[00:00:03] Nick: I'd like this kid, if he ever came into us may have kept going on with this pain on and off and just thinking my legs broken all the time. It's just broke. I can't place work on, my legs broken. So he could have just kept going on that that path. So gotta be careful the way you talk to anybody.
[00:00:29] PODCAST INTRO: Welcome to “In The RACK” podcast, where we provide you with the practical framework for breaking PRs in all facets of health and wellness. We are just a couple of bros giving you the simple house in a world of complex wants. No filters, no scripts, no rules, just straight talk, talk tune. Now, let's get into the rack with your hosts, Dr. Chad and Dr. Nick.
[00:00:55] Chad: Alright, everyone. Welcome to “In The RACK” podcast. It is a reckless in the rack series episode, which means we're the five episodes in. I am your host, Chad. And with me is my co-host and fellow physical therapist, Nick. So that means you guys know what time it is. That means it's story time. And for all of you that are new to our reckless in the rack series. This is where Nick and I share some stories from our patients. We like these stories only because they are not only reckless, but some of these stories may sound familiar to you, in the fact that you might be able to not only relate to the stories, but you're gonna get some free information as to how to deal with these stories, and not have to go through what our patients went through. But it's perfectly okay. I mean some of these stories, they might sound familiar. And in fact, that's the exact purpose of this podcast. So you're in good hands. So for all of you that are joining us, in this episode, Nick and I will talk about just a couple of quick stories. I'll do one. Nick, will do a couple and then we give a two cents on the story. So you're up Nick. Let them have it.
[00:02:05] Nick: So this story is and if anyone's out there that's listened to these before we give some surnames to these people, some fake news. So this first one is going to be Stick Mobility. Stick Mobility came in with knee pain. And Stick Mobility came in and said it only hurts to kneel. And this individual is an employee at Lowe's. So has to kneel down pretty regularly to put stuff on the bottom shelf that pretty much the floor level. So kneeling for extended periods of time, so needs to kneel but was diagnosed with Kendra Malaysia, and I'll go into that in a little bit.
[00:02:45] Chad: Haven't heard that diagnosis.
[00:02:46] Nick: So diagnosing Kendra Malaysia and so basically that just means softening of the cartilage on the backside of the kneecap. And was told not to lunge squat everything. But mind you let's think about this logistically. We only came up with a complaint of it hurts to kneel. So why are we telling this individual to stop squatting and lunging? Stick Mobility reported zero discomfort with squatting and so why are we stopping that? So this individual is going to physical therapy elsewhere. After two visits, Stick Mobility was like nothing's changing. I don't know what's going on. So I was like, “What were you doing with this other physical therapist?” Pretty much everything on the table, straight leg raises in all directions, all directions.
[00:03:36] Chad: All directions.
[00:03:37] Nick: And he'll slides for some, with those in all directions, range of motion and answering innovation, I guess. Nonetheless, and those aren't if you got a postdoc situation, I get it. But come on, this is someone who came in and said, “It just hurts to kneel”. That's it. Let's investigate a little bit. Let's see what's going on there. So, I quickly was like, Look, you can do these exercises if you want at home, but we're not going to waste any time here with those. We're going to start getting you doing things like squats and lunges to strengthen some of the muscles around Sydney. Because the reality of it is it in Kendra Malaysia, people can argue that all they want whatever. But if we know that there is some signs of softening of the cartilage behind the kneecap. Behind the kneecap has the thickest card. It's the thickest area of cartilage in the human body. Now, there's a reason for that there has to be. And the reason is largely because we've been deep squatting for a long, long time, millions of years. And that was primarily our resting position. But no one does that anymore because we have chairs. And I'm not saying that you need to be able to go deep squat. , it actually might help with your hip mobility and all that kind of stuff. But you could probably get through life without it. However, if we stop stressing that cartilage because that's why it's so thick. It's meant to be compressed. There's meant to be friction, and there's meant to be load on that cartilage. If it now undergoes none of that load or much less load, compared to what it's accustomed to, it's going to soften, it's going to decrease in size, it's going to become less hydrated, because it doesn't need to do those things. Your body will not divert attention to it, if it doesn't need to, if you're not taking it through those types of stresses and movements. If you stop that, then your body's gonna say clearly we don't need it. So most people out there, I would argue would show positive for contemplation because no one's deep squatting. Well, some people are but not everybody. Most people are sitting in chairs. A lot of people are avoiding squatting and lunging because they think it's bad. So that's gonna lead to some softening your cartilage handicap. So we started doing some squats, lunges, started bodyweight got a comfortable. And then we started actually getting into kneeling, go figure, we started working on kneeling. And I saw Stick Mobility three times. And I'm not trying to toot my own horn or anything, but three times, and things are going well. And a lot of it was just that, Stick Mobility just need a little guidance on how to navigate this. Because clearly, she was getting pain at work. So she started subconsciously stopping things or subconsciously compensatory patterns. So we just had to help. And guide Stick Mobility on where to go with how she should be moving and going about her day to day life as well as work. So don't avoid if you can deep squat. Great, that's awesome. I'm still working on getting my back fully, I can get into the position but still having trouble with the feet and ankles. But working on it every day. So if you can get it great, if not, low those knees up a little bit, because your cartilage is meant for that. And I could dive deep down into nutrition on that aspect. But we had a whole podcast on Vitamin-D go listen to that one. Vitamin-D can help your joints your cartilage. And then another one that's big with bones and joints is Vitamin-B six and folate, which go figure, what foods are they in? Fish, meat, liver, eggs, beef, all those all those good ones we talked about all the time daily.
[00:07:27] Chad: Why don’t we have a podcast, we keep talking about it, we're not going to do it, or we're not going to do it. We're just not going to have a podcast on plant versus animal based foods.
[00:07:36] Nick: Let's do it.
[00:07:37] Chad: We keep on talking about it.
[00:07:38] Nick: Let's do it.
[00:07:38] Chad: We keep throwing those little puns in there, but we're not going to do it, I
[00:07:40] Nick: Alright, we will do it.
[00:07:42] Chad: It's coming up, and I’ll make sure that.
[00:07:45] Nick: And one last thing on the Kendra Malaysia thing. So we're talking a lot about movement, but movement may hurt. So those squats and lunges, they may hear different and that's okay. As long as it's one night excruciating, not super sharp, and it's not intensifying as you go. I would venture that most people out there, they try squat or lunge for the first time in a while. Even if it's just bodyweight or with load, the first couple may hurt and then it's going to feel better, the more you do, then there may be some out there that it hurts more than more you do. That might be something we got to look at mechanics, other things like that you might want to see a movement specialist about that. But the vast majority of people will try it and do it and be like, “Oh, this sucks”. And then after they keep doing it like that it actually feels better. And then afterwards, you feel better off for things feel good. So that that movement. And if you are someone who loves supplements, like everyone in the world today. Supplements, certainly, they can help your joints, help your cartilage. But just know that supplements are, most of the time in terms of the supplements for joint health will not be active forms of vitamins and minerals that are good for your joints You're going to absorb those the best from food. So just know that with any kind of supplement, it's typically not the active forms. It's a synthetic form of the vitamin or mineral.
[00:09:09] Chad: And that's why it's called a supplement. It's supplemental to the stuff that you're already taking in.
[00:09:13] Nick: That is correct.
[00:09:16] Chad: Alright, cool. And beyond popular belief, we can't squat deep. It’s okay everybody that I know there's a lot of crap out there where people are talking about “No, you should only be squatting here, you request you should be squatting there”. But if you can deep squat, and you have no pain, deep squat, just do it.
[00:09:34] Nick: And also that's not to say that everyone should be loaded in a bar with their deep squat. Like some people it's just do it for mobility, that people who can deep squat really, really smoothly and have done it with a barbell on their back, by all means, keep going. But if you're just trying to regain the squat, just use it as mobility. Just use the deep squat, the depths of the squat as your mobility work. Try to hang out in it as long as you can kind of thing, work those hips, work those knees where the ankles, the feet, even the spine is gonna get some good range of motion through a deep squat. But if you're loading up the squat at the gym, and you don't feel comfortable, that's fine. Just go to where you feel comfortable, that’s it.
[00:10:12] Chad: That's good story. And my story is, I actually called this kid Thor, and you'll understand why in a second.
[00:10:21] Nick: Bolt.
[00:10:23] Chad: This kid is18. He's a high school senior, I believe.
[00:10:26] Nick: Looks like he's 12.
[00:10:27] Chad: Yes, he does look like he's 12, that's wild. And he's probably like 5’6” and 60 pounds maybe. And comes in with low back tightness. Typical kid probably going through some growing pains. Lacrosse athlete started lifting like two years ago, right about when COVID started to hit. He was like, “I think I'm gonna start lifting this seems pretty cool”. And this kid took it so seriously that he he's squatting about 400 pounds and he's deadlifting about 480 pounds, which for this kid statues, some pretty serious weight. And I was like to kind of call bullshit on it first. I'm like, “No, no, no, I don't really believe this”. You got some footage, video footage. What kid doesn't have video footage nowadays? So it showed it to me. It's legit. He's mechanics need a little tweaking. But he did it and I was surprised. But it also wasn't surprising as to why he has back pain. But he went to go see the doctor. And what did the doctor recommend? Good thing you recommend a PT but he recommended core strengthening. Understand understandable, I guess. But this kid is pretty strong. He's squatting 400 pounds. He's deadlifting almost 500 pounds. I think we can honestly say he's probably got a pretty good core for the most part.
[00:11:44] Nick: Is it functional? Because pain is pain.
[00:11:50] Chad: Exactly. So I took a good look at him. He's got a lot of hypertrophy in his back, which tells me he's probably overusing that a little bit. I'm sure he's got some issues with some hinging. He's definitely got some issues with some single leg balance and strength. And that was one of the big things that I worked with him on. And I was like, “Hey, listen, you ever done anything with one leg on the ground?” I was like, “You're really strong with both legs on the ground.” And he goes, “Oh yeah, every now and then”. And we did a just a little single leg. RDL. And it was, it was wild. We'll sit down. This is wild. But it also tells me that being a lacrosse player. There's not a lot of times playing lacrosse. You're on both feet. You're running. It's a running game. So which was scary for him and as well as his mom that was present. And I was like, “Man, we got to work on this”. His low back definitely needs some attention but that's not where this is coming from. So kind of wild how just in two sessions don't want to truth my own horn. You said three days, he's feeling pretty good. And his honestly, his single leg balance is unbelievable right now, which I know he would do on his own. But for this kid, it's more. Yes, it's consistency with the exercises. But I have to have this kid check the ego at the door. And that's so hard to do sometimes these high school kids, and it's all about weight. It's all about weight. And how many kids playing lacrosse have to checks?
[00:13:21] Nick: He does. I think that's why he's doing so well. Because he checks it.
[00:13:26] Chad: And he does. And I think that's the good thing. But one of those overlooked areas where we start just taking out little things and added some other things in terms of his training. And now he's incorporating a lot more single leg stuff which is awesome. We haven't really touched too much on the core, because his core is solid. It's not so solid when he's doing single leg stuff. But that all kind of works together when he's doing his exercises. So he's made a lot of great improvements. So if you are strong individual, and your doctor tells you any core strengthening, which may be the case. I would just question that and see if it's really the core, or is it coming from somewhere else? And I think I do a lot of that on these stories.
[00:14:09] Nick: And the vast majority of cases, I would say that is not so much a score actual abdominal strength issue. It's more of a timing issue. The timings out the sequencing is off. And that's exactly where we come in. We hope, aren't that stuff out.
[00:14:23] Chad: Exactly. Cool, man.
[00:14:25] Nick: Alright, last story. We're going to call this one Foosball. We actually so in the clinic, we movie code all day, but we really had a podcast. I think, it’s a comfortability level, we're not quite there yet. We may sound like we're comfortable, but we were kind of jittery over here. We're still getting this thing, only 30 episodes in. But we're calling this individual Foosball because Foosball is the devil. So this individual is a Foosball player, so I went Foosball because movie The Waterboy if you guys didn't know gave that shame on you go watch it. Adam Sandler in the 90s was prime. So 17 year old high school football player, very, very good athlete, very good athlete. And this individual came in. I had actually heard about the injury bought from other patients, because it was a local kid, and they were going through the playoffs that they are playing up to the playoffs at that time, trying to get a good seed and all that. So I heard about the injury, and I heard that it wasn't too bad, kind of just typical ankle sprain kind of thing. But I saw this individual, five days after the injury came in on crutches and with a walking boot non-weight bearing. So I'm like, “Oh boy, what's going on here?” So then ask him what happened, Foosball was like, I want to make a tackle. My legs were airborne. And he thinks a guy came and hit his leg while it was airborne. So no, my not typical mechanism of ankle injury. So thinking more like collision with the lower leg. Like what went on here. It was a different fracture. So went to urgent care. Got some images down. They did the first ones. They're like, “No, everything looks good. And then they did the second image” and they said, “Oh, actually, right here, it looks like you have a hairline fracture on the fibula”. So now this stuff's really not matching up. So I’m like, “Hairline fracture on the fibula, the fibula barriers 2% of your body weight. Why did we send them out with crutches in walking boot, very confused at this point?” So that's exactly what he was told, walking boot, bilateral crutches, no weight bearing until you see the doctor. Now, Foosball was encouraged by his coaches to come see us real quick before he could get in with the doctor just because it was like another week or so before the doctor. So came in, I was like, “Honestly, based on those images, let's start getting some weight through that. And we'll do everything to tolerance”. And after talking to Foosball more, come to find out this exact pain had been bothering him for weeks leading up to this. So whatever triggered the pain to intensify, to some extent, was probably the collision, whatever it was, but he was dealing with this and then the spring before, was trying to run track and couldn't even run track because of shin splints. So now I'm thinking it's not even a hairline fracture, it's a stress fracture, crazy tightness in his ankles, crazy stiff feet, and all this kind of stuff. So all those muscles are just creating so much stress and strain on the lower leg. So I'm thinking more of a stress fracture along that distal or lower fibula, the outer leg bone, lower leg bone. So now I'm like, “Now we really got to load this thing up”, it's gonna be a volume thing. We don't we want to manage his volume. And I had that conversation with him and his dead, but we want to manage this volume. But we need to get to the root cause of this because this is clearly been going on almost a year. And we need to nip this in the bud now, because this is a kid who's very good athlete wants to play football in college if he can, so we got to get back now. Foosball is gonna be a senior next year, so definitely got to get him back soon. So we got out of the walking boot. I was like, “Alright, let me see you walk and it was so guarded”. Like, not even getting through the foot. Minimum, the bend on that side, super stiff in the trunk. And I was like, “Is it painful? Is that while you're walking like that?” And every answer from Foosball was as a little bit of pain. So it was never to the point where he would come out and be like, “It's really painful”. Like, if you're hurting, if pain is making your gait that stiff, you feel it right away. You would say if someone says, “I'm in pain”. It's right away. Not it's kind of like a fair-weather answer. So now I'm like, “This was a situation where it got in his head”. He said, “They told him fracture”, and I was like, “Oh geez, I've had a fracture this whole time”, because he's had pain for the whole season, basically. And now he's like, “What have I done wrong, that kind of thing”. And then like, “No weight bearing till you see a doctor crutches, boot, whatever”. So now he's panicking inside. So you tell a 17 year old kid that he's got a broken leg, basically, when you could barely even see it on the image and tell him he can't wait bear. Even if you just know that it's a small little tiny fracture on the outside of the bone that's bears a little bit of weight. You could say “Alright, let's try it. Let's try to crutches still put way through it, though”. Let's do some education. So, it was just this type of thing that it was more so working with the neuromuscular stuff, trying to get him out of this fear avoidance patterns that he was already in. And he had probably developed some of those throughout the season, just because he was dealing with this pain on and off some days were some days a little bit better. And his coaches, after talking to his coaches. They said, “He was limping all season”. So he was dealing with this pain for a while, so he probably shouldn't try to come see us a little early, but we’re still trying to get him pass this where he can even be better for next season without all that stiffness, tightness in the in the lower leg. But if you go to urgent care or anything like that, they're trained in certain things, they're trained in more emergent situations and something like that. If the kid's been having pain all season, and then a particular movement or hit, maybe triggered a little bit more pain. You can go like most states have direct access to physical therapy, you can go see a physical therapist, I would say, most are well equipped to handle that. But don't just take the first answer. And, , be with that, if it's been pain that's been going on a long time, if it's an acute injury, like if he had no pain before this, and he went and got injured. Now we're like, “What's going on”. We got to see a doctor get some more imaging, but he was dealing with pain for a long time. So now we're thinking something a little bit more chronic. So providers out there, you can't be telling younger, especially children, adolescents stuff, threatening stuff like that, you gotta be careful your words, because they don't know any different. It could change the way their movement patterns, you could change the way they move. And it could really be the type of thing that makes your breaks their progression. Like this kid, if he'd never came into us, may have kept going on with this pain on and off. And just thinking like, “My legs broken, my legs broken all the time. It just broke. I can't play a sport anymore. My leg is broken”. So he could have just kept going on that that path. So gotta be careful. The way you talk to anybody, but especially the younger people, because most of the time, they just don't know any different. So you got to be carefully choose the words you use.
[00:22:16] Chad: For sure. Language is so powerful.
[00:22:19] Nick: Yeah, absolutely.
[00:22:20] Chad: It's part of the healing process for sure. And I think some of us missed that. So, absolutely, lesson learned. Absolutely. Cool. That was a quickie. I like the quick one. I like the quickies. I was actually looking at our stats. And it seems like every time we go over 45 minutes, which we do pretty often because we like to talk, our numbers go down. So enjoy the shorties.
[00:22:41] Nick: What’s wrong with that?
[00:22:42] Chad: I don’t know. I just want to talk to you. It's really most guys want.
[00:22:45] Nick: You guys want more movie quotes, tell us what you want. Tell us what you want. We can give you movie quotes. We can give you movie quotes all day?
[00:22:53] Chad: Well, I can say that next week, we're probably going to have a pretty long podcast. And that's only because of the next guest speaker that we have coming up next week. And his name is Dr. Jeff Newman. He is a chiropractor in Salisbury Mass. And I've known Jeff for over 15 years actually probably closer to 20. It's hard to say. But it's something like that. And Jeff and I went to school together at salvia, Regina undergrad, he went one way, I went the other way. He's a chiropractor. So he went to Palmer College of Chiropractic that's in Florida. And I went to PT school and in good Old Island. So we separated for a few years there. But once we kind of opened up our own locations, he was in business for almost a year. And I moved right in the back of his business to start. And as we started growing, we kind of both outgrew the space. So he stayed and we moved right next door. So we're still close, and we share a lot of commonalities with how we look at certain things, whether it be health related issues, healthcare as a whole. And as well as some of our treatment styles are very similar. So we're excited to have him on the podcast. And he's the type of guy that can pretty much talk about anything, which means this podcast could be long, because we can do the same thing.
[00:24:13] Nick: It could be pretty lengthy.
[00:24:16] Chad: We might be diving deep, he dives deep. So I know if he starts diving deep, then we're just going to dive with them. So that's just how it goes. But we are going to plan on focusing on a few things. I know mainly, one of the things that he wants to focus on is the chiropractic profession as a whole and we want to hear about it too. We want to hear where it's going, where it's been, where it is now. And, , I know he's going to talk a little bit about, , health care to like the future of health. He's very, very big into that and I know we'll be able to help and collaborate with that with that topic for sure. He's probably going to talk a little bit about sleeping longevity, because we're all into that. It all kind of works together as a whole for sure. So now I'm excited about it.
[00:25:03] Nick: It's gonna be a good one. It'd be good for sure.
[00:25:05] Chad: So moral of the story pretty, pretty similar to the other ones in terms of our reckless in the rack series. We obviously have a long ways to go with progression in the field of physical therapy and other fields in the medical profession. We do understand the healthcare system will never be perfect, but it seems that we hear stories like this all too often. The best thing we can do is just bring awareness like we talked about. And that is the intention of the podcast. So listen, if you're a healthcare provider, and you're listening this we just ask that you don't be reckless with other people's health. And for all those patients that are listening, you shouldn't put up with people that are reckless with yours.
[00:25:43] PODCAST OUTRO: Thank you for joining us “In The RACK” this week. Make sure to subscribe so you don't miss out on any future episodes. You can also find us online at proformptma.com, or on social media at ProForm PTMA. And remember;
“If you train inside the rack, you better be thinking outside the rack”.
