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In this episode, we’re diving into the common questions postpartum moms have about low back pain. From the physical toll of pregnancy and childbirth to the demands of caring for a newborn, back pain is an all-too-common issue many moms face. 

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In this episode, we’re diving into the common questions postpartum moms have about low back pain. From the physical toll of pregnancy and childbirth to the demands of caring for a newborn, back pain is an all-too-common issue many moms face. 

Whether you’re struggling with discomfort or just want to better understand your postpartum recovery, we’ve got expert tips and actionable advice to help you feel stronger, more supported, and pain-free. Tune in and take the first step toward reclaiming your comfort and mobility!

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In this episode, I’m diving into my personal experience with not one, but two hamstring tears from sprinting. I’ll take you through exactly what happened, how it felt in those first few days, and the emotional and physical challenges I faced. From the initial shock of the injury to the frustration of trying to stay active, I’ll be sharing it all.

I’ll also break down what I’ve done so far to kickstart my recovery. From the immediate steps I took in the first 48 hours, like icing and rest, to the mobility and strengthening exercises I’ve started implementing, I’ll give you an inside look at what works and what doesn’t. Whether you’re dealing with a similar injury or just want to understand more about hamstring recovery, this episode is for you.

Tune in to hear my story, the ups and downs, and the lessons I’ve learned so far!

The Sports Hernia 6 Step Recovery Plan

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In this episode, we answer some of the most frequently asked questions about sports hernias and other related conditions like inguinal and femoral hernias. How can you tell the difference between these hernias, and what are the best treatment options? We’ll discuss the success rates of non-surgical treatments, which are highly preferred unless significant MRI findings are present.

We’ll also cover:

• The recovery timeline: How long does it take to get better? From just a few months to over six months, depending on the severity and onset.
• Can sports hernias heal on their own? It depends on triggers, biomechanics, and habitual movements.
• Over-the-counter solutions, nutrition, and supplementation: While natural anti-inflammatories can help, they treat the fuel, not the spark of the problem.
• The real spark: poor tissue mechanics, muscle imbalances, improper exercise programming, and load management.

Tune in for practical advice and expert guidance to help you understand your body better and manage your recovery.

Sports Hernia Book Reference:

https://p2sportscare.com/product/understanding-sports-hernias-unveiling-the-mystery-behind-groin-pain/

Sebastian's Groin/ Hip Books:

https://www.p2sportscare.com/product/understanding-hip-diagnosis-book/

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PREMIUM PODCAST LINK (for Clinicians only)

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The Sports Hernia 6 Step Recovery Plan

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Struggling with groin pain or an adductor strain that just won't go away? It might be a sports hernia, also known as athletic pubalgia. In this podcast, we break down everything you need to know about sports hernia pain, from diagnosis to recovery. Learn the critical DOs and DON'Ts for a faster recovery, with expert tips on sports hernia therapy, managing hip impingement, and how to handle a sports hernia injury. Whether you're an athlete or active individual, understanding the right moves is key to overcoming this condition. Tune in as we explain the ins and outs of sports hernia and guide you to pain-free movement!

Sports Hernia Book Reference:

https://p2sportscare.com/product/understanding-sports-hernias-unveiling-the-mystery-behind-groin-pain/

Reference Podcast:

https://www.choosept.com/podcast/treatment-of-core-muscle-injury-don-t-call-it-spor

Sebastian's Groin/ Hip Books:

https://www.p2sportscare.com/product/understanding-hip-diagnosis-book/

DOCTOR LINKS BELOW

PREMIUM PODCAST LINK (for Clinicians only)

FREE GROIN WEBINAR (LAYPUBLIC)

The Sports Hernia 6 Step Recovery Plan

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Welcome to Episode 284 of our podcast, where we tackle one of the most confusing and misleadingly named injuries in sports: the sports hernia. Despite its name, a sports hernia isn’t what you might think. Join us as we break down the myths and facts about this tricky injury that affects athletes across all kinds of sports.

In this episode, we start by explaining what a sports hernia actually is. Our in-house sports injury expert will walk you through the basics, showing how it's different from the typical hernia you’ve probably heard of. You’ll get a clear picture of what really happens when an athlete suffers from this injury and why the term "hernia" doesn’t quite fit.

We’ll dive into the challenges of diagnosing a sports hernia. 

If you’re an athlete, coach, or just someone interested in sports injuries, this episode is packed with useful information. Tune in to learn why the term "sports hernia" is so misleading and get the latest on how to manage and prevent this complicated injury.

Subscribe now, leave us a review, and share this episode with your friends and fellow sports fans. Let’s get to the bottom of the sports hernia mystery together!

 

Sports Hernia Book Reference:

https://p2sportscare.com/product/understanding-sports-hernias-unveiling-the-mystery-behind-groin-pain/

Reference Podcast:

https://www.choosept.com/podcast/treatment-of-core-muscle-injury-don-t-call-it-spor

Sebastian's Groin/ Hip Books:

https://www.p2sportscare.com/product/understanding-hip-diagnosis-book/

DOCTOR LINKS BELOW

PREMIUM PODCAST LINK (for Clinicians only)

FREE GROIN WEBINAR (LAYPUBLIC)

Looking to get in touch with our office?

Send us a message here.

We are in Costa Mesa CA but we can help people virtually very efficiently. 

Are you struggling with a stubborn running injury that just won't heal? You might be dealing with more than just a physical ailment. Join us on this enlightening episode where we dive deep into the often-overlooked condition known as Relative Energy Deficiency in Sport (RED-S).

RED-S affects athletes who don't consume enough energy to support their level of physical activity, leading to a cascade of health issues that can hinder performance and delay recovery. From chronic fatigue and decreased bone density to hormonal imbalances and impaired immune function, the impacts of RED-S are far-reaching.

In this episode, we'll explore:

• The symptoms and signs of RED-S, and why it’s commonly misdiagnosed.
• How RED-S can be the underlying cause of persistent overuse injuries in runners.
• Expert advice from sports nutritionists and medical professionals on how to recognize and address RED-S.
• Real-life stories from athletes who have overcome RED-S and returned to peak performance.

Whether you're a dedicated runner, a coach, or simply interested in sports health, this episode is packed with valuable insights to help you understand and manage this critical condition. Tune in and learn how to fuel your body right, prevent injury, and stay on track to achieve your running goals.

Don't let an undiagnosed condition keep you from the finish line. Discover the link between nutrition and injury recovery, and take the first step towards a healthier, stronger you.

Looking to get in touch with our office?

Send us a message here.

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:

https://www.neurodynamicsolutions.com/

https://www.instagram.com/neurodynamics/

DOCTOR LINKS BELOW

PREMIUM PODCAST LINK (for Clinicians only)

FREE GROIN WEBINAR (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 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. Michael .

 

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. . 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. ,

 

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):

. 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. , I, I don't care because I'm not gonna push my side. Yeah. Can't be bothered. Yeah. Return on investment is low. ,

 

Sebastian Gonzales (17:49):

I, I, yeah, I remember there was somebody I, I, I was managing that. They were a really hard case for me anyways for the most part, things got better. And then, you know, we talked for every month or two and stuff would come back, and the amount of volume that they were doing with their sport was pretty high. They were not paid athletes. They're recreational, and that's really just what they want. It keeps them sane. And so I, you know, in so many words says it's assumed risk, you know, like, Mm-Hmm. Like, you, you don't, this isn't your day job. I know you love it, but like, you're gonna have to choose how much you wanna deal with, because it was just more highly provoked with what she was doing. But, so, but I've had some people too.

 

Michael Shacklock (18:32):

Yeah. Yeah, exactly. And I, I, and for the, for the listener who's not a health practitioner here unfortunately, licensed health practitioners are bound by law. And that's to protect the public from, from danger. And even though someone might say, don't worry, I'll take the consequences of something extreme and risky, we're still not allowed to do it if we know that it could place them at significant risk. And again, it's a cost benefit risk analysis, and that's between you and the patient, . So even though someone might say, oh, stretch the heck outta my nerve, I don't mind if it wrecks it. Well, we do. Mm-Hmm. . And so there's that very, particularly a high performance level that's where that 2%, 5% puts 'em into a window of risk in some people, not all, but some. And that's where, where, you know, the cost benefit analysis comes through and ethics.

 

Sebastian Gonzales (19:24):

Mm-Hmm. . Mm-Hmm. . Now you've mentioned the disc quite a few times here and I know that there's gonna be a lot of people who have been told they have disc injuries creating their leg pain or their sciatica. I know there's other types that you alluded to that there's what are the other causes? Can you talk a little bit more about a disc injury and how that affects it versus maybe another type of problem?

 

Michael Shacklock (19:50)

Yes, exactly. It's a really good question because even though the disc injury, a disc problem pressing on the nerve root is the most common cause of sciatica. It's not the only one. And if we jump to the assumption that it is Disc hernia, when it's something else, then things might go, not go well as you want. Disc hernia presses on the nerve root, it's a bulge in the disc, or specific terms, we're gonna call it a herniation, which is the kind of more official term. And it's like a bulge in your bicycle tire. And, it can press on the nerve root. Now that the nerve root needs blood flow it's a little bit like if I were to put a small tourniquet around my arm, the upper part of my arm might be okay for a while, but then finally the veins will start bulging.

 

Michael Shacklock (20:35):

It'll go blue, and it may start hurting. And so take the tourniquet off and it will relieve it. And that's kind of what's happening in some nerve root problems, particularly in the early stage. So if you get a lot of pressure, you can get pain, but you can also get loss of function like paralysis or numbness. And unfortunately, there's not a close relationship between the two. So if you get severe compression early, suddenly often you don't get much pain, and instead you get a weak limb, you, your foot might not be doing what it's supposed to or something like that. The other part, the other sort, is that it might not be so severe, but it's more irritating and it can be really painful. And, and so the really painful one doesn't always indicate that it is serious, which is a pain in the neck, not quite literally, but for the sufferer, I've got really severe pain.

 

Michael Shacklock (21:24):

The problem must be serious, but actually not always, we're actually, as a health practitioner, are actually more concerned about whether you're paralyzed. So if you're paralyzed from a pressure on the nerve root, then you, particularly early, you might end up, you, you might need to get a medical consultation or some sort of radiology or something. So for me, there are, again, there are different kinds. The more severe, more likely cause loss of feeling and loss of movement. But it's not a determinative pain. Pain is often related to irritation and inflammation and loss of blood flow. So it's, there are different, well, this is why I'm sort of impressing the audience here. That type of problem is important.

 

Sebastian Gonzales (22:03):

Some people decide to just wait it out.

 

Michael Shacklock (22:05):

Mm mm Yeah. Then wait it out. I personally find the wait out approach controversial. Now there are two for the listener.

 

Michael Shacklock (22:16):

There are different parts. We read research. We learn what the clinical trials show. We, you know, we, we learn what happens when you don't touch something for a long time, don't treat it. Mm-Hmm. , and a lot of problems are what we call self-limiting. So they, you heal naturally. But unfortunately, and, and that is common with sciatica, but unfortunately there's a, about 10 to 30% of people are still problematic after a year. And it's not very easy to predict who's gonna go in that direction and who won't. And so if someone has sciatica early, you could say, ah, don't worry, be happy. Just keep moving and it might work. Or you might need something quite specific from the health practitioner such as a chiropractor like yourself and, and so forth. And it might really help, but there's another group that if you leave alone, don't.

 

Michael Shacklock (23:10):

And my opinion is that that's, that's horrible because from, from a political perspective, we help practitioners that are not really doing very much. We, we are supposed to help people, and if we're told that we can't help you and it doesn't work, then that, that, that's a failure as far as I'm concerned. Mm-Hmm. . And so my opinion is that partly based on research, partly based on my experience, I would much rather see someone with acute severe or severe sciatica early figure out as best we can with what's going on, and give them the best advice that we can and give them home treatment strategies and some physical diagnosis and treatment, sometimes with their hands, et cetera, and sometimes with exercise and so forth. And that is influenced by what the practitioner sees. Mm-Hmm. , are you moving properly? Is it, it doesn't look like there's too much pressure on your nerve root. So then we'll show you some positions that can, which can at least transiently reduce that pressure and give you some symptom relief, some pain relief. And then as you're improving your pain, we can then give you training and so forth exercises and some physical treatment maybe to help optimize your healing.

 

Sebastian Gonzales (24:23):

Okay. Yeah. Actually, one thing that I've had people ask me a bit is, well, the position you gave me, it does feel good when I'm in it. I don't really have the problem, but it just comes back. So it really doesn't work. So what do you, what do you think, you know Mm-Hmm.

 

Michael Shacklock (24:39):

Like what's the point? That's what that Yeah, that's exactly, that's where the balance between transient benefit or temporary benefit has to be married with long-term needs. My feeling is if, or if, we did a recent pilot study on putting people into this position to relieve pressure on their nerve root in hospital. They arrived at the emergency at the hospital with severe pain and they were assessed them and, and so forth. And, we found that people who got, they've got this position to open their frame in and, and prove their pressure on their nerve root transiently did much better at a week than the ones who didn't get it.

 

Sebastian Gonzales (25:18):

Mm-Hmm. .

 

Michael Shacklock (25:19):

But that's not, that's not long term as you say. And so my feeling is keep adding to it like a yo-yo going upstairs and inserting other treatments in the process to address all the problems that relate to that sciatica.

 

Sebastian Gonzales (25:35):

Okay. I, I, I can't help but talk about that. Yo-Yo going up the stairs. Is that something that you did as you did? Were you a yo-yo man?

 

Michael Shacklock (25:43):

Mm mm mm Yeah. Yeah. Yeah. I was, I mean, in real life. I remember when I was a young kid buying this yo-yo thought, whoa, fantastic. This is, my parents probably thought, great, this kid's occupied for hours. .

 

Sebastian Gonzales (25:56):

Yeah. So, you know, my dad, he I forgot, I totally forgot. We saw him a couple weeks ago. And so we watched Tommy Smothers, I guess Tommy Smothers died, I think re recently, but he was the yo-yo man. Oh, wow. We used to watch this yo-yo video when I was younger. So we weren't super,

 

Michael Shacklock (26:15):

It's amazing what you can do with the, with a ball on a string or a on a string

 

Sebastian Gonzales (26:19):

. You can say that, like in that step by step type of scenario, does everybody have to do all the steps like the relieving position and then the exercises, or can they skip steps or can they just, you know, not continue up the steps and they'll be okay? Is there Yeah,

 

Michael Shacklock (26:39):

Yeah, exactly. I, I, I, I personally think that there are, we say in Australia where there's a lot of horse racing and gambling, you gotta pick the right horse for the right horse. If you get the soft course and it's been raining, then you gotta pick a horse that can run on soft turf. Or if you've got one that is strong on hard surfaces, then you gotta pick a horse that runs well on hard surfaces. So what I'm, what I feel is that the practitioner has to assess the person, figure out what, what the dominant problems are, and work with those dominant problems. And you might even jump tracks at some point. So I actually, we got stronger in this area really well, better than I expected, but this is what's lacking. Forget that for now. Just maintain it with a few exercises and without gonna add something different because this is the other, the, the next part that's lacking. So I'm okay about changing things and jumping steps as long as it's, you know, appropriate for the patient. Mm-Hmm, .

 

Sebastian Gonzales (27:35):

So for some of these step-by-step or general, general things that you give people over time I don't think I've ever asked you how, how long do you usually see somebody from early onset to like, you know what, you don't really need me anymore. How long does that usually take? How frequent is that touchpoint?

 

Michael Shacklock (27:55):

Hmm. Okay. Let's just say someone who limps in with severe pain. Mm-Hmm. . I like to see them probably two or three times in about three times in that first week. Say we're in, you know, we're in, in a utopia where we can do what we want, which mm-Hmm. Is rare. But, you know, we'll say we can, I like to go to the top and then dial it back. If it can't be done then I would like to see 'em two or three times, at least two or three times that first week. So we can give them some pain management strategies, how to unload their nerve root, how, how to move better and so forth, how to sleep better and so forth. And then move it to a couple of times a week with rehab strategies, some manual, some manipulations or manual therapy, whatever. And then, and then develop their understanding of the problem and not be frightened of certain things. And then go from there. It could take, I like to see a big improvement in the first one week, first week in the first one to two weeks. So I like to see, it doesn't always happen, but I'm willing to spread it out after that. And you might manage someone intermittently over a year. Mm-Hmm. depending on, depending on how they go.

 

Sebastian Gonzales (28:56):

Yeah. And, and so that was a, I'm glad you mentioned some of those points in there. 'cause I think I've met a lot of people who have said, you know what? I know this is, I know this is rehab, it's gonna take some time. And so it's okay that I feel bad for months, you

 

Michael Shacklock (29:09):

Know? Mm. Ah, yes. That's, that's really important because we're in a, we're in a world of re of velocity these days. And people want stuff quick. They want particular improvements. That's fair enough. But there are times, well, for example, just say someone who bends over, they, oh, I've got a back pain. Oh, it's not too bad. Then by tomorrow they had sciatic. It's really bad that that's an incident now that might be managed differently from someone who's, who's been, been building up, might be a repetitive task that's been building up that their pain's been building up. And sometimes we have to explain to the, to the, the sufferer look, a process got you here. So a process has to get you outta here. Mm-Hmm. . And so you might say, well, you've been bending over a fair bit. You haven't been moving very well over the last five or 10 years.

 

Michael Shacklock (30:01):

It's been loading you back in a way that we don't think is balanced. And that might be why you've got this problem. So we're gonna have to show you how to move differently or load you back differently. And that takes time for a tissue to change. The disc itself does not generally have a very good blood supply, so it doesn't heal very quickly. We know muscles can heal more quickly because they have good blood supply. We know that in the right situation, nerves have good blood flow. So they can often change quite quickly sometimes, not always. And so, but the disc not having very good blood flow means it's gonna take time to adapt to new load heals and so forth. And so one of my favorite statements to people who've got this problem is, look, remember that a process got you here. So a process has to get you outta here. Mm-Hmm. and the process is about if you're building a house, one brick at a time, one step at a time, finally you have a house. But it is step by step and piece by piece.

 

Sebastian Gonzales (30:59):

Mm-Hmm. I like that. That's a good process. Got you. Here, the process got you out. I know. Did you ever meet Dan John, by chance? You never Yes,

 

Michael Shacklock (31:07):

I have a couple of times actually. Did you really? Yes, yes I did. Yeah.

 

Sebastian Gonzales (31:10):

He, he, I thought he said, you're the sum of your, your habits, you know, maybe a little bit more brash than yours, but I like it.

 

Michael Shacklock (31:18):

Hmm. Yes. Ha. Habits, I mean, really a lot of health practices about changing habits.

 

Sebastian Gonzales (31:22):

Mm-Hmm. . So we have a few minutes here. Is there anything that you think is important to take home that we have not hit yet about? 

 

Michael Shacklock (31:33):

I, I think, well, what from the, the, the, there's the listener's perspective, there's a broad range of services for, for sciatica. Mm-Hmm. And in physical therapy, particularly in the British Commonwealth countries, and it's sort of partly through the US as well, but more, more in the British commonwealth countries, a lot of physical therapists are reducing their emphasis on physical function or not function, physical causes. And they're going into the psychosocial meaning, look, if you're worried about your pain, then it's gonna make your pain worse. Which is kind of true to some extent. But I think you gotta be careful about overdoing some of either end of the spectrum, physical or psychological. And so I, I really worry that some physical therapists, so I can't only speak for our profession, are telling people, your disc is not hurting when maybe it is and you should test it.

 

Michael Shacklock (32:23):

Mm-Hmm. . So you, you're entitled to a decent physical examination and a decent interview with, with your health practitioner. And I get worried when people go to a health practitioner, they get a short time, they don't get a good explanation. The statements given to them about their problems are not tested. Mm-Hmm. That they just read a, read some paper, read a research paper, and tell a patient what to do. To me, that's not enough. Because we are paid and we have obligations and responsibilities to the patient, to the sufferer to give them the best we can. And so I would, number one, be discerning about who you see. I'm not recommending anyone or not recommending anyone, but make sure that you feel that someone's communicated with you, well, listened, well tested the ideas with you, and negotiated an outcome or a plan with you.

 

Michael Shacklock (33:10):

And I just worry that a lot of physical therapists are not doing so much physically. And, and I personally think that the body is important, that we know that disc hernias can hurt. We know that the prevalence of disc hernias in people with back pain is higher than those without back pain. And, and, and, but because there are studies that show that some people without back pain have disc hernias, therefore disc hernias are not important. I, I don't think that's to some extent biased. It's, you've gotta balance all the information and hopefully you come out of the evaluation with your health practitioner that you've got a good balanced view and tested a bunch of ideas with the health practitioner. Yeah.

 

Michael Shacklock (33:47):

Nice. Thanks. Well said. Michael. I, I, God, I, I want to do this just again and again and again,

 

Michael Shacklock (33:53):

But Zoom's gonna cut us off. Yeah, sure. Thank you. It's been, it's a pleasure. It's an absolute pleasure. Thank you, Sebastian. Thank you.

 

Michael Shacklock (34:00):

Yeah. Well cool. Thank you for being on. Alright. I hope that was helpful to everybody. Unfortunately in the middle of the podcast we had an audio glitch and I, I don't, I don't pay for Zoom 'cause I don't really use it that much. So it cuts us off in 40 minutes and that's kinda how it goes. So we lost a little bit of time there, but I, I think I wanna recap just a couple things here that he said. And I hope I don't misquote, but I think the takeaway that I thought was interesting is that obviously there's different types of sciatica, you know, there's different variants if you will. But also too, in that utopia type of scenario, like how often would we see somebody with this type of problem? And I would, I would echo the same thing because people who have full-blown pain associated with sciatica or the disc, or radiculopathy, whatever you wanna call it, it really hurts, you know?

 

Michael Shacklock (34:52):

And so we can supply some treatment on day one and it's transient effects and ideally we get them to do some things at home. But I think if I were the patient in that scenario, I would just, all things considered equal, I don't have to pay it all. And I just come in and see me for 15, 20, 30 minutes and just make me feel better. You know, and, and I think Michael's right with that two to three days a week would be pretty appropriate. 'cause When I've had family members with the same type of thing there's a lot more more in it, you know, because they're, they live really close by. They're not paying me for help, you know, they contact me on my phone. And there's a lot of questions, there's a lot of concerns. And there's a lot of things that I can do for them in week one.

 

Michael Shacklock (35:34):

And so hopefully if you guys are looking for some help, you find somebody who practices in a similar methodology that Michael's talking about. Again, if you're looking for a provider, I don't think at this point he has a certification for the people who've gone to his workshop. It's just educational. They show techniques and methods and so on. But I'm hoping very soon because I was kind of poking Michael with that, that it's, it is very hard to find people who are vetted for this type of management style. We do it here at Performance Place and if you guys are looking for somebody, we can certainly look around and see if we know any around, around your area. But it'd be really nice to know. I'd love to connect with the people who have taken his workshop.

 

Michael Shacklock (36:18):

'Cause there are some step-by-step. And to be fair, everybody may do a slightly different treatment as well. There, there may be someone who does more soft tissue work. There may be someone who does more exercise, there may be someone who does some adjusting. But it's all based upon your unique presentation as well as what is found in your physical examination, like what's found in the assessment. So I hope that recap was, at least, enough to highlight the things that I found, you know, interesting in there, amongst many other things. So if he'd been suffering for this for a long time and you're not finding any relief, hopefully you find someone who can do a good job with you. So if you guys are looking for help from Michael or someone who's been helped who's learned from him, again, neurodynamic solutions.com subscribe to the podcast for more to come take care.

The Sports Hernia 6 Step Recovery Plan

Looking to get in touch with our office?

Send us a message here.

We are in Costa Mesa CA but we can help people virtually very efficiently. 

Join us on a deep dive into the world of sports hernias, where we uncover the treatments that make all the difference. In this episode, we explore the cutting-edge strategies that athletes and medical professionals swear by, alongside the cautionary tales of treatments that fall short.

From innovative surgical techniques to the latest in rehabilitation protocols, we leave no stone unturned in our quest to uncover what truly works for sports hernias. Experts in sports medicine weigh in, sharing their insights and experiences to shed light on the most effective strategies for recovery.

But it's not just about success stories. We also delve into the treatments that have left athletes sidelined for longer than expected, exploring the pitfalls and misconceptions surrounding certain approaches. With a blend of science, firsthand accounts, and expert analysis, we provide listeners with a comprehensive understanding of the best—and worst—options available for managing sports hernias.

Whether you're an athlete striving to get back in the game or a curious listener eager to learn more about sports injuries, this episode promises to be a game changer in your understanding of sports hernia treatments. Tune in and discover the keys to recovery that could make all the difference in your athletic journey.

Sports Hernia Book Reference:

https://p2sportscare.com/product/understanding-sports-hernias-unveiling-the-mystery-behind-groin-pain/

Sebastian's Groin/ Hip Books:

https://www.p2sportscare.com/product/understanding-hip-diagnosis-book/

DOCTOR LINKS BELOW

PREMIUM PODCAST LINK (for Clinicians only)

FREE GROIN WEBINAR (LAYPUBLIC)

The Sports Hernia 6 Step Recovery Plan

Looking to get in touch with our office?

Send us a message here.

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:

https://www.p2sportscare.com/product/understanding-hip-diagnosis-book/

DOCTOR LINKS BELOW

PREMIUM PODCAST LINK (for Clinicians only)

FREE GROIN WEBINAR (LAYPUBLIC)

References:

https://pubmed.ncbi.nlm.nih.gov/23080315/ 

 

(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 trauma based. There are trauma based ones in here, like contusions, which is a direct muscle disorder, but a functional muscle disorder, it's pretty, it's indirect. It's not like you experience any trauma to the area. There's not any EV evidence of MRI or ultrasound findings of tissue disruption. You probably won't even notice any swelling in the area, although you may. But there's usually no discoloration in the skin. There's not a pop, there's not a clunk associated with the original injury time either.

 

(20:03):

Some people even notice with some of these disorders within the functional muscle disorder category the four different subsets, some of them wake up with it. It's not even related to actual motion. Now, there's four basic categories in this functional muscle disorder category, okay? The first two I will mention, but we're not gonna spend time on it because it's not gonna be relevant to a lot of people. The last two are gonna be the most relevant for your understanding. So first, there's fatigue induced muscle disorders, and then there's delayed onset muscle soreness. I'm gonna start with delayed onset muscle soreness or dorms, because most people who do exercise, they know what DOMS is. Several hours. After doing an activity, they start to feel soreness in their muscles. Technically, this is a muscular injury, but we all know that no one goes to the doctor for them.

 

(20:57):

And there's no MRI ultrasound findings. There's also fatigue based muscular injuries as well, or fatigue induced. So there's stiffness during the activity due to poor warmup. Typically we believe this could be a predisposition for an injury. So it's something that you should be weary of. And just note, because over the course of time, you may experience other conditions in that area. But those two are ones that people typically don't go to doctors four because they usually dissipate on their own. The other two are the ones that we see a lot of people for. So there's spine related, and then there's muscle related neuromuscular muscle disorders. Okay? Spine related one is the easiest one I think for most people to relate to. An example would be an L five S one nerve root impingement either created from stenosis or foraminal stenosis, or a pinched nerve or disc herniation, whatever it may be.

 

(21:52):

If it affects the S1 nerve root, then the person may experience tightness of the hamstring or calf, which limits flexibility or the ability to bend forward or stretch those muscles. And so this may mimic a muscle injury, and it will last for quite a bit of time until that actual root cause is solved. This may require different forms of treatment beyond simple muscle treatment, beyond simple stretching and tissue work and massage and red lasers. And by the way, I'm not bashing all these things. These are just things that people do and ice and heat and rest and so on. There's other things that need to be done. And so for spine related disorders, a lot of times there's core involved. There's internal pressure management, as I call it. But the actual technical term is intra abdominal pressure coaching from diaphragmatic breathing.

 

(22:47):

A lot of times there's, there's other ways to solve the issue rather than just beat the snot out of the muscle. That's, that's tight. Okay? Many clinicians also believe that athletes with lumbar spine pathologies will have a greater disposition for tears of, say, the hamstring. Now if we relate this back into our sports hernia, people, lower abdominal scenarios, we find that people who have bend points of L1-T12, L 1-L2, like that's their, we call it a spinal hinge. It's there, like, there's like a sinkhole right there because they use it a lot too, to move from those people tend to have a lot more lower abdominal strain feelings. And again, I'm using strain very loosely on purpose. 'cause now we've already defined those, some of those terms. So in that case, settling down the spine may dissipate the feeling of the strain in the lower abdominal area.

 

(23:41):

Now spine related disorders, now you might find positive imaging findings in the spine, but it's not a hundred percent needed to do that. A good examiner can actually figure out how to manage you without having to get the images done, which again, wastes time and money. You're, if you have a good skilled examiner, they can also figure out if you need the image. So they may find in your history and exam that you actually need to have an image performed, which helps them make a decision about how to help you. Okay? But there are normal findings in the spine images that are not anything you need to worry about. We've done podcasts about disc degeneration before and disc herniations and stenosis. We've done 'em on all of these. And generally speaking a lot of them are not surgical based.

 

(24:33):

Some of them are re: it relates mainly to how you present in your functional loss. But a lot of 'em are just a lot of hard work and guidance. People just need guidance on what to do. The last category here is that muscle related neuromuscular muscle disorder is a big, a big word there, right? And these ones are more of what I call as a reciprocal ambition. One. First, some of you have been through physical therapy, rehab, or even reading some of these articles online. You may have figured out that term of overuse. Some of you may even have gone into the rabbit hole of regional interdependence or the joint by joint approach to training or rehab. And this basically relates to how the body not only neighboring joints, but muscles within the same joint work together.

 

(25:26):

And so if you have a hip flexor that's tight, chronically tight, or "strained," it may be due to your glute max and other glute muscles not working well. And rather than focusing on that hip flexor and figuring out what you gotta do to relax that thing directly, it may be easier to take the overused chronic workload away from it so it stops becoming so tight. Similar to the spine related one, if you take the spine insult away, then it decreases the amount of tightness you feel in the innervated tissue. Same thing with the reciprocal inhibition type, which is basically opposing muscle groups. So in a lower abdominal area, you may wanna make it. So also the hip works better. You also may wanna make it so the other musculature in the abdominal area works well with the muscles that are working too much.

 

(26:24):

And you may also want to help out with improving your internal pressure so that you can decrease the insult on that. We called it the shutter effect, and we covered it in the other podcasts as well, which is more associated with the onset of people with sports hernias. Okay, so now just to reiterate, we have fatigue-based muscular injuries, which is, again, no imaging findings, delayed onset muscle soreness or doms, which is no imaging findings. Spine-Related neuromuscular disorders, which have no imaging findings of the local muscle tissue. And then muscle-related neuromuscular muscular disorders, which is, again, no positive imaging on the area of concern, but you may find other muscles around it which are not working well. So that basically encompasses, in a nutshell, the majority of you experience either spine-related or reciprocal inhibition base, which is other muscles and around it are not helping.

 

(27:22):

Okay? So I cannot stress this enough. Do not always focus on the area that hurts. If you find what is creating that muscle to become tight, either protective, which is spine-related or overworked, which is muscle-related, then you can solve the issue long-term. Nothing's more frustrating than going back into your activity. After you've rested it and it feels better, then it comes right back, okay? Which is a common scenario for a lot of people with this, if they don't address the underlying cause. Now structural-related muscular injuries, which is again, gonna be positive. Imaging findings don't always have a direct trauma to it, either. No one has to hit you to create it. I had this experience when I tore my hamstring. I was sprinting for a baseball, and it felt like someone threw a baseball and hit my leg.

 

(28:14):

And I looked down, there was no ball there. I fell over. I felt a clunk. And then what ensued after was swelling into the area and bruising, that's a, that's a structural muscular injury, and I probably would've had a positive image whether I had gone, but in that case, I didn't need to because I knew what it was. Again, you may feel a snap, it may be a minor partial muscle tear, it might be a moderate partial muscle tear, which may include a little bit of retraction, a part of the unit or maybe a total an avulsion. If it's something like an avulsion, you're gonna know because you won't be able to move the area and you'll, your movement will be arrested and you'll have quite a bit of bruising. In that case, it may be important for some areas like the shoulder or the bicep or certain muscles to actually have 'em reattached.

 

(29:04):

And this is a little bit more outta my realm, but I, I don't do surgery to reattach things, but from my understanding, the sooner you get it reattached, the better because then it won't mat down and attach to other surrounding tissues, because if you leave it long enough, it'll, it'll start to find an attachment point, and then it'll mat down with its scar tissue. Now, I'm gonna go back to the consensus statement now and give you just some line item things that I thought were really interesting, and they were talking about terms that need to change. So, muscle injury terms with highly inconsistent answers in the survey were strain, pulled muscle hardening and hyper tous, essentially across the board. There's no uniform answer for this. So we either need to stop using them or we need to define them better. And that was part of their goal.

 

(29:50):

They said the term strain should basically not be used anymore. And we should substitute that for these things that I just talked about, which is the four other categories, pulling muscles is a layman's term and is not really defining any types or grades of muscular injuries. So it shouldn't really be used as a scientific term. And they said that hardening and hypertonus also was not well-defined and shouldn't be used as scientific terminology. We can use 'em as slang, but essentially it's not gonna have a definition. Now lastly I'm gonna give you leave you guys with the idea again of is an MRI needed, okay? Because I think this is the biggest question that I get when I work with people who are tired of dealing with stuff for a long time, and they have pain in their full function. They don't have any bruising.

 

(30:39):

You know, it just came on. There was no pop. Do I need another MRI done? Well, probably not, you know, and I mean that mainly because if you have a good examination, you don't need one done. Okay? If it's a structural injury and you suspect a possible fiber tear, or, and you have the history and exam findings to indicate that it matches, then maybe probably essentially if you think that there's more of an a complete detachment, I think that would be something that maybe reattachment sooner or later would be a, a better idea. But even with old tears, the body finds a way to get around it. I never had my hamstring tear addressed. There's no divot. It's not a big one. It's pretty small. It was probably more into the, the old category would be a grade two, which is some tissue damage with reduced strength, but really not any tearing off of the bone.

 

(31:48):

But it heals itself. That's the function of scar tissue. It's supposed to heal itself and the body finds a way, and then now the area doesn't hurt at all anymore. I didn't even notice it. But if we plan on changing our protocol and treatment plan, then yes, an MRI is needed based upon if you find what you think you'll find, okay? And I mean this with the best intentions, it's really an MRI should not be up to the patient or the cli or the client. It should be up to the, to the, to the clinician. It's a tool to figure out if we are managing this as we are or not. Okay? I had a really great instructor in school that they had, they had a case they talked about, which was a knee MRI, they had to redo a couple times.

 

(32:39):

It was a younger kid. He had a contusion direct trauma to the knee in that case. Trauma's a wild card. It could be anything. The kid wasn't getting better. They did an MRI and it was normal. And so a few weeks later, the kid still wasn't getting better. MRI normal, his kid still wasn't getting better a few months later, even though the insurance company wouldn't pay for it anymore, MRI positive bone marrow edema, which indicates small fractures of part of the spongy bone of the femur. In that case, since he thought he may find something that changes his judgment, he kept imaging or changing the image or asking the radiologist to figure out if there's something missing. I had, I had somebody years back that I had to call the radiologist to see if we can find finer slices of an MRI to make sure that there was no bony injury to the area.

 

(33:38):

And they did that for me, and it was clear and it was good. Okay? So, but if I found that I would probably refer this person out to an orthopedic, okay? And when my instructor found that he no longer tried tissue work, he no longer tried rehab, he took the kid outta the game and let the area heal itself. So if you think your management will change, then your doctor, your physical therapist, your chiropractor, your orthopedic doctor will probably suggest an image because you're not abiding by the same timeline of recovery. Okay? If I cut my finger with a, you know, like a paper cut, we should all know within, you know, three days, most of the pain goes away, it's still red, you know, within a week's period of time, it's scarred over within two weeks. You don't even know it's there.

 

(34:28):

You know, if it hurts like heck in the beginning do we need an image for that? No. Do we need blood work? No. It's abiding by the normal healing timeline. Okay? Now, something like a sports hernia, which should, the pain should reduce, especially if there's no bruising or swelling, there's no discoloration. It should reduce within about a week's period of time, maybe two. And it should feel normal doing day-to-day things. If it doesn't, then maybe we wanna do an image to see why. Now, if the person's being treated and the exam and the history indicates that they don't need an image, and they're gonna be treated for two to three weeks expected timeline, again, if you get the right treatment down, or you take the, you take the triggers away, triggering movement away, or the triggering activity, then two to three weeks, yeah.

 

(35:20):

Is, is enough time to find a really good result. And that's what we find at Performance Place. We find that two to three weeks is enough for most people. With even stubborn lower abdominal strains and adductor strains and groin pain in, in sports hernias, we find that a lot of 'em over the course of two to three weeks feel a lot better when we get the recipe right, okay? Now, if they don't, we may consider changing the treatment protocol, or we may decide to do an image. It's really our decision. Now, we, I've had people who have asked before, like, do you think I should get an MR? I'm done. You know what? It's up to you. You know, your, your money, your time, you may not, if you don't get it paid for, that's okay. You know, I've had enough things over my lifetime where I've got images done where probably my doctor wouldn't have sent me for them because I wanted what I call a clean bill of health.

 

(36:11):

I wanted to make sure there wasn't any muscle, muscle injuries. I wanted to make sure I didn't have an infection. I wanted, make sure I didn't have anything else that would change my protocol. And I wanted to know early, so I paid cash and it was negative, or I found normal things for the scenario. And I wasn't worried about non findings. I wasn't worried about normal activity and age related findings. I was worried about that one finding, was there an infection? Was there tuberculosis? Was there a fracture? Was there a tumor? Was a tendon torn off a bone? Those things weren't really found so cool. Let's just do what we're doing. And if people want that, by all means, I have no problem with that. But if you get hung up on the idea of finding and seeing something in there, you may be disappointed because not all pain is related to positive imaging findings.

 

(36:56):

And I think that's gonna be the whole takeaway in this podcast. Okay? So if you guys ever need help and you want advice, we are here. Okay? At Performance Place, we have virtuals. And in-person sessions we've seen people virtually for sports hernias with not a lot of problems. We're pretty transparent with, again, our timelines, as I mentioned on here, two to three weeks. Generally, things feel pretty good. Obviously this is a case dependent person, dependent, you know. But we also, because people may not, if they don't fall into those timeframes, they're also not something's wrong. Not like wrong, like disability or surgery wrong, but it's like we don't have the recipe, right? We may have given you the wrong exercise to do. You may have done it poorly. You may have interpreted differently how we want it. Maybe form is an issue.

 

(37:49):

Maybe we coached it poorly. Maybe it wasn't enough reps, so we need to reevaluate. But usually when we get the recipe right, people don't need surgery. They don't need medication, and they return to sport. Okay? So if you guys ever want help from us I, I don't wanna say we're the specialist of sports hernias, but we sure see a lot of 'em. We see a lot of groins lower, a lot of adductors, a lot of low backs, a lot of hamstrings. And especially in the regards to the sports hernia realm. If you're not finding help where you're at, come see us. We'd love to provide some clarity for you and some guidance and get you on the right track. And just make sure you get back to a, a, a healthy and fulfilled life. I know that if I was not able to play my sport, baseball, which I still love to play weekly, if I could spend 10 hours in a baseball uniform every week, I'd be very happy. But if I don't feel like I can play how I wanna play, I'd be very frustrated. And it degrades my quality of life. So I don't want that for you guys. Mandy and Dawne don't either. And so reach out to us [email protected] or 714-502-4243. We have all of our contacts in the description for the, for the podcast, and we're looking forward to working with you. See you guys next time. Subscribe to the podcast for more of this to come.

The Sports Hernia 6 Step Recovery Plan

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In this podcast episode, we dive deep into the factors that distinguish athletes experiencing hip or groin pain from their pain-free counterparts. This information helps us understand sports hernias as well (biomechanically speaking). Join us as we unravel the complexities of athletic injuries, exploring the unique biomechanical, lifestyle, and training variables that play a pivotal role in shaping each athlete's experience. Whether you're an athlete seeking to understand and prevent pain or a fitness enthusiast curious about the intricacies of sports injuries, this episode offers valuable insights to help you stay injury-free and perform at your best. Tune in to discover the secrets behind hip and groin pain in athletes!

Study https://pubmed.ncbi.nlm.nih.gov/26031646/

Sebastian's Low Back Books:

Part 1: 6 Powerful Exercises To Reduce Lower Back Pain

Part 2: Understanding Lower Back Diagnosis & How To Not Let Dr. Google Lead You Towards Failure

Part 3: Understanding Lower Back Treatments & What Works For Most People

Part 4: Weight Training After Lower Back, Hip or Groin Injury

Sebastian's Groin/ Hip Books:

https://www.p2sportscare.com/product/understanding-hip-diagnosis-book/

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