Understanding a sports hernia: causes, compensations and recovery

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Find the direct links in your podcast player. Now on to the show. 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, this is your host, Sebastian, with the Restoring Human Movement podcast. Thanks for joining the show. Thanks for being part of the Movement Movement. I think this is episode 277 we're in here and we have lots of different episodes about sports hernias and hip impingement and groin pain and low backs and sciatica and so on.

So if you are brand new to the show, you've missed a lot in the past, please go back as we have a lot of great experts that come on and share some great information about how to heal your body and how to understand what's going on. So on today's, I wanted to cover the idea of how to understand a sports hernia. There's a lot of, I think, confusing information on the internet. And so right before this podcast, I went through and wrote down a little bit of context, a little bit of an outline so I can deliver the simplest way to understand this information so you guys can get the care that you need.

At any point in time, if you want to contact us about your sports hernia, we do specialize in non-surgical management of it, you can call us at 714-502-4243. So here's the things I think you should first consider with your sports hernia. Number one is you need to understand that there is a symptom-generating structure. And there's probably only one. Okay, there's typically a symptom-generating tissue, just like if you were to cut your hand, your skin and the nerves in your hand and all the tissue underneath your hand or underneath the skin can create your symptoms. And although it can create other types of compensations, typically there's only one symptom-generating tissue.

The second thing you've got to understand is the collateral or compensation effect. And this can explain a lot of the other symptoms that people end up feeling. And if you've looked at enough information about sports hernias online already, you've realized that people have different experiences. Some people have just lower abdominal pain. Some people feel it down to their adductors. Some people feel their SI joint, low back, and their knee. Various different things. And the reason is, is because people compensate or create collateral effects in different ways. And that's just because we're unique humans.

Everybody's a little different. Their body's different. Their habits are different. The activities they do are different. There's a lot of differences. And the third thing is just understanding root cause. So symptom-generating tissue generally is only one. I'll cover each one of these in turn a little bit more as we go through. Second is collateral damage or compensation. And third is root cause. So if you itemize those three, it'll help you get a better idea of how to manage this and understand that you only need one symptom-generating tissue. And it's okay that you have adductor pain and stuff into the knee.

You don't need all these other things. Generally, the body will compensate around the most. We'll call it the highlight reel. Like, the biggest thing going on. Just like if you had sciatica or leg pain down the back of your leg, the limp associated to it sometimes creates other things going on. And this is no different. People walk differently. They act differently. They do different things. The next part, which we'll cover at the very end, is just a brief overview because we did cover this in another podcast more recently. And we do have lots of YouTube videos on our YouTube channel about what exercises and stretches we tend to give to manage these things non-surgically with a really good success rate.

So, treatment's pretty simple but challenging. You reset is number one. Number two is reverse engineer. And number three is re-engage. And I'll cover these towards the end. So, at this point, let's get into the symptom-generating tissues. And there's three basic ones. I've noticed over time, I think I've been looking at sports trainings over the past 10 years or so, and the theories change. And so, I'm dealing with what I see currently, and I'll tell you what I agree and disagree with, too. But I don't think everyone's going to be all on the same page on this. There's always theoreticals that are floating around a little bit, too.

The first one is the conjoined tendon. The second is going to be the pubic symphysis. And third is going to be local nerve pain or irritation or local nerve response. And it's not exactly going to be in this order. So, first, let's just cover what the conjoined tendon is. I'm going to read through some verbiage that comes from some research papers that I pulled up just for this podcast here. I will cite them in our show notes so you can see where this verbiage is coming from. And I'm going to see if I can do my best to boil things down, too. The conjoined tendon is a combination of tissues that run through the lateral edge or the outer edge of the lower rectus abdominis sheath.

So, the rectus abdominis is the six-pack or eight-pack muscle right in the middle. And the sheath is there's a sheath right around it. It's also located at the lower abdominal area. And it's formed from the common aponeurosis of the internal oblique muscle and the transverse abdominis muscles. So, these two muscles conjoin and come together to form a common tendon. Before they get to the common tendon, there's the aponeurosis, which I'll discuss in a little bit of time here, too. There are other muscles of the body which go into a conjoined tendon. The hamstrings are one of them, too. And also, the peasant sariang down at the knee.

So, that's a combination of three different muscles which go into a conjoined tendon, too. So, an aponeurosis is a shin – sorry. Aponeurosis is a thin sheath of connected tissue that helps connect your muscles to your bones. Aponeurosis are similar to tendons. They support your bones and give your bones strength and stability. The aponeurosis absorbs energy when your muscles move. So, basically, like a muscle becomes a tendon. Like if you imagine a bicep, a bicep muscle becomes a tendon and there's a little bit of interplay in the middle there. So, the aponeurosis is kind of in the middle between them as it conjoins and becomes it.

The fibers of the conjoined tendon run downward and insert into the crest of the pubic bone and immediately deep to the superficial inguinal ring. For those of you, a lot of men have this issue. I think the estimation is about 90% of sports turners are going to be regarding men. But I know women who have had issues as well. So, the superior inguinal ring is going to be more of like where you're talking about your hernias and so on. Like where the vessels go into the scrotum. So, part of this conjoined tendon runs down and actually inserts in the pubic bone. If you run your hand down your belly, past your belly button and down into like that bony area, like right above any privates, that's the pubic bone.

And then right in the middle of it is the pubic symphysis, which we'll talk about a little later. So, some of the fibers of the tendon go downward, but also some of them run a little bit more inward. So, inward, they run to fuse with the anterior wall or front wall of the rectus sheath. So, we talked about the sheath around the six-pack muscle earlier. The conjoined tendon is also known as Henley's ligament, which forms from the medial fibers of the internal oblique aponeurosis as they unite with the deeper fibers of the transverse abdominus aponeurosis. So, again, just to reiterate here, there's two muscles that form the conjoined tendon.

Before they become the conjoined tendon, there's the aponeurosis. It's the muscles of the abdominal area, which you may have heard of, is the transverse abdominus, the internal oblique, and the external oblique. Okay? So, they form the conjoined tendon, which inserts into part of the six-pack muscles and also into the bony border right around the pubic bone. So, the conjoined tendon physiologically supports the abdominal content, which is why it's going to be a part of hernias as well. But it actually increases its tension when it goes under higher intra-abdominal pressure. Intra-abdominal pressure is when you bear down and it creates more stiffness into the abdominal area.

So, the current theory of the mechanism of a sports hernia is, they call it a shutter effect. It's where the aponeurosis of the transverse abdominus muscle tenses and increases with intra-abdominal pressure. And at that point, it may give or it can keep its composure. Okay? A similar thing happens to the foot at the plantar fascia. So, if you actually take your foot and you, say you're seated and you bring your foot up and just relax your foot, you'll notice the bottom of your foot is actually pretty relaxed. Okay? It's really, it's a unique structure and different parts of the body work similarly too.

And it can be soft and supple or it can be rigid because it's trying to provide a function. So, the bottom of the foot, the plantar fascia, as you bend your big toe back, you'll notice that it'll start to pucker up intense. This is normal. And this is how it helps transfer load as you start to walk and run. And so, it almost begs the question too, like I know that people try to stretch out their plantar fascia when they're in plantar fascia pain. It's supposed to be tense. It's supposed to have a function to create tension. And the same thing happens with the aponeurosis and the conjoined tendon.

They're supposed to be able to provide a function. So, you can't just stretch these things out or snip them away or anything like that. So, back on the idea of that shutter effect. Again, it tenses when intra-abdominal pressure changes or increases. We're going to come back to the idea of intra-abdominal pressure as we start talking a little bit more about mechanics versus, right now we're talking about symptom-generating structures. But just know that the conjoined tendon, it does have a function, all right? And if that function is asked to do too much, it's doing too much of the function, potentially it could lead to an injury like this or some fray or a tear or so on.

So, the next step is going to be the pubic symphysis in regards to the symptom-generating structures. And so, a few years back, I did a research update and there was more papers that were talking about the pubic symphysis potentially being more of the symptom-generating structure. I don't see quite as much of that now. I think it'd be ridiculous to leave it off of this list because it does get more shear force as you limit hip movement and have some of the mechanics associated to conditions like sports hernias and osteitis pubis. So, shear force can be measured at the pubic symphysis and, again, they had cadaver models where they limited hip movement and then simulated some of the forces at the hip and then they found it moving more into the pubic symphysis.

Now, the pubic symphysis is the joint between your two halves of your pelvis in the front. As I mentioned earlier, you run your hand down your belly and right above any private parts, there's a bony part there and right in the middle is going to be a joint. So, it's a cartilaginous joint. It does absorb more shear force if your hips aren't working super well. And as we found out with knee joints over the years, knee joints are subjected to more motion as the hips or ankles don't really work super well. They call the knee as a simple hinge joint that's just caught in the middle of two bad scenarios.

And the same thing is found for lumbar discs as well. And so, if you've, with lumbar disc fusions, say at L5S1, they find that the adjoining areas, like the neighboring areas, end up picking up a little extra movement over time, which is why some of the surgeons are going back to the idea of synthetic discs that I think they did years ago and then there was a little bit of a fallout with, from what I hear. So, they want to preserve the movement at all costs if they can. And then the same thing is considered with the pubic symphysis. The pubic symphysis does get sensory innervation. So, excessive force at it, kind of like with the knee or the low back disc, there could be some sensory that goes along with it or some pain.

And if we take the workload off of it by improving the hip function, which we'll talk about a little bit later, then reasonably speaking, I think some of the symptoms could dissipate as well, even if you don't damage your joint. There's a difference between damage and sensitivity, by the way, which could account for some of the image, lack of positive imaging findings you guys may have. So, you may not find any of these symptom-generating structures are actually damaged at all. It's just, they're just sensitive and it's super common. Okay. The innervation to the pubic symphysis, it's going to be the pudendal genitofemoral nerves and the branches of the iliohypogastric, ilionguinal, and pudendal nerves.

So, I'll read those off again. There are some great pictures that you can see on the internet where they describe the pudendal genitofemoral nerves and the branches of the iliohypogastric, ilionguinal, and so I guess I said pudendal twice because I'm citing two different papers here. But you'll see where they go and they look very much like the sports hernia. And on YouTube, we have these skin rolling demonstrations. If you guys have not seen them before, go on to our channel and search a sports hernia. And I don't think we label it skin rolling, but I think it's can your low back and your groin pain be connected.

And so, a lot of times it's these. And I'll tell you a little bit more why when we get into the local nerve response section. But for the most part, I think these can contribute to a lot of people's pain. The skin rolling commonly helps people, surprisingly. I didn't think it could be so. But I've been surprised how often it helps people. And these are people who have had ongoing sports hernia pain. They've been examined and imaged and so on. And it still helps them, surprisingly. It's not an end-all, be-all answer, but it does provide a little bit of questioning. And the last research update I did about two years ago, they accounted for about, I think it was like about 15% to 20% of people with sports hernia diagnosis feel some testicular tightness, too.

Again, because it is more male-dominated as the condition. I think females will find a little bit more sensitivity in the area of the mons pubis. But I can't say that exactly for sure. It would be something deriving from the same histology, or the embryology, rather. Local nerve pain response is number three of the symptom-generating structures, which I just mentioned. The ileo-nguidal nerve, ileo-hypogastric, and genofemoral are all very much in the game here. The genofemoral nerve passes through the psoas muscle, which for a lot of you who may end up having some hip flexor tightness and a little bit of low back pain, these are the ones that are the hot spots of possibility, and they can create the testicular tightness.

The ileo-hypogastric is a little bit more of those people who have the lower abdominal area, right above the crease of the hip. And then the ileo-inguinal are a little bit more crease of the hip and outer to the side of the hip. But these ones actually, they could be affected in three different ways. The first thing is they could have compression or entrapment. The second is they can be exposed to prolonged stretch. And the third is they could be a local inflammatory response. I've also noticed that some people actually have like pseudo-sports hernias. Like they're not really sports hernias because there's no evidence to support it, no imaging, no mechanism.

They're not soccer players. They don't kick and twist and use their hips too much. They're just sitting. Or they're weightlifters. Weightlifters aren't really for the—they're not par for the course on this. They don't have the mechanism because, in theory, you have to be able to have the mechanism to be able to have the injury. You can't have a bicep tear by waking up in the morning. You can't get a rotator cuff tear by brushing your teeth. You could tear a bicep if you tried to pull a friend off of a cliff. The load is there. There has to be the mechanism. So weightlifters aren't the mechanism for it.

It's going to be a little bit more twisty based, as you see in some of the studies that I'll put as a reference is. So some of the possible pseudo-symptoms can be more from high lumbar pain or past low back injuries, which I'll talk about a little bit later too. Would you like to work with us here at Performance Place? Perhaps pick our brain about your situation? You can. For a limited time, we're offering a $29 special. That's 30 minutes to discuss with us any questions or concerns you may have about your current situation. We call this the Discovery Session. You get to learn if you want to work with us, and we get to learn if we should work with you with your specific case.

Contact us at info at p2sportscare.com to learn more. Overall, though, nerves are pretty simple in regards to how they typically create some irritation. Number one is there could be compression or entrapment, which a lot of people are familiar with. There could be either local compression around the area where potentially there could be, like, pressure of the pants on the area. I know some people just can't really wear, like, some cops can't wear a gun belt because of this. There can also be compression as they exit the spine. There can be compression between soft tissue layers. There can be compression inside the inguinal canal because of an actual hernia or intestines going through the inguinal canal.

So there can be various reasons for it, but generally they're pretty simple. If you take pressure off them, usually within a few minutes, especially if the symptoms are transient and just come and go throughout the day, the symptoms reduce after a couple minutes. They come back, you know, but it's a nice thing to see that the symptoms can reduce very quickly if you just take pressure off the nerve, essentially the nerve's in a tourniquet. The tourniquet creates a swelling distal or further down the nerve than the compression's at because you're occluding venous return of the blood flow of the nerve while you're still getting the artery, which has higher pressure to pump in.

So it's essentially filling it and creates, like, a tourniquet effect on it. So if you let it backflow a little bit, you help out a little bit with symptoms, but it doesn't really change it as an overall long-term solution because there's other things that need to be done too. The prolonged stretch, some of you who have noticed that your legs fall asleep when you sit in a certain way, it's an example of a prolonged stretch. And again, it comes back within minutes, you know. So the same thing happens with the nerve. The theory is that, and I'll read from one of the papers here, that others have suggested that the ilioinguinal or genofemoral nerve entrapment could give rise to the pain.

Entrapment of the ilioinguinal nerve caused by a hernia of the external oblique aponeurosis is called a hockey groin. There's also, this could also be from nerve's path. Oh, sorry, that was my notes to myself. But essentially, if there was a hernia or a extra path of the nerve, if you will, so say a nerve has to travel, I'm looking at a block wall right now. So imagine the block wall is about 10 feet long, and there's a piece of rope on it all the way across, so 10 feet. Instead of being a flat wall, say there is a basketball right in the middle of it. So essentially, right underneath the nerve, there would be an extra mound of something creating extra length demand.

And so that can create extra stretch in the nerve with already normal movement, creating irritation, and that can be resolved too non-surgically. And the third thing is, by the way, the compression entrapment can be resolved non-surgically as well. The last thing is low-conflammatory response. And this is basically the nerve passing through the wrong neighborhood. And there was a study they did a couple years back where they basically dripped a liquid irritant onto a nerve, and they found that it had a response down the line, or we call it peripheralized response. And so there was no pressure on the nerve, there was no entrapment, there was no stretch to the nerve, there was just local irritation of it, because it was around an area of irritation.

And this could be where maybe being kicked in the area would create the response, because now there's a bruise, there's inflammatory response. So that could potentially be part of it, and that's easily dealt with without surgical methods as well. So just to reiterate three things on that, again, there's the conjoined tendon, the pubic symphysis, and local nerve irritation. So those are the big three. All right. Now, here's where we're talking about collateral or compensation, because these are going to be important. All right. This is basically how you reverse engineer the process. As we talk about the very end, we're going to talk about the process of getting out of this thing and being able to get back to your normal active lifestyle again.

These are potential areas where you may want to spend a little bit of time in reverse engineering. So the first one is limited hip range of motion. Throughout endless amounts of piles of research that you can find on PubMed and some of the peer-reviewed journals, limited hip range of motion is a big part of it. Limited hip range of motion isn't just limited stretching. It's a limited function or control within a certain range. Also, there's been quite a few studies that show that the pelvic position that you have limits, can limit how much range of motion you have with the hip. So if you have too much of an anterior pelvic tilt, by the way, which is not a postural problem, it's a patterning issue usually.

It's a habit. And so there is limited hip range of motion, especially internal rotation and flexion that happens with an anterior pelvic tilt or butt out type of position. So that is something that should be considered is how do we improve hip range of motion? And there's a lot of different ways to do so. It's usually unique to the person. It's not just your general YouTube stretching videos. There is other things to do. All right. So you need to be able to make sure that your hip not only has range of motion, but it also has the ability to control that range of motion. The next thing is going to be a poor core function or what I would also deem as pressure management.

The reason why I call it pressure management is because people oftentimes when you tell them about their core, they're like, oh, I'm just my core's weak. Okay. So I'm just going to go find a YouTube video on how to strengthen the core. And then go to some random channel and they find sit-ups and crunches and V-ups and Russian twist and boat pose and side planks and bird dogs and supermans and flutter kicks and all these things. And essentially, the core function is not just about aesthetics. Okay. You need to make sure that you have the ability to keep and manage the appropriate amount of internal pressure as you go through an activity.

And I'm not saying think about your pressure or hold your breath or brace throughout doing your activities. That's not it either. Usually, getting a scenario of rehabilitation to create the appropriate amount of pressure for the challenge that you're being put under is part of the thing. There's a few disciplines of rehabilitation that cover this. Dynamic neuromuscular stabilization is an excellent one. I think if you go on to the DNS, Dynamic Neuromuscular Education, sorry, Exercise, Dynamic Neuromuscular Exercise website, you'll find a provider list. And those people are pretty vetted. So those ones are excellent people to find on this because essentially it's all structured around the ability to keep intra-abdominal pressure despite moving your limbs.

Because a lot of times people will end up losing their pressure or lose tension in the area as they move their limbs, such as kicking a ball, twisting, and turning, and so on. We find it with people with deadlifting and squatting and so on, which are not the mechanism for this injury, but they are for other things like low back disc herniations and things of that nature. So if you lose tension while you're under load or challenge, potentially it could lead to some injury. It won't always, you can get away with it for a long time, but if this is a big part of it, it needs to be addressed. So pressure management, core function, not aesthetics, not how big the muscles are, not strength, it's function.

Okay. The third thing is going to be past injury. So stiffness to the low back, hip, even all the way down the leg to the knee, ankle, big toe are big parts of this. Because your body will compensate and work around areas of stiffness that it can't get motion out of. Earlier I mentioned the hips. That's a big part of it. But also we've met a lot of people who have had old L5S1 injuries to their low back or past sciaticas. And then we found that actually getting rid of some of the stiffness in that area reduced their symptoms way faster than dealing with their hip. And the theory is, again, if the body doesn't have to work around that stiff structure anymore, the areas that may be moving too much, such as the pubic symphysis or putting excessive load on the aponeurosis or the conjoined tendon or potentially the high lumbar spine referred pseudo symptoms of a sports hernia, all those ones can start getting less workload.

Because you're putting it in the areas where it's really more intended to. So the low back should have some motion, not a bunch, but some. And usually when people end up having old injuries, the area doesn't hurt anymore, but it essentially becomes an area of dysfunction. It does not hurt, but it does not work. The hips are a big one. If you've had past hip injuries, say you weren't able to walk for a couple days or you had a painful pop, you had a dislocation, even catching popping. I had a hip injury back in the day where I twisted and I felt a, you know, and so I still have a little bit of an issue here and there because of that.

Also things down your leg, like if you dislocated your knee, if you had an ACL injury, a meniscus, repetitive ankle turns, those are all parts of this. And so if the entire leg does not work, it's really hard to get the appropriate areas that are good at taking load on throughout your sporting activity to actually work. You got to get them to help. Complicated one. Let's just read through some research here. So the expression of a sports hernia includes many structural abnormalities along with a set of secondary causes. The most commonly hypothesized cause of sports hernia occurs secondary to intensive hip muscle contractions and excessive use of flexion, extension, abduction, and adduction moments across the hip joint with twisting or hyperextension of the trunk during sports, leading to exaggerated movements of the pelvis, creating sheer forces over the pubic symphysis.

Kind of all the things we just talked about. The force is further exaggerated by imbalances between the two opposing forces acting on the pubis. The upward and oblique dragging of the oblique muscles from one side and the downward and lateral dragging of the adductors to the other. So opposing forces pulling against each other. The disequilibrium of forces can cause injury to both the abdominals and the hip adductors. The traction of the hip adductors against the non-moving lower limb may generate sheer forces across the half of the pelvis and been considered as an additional cause of sports hernia.

So even the research is indicating that the hip, the pelvis, how you move, exaggerated movements of the pelvis, hyperextension of the torso or the trunk during sports, twisting the hips. Like these are all part of it. Okay. Now I know this may all seem a little complicated, but it really is not. The ideal thing you should be doing already if you're already confused by what you should try is you should have someone assess you. Everybody has a different starting point. Okay. This whole thing needs to be rehabbed together and you need to have a customized program for you. Okay. Now let's get on to root causes and I'll, I'll just cover these based upon the three points that I kind of talked about.

So a limited hip range of motion. What could potential causes be hip arthritis, cam pincer or mixed impingement of the hip old label pathologies. I've met a lot of people with that. They said, oh, I got this hip image and it showed a hip labrum. I don't think it's my hip. I don't have pain in the hip right there. I have it elsewhere. Right. But the old hip labrum tear insinuates there is probably something going on there. It may be a really good starting point. Poor general physical preparedness. You're just generally inactive. And then just an overall lack of using the hip range that you may already have.

Stiffness, if you will. Like when you get your leg arm out of a cast, it's hard to move in all directions until you do it. And over the course of a couple of weeks, it all comes back. People sit a lot throughout the day. So you being able to extend your hip a little bit more throughout the day, walking or starting to do some sprinting at some point in your life may expose it to the other. When it's not really a diagnosis that's causing your problem. It's more of a lack of exposure. Okay. Poor core function or poor core pressure management can come from past low back injuries and the compensation that usually comes from that.

Past low back injuries are a big part of these because if people arrest movement in their low back and they start raising their chest up a little bit to create, quote unquote, better posture, as they say. Then it ends up creating anterior pelvic tilt. It can create compression on L1, which a lot of times refers to as the pseudo symptom. But it limits hip range of motion, activates hip flexors, activates low back muscles, decreases activity of the glute max muscles. So there's a lot of different things that happen is the compensation from a past low back injury, even though the back may not hurt anymore.

There's something called nocebos, which is we call them thought viruses. And this is mainly about posture. Like if you think that perfect posture is always perfect, you may be creating your own problem because as you start to, you know, kind of open up your chest and flare your ribs forward and drop your belly button down between your ankles, kind of that open position there, that can actually create more limitations of hip range motion, make certain muscles overactive. And it doesn't help out with pressure. Usually when we coach pressure, we actually try to reduce that as one of the first things.

And then we coach them into how to actually create pressure through different exercises we show them. Sucking in, believing that you should be sucking in or hollowing all the time is an issue with, creates poor pressure management. Also poor exercise selection that you're doing. And stress. Stress, if you're always up into your chest with your stress and you're always, you know, stressed out, it really doesn't help out. Like we say people are cut in a low grade form of hyperventilation. Utilizing the diaphragm, which is a, it's a respiratory muscle, is important when you try to get back your, your pressure.

And the past injury thing I mentioned, there, consider the areas, almost like a highlight reel of the, of the ones that you, the biggest injuries that you had. As I like, when I see people, I always like to ask them like, what is the, what is the biggest highlight injury that you've had? And, or ache or pain or thing that kept you down for more than a couple of weeks? You know, and some people like, like, you know, I don't, I don't really have any injuries. Right. And you see a scar in there and you, what's that? Oh, you know, I, I kneeled on a piece of glass when I was 15 and, you know, it's funny.

Like I got stitches there and I got an infection and all of a sudden the infection, it was around for a long time. And I was on crutches for six months. Like there, like there's those things that like, you just have to recap on a little bit to see if there, because there's a chance that that knee issue is a big part of this. And we just have to get it to function again, even though it doesn't hurt. So big ones on the list is old L5S1 injuries, old hip trauma, old hip history, as you will. Like I've had this hip flexor issue on and off for the past 10 years. Old knee ones, again, like I just mentioned, it's not always on the side of involvement.

Sometimes it's the opposite one. Because if you, that old knee injury, say on the left, never really integrates back in. It really doesn't work super well and it may not hurt and you may not notice. But if you start overloading the other side, it starts to create a little bit of changes that may lead into this poor ternia. Repeated ankle turns and lack of motion of the big toe, which is a pretty significant one. So root causes, again, you need to make sure that you just take a highlight reel of your life and think about all the things that may have come up. In regards to things that kept you downed or certain joints that are kind of highlight reel joints or highlight reel muscles.

And also, it's important to note that you are some of your old habits. So I talked earlier about the general physical preparedness. It may be an issue. Yeah. So you are some of your old habits. If you eat poorly, you will probably have nutritional problems and everything else that goes along with it. If you behave poorly with physical activity, then you may have some easy wins. I mean, they're good opportunities. Clean up the diet, a lot of those problems go away. Clean up physical activity, a lot of the sports ternia things and mobility will improve. Okay. Hip mobility will improve just automatically, probably just by walking a little bit more.

And now we're on to the very last part here, which is treatment can be simple yet challenging. We talked about reset, reverse engineer, and re-engage. All right. So reset is pretty simple. Don't provoke the area. Usually for about a couple weeks is enough. Most of you who have been dealing with this for a while, you probably have been playing around with it. And you're like, ah, it bothered me again today. And, you know, I just took a couple days off and it went away. So a couple days to a couple weeks is usually enough to reset, if you will. Let the symptom generating structure have a chance.

Give it a, give it a second. Just like a cut on your finger, it will start to settle down. Almost everything does. And then you can try to reverse engineer this thing a little bit better. Reverse engineering comes down to finding those highlight reels and any deficiencies that you may have. How is your internal pressure or how's your pressure management? How's your hip range motion? How are your habits? So these are all things that need to be reverse engineered. And I'd love to say everybody just needs to do hip mobility. That would be completely wrong of me because there's been enough people that I've worked with with sports hernias where the key to their problem was actually their mid-back.

Their mid-back was stiff. Some people had long-term sickness. They were coughing for about a month and then their symptoms developed. So we had to improve their ability to just generally breathe, which helped out their internal pressure, which helped out their hip function, which helped out taking pressure off and so on. So there's a lot of different ways to intervene, but really reverse engineering comes down to actually having someone look at you and decide what a good starting point is. Not to say those other things won't help either, but ideally if you want to spend your time wisely, you pick a focal point and you start there first.

And the third thing is re-engage. If you don't want to go back to the activity that you were doing, like you hurt yourself, like taking out garbage and you never want to do it again, by all means, that's your call. But if you want to go back to your activity again, like soccer or hockey or baseball or whatever, and you kind of have a slot in your head, like, well, maybe I'm just too old for that because it keeps coming back. I try to do a reality check on that because I've met a lot of people who, you know, at 40, they're like, oh, man, I just think I'm all too old for this. And they get better and they play all the way until they're like 45 or 50 and they're like, oh, you know, I just came back again.

I might just be too old for this. Like every injury at every age, I've heard 25-year-old say, ah, this is too old for that. It's like, you guys aren't old at all. It's just you have some pain. It's uncomfortable. Let's get through it. Let's get logical about it and let's re-engage in the sport if you like the sport. There's nothing wrong with the sport most of the time. The problem is is all of these other things we talked about in this podcast today. So reset, reverse engineer, and re-engage. Generally, the process for at least reducing symptoms takes, I mean, I've seen people feel better within a week's period of time.

A lot of times I've seen people on the long end take a month or two. Usually giving them something to reverse engineer the process usually takes only, that happens well within the first month. And re-engage in activity easily over the course of 90 days. It's all dependent on the severity of what you have going on and lots of other things. But ideally, we get you re-engaged as fast as we possibly can. And so if you guys are looking for help with us, we'd love to help you. We specialize in seeing people with sports hernias. People fly in to see us for them. And we do our very best to give good logical approaches, to rule out other things that you may be concerned about, and give you a structured plan of attack.

Like all these things I talked about today, these are considerations that we're going through in our assessment. And we boil everything down and give you the exact things to do. Most people can feel a lot better just by spending, structured-wise, 10 to 15 minutes a day doing something that is working on their deficits in reverse engineering the process. So let's get you started on that. We have consultations available. If you go on to the link onto the show, the bottom of your podcast player, there'll be a way to contact us. And so we love to do consultations to screen out to see if we can help people in the first place.

There's no point in wasting anyone's time if it doesn't seem right in the first place. Because we can tell a lot about what's going on just by talking to you. And watching you move would be the second step. And then we test to see if things are right and establish a starting point. But reach out. We would love to help. There's so many people who are struggling with this problem throughout the world. It's very unfortunate because it's really not too complicated. It's just challenging. It's just work. It's simple, yet it takes work. So let us be in your corner to help you with that. You can reach out to us at 714-502-4243 or email us info at p2sportscare.com.

I'll see you guys next time. And subscribe to the show. We have more coming just like this.