What Rehab Technique Is Best for Your Injury?

This is session number 29 of the Performance Place Sports Care Podcast. It's just how old I am. Welcome to the Performance Place Sports Care Podcast, where you can learn about sports injury theory, rehab, diagnosis, and how to understand the doctor lingo you didn't understand at your appointment. And now, your host, Dr. Sebastian Gonzales. Hey, everybody, and welcome to the Performance Place Sports Care Podcast. I'm your host, Dr. Sebastian Gonzales. And if you can't tell already, hopefully the audio is better. And the reason why this isn't, because this is actually the very first podcast that I've done on a legit setup.

And I actually have a spot in the back of my office now, which is my studio. I have a mixing board and a legit mic and all this kind of stuff. So I'm really excited to go forward and really dive fully into podcasting, because it seems like I've gotten a really, really good response from some random people, actually contacted me and telling me how much they like the podcast. So on that note, we're going to go forward with kind of redoing a topic that I addressed before. And actually, I was listening back at some of the podcasts I did before. I used to do them in my car. I used to do them on a different microphone that I can travel around with.

And one of the ones which I did in my car, I thought was a really good topic, but I thought the audio was absolutely terrible. So I know that there's been some podcasts that I've actually ditched. One was on coffee, actually, that I really wanted to hear, and I was on a plane. And when I was on a plane, I heard the hum of the engine, and the audio was so bad on this podcast that I just never came back to it again. So I want to make sure that's not one of the reasons why you don't listen to this one, because I think you have a lot of stuff you can gather from it. So we're going to dive right in, and this one I called the death of the technique.

And if you're wondering about techniques, and if you're a patient or an athlete, you've been exposed to probably many different theories of techniques and styles of treatment, which will work best for your injury. And it's interesting that all these techniques, at least a lot of them, they kind of discount the idea of the other ones. But good providers will blend all these parts together and give a really, really good style of care for you. But it's funny how things have kind of gone over time. At least for me, I can tell you my personal experience as a healthcare provider. I started with, through chiropractic school, we actually talked a lot about joint manipulation or movement of a joint.

And there's a couple different techniques you can do this, which is adjusting it. Physical therapists in the past have, they would call it grades of mobilization, from what I understand. That might have changed by now. But also, too, you have to make sure that the joint doesn't have any contractures around it. So that's the second part that I actually went into. And my kind of story was that I got really, really deep into active release, which is ART. And I do still love ART a lot, but I realized that when I got into ART, I kind of just ditched the whole idea of joint manipulation, which I don't think was a great idea.

Although I did get good results using just active release. And a lot of the patients that I still see now, they love to come in for active release, and I still provide it for them. But the idea of active release, it was mainly circling around muscle contractures or scar tissue development, mainly like a muscle-focused type of technique, which will then release the joints. And the joints can move better, and you move better, and all that kind of jazz. So there's other types of techniques which will theoretically do this. ART is one of them. Trastin, A-STEM, massage, deep tissue work. I'm sure I'm missing a lot of them out, or I'm leaving a lot of them out.

But for the most part, the idea of this podcast today is not to go into the validity or the amount of time that I spend with each technique, but mainly kind of like my mental workflow through all these styles or quote-unquote techniques again. Now, before I continue too far with this podcast, I want to make sure that everyone realizes, and I know there's credentialing bodies everywhere who could take offense to things like this. I'm not bashing any type of technique. I'm just saying that there's more out there than just one. And I'm sure every healthcare provider knows it, every trainer, every medical staff knows it.

There's multiple types of fixes, or there's a fix that will work better for one condition than another. So, just realize that off the bat, I'm not trying to offend anybody. All these techniques that I'm listing have been very dear to my heart for treating some of these conditions in the past. I might not use them as frequently anymore, but I want you to know that I still use a lot of these techniques. I don't use them all. I know I'm going to mention some that you need certifications for that I don't have a certification actually for. So, I'm not saying I do any of these. If you guys want to know what I actually do, you can go onto my website to see what my credentials are.

So, the next thing I kind of went into was strength and conditioning or getting the joints to have better strength and endurance surrounding them, or what we call local stabilization. So, that kind of led me down the path of adding more weight lifting in, suggesting more machines, working on increasing muscle growth to increase the amount of stabilization around a joint. Now, I know that actually there's multiple different reasons for stabilization around a joint, but again, this is kind of my workflow of things. And I thought that every single time that I learned something new that I was actually kind of at the end of my journey.

I thought, hey, like I'm providing better care than I ever used to. I'm using different parts of now joint manipulation, scar tissue, addressing, as well as giving some rehab. And now we've jumped into the era of movement patterns, we say. And I don't know if you've heard of FMS is one that's out there, which is the functional movement screen. There is the SFMA, which is another subcategory of that same thing. DNS, or dynamic neuromuscular stabilization, is a whole other thing as well. And then just really people are starting to categorize themselves as movement specialists. And there is a lot of research to show that, or actually, I take that back, there needs to be more.

But there are some very convincing ones that show that movements or the way you move really dictates your injuries in the first place. So that might be the root cause of everything that's happening anyways. But, again, thinking back to the way I was thinking with all these techniques, it was, I thought I was addressing the issue with, you know, the joint issues, and then the muscle issues, and then the strength and endurance, and now the movement. Like, so, at every point, I kind of thought that I was going to leave part of the other techniques behind. And I know that going through all these certification seminars, they don't really talk too much about the other techniques, because they're almost, quote-unquote, competitors.

But that doesn't mean that we should do everything for this injury, for all injuries, with that one technique. So I call it the idea of tools and a tool belt. And really, what it comes down to is, can we need to be able to assess the patient and the injury to tell what that actually needs? Now, the way I kind of assess is, I take, I look at flexibility overall. Number one, do they move into that flexibility within normal parameters? Like, are they normal for that age and that gender and so on? And if so, yeah, if not, then we break it down and we look at maybe the hip doesn't move well. Well, why doesn't the hip move well?

Perhaps it's a joint issue. Maybe it's a soft tissue one. Maybe it's a cartilage, muscle, ligament. Who knows what it is? And it could even be neurological guarding, which happens after procedures or, like, even knee replacements sometimes. So sometimes you knock these people out and you put them under anesthesia, and all of a sudden their joint has normal range of motion again, which is very, very interesting since if we're doing some soft tissue techniques in there or joint mobilization, really are we, and we almost have to train the brain to stop contracting these things up. You know, it's not like a muscular issue anymore.

Now, I also look at trunk stabilization. Can they control their core and hold a position? Are they moving well through closed chain motions such as squatting, deadlifting, sitting, standing, walking, running? And then also there's other things like outliers, too, where someone walks into your office and they could have MS. They could have, gosh, there was a guy that walked in that I'm pretty sure he had core compression, and he had issues down into the hands of numbness of both of them, and he presented very much like he could have had some type of issue higher. And I would have done him a very big disservice if I only pulled that one tool out of that toolbox and did only that one technique that they were asking for, when in reality, they might need something else, which even I can't provide.

So, this is still going down that process. Basically, even in healthcare or rehab, we kind of had these eras where we thought that the main focus was one thing and not another. From what I understand, there was the muscular era in the 60s or 30s to 60s where we're focusing mainly on contractures. And by the way, you guys can correct me if I'm wrong. This is not like I'm going deep into research with this part, but this is just what I hear from some colleagues. And then they would go into neurological and then into joint, and now we're into the movement-based ones now. But in all those eras, we thought that one was right.

And even still now, like you'll see me on some of my YouTube videos where I say, hey, this is how we rehab the knee for local stabilization and so on. And I kind of laugh. Like, it's really this is correct right now, but it might not be in 10 years. And that video will stay there for probably 10 years. And hopefully the quality is going to stand up, but in some of the rehab will still apply. But there'll be a couple parts where I'll probably absolutely get a bunch of hate comments at the bottom saying, this is wrong, you need to read current research and blah, blah, blah. But realistically, I know I have a friend who he's all about the motions, which I am too.

I love the motions. But when we're talking about shoulders, shoulders, we've been, I think it was Job back in the 90s, Dr. Job, who coined the P's of the shoulder, which then we would do, you know, we'd rehab part of the shoulder, part of the rotator cuff, the internal rotation, the external rotation, the scapular movements, and so on. And now some people are saying, well, there's much more than that. Well, yeah, there is. But we did a pretty darn good job of rehabbing some shoulders back then, too. So part of it must have been right. You know, we can't discount the entire thing. I think we need to take bits and pieces of everything.

So the way I think this would help you guys, anyways, is I want you to understand that every person, every doctor, every rehab specialist that you go to is kind of in a different phase, kind of like I have been over time. Like, if you would have approached me probably back in, gosh, when did I start? Let's say 2010, you know, I might have thought one way, which I think very differently now. I mean, I still remember, I still remember what I, I still had good success back then, but there's probably people who slipped through the cracks because I didn't assess them well. So I think you need to really ask these providers why.

You need to ask them why they're suggesting what they're suggesting and why go even further down the rabbit hole. You know, ask them, gosh, I don't know. I mean, but just definitely ask them why. You have to ask them what rational reason, what logical reason are they recommending what they're recommending. And if it doesn't make logical sense to you, it might not be right. They might be, they might have missed part of it in the assessment. You can ask them for research. You can do your own research. And I definitely suggest everybody do their own research. And by the way, if you have a condition, let's say a shoulder or a knee or a hip, I've actually tried to do a lot of footwork for you guys.

I have probably spent a month easily of my life on each one of these webpages on my new site, the brand new site, p2sportscare.com. And there's an easy way to navigate it. You just go through and you see right currently there's a baseball player, there's a golfer, and there's a runner. And there's highlighted dots over the spots where the injury might be. And I've gone through like the top five to six things, sometimes even more, of what happens in that joint area with that specific type of athlete. Now, you might not be a runner, golfer, or a baseball player, but a runner would probably be very similar to a jogger or maybe a weekend warrior.

A baseball player would be really close actually to a golfer because it's a rotational athlete. So there's pick one that you kind of associate most with. A lot of the lower extremity conditions or the ones that you'll get as weekend warriors will be probably on the runner, honestly. But anyways, I've spent so much time putting the footwork in here and doing most of the research for you that hopefully that is the only spot that you'll have to go to. And I've referenced so many research articles in these things where you won't have to go any deeper and go into technical language either. I'm trying to break this stuff down.

And that's the whole point of this podcast is to make it really easy for you guys to digest what you're supposed to be knowing here. Now, also too, I think you should ask for a second opinion. Now, your doctor might not like that. He might take it personal. But I don't think there's anything wrong with it. And I totally suggest patients that come to see me get a second opinion somewhere else. And if they don't like what I'm saying, I don't want to continue with them. Because I've actually had, I remember there was this one lady where she had a knee condition. Actually, she had two knee conditions.

And we explained the entire first time, or I explained the entire first time why I thought her condition was related to a hip issue she had, as well as some postural stabilization issues. She had a weak trunk and so on. Anyways, there's tons of research on this kind of stuff. But I explained it all to her. And then we went in and we started the basics. And for that case, it was learning how to create intra-abdominal pressure, to be able to stack the trunk, to be able to breathe well, and then move on to a standing type of movement. And we actually started with something like a bird dog, a dead bug, some of the basic floor stuff that we do for even lumbar spine and pelvic and hip conditions.

But the knee getting a little bit further away than, you know, the other conditions, it's a little bit harder to swallow sometimes for people. So anyway, she comes in the second time. And we're going over the homework of what I've asked her to learn. And I want to move beyond the homework very quickly. But obviously, just like calculus, you can't learn calculus without knowing algebra and so on. I think geometry is actually the only exception through the math thing from what I understand. But either way, you need to make sure to learn the basics first. And I wanted to make sure that she knew that.

So I could tell she was very not into it, in so many words. And finally, I stopped her. We're about 10 minutes in. I said, is everything making sense here? And she's like, yeah, I get this stuff. But what does it have to do with my knees? So she's still continuing with care. But it took a little convincing. And I want to make sure that everybody who's going to go on a rehab program or undergoes some type of care anywhere, not just here, understands the reason why they are doing it. And if they don't, if they don't mesh well with my idea or someone else's idea, get a second opinion. And probably if you hear the same opinion from that second person, you're going to hear it ingrained in you more and more and more.

And then you'll start to see that maybe this is a actual correction. I don't want to say fix, but it's an actual legitimate reason to follow down that path of rehab or treatment. So I want you to always know that you're on the right track is the basic thing, because learning more about your condition is really, really the first step. So anyways, I think this will probably close out this podcast since I can continue to ramble. But I am going to have some guests actually on very soon. And I am really excited to use this new podcast station I have. So actually, I have figured out how to get way better audio through Yelp.

So if anybody actually knows a expert in the rehab as well as medical field, direct them my way. Because I would love to meet really, really good health care providers, strength coaches, trainers, athletes, even patient stories. I think these are the type of things that are going to be helpful to you guys. Everybody's going to say something a very different way. But for the most part, send them over to me. Have them go to p2sportscare.com and just fill out the comment box. And I will get back to them as soon as I possibly can. I would love to share as much information with you guys as I could.

Any final touches here that I have? Geez. Well, let's see. Some of the people that I think we're going to have on pretty soon is there is... I'm hoping to get a Paralympian. I want to get someone who is actually one of my mentors in musculoskeletal ultrasound, which is ultrasound, which sees the muscles and joints. That would be really, really awesome to see. And we already do have a fitness professional who works with golfers and rotational athletes already on the books for it. So there's going to be some really, really good topics to come. Go ahead and if you guys have a personal question for the podcast you'd like me to answer or mill around with other types of healthcare professionals, just go on to the P2 Sports Care site.

There is a voicemail button on the side of the page, which you don't need anything, any audio or anything plugged into your computer to be able to talk to you. Just talk right to your computer and it sends it right to me. So take care and peace.