Nine common misunderstandings that slow injury recovery

This is session number 90 of the Performance Place Sports Care Podcast. Do you have your own strawberry plant? Welcome to the Performance Place Sports Care Podcast, where you can learn about sports injury theory, rehab, diagnosis, and how to understand the doctor lingo you didn't understand at your appointment. And now, your host, Dr. Sebastian Gonzales. Hey everyone, it's Sebastian. I'm back. We're going to do a solo podcast today. I thought I would do it on stuff that, some barriers that I, miscommunication I have with clients weekly, and I thought, selfishly, I can make this podcast available to them, and I know it's coming out late in the year, or middle of the year, but I thought addressing these things in a proper format is better than having the back and forth in the office, that it's usually, honestly, it's usually at the end of the person's appointment, so I can't completely answer it, but it's an unsaid thing that they bring up later.

So, some of the things I'm going to be going into today are, are you going to work on me? And because sometimes we go over just stabilization stuff, because it seems like it works better for their condition. Let's see. What's another one? Does my back injuries from a slip and fall or a trauma, how does sitting in posture matter with that? I have not, so we're going to get rid of that. So, these are all types of questions that I get weekly, so we're going to go over about nine of them, I believe, unless for some reason, between making this intro and creating the podcast, I decide there's a tenth one that's going to be important, but at least nine here.

And I don't want you guys to feel in this podcast that it's going to be, I get excited about these topics, so I guess I'll start with that. I don't want it to sound like I'm being negative about it, but it's a passion of mine. I need people to understand. I want people to understand. They need to understand their body, their condition, and so on to get better. Otherwise, they're going to be targets for easy sales of easy, quick fixes and so on. They're going to be jumping around between providers and just not know what's going on because that's what we see a lot of nowadays. People just jump around to different docs, different clinics, and so on, and they're frustrated.

So, I want the buck to stop here. I want the buck to stop in your office. I want the patients to understand, and I want them to get better at your clinic and not have a miscommunication or an altered definition of a term to be a deterrent for it. So, when we go into that again, I might get passionate, but at the same time, this is all well-intended. It's all for your own good. Let's not let this madness continue. Now, do you have your own strawberry plant? Because I did at one point. I don't anymore. I live in a place where the area that the patio's in doesn't really get sun. Like, it's not sunny.

I mean, it's sunny. I mean, it's bright, but it's shaded. So, there's an area, there's a strip that only gets maybe about six inches of sun for about two weeks out of the year. So, we can't really grow much other than, like, staghorns and orchids and succulents and stuff like that. But I had a strawberry plant when I was younger. So, a lot of the people I play baseball with will realize this. It was on the down low when we were playing, but I told them after the fact because I didn't want anyone to go out there and steal my shit. I played center field and out there, like, no one typically goes deep into center field along the fence line unless they got in trouble and they're running or if they had to run a ball down there.

Like, even I wouldn't really go spend time and mess around at the fence line. But there was one time where actually I went out there. I bought a strawberry plant, a couple of them, and I planted them right underneath the fence. And so, in games, between innings, I would carry water out in my mouth and I'd spit it on there to make sure that I was growing my strawberries adequately. So, in the middle of the season, actually, there was finally a strawberry there and I got a chance to eat the strawberry. But after that, people caught word that there's a strawberry plant out there and people started eating my strawberries.

So, but it was in left center field for all you people who went to that high school. So, before we start into the actual content here, I want everyone to remember, if you are a clinician and you're listening to this, share with your clients. If you resonate with what I'm saying, the reason why I make at least half these podcasts now is so you can share with your clients. The other ones are obviously, they're more technical. I don't expect the patients to understand the technical language, but I want you to understand it. So, if you are sharing these, by the way, go on to p2sportscare.com slash shop.

There is a bunch of posters there. I made them because I believe you honestly need them. They're the things that I needed but didn't know I needed after I graduated school. So, I would have easily spent, I would have gotten all these, honestly. Educating the patient and getting their eyes to understand, their ears to understand, and then lastly, but not least, getting them through the movements of what their homework is, is extremely important to create buy-in to get them to do what they're supposed to be doing. And you're going to hear some of the doctors on my podcast speak about this. This low compliance of treatment plans by patients.

And it's misunderstanding is all. So, this is why I created these things. So, if you go on there, you will get access to a document as well. A Google Doc, it keeps populating. And these are the things that I send out to my new patients who need to understand better. And so, they get podcasts just like this that address all the things that they will be asking you about in your clinic anyway. So, trying to make your job easier. So, let's go into the content. Let's go into number one. So, I get this asked pretty often actually or commented pretty often where the person, the client, the athlete says, Well, you know, Doc, I think I'm just getting old.

And I've heard this from friends. I've heard this from people I don't know. And for me, my understanding of it is that, yeah, I mean, part of you gets old. I mean, part of it degrades. Yeah, it happens. But it doesn't mean that you have to allow it to have full effect on you, if that makes sense. I have friends who are 55. They run faster than I did at 25. You know, they feel better than I did at 25. And how many out there actually said that around the age of, let's say, 40, you're like, this is the best I've felt in my entire life. So, in that grounds, don't we have the opportunity? Don't we have the chance to actually feel better?

I think age is, I mean, time. Time is something that we really don't have any control over. It's just coming, all right? We're always going to get older. We're always aging. It happens, but it doesn't mean that we can't use all the things that we know about the body, that we know about in injuries, actually, to decrease the effect of gravity and time on us. Now, what I typically say to these people is that, look, I understand. I understand that you feel like you're getting older. It's frustrating and so on. And I've had people tell me, look, you don't understand. You're 35. You're not 50 like me.

You don't know what it feels like. And I get that they want the empathy. They want me to understand that it's different for them. It's different for their age than my age. And I feel different than I did at 25, but honestly, I feel better. I don't feel better at 35, but I feel better at 30 than I did at 25 and 20. So, I think that these people that are injured and are using age as a cop-out, I think it's crap, man. And I'll be honest with people on this podcast, you know, like it's not true. Sure, there is an age component, but realistically, we know a couple things about the body. And I'll try to break it down into topics that you might have heard about before.

Now, osteoporosis is one condition that people will hear about. It's basically a loss of bone density from the insides, typically. I think it's roughly about 50% of the bone density deteriorates according to the age group and gender. And that is, I mean, that's something that you can improve on dramatically. Now, what your doc's probably going to tell you is that, well, look, you have to take this and this and that. And you should probably do some resistance training or body weight training. So, what does that really tell us? Now, you can put the proper nutrients into your body to allow the repair to happen.

But at the same time, bone is like, bone's architecture that's just waiting. It's just waiting to have a stimulus to it. So, when you weight train, when you walk, when you run, when you lift weights, these will build your bone density. And what we call is the wolf's law. And the bone will react to the stimulus put upon it chronically. Okay? It takes time. And if you consider now muscles, muscles are kind of the same. Tendents are kind of the same, too. Where when you subject it to a chronic stimulus, if you lift weights for five years. And my mom asked me this actually the other day. She said, hey, why don't, what do I got to do to get big calves?

And I was like, well, why do you want them, number one? But how bad do you want them? She's like, well, I just thought I would try to get big calves. What do I got to do? What exercise will do it? And I said, well, look, that's really, for what you're looking for, you're probably going to have to train for 30 minutes a day. Pretty hard. Probably for about, let's just say conservatively, three days a week. And it's going to take you three years. Do you want to do that? No. But, I mean, it's fine if she didn't want to do that. But at the same time, we have to consider that is the length of time that it takes.

There is no quick route. And the same thing with building up bone. Same thing, building up muscle. Same thing with recovering from injuries, too. The body responds to the stimulus. So, if you have an area that's injured, sure, age is a variable. But just because I have a ball in my clinic, a tennis ball, doesn't mean I have a dog. It just means I like tennis balls, maybe. Or perhaps someone left a tennis ball there. Like, the two are not always correlated. So, don't always consider them as such. So, I always tell them that, look, we just got to get the body to work. We have to stabilize the area.

We have to strengthen around it. We have to do things over the period of our life to offset the possibility that age is a relationship to it. People say this a lot of times with osteoarthritis. They say, well, arthritis, it comes with age, right? But they probably haven't heard that college soccer players, women, or high school ones, it's well documented that after about five years after an ACL injury, after a tear, I mean, they're like 25 at the time, and they have signs of early onset osteoarthritis in that knee. So, what that tells me is that, well, it's not age anymore. So, what is it, right?

So, we have to consider that all these things that you guys think are correlated to your pain, they're not pain generators always. Age does not equate pain, all right? And I know a lot of people who are older who don't have pain. I know a lot of younger people who have pain. So, let's not equate those two things, okay? And again, throughout this entire podcast, I'm going to be very direct and brash, and I'm usually very softer with my words, but I want to make sure that there's no wiggle room in this, and this is truly what I believe in these. So, if you guys are a patient at my clinic, I want you to understand where I'm coming from with this.

It's not to sound like an a-hole. It's to get around all of the misconceptions and questions that people might have regarding their injury. If it's age-related, well, there's no point in you coming, right? We can't change age. We can't change time. So, why even bother? And that becomes like a victim mentality. So, let's focus on things we can control, and that's loading the body and knowing what your pain triggers are. For all the other clinicians out there, if you're listening to this, if this resonates with you, share it with your patients, because I'm sure they have the same questions, whether they're saying them or not.

A lot of people have these unsaid concerns that are barriers to their success. So, I truly believe that we need to address these things early on. Now, number two is when people tell me I have knots. I had someone talk to me about this the other day, and we had a very candid conversation about it, and I just went back and forth on it. And I said, well, why do you think that area has knots? And they said, well, because it feels knotty. And I said, okay, well, so what else could be there that is creating that naughtiness? And she said, well, adhesions or scar tissue or I don't know what else. I don't remember what else she said.

So, then I posed the question. I said, what if there wasn't actually physically anything there? What if it just felt like it was knotty? How do you feel about that? And she's like, well, it feels like there's something knotty. There has to be something there. I'm like, okay, well, let's go down this route a little bit further. So, what if it's fluid? And she didn't really have much to say about that. And I said, well, what if it's just increased tightness of the spot? But there's nothing really wrong with the muscle. It just has a contraction bulge, say. And I'm not saying this is actually what is occurring, but just playing devil's advocate with it is that there's not always things to break up.

There's not always knots that need to be addressed. Sometimes we need to consider via testing what are the things that are creating these sensations for people. And for patients out there, I'll go into this concept a little bit later. But what I typically do is, so we do all the standard orthopedic neurological testing to make sure that you don't have, you know, a major nerve concern, that you don't have a broken bone, a torn ligament, a torn tendon, a muscle tear, things like this. Because a lot of times we'll find those on those tests. And what I always tell people is, if I stabbed you with this pencil right here in your thigh, does it matter what we do today?

Will this feel any better? And they used to say no. I said good. So we're in an understanding that a structure injury, a true structure injury, that is the pain generator, probably won't have any major change today. Now, what I want you to try here is I want you to, and we did this with a hip condition recently. So we put it in the hip range of motion that was painful. And I said I want you to press your hand into the sky really hard like you're trying to punch the ceiling. So what this does is basically gets them to contract their abdominal wall, which then helps out with position, the pelvis, and so on.

So what we found was an immediately, immediately drop of pain. Oh, it went away. And I actually have a video of this if you guys want to see it. I'll try to link it. I'll link it in the show notes for you guys. So it went away. And so I said, okay, relax. And I said, oh, it came back. And I said, go to the ceiling again. Hey, it went away. So what this tells me is then are we, or I pose the question, is are we looking at knots? Are we looking at tears? Is there anything structurally there that needs to be addressed immediately? I personally don't think so. And granted, I believe there is a time and place for tissue work.

I use tissue work on people all the time. I use adjustments on people. I use stretching. I use foam rolling. I use all that stuff. But at the same time, if I see that you're responding to, you're decreasing your pain with the way you move, the what you stabilize, the cues that we use, contraction of the abdominal wall, contact of the foot on the ground, contact of the hand on the ground. And then what is the remedy today? Well, the remedy is going to get you to learn to do that stuff through your movements, through your daily activity throughout your day. Now, could we do tissue work on it? Could we do adjusting?

Could we do all that other, we call it passive care? Could we do it? Yeah. But what makes you feel better already? What is already shown to make you feel better? The stuff that we just did. Okay. So I need people to really understand that, at least patients at my clinic, because we're going to go over this on day one, all right? And I want everyone to realize that I will do the other stuff. But if I take you down that route first and try to beat up these quote-unquote knots, then we're just killing pain receptors at that time. This is why people, when they stub their toe or, like, scrape their shin, they'll go down and rub it.

Like, there is a tactile sensation that will decrease the amount of pain sensation in the area. It happens. We use it. It's a tool in the toolbox. Tool in the toolbox. It happens. It's needed. However, is it what's needed in majority of that case? Chances are not. So is there a possibility of actually having knots? Yes, there is. So they call those things trigger points. I'm not going to go into the validity of trigger points or not because I don't have any valid research that I read into on that. Just not lately, anyways. But I do believe there is truly structural components. There can be muscles that have relative slide issues in cases.

And I was one that later on in my condition when I was in high school with a back condition, that really helped. It really helped to get tissue work done and increase relative slide. So it was great. But at the same time, that wasn't what I needed in the beginning. So going back to the major part in this is that do you have knots? Sometimes yes, sometimes no. But we need you. We need you to be at the understanding that there's a possibility that you don't. So I need you to get it out of your head thinking that that is the reason. Be open to the reason for the knots. All right. If you find that your symptoms or your knots or your sensation of knots decrease within the testing, with only the testing, because we do dynamic testing, then there's a strong possibility that we don't need to beat the knots out of you.

Okay. It's just going to come back after a day or so. So I'd rather not be contributing to the insanity of just keeping doing the same thing and expecting different results all the time. It just doesn't work that way. Now, this leads us into number three. And I don't know if other healthcare providers get this, but I get it a lot. And perhaps it's the profession that I'm in, chiropractic by trade. PTs and massage therapists probably get this too. Trainers don't have the licensing to touch anybody, so I don't think it's a big deal. But you probably get it in different fronts as well. So I have people come in that we go through that whole rigmarole right there, and we figure out what is their, what is, what are they going to respond to best?

Stabilization, mobilization, tissue work, adjusting, things like that. So we're finding a route. We're finding the correct direction for their condition. Now, I had a friend come in actually the other day, and we found that their neck condition really responded well to farmer's caries. It really responded well to wall wedging. And at the end, he looks at me, and he says, so do you want to do any tissue work on me? Are you going to work on me in so many regards? Because I know you guys will get that. It's like we didn't, as healthcare providers or chiropractors or PTs, it's like we didn't do anything if we didn't touch them.

And I don't think that's the case. It's are we solving the concern? Are we solving the problem? And in this person's case, I said, well, I already examined you, number one. We looked at orthos, neuros, and all that kind of stuff to rule out major things. Now, how do you feel? And he said, well, it still hurts a little bit when I tilt. I said, okay, so let's do that. Let's do that farmer's carry again, or at least the simulation that farmer's carry. Can you drop your shoulders out of your ears? How does that feel? Tilt your head to the side. Oh, well, it feels better. And then after that, he relaxed, and he tilted his head to the side, and he's like, oh, it came back.

I'm like, well, so it's coming back, but you're showing that you can moderate your pain, and you can decrease how it feels. So he's like, are you going to work on me? I'm like, for what? This is what it is. Like, today is learning how to move. Today is learning how to modify your pain throughout the day, how to desensitize your pain throughout the day. So, no. Could I have? Yes, I could have. And some of you providers out there might, which is fine, but I personally believe, and if there are patients that are coming to my office here, if you're listening, is that I want you to understand that there is no quick fixes in this.

My goal is to get you to understand your body, to understand your movements, to understand your conditions. I want you to understand how to be empowered and modify them yourself. That takes time. And I have been having an hour and a half initial exams with people, and it is still not enough time because we've got to go through all the testing, the dynamic testing, and then finding out how to get into something, just like I mentioned with this guy or my friend, was that we need to figure out a barrage of exercises or rehab or movement corrections that will help that person. In an hour and a half, this isn't enough.

And plus, it's a ton of information. So, the next time they come back, we do another hour and a half. And I typically say, well, what do you remember? And they're like, well, we held these weights, and we did that. And I say, well, what have you done throughout the week? How's it been feeling? They're like, well, it's been hurting. I said, when it hurt, did you get your shoulders out of your ears? And they say, no. And I say, okay, what did we learn last time? So, this is an educational process. I honestly call it a college course. It is a crash course. You need to understand. We can do tissue work.

We can work on you. However, I believe we're not doing any major favors by not getting you to the inception point. You need to understand, and you need to have truly inception to realize, holy crap, I've been doing this wrong all these years. I'm going to apply this to the rest of my body, the rest of my life. That is the best thing we can do. It's almost like that analogy of we can teach people to fish or we can give them fish. I'd rather teach them. I don't believe in enabling people, okay, and that might make me sound harsh, but realistically, I am, I don't want to say I'm self-taught, but I'm a hard worker, all right, and I believe in educating myself.

And I expect everyone that has, not that they have more time than me, not that they have, they probably have less time than me. I probably have more time, but I can tell you what, when I'm in the office and I'm working with people, I'm in here for sometimes, well, it's a long time. It's a long day. I'm going to put that. And we're one-on-one attention, and I don't have time to, like, watch videos and listen to podcasts and stuff like that. But when I drive home, I drive less than five minutes. Most people, if you're in the car, if you're listening to the radio or the news, turn that off, all right?

Listen to a podcast. Listen to something like this. Listen to the ones that, I mean, I send these out to nearly all my patients. Understand the concepts we're going through, all right? Do you have back pain? Well, we did a podcast by Stuart McGill, all right? Do you have questions upon stabilization or why things are always tight on you? Well, we did one with Dr. Richard Ulm, number 62. I want you to understand these things. I want everyone to understand these things. And docs out there, clinicians, if you don't have educational materials for your patients, I strongly suggest you do. It puts the ball in their court.

And I'm not deflecting my responsibility over their case, but our job is an educator, and our job is not allowing these people to go down these wrong thought processes and thinking that there's quick fixes and not understanding their body. I was talking to a friend the other day about breakfast, or at breakfast, and I was looking at the leaves. And we were talking about someone that we knew about how they, at the age of 25, they finally asked where rain came from. And I'm not making fun of this person, but it's just observationally, you look up in the sky and you look at the clouds, and at one point you ask, what are the clouds for?

You know, just observing, observing and questioning. And I remember, I mean, I hear, this is a question that people get from their kids, right, is, why is the sky blue? It's observational. You have to be able to observe your surroundings, observe your body, observe your feelings. And this is what is going to get you further in life to a better competency of how you move your body and how we decrease these injuries. That brings us to number four now, and this one is, what is it here? I should look down my notes, huh? My X, Y, and Z is out, okay? I don't know if therapists get this much, but we get a bunch as chiropractors, or my hips are out of alignment, or my C1 is out, or my hip is out, or my acid joint is out.

Typically, they talk about joints. They never say, like, my big, my bicep is out, or things like that. But, so I always question people, like, what do you mean by out? And they say, well, it feels like it's not in the right place. And I was talking to someone earlier today about this, and we were questioning, where did people get this thing from? Where did they get this term from? I have no idea, because I've never told it to anybody. And it's very, very generalized. I'm not going to say that there's not conditions that have joints that actually move slightly out of place, but out. And that sounds like you just lost a tire, right?

And also, too, what holds those joints in place? All right? What's the correct way to get it back into place if it is out of place? By the way, I don't really think a lot of them are out of place. So, when people come in, I typically question them when we go down this series, you know, like, well, what makes you feel like it's out? Well, because it hurts. So, why does that equate to out? Well, it just feels like it needs to be pushed back in. Okay. So, what can we do to decrease that sensation? If something truly is out, then you have a sloppy joint. It's really sloppy. And what we need is stabilization around it.

Okay? So, if that is the case, then we go down this entire route. And I show these people these, there's a couple things I stack up in my office. And I say, imagine we have a stack of jingle blocks here. If I push down on the jingle blocks, how easy is it for you to get the block out? It's hard. Now, if I lighten it up and I take my pressure off, now, all of a sudden, you can push jingle blocks out. And that is our, quote, unquote, out of alignment, I guess. And I never tell people that. Okay? I'm going to be very clear. I wish this term would be eradicated. I don't think we should be telling patients this at all.

Because to them, I think they're very visual. And this is why I hate the term of core. Because they think six-pack. Or they think back and belly. And I think it's wrong. I mean, they think that region. They think the region below the cage. And it's actually the entire area from the neck to the pelvis. And some of the muscles which cross from the bone sockets. Okay? So, when it comes to out of place, I think we should clean that up. I think you guys should take some time with your patients and clearly explain that. I tell them that, look, a sensation is not always out of place. And we looked at an x-ray of you.

It's going to be anatomically in place. There might be things that are not optimal in regards to positioning or we call alignment. But it doesn't mean it's like you lost a tire. So, let's clean that up for people. I believe that if we stabilize an area where something is out of place, it's going to correct it. Granted, there might be other things to address around it. But sometimes, the squeaky wheel shouldn't always get the oil. Okay? And I've had patients actually come in before where they say, like, look, it feels like my back is out of place. And lo and behold, we find that there's a disc injury there.

And I have a whole different subset of things that I do for disc injuries in the low back. I had a gentleman come in one time where I guess he truly would be out of place, actually. This is the one instance where I would say, ah, you're out of place. It's out. So, he tells me about this spondylolisthesis, which it was a walk-in guy, actually. And he says, hey, I want to come in for a quick adjustment. I said, why? And he's like, or why? What are we dealing with? He's like, well, I have a spondylolisthesis. I said, okay. So, first off, we don't just do quick adjustments. We have to do an exam. Plus, I'm going to see what tool is correct for your condition.

Perhaps it responds to something else other than adjustment. Are you open to that? Well, no, adjustments work for me. I said, okay. Well, so, let's go down this question and rattle a little bit further. So, what do you know about your spondy? Well, it's just, there's a spondy that's been there for 10 years. I said, well, is it stable? And he said, I don't know. I said, do you have an x-ray? And he said, well, they haven't done one in like 10 years. And I said, have you done a flexion extension view? Have you seen if it shifts or not? And he says, no. And then he continues down the route and he says, I would still like an adjustment.

I said, we're not going to do that. You know, I'm not going to do that because I don't think it's going to be helpful for you. I think we better get that thing to push back into place if we could, you know. Not to say it could go back into place. I don't want everyone to misconstrue what I just said there. But perhaps it's a loose spot and we need to stabilize it, right? Sometimes things move too much. And that concept of being out of place, I think we need to, again, we need to clean that up for our patients. I have only led person knowingly one time down a false terminology route. And I guess this comes back to our communication part with it.

I'm sure you've heard me over the year talk about how we need to improve our communication with people. How can they truly know what's going on if we can't break them down into simple terms? Or at least, and I've hit this a couple times too, is that, and this is going down the route of this story, is that we need to be met in the middle too. Because I don't know a way to break down the term diaphragm. I can explain it, but it's going to be a whole book. So this person came in before and she was 25 or so, roughly mid-20s, let's just say. And we kind of went through a consult a little bit and I had a good idea.

I mean, we didn't do an exam because she just came in and wanted to talk to me. I said, that's fine. Let's do that. And I just looked at it and I thought, okay, well, we're going to have to look at the ligaments and joints and so on. And she says, and this is after about 10 minutes or so, she says, what's a joint? And I realized at that point in time that if I was going to help this person, I needed to get them to come back using something else other than talking about their injury. If I were to look back, I probably would have been like, I should have used empathy because apparently empathy is extremely important for working with people.

I know that now. So what I defaulted to is I said, your ankle might be broken. And here's the long term of this. She didn't come back, which is fine. I could have done a better job of explaining that. But here's the long term of it. What if she went to someone else and said, I went to this guy and he said, my ankle's broken. Or she went back home and said, my ankle's broken to her husband. I'm being the problem. I'm the problem here, right? I'm that guy who's saying that something's out of place. When I could have done a better job of explaining and then it would fully understand how to address this condition.

Now, I don't think everyone's going to, not everyone's going to agree with me on this in place, out of place or so on. I'm just speaking from my own experience and how I practice. So I don't want you to misconstrue that this is only about that. This is about a lot. This is about more than just that concept. We need to be met middle ground by asking patients to understand the basics of at least terminology. They understand what a muscle, joint, ligament, and so on are, or at least trust. And this is that second route with that is that if you're going to create a change with someone, you need them to number one, understand the reasons for the changes.

Or second is they just have to blindly follow you. And I'm fine with either sometimes, but if they put up resistance with the blind follow, then I say you better understand. And they're like, well, I don't have time, which brings us into another one later, which is, which is fine. You don't have time, but you came to me. You're paying me money. Trust me. All right. You see, we've got a ton of good reviews. Just trust me, please. I'm not going to screw you. I'm an Eagle Scout. Okay. So that brings us then to the next one. We're going to go into number five. Okay. This one's going to be a really good one.

Number five is, but my back pain is from X, Y, and Z. Sitting in posture of nothing to do with it. I've had this conversation a couple of times over this last month. And I guess the X, Y, and Z is typically it's incident trauma. People will say, you know, I slipped and fell. People will say, well, I deadlifted. That's what created it. People say it was the bed. But so they don't always equate these changes of daily activity to correcting their issue. And so, I mean, I've had people say like, I don't, I don't want to learn this stuff. I don't think learning how to sit has anything to do with how I'm feeling right now.

And I say, well, yes, it does. It has a lot to do with it. And it doesn't have to have to, it's not important for every single person. But for those people that I recommend it to, I recommend it for a reason. So I typically go down the route of, I write this down for people. If they come in with back pain, hip pain, shoulder pain, you name it. I'll ask them. I'll write down these things. I'll say sleep, walk, sit, and exercise. Or I'll let them pick the fourth category. And what these are is, these are things, these are, these are things or activities that people typically spend a lot of their day doing.

Breaking that into a 24-hour period, sleeping in seven to eight hours, sitting, I mean, I do much less than this, but a lot of people, 10. The walking, let's just say it's, it's two hours. Exercise, maybe two hours. So we got, what, 20 hours there accounted for? Now, can we correct the other things like, so deadlifting is what, a total of maybe five minutes of your day? Well, yeah, we can. But how about right now we just cut that part out? And we modify it significantly or deload it, okay? If it was an accident or if it was a slip and fall or some type of thing that was out of your control, then that is something that is a single incident.

It's not going to happen again. Or at least the odds of it are very low. How many times can you flip a quarter and hit heads again? You know, so that is, that, that's in the past. That's in the past. Let's not think about it. Let's think about right now what you have going on. Now, let's just use the analogy of the scab. It's pretty, it's a pretty easy thing to think about. So the scab, let's just say I was stabbed. I was walking out in the alleyway and someone just came up and stabbed me in the arm. All right. The stab was the thing. But what are the things throughout my day? Let's just say I was stabbed in the, let's just say bicep.

That's a good one. What are the things throughout the day which will not allow the scar to heal? Well, number one, probably doing pull-ups won't. Second is probably if I were to be picking up my children, that probably wouldn't either. Perhaps I like to play tennis. That wouldn't either. And all these things have an aspect of not letting that area heal up. Now, when it comes to back conditions and hip ones, especially being in a chair, being seated, puts a ton of load on the back. But also, too, people typically sit with their hips in the wrong position, with their feet being in the wrong position.

I mean, Dr. Cody Dimak did a video on exactly this. And I've had patients come in before where they say, well, my hips hurt when I sit. And I said, cool, show me how you sit. Great. Okay. Slide off the chair for me. Can you widen your stance? Let's raise the chair. How does that feel? Well, it's better. Great. So, does that have anything to do with how their hip condition started? Probably, maybe not. Arguments would say maybe yes. But in the patient's eyes, no. Which is fine. I don't expect everyone to understand fully the mechanics of the body if they're not in the field. If you're in the field, it's a different story.

I want you to fully understand it. But when it comes to letting the scar heal, you have to understand that it's a little bit of a different process. And you have to look beyond the single incident. Okay. Let the scar heal. That is extremely important. And that does not just go for skin lacerations, disc injuries, or hip impingement, or labral tears. It goes for shoulder ones. It goes for neck ones. So, we can look at sleeping, like I said. We can look at sitting. We can look at walking. We can look at transitions. Transitions, what I mean by that is going from sitting to standing. Transitions are also getting out of cars.

Transitions are also picking something up off the ground, which is how a lot of people hurt themselves. Because they don't know how to transition. I've been spending a lot of time talking about posting work, which I will do a podcast on. Posting is basically respecting your ground contacts. And I realized last night when I rolled in bed, I didn't just roll like a log. I actually bent my knee. So, my legs were straight. I bent my knee. I put my foot onto the bed and pushed myself into the opposite direction, into a log roll. Now, I had no idea. I actually kind of woke up because I was turning. And I thought, holy crap.

That is half of a kettlebell arm bar. That is posting. Like, that's great. And the great thing is that I learned how to do it, apparently, when I'm sleeping. Okay? We're hardwiring software. Or we're putting software together. The hardware is your muscles, joints, tendons, ligaments, all that stuff. Now, we can't expect for the body to want to repair if our software is not working properly. So, let's get everything dialed in. And especially, if we're looking for bang for buck, let's look at the things you spend most of the time doing to let that tissue repair. Walking, sleeping, sitting, standing.

Those are all big things. Okay? And granted, I'm going to say it again. Was it your major reason for pain? Probably not. It could be. But probably not. And I want you to understand that I understand that. And your healthcare provider understands that, too. So, we're not going over this stuff to not believe the story you're telling. It's just that it is the means to an end. And I promise you that, at least in my office, when we go through this stuff, and when people finally have that inception of realizing, holy crap, sitting to a chair is squatting. It's a goblet squat. Say, yeah. I say, remember that thing where we have our feet in the mud and we try to spiral our feet out of the mud, but they're stuck in it?

Yeah. Well, when you have a lot of weight on your back, you might do that more aggressively. But, when you're sitting into a chair, you still got to have those same mechanics. It's all about posting. All right? You still got to zip the posture up. You still got to drop the back pockets towards the chair. And you still got to have tension when you're sitting there. You can't be like a gummy bear. Okay? Or else your tissues are going to pay the price. All right. Going into number six, we have scar tissue. So, scar tissue is a big topic I have a lot of people come in and speak to me about. They say, well, I have scar tissue in my hamstring.

And I say, why? And they're like, well, because I run. And I said, well, what does that have to do with it? And they said, well, it just feels tight. And I said, so is it tight or does it feel tight? And again, I don't do this to, you know, antagonize them. But scar tissue is, I mean, you'd see it. You'd have a significant, you'd have some type of past tear. It wouldn't just feel tight. It would be larger, in my opinion. And I know some of the providers might disagree with me on this. And there's going to be a sliding scale on it, honestly. So, I tend to think that, I mean, when people come in and they haven't done anything to merit scar tissue to form, there hasn't been enough damage.

Then I say, well, we're not going to be looking at scar tissue, but we need to address the possibility that there might be increased tone from the nervous system. Perhaps there is adhesions, which is slightly different in definition, which is relative slide between structures, creating local irritation and pain. So, there's a lot of possibilities. Now, I had an ankle injury recently where I dropped a glass carboy. That is one of those glass bottles, five-gallon bottles that we were brewing beer. And I dropped it, and I sliced my ankle. And I can visibly see right now, there is scar tissue. It's still red.

And this is about four months ago. And there's definitely going to be scar tissue in there, because there wasn't enough significant damage. I had a past hamstring tear as well, which visibly bruised. These are reasons for scar tissue to form that, yes, I think, I guess this is a semantics thing now. So, just realize that when we're working on tissues, we're not always, always working on scar tissue. Sometimes we're working on other things. So, when I say this again, I want you to just be open to the idea that it's something else. It kind of goes down the route of, hey, I have plantar fasciitis.

Well, just because you have foot pain doesn't mean you have plantar fasciitis. Just because you have muscle pain doesn't mean you have scar tissue. Sometimes you have other reasons for it. And sometimes it can be referred. And if you guys have not listened to a podcast I did in the past, I think it's 46, it's classifications of muscle injuries. It was on the 2012 consensus statement. It's amazing. But it breaks down the reasons why we will find negative MRIs and still have pain. It could be referred. And it could be, I mean, even DOMS. DOMS is a delayed onset muscle soreness type of muscle injury.

So, just realize that it could always be referred. So, scar tissue is not always the culprit. Sometimes it could be, and I have honestly found a lot of cases where it is the culprit, but it's not always. In this discussion we have with people, they have a preconceived notion that they need to get the scar tissue to go away. In fact, scar tissue, just like a bone callus, is a normal occurring substance. It needs to develop to some degree. So, don't blame scar tissue all the time. I mean, it needs to be there to some degree. If it's out of control, yeah, sure, you know, scrape it away, beat it away, that's fine.

But you have to let it develop. It's not evil. It has to happen, just like the bone callus when you have a bone injury. Now, let's get on to number seven. What did I write for this one? I can barely read my writing. Can we do something for my arms? Oh, okay. Sorry, I wrote these this morning. This is probably going to resonate more with trainers, actually, but we have a fair amount of people doing whole body conditioning in here because I believe that load helps heal a muscle and tendon and it helps grow bone as well. So, I have them do complex or compound movements. I forget the common term, whatever.

They're large movements, push, pulls, carries, hip hinges, squats, and so on. And then I have this one guy. He likes to do this and we joke around and I give him, excuse me, just burped. So, I give him a little bit of programming to make him happy to what he wants. And when I joke about it, I'm like, hey, I made this just for you today. He's like, yeah, okay, okay. But I did some things in there for me as well or for me as in regards to I thought it was better for him. So, he'll always say like, hey, I want to do things for my arms. I said, well, we just pushed a sled. Was that not for your arms?

He's like, well, I want to have big shoulders. I'm like, well, we did pull-ups. Wasn't that for your shoulders? And didn't you get your biceps in there too? So, what I'm getting at with this is that probably trainers get a lot more like people want to focus on a certain area. But when really though, I mean, you're doing an entire large movement. You're being so effective with your body and you're burning so many calories if that's your goal. You're training new, you're improving software patterns if your goal is to improve movement. You're adding load to a daily activity type of movement, which would be my goal for people as well.

And then someone says, well, what else can we do for the arms? Well, and this would go down to another goal. So, what's your goal with the arms? Well, I want to get bigger. Yes, we can. So, that's why I program it for him. We do skull crushers, bicep curls, things of that nature that he's like, yeah, that felt good. And one time we ran the rack on biceps. So, that made him happy. But that's the importance of knowing the goals of people. But for most people, I try to see through the reason why they're asking that. And I don't want to assume. So, I say, why do you want to do arm work? Well, because I feel like my shoulders are weak.

Well, what do you feel when your shoulders are weak? Well, I feel like I can't hold up grocery bags. I'm like, well, let's do some farmer's carries then. It's a little bit more applicable to what you want to accomplish rather than just having aesthetically larger arms. Because not everyone knows what they're asking with that. So, make sure you want to get down to the deep part of it. Let's go to number eight. I wrote down not understanding why. And this is kind of a come from of people that are usually new at my clinic and probably yours as well. You throw a lot of information at them. And it clinically, to me, sounds amazing.

Like, I try to drop in like really simple things in the first time. Sometimes we teach how to sit. Sometimes we teach how to sleep. What's painful with you? Well, I can't walk. Great. Let's work on walking. But then I always like them to understand why I'm having them, say, carry an object while walking or why we're doing arm swing while walking. So, I try to bring their attention to the things that we're addressing. And they don't always understand. So, they come back the next time and say, well, and actually, I had a lady that asked this one time. She was a knee person. Her knee pain. Or she had knee pain.

So, we started with the blatant thing that she had on her was that just her overall foot contact was bad. So, we started with foot, ankle, and contact stuff and so on. And although I was talking about foot contact, ankle alignment, and so on, the knee then reflects it. So, we know this. I could have looked above it as well. I could have looked into the hip and torso. But it's just, I just try to attack the thing that's glaring first. The elephant in the room, as I say. So, the next time she came back in, she's like, well, when are we going to do something for my knees? And I'm like, well, we did.

Last time she said, well, no, we just work with my ankle. Well, I said, well, they're together. They work together. So, the misunderstanding that we had, I think, needs to, we need to address that first. We should have spoke about that first. Now, I could have also probably created some more buy-in with her. Perhaps I could have had done something with the foot ankle, which then would have changed one of her outcome measures, which is important as well. If you're not doing this with your patients, you might want to experiment with it. So, I tend to ask people, what is, you know, what bothers you right now?

What can you make your knee or your hip or whatever we're talking about become symptomatic right now? Well, I can sit and do a chair. Okay, so do that for me. Good. Let me change a couple things here. Can you spread your knees for me? Can you spread, can you draw your feet into the ground? Can you brace? Can you sit back into the chair rather than, rather than bending at your knees first? So, do any of these help? Well, yeah, the X, Y, and Z helped. Well, good. So, now I've framed it. Framing things, framing rehab isn't really important. So, rather than just giving random stuff, framing the reason why we're doing it and creating that understanding with the person is critical in the beginning or else they're going to think that you're just doing your own thing.

I remember I went to a massage therapist one time and I had a hamstring injury and I said, hey, I got a hamstring injury. Can we do that? So, she starts with my neck, my back, my low back, my glutes, and then finally the last five minutes she went to the hamstring. And my thought was, I wanted my hamstring work on, right? But perhaps she knew better than me, which is fine. I don't assume to know everything, but she should have communicated that, I think, because I left feeling dissatisfied with the end all result because I came in wanting that. And that goes back to all this stuff that we spoke about earlier, like I have knots.

Is this person, is this doctor addressing my knots? My back pain is from X, Y, and Z. It's not posture related, I think. Why is this person talking about posture? So, there's a lot of things that we need to frame and let the person understand before we can really get them to take hold of their own injury. Lastly, this is number nine, no time to understand. They often say, I don't have time for this. And actually, I had a friend on the podcast before. I think he's around number, I want to say 64, maybe 60 or 59. Anyways, we were talking about, I gave him a little bit of a program. I emailed it to him.

He came in as well. So, we talk a lot. So, it's, it was, I got a lot of feedback from him of what he was doing with that program. So, I didn't have time to show him an exercise for one of them. So, I sent him an email on it. And I made a very detailed video on this one, as well as everything that I say in person when you are here with me. Granted, I can't ebb and flow with him because I don't see what his compensation patterns are. But generally, the cues, it's at least remember the cues and get in the right position. So, I sent him this video. And explanation takes sometimes a long time because I'm going to frame it again.

So, this video was, I think it was five minutes for this one video. Or for this one exercise. And so, I emailed him the next day and said, well, how'd the video go? And he's like, I couldn't watch it. And I said, why? And he's like, I don't have time. I'm like, what do you mean you have time? I don't have time. And he's like, it was too long. And I was like, it's like five minutes. And he's like, I just, I just couldn't do it. I couldn't watch it. So, and I know what he does. I know what he does. He watches the Lakers a lot. He has a, he works from home. He has a little putting thing in his office.

I know he has time. But creating the time and getting an understanding of when they can fit that time in is something we can do for them. We can let them, we can bring to the attention of where they can fit this into their schedule. Perhaps do it coupled with another task. If you're going to brush your teeth, watch this video first and do them. By the way, after you do the video a couple times and watch it, just like your favorite movie, you're going to remember all the parts. It just takes repetition. So, I tend to listen to podcasts when I, when I walk, when I exercise. And sometimes in the morning, I just like to sit there and drink coffee and do it.

So, these are all opportunities for people to do that. I know a lot of people drive further than I do. And I don't even have a dog and I walk. So, if you walk your dog, perhaps you want to listen to it then. So, these are all opportunities. And these are all things that people can be doing to better manage their time. And I honestly don't think a lot of people manage their time well. I've heard before, everyone has the same amount of time in the day. You can't create time. It just, it's just there. So, you might as well manage your time better. Some, a lot of people don't manage their time well.

And I think this speaks to, you know, people that have a worse job than they want. They don't have good physical fitness. It's, it's never going to get better. You might as well take the time today. You can't do it tomorrow. You got to, you got to do it today. Write it down. Make someone make you accountable and listen to it. So, I hope this was helpful to everybody in that. Again, I didn't want this to sound like I was bashing on things or people. Because I know this is, these are things that, when I get asked every day, like, I, I can see that some of them have a deep-seated understanding. It's almost like grandma told them.

And we're undoing what grandma said. So, I don't, I recognize that. But just know this is coming from a good place. It's a place of serving and improving the public's understanding. Awesome. So, if you guys enjoyed that, I want you to review me, if you can, after you go and get the show notes. By the way, you just go down to the bottom of the podcast and there'll be an area to, if you're in iTunes. I don't know about Google Play or Android, but go down there, put whatever stars you want to put. But I do want some feedback on this thing. This is session number 90. So, you are going to have some transcripts available to you.

So, go on to p2sportscare.com slash 90, which will have transcripts and any links that I spoke about or videos in this podcast. So, if you're walking your dog, if you are running, whatever, you don't have to write all the notes down. Just go on there and get them all later. Share this with friends. Share them with patience. Talk to you guys soon. Be good to each other. See you later.