Changing Symptoms and Why a Detailed Examination Is Key

Hey guys, Sebastian. Before we start the show, I want to reintroduce again the premium version of the podcast. Scroll all the way down in your player, hit premium. It's $5 a month at this point and it covers all the stuff that a lot of times, you know when you go to a workshop and like you're hanging out with your buddies, you haven't seen them in a while and you talk about case presentations and how you could have done better and how you want their opinion on it and so on. It's that, all right? It's that plus a little bit of business sprinkled in too. And so it's a weekly show that we're putting on. It's 15 minutes. It's every Monday and it releases. The audio is getting better as we go, but it's not on this large podcast mic because we're sacrificing freshness for sound, I guess a bigger microphone if you will. So I'm recording these as I leave the office after encountering with people, with patients, new patients, so I can give you the rundown as quick as possible. The idea is to almost make it a scenario like you're an intern here and we talk about this case and what we could have done better and what should be done as we're leaving the exam room. Obviously, patient privacy protected. So take advantage of this. It is the only way we ever make money on this show. So it's cheap and it will give you a lot of benefit. I promise that.

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. What would you have done in Session 3 if it came down to it? That's a tough one. I think because IEP, you know, was working for him. I might try to hammer that into other types of stuff, whether it's carries or something, you know, and then just focus in on dialing that in. You know, maybe he's, you know, where other patients we've seen their two tents in there and their IEP or the other one, maybe you got to dial it, you know, dial it down or the opposite dial it up. I don't know. So I probably would have gone there maybe. Yeah. I would wonder about training volume. And after going over to the gym and watching them, watching them do some of their lifts, their lifts are like, there's a lot of low back extension that's required with like log press and even getting like some of the implements up higher. Okay. And so they like, especially short of the person, they have to really lean back. And that's, I mean, that's just going to happen. So yeah, it's kind of like, I guess if you were a, you know, if your job was to stick your hand in an oven, that was just the, you know, maybe you would reserve some of those movements a little bit more so like more reps in the tank for competition versus, so maybe we can cluster that up or say if his, if his squatting, say we wanted to actually do squatting with him. Maybe the provocative thing was back squat, high bar back squat. Maybe we have them do, you know, a certain amount of, of low bar back squats and then a certain amount of front and then goblet and then split. Obviously that'd be a coaching thing, but maybe his volume on that hinge point was just too high. Yeah, no, that's a good idea. I mean, even just prepping him with more goblet squats and openers before, you know, and then go right in the movement and then desensitize the area before he goes in, you know? Yeah, possibly. So yeah, that, that works for a lot of people, but I don't know, like that level of competition, it's like, that's a whole nother ball game. I feel like. Yeah. Well, good. That was a good, that was a good case. Um, for everybody in the premium podcast, that's the end of the episode, but for all you who are on the regular podcast right now, that was a hint of part of what you get in the premium podcast for clinicians only. I know I've been pitching a lot lately because it's really good. It's, and, uh, as we go over time here, the regular show is going to migrate a little bit more into general conversation, which you guys will probably still be interested in as clinicians, but at the same time, uh, we will, um, uh, it's going to be a little bit more late public friendly. So if you're looking for intricacies and diagnosis and, um, examination and maybe where you would take things and kind of the set by set process, I think you're going to want to take advantage of the premium show. Scroll all the way down, click on the button.

It's right there. Premium show cancel. If you ever want to cancel. Um, now me and Mary Lou are going to go into the real show. Uh, what are we going to talk about today? I don't know. Oh, I know what we're talking about. We already got so far. Um, so if you're listening to the show for the first time, by the way, um, the format of the show is, is we do interview like this, or we do a, uh, a solo podcast. It really depends on, on the day. The idea is to improve better patient outcome to make sure that patients also understand and clients understand what's expected of them. Um, and just give a, some insight into what might be happening, um, kind of to, uh, I guess, take some of the fear out of having an injury and so on. Cause everybody gets problems. It doesn't mean it has to be forever and have disability. So we're going to, um, demystify some of the stuff. Uh, so the topic we're going to talk about a little bit today is, is maybe some, um, maybe some things that, um, need to be found in, in your, your situation. Um, we've had a few cases that have come over the, uh, over the last year that, um, quite honestly, they needed to be worked up a little bit further.

They needed a little bit more evaluation, uh, to give more clues for us of what to have them do. Um, and there gives a lot of insight of maybe why they weren't improving. Um, we'll probably dive into other things and have a flow a little bit. So we'll keep the conversation as long as possible. Uh, Mary Lee, you brought up this, this topic originally. So is there one thing, do you want to start this off? Um, sure. Actually, yeah. Once you said that, I forgot what we were, we had decided on what we were going to talk about. So thanks for the reminder. Um, but yeah, so the reason I thought, you know, that was a good, uh, topic is because I think, you know, we see a pattern of patients come in here by the time they've gone through maybe two, three different providers sometimes, you know, and they're trying to get answers, somebody to, you know, figure it out. You know, Dawne Costantino likes to call them the trash can cases where nobody else has figured them out.

Then they end up here. Right. Um, and you know, it makes it difficult, but it's kind of interesting as an intern to see kind of what walks through the door. Um, and then making sure that like, you know, the neurological exams are there and, you know, they, they hone in on that so much in school. Um, but you know, they don't really tell you that like, Oh, okay, you've got to be holding yourself accountable for these things in your office. And I've found, you know, that unfortunately, even, um, shadowing as a student, you go into other people's office and they're not doing all these neurological exams, maybe as thorough as, you know, we are here. Um, and it's kind of unfortunate because then if you're not, you can miss something, you know, and they, they hone in on that so much in school, but like now I'm actually seeing like, Oh yeah, this is really important. You know? Yeah, I agree. I think there's, you know, like we, uh, when I went through the, uh, diplomate, uh, course, uh, for, uh, was it as sports medicine, sports physician, I forget the acronym anyways, the long one, um, one of the instructors said, just do every reflex every time. Like it doesn't take that long. Uh, you kind of get a flow down. Um, and like, there are times where like people are a little bit resistant to doing certain tests. And, um, I just say, humor me, just, just let me do some tests. They're going to seem unrelated. Just humor me. And they might not make any, any, uh, real rational, logical thing to you guys, if you're the client, but for our end, it helps us give us clues and give us information of how to help you. Uh, and we've every, most people have the same experience where they have their first incident of some type of issue and they go to Dr.

Google, the Dr. Google spits out this list of 30 different things that it could be. And some of them are scary. Some of them are nine. And you wonder what you should do. Well, what part of this exam and part of doing some of the things that are seem unrelated to your problem, it helps us narrow that list. And it's called a differential list, differential diagnosis list. And then we arrive at something called a working diagnosis, which is the theoretical highest probability one based upon the exam findings we have. And so without doing all these tests, that list is not necessarily narrowed. And so also your treatment approach is not narrowed either. It's a little bit more broad. So, um, I didn't realize till years ago that I, I realized that patients don't understand that there's differential and there's working and working.

There's still, you still, we're still as clinicians, we're working with a certain level of uncertainty. We don't know if it's right either, but we have a high probability of believing that it's right. The only way you really know that's right is if it goes away. And cause you successfully treated the problem that you knew that you were theorizing it was, it's like the scientific method. So, um, but there is no absolute certainty, even if you have an x-ray or MRI, there is no absolute certainty. Um, it just gives more clues. Yeah, absolutely. I think that's the other, you know, misconception that patients have. They think like, Oh, if you get an MRI or an x-ray and it's like, Oh, okay. It has to show up there. And if it doesn't show up there and well, this doesn't explain why I have any pain, you know, it's not always going to come up on imaging sometimes, you know, and I know you've had other podcasts where they talk about that, but I think that ties into it, right. Where if somebody has like, you know, a weird neurological exam and then you tell them, Hey, we've got to follow up with these MRIs or x-rays. Like there's a reason for it. It's not just because you're trying to get them to go spend more money somewhere else. Like you're truly trying to help them, you know? Yeah. We don't, I mean, I don't know about other places, but we don't own image. We don't own stake in imaging centers. Yeah, no, it's just more, it's actually more of a hassle.

You know, it's more work on our part to, uh, uh, give you, give you the results of the, uh, of the imaging. And also sometimes, especially if you want your insurance to try to cover, it's actually quite a bit of work. Cause sometimes we have to call the insurance company to talk to them about why you need the image. And so we're trying to battle on your behalf. We're, we're a patient advocate, you know? Absolutely. And I think like, you know, sometimes the patients that come in here, if you're referring them out, like they don't realize like, that's actually more work on your part. You know, you're going above and beyond where these other people may have, you know, not caught that early, but maybe didn't, the symptoms weren't there. They didn't progress until now. And then if you're sending them out, it's like, that's important to follow up on those images, you know, not to just say, Oh, okay, no, I don't really want to do that. So I'm just going to go to a different doctor. Cause that's what happens sometimes too, you know? Yeah. Yeah. And, and I think we were talking the other day about some people who they've been told multiple times by different people, they need to have a certain test done. There might be this X, Y, and Z thing going on with them. And the patient's responsibility is to follow up with that. It's not necessarily that like you shouldn't have to track them down and make sure they're doing their stuff. And so, I mean, you can only do so much there, they have the rights. So, but at some point it's like, if you've been, if you've been told by multiple people, you should be doing this one thing, don't just find someone who's telling you what you want to hear, clean up, like rule out, do, do a good clean bill of health, like do what they're asking. I mean, what does it cost? Like under a grand to do all these tests? I mean, I'm not going to say everyone's got a grand, but I know a lot of people spend a hundred bucks at a bar, you know, in a night and, and just allocate the money accordingly. If you need to, it's a, becomes a prioritizing thing, right? It's like the patient has to prioritize their health more than the thing. So yeah, I just thought it was an important thing. Cause I realized like, okay, this is a, you know, a theme that we're, we're kind of seeing. Yeah. You know, some, maybe we should talk about too, is that the, um, since you mentioned that not, not everybody will do like all of those tests. Um, and so any place that you guys might be going, who's doing those tests and they find like, if they like sit you down, they have like a big grownup conversation with you about, Hey, this test means this, this could be going on. We need to figure this and this out. Um, come back, like do that and come back. Um, reason I bring this up is because a lot of times when we send people out for things, they don't come back and it needs to be thought of as like, this person apparently went above and beyond and did extra testing to find something that was, uh, uh, suspect on you. And they're trying to rule something out. They're trying to quarterback you. So if you go somewhere else, there is no guarantee that all these tests are done still. And no one's really keeping an eye on that thing that we had, that they were concerned about. Yeah. And sometimes it can be something that, okay, people have these just kind of like, uh, you know, abnormalities where it's like, that's their norm. Right. But if you're able to keep an eye on it and track it, then, you know, it's not progressing, then you're in the safe zone. But if you go to somebody else, they're not tracking that. You don't know if it's progressing. You don't know if it's getting wrong, you know, getting worse or not. So yeah, that's important. Yeah. Um, now this is a, I guess, side conversation. Actually, this is probably pretty much what you already kind of talked about earlier too, about how people's symptoms change. Oh yeah. Yeah. Um, there was somebody that, uh, Max was working with the other day that just reminded me of, it's very easy. Like there are obviously people who fixate on their pain for a long time and become more chronic, you know, fearful cases and so on. But there's people like, like I feel, I feel this way.

I totally forget I was ever in any pain. And so, uh, this person he was talking to, uh, they had, uh, like neck pain on one side, they had shoulder pain on the other side. Uh, they had a lot of stiffness up and up into the neck area. And so after a couple of sessions, their neck stuff cleared out and now they have a pinpoint like on, on one single finger shoulder pain remaining. They're like, I don't know. This is not getting any better. And, and he's like, so what, what were you like when you came in here? And she's like, Oh, my neck was hurting and so on. And he's like, look how far you've come. So fixating on the things that are still there. It's like, obviously you want to get a hundred percent better, but you got to remember where you came from too. Success doesn't happen overnight. Yeah. Uh, so you're mentioning people's symptoms sometimes change. Yeah. Yeah. Well, and it's funny you mentioned that. I'm like, I've had that experience with, you know, clients they've told me, Oh yeah, you know, this or that. And we'll talk about something. They're like, Oh yeah, I forgot. I had that. You know, I forgot my shoulder hurt. I forgot, you know, my back had hurt at that point. Like, and it is, it's like, it's so easy to forget that you even had this other symptom or that it changed, you know, and that not realizing like, Hey, those are all related, you know, this shoulder thing might not seem related, but it's, yeah, it's still related to the, to the neck. Yeah. Yeah. By the way, I could, if everyone's hearing that, uh, the gardener outside, we've been trying to dodge his efforts in the morning here. So we success, we succeeded earlier. We're going to push through. There's no grass in front of our office, so he's got to stop at some point. So you just bear with us. Okay. Uh, I mean this in the nicest way. This is a free podcast. Okay. We're doing as best as we can. Uh, so they say no Joe Rogan, no studio here. This is literally in one of our rooms or office. Yeah. Um, but yes. So symptoms will change. Um, sorry, I got partially distracted there. Continue. It's okay. No, yeah. I think it's, it's also, we were talking about symptoms changing for patients because, you know, people come in here and they're like, Oh, okay. Yeah. This back pain got better or this leg thing got better. And they're like, but now I'm feeling this. And you know, or it moves from one place to another and they don't realize that it's all kind of related, right? If they had something that was going on in their, you know, it band area. And then now they're like, Oh yeah, well that's better. But now I've got this back pain. Oh, okay. But now it's on this side. You know, they don't, they don't realize like, these are all symptoms of the same thing, you know, just progressing and changing over time. But I'm falling apart, Mary Lou. I don't know. I don't know if this is working. I'm not quite sure. Do you think I need PRP? Yeah, definitely.

I heard Sarah, I heard Sarah talking to me some of the other day about, about PRP. I think they had brought it up and you know, Sarah's like very, like, like very direct. She's like, why? Yeah. Why do you think you need that? She is, she is very direct with her patients. I'm like, yeah, and I get it, you know? And I think you, you kind of have to do with some people. She deals with like running population. So I think they're, you know, they're right away thinking, Oh, do I need some cortisol injection or cortisol injection? So I need PRP, like, what do I need? You know? And they want a quick fix because they want to keep running. Yeah. Yeah. Yeah. It's, and, uh, it's totally normal. And we joke, it's totally normal for people to kind of mentally, um, I don't want to say lose control, but they start spinning a little bit about, Oh, maybe like, like things keep moving. I don't understand what's going on. Right. That's, that's why you're paying someone for help. Just if like, I mean, I guess I could have a reason to lie to you, but we don't have any reason to lie to you about it. Look, that's all normal. Look, if something was, it was fishy, we'd be doing all these weird tests and we'd be sending you off for an image. Like nothing's fishy. Um, so just follow the plan. What you say is important.

And it means something to us because we're tracking your progression to kind of reverse engineer how you got here. Um, and just generally be, I don't want to say be okay with being in pain, but pain is a normal thing. And so it doesn't mean that you're like your insides are cracking or anything, you know? Yeah. It's just giving you a signal of like, Hey, this is a, you know, this is something that's, you know, bothering you right now. This is your yellow light. Right. So just move through something else, change it a little bit and modify it. It's only for a short amount of time. Um, I think on that note, it's important to like, talk about communication for on the patient's end, right? Like, don't be afraid to tell whoever you're working with that, like, Hey, this is progressing or this is changing. Like, cause I think sometimes people don't speak up, you know?

Yeah. Yeah. So there was that one person I'm thinking that has the hamstring that, uh, so you're, you're familiar, you're familiar. I'll describe it a little bit more. So he has, he has the hamstring and he had that back stiffness that was occurring for like, he kept asking questions about, uh, I think about his back, if I recall or something he had like things like we asked him about his hamstring. He's like, Oh, it's going great. You know? And so he kept asking more questions and he seems that like when things go awry, he seemed to ask more questions. And when things are going good, he just doesn't work. And so he's asking questions like, why are you asking? Oh, cause my back's a little stiff. How long has it been like that? About a month. Dude, you got to say something, man. Like we thought everything was going well. Cause you were saying your hamstring was good. Yeah. Yeah. So it's like a lot of these things are related. So don't be afraid of bringing that up. Yeah. The original issue might, you know, be calmed down and it feels better. But if you have anything like any kind of other ache, pain, tightness, all that stuff is related. So you, you've got to bring it up in some way, you know? Yeah. Yeah. And it's just the, you know, the team that we're on. So, uh, you're, you're the only person who can feel your pain and we can't feel it. Um, obviously we can watch you move, but just because say you move weird or you walk where it doesn't mean you're in pain either. And you might not even care. Like people walk with limbs and they don't care. You know, um, there's some people that have like a noticeable, you can see them coming down the block, you know, they have no pain whatsoever. No dysfunction. They just feel good. Yeah. So you just got to speak up. We don't, we can't feel what you feel.

So, um, yeah. Where do you want to go now? I feel like that was a good ending on that part. Yeah. Yeah. I don't know. Um, trying to think we've, uh, we've covered a lot of stuff. Yeah. So let's recap on at least a couple of those things there. So number one is, is, um, your, you, you should have a big, a good thorough test, uh, thorough examination, uh, at least on a single region that you're talking about, like, like say neck shoulder area, um, might take, uh, including your history might take 30, 40 minutes. It depends how many questions you have, how many concerns you have, uh, how many, uh, side, you know, side tests the person might do with you.

Uh, it takes a little bit of time. Um, the, I guess this, the second part was, this is a team approach. Speak up your, uh, symptoms and how things change your tightnesses, things that you might feel abnormal or even as normal for you are actually important information to us that we were not aware of. We're, we're like sure we're trying to be Sherlock Holmes here combined with, uh, John Wooden. We're here to motivate you, but we need some clues. It's a good one. I like that. It's a good way. Um, let's see. Uh, yeah, I don't know. I'm quite where to go with this. I wish we had callers. What do you guys want to hear about? Okay. What do you want to talk about? Yeah. Um, I don't know. I think on that note, uh, I was like, just thinking as you're talking about like, Oh, okay. A good initial exam should take 30, 45 minutes. Typically, if you're going through all of these, you know, history questions and your neuros, but that's also why, you know, it's important to find a provider that it's like, that's giving you that time, right? There's a lot of other people that, you know, they go in and it's fine. If you want to go in and just get an adjustment, you feel like it's your tune up. But like, if you've got something that you've been dealing with for years and years and you're not getting that address, then like, I think it's important to look at that time and like the type of treatment you're getting, you know? So, you know, I think, I don't know if we talked about it or if you were on break at the time. Oh no, I think we were. Cause I think Max was here.

Did you know that some people don't know that chiropractors even examine people? Wow. Like that was, so recently we, uh, did I tell you about my donut thing? No. Okay. So I don't know if this will work or not, but like, so over the last, um, so since Dawne Costantino was an intern, part of her, like we kind of re-upped the possibility of maybe having like a family practice doctor who then uses us to handle the musculoskeletal cases. And so, um, obviously we're not going to do medicated and they're probably not going to do hands-on musculoskeletal. And so there's a lots of people around here and we are trying to find places that will not only trust us with their patients, but also, um, like the higher up levels, like the neurologist, we're trying to get them to communicate with us because we don't want, as I mentioned earlier, sometimes we refer you out and they're like, you know what? Yeah. Um, we're just going to examine you. Cool. We used to go here instead of there. And it's like, well, no, we were just asking for an opinion. And so we want to work with this person, but they don't always send them back. And so anyways, after I figured out that some people, uh, I'm sure medical doctors, neurologists, um, even general public probably have no idea we examine. Um, I'm, I, one of our patients owned a donut shop. And so, uh, I, I'm like, I'm going to buy a half dozen donuts from you once a week, uh, in like multiple boxes. And so there's, I just picked some random YouTube, uh, family practice doctors around and I just dropped them off. And inside the box, I taped something, which is me and Dawne Costantino's face. And pretty much all it says is we thoroughly examine our patients. That's awesome. Like I don't, and so below those bullet points, it says, uh, pathology reflexes, CNS workup, regional orthopedic exam, and I put something else too.

Um, but just, I don't, I don't want to, I don't really need to know how they do what they do. And they probably don't care about how we do what we do. This want to make sure that we're thorough, safe, and that we do a good job. And so I'm just going to keep hammering these offices. We're just giving them donuts. No, I mean, that's a good idea. Cause I mean, at least you're letting them know, because I think you're right. A lot of people don't realize, I mean, you know, I didn't really know that the extent of what you end up learning. Right. When I started to carry school, I had no idea it was going to be that intense. And then you're like, Oh, you actually have to learn all of these other things, you know? Yeah. So I think it's important, you know, people don't realize it.

Did you have someone in school yet where, um, I had, I remember I had somebody like the clinic closed at like seven or something like that. And so they never turn anyone away. So there's like a six 45 that comes in new patient. And so, uh, like, you know, it seems like a neck issue or something like that. And then you get the whole history and you got to review a system. And so on, it says past history of cancer and then a high blood pressure and then recently falling. And there's always, it's like, so you have to do a side story of all of these things. Yeah. And so it took like three hours to do this. Yeah. You're like, yeah, it's not going to be in and out 15 minutes. Yeah. No, I haven't. Thankfully I haven't had that.

They're, they're actually pretty good. Like they won't let somebody schedule, you know, if they're an initial, especially like even that last hour, they know, okay, it's going to take you minimally at least an hour to get through that initial exam with somebody at the clinic, you know, for school. So, yeah. Yeah. So, um, I guess we can go backwards on examination real quickly. The, so we're mentioning that list of differentials. Um, I don't know if you've done this with the people you've worked with yet, but sometimes when I remember if they seem like they have a lot of questions about, well, so I have this hip issue. Do you think it's impingement? Do you think it's this? Do you think it's, and so, um, I'll, I'll do all the tests and I'll say, so I've checked you for hip impingement, hip labral tears, hip arthritis, um, uh, whatever else I can find that would Dr. Google would say, um, you know, MS or like all these things.

Right. And I said, I've done all these tests and I don't see any reason to think that you have them. So just don't read any more on them. And so we've narrowed the list just to let them stop fussing and thinking about all these things that could be, and just focus on the one and keep their eye on the prize. Yeah. I've noticed that you do that, you know, on your initial exam with patients. And I think it's really good because you know, yeah, somebody might be telling them what it is, but maybe because they haven't been very clear on what it isn't, then they still have all these other thoughts like, Oh, could it be this? And you've given them a very clear, you know, diagnosis on it's not any of these other things. This is what it is. And this is how we're going to, you know, treat it. Right. So I think that's just as important as giving them their diagnosis is letting them know what it isn't, you know? So I do like that you do that on the initials.

So what do you think about, um, I don't think we've ever talked about sensitivity, specificity of exam testing. Cause some people might think, well, I had this one test positive. I have this. Yeah. Well, for me, I think it's, it's, you can't always have one test. I mean, I guess that brings me to the thought of like, remember we were kind of, you know, in office, we always, you know, tinker with each other. If we've got one issue and we'll do another thing and we'll check, check this. So just to test it out, right. Do you remember we did some shoulder exams on each other? We had shoulder stuff going on and there was like two or three positive tests on the shoulder test. Um, but then we thought, okay, well, let's see if this changes when we address the next stuff. We address the next stuff. And then now those positive orthos became negative on the shoulder exam. So that to me just proved that like, you can't always just trust like one orthopedic exam and you can't trust all these other things. So I think it's important. You've got to cluster it, but it's also, even that can still kind of trick you, you know?

No. Well, and, um, there's like, I noticed that I really liked to stress, it's a stress test or scour, like me and you were talking about scours tests of different types. So there is a technical test called the hip scours test, which you scour the rim of the hip. And so, um, we were talking about wrist. We did a little wrist in service where we were learning about wrist and examining on each other. And so me and you were talking about like a wrist scours, you developing something like that. Um, and we were talking about a, uh, ankle scours yesterday, right? Yeah. So, um, low, I think load testing to see if like, if you, if you really do have a ligament or a impingement or a car lidge or whatever, it would be pissed off if you loaded it. Right. Absolutely. And so if you can get a little creative in there with your examination and load different areas of the wrist, you would reasonably rule out a lot of different like TFCC and things like that. Yeah. Ligament is much muscular stuff even. Yeah, definitely. But I, yeah, we're definitely seeing a theme on that, right? Wrist, hip. And then now the ankle, that was the first time I've actually seen more of that like scours type on an ankle. So I thought that was actually pretty cool. Yeah. I've never seen that either. Yeah. So, but that's kind of what I thought about that. So I was like, Oh, it's kind of like the TFCC one that we were, you know, trying to modify and change. Well, um, the shoulder exams like, uh, crank and clunk, and those are kind of like almost scoury Kim's jerks. Yeah. You get a little axial load in there and some movement. Yeah. It's definitely like a scours. So in what spinal stuff, it's nice to load different, like forward, backward, side, turn, turn, lean, lean. Um, and then variations of those too, to see if there's any sensitivity on like, in theory, if you had like a fracture of the backside of your spine from like dance, if we leaned you backwards and then pressed on you, you would light up like a, like a firefly. Oh yeah. You know? So yeah. One, I think that's one of the things, the big, you know, big things that, um, McGill goes into, right. Remember we were like practicing even some of that shearing testing where it's like, okay, is it more sensitive in there? Is it rotational? Is it, I mean, there's so many different things that you can try to get specific on.

Does it change your diagnosis? Not necessarily, but you can at least start to build more stability based on that for the person's activity and what, whatever pisses the area off. Right. Yeah. Well, and, um, I think you were gone, I think last week we were talking about this, um, me and Jared and Amr, we were talking about, you know, diagnosis and, um, obviously how imaging and diagnosis can sometimes make people feel like they're broken, you know, cause they're looking for like what's the issue in the tissue. Right. Yeah. Yeah. And sometimes it's not necessarily that clear. It's just your body isn't like this. Like, um, obviously you have a diagnosis of a sunburn, but it's intolerant towards the more sun. Okay. That might be our other patient, but we'll see. We'll let it, we'll let it ring. Okay. Okay. So good problem to have the, we'll be done in probably about 10 minutes here. So, uh, we're talking about the, um, how diagnosis obviously are important. And, you know, we obviously diagnose everybody, but, um, maybe rethinking the non-surgical ones and talking to them about the patient in this fashion. And so say you have something that is surgical where there's really something wrong with the tissues, uh, uh, a cartilage tear, a bucket handle, a fracture, like there's really something wrong with the tissues. And those would be classified as more surgical cases. Um, like just depending upon the type of fracture and so on. But then maybe instead of calling it hip flexor syndrome, call it hip flexion intolerance. By the way, you're, you have, you have hip flexor syndrome too. Yeah. You know, so just stop, just talk about the intolerances of it because when you rehab, it really comes down to just that. That's kind of what we need to know. Right. Yeah, no, it's true. It's kind of like offloading that area, but I do like that instead of calling it a syndrome or a, you know, I mean, that's why they've got a away from some of the terms where they say, okay, they don't call it degenerative joint disease anymore because they don't want to tell people they have a disease. Right. So they're changing the terminology. So I think that's similar, right. Don't call it a syndrome to say, okay, it's a intolerance for that. And that can change just like we're talking about symptoms changing, you know, right now it could be flexion intolerant, but then, you know, in three weeks, four weeks that that's going to come back or it's going to change and, you know, you just modify it again and move on. I agree. Yeah. Um, as we start to close up here, is there anything that we should probably recap on? Um, no, I like the way we kind of circled back on all the other stuff, you know, I'm good. I have no idea what we're going to title this one.

Okay. Well, um, I guess we'll wrap up on that then. Uh, I hope that was good information for everybody that, um, you can, um, just kind of stew on some ideas of, of maybe, uh, things that you need to plug into your care, um, things that you maybe need to, to improve your body and you're going to get, get to your recovery. Um, if you're looking for our help, you might not know where we're at, but we're in Costa Mesa, California. Uh, we're inviting people. If they have complex conditions, you can certainly fly in and see us. I've heard people fly to the Mayo Clinic. So why not us? Um, we're very good at things, uh, low back, hip, uh, shoulder and neck. The further you get away from the spine, we're not quite as good at. So if you're suffering with things and you want to spend some time on California and just, you know, hang out in the sun, I heard people just feel better at the beach anyways. And so you can always come in if you want, but certainly subscribe to the show.

Um, you can find us at p2sportscare.com and thanks for being part of the movement.