Pain cases where the source wasn't where it hurt

Recent one, I had a, uh, a knee patient, which is based off the expose paper is low probability of spine. Um, but she actually, I D I was able to decrease her pain by just loading into the knee with like a single leg deadlift. And, um, so that got rid of her pain like significantly and then put her back into a door jam squat and then into, um, a goblet squat. And at the end of all of it had like no pain at all. She was able to do, she was busting out like 20 squats, no issues. You're listening to the restoring human movement podcast where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now your host, Dr. Sebastian Gonzales. Hey everyone. It is Sebastian and he's your host for the restoring human movement podcast. Thanks for joining the movement movement. This is your first time.

Welcome. This is the show where we try to boil down everything to make it really user-friendly for the practitioner to get better at patient outcome, as well as to try to make it really easy for patients to understand too. Um, this is well up into the 200 episodes. So every, uh, every week we used to, uh, release, but now we're releasing once every two weeks to give you guys a chance to go back and really figure out, um, what topics you're interested in and just really learn with me along the way as well. And so, uh, every podcast is about 45 minutes to hour long format. I suggest that you subscribe right now, do it right now, right now, scroll down and subscribe because you're not going to miss all the good stuff that's going to come up here. So in this podcast today, we're going to do a group call. Um, mainly with a lot of the participants, um, of the five step workshop that I put on, um, this is, I see Kyle is on there already or sorry, Tyler's on there already. Um, Tyler, I'm going to make this part of the podcast by the way. So I'm going to start the intro on this. And so basically we're going to have a group discussion and, um, communicate about, um, maybe how to implement the five step process, um, that we've gone through in the workshop and just troubleshoot things. And so not everybody's going to be on there. Um, but I thought this might help everybody understand maybe what we went through on those workshops and it's going to help the attendees, um, understand how to implement it into their practice. Um, let's see, we're just going to start straight out and just start chatting. So, um, everybody, there's, there's no agenda on this. We're just brainstorming things. And the intention intention was everybody just learns a little bit more about how to apply a new strategies. Cause I know when I go to web, uh, workshops, it's really hard to, um, it's really hard to apply to things sometimes because, um, you don't have someone to kind of go back and forth with. So we're going to see what everybody has to say. And there's Mary Lou again. Uh, Tyler, I think I turned your, uh, microphone on.

Can you talk? There you are. So I'm gonna allow all you to talk. Uh, who are you? Um, Mary Lou. Hey, yeah, I'm here. Hello. Can you guys see me? Yes. Okay. I'm going to promote you to a panelist so I can see all of you. I want to see your face. So, um, it might kick you out while I'm promoting you to panelist, but, uh, okay. Um, whoever, uh, would anyone like to start out? Oh, Hey, Mary Lou. Uh, I know you got to leave early. So, um, what did you, do you have any questions about how to apply things or, you know, how things went? Um, no, I mean, I, I actually, um, I think I told you like, you know, I, I did actually get some, you know, hands-on stuff with, uh, some of my clients to try it out. So I actually got my, uh, my first, uh, pseudo it band, which is pretty cool. Actually.

Did you really? Yeah. Yeah. It was pretty exciting. Um, that was last week. No, almost two weeks ago. So I'll see her, um, Friday to kind of see how, but we did like, uh, the, the opener, the side opener and that actually worked and it was pretty exciting actually. Cause that was the first time I ever had something like that. She was like just complaining about like knee pain. And then, uh, then it was like, I don't know where I started this, you know, pain she was having down the side of her leg. Um, like one of the, uh, neurodynamic sideline openers and, and it worked. And honestly, I was pretty surprised.

It's surprising the first time it works, huh? Um, by the way, you guys can all, um, is anyone's internet feeling glitchy right now? Is everyone good? I think I'm okay. Okay. We're good. Okay. So then, um, why don't we just start with yours, Mary Lou? And then, uh, so what, maybe what was that case presentation like that made you want to, you know, go the route of, of what you did and, um, what else did, what, what do you think about it? Yeah. Um, honestly, it was like, I showed up, uh, it was the first time I'd seen this person. She had been referred to me from a trainer and she just, you know, was thinking, Oh, I'm just going to get like a regular, you know, massage. And I told her, well, I, you know, uh, my approach is a little bit different. So don't just expect that. So I was trying to like set her up to know that like, you're not just going to come and get like a massage, just that's it. You know what I mean? Um, since she was first time client.

And so it was nice. And I was able to take her through like a whole, you know, evaluation, kind of see what was going on. And first, like I said, it was just the knee pain. But when I had her go into a squat, her knee just completely did one of those, like, you know, little wiggles when she was going down. Um, so then I wanted to target and that was on her right knee. So I wanted to target her right glutes. It was fired up. I thought that was going to be the primary. And then she said, well, I think my knee pain is because of this pain that I get, um, down my leg. And that wasn't even like, you know, her complaint realistically. And I said, well, you know, tell me what's going on with your leg. Like how long do you get this? Like how long have you had that leg pain? And she said, she's had it off and on for like two years, but she kind of just, you know, deals with it. Or she said, she tries to roll it out on like the foam roller.

And, um, so yeah, so she said it would help like a little bit, but it wouldn't like completely go away. So she kind of gave you a good lean in there because she mentioned thigh. And, uh, so if you go off the percentages, that's 72%. Yeah. Yeah. So that, that was kind of why I went, went there because of like with the knee pain and she said the thigh pain, I thought, okay, well, you know, and I told her, well, do you mind if we try a couple of things first and you know, it's part of your evaluation. And she was like, okay. And so, um, it differentiated and recreated that pain when I did the SLR on her. And so he goes, oh yeah, that's my thigh pain, which I knew isn't like your typical presentation, right? Like, um, for the back of the leg kind of thing, you know, you usually feel in the hamstring and I was like, oh, you get it down the side of your thigh. And she goes, oh yeah, that's my IT band pain. And so that was kind of like my giveaway for that, you know? So I was like, okay. So, um, yeah. Nice. Did you have to load up the foot a lot? I know, um, I think Shackhock loads up the foot a little bit more when he, and I know you've been to neurodynamics already. Did you have to get a lot out of her to tease that? That's what I started with. Like, cause at first I did, um, just, you know, a normal SLR and it wasn't as much. I put her in a more dorsiflexion, like you're talking about, you know, kind of more there. And then I differentiated with that ankle. Um, and, and it, it definitely, and I was like, well, does that take that away?

And she goes, yeah, it released it. And so I was like, okay. Yeah. I was kind of like, yeah, your IT band isn't, isn't going to do that. So it was, it was pretty cool. Yeah. Was it, um, I forget, was it Eric, were you the one that was, who works in the, in the tissue work heavy clinic? Um, I forget who did. Do you? Um, so then Mary Lou was at that point. Cause I know that I, sometimes you have to trick people, I think, into what you want to do because they came in with a, with an assumption of what they wanted. Um, or if you're working in a clinic where they do that is, is, um, did, was the person at all like, okay, were they like, Hey, I just do whatever you want to do. Or they're like, Hey, I still want you to touch it. You know, she, she was pretty receptive. Um, so the way I tackled it because she had never seen her before, what I did was like, okay, we're going to go through this evaluation. I'm going to show you some, you know, I just told her, this is an exercise you're going to do like, and showed her how to do the sideline opener. Um, and she's like, okay. And she was okay and comfortable with that. And then that was probably between that. And then doing after that, we did like the hard playing style and stuff to kind of stabilize and everything. But so that took up at least 30 to 40 minutes of her appointment time with me. And then I just did like a rest of her massage for her. So that's kind of like how I kind of met her in the middle for that. Um, so that was my workaround. Nice. Anyone have any questions for Mary Lou? That was a, that's a, that's a, that's a fun one to find first. So yeah, that's cool. Um, what, any questions for Mary Lou? Cause I can always find more. Okay.

Um, okay. So, um, what are you going to do next when she comes in? Um, I'm going to see if she can maybe get more into her glutes. Um, she has a trainer. So I did talk to her personal trainer to kind of tell her to work more and doing glute stuff. Um, I also, I wanted to kind of ask you, cause I thought maybe she, she seemed to be more extension, like, uh, driven with pain and it was kind of hard to tell if it was more nerve base or disc base. And I don't know that it actually matters. You know what I mean? But like, cause the sideline opener helped rather than like the press ups. But I was thinking if I should try, you know what I mean?

Kind of getting her into one of those other, um, disc, you know, kind of press the things or just stick with what she, what she's working. So I would just go with what works, you know, like there was, it's, I know I had a guy come in the other day. He had, um, uh, he had an interesting case. He couldn't duplicate it in office. I couldn't, I couldn't tease it out of him either, but he had, um, like he said, it felt like someone took a blade and stabbed it in his leg, in his outer anterior thigh, like by the rectus femoris area, which he was convinced that was what it was. Um, and so he, it was no trauma and he was just running. And so it felt like I just dug it deep in there and it felt like a strip of a tight muscle. Right. And so he kind of like, didn't really, it didn't really hurt anymore. He's like, I could, I just know it's there. I can feel it.

And so, you know, we tried, I tried an opener on him. Didn't work. We, we tried 20 press ups. It went away. He also like, he didn't really have any pain with movement. So I just, I gave him, I gave him some press ups and I said, look, man, I don't even think you have to do these, you know, like maybe a little bit because it felt better afterwards, but I just went straight glutes, abs on him. And, uh, he could do it all. No re reoccurrence of symptoms. He felt much better. He had a, like a crookedness to his squat. I don't know if it was really, he would shift away from the side of complaint and, uh, it was a fresher injury. So I don't know if that was really an, like a thing that was needed, but, and I don't even know what his squat looked like before I saw him.

So, um, but in that case, it's like, they don't need a, they might not need a first aid. It's like, so if it works though, just to stick with that, you don't need to give multiples. Okay. Okay. Uh, uh, Tyler, do you have any good cases? I know we were emailing about a couple, but yeah. Um, yeah, I have a few, um, recent one. I had a, uh, a knee patient, which is based off the exposed paper is low probability of spine. Um, but she actually, I D I was able to decrease her pain by just loading into the knee with like a single leg deadlift. And, um, so that got rid of her pain like significantly and then put her back into a door jam squat and then into, um, a goblet squat. And at the end of all of it had like no pain at all.

She was able to do, she was busting out like 20 squats, no issues. And then I was like, all right, so we were good for today. Like go home, work on this stuff. And she's like, Oh, but you didn't do the ART on my knee. What about my knee? You didn't fix my knee. So I was like, don't know what you want me to do. Yeah. You gotta, you gotta, you gotta touch them sometimes. I think, you know? Yeah. And I was, I was, I wrote down like a list of, um, like talking points and questions. And one of them was, um, how did your going from an ART soft tissue clinic to like this, uh, five step process? How did your communication with patients and patient expectations change?

Um, I think there's still some people that come in that are just like, I mean, they, they, they, yeah, you know, but there's other people who have like, they just trust me enough to where I said, look, uh, you know, I think tissue work was good when we did it. And that was, that was what I knew. And that's what it felt good. And, but I think you have to trust me. I know, I know, I think I know now when I want to apply that with you in what type of circumstances versus just on, on everything. And, uh, so they'll usually take that unless they're super married to the idea. Um, but the, I don't know, like sometimes you still get people at a guy the other day. It's like, um, the, like I got him to feel better with his neck, just with, with some cervical retraction. That's, that's like significantly better. Right. And he's like, yeah, yeah, it feels good, you know, but he just wasn't fully getting it. Cause he would slouch down a little bit again. He's like, yeah, it still hurts again. I'm like, dude, you can control this thing whenever you want.

And, uh, I finally, I was like, uh, I was looking at the clock. I'm like, oh shit, I got a lot of time with this guy. Uh, do you want to do some tissue work on you? He's like, yeah, yeah. And so I just lay him down. I started doing tissue work, adjust him. He just loves it. You know? So, um, it's bang for buck. You know, I was talking to my girlfriend about this the other day. It's like, say, say there's things that people can't do or won't do on their own that hold value. Um, a cervical adjustment. I wouldn't try it on myself. You know, I know people do, but is that might be worth 70 bucks, you know, and that's, so you're adding value to the appointment. Um, so sometimes you just want to add value and cause you just got to get them to come back to get them out further out of that hole. Um, but yeah, I would start with asking them, what's your expectations? What do you want from me? You know, what do you expect from this appointment? And if they say tissue work and it's all over their paperwork, it would probably be a good idea to not ignore that. Okay. Um, but yeah, so I'm curious, you, you took a knee case, but decided to load knee dominant. Does that sound right?

Yeah. So what were you looking to accomplish? Like, were you trying to buy a certain? Oh, good. Okay. Was there any, so was there any contrary indications? Go ahead. Sorry. Uh, no, I mean, it's a young patient, not no trauma. She, um, she, uh, was out of running for a little bit and just wanted to get back into it. And, uh, she's been doing, she's been running on the treadmill with no incline. And so I was like, so first visit actually was, um, messing with like her cadence and messing with the incline, stuff like that. And raising the incline a couple of points decreased her pain already. So I knew it was something that I could load and be okay with.

Cool. Yeah. Um, uh, I've, there was, there was someone that we had last week that, um, it was, it was, it was Dawne Costantino's patient. And so it was somebody who had, they had knee pain, they were young. And so, um, a lot of the hip stuff took it away. A lot of the work that they were doing took it away. And, uh, I know that, um, she, she was like, well, you know, what else can I do with this girl to make it? So like, she can run. Like I, from when I recall, she couldn't walk in without pain the first day. And then after like third sessions, like she's able to run with minimal pain. So she's still having pain, but now she's running to, I'm like, she's like, what can I do more? I'm like, dude, I'm like, you performed a miracle. You should be very happy for yourself. Like, like you took someone from no walking to running with minimal, dude, you're fantastic.

So, um, but then, so we, we took her outside. She's like, what else would you, cause we're talking about returning to running. And I said, I would sprint her. And we're kind of talking about, well, like, does that put more load into the knee? Yeah, sure it does. But is there a contraindication to loading the knee? And there wasn't any. So, but what that does is it increases tension through the stride. And she went out and they went out and ran and they walked back in and they looked like they were happy and smiling. And so it didn't hurt her. And so she asked, when is it a good time to load the knee? I said, well, is there any reason not to, you know?

Right. Yeah. So I like your assessment. Yeah. She, she was, she wasn't able to get past a quarter mile without having to like stop. And I saw her today and she was doing over two miles with like a one out of 10 pain at the end. Nice. So she was like, I could keep going, but I, I was tired. Yeah. Yeah. That's good. I like that. What else you got? You said you had another, or anyone, anyone want to ask Tyler a question on that one? Oh, okay. Where are you going to go from here? What's next? So, or sorry, you, you loaded her with a knee dominant movement. You said it was a single leg, was a single leg squat, uh, a deadlift, single leg deadlift. So like the Stanley's I was doing Stanley's and the one with a hand in the crease of your hip and you're reaching out.

Oh, so you didn't get super knee dominant. You still kept the hip involved. Right. So maybe then do you feel comfortable doing a sissy squat with her? Like you said, I knew you said door jam squat and goblet squat, right? That's a little bit more knee dominant. A sissy squat is like, it's like say a small knee bend. Um, say like grabbing a basketball, like your basketball player, you're looking for the pass and you sink. So like walking up and downstairs is a small knee bend cause you're erect yet. There's still knee bend. You can't go super deep though, but it's pretty knee dominant. I was doing, I wanted to do, um, buddy squats with her and just mess around with like a position, like bottom position, like rock back and forth, make her shift stuff like that. Cause like, it really is like, just like a fear avoidance. I really don't think there's a structural issue with me. I think she's fully capable of doing it. She just, she had pain with running and now she thinks she's going to have pain with squatting and she thinks she's going to have pain with whatever activity.

Did she verbalize it? She's afraid or did you just have to identify it? And then just not directly, but pretty much she, she hinted towards it. No one ever wants to say I'm scared to Yeah. It is nice that you got that's, that's not a good bedside manner when someone's willing to cry with you or they're willing to say they're afraid of something. So yeah, that's good. Uh, but from here on out, I, uh, I mean, she was able to do a, a deep, uh, goblet squat. Um, so, I mean, I would just try and continue to up her mileage. Good. Well, I liked it. You're not over complicating it because it, we could make these really complicated and put bands and balls and stuff like that. But you took something simple, like a, like a single leg deadlift, no weight. Um, you can probably go to a split squat, knee dominant, single side, frontal plane challenge. Um, and, uh, you can take it into a, uh, goblet squat. So it's like those simple movements can still create a good bang for buck for these people without having to get too nutty, you know? Yeah. That's, that's why, um, I watched, uh, D max videos and how he breaks down. Like he's coming down to a squat. He's like, okay, you're good here, here, here. Second, your knees hit 90 shit goes wild. So I like how he breaks it down. He's like, all right, so let's start from that. Let's pull out like a chair. So your knees are already at 90 and let's just squat to the chair. Okay. Let's go from the chair down like further and start cueing more tension, lifters wedge and holding tension through the whole movement.

And that's why, that's what I like to do a lot with people. Nice. I had, I had one, uh, last week that she was an interesting one. I guess I'll share my thing. So it was a telehealth. Um, and the person had nine years of groin pain, um, multiple orthopedics and, uh, evals and opinions and so on. Uh, but no one really had an, I mean, everyone was very candid and said they didn't really have an answer for her. Um, and so, uh, she, uh, she had pain with lifting her leg. And so I took the gamble of doing dermal traction first. And so I just grabbed the skin in the flank as well as into the, into the inguinal region. Uh, Phillip Snell, Justin Dean, you should go and watch your thing. And we just did a bunch of hula hoops, just spinning hula hoops, kind of movements, big old turns. Uh, she was able to lift her leg up, um, beyond what she did before with zero symptoms or sorry, it was, there was a minimal symptoms, very minimal. So she's super excited, but we progressed on to a side plank on the opposite side. Uh, her symptoms went away even further. Eventually we got into a, uh, I had to take her through a couple of correctness first, but eventually, um, and this was on the second session. Uh, I took her to a high tension goblet squat. Um, it was, she had dumbbells at the house and, uh, she, she was just a tension beast.

It was good. And after that, she's, I'm like, okay, good. Do your thing. How's it feel? And she's like, yeah, it doesn't hurt at all. I'm like, I'm like, isn't it so cool that you had, I mean, I'm like sad, but isn't it cool. You had nine years of pain, but it took away by grabbing the skin. So she was super excited about it. Yeah. But, um, I, press ups didn't work with her. Um, I would venture to say that openers would probably work with her, but, um, I don't recall if she did those at home or not, but the dermal traction certainly worked really well. Uh, who wants to go to a point where I usually got pain to reduce with, um, openers or, um, McKenzie's. So I haven't gotten really, really to use dermal traction yet.

Yeah. Yeah. I find it works well in the groin. Okay. It's like a referred pain in groin. Well, so that's the thing. Yeah. I don't know. You know, you don't really know until yet, but what I always try to make the bargain with the person is with those is, is cause I know how stupid it's going to look. And I said, look, this is going to seem really, really stupid, but I'm going to ask you to do it. And if it works, I'll tell you about it. You know? And so we do about two minutes of it and so on. They're like, Holy shit, why does it feel better? You know? And then I say, look, I'm not even going to say what it is or what it is, but I'll tell you what it's not.

Did we affect your groin? Did we affect your labrum? No. Did we affect your hip bone? No. Did we, did we, did we, could you grab your hip flexor? No. Can we agree? It's not those good. Just do what I ask. And this, I think this will go really well. It's a good sign. So just try to, I just, I just try to strip away their, um, their, their biases against doing it and further what I want them to try. Uh, who wants to go next? We got time for, Oh, we got, okay. Eric. Yeah, I got one. So, um, I'm at a clinic now about to start my preceptor ships. I don't really have any patients anymore, but, um, my sister called me saying that she had some shoulder pain, um, that had been going on for about two weeks. She had recently started. It's like doing some basic working out, um, with some dumbbells, but nothing crazy. But she said that it was deltoid pain and she was kind of doing, doing this with her hand a little bit and she couldn't raise her arm above, above about here.

Um, and so, um, I kind of just went the route with some end range loading with some, um, like chin tucks and I had her do about 15 and she said it improved a little bit. She's able to get up just a little bit further. So I just told her to do a hundred of them for the, for the next three days. And then after three days, she said that she would have helped 80% better with her shoulder. Nice. And so, um, since then she's, she, I haven't really been able to chat with her too much, but she, she's kind of regressed a little bit, but, um, she's at a good spot right now. And then I'm just trying to figure out how to progress her a little bit to, to get further.

Nice. So you, you did, you did the miraculous thing where you didn't have to touch her and she felt better. Yeah. Well, she was calling me to, for advice of who to go see. Um, and then I just, yeah, asking some questions and then just had her, I just told her to try something cause it could be coming from her neck. And so, and it worked. It was nice. Where are you going to, what are you going to, what are you going to have her do next? If, uh, what do you think you want to do? So I'm not really sure. I mean, I, I'm assuming that in the doing more like extension based exercises would be helpful.

Um, and so, but as far as like neck, cause I don't think it's really a shoulder issue. Um, it's more of a neck issue and she hasn't had any shoulder issues in the past either. Um, but as far as loading more, I was thinking of doing just some rows for the shoulder, um, to get some more thoracic extension and then, um, doing maybe just, yeah, I don't know other extension based exercises for thoracic spine. But I wasn't really sure exactly, um, what the best next step would be. Yeah. That's a good start though. I think, um, do, uh, Mary Lou or Tyler, you want to, do you have any ideas of where you would take them?

Eric picked a hard case. So I love the, the halos kettlebell halos. Yeah. It's like my favorite exercise for shoulder mobility and, uh, cervical spine. That's the one around the head, right? Like, yeah. Okay. That's what I'm going to do. That one's pretty cool. Cause you get the chin retraction with it. That's like, yeah. You do that with the chin retraction? Yeah. So like a cue that I would do, or like what DMACC did in the video was when you're coming up, the doctor will have like the hand in front of like their face and be like, don't touch my hand. So that it's like an external cue to keep their head back and start just keeping chin tuck an external cue.

So they kind of like can see what they're doing. And then doing some sort of like doing the halo motion above their head with, with a kettlebell or something. Kettlebell. Yeah. Yeah. You could use a plate too, or you can honestly use like a book or something. It's, it's more, I think the movement and the tension rather than the, uh, the weight for most people in the beginning. Yeah. Merrilee, you want to add something? I see you chomping at the bit. No, I, I was just thinking like when he was explaining that it's almost, I think when you bring the kettlebell around, it's almost a external cue.

You don't even have to cue them if they're bringing it around, right? Like they have to kind of retract without even putting anything in front of them. I feel like, you know what I mean? Like when you're doing like the kind of around the head with the kettlebell, um, or even the plate, I haven't tried it with the plate, but the kettlebell really works well. Yeah. I find a bottoms up carry is nice too. It also, I think it works as an external cue because if it's heavy enough and the threat of hitting the face is real enough, it's just, it's kind of right there. They kind of pack it too, you know? Um, but I'm, I'm sure there's actually for shoulders.

I've been going a little bit more of the DNSE route, you know, the, the shoulder hinge. Um, if it's, if it's kind of sticky, especially with radicular cases, I'll go that route a little bit more. Um, but I find that DNS is kind of nice to, to build some tension in the area and you can co-contract around the shoulder because the shoulder to the neck is basically the hip to the low back. So, um, I think it'd be a good idea just to get into that shoulder area and just make sure that the tonic isn't winning too much. Uh, Kyle, did you have another one? We probably have time for one more cause, uh, I got to have a patient in about 10 minutes, 15 minutes.

Um, yeah, I have, which one I had one today, actually. Um, university pitcher, uh, had elbow pain and he was coming in before I started here. Um, so my preceptor got it down to where he was, um, treating the shoulder. I think he was, I don't know how he was treating it or what all he did with it, but the gist of it, he, he loaded the shoulder and his, um, elbow pain went away. And initially they wanted to do a Tommy John, uh, cause he was having pain right there and loaded the shoulder, took away the pain. So he never had the surgery. Um, so today what I worked with him, I did, um, the baseball grip.

You like that one, don't you? I love it. I do it with everyone. We get, we get a lot of lifters in here. Uh, so I love that grip exercise. Um, so I did that with him and then I did, um, the shoulder hinge with a high oblique. And I did, um, my, or an exercise that I do with patients. I haven't found it on the internet anywhere. Um, I just call it a screw in. It's like your supine thumb out or thumb pointing medial. And then you bring your shoulder down like that. So it packs, engages your lats, packs the shoulder down, gets the, um, humeral head to go, uh, posterior. And then as they're holding that, I just do like perturbations, moving the arm.

You could do that bilaterally with a pushup plank, like a Dan John high tension pushup plank. Um, and then you can perturbation on that too. I didn't think about that. Yeah, that's it. Um, I like the screw in though. That's good. It's almost like a, an anti shrug cue. That's what it is. Yeah. Because I'll usually when people do it like nine and a half times out of 10, like their traps are completely off. But you can't even, they're not even using that. And I just cue them to push their shoulder down into the table as they turn their arm, um, externally rotate. Hmm. I wonder how, so you're having them pull, not press.

Is that a press? It's a pull. Okay. Uh, yeah, I guess I take that back then. Um, my screen's not big enough, but down like that. Yeah. I was, I was thinking how we can improve on this, but maybe you just found the perfect exercise, but it looks pretty good. Yeah. Um, I've been using that with like every, not every shoulder case, but a lot of shoulder cases just as like a, a step one. I pretty much use it as like my, uh, as a step two corrective or a step three. And, um, it, it's, it works really well for me. So I just roll with it. Nice. You'll be making your own, uh, DMACC series soon. Are you having them focusing on like the thumb then?

Like the thumb is like an external thing for them. So what I call it, I was like getting, get into your superhero pose, superhero. And then now point your thumb back. So, so they're going like that. Cool. I, I kind of, I bet if you had like a free movement machine, like a TRX suspension trainer or something, you can probably get them to screw the handle too. Right. Um, we're, we're just now bringing in, we just got our, um, a squat rack. So we're, we're messing around with that with patients too. Now. Nice. That'll be fun. Yeah. I'm, I'm about to get rid of my squat rack. I think. Yeah. It's, it's nice and fun, but at the same time, like I don't see enough people that I put on it.

Cause I always scale them back, you know, and I got the barbell. I can teach tension and smoke them that way. So I don't even know if I'm like, this thing's just in the way now. So our primary use was our gyms are still not even open here in Pennsylvania. So our primary use of it was we want to work out. That's a good use. Well, we ordered it five weeks ago and now our gyms are opening Friday and we just got it. We're like, of course, you know, we waited this whole time. Right on. So, um, let's, let's take the last little bit here just to, um, do you guys, I think that the last two workshops, I don't know if all of you have watched it or not, but, uh, I'd asked on what is the best thing I could possibly do to sum this up?

And she said, tell them what it's not basically like tell them that all of these things are not truly these syndromes. And they to really think outside the box of things that you're already going to, that are down the chain. Um, do you guys have any questions on those? I think I was wrong. I was definitely wrong on the, like you mentioned the need, the percentages was against me, but I wanted to play devil's advocate. Um, do you guys have any questions? Do you understand that portion? Cause it's pretty, it's pretty critical. You know, I was going to ask, um, with your active population that you treat, um, and if you ever, if you talked with any other docs, how accurate are those numbers in their practice?

Um, I'd say they're pretty, pretty close, you know, like I think at all, it's, everyone's going to skew a little bit differently, you know? Um, but I'd say it's, it's pretty close, you know, like, uh, I, I know the skin, like the skin pulling on dancers is going to almost always work, you know? Um, and I think I, you know, with like power lifters, they're almost, they're going to be a lot of press ups, you know? So, um, but if you like, I'm trying to think of it, maybe, uh, an athlete that would have like an ankle thing that would be, that would spike the, you know, the incidents because it was ankle, like a low thirties or something like that.

Um, let's say if you had someone who's a tap dancer, like that's going to spike your incidents probably or so when he turns ankles, Ooh, a parkour person that would definitely spike those percentages. So I don't, I'd say they're pretty fair. And I was telling Dawne Costantino earlier, I was like, we were talking about some really fun cases we had. And I was like, dude, I hope I never see an ankle ever again. You know, it's just, I don't want to think that hard. So, but I know, I think I'll do an okay job of them, but it's just the other ones are so like, you're like a superhero to all these people. You know why I want us, I just want to feel good about myself, you know?

I had a good ankle one today too. Yeah. Just an acute roll, rolled his ankle on, it was a pitcher. He, uh, rolled his ankle on the mound and I, we learned, uh, a Moab from, uh, Brett Winchester. Um, they're on a wall and they're leaning into that, the bad ankle and kicking out their legs straight back. And you're at the ankle, just moving it as they're doing that. And that's what I did. He was like, this is the first time I've walked without limping in three days. Yeah. I saw Winchester did that. He did that triplanar, uh, wall thing too. Right. Yeah. So, yeah. Uh, I'm sure I get a lot more to learn when it comes to ankles and toes and, you know, all those things, but, but yeah, I'm pretty sure my percentages are pretty close to what are in that.

Um, anything else? Any last pressing questions? Yeah. Um, I guess my question is more about like when you have to do all the paperwork and like the actual diagnosis. Like, so if I know, like I understand the concept of like, it's a pseudo, um, you know, FAI cause it's not a true FAI. So how do you document that kind of stuff then? So what do you, you know what I mean? Like what do you end up, I guess, putting down their diagnosis and if it's differentiating them? I try, I try to go a little bit more textbook, you know, if someone comes in with groin pain with no back pain, that's an FAI. Um, okay.

It's because if they have the positive orthopedic test and everything, you know, if they come in and they have a like lateral knee pain associated with this at least sign and then tenderness along the, yeah, that's a lateral meniscus, you know? Um, okay. It, what, what gets it better or not? Like this is, I think this is what gets us in the trouble of, why we have all these stupid syndromes anyways, you know? Um, so I don't, I don't really care about that part as much as just, I just need to get the person better. So, but I, but I will usually go down the route of more of a classic diagnosis. Um, because if you, I mean, I'm sure you have, you know, friends that like, if you mentioned like, uh, maybe a, uh, like Tyler's cases as a ridiculous case, then they think you're full of shit, you know?

And so it just puts up a battle. I don't want to do, it's not my, I don't want to create fights. I just want to treat people. So yeah, yeah. I'm going to stick to that course. And that's where I was trying to understand that component. Cause I feel like that's going to be difficult. You know what I mean? Like to, how do you now put that on paper to prove like, okay, this is what they have. But I guess that makes sense. So you keep with the classic diagnosis, but it's more about you're treating it a different way. And that's, that doesn't matter at that point. Yeah. It doesn't really matter unless you, I mean, I think something where it would come up, it'd be a little bit of an issue is like, so like your med legal cases, like, so if someone comes in and they have ankle pain, you know, and, or say a plantar fasciitis and it, and it's really a radiculopathy.

Um, and the provider or the third party pair will only pay for plantar fasciitis. Don't, don't like, don't shake the boat, you know, like they're already paying for the care that is that they need. Why would you shake the boat? So, um, I would just keep like, I think in the end of the day, people don't really care that much about what they have. They just want to get better. Um, but which actually this brings up a good, um, I was talking, I was talking to someone recently about this that, um, I know we, I, I've struggled with this over the years where somebody comes in and I say, Oh, look, you got, there's a little bit like a downfall.

I'm like, Oh, you got a little bit of hip impingement. It's almost like you have the bruise in the bone. Don't worry. It'll be okay. And like, this is, you know, like, and so like, say I strike out on sessions one and two. Right. And so they say, Oh, you know, I'm not going to come back. What are you going to do? Oh, I'm going to go to the orthopedic, you know, and they go to the fix and they say, Oh yeah. They said, I have hip impingement. And like, that's what, that's what I said, you know, but I said it in a really like kind of lightweight. So now I'm just going to do like, you have hip impingement.

I'm just going to shut up and let it soak in for a second and say, but don't worry, this will get better. I'm going to show you exactly what to do. Okay. Don't go look up stuff on the internet. It's going to freak you out, but I believe you have hip impingement. We're going to solve this problem. You're in the right place. Do you have any questions? Because some of the people really want to know their diagnosis. Right. And they'll keep hunting until somebody affirmed it. Like these people might not even say, they might not even examine them appropriately. And they're going to say, you have hip impingement, you know, and they're like, well, shit, that guy sounded right.

You know? And then all of a sudden they're doing what he says versus you. So I just want to make sure that they're going to stay in the right place. If I feel comfortable with their case and give me enough time to strike out before you leave, you know, but I wouldn't rock the boat too much. No, but yeah. Okay. Thank you. That makes sense. Yeah. Cool. All right. I think that's it then. Do you guys, my, my ability to do zoom as a group like this will terminate after the 28th because I pay for it. So if you guys want to do it again before the 28th, just let me know. And I'm, I'm open to do it, but we can always do like group calls and stuff like that.

It's not a big deal too. Cool. All right. I'll talk to you guys later. See you. Thank you. Bye guys. Okay, everyone. Thanks for listening to that. So that was the group chat with the group that went through live to, through the five-step process of patient recovery. So as you can see, I think everybody's doing pretty well there. I think everybody has, I've had a struggle implementing things into practice and even stuff that they were talking about. I'm like, man, I think that's, I got to try that too. You know? So if you guys are interested in, in seeing it and taking part of it, I will put a link in the description below.

I suggest you start at number one of six. I'm not getting rich off of this. This is just, it's a way for me to train any interns that come in, as well as if you guys ask me questions about what are you talking about with this? How would you do that? This is the easiest way to boil down the information. I'm not trying to reinvent the wheel. I'm just trying to simplify things for you. And I think if you go through number one, you're going to be pleasantly surprised and you're going to want to go all the way through number six. I don't intend on making anything else in the near future clinically other than that.

And there are suggested readings and things to do in there, such as Shacklock's course, Philip Snell's course, McGill's and Dan John, things of that nature. So there's lots of resources for you guys to spend any of your other money at, which I do reference in there that I would love for you guys to take. So thanks for being part of the movement and go to P2 sportscare.com and go into products and just look for one of six. I'll talk to you soon.