Restoring Human Movement

You’re listening to the “Restoring Human Movement” Podcast, where movement experts discuss the latest evidenced-based practices to help you and your clients move with mastery. In this podcast, we interview other movement professionals from a variety of disciplines (medical doctor, sports chiropractor, personal trainer, strength coach, physical therapist, athletic trainer, etc) about how they treat and prevent aches/ pains in their client population. Some experts we've had on the show are: - Dr. Stuart McGill PhD (Back Mechanic) - Dan John (Strength Training) - Dr. Thomas Michaud DC (Foot Ankle for Runners) - Brian Carroll (Powerlifter Experiences & Cues) - Dr. Ryan DeBell DC (Movement Fix Podcast) - Dr. Phillip Snell DC (Fix Your Own Back) - Micheal Shacklock (Clinical Neurodynamics) Subscribe if you're a chiropractor, physical therapist, strength coach, personal trainer, fitness enthusiast, athlete, or generally interested in sports medicine. Hosted by Dr. Sebastian Gonzales DC, a Sports Chiropractor from Huntington Beach, Orange County CA, owner of Performance Place® Sports Care. Dr. Sebastian Gonzales understands most athletes don't go to doctors because they are afraid of being told to stop or "rest." At Performance Place® Sports Care we focus on what you can do.... education and a positive mental attitude is half the battle!

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Why Sciatica Comes Back - Tips From Michael Shacklock - Nerve Expert 07/29/2024

Why Sciatica Comes Back - Tips From Michael Shacklock - Nerve Expert Looking to get in touch with our office? . We are in Costa Mesa CA but we can help people virtually very efficiently. Discover why sciatica often returns and learn essential tips to prevent it with nerve expert Michael Shacklock. In this episode, we dive deep into the causes of recurring sciatica, exploring both common and overlooked factors that contribute to this persistent condition. Michael Shacklock, renowned for his expertise in nerve mobilization, shares effective treatment methods and discusses the latest advancements in sciatica management. Listeners will gain valuable insights into preventative measures, including exercises, lifestyle changes, and ergonomic adjustments to keep sciatica at bay. Shacklock offers practical advice for both healthcare professionals and individuals suffering from sciatica, emphasizing the importance of understanding nerve health and the role it plays in chronic pain. Learn about the science behind nerve pain, discover how to manage and reduce sciatica symptoms, and uncover strategies to maintain long-term relief. Whether you're seeking to enhance your professional knowledge or find personal relief from sciatica, this podcast provides a comprehensive guide to understanding and tackling this common yet challenging issue. Tune in for expert advice, actionable tips, and the latest research on keeping your nerves healthy and staying pain-free. Michael Shacklock's Contacts: DOCTOR LINKS BELOW (LAYPUBLIC) Sebastian Gonzales (00:41): Hey, everyone, it's your host Sebastian, with the Restoring Human Movement podcast. Thanks for joining the Movement Movement. This is your first time at a show. Welcome. You've missed a lot of different shows in the past. I think we're around 200 and almost 90 right now. We've covered various things from sciatica to sports hernias to hip pain, to neck pain, nerves, and so on. Many, many, many different things. So I've had guests on, more guests on in the past, and as of the recent years I found it easier to just sit in my own little room here and just podcast with myself or some of my associate doctors. So I wanted to have Michael Shacklock about a year ago. I've had him on before, but we got lost in communication by email a little bit because he is on the other side of the world. Sebastian Gonzales (01:24): I've been to multiple of his workshops before. They're excellent. I've seen him speak multiple times. Every single person I know from chiropractor to PT to doctor or let's say medical doctor orthopedic that I've ever met, who's watched him speak the dang everything that he said was missing parts of the puzzle for treating people with sciatica. But I had no idea. I didn't know it. I remember one friend I've had on the show, Cody Dimak before. He said, you have to go to his workshop. Basically, if you know all the stuff that you know, this is a part that you cannot afford to miss if you're treating people with sciatica. So I thought we would call this podcast Why Sciatica Comes Back, tips from Michael Shacklock Nerve Expert. But gosh, I hope I don't change the name of the podcast, but I want it to be something really catchy and really precise for you guys. Sebastian Gonzales (02:17): Because here's the thing, I've met a lot of people who have had lower back pain before, just generalized lower back pain. And a lot of 'em heard of, have heard of the Mckenzie Method. Robin Mckenzie was a famous therapist who put together a methodology that really, really helped a lot of people. And then for other people who have been experiencing low back disc pain, a lot of you have heard of Stuart McGill. Stuart McGill is an excellent source of information. He's well researched. He's done a lot of research on his own in his lab, and he's written quite a few books. The books, I think both Robin McKenzie and or I don't know if Robin actually wrote it, but the McKenzie institute wrote it. And McGill wrote for the lay public, I think we're excellent. Mckenzie's is called Fix Your Own Back. Sebastian Gonzales (03:04): They have Fix your own neck, fix your own shoulder in various methods. Stuart McGill has The Back Mechanic, which I think is excellent as well. So there's these types of treatment methodologies that are synonymous with these problems. Even. I'm hoping one day to have Jill cook on for tendinopathies. And then you'd think that everybody who has these problems should probably know about these people and the information that they have come across in order to get themselves better, quicker. The sad reality is a lot of us end up having encounters as clinicians with people who have just not been doing the best things at the moment. You know, sadly and there's a lot of great information out there that we just have to become exposed to. So in this podcast, this is intended for lay public. Sebastian Gonzales (03:54): My intention is, I want to course Michael one day to write a book, almost like Fix Your Own Nerve. You know, like he doesn't just work with sciatica. He doesn't just talk about sciatica. He talked about the whole nervous system. And so I hope his information today is clean enough and informative enough to help you guys find that there is gonna be a solution, even if he tried other things before. And then I'm hoping one day that he actually puts together a provider list of people who have been through his workshops. I think we've talked on email a little bit, and he said that possibly over the next year, he will be a little busy. But I think from my struggle as a clinician, I've met people from different areas and they say, I have this sciatica. Sebastian Gonzales (04:36): Where should I go? You know, I wish I knew who took that workshop because I know everybody who's taken that workshop has the relevant information and can probably treat you really well with simple things and get you better faster. Now, if you're compelled in this podcast to think, you know what? I really need that type of care. I need help. I need to get better. I need to know all the things that I should be doing, should not be doing, and how to progress my care. What type of sciatica do I have? What are the causes? I need some education. You're thinking all that kind of stuff. You should find somebody who's been trained by Michael, if you can't see Michael himself, but certainly see someone who's been trained by Michael or his disciples. So you can go to neurodynamics solutions.com. Hopefully very soon he's gonna have a provider list up and find somebody who practices neurodynamics. If that listing's not up, you can certainly ask one of your local providers, Hey, do you, do you know anybody? You can even email us. There's a contact in the podcast as well. Just ask us if we know anyone around you, and we'll certainly do our best to find somebody. So without further ado, let's meet Michael. And here he has to say about all things sciatica. It's morning time, right? Michael Shacklock (05:47): Yeah, that's right. It's 9:30 AM Sebastian Gonzales (05:49): I thought we'd narrow the topic to sciatica more so than other types of nerve problems. And can you tell everybody why you're so qualified to talk about this topic? Michael Shacklock (06:01): Well, that's a really good question. I find it hard to answer because even though I've been studying the area for a long time Yeah. And treating patients the more you know, the more you realize you need to know. And so people say, you know, do you know a lot? Or you're an expert? Well, maybe, but certainly there's a lot more to know. And you know, even though we do know a lot, so I'm gonna say yes, I might be an expert, but <laugh> let, let, let's talk about what we dunno as well. 'cause We need to learn, you know? Sebastian Gonzales (06:31): Okay. So, we're not gonna call you a guru or anything, right? Michael Shacklock (06:35): Oh, well, just Michael Shacklock. That's all I need. <Laugh> Michael <laugh>. Sebastian Gonzales (06:39): Okay. So for everybody, just to give context again this is gonna be lay public based. So no big need to talk about clinical stuff. If there are clinicians listening, then they should know there's other podcasts. Taylor and Brett interviewed you very well recently too. So there's lots of other references and everybody should go to his course. So can you explain for the lay public, at least in regards to sciatic distribution, what's the difference between something like a neurodynamic problem and something more like, say a diabetes neuropathy? 'cause I think those are confused sometimes. Michael Shacklock (07:15): Yeah, yeah. First of all, what is sciatica? Sciatica is simply symptoms. And it could be pain or pins and needles or numbness itching. It could be all sorts of symptoms in the area that would cause it, it follows the course of the sciatic nerve. So usually it's the back of your, your buttock, right? It could be anywhere in the area, the back of your buttock, right down to the, to your foot on the back surface of your leg or your lower limb. That's generally where it is. It can vary a bit because people's anatomy is not completely uniform. And, and so that's the general description. The next step is what's it caused by, because as many possible causes, you could have a little swelling in your sciatic nerve that can produce sciatica to occur. But that's not the same as low back pain with a pinched nerve root by disc, for instance. Michael Shacklock (08:08): That can produce symptoms in the same area 'cause it's a pathway. And if you, if you think of a garden hose and you block, you block the garden hose, you can affect all the flow all the way down that hose. And so part of our, the issue from defining it for the layperson is what's, what's the cause it's a symptom in sciatic is just a symptom. The next thing is what's the cause? And that's where the health practitioner enters the picture and tries to establish that so they can plan a treatment. And so really it's symptoms in the area where the sci nerve goes. Yeah. Sebastian Gonzales (08:42): But can I, can I ask a couple questions on those two? Michael Shacklock (08:44): Yeah, of course. Is Sebastian Gonzales (08:45): Is it allowed to jump, does it need to travel all the way down your leg in Michael Shacklock (08:48): Continuity? No, it doesn't. No. No, it doesn't. You could have a buttock pain and a pain in your calf down the bottom of your leg, two areas, but it's coming from, could come from a similar general area. So that's technically a variation on sciatica. But people don't usually call it that because they're not so aware if the, if the, if someone's not, hasn't looked into the area in detail, they might say, I've got a buttock pain and calf pain. So what's the cause? Is it two things or is it one or so forth? So it doesn't have to be in continuity? No. Sebastian Gonzales (09:18): Do they have to, does it have to feel like electricity? Are there other different qualities? Michael Shacklock (09:23): No, no. That's a subcategory of sciatica. So if you imagine you have pain and aching down your leg, that could be sciatica. But if you had burning pins and needles or something like that, itching even, that could be a nerve called neuropathic, which means something that's related to definitely abnormal function of the axons. The little, the little, the nerves inside your nerve. But nerves have connective tissues around them as well, and they can cause aching. So different parts of the nerve can produce different types of responses from, and from a science or health perspective, we can define them differently. But for the umbrella statement, it's still sciatica. Different components of it though are different types. Sebastian Gonzales (10:06): Okay. And so I know there's a phenomenon with sciatica that comes on with movement. You know, when you lay down, it goes away or bends forward or you kick, you know. Mm. Michael Shacklock (10:19): And that's what I call neurodynamic pain. 'cause It's dynamic in the nerve. And a, a sort of more umbrella, or a superficial way of describing it would be movement-related nerve pain. Michael Shacklock (10:32): Mm-Hmm. <affirmative>. Okay. Michael Shacklock (10:33): And, and that's, that's reliant on the nerve being center to force, such as movement, stretch pressure and so forth. Sebastian Gonzales (10:39): So there I know that with some of the patients that I've seen, we've talked about what I described as tolerances. So some of the tests that you perform to identify how sciatica or not is, or what's causing sciatica and so on. And we talked about the tension. And like, I know a lot of people who have been down the rabbit hole of looking at things, they think about pinched nerves, and where's the pressure? Can I do nerve flossing? Is that right? Should I stretch my leg? Michael Shacklock (11:08): Mm-Hmm. <Affirmative>, Sebastian Gonzales (11:10): You know, how do you identify which things are good for them? Michael Shacklock (11:12): You know, I, I sort of, I feel like I'm on thin ice here because I watch, you know, you really watch social media. It's a way of life now. And unfortunately there's a lot of junk. And unfortunately the lay person is not aware of what is junk and what is accurate. And unfortunately, junk can be just low quality, good stuff, or it can be downright false. And, and so unfortunately the lay person is vulnerable to misinformation. And so if we go to flossing or nerve mobilization or stretching as you call it, there's a lot of stuff outside there saying, Hey, do this for society, do this. It might work and it might not. But the key is finding out why it's there and changing the why. And so nerve flossing is a possibility, but it's not always useful. Michael Shacklock (12:05): Nerve tensioning or slight and so forth, or stretching is also a possibility. But a lot depends on what kind of problem you have. For example, if you are limping into your pal practitioner's clinic because you have severe sciatica, my opinion is give the person pain relief. It's pretty simple. And 'cause that's what they want. The reason they have loss function is their pain. And so why are we applying force to a nerve that's already forced on from a, we know that from a most common diagnosis, disc hernia. So we're, we are applying force to that's already forced on, and we're supposed to help. Now over time that might be true, but today I can't sleep, I can't walk and I need help. And for me, unloading or taking force off the nerve root for pain relief to me is really important for, particularly in the early stage of saying, okay, I'm not saying that, the approach is generally wrong. Michael Shacklock (13:08): What I, but what I am saying is different stages require different needs to have different needs. So we can do different treatments along a spectrum of different mechanisms, of different ways of treating. And I, and I, it's like you, Sebastian, you know, this stuff, you'll be familiar with, okay, this person needs this type of treatment, even though it's still sciatica at, at different stages, the same medical, same classification, if you will, or label actually needs different treatments. And so that's why I really recommend that people see a health practitioner skilled in the area. Unfortunately, it's not always easy to know who is. Sebastian Gonzales (13:42): Yeah. Well, that's why I want you to make that directory Michael Shacklock (13:45): <Laugh>. Oh yes. That's, I take your point. I take your point. Yes. Sebastian Gonzales (13:49): So, but yeah, you're right. And, and I like the, the, since I am on social media and, and you know, we try to provide context to everything that we talk about, but the hard thing is, and, and it's like a common question that we always get is, so I have side, I guess what do I do? I don't know. What do you mean you treat sciatica? Yeah. Michael Shacklock (14:06): So yeah, I'm not saying we shouldn't put that stuff on the internet. I'm not saying that I'm just saying that, that, that the certain aspects are important and you are Right. Situation, context. Sebastian Gonzales (14:15): Yeah. So they're all, they're all situational, I feel like, and what you mentioned to that person that limps in is maybe different than someone who's fully functional, but they can't do, you know, just a few things, right? Michael Shacklock (14:27): Yes. The athletic sciatica can be treated differently from the severe pain sciatica. And one is a, the top one, the athletic one is just, just lost a bit, lost a bit of performance. And, and for example, a hurdler or a hundred meter sprinter or a performing artist, a dancer, a football player who's a peak performance, that a small problem for them is a big problem for them because, because their top 2% of their performance can be the difference between winning a competition and losing in the finals. And so for them, what I would see, I'm not, I'm no athlete. I'm healthy and reasonably fit, but I'm not an athlete. And so my top 2% isn't tested. So I would never know if I've got a 98% sciatic nerve, but an athlete would. And that's why they had to be treated differently. And that's why we have to go into performance strategies that are often more complex and more intricate for the athlete. Sebastian Gonzales (15:28): Okay. So that actually brings up a i'll, I'll tangent around. I know I have a bunch of questions written down here, but let's just say since you haven't tested your, you know, your upper limit of your, your, if you have that 5% sciatica, should you just never try athletic endeavors again and just you'll be okay? Or is it Michael Shacklock (15:49): You mean for, you mean for an athlete? Sebastian Gonzales (15:52): Let's just say for you because like, oh, Michael Shacklock (15:54): For me, yeah. Okay, Michael. Yeah, unfortunately, I've had experiences with patients where you, a good example, if someone had neck pain or something, and I treated them and they did really well, and they said, oh, by the way, I've had this achy brachy sciatica for about 10 years. It's only achy brachy. It's not really severe. It doesn't really stop me, but I do notice that when I do something extensive of this occasionally, can you fix it? So we did a history and he had a disc hernia and stuff like that. And, and I said, well, we'll try, well, unfortunately with him, every time I treated him, it was provoked and it didn't improve in the long term. And he may have had some adhesions or some other pathology or some other pain mechanism going on in his back or his nerves. Michael Shacklock (16:39): And a, we, after several visits, we just agreed that it's probably safer for him not not to push it. And that was partly based on him not needing much function, high function. But for an athlete whose income, particularly a livelihood is dependent on, on, on their performance, then I would be more willing to take it further. But with closer controls, such as different types, examination neurological, make sure their nerves are okay and so forth. So I think the decision is based on the person's needs, and that's close communication with the, with the, the sufferer. And, and what they're willing to tolerate and what is safe. Because remember, we help practitioners, our requirement is to be safe, even though the patient might say, just try it. We still have to say, we think it's dangerous that we shouldn't do it. And, and so the situation is really important and requirements. Sebastian Gonzales (17:36): Mm-Hmm. Michael Shacklock (17:38): So for me, I don't mind, I don't mind bent over and getting an extra stretch down the back of my leg. <Laugh>, I, I... /episode/index/show/p2sportscare/id/31452847

Sports Hernia Treatments That Work And Don't 07/15/2024

Sports Hernias: Classifying The Extent of Muscular Injuries Correctly 07/01/2024

Sports Hernias: Classifying The Extent of Muscular Injuries Correctly Looking to get in touch with our office? . We are in Costa Mesa CA but we can help people virtually very efficiently. In this episode, we delve into the often misunderstood realm of sports hernias and the classification of muscular injuries associated with them. Sebastian Gonzales attempts to unravel the complexities of sports hernias, shedding light on their diagnosis, treatment, and the importance of accurate classification. Listeners will gain insights into the various types and severity levels of muscular injuries, from mild strains to full-blown tears, and understand how proper classification is crucial for effective treatment strategies. Dr. Sebastian Gonzales DC breaks down the diagnostic criteria, discussing the role of imaging techniques and clinical assessments in determining the extent of muscular damage. From professional athletes to weekend warriors, understanding the nuances of sports hernias and muscular injuries is essential for both prevention and recovery. Join us as we navigate through the intricacies of these injuries and empower listeners with knowledge to make informed decisions about their athletic pursuits. Enjoy! Sports Hernia Book Reference: https://p2sportscare.com/product/understanding-sports-hernias-unveiling-the-mystery-behind-groin-pain/ Sebastian's Groin/ Hip Books: DOCTOR LINKS BELOW (LAYPUBLIC) References: (00:41): Hey, everyone, it's your host, Sebastian, with the Restoring Human Movement podcast. Thanks for joining the Movement Movement in this podcast. Today we're gonna cover the topic of sports hernias. Again, we've done this quite a few times over the last few months, and hopefully we're gonna be the biggest resource of sports hernia information on the internet. I guess this podcast would be on the internet. Strangely, this is a condition that plagues a lot of people, but the story that we tend to hear a lot at Performance Places. You know, people just don't have any good understanding of what's going on. There's a lack of information out there. They're not sure what to do, they're frustrated and so on, which is why we're putting these out. We've covered in past podcasts, mechanics, symptom generating structures, and today we're gonna cover more in understanding a strain versus a tear. (01:29): This topic coincides with various different types of conditions as well. If you consider a hamstring, what is a strain versus a tear? How do you know which one you have? I did have someone the other day talk about how we're dealing with back pain with this person, and they said, what do you think about the muscle? I said, well, what about the muscle? And they said, well, do you think it's the muscles causing the problem? Well, you didn't have any bruising or swelling there. There was no discoloration in the skin. There was no pop or feeling like you got shot by a gun. So all those would be indications of some type of fiber disruption in that case. Yeah, the muscle is probably part of the problem, but in this case, the muscle spasm and feeling of muscle pain may be protective or compensatory. (02:13): And so this topic of, is the muscle the issue, or is there any damage to the area? Is it the primary symptom generator, I think is a big topic. And so I want to cover that a bit with you today just so you can get an understanding and not worry so much about the muscle and maybe worry more about or in, in some scenarios, the let's worry more about what to do, about what you feel versus thinking. The muscle's, the big old problem, which honestly, most of the time it's not. Just let you guys know too, if you subscribe to the podcast, you'll get all the great old episodes that we have on various different topics like shoulders and necks and ankles and hips and knees and thighs, and sports hernias, and disc degeneration, and disc herniations and what have you. (03:01): We have lots of different topics, topics on things. We have other hosts that are gonna come in pretty soon. I work with Mandy Wainfan and Dawne Constantino, who have a wealth of knowledge. And, and in order to try to get the Keep This Podcast going with a consistent basis, I need help. And so they're gonna host some of the shows coming up at some point in the future. Please know that I, I do verify they know exactly what they're talking about, so learn from them as well. So, some of the information I'm gonna be sharing today is based upon an older, older, I wanna say older publication at this point in time. It's from 2012 at this point, or 2013 rather. If you look it up and you go online and type up terminology and classifications of muscular injuries in sport, the Munich Consensus Statement, this is again from the British Journal of Sports Medicine. (03:51): And I've been referencing this for quite a while because I think it provides some understanding and a better, a, a better idea of how to manage people. For patients or clients. It's, it's a good idea to understand, do you have any, are you gonna have a positive MRI? Are you gonna have a positive ultrasound if you decide to go that route? Or you just on a, on a goose hunt where you're not really gonna find anything because you're really not in the land where there's any tissue disruption. So in this in this research article, by the way, I'll post well consensus statement rather we're gonna post, I'm gonna post it reference on the show notes so you can't link and read it and do your due, do your own due diligence. But essentially what happened was, they were trying to establish a better terminology for how to manage people with muscular injuries. (04:45): And so what they did was they went through and asked what do you mean by strains? And they ask various different healthcare providers of very different, various different class classifications or expertise. And they found that there really wasn't a precise terminology. It was kind of wishy-washy. One person would explain it one way, one person would explain it, another and so they, they really decided that how do we, for, for people who are experiencing "strains," which is includes about 70% of in this case, they mentioned mainly soccer players that I'd say that extrapolates over to a lot of different sports as well. For a majority of the people who are dealing with muscular injuries, how can we appropriately give them a timeline of recovery and manage them if we don't know exactly what we're talking about? And so I'll read a couple of these things verbatim. (05:36): So the first step in establishing a precise diagnosis, which is critical for reliable prognosis, is knowing how long it'll take, when they can return to sport, when things will dissipate on a day-to-day basis and try to find each provider's clear guidance for treatment and management. We need to, we need to be able to find precise terminology again. So how can we reasonably, reasonably give a timeline for re-repair and recovery for the air if we don't exactly know what's going on? So for those of you who don't have fiber tears, which are gonna be found on imaging, your return to sport and activity without any major disability or fear of making things super bad, is really a quicker return. There's less disability. There may be a little bit of pain, but then there's always this idea of, if I, if I work through pain a little bit, am I gonna make things worse? (06:33): Now, if you have fiber disruption, which is gonna coincide with positive images then your timeline is longer. And there may be a chance that we need to change the management protocol to let those areas heal up a little bit and then return you back into sport again. Now, it's important to note too, I'm not saying by healing them up, I'm not telling you to do a certain PRP or prolotherapy or rest excessively. I'm not saying any of that. I'm just saying the management changes, which may require you to do different types of things in the beginning of your recovery, versus people who are only dealing with "strains", which don't have fiber disruption. Now, on the flip side I've met a lot of people who have been dealing with the feeling of a strain or pain into the lower abdominal area, into the groin, into the hip, into the hamstring, wherever. (07:25): And they're unaware of what is happening and how bad it could be. Or if there's tears, their mind is what takes them out of the sport. And they say, you know what? I'm gonna listen to what this person says. I'm gonna give it six weeks of doing nothing, and I'm gonna see what happens. But the reality is, if you don't have any real tears, then you could return faster than you think. And the time spent off, "resting it for six weeks" actually gives you a little bit more of a higher risk factor for other conditions. Tendinopathies other aches and pains that come out of doing less and then doing more, or spikes of exposure. I think I mentioned an old podcast that we saw a lot of this during the shelter in place, covid type of scenario. People did, a lot of people did a lot less even kid sports. (08:17): Child sports were not, were not in existence. They weren't doing anything. And all of a sudden, once they came back into sports and they could do it again, there was a lot of exposure. There was a lot of activity, not only with one sport, but multiple. And because of that, we saw in our clinic, I believe, a lot of different odd conditions that we typically don't see kids have. And it was related to, in my opinion, doing less than doing a lot. And reasonably, like, if you're gonna run a marathon, you don't just run a marathon on day one. Like, that's ridiculous. So you would probably build up, and that's what happens if you give it a lot of time off, you have to build up. Okay. So as we go through this before I do I should mention, if you have not, if you don't know what a sports hernia is, I cover that in pretty much detail in other podcasts. (09:05): So for the most part, it's gonna be a lower abdominal type of pain or discomfort. Some people have testicular tightness. Some people have into the front of the hip, into the upper adductor area too, kinda the crease of the hip. But if you want more details, you should listen to the podcast. Now, I'm gonna read a couple things just verbatim from the consensus statement. 'cause I think that'll make it easiest on all of us, and I'll boil it down to clarify anything I see in the middle. So when they asked people about strains, they mentioned that the responses confirmed marked variability in the use of the terminology relating to muscular injuries with the most obvious inconsistencies for the term strain in the consensus, meaning practical and systematic terms were defined in established meaning they actually tried to narrow things down and make them more specific. (09:52): In addition, a new comprehensive classification system was developed, which differentiates between, between four types of muscular injuries. The ones we're gonna be covering today are going to be mainly ones that we can do something about at least in regards to rehab. But there were functional muscle disorders describing disorders without evidence of fiber tears. Okay? And these are all, they're sub-classifications of these two, which I'll talk about a little bit later. So functional muscle disorders are ones that will not have a muscular muscular injury on imaging. That's ultrasound or MRI X-rays, by the way, don't show muscles. So those are kind of exempt from this. And then there's the structural muscular injuries, which are partial tears, total tears, avulsions, muscles torn off of bones, which is, they say , macro evidence of fibro tears. And these are going to have positive MRI ultrasound findings. (10:46): Again, x-rays don't really matter in this scenario. So, again, probably about 70% of the people that have muscular injuries are functional-muscle injuries without any actual imaging findings. But it's funny that a lot of people, when they're in pain, really wanna see what's wrong. You see the discrepancy in that. You won't see anything, which makes it hard for the person to understand what's going on. Like, I don't know what's wrong with me. I, I, you know, maybe it's hereditary. If they can't see anything, then what else could it be? You know, there's a lot of unknowns that happen outta that. If you don't take the logic of knowing that you can have muscular pain without any MRI or ultrasound findings, okay? And that's a majority of you, a strong majority. (12:10): A lot of the lower abdominal findings we have in sports hernias, I'd say easily 90% of them have no findings whatsoever. A lot of 'em don't have hernia findings. By the way, hernias in sports hernias are different. We don't find anything on imaging indicating tendinopathies or tears of tendons and muscles. Some people have some findings, but as we mentioned in the prior podcast, not all imaging findings are a hundred percent related to their symptoms. Sometimes you find 'em, sometimes you don't. Okay, now, just this, let's take a now another logical approach to this, because I've, I've been in around enough sports injuries and I've had some of my own, where if you feel a pop, when you're, say, sprinting or you hit a hockey puck, or you kick a soccer ball, you feel a pop. And it's followed by swelling to the area where the pop occurred. (13:02): And then a few days later, you notice bruising or discolorations, like it feels like someone shot you. It feels like someone threw a ball at you. You feel a tho you feel a thunk, right? In the muscular area, yeah, this is probably a structural muscular injury that has a positive imaging finding. In that case, your timeline changes a little bit. And we talked about how to rehab things in other podcasts, okay? But, and I'm, I'm trying to narrow this down the best I can, because I don't want you guys to go on this long hunt for imaging findings when there's probably not gonna be any, and it's a big waste of money too. How many MRIs and ultrasounds can you do before you realize that there, you didn't have the mechanics, you didn't have the history, nor the exam findings to merit the image in the first place, okay? (13:50): And have the unknown in your mind about, well, what could it be? Now, you know, you're probably a functional-muscular injury, which is okay, all of 'em can be rehabbed. Almost all of them can be solved without surgery. And there is a way out of this, okay? Most of you can recover back to normal activity, and most of you can get back into sport, but you need to have some guidance typically 'cause all this information on the internet and the lack of information or the wrong information is pretty prevalent, and it makes people get a little confused about what to do. Okay? Now I'm gonna go over some of the other parts of the, of the, of the classifications that there used to be. So the old classification was mostly used. It was called the O'Donohue, and was from 1962. (14:32): This system utilizes the classification to, based upon injury severity related to the amount of tissue damage and associated to functional loss. So it categorizes muscular, muscular injuries into three grades. And this is what most people still use when they talk about muscular injuries, which I think should be eradicated. I think we should go to the Munich Consensus Statement type, because this gives better education to the patient, but also gives us a better idea of how to manage the problem without wasting all the time and resources on imaging. So grade one has no appreciable tissue tear, which is the functional muscle disorder category, broken up into subtypes. Now, there's grade two, which is a tissue damage and reduction of strength in the musculotendinous junction, which is where the muscles and tendons come together. So you'll see a change of function. (15:23): It won't just be pain, it'll be a change of function or a change of strength. Reduction of strength, because now the tissue has damage, which can be recovered from, but it has appreciable tissue damage. It will be found on an MRI or ultrasound. Grade three is a complete tear of the musculotendinous junction, a complete fun complete loss of function. It's funny people that I've met who have actually had ruptures of, of,musculotendinous junction,musculo tendon off of bone.,They actually don't really have a ton of pain. They just can't move their limbs, okay? Like a shoulder. If you tear a supraspinous off of the off of the shoulder, usually you just, you can still move the shoulder to some degree. But then there's a loss of range and function in a certain range. Uwe had a kid come in recently that had a fracture of his elbow, and it was about two weeks old. (16:14): He had no pain, but he couldn't move it. Okay? So there's a difference between pain and full range and full strength. 'cause A lot of you who have functional muscle disorders, the ones that are more of a "strain" category, actually have pain. You have full function and you have full strength. Okay? So that's the difference between 'em. And when you have an actual tear or a tissue disruption, there's actually a loss of strength and a lot of time function too, or range of motion. The current ultrasound based grading scale, which is from 1995 is used quite a bit less than MRI, by the way, I should mention that. I think ultrasound is actually a really useful tool for sport hernias for shoulder conditions as well. If we're not talking about inside the joint, I think they're kind of useless for spine conditions. (17:07): But I think for muscular injuries, I think you can see a lot with an ultrasound if you find a good sonographer per, personally, I wish we see more ultrasounds because there's no claustrophobia associated with going in the machine. 'cause The machines just put on your skin. And seeing things close to the surface is really, really easy. And it's cheaper. So I think there's a lot of benefits to doing ultrasound to diagnose some of these fiber disruption types of conditions. But I don't know if that'll be something that's really in the quick future. Back on some mentions in the study. So the MRI based criteria was from 2007. Uit's from Stoller and so grade one the MRI is negative. So again, if we're, if we're matching these from the O'Donohue 1962 version, grade one, no appreciable tissue damage, no MRI finding,so the MRI based one from 2007 is grade one MRI negative for, for structural damage. (18:09): Okay? And then grade two is MRI positive tearing up to 50% of muscle fibers. And then grade three is muscle rupture, which is a hundred percent structural damage complete tearing with or without muscle retraction. And so those match up, okay? But again, most of you are gonna have grade one, which is gonna be negative, any imaging findings. Other things that were evaluated in this questionnaire that they sent the doctors that the sports medicine experts associated with the disconnect with the terminology was so they actually found marked variability with other definitions as well. So marked variability and definitions for hypertonicity muscle hardening, muscle strain, muscle tear bundle, or fascial tear and laceration. But the most obvious inconsistencies were associated with muscle strain. They found relative inconsistencies with pulled muscle in that laceration. So again, their decision in this questionnaire was that there's really no clear definition. (19:15): And so their goal was to define better. And that's where we get these results from. And now we're gonna talk a little bit more about the functional muscle disorders and the structural muscle disorders, and how these may relate to a little bit more of like sports hernia. So as mentioned before, functional muscle disorders can be acute, indirect muscle disorders mean that they don't have to be... /episode/index/show/p2sportscare/id/31063203

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How To Recovery From A Sports Hernia Without Surgery Step By Step Looking to get in touch with our office? . We are in Costa Mesa CA but we can help people virtually very efficiently. This week's episode is dedicated to guiding you through a comprehensive, step-by-step recovery process for sports hernias, all without the need for surgery. Whether you're an athlete or someone who enjoys staying active, dealing with a sports hernia can be daunting. But fear not! We're here to provide you with practical strategies and expert advice to help you bounce back stronger than ever. Join us as we break down each crucial step of the recovery journey, from understanding the underlying causes of your injury to implementing targeted rehabilitation exercises and techniques. We'll share insider tips and insights to help you navigate the road to recovery with confidence and efficiency. Plus, we've got an exciting bonus for our listeners! We'll be referencing a valuable resource during the podcast - a book that dives even deeper into the intricacies of sports hernia recovery. And guess what? You can access this book for free! Simply sign up for a Discovery Session with Sebastian, Dawne, or Mandy, and you'll unlock a wealth of knowledge that could change the way you approach your healing journey. Don't miss out on this opportunity to take control of your recovery and get back to doing what you love. Tune in to this week's episode and embark on a transformative journey towards a pain-free, active lifestyle. Sports Hernia Book Reference: https://p2sportscare.com/product/understanding-sports-hernias-unveiling-the-mystery-behind-groin-pain/ Sebastian's Groin/ Hip Books: DOCTOR LINKS BELOW (LAYPUBLIC) (00:00): Clinicians, thanks for joining the show. Just to let you know, this is a lay public friendly podcast. This is really not even for you, but if you're looking for a podcast for you and you wanna learn all the tips and tricks that we talk about on this show, subscribe to the premium version of the Restoring Human Movement podcast, and all the stuff that you'll want for your own clinical practice is in there. Take advantage. You won't be disappointed. Now, onto the show, (00:26): You are 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 Gonzalez. (00:41): Hey, everyone, it's Sebastian, your host with the Restoring Human Movement podcast. Thanks for joining the Movement Movement. Wow, this has been a long time coming. I think this is about a year from the last time that we released an episode of the show. And it's not because I didn't wanna come back to it, but I'm gonna say the show was a little bit more work than I thought it'd be just to come up with new content all the time. So I'm gonna do my best this time too, to keep it within the parameters that we can do here at Performance Place. I'm gonna share some loads, see if I can get some of the other clinicians on Dr. Don and Dr. Mandy would be good additions to the show, and they have good information to share as well. (01:16): In this podcast, we're gonna cover sports hernia. We're calling this How to Resolve a Sports Hernia Without Surgery Step by step. And obviously this whole podcast isn't gonna direct you for a hundred percent success, but I think it'll give you some good guidelines to follow. Unfortunately, at Performance Place, we have a bunch of people come in with very frustrated stories about their dealings with a sports hernia and the frustration of the lack of information on the internet, the lack of information on YouTube when they go to some of their doctor's office, physical therapists, chiropractors, whoever they may be visiting in a big town or a small town, they're very frustrated about the lack of information and knowledge. And, and this is nothing against them I always tell everybody who calls in that people have different disciplines of what they work with. (02:05): And I think the best thing you can ask for with your healthcare team is the answer of, I don't know. I'm not sure how to deal with this. I'm not sure quite what it is, but hopefully I know someone who does. And that's all we can really ask of our healthcare team. We have expertise and specialties and so on. There's people that we refer to all the time here at our office in Southern California. So in this podcast, we're gonna go over the 10 steps that I think are the most important. I'm gonna give you some details on each step, but also keep in mind that we have lots of YouTube videos on these topics on YouTube. If you go to Performance place, SportsCare on YouTube, we're type in sports. Hernias. I'm sure probably one of our videos will pop up first. (02:47): And we have other videos on related topics sorry, other podcasts on related topics too. We have a few sports hernias. I, if I believe, over 250 different episodes. We have. We also have one on testicular tightness. I think for females, we're gonna have a similar type of presentation, but it's more, in the Mons pus and other related things like groin pain and adductor tendinopathies and so on. So feel free to dig through all of the show, and we're gonna get right into it here. So the first thing to understand about a sports hernia, actually, you know what, before we get into it, let's just understand what it is. Okay? It's pain, tightness, or discomfort down into the pubic bone area. Okay? It's actually a fray of some of the fascia into the abdominal area, but really more precisely it's actually more pain into the pubic bone. (03:38): I know a lot of people will say that there's associated symptoms of lower abdominal strains. They'll feel the adductor, they'll feel their groin, they'll feel their hip. Some people feel their low back. And personally, I think that some of these things are actually more of a testicular tightness, they're more of like a compensation. Like that's why people end up having a lot of other symptomology and, and patterns. Nobody's exactly a textbook case, although those variants to things and so on. And the reason why I think people have these things is because it's their own body's way of trying to get around the symptom. Typically, all we all have about one symptom generator, which in this case may be the pubic symphysis, but a lot of other compensation patterns. Everybody has their own unique way of getting around things, which may create stiffness, tightness, pain in other areas and so on. (04:26): And so, step number one is don't panic. Nobody panic. This is not gonna be the end of the world. I know it's frustrating to find the information on it, but let's, let's all be logical about this. Okay? I think if we all can sit down and get a little pen and paper and just think about what is the plan of attack here? Alright? It's very common that people who have these types of problems, whether it be sciatica or low back pain or a disc herniation or different things that they're frustrated with, lose the ability to think logically. Okay? I think if all of you are active individuals, you've probably had an injury in the past. Let's think back, you know, 10 years ago, what was something that you were suffering with 10 years ago? I know for me, I was having a knee issue on the right side. (05:17): I don't even feel that anymore. And so I think if you talk to enough people about it, you remember Jimmy. Jimmy, didn't you have that? Like, didn't you tear your ACL like a while ago? Yeah. How, how's it feeling? I don't even notice it. This is kind of how this is gonna be, all right. So right now it's gonna feel like the end of the world, and that's okay. Everyone has the right to feel what they're feeling, but just remember it will go away. And you can probably more than likely be just as physically active as you once were. I think the stereotype associated with sports hernia is, if you just need to rest it. And then, you know you do some activity and all of a sudden it comes back and so you rest it and, and so on. And then maybe you need surgery to correct it, and then you may never be the same. (06:04): You know, it's kind of like that thought process, and that's not really correct. People who have the surgery, people who don't have the surgery, most of 'em get better. And if they decide to go back to their own, their old sport or what they did when they first bothered, it's completely up to them. I usually encourage people to think about what they actually like in life. You know, do you like going to work? Do you like going like I have a, I have an air bike at my house. Do I like air bike? It's okay, you know, but if I had some free time, if I didn't think cardiovascular fitness was important at all, and, and you know, I don't think I would, I don't think I'd jump on that bike. You know, I wouldn't go running. I don't really like running. (06:48): I like sprinting. I like playing baseball. Some of you like playing soccer. Some of you like to pick daisies. Some of you like to play dodgeball or pickleball and so on. And going back to that, going back to what you like is super important because if we think about what you, how your life, your life will go, if you don't incorporate something back that you love that's physically active, you're gonna miss out on a lot of things. You're gonna miss out on the benefits, the cardiovascular benefits of that sport, you're gonna miss on the community of that sport. You're gonna miss out on just the overall mental feeling of, of winning or challenging yourself. Or I remember in pickleball where you make a good shot, oh, you know, like even table tennis, like, there's that feeling. I know in baseball, there's the feeling of sliding in and being the winning run in the bottom of the ninth. (07:37): That is an amazing feeling. I felt it a couple times before. Where will you ever get that again? Okay? You need to think about what it means to be physically active, especially in a community sport for the rest of your life. And whether you go back to your old sport, 'cause you like it, or you go to a new sport because you wanna try something new is totally up to you. But I encourage you that whether you get the surgery or not, whether you still have pain or not, going back to your old activity is gonna be important. Number two is we need to get educated. Okay? I know there's limited information. I've heard your call and I have a book online that's pretty cheap. It was free for a while. We started charging for it a little while back, but it's called Sports Hernias. (08:22): Understanding The Mystery Behind Groin Pain in Athletes, there's a few articles that we have at our website as well, P2sportscare.com. If you search sports hernias, you'll find it there too. And there's endless publications about sports hernias on PubMed. If you wanna dig into the weeds of it, PubMed is where you'll get most of the clinical information like the research studies and so on. And just remember that if you do choose to do that, there is actually misinterpretation or a verbiage on with the publication, which is really unfortunate. A sports hernia is not a hernia. It is, it is not a hernia. So when you start reading through these things, when they talk about things protruding through the abdominal wall, even if they're referring to sports hernia, that's not, that's not correct. (09:11): There is no protrusion of abdominal contents coming out of the abdominal area or through the inguinal canal to the, to the scrotum that that's not happening. Okay? This is a whole different thing. So if you are reading through Pubmed and you find that, just find another one that's talking about something else, you know, 'cause it's, it's not that. But there are some really good publications out there. I created an in-services at our clinic. And so the in-service goes, goes over all the relative relevant information that's found recently, and we educate each other about the, the relative information. And so I found something a couple years back, and it only took me about two hours, and we found the stuff, it was all good. So I bundled it all in that book for you guys, which I will put in the link description. (10:03): And remember, if you do, you do decide to consult with us. It's almost the price of entry. We give away a free book currently with our consultation, so you can always access it there too. We have YouTube videos on it. We have YouTube videos on the mechanics on it. We have YouTube videos about the exercise and stretches we typically use for it. So there's a lot of free information out there if you know where to look. Hopefully you're gonna start with the stuff that we have, because I know it's vetted and I, I know what we have on it. But there's other great articles out there online too. So just to let you, just to give you a good idea it should incorporate conversation about how to improve hip mechanics, hip mobility, especially internal rotation. (10:48): It should include something about core and it should probably include something about how to avoid surgery. Those are all very probably gonna be more relevant articles. Not to say surgery isn't needed on some people, it is. But ideally, we all wanna avoid surgeries, and I'm assuming most surgeons want us to avoid surgeries as well. So let's do everything we can to not. I'll put some links in the description for that. Number three is establish a timeline for your pain and return to activity at least in a modified fashion. So establishing a timeline is, I think this is important to realize the value of different procedures or protocols if you, if they were successful let's just say if I went to driving school, you'd assume that within one month I would be able to drive, right? (11:35): There's something kind of wrong. If I'm there for eight months, I would assume, and I haven't been to driving school in a long time. The same thing is, the same thing happens with treatment protocols too. Rest is one where about five to seven days, if decreasing activity or resting is not helping and it's still there, then that's probably not gonna work long term. If you go back to activity after prolonged rest and it comes back again, that rest probably isn't gonna work. There should be an expectation, at least I know in our office, the expectation of giving the right exercises and stretches to do as well as some activity changes is usually about two to three weeks. The person should feel 50% better. With acute cases or like recent onsets, that timeline may change a little bit. That's, in that case, the five to seven days rest, or maybe even 14 with some pretty severe ones is, is okay, you know? (12:29): But after that, once it's kind of settled down and you're trying to return back to activity, usually two to three weeks is enough to actually get back to feeling sane about it again, like being able to go back to activity, at least in modified fashion. Now, when I talk about returning back to activity it's important to realize that you can scale your activity. I had a kid the other day who came in and we were talking about how he could scale his baseball practice based upon his hip pain. And so the only thing that bothered him was really fielding a ball. He was a shortstop. And so I said, does it bother you to get balls in the outfield? No. Like shagging balls, no. Hurt you to throw, no. How about hitting? How about running? (13:11): How about all this? You know, you get the point, right? I said, you're allowed to do anything. I'm gonna if you allow me to, I'll call your coach and tell them you're gonna do everything except for field balls in the infield. It's not because you don't want to, it's because it hurts you to do so, and we're gonna modify it for a couple weeks, but I want you to go to practice. The reason why this is important, and, and this goes for anyone of any age, is if you wanna get back to that sport again, it's in your best interest to keep it around. Mainly because, and we saw this a lot during when everyone did the shutdown during COVID, is that we had a lot of kids who weren't in sports, and they went back to sports and actually not just to their one sport, but to double sports all in the same season. (13:50): And they end up having various different injuries. And it's, it's my theory is because that we have a spike of exposure, and at least when we're talking about tendinopathies and tendon disorders, like that an exposure spike would really make a lot of sense. You probably see a lot more patella, tendinopathies and achilles tendon issues and so on. And we see this a lot through our recreational baseball league. If people don't play for six months and they throw, you know, really hard over the course of, you know, the first game and they hurt themselves, and it's not because they're damaged, but it, they, it, it spikes, it's a spike of exposure, it creates pain. And so ideally, it's better to keep yourself physically active and able through the recovery process, which hopefully shouldn't take more than a couple months. (14:32): Anyways, number four, decreased triggering activities at least for a couple weeks or so. And so this is, especially for those early onset ones where if you've just, if you've just experienced the problem the best thing to do is just decrease the amount of things that bother you. Don't, don't worry about them and focus on things that you can do. Again, it's a different spin on the thing that we just kind of talked about. But for a lot of people that we've worked with in our, in our office, and even some of the virtuals, like they, they're really focused on the things that they can't do. Well, I can't squat. Well, I can't lunge, I can't run, I can't sprint, I can't, you know, I can't, I can't write, which is okay, but let's focus on all the things that you can do. (15:17): You can still squat if you want it. Does it hurt you? No. Do it. You sure it's so safe. It's safe. Well, I mean, the body's pain mechanism or pain system's pretty appropriate for most people, especially early on in their injury. Yeah, I know when I touch a hot pan and it hurts, it's pretty appropriate. Maybe I shouldn't do that, but it's okay to touch a cold pan, right? Doesn't mean I shouldn't touch pans. So scaling your activity is important. And if you don't know how, this is where a strength coats or a personal trainer or your skills coaching your sport may have some suggestions too. I've met people who can't throw fast balls, but they can throw curve balls. I've met people who can run at a certain speed, say a seven minute mile, but they can't run an eight. (16:03): I know an eight is easier, but the eight bothers them. So run a seven, like, you'd think that running faster would bother them, and it doesn't always I know a common thing that I see people having problems with is sit-ups with this. They're like, oh, I just, you know, I can't do this. I can't do leg raises. I can't do sit-ups. I can't get out of bed by sitting up. And then, then don't do it that way. Roll over, you know, do a plank. Don't, don't do that leg lower in exercise. Maybe do like a dead hang. I met somebody before that was having trouble with an AB wheel, you know, and so then like, I can't do this. And it's like, then let's try something else. You know, there's endless different ways, there's endless ways to stimulate that one, the, the musculature that you're trying to stimulate that exercise. (16:50): And there's many different ways to do abs, okay? So it doesn't have to be with that one triggering activity. And, and I, I don't wanna beat a dead horse on this, but just do something different, but it doesn't mean stop doing things, which leads to number five, keep doing all your green line activities. This is, this is something that I think people... /episode/index/show/p2sportscare/id/30590643