opinion, a lot of times it's a, it's a movement based thing. Um, and in this case we can see it, we can see what's pinching when the movement occurs.

But when you go into a static image, a non-movement based image, like an X-ray or an MRI, it was, it was just missed in this case. I mean, those images are great for a lot of other things, but in this case it just, it just missed it because it wasn't a movement one or we couldn't put it in the right position. Cause it wasn't like the standard view, um, for those images, but either way. So what this guy did is he got it drained out and then he called me and he's like, look, that was great. Like I don't have any pain anymore. It went away. You know, we ended up, uh, getting rid of the entire thing.

The, the, the whole condition he said would just by pulling the fluid out. And I told him, I was like, well, here's a whole article on, on ankle instability. You should probably read it. And we need to start some rehab. Um, cause the best time really to start rehab, you really get into the nitty gritty of it. I think is after you start to feel better. I mean, there are things that we give you originally, um, to start strengthening the area a little bit while you're still have some symptoms, because with this guy, he really had, he really only had pain when he moved his foot in a certain direction, but it doesn't mean we can't work around it for a small period of time. You know, at some point it does become cumbersome. Like it kind of ties our hands with recommending what's really recommended. Um, but for the most part, we got rid of the pain on that and the pain is not the major issue. It's the dysfunction. It's a dysfunction, which is creating that fluid to come out of the joint space and get smashed on. So in a case like that, and in a case like this guy, it sounds like they haven't identified the pain generator because, I mean, I don't know if he did any, uh, images. I can't tell. He didn't, he didn't say anything about them. Um, but they're willing to get, they want to go in and look to see. So, and he's, he's looking to see if there's any techniques that will release other parts of the ankle, which might be creating the binding. So, I mean, the ankles are pretty complex regions. So I, I can't give any specifics, but for the most part, I would, I would kind of take a step back a little bit and maybe get a second assessment somewhere and just say, look, we need to make sure that we're finding the right road that we're going down. And I, I, I always think that, I mean, moving forward in something in life and in rehab and in, let's just say investing or whatever you're going to do, it's not always just because you're moving forward doesn't mean it's the right direction. So sometimes you have to come on back, reassess, change direction, then start moving forward again. And if there's still no fruit with that, you move back again. And then, but you can't say just after moving one direction that it's not going to work. And if you listened to the podcast that we have with, with, uh, Eric Reese, he kind of talks about that a little bit. He had a couple of complex cases that just weren't working for, um, they, they weren't working for other people's typical techniques.

And there's not, there's anything wrong with those techniques or the methodologies, but it just doesn't work for everything. I believe that's session number 42, by the way. So we talk, he talks a little bit about how sometimes the neurology or the way the brain or the software of the brain is not uh, functioning well. And it's not always, not always purely the hardware. And in this case, hardware would be the foot and ankle. And also too, to take into consideration, uh, we did have a podcast with Dr. Justin Dean on session number 43. And we talked all about the foot and it was mainly about quote unquote, panor fasciitis, but actually since then, since we did that podcast, he made a couple recommendations where just mainly on the inner part of, of like the shin. If you're having like medial ankle or, or inner arch pain anyways, he said, just kind of yank on the skin right there. And the reason was because the superficial nerves kind of run through there and they, they can create pain as well. So he's saying that the, the fascia, sometimes you get stuck in the fascia, which is kind of like a, a surrounding layer, uh, just under the skin layer. And if you can yank it free from the fascia, then it'll relieve the referred pain into the foot. And in the ankle, this could possibly be the same thing because there's other nerves which can travel down and get trapped within fascia. So if you have questions on more about how to yank your pain away, Justin Dean's going to be the one to go to. So check that out. That's session number 53. Um, but for the most part, I mean, I would bet if they went through and looked at that ankle on the inside, they're going to tell you that it looks fairly normal.

That's just my guess. Um, because I've seen a lot of people who have had stuff like that done. Um, sometimes they find stuff, but, but really, really think about it. We are only looking at hardware right there. Okay. That's only half the battle. We're only looking at the nuts and bolts. We're not looking at the computer system, which is controlling the area. If we chronically keep irritating this area and he said gates altered in this case and weight bearing exercise isn't possible, then I can almost guarantee there's something going on with software upstairs. You're just not moving well. Um, there's compensatory movements going on. Um, and it's just, even if we fix the only the hardware, it's, it's not going to, I don't think it's going to bear long-term fruit like you're wanting. So, uh, I hope this was helpful with that part, but, um, the, the ankles are really a little bit more complex than you think as well as the wrists. And if you look at the, uh, if you look at a diagram or a, uh, a picture of an ankle, uh, there's so many bones right there. I mean, I mean, I think the estimation is that a fourth of the bones in the body are in the ankle region. I think the ankle and foot don't quote me on that, but I think it's a high percentage of it. I mean, there's a lot going on down there, so it's not a simple fix. Um, you have to really know you're going in the right direction and then, uh, and that's only going to figure that out through assessment and possibly imaging.

And then you're going to hopefully have someone to guide you down that route because not a lot of people can do it on their own. Okay. Next, we're going to go on to the other question. And this is going to be a baseball player. Now we'll save that one for last. Actually, let's go into the, uh, the other one about leg pain. So this one's from a YouTube video that we had on foot numbness. And the reason for the video actually was that we want to show there's different reasons for foot numbness. Now, so this person asks, is there a natural way of treating numbness from nerve damage that causes pain within the back of the leg running down to the foot causing numbness in the bottom of the foot? Ooh, that's a long sentence. And toes, is there a way, is there a home natural way of healing back problem that nerve? Or healing back, healing back that nerve. Um, this one, I'm going to deflect a little bit and I'm going to say that if there is an issue with the nerve that has created kind of like quote unquote nerve death from the, uh, usually happens from the distal region from what I understand from, so it happened from like the foot and it starts to travel up. The nerve is to kind of regrow the nerve back a little bit and let it, um, kind of do its job again. Uh, nerves are kind of like hoses, they say, and nerves are one cell. They have one body and they have a really, really long arm.

Um, the long arm, because it's so far away from the body, it has to get its nutrients along the path of that arm or the, or the, or the hose in this case. And when you get, when it gets trapped somewhere, then it doesn't get nutrients to the end. Um, so the thing eventually starts to die off kind of like from the very tail end all the way up to the top and it can create things like numbness, tingling pain, uh, and all that kind of stuff. And I eventually, uh, at muscular atrophy or, or lack of, um, ability kind of to use the muscle because it's been so riveted away. Um, and actually did have someone come in that happened that happened over the course of a year or so, it looked like with his hand. Um, I saw him for an ulnar nerve condition and then a year passed, he never came, he didn't come back. Then he dropped in and he had this, this hand that just looked like it was just like there was, it was just kind of withered away.

And I, and I was like, what's going on? Is that, did you ever, you, did you ever get thing that, that thing taken care of? And he said, no, I did just thought it would go away. And I said, no, man, you gotta, like, the nerve is one cell. You got to get it to, you know, get nutrients to the other end or else everything that's, that it's working with at the other end, such as muscles, in this case, the foot and of the calf and the leg will start to kind of die off. And, um, if you ever see anyone who has had long-term nerve issues, they'll probably tell you like the calf is maybe larger on one side than another, or they'll start to describe one leg as this is my better leg. And this is my weak one from X, Y, and Z 20 years ago. So I'll deflect this one a little bit, mainly because I think someone else has answered it better in a past podcast. And that is going to be from, uh, let's see, it is going to be session number 43. That is Dr. Robert Silverman. And we talk a little bit about, um, new, uh, nutrition and sports injuries. And he describes a lot of the stuff, which I think would be helpful to this question. Um, there, obviously we need to stop the impingement point. And if this person has not figured out what it is, they need to figure it out very quickly.

Um, and that could be, uh, let's just say we're talking about sciatica and that's the, since it's the most common, probably a thing that everyone's looked up. Um, I'm not saying it's the most common nerve entrapment of the leg, but, um, it's definitely, uh, it's, it's up there in the, on the higher realm. So, uh, sciatica or sciatica like pain, by the way, sciatica, in case everyone knows, sciatica is a symptom. It's a symptom pattern. Okay. It's created from different things. It's created from nerve entrapment, usually within the spine region. And that could be happening for many reasons. And I'm going to, I'm going to address this right now because I know that, uh, I've talked, I think I've talked to friends about it in the past a lot, but it really, you know, it really grinds my gears. I would probably tell them. And so sciatica, it's called sciatica.

And I don't know where along the lines someone decided to start calling it my sciatic because it is the sciatic nerve, but it's the, it's sciatica CA, don't drop the A off, which is going to be the actual symptom pattern. And also say this, I know we're tangenting slightly again. It seems like this whole podcast is going to be like that because it's me alone in a room with a bunch of, uh, foam all over the wall, just staring at a computer screen and talking to a mic. So, uh, I'll say this, really look at the symptom pattern of sciatica, because if you go into a doctor's office and you say, I have sciatica, what they think is you have searing leg pain, probably down your leg to your foot from your back. And they're thinking that there's already, I mean, if they, if they're not investigating for it any further, but this is what's just off the top of their head is like, okay, I got to rule out this, this, and this, the spine, but I can't tell you how many times I've had someone say, they come in and they say, well, my sciatic is hurting. And I tell them, ask him, ask him what's going on. And it comes down to it that they have a tendonitis of the hip. It's in the backside of the hip. It's in the buttocks region, which is typically what people correlate sciatic or sciatica with. So I'm going to try to change that.

And I should probably talk about it on multiple podcasts from here to here to the end of time, because that is something that really grinds my gears. Let's get rid of that term sciatic because it is sciatica. If you're going to look for some quality information on sciatica, it's going to be with a CA on the end, not the EC. A lot of times you'll get probably the C, you'll get the anatomical term, or you'll get someone griping on a forum about their sciatic, which a lot of times there won't be great information on that because unless someone pipes in as an expert on the other end. But so anyways, let's go back. What were we talking about? So the sciatic nerve, actually, so let's talk about numbness in relationship to the sciatic nerve. So this, it can, it usually happens from the spine. It can happen from trunk instability, which you guys would probably think about more as core weakness, but really there's lots more to it than that. It can happen from a spinal tumor.

It can happen from a facet syndrome. It can happen from, let's see what else, a disc herniation. It can happen from a spinal fracture. It can happen from a foraminal stenosis or central stenosis. So there's a lot of different reasons why it can happen. And the reason why I'm telling you all these technical terms with this is because it's really important that no matter what you do in regards to the nutritional stuff that I already talked about on the other podcasts, then, I mean, you really got to figure out what's, why it happened in the first place. The root cause, the root cause is extremely important. And there's many different reasons why that, why it could have happened. So, but I really think that listening to that other podcast is going to be beneficial. And yeah, I think that one, I think I'm going to stick on that one with, because it's, um, rather than, I, rather than give recommendations and, and too far down, I think we have to get to the root cause. Cause if, if there's something that's creating pain for that long, it's, it's been, been an address or neglected. Um, and it really comes down to education on usually the patient's part or possibly they went in and they just were not given attention or they didn't know what someone didn't follow up to book them an appointment or whatever. It could be a lot of different reasons. But, um, I think when patients really understand, uh, what is going on in their body, they feel a lot, a lot more empowered and they better know where they can seek help at as well. Cause there's lots of different types of doctors and clinics out there as well. Lastly, we're going to go into the pitcher with elbow pain. And this one was on a video I put up actually on elbow impingement on YouTube. Um, I'm surprised they found this one, but, uh, either way. So this person said, I'm a baseball player and I've had the issue since my sophomore year of high school. Um, by the way, or I don't know how old he is, but, uh, he should probably, if he hasn't talked to his parents already, he needs to, because, um, if you're a minor and you're listening to this, which is under 18, then you can't really get help by anybody unless your parents there. So that is a thing. You need to make sure your parents are there and you need to be able to communicate with your parents first and foremost, um, or talk to your coach, which then your coach hopefully relates to your parents. So, um, sophomore year of high school. So it started in the summer when, uh, when I thought I had tendonitis, I, I'm now a senior. Oh, there you go. Senior in college and still have this problem. Usually the pain is unbearable and won't go away until I start throwing after not doing, or after not doing so for a few days to a week. So he takes a rest.

Uh, once the season's back into swing, I'm throwing on a consistent basis and it begins to reside as, or as long as I don't overuse it. I've learned to deal with the pain and to limit my throwing due to never finding a solution. That's, that's terrible. Um, I'm going to give this a try and hope for the best. So it sounds like he took the, um, elbow video and started playing with it. Um, now I'll start with this, that if you're a baseball pitcher and you're listening to this, I wrote a whole article on, um, I have a whole section on baseball injuries on my website, ptsportscare.com. Um, you'll find it's a injury link and you'll see a whole baseball player there. So whatever reason you have, please click on it. I spent a lot of time, uh, doing research and putting videos and, uh, suggestions of care in there. Um, but for the, uh, first and foremost, I think we have to realize that with throwers, majority of elbow conditions, shoulder conditions, um, happen from poor mechanics or issues down the chain or down the body. So sometimes core issues, sometimes hip ones, sometimes they're not using their legs when they're driving, they're not driving off the mountain.

There's a lot of different reasons. Um, and I actually did a podcast with an orthopedic surgeon named Dr. David Geyer. Uh, it was a great one, by the way, it was session number 50, uh, the very towards the tail end or actually towards the middle, we started talking about ulnar collateral ligament injuries and ulnar collateral ligament is the area of the elbow that usually baseball pitchers or throwers have an issue with. And he wrote an entire book on the area and actually the surgery, which is, it's commonly associated with, which is Tommy John surgery. Um, so he did a whole write-up on it and he has, it's funny, we kind of had like the same impression of this injury. Um, and I'm, I'm not saying this person's like this at all, but we're noticing there's a, there's a big trend.

There's certain injuries that people just don't want at all. And especially at a young age, um, and elbow injuries with baseball, it seems like there's almost like a badge of pride partially of having a Tommy John. Um, it's just that I feel like the recovery is so, it's so, uh, successful. Um, I don't know the, I don't know the range. I think it's the range is over 80% or so as compared to like a rotator cuff repair with baseball, like a pitcher, like has a 8% chance of coming back. And I think with a lay room, I thought it was like a 7% chance. It's just not very high. So I feel like partially the elbow conditions of pitchers and throwers aren't respected as much, but really it comes down to the same mechanical issues. Maybe not from the arm perspective, but from the lower body. So I guess my suggestion in a condition like this would be, how is your pitching coach looking at this? Are you, do your hips work well? Because we had a, we had a baseball player that had an elbow and a shoulder condition. Um, it was like a small labral tear. I would say we didn't have it assessed by imaging, but I'm pretty sure it was a grade one. Um, we, we found that he had also had hip impingement as well. So, uh, after talking to his pitching coach, he wasn't using his legs as much as he should be. But after he started using them, a lot of his upper extremity shoulder and elbow conditions went away. But over the course of time too, during the season, I don't think it was from the pitch count, but it was the fact that he was getting lazy with his drive and using his legs where some of it started coming back. But what we did rehab wise was we cleaned up the hip impingement, which wasn't, didn't take very long. And then we taught him to use his hips better. Now we're not teaching him how to pitch.

We're teaching him how to function with his hips. Um, and that does take a little bit of time and sometimes they forget. And I remember this guy, this kid specifically, it was kind of funny. We just harass him like no one's business. Um, but he would come in and we'd have him do an exercise called a rotational squat, uh, which, which uses a band and it's, it's basically doing a squat with a slight swivel. So we're just kind of loading one hip slightly and putting the, the squat pattern into slight rotational challenge. So he'd come in and he'd look at me and he's like, well, what are we doing today? And I'm like, well, show me that rotational squat. And he'd sit there and he'd, he'd, he'd do it really, really badly. Um, and then finally about like the third, fourth day in, and he'd already, he'd actually done this a lot of times because he came back for a second spurt of, uh, of, of rehab.

But, um, the first time around he was really good, but coming back, it's like he was really, really bad at it. It's like his body or mind, probably his neurological system had forgotten how to use the muscles in the area. So, um, that was a problem. I mean, I would expect he should be like a phenomenal salsa dancer, you know, like by how much you use your hips during pitching and running and so on. So, but he just wasn't good at it. But after about the third, fourth time, he started picking it up again. And I told him that we're not going past this exercise until he masters it. I mean, he's going to be, he was required to do it, um, well over 40 times per side each time until he proved that he can get it and we'll move on to something else. So with this person here, I mean, we don't know how he moves. And I'm thinking, I think you guys are seeing a consistent thing across the board with, um, what I'm seeing in these, uh, conditions is we, I can't see the person. I don't know how they move. So that's the first thing I consider. I mean, it's that important. Um, and it sounds like he doesn't have anything that's completely blown off and torn in the elbow because it seems to subside.

And even with decreased volume or pitch count, it seems like it does okay. Um, but there's other factors in baseball as well. Like, is he getting enough rest between bouts of pitching? Um, uh, there's, I mean, also nutritional aspects. Is he eating the right things? A lot of college and high school baseball players or athletes in general don't eat well. Um, there, so there's a lot of things on the plate here. And, um, I would strongly advise at least that there's, there's going to be a, a hinkling of every person with an elbow condition as a thrower to surround the rehab with only elbow stuff, you know, doing like tricep extensions, do bicep curls, um, do things where they're using like a J band for the shoulder. And I mean, that's all fine and good. Like, I don't have a problem with that, but we need to look lower. Um, I think the rough estimation, uh, if you go into one of the articles that I wrote on pitching, uh, with shoulder pain, I think it's about, I want to say it was more than half of the power comes from the lower body. I think, I think, and don't quote me because I'm looking at the article right now. I don't remember all these stats. I want to say like it was like 18 or 28% of the power comes from the shoulder and the arm. It wasn't much at all. So the more we're allowing these upper areas to generate force and really try to become dominant with the shoulder flicking motion, then we're going to end up with these upper extremity conditions. So I think we need to really focus on the lower body with rehab. Typically make sure they know how to throw the ball. And that's a pitching coaches, uh, area of expertise is not mine. Um, I was never even a pitcher when I played. And actually I was, I was asked by one teammate to throw this weekend. And, uh, I'm actually not comfortable being even that close to the batter. I'd rather be way out in the outfield where I know that it's not going to take a bad hop and hit me where I don't wear a cup.

So, um, I hope this was all helpful with you guys today. And, and I, and we're not going to spend too much extra time on these, uh, right here. Cause this was probably a lot, um, just to only hear my voice today, but I hope it was at least entertaining enough where we cut it up into bits and pieces. And, um, so if you guys do have questions, uh, feel free to go on to, you see these people's questions that got picked up off of YouTube. Uh, I do encourage a lot of interaction on my YouTube videos. Um, I answer as many as I possibly can. And sometimes I answer via podcasts like this and I can really get through a lot more very quickly. Um, or I have one of my staff hold a camera for me and we just blow through a video really quick. And there was two questions that I'm actually going to, uh, be answering on YouTube pretty quickly. So, um, yeah, leave them on there or go on to Instagram. I try to put some corrections on there as well, but obviously if you go through my feed, I don't love doing videos on there. I'd rather do it on YouTube where I think they're intended to be. So I think you can get more done in that amount of time. Um, or lastly, you can email me or go onto the website, which you really, really need to, because I wrote a ton of articles and a lot of these things can be answered through the articles. If you're not someone who likes to read articles, that's why I'm creating the videos in the podcast, but really a lot of the stuff I put down, there's in the articles, there's an entire section on different types of joints. Just go into the area that says injury articles and it has a ton of information. I've spent a ton of time doing it. Um, lastly here just to clean up and I want you guys to know that I'm very appreciative for you listening in. Um, I've looked at my stats for this podcast over the last couple of months and I see that it is growing. And I thought at one point, I'm like, I wish it was growing faster. You know, like I, I know these topics aren't, they're not, they're not super interesting. Like the, you know, how to make money online types of things or how to, you know, improve your life through, you know, um, life hacks types of things or Joe Rogan podcasts, which are a little bit, they're a little bit more on topic of things that everyone thinks, I think they care about. So, but I'm really appreciative to see that everyone's listening in here and consistently we're going up and I think about, I had to think about this the other day. If I was in a auditorium speaking to as many people as listen to this podcast, I would be blown away. But since I don't see you guys, I, it's, I mean, I guess it's, it's hard to imagine, but you know, there's, there's over 500 people listening to easily, easily each download. Um, and that's, that's growing all the time. But if I was an auditorium, I've never spoken to 500 people in an auditorium at all, but, um, gosh, I'm really glad to, to reach, reach you guys. And I hope you guys are learning things from this. And if you have people you want me to interview, please send them my way. So I'll talk to you guys soon. P2SportsCare.com. Check out all the stuff on there. Peace out.