What to expect from care at a sports therapy clinic

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, it's Dr. Sebastian. And this is our introductory course. And thank you for joining me and listening. And this is going to be my attempt. This is my attempt to duplicate myself and really streamline your care. We've had a lot of questions over the last years. I mean, it's been years and years. I graduated in 2008, I believe it was. And I've learned a lot since then.

But more so than anything else, I've learned that communication and getting you guys, you to understand what I'm trying to do with you is one of the biggest things, one of the biggest barriers that I need to address. And mainly, it's just communication. So starting off here, I want you to understand that we have, we want to understand your goals. And I want to understand what you want to do with your care here. And I want to know that what you want from me. And just some of the things we've had some people say they want to do are, say, run a marathon or throw a baseball without pain or even picking up their kids. Some people even say they just want to be able to sit at work or sit down without pain. And all these are legitimate goals. Not one goal is better than another. It's all very personal.

And I want you to understand that there are certain types of work in rehab that I'm going to recommend based upon what you say to me. Running a marathon, for example, we're going to have to be able to lunge and land well because running a marathon, there's a lot of load upon the knees, the hips, the ankles, which we just have to optimize those motions. And the lunge and landing are things that they're really, really going to need. Throwing a baseball is really, really correlated to hip strength and power generation as you're leaving the mounds and also shoulder stabilization. So although these aren't directly in the shoulder in regards to where the pain is usually at, there are things that we need to address or else the pain is going to come back.

And you're not going to feel good or performal. Picking up kids, I know this is something that seems very easy to do, but core strength and even deadlifting and squatting technique are highly correlated to this. And in fact, today, before I made this podcast, I basically had to deadlift up tiles because I'm going to redo my bathroom this weekend. If I don't know proper technique or lifting technique, I probably could hurt myself doing that because it was about 40, 50 pounds per load. Sitting and working at your desk without pain requires postural control for endurance, and this is core strength as well as glute strength and a lot of things.

So these are all things that, based upon your goals, we can do and we can teach you within a controlled setting. We can get the body to work in a fashion where these things can improve, and I think the body is very incredible. It's incredibly adaptive, and it can do many things if you teach it to. And the goal should not be to decrease pain, but it should be to control the body so the muscles, tendons, joints, and everything of that nature are not loaded excessively. And if I haven't done an example with a pen yet, or if you haven't seen a video on it, I'm probably going to make a video soon if I haven't already, or I'll show you in person because it really makes sense.

Now, with assessment, when you come in and see me, and I'm working with you to figure out what's going on, a lot of times I'll go through a mental checklist, and I have it up on the wall. I don't always talk about it there, but I am going through it mentally. I'm looking for a few things, and the main reason I do this is because I don't want to recommend something that you're already good at. Typically, you want to recommend things that you need improvement on, and I like to talk about, or I like to address it as saying the white elephant in the room. If you walk in and your hamstring flexibility is terrible, and you're talking about back pain and hip issues and so on, perhaps I want you to stretch your hamstrings.

And this is generally speaking. Now, if your flexibility is good in the hamstrings, why would I tell you to stretch it more? We consider this a bell curve. We want you within the normal range. So the things I'm going through checklist variety, at least in my head, are flexibility. If we're looking at the low back or hips, are the hips flexible enough? Are the ball and socket joints flexible enough in all ranges of motion we're looking for? So flexibility is checkbox number one. Next is core strength or isometric trunk stabilization. Examples of these would be front planking, side planking, Sorensen's test, torsional buttress.

These are things we'll probably go through on day one. And there's standards that we want you to hit, even as weakened warriors or desk workers. If you have these conditions, it's probably because these things aren't good. Next is strength. Then dynamic core stabilization. This is a little bit more towards running. Actually, so strength and dynamic core stabilization are different ones. And then we look at structural changes and neurological changes. And these are examples of, let's just say, if you came in with perfect flexibility, terrible core strength, and you had a hatchet sticking out of your knee.

Obviously, someone hit you with a hatchet. It's not that your core was weak or any of that stuff. There's a structural thing that happened there. It's trauma. You might have torn a meniscus. You might have cut some nerves. You might have done a lot of these things. So a lot of times, if there's issues there, if something's actually physically ripped or torn, they need to be treated in a different way than if they're just almost a baseline itis condition or inflammatory condition. So I hope this makes sense so far. But mainly, I like to follow the definition of insanity, or I don't want us to be insane.

And if you've heard this before, the definition of insanity is doing something over and over again and expecting different results. And if you're in here to see me, it's probably because things weren't working. And I really, really need people to be open-minded about what the white elephant is. And it's not always something they want to hear. In certain cases, we've had people with weight issues in before where it's very difficult to talk about or eating issues. They're definitely the white elephant in the room. And we can't say, or it's pretty safe to say that usually with knee conditions, if you're 200 pounds overweight, there's a weight issue there.

There's just more load upon it. So we need to make sure that, I need to make sure that you guys are open-minded to the suggestions. Now, when we go through an exam, I'm basically going to tell you what's going on as we're doing it. And I might be just speaking out loud. And don't get overwhelmed with the information because typically I summarize it in the end. And I want you to ask questions along the way, too. But if I seem to tangent you back or bring you back, it's because we're going off on a side tangent, which won't be productive for what we're trying to do of the day. So I don't think I'm trying to be a jerk about that.

But I want to hear what you have to say as well. And I want to hear your questions. If it doesn't make sense, just ask me. I love educating and giving visual examples when I can, especially if I can think of one. And I have used a lot of visual examples in the past. Now, imaging is something that I don't require of everybody. And imaging could be x-rays, MRIs, ultrasounds, CT scans. Based upon what I'm looking at, I might recommend different things. And I'd say majority of the time I do not recommend imaging. But just know that when I do recommend for an image, I really, really do mean it. And typically, when I look for an image, I'm looking to confirm or unconfirm something.

So I'm trying to recommend the best type of rehab we can. Because if I steer you in the wrong direction in the beginning, and this is a very extreme example. But say you came in with shoulder pain. And I said, hey, we're looking at a rotator cuff tear here. And we rehab it for 12 weeks with a rotator cuff tear. And we finally look at an MRI, and we find it's cancer. I didn't do you any favors. So sometimes I'm looking to rule things out. And it's not always cancer. Sometimes fractures. Sometimes tears. Sometimes other things. And I want to make sure that we're not blindly driving into the night with your care.

I want to make sure that it's as specific as possible. Because I'm sure you want to get back to what you want to do as soon as you can. And the next topic is basically weight lifting here. And the reason I'm bringing it up is because, although we don't always talk about it the first time, sometimes new patients are really intimidated by lifting weights. And when you walk into the office, you'll see there's Olympic bars there. There's lifting platforms. There's weights. And there might be people doing rehab or weight lifting out there. And a lot of times we recommend weight training for various reasons for people's rehab.

But we make it as safe as possible. We're nitpicking on form. And it's for a reason. And I wrote a whole article on this. And the reason is because I had this question so many times. It is on the P2 Sports Care website. It's under pain relief. At this point, I know we're going to reconstruct the site. But if you look up on the search bar, resistance training for athletes, it's going to go over this whole topic for you. It is the most common question I get. And this is the reason why there's a whole article on it. Be open-minded about it. I even went to the extent of quoting myself on this article.

And it was the dumbest. I thought it was the dumbest thing when I was doing it. Because who quotes herself in their own article. But it was something that I thought was very important to me. And it was something I thought would be very good to relay to patients. So I'm going to say it now. Don't try to rehab a musculoskeletal injury with a cardiovascular activity. And the reason why I'm bringing this up is because probably the second most common question I get is, Hey, I'm running right now or swimming. Is that good enough for my knee condition? I'm doing exercise. Correct. You are doing exercise.

But that is a cardiovascular exercise in majority. Yes, you do have the legs get stronger and the trunk get a little stronger and so on. But it is not resistance training, at least in a lot of people's books. So in regards to a knee, we might have you do deadlifting. We might have you do core exercise on the ground. We might have you do single leg balance activities or change of direction. And these are not the same as running. They're not the same as swimming. Swimming and running and things that last beyond 10 to 15 minutes, typically they are heart health things. So let's go back to that quote again.

Do not try to rehab musculoskeletal injury with a cardiovascular activity. So I will recommend musculoskeletal rehab when you come in. And also you can see some of the examples of this in that article that was on the P2 Sports Care site. So again, resistance training for athletes. So my goals first with you are to decrease pain, increase strength. And strength can be within the core, the legs, the trunk, or whatever else we're looking at because you can have a variety of different conditions. And this is a very general topic. And the last is to improve movement and then load it. Because with that example, again, with me having to deadlift up 60 pounds of tile up a stairwell today, it is an example of having proper movement and then loading it.

Because if I only loaded it to 10 pounds, there's no way I could have done 60 pounds today. And a lot of times picking up kids is more than 10 pounds. So the next section you're going to hear is on common terms or common terminology. I'm going to go over anatomical terms, flexion, extension, retraction, protraction, and ligament, muscle, cartilage, all the stuff that you're probably going to hear us reference, and even the concept of loading. These are things I really, really want you to understand because it's going to be so, so important to your compliance mainly. We found that one of the most common reasons why people don't get better is, at least when they come in, we ask them about their history, and they're like, you know, I tried something for a couple times, it didn't work.

I went somewhere else for a week, it didn't work. And that is a big issue, a really big issue. Research is very clear of what works. It says A plus B plus C in that order works well. Let's do that. But a lot of times when patients come in, and I'm not saying this to, you know, talk down upon people, but they might say, well, I don't want to do A and B, but let's do C. Or maybe I'll do A and B, but I want to do B before A. You know, again, research is very clear, and that's why I want you to be open-minded about the suggestions that I'm giving you. So I'll be seeing you soon, and have a good day.