Latest / The Driven Athlete / Why Your “Arthritis Flare” Isn’t Sudden And What Actually Calms It Down | Ep 103

Transcript

Why Your “Arthritis Flare” Isn’t Sudden And What Actually Calms It Down | Ep 103 · The Driven Athlete

0:00
SPEAKER_00: If you're a driven active person who wants to reach and pursue a higher quality of life with some ambition, then guess what?
0:06
SPEAKER_00: This podcast is for you.
0:08
SPEAKER_00: This is the Driven Athlete Podcast.
0:12
SPEAKER_00: What's up, y'all?
0:12
SPEAKER_00: It's your man, Dr.
0:13
SPEAKER_00: Kyle.
0:14
SPEAKER_00: So I wanted to talk about something that I've talked with patients a bunch, like answered this question a lot.
0:20
SPEAKER_00: So I wanted to break it down a little bit more in detail in a podcast like this and share it with y'all.
0:26
SPEAKER_00: So a common question I get with somebody coming in with like knee pain, all right, and they're like, I have arthritis.
0:34
SPEAKER_00: Do I like it?
0:35
SPEAKER_00: It's very swollen.
0:36
SPEAKER_00: Should I get an MRI?
0:37
SPEAKER_00: Like, what's going on?
0:39
SPEAKER_00: What's the problem?
0:39
SPEAKER_00: It's not, it's taking a while to get better.
0:42
SPEAKER_00: Like, what's what's going on?
0:43
SPEAKER_00: And this is for a profile of a person who's active and athletic and wants to have a dynamic lifestyle, and they're over the age of probably 50, all right?
0:51
SPEAKER_00: Over the age of 50.
0:53
SPEAKER_00: So an active adult that um plays golf, pickleball, exercises, jogs, runs, uh, walks on the beach, just active lifestyle, right?
1:03
SPEAKER_00: Um, and now all of a sudden they, after a somewhat of a moderately mild kind of accident, like they twist their knee or they fall on it, or it just kind of came out of nowhere if they misstepped somehow, and now they have inflamed, like uh their knee hurts, all right.
1:18
SPEAKER_00: And it's inflamed and swollen.
1:19
SPEAKER_00: Like, what happened?
1:21
SPEAKER_00: And uh, why is it this bad?
1:23
SPEAKER_00: It's taking longer than expected to get better.
1:26
SPEAKER_00: And uh the underlying imaging is concerning, all right.
1:31
SPEAKER_00: As in like they got an x-ray, that's the standard first step, and the x-ray is just demonstrating um arthritic changes, roughening of the articular surfaces of the of the joint and the bones of the knee, where the bones articulate with each other, um, and um increased signaling for inflammation, all right.
1:50
SPEAKER_00: So um commonly what happens is like this.
1:53
SPEAKER_00: All right, so somebody comes in and they say, My knee's bothering me.
1:55
SPEAKER_00: I was exercising like normal.
1:57
SPEAKER_00: I felt maybe like a little, my strained my knee a little bit with a workout or like with walking, but I didn't really think much of it.
2:03
SPEAKER_00: And then the next like two days later, it just progressively got way worse, the pain and the swelling and the irritability, and like and now it hurts.
2:11
SPEAKER_00: And so I went to the doc, they get an x-ray, and it was showing these underlying did what they would suggest as degenerative changes, like arthritic degenerative changes where the joint surfaces of the bones and the cartilage are maybe roughened and increased signaling indicating inflammation.
2:27
SPEAKER_00: All right.
2:28
SPEAKER_00: So, what what's going on and why?
2:30
SPEAKER_00: All right.
2:31
SPEAKER_00: So um, these things can take a little while to get better.
2:34
SPEAKER_00: The underlying degenerative changes of the joint, like arthritic changes, cartilage breakdown, roughening of the articular surfaces, maybe even soft tissue derangement, what they would call like internal derangement, like the meniscus gets frayed or tear in evidence of tears of the meniscus, um, and underlying soft tissue that's um inflamed and degenerative changes as well.
2:57
SPEAKER_00: All right.
2:58
SPEAKER_00: Um, so they get that and it looks concerning.
3:00
SPEAKER_00: And they're like, man, I have this arthritis.
3:02
SPEAKER_00: Like the doc said, I'm bone on bone, or I'm I'm almost bone on bone, but it's pretty bad.
3:06
SPEAKER_00: Um, those underlying joint degenerative changes take years to develop.
3:12
SPEAKER_00: All right.
3:12
SPEAKER_00: Bones don't just get arthritic like that after one incident where it's like, I don't know what I did, and all of a sudden I have arthritis.
3:18
SPEAKER_00: It's like it's not what happens.
3:19
SPEAKER_00: The underlying degenerative changes were already present.
3:22
SPEAKER_00: And this uh event that happened, this episode triggered an inflammatory response that are that triggered an underlying vulnerable joint that's are set the stage for it to be maybe more vulnerable and sensitive.
3:35
SPEAKER_00: Now is just inflamed.
3:36
SPEAKER_00: All right.
3:37
SPEAKER_00: And it's exposing the underlying degenerative changes that were already present.
3:40
SPEAKER_00: Uh didn't create more degenerative changes, as in like um the meniscus maybe being frayed, because if meniscus gets frayed over time, like a rope gets frayed from micro instability, not the best movement mechanics and movement patterns that leads to fraying and breakdown, uh, minor micro trauma injuries, like tiny little things.
4:01
SPEAKER_00: You don't feel them over many, many years and episodes of doing exercise and stuff like that, stairs, pivoting, getting out of your car, playing basketball, playing with your kids, running on the beach, exercising, all that stuff, right?
4:12
SPEAKER_00: Pickleball, tennis, golf, all the fun activities.
4:14
SPEAKER_00: And then to the point where it's like you're 56 now or 54 years old, and then uh one little incident that you didn't think was that big of a tweak, you tweaked your knee, and it just creates a huge cascade of inflammatory responses.
4:26
SPEAKER_00: And now your knee is swollen, it hurts, it's irritable and sensitive.
4:30
SPEAKER_00: All right, this cascade of inflammatory responses, it creates a heightened neural irritation, the nerves that innervate the soft tissue in your knee, the joint capsule, the underlying synovium, um, the soft tissue structures that connect to the knee joint, the tendons, the ligaments, all those things, all right.
4:50
SPEAKER_00: Those soft tissues have nerve endings that are millions of nerves that are over the place.
4:54
SPEAKER_00: They're just very sensitive for the purpose of feedback, which is good.
4:57
SPEAKER_00: And they get very neurally heightened and sensitive and irritable, all right?
5:02
SPEAKER_00: And that irritability also creates some inflammation and it gets sensitive, all right?
5:08
SPEAKER_00: And that joint inflammation makes the joint get puffy, it's bigger, it's feels less mobile with range of motion is limited.
5:13
SPEAKER_00: Maybe it's puffy, feels full.
5:15
SPEAKER_00: That's another thing I hear a lot of my knee feels full.
5:18
SPEAKER_00: Well, it's full because it's inflamed, right?
5:20
SPEAKER_00: That's a expected thing with this little tweak that you had.
5:23
SPEAKER_00: Um, and then the irritability in the soft tissue and the presence of swelling and the neural irritability, that also creates the muscles to be guarded.
5:32
SPEAKER_00: So muscle guarding and hypertonicity, and we think hyper being a lot and tone of the muscle, the resting tone of your muscle.
5:39
SPEAKER_00: And your muscles are always all always are always turned on, and that resting tone is heightened.
5:46
SPEAKER_00: So things are guarded and tense.
5:47
SPEAKER_00: All right, it makes them feel stiff and tight.
5:50
SPEAKER_00: In addition to that, the muscles also become weak.
5:53
SPEAKER_00: So muscles can be hypertonic, guarded, and they can also be weak where they're more inhibited, and that also leads to maybe more uh underlying instability of the knee, and it's just more vulnerable in addition, right?
6:06
SPEAKER_00: So it's just all these cascades of events that occur now because of this one little tweak that happened of an underlying joint that already had some underlying degenerative changes that already had some underlying vulnerability, that now this one little tweak or one little move exposed all these underlying degenerative changes that makes it look scary on an image, like an X-ray or MRI or something.
6:27
SPEAKER_00: And then now all these other cascaded things happen.
6:29
SPEAKER_00: All right.
6:29
SPEAKER_00: And so now they're present at the clinic, right, to see us, and they're like, my knee's swollen, why?
6:35
SPEAKER_00: Right?
6:36
SPEAKER_00: Like what's what's happening?
6:38
SPEAKER_00: It's not really, it's taking a lot longer than I expected.
6:41
SPEAKER_00: And uh, what do we do?
6:42
SPEAKER_00: What's the course of action?
6:43
SPEAKER_00: Do I need an MRI?
6:45
SPEAKER_00: Do I need surgery?
6:47
SPEAKER_00: That's all independent cases.
6:49
SPEAKER_00: But for the purposes of this person that I'm thinking of right now in my head, they're an active individual, they're mid to late 50s.
6:55
SPEAKER_00: Um, they're an intelligent person, of course, like they want to get better, they're motivated to get better, they're just concerned.
7:01
SPEAKER_00: And the message that I give them is um what I just educated y'all on, as in like, here's what happened.
7:09
SPEAKER_00: Um, the underlying degenerative changes have been there for years.
7:12
SPEAKER_00: All right.
7:13
SPEAKER_00: So, what studies and the empirical evidence and research would suggest is that if you were to take an MRI or an X-ray today, and it demonstrates underlying degenerative changes that we talked about.
7:24
SPEAKER_00: And if you were to take an MRI of that joint, let's say the knee for this particular conversation, five years ago, have another MRI, and you put them side to side next to each other, they would look almost identical.
7:35
SPEAKER_00: As in, like the degenerative changes really haven't progressed significantly that much to be noticeable on an MRI or an X-ray from five years ago to today.
7:44
SPEAKER_00: The only difference would be that there would be maybe increased signaling indicating acute inflammation.
7:49
SPEAKER_00: All right.
7:49
SPEAKER_00: Signaling being like that's brighter on certain images or certain areas of the knee joint on the bones or the soft tissues surrounding, that would indicate increased inflammation, it'd be acute inflammation from the tweak that just happened, and then the inflammatory cascade of events and uh responses that just happened.
8:06
SPEAKER_00: All right.
8:07
SPEAKER_00: But if you were to take an MRI of today's knee and last five years ago knee and put them together, and you were to present them to a researcher or a radiologist and say, hey, look at this MRI, these two knees.
8:19
SPEAKER_00: Which one's in pain and which one's not in pain?
8:22
SPEAKER_00: They would look identical, right?
8:24
SPEAKER_00: So you'd be like, they based what I'm looking at, they both would probably be in pain.
8:28
SPEAKER_00: Well, actually, the one from five years ago is not in pain, and the one today is in pain.
8:33
SPEAKER_00: So there's a disconnect in what the image shows and the person's actual symptoms, functionality, and prognosis.
8:40
SPEAKER_00: All right.
8:40
SPEAKER_00: So we don't hang our hat just on what the image says, but rather like their mobility, their reported symptoms, their functionality, their irritability, um, underlying comorbidities, their goals, what they're looking for, their profile, all those things kind of combined would indicate like what's the next step, right?
8:59
SPEAKER_00: So for this particular person in this demographic, and if you fall in this demographic case, I mean, we're this is you're not alone.
9:06
SPEAKER_00: All right.
9:07
SPEAKER_00: Um, we're like surgery surgical intervention right now is not indicated based on what that's what other docs have said too.
9:14
SPEAKER_00: And us, we'd be like, you know, if it was my knee, if it was my aunt's knee or my family member, I wouldn't, based on what you look like, I know you, like we've been working together, I wouldn't suggest surgery at this point.
9:26
SPEAKER_00: And what we would do, the course of action that we do do now is motion is lotion.
9:31
SPEAKER_00: All right, we got to improve the overall irritability state of all the neural structures in the joint of the knee itself.
9:39
SPEAKER_00: We have to settle things down.
9:40
SPEAKER_00: All right.
9:41
SPEAKER_00: The the best way for anything to get better is first you have to settle it down, get all the heightened neural activity, sensitivity and irritability of all the structures in there and the soft tissue, the connective tissue, to also settle down and decrease its inflammation.
9:56
SPEAKER_00: So it has to get less sensitive and irritable.
9:59
SPEAKER_00: And the best way to do that is non-aggressive, non-painful movement and motion because motion is lotion and exercises, appropriate therapeutic exercises to improve the blood flow, synovial fluid, and acclimate the nerves to movement again.
10:15
SPEAKER_00: All right, so it's threefold.
10:16
SPEAKER_00: All right.
10:17
SPEAKER_00: It's to increase blood flow to the area to help facilitate a healing response, increase synovial fluid production in the joint because that's where the nutrients come from.
10:25
SPEAKER_00: And it also helps to settle down uh the joint structures in there for irritability.
10:29
SPEAKER_00: And then also acclimate the nerves that are in there to movement again and pressure, a little bit of stress on the joint on purpose, but a little bit of pressure, not so much where it's going to cross the threshold of pain to make things more irritable and painful.
10:41
SPEAKER_00: All right.
10:42
SPEAKER_00: So a little bit of stress and pressure, movement, blood flow, um, that is the best way.
10:49
SPEAKER_00: Graded and progressively appropriate.
10:51
SPEAKER_00: That's the best way.
10:52
SPEAKER_00: Number one, to help settle things down and get things feeling better.
10:56
SPEAKER_00: All right.
10:57
SPEAKER_00: Number two is progressively then strengthen things and get things stronger further to increase the stability of the joint.
11:04
SPEAKER_00: If we don't improve the stability, then things are going to be more at risk and vulnerable to a tweak like just happened, to happen again.
11:12
SPEAKER_00: Because you want to walk on the beach, it's an unstable surface.
11:15
SPEAKER_00: You want to like uh walk your dog, uh, play pickleball, tennis, golf, exercise at the gym, like all those things.
11:23
SPEAKER_00: A joint is only as strong as the muscles that surround it.
11:26
SPEAKER_00: All right.
11:27
SPEAKER_00: All the other soft tissue structures, like the capsule and the ligaments, are all passive structures.
11:32
SPEAKER_00: They don't actually contribute to dynamic stability of the joint.
11:35
SPEAKER_00: So we have to get the muscles to be stronger and make the joint itself, knee joint stronger.
11:39
SPEAKER_00: And the best way to do that is by strengthen exercises appropriately and again, not to the point where it causes more pain.
11:45
SPEAKER_00: All right.
11:45
SPEAKER_00: That's the last thing we're gonna do.
11:46
SPEAKER_00: We definitely want to have everybody leave when they work with us every session, feeling like they feel better.
11:52
SPEAKER_00: Like I feel loose, I feel better.
11:53
SPEAKER_00: It feels less sensitive, it's it's more motion, I feel better.
11:56
SPEAKER_00: That's the goal.
11:57
SPEAKER_00: So imagine that over several weeks.
11:59
SPEAKER_00: You're definitely there would only be as long as you don't f it up on your own at home, all right.
12:04
SPEAKER_00: You're only, we know we are very confident you're gonna get improved symptoms over the seven next several weeks.
12:09
SPEAKER_00: All right.
12:10
SPEAKER_00: Um, and let's say you don't, then we go back for a consult with the doc again.
12:14
SPEAKER_00: All right, maybe consider another image and then another consult and see like things aren't getting better.
12:19
SPEAKER_00: Are we missing something?
12:20
SPEAKER_00: Are we checking off all the boxes?
12:21
SPEAKER_00: And the most important box to check is to not f it up at home over and over and over again, just not knowing that you're effing it up.
12:30
SPEAKER_00: A little bit of a little bit of pokes all the time.
12:32
SPEAKER_00: The best way for something to stay irritated and sensitive and irritable is to poke it all the time.
12:40
SPEAKER_00: And that would be things that unknowingly would be poking it, like, well, I'm just going for, you know, um a spin bike ride, like a workout.
12:49
SPEAKER_00: And I felt, how did you feel afterwards?
12:51
SPEAKER_00: I felt not better, like it felt swollen and a little bit sensitive.
12:55
SPEAKER_00: Then right now, it just might have been too aggressive for you.
12:57
SPEAKER_00: We need to dial it back a little bit.
12:59
SPEAKER_00: And then in the meantime, we can work on the things that we're working on to improve the movement mechanics and the mobility and range of motion and the dynamic stability and still exercise and work out, but we have to dial it back.
13:11
SPEAKER_00: If we keep poking it and effing it up over and over again, all right, and just like making it more irritable, it's not going to get better.
13:17
SPEAKER_00: That's the best way for things to linger and not get better.
13:21
SPEAKER_00: So, the other thing to consider, what that we need to work on, we have to check out your hip mobility for the knee specifically.
13:28
SPEAKER_00: We have to check out your hip mobility, where if the hips are stiff, which is a common thing after a knee tweak or an injury like this, an inflammation, inflammatory response, the hip joint can get stiff even more as well.
13:40
SPEAKER_00: And that stiffness sets the stage for the knee to have to overcompensate.
13:43
SPEAKER_00: And if the knee overcompensates, it's gonna make it more stressed and overwhelmed.
13:47
SPEAKER_00: And that's not gonna be a good recipe for the knee to calm down.
13:51
SPEAKER_00: All right, and instead, the other thing we've got to check is the ankle.
13:53
SPEAKER_00: All right, your ankle mobility is really important too.
13:56
SPEAKER_00: Um, ankle stiffness can be from the ankle joint totally.
14:00
SPEAKER_00: So we got to mobilize the ankle joints, and then also the soft tissue that connects to it, which would be like your calf, all right, the calf muscles, the tricep surray, the gastrocnemius, and the soleus, those are two key players with allowing ankle dorsiflexion range of motion and mobility.
14:15
SPEAKER_00: We're allowed, and that's moving your ankle up towards your face, like bending it backwards.
14:19
SPEAKER_00: All right.
14:19
SPEAKER_00: So if the ankle joint is limited in that dorsiflexion uh direction of movement, it's gonna make your knee overcompensate even further.
14:26
SPEAKER_00: So imagine somebody has a lack of ankle mobility and a lack of hip mobility.
14:31
SPEAKER_00: What's the joint in between that that's gonna take all the stress, get overwhelmed, and have to overcompensate?
14:36
SPEAKER_00: It's the knee.
14:37
SPEAKER_00: All right.
14:37
SPEAKER_00: So that's a really common thing that we have to have to check out too.
14:40
SPEAKER_00: And then in the meantime, core stability plays is important too.
14:44
SPEAKER_00: Balance, proprioception gets decreased when there's a presence of inflammation and swelling in the joint, which is like kinesthetic awareness of where your joint is in space, which helps with balance.
14:52
SPEAKER_00: And that is another key player, which is stability, dynamic stability, right?
14:57
SPEAKER_00: For doing uh active athletic dynamic lifestyle activities.
15:01
SPEAKER_00: All right.
15:01
SPEAKER_00: So that's something we don't want to leave, a stone unturned that we don't want to leave unturned.
15:06
SPEAKER_00: Okay.
15:06
SPEAKER_00: So uh that the the ankle mobility and hip mobility.
15:11
SPEAKER_00: The other thing I'd uh suggest is like other key uh um things that add up that we can't neglect talking about, all right.
15:22
SPEAKER_00: There's three more things, and these are all little golden BBs that add up and stack up and tip the scale for things to not get better or to get to maintain inflammation or to get worse.
15:31
SPEAKER_00: Um making it worse over and over again and just poking it, um, not providing it the um and facilitating the healing that it needs with like blood flow and synovial fluid, which would be like motion is lotion, created progressive strengthening exercises to create more stability, the mobility in your ankle and your hip joint as it relates to allowing the knee to move better.
15:51
SPEAKER_00: Um the other one, another key component of this is uh is nutrition.
15:56
SPEAKER_00: All right.
15:57
SPEAKER_00: So, like if we're maintaining a level of stress and inflammation systemically in our body, it's just not setting the stage for the knee to heal as best as it could.
16:07
SPEAKER_00: All right.
16:07
SPEAKER_00: So the say the stage is not set up for success.
16:10
SPEAKER_00: So inflammatory things is different for different people, but commonly people on this list would suggest things like um what we know the smoking and alcohol are definitely going to be inflammatory, uh systemic uh things to put in your body.
16:24
SPEAKER_00: It's not gonna be helpful for healing, all right.
16:26
SPEAKER_00: Um uh uh nutritional food that you consume would be like if a gluten, dairy, um, those are really common ones that people uh suggest are inflammatory for them, um especially if someone has like celiac, diabetes, and stuff like that.
16:42
SPEAKER_00: So it's just something to consider, all right, that like nutrition plays a role.
16:45
SPEAKER_00: Um, the other one is um stress and anxiety, all right.
16:50
SPEAKER_00: So a person's perspectives and the overall pain science approach and philosophical perspective on pain plays a role.
17:00
SPEAKER_00: Like we can't neglect the psychological component of pain and its role in recovery and healing, all right, and improving their symptoms and improving body function.
17:10
SPEAKER_00: Like the mind is a very powerful thing.
17:11
SPEAKER_00: That's something I definitely put a lot of weight on, where um this we can't neglect the psychological component of improving symptoms and functionality.
17:20
SPEAKER_00: All right.
17:20
SPEAKER_00: So stress and anxiety, the psychological component, pain, which is pain science, it plays a role.
17:25
SPEAKER_00: And by the way, I've done a uh a couple podcasts at length diving into pain science.
17:31
SPEAKER_00: So please check that out.
17:32
SPEAKER_00: It's super interesting.
17:33
SPEAKER_00: I'm a nerd when it comes to that kind of stuff.
17:35
SPEAKER_00: Um, that the pain science is a neglected component of rehab, healing, recovery, pain, improving quality of life, all that stuff.
17:44
SPEAKER_00: We can't neglect it.
17:45
SPEAKER_00: All right.
17:46
SPEAKER_00: Um, and the last component of this of like, why is it getting better?
17:50
SPEAKER_00: What's the other golden BB?
17:52
SPEAKER_00: Well, we the age is a thing, okay?
17:55
SPEAKER_00: Um somebody's 55 and they're not 25, that's third twelve that's 30 years worth of mileage on our boss system and body and life that um our cell turnover rate is not as rapid and quick and metabolism as quick as it used to be.
18:11
SPEAKER_00: All right.
18:11
SPEAKER_00: And our body remembers things, like our nervous system and our our psyche remembers stuff, and that also can set the stage for things to not heal as quick as they need to or they could.
18:23
SPEAKER_00: And then also just cell turnover and metabolism, like we're not 25 anymore, you know, where um the things that set the stage for stuff to heal up quick is how long has the issue been a problem, how severe was the problem, how irritable is it?
18:38
SPEAKER_00: And then what's the age of the person?
18:40
SPEAKER_00: All right, all those four things kind of add up, all right.
18:43
SPEAKER_00: Um, where if somebody is 19 years old, um, they had a mild sprain of their knee or their ankle or something like a week ago, and uh they're a healthy individual, like they're gonna get better fast, right?
18:56
SPEAKER_00: That's gonna be a quick turnaround.
18:58
SPEAKER_00: If somebody's mid-50s, okay, and they uh have underlying degenerative changes in their joint, so the joint's already vulnerable, all right, and it's a kind of a severe injury, like right now, it's moderately severe, all right, like the pain, the inflammatory response, it's sensitive to touch, it's swollen.
19:17
SPEAKER_00: That's a moderately severe what you would describe as like a knee injury right now, all right.
19:22
SPEAKER_00: Um, and they're 55, and it's been going on for a couple weeks now.
19:26
SPEAKER_00: Well, that's gonna take a little bit longer, all right?
19:29
SPEAKER_00: So we have to accept the reality that um things take longer when you're a little bit older, and the severity of the injury, the length of time, the overall irritability in the person's age, like all those things kind of play a role.
19:40
SPEAKER_00: So it's gonna take a little bit longer than normal.
19:42
SPEAKER_00: But we have to do the best week, the best course of action right now is uh motion is lotion, blood flow, synovial fluid, reacclimating nerves to movement again, so that um the irritability, the sensitivity of everything, the irritability settles down.
19:58
SPEAKER_00: Not poking it and effing it up at home on your own all the time.
20:01
SPEAKER_00: So, like we have to stop stressing it enough to where it's gonna help healing, but not so much to where it's gonna be crushing the threshold of pain and making things worse or just linger.
20:09
SPEAKER_00: That's how things linger.
20:10
SPEAKER_00: Um, and then nutritionally, uh being mindful about inflammatory things that we consume, um, smoking alcohol for sugar my list, the psychological component, and then the age.
20:22
SPEAKER_00: All those things add up together of all the golden BBs that set the stage for things to just like linger.
20:28
SPEAKER_00: And it's like, man, it's taking longer than I thought.
20:30
SPEAKER_00: All those things kind of combine play a role, and we can't neglect those or leave any stones unturned.
20:35
SPEAKER_00: So, what are we gonna do on our end?
20:36
SPEAKER_00: Like, what's our course of action, our lane?
20:40
SPEAKER_00: Well, we're gonna improve the knee.
20:42
SPEAKER_00: We we definitely gonna treat the knee.
20:43
SPEAKER_00: We need to get the knee joint moving better, improve some synovial fluid, neural uh de-escalation, all right.
20:51
SPEAKER_00: Uh, blood flow and synovial fluid, motions, lotion, mobilize the hip, all right.
20:55
SPEAKER_00: The posterior hip capsule plays a huge role.
20:57
SPEAKER_00: The psoas muscle gets guarded, the quad, like all the musculature that surrounds the knee, can get guarded and lit up, the hamstrings and the quads totally for sure.
21:05
SPEAKER_00: Um, the ankle joint needs to be improved with mobility.
21:08
SPEAKER_00: The soft tissue of the calf muscles also need to get settled down and de-escalate their sense, their guardedness.
21:15
SPEAKER_00: Um, that's going to improve ankle dorsiflexion, but also your calf muscle, the gastric nemius, crosses over the knee joint.
21:24
SPEAKER_00: So, like if somebody's really tender in the back of their knee, um, the calf muscle is a culprit is a main contributor and a and a key player with that.
21:32
SPEAKER_00: Like the calf muscle crosses the posterior aspect of the knee joint and it helps flex your knee.
21:37
SPEAKER_00: So that guy being guarded is going to contribute to the sensitivity and durability of the knee joint.
21:42
SPEAKER_00: So that's something soft tissue-wise that we can intervene at.
21:44
SPEAKER_00: And intervening would be um soft tissue work, stripping, cupping, and then dry needling.
21:50
SPEAKER_00: All right, dry needling is really helpful for those for those things.
21:52
SPEAKER_00: And also in the knee joint, too.
21:54
SPEAKER_00: It's been found to be helpful with decreasing inflammation, stimulating a healing response, and uh um getting things to the muscle guarding of surrounded muscle tissue are guarded to settle down to.
22:04
SPEAKER_00: So it improves mobility, blood flow, neural acclimating, neural healing, sensitivity, decrease inflammation and stimulates a healing response.
22:11
SPEAKER_00: So that's why drainaling can be really helpful.
22:13
SPEAKER_00: So we find if someone's appropriate for it and we they're cool with it, they feel uh it's appropriate for them, um, weighing all the risks and benefits and what they just like or don't like, needling could be a helpful thing.
22:23
SPEAKER_00: And we find ourselves doing needling with a lot of people.
22:25
SPEAKER_00: Um anyway, that's the recipe.
22:27
SPEAKER_00: All right, that we can't um um neglect all those uh factors play a role, you know, with letting things stay irritated and not and just not getting better.
22:36
SPEAKER_00: So anyway, I have this conversation with this patient at the end of this.
22:39
SPEAKER_00: This patient was like, Man, thank you for nobody's ever explained this to me before.
22:43
SPEAKER_00: So I was like, I'm gonna I'm gonna make a podcast about this then and and at least share it with people that want to listen.
22:47
SPEAKER_00: And then we can share with our patients, right?
22:49
SPEAKER_00: That's what this is for, too.
22:50
SPEAKER_00: So that's a little bit of a breakdown.
22:52
SPEAKER_00: And this methodology applies with, I mean, basically every joint in your body.
22:58
SPEAKER_00: Like if somebody's neck joints, their facet joints are irritated from like I slept funny and now that things really hurt.
23:06
SPEAKER_00: That's kind of a similar mechanism.
23:08
SPEAKER_00: There you have a there's a ton of nerve endings all in the facet joints of your neck vertebrae joints, and the musculature that connects there also gets very guarded and tense and that makes things stiff.
23:18
SPEAKER_00: Um, the neural irritation can start sending signals down the arm or down the trap or the back of the shoulder blade.
23:23
SPEAKER_00: Those are classic referral sites for referred nerve pain from the cervical spine.
23:27
SPEAKER_00: Um, that's that's pretty classic.
23:29
SPEAKER_00: And so our approach is be very similar, you know, and then same thing with the lumbar spine too.
23:33
SPEAKER_00: The lumbar spine joints, the neural irritability, the muscle tissue gets guarded intensed, and then um it will neural the nerves that when they get irritated enough, they can send signals down the glute, which would be like in the hamstring area.
23:47
SPEAKER_00: That would be like sydtica type symptoms, but it's preferred neural symptoms from the back.
23:52
SPEAKER_00: But anyway, but it's a similar approach and similar uh discussion that we have with our patients in a similar way.
23:57
SPEAKER_00: It's a little bit more of a delicate situation, person to person in the spine is a little bit more of a sensitive uh region that's very common for people.
24:07
SPEAKER_00: But um that anyway, that's the conversation we have.
24:10
SPEAKER_00: And this patient was very appreciative as in like, no one's ever explained this to me, like and break it down.
24:16
SPEAKER_00: Where they just were very confused and frustrated as in like, do I need an MRI?
24:21
SPEAKER_00: Like, what do I need, what do I do next?
24:23
SPEAKER_00: Nobody's giving me any answers, right?
24:26
SPEAKER_00: Um, they didn't want to pursue an injection and they didn't want to take any meds.
24:30
SPEAKER_00: So, like, there's gotta be something different, right?
24:32
SPEAKER_00: Um, where it's you know, injection, I don't hate injections, I don't hate medications.
24:38
SPEAKER_00: It's just not always the right fit for the right people.
24:40
SPEAKER_00: And the number one filter of decision making as like, do I do one or not, is just if you value it and you like it, and then there's no contraindications for you at this time for those medical interventions.
24:51
SPEAKER_00: All right.
24:52
SPEAKER_00: Um, but a joint injection, like a steroid injection, cortisone, um, that just really helps to decrease inflammatory responses right away and gets things feeling a lot better very quickly.
25:03
SPEAKER_00: And my argument for that would be like if you're for like the spump, the spine, the neck, the lumbar spine, the cervical spine, the knee, whatever, is if you're living in agony and you like can't sleep, you can't drive, you can't concentrate for work, you can't bend over, you can't be with your kids, like that that would be an indicative, an indicative time to pursue an injection like that.
25:24
SPEAKER_00: So it can quickly decrease the symptoms and you can live life.
25:27
SPEAKER_00: And then you can tolerate rehab, like sports physio type of activities, maybe a little bit better.
25:34
SPEAKER_00: And as the injection wears off and you work on things in the meantime, that's when the threshold improves.
25:40
SPEAKER_00: And then by the time that wears off, you're feeling significantly better and you don't need to pursue any more medical intervention like meds, like pain, pain meds.
25:48
SPEAKER_00: Anyway, that's that's uh my spiel on that.
25:50
SPEAKER_00: Obviously, I mean, I'm a conservative clinician, right?
25:53
SPEAKER_00: That's what I do, and I believe in it.
25:56
SPEAKER_00: I believe in what I do and I and what we do, and we've helped a lot of people.
26:00
SPEAKER_00: Um, so my personal opinion on these kind of things is I'm not gonna pursue surgery right away, and I'm not gonna pursue medical intervention like an injection or pain meds right away.
26:11
SPEAKER_00: I'm gonna try some conservative stuff first because I know that the underlying mechanism for stuff like this can be fixed, and it's not um a surgical candidate right now, or something that would need to be uh having medical intervention right now, where I'm like, I can do this.
26:28
SPEAKER_00: It'll settle down.
26:29
SPEAKER_00: It just gotta do the right things, right?
26:31
SPEAKER_00: Over a significant amount of an appropriate amount of time and then progress appropriately.
26:36
SPEAKER_00: And then the next step after this is where we get really fun and excited is like now that things are imagine seeing somebody, this is what we this is a classic situation.
26:44
SPEAKER_00: We see somebody like this, and after a couple weeks, they're like, I'm feeling better.
26:48
SPEAKER_00: Like I'm noticing it's less irritable.
26:50
SPEAKER_00: I'm able to do things a little better, I'm tolerating activities and improv better.
26:54
SPEAKER_00: Cool.
26:55
SPEAKER_00: Now's the time to continue doubling down on strengthening stuff to create more stability and more um um of a of a resiliency and a threshold for tolerance to activity for the knee, which is like progressive strengthening.
27:10
SPEAKER_00: And that's the best way.
27:11
SPEAKER_00: Progressive strengthening, that's the best way to improve resiliency of a joint, like your knee joint, your hip joint, your shoulder, your neck, your back, whatever, to lower the risk of things getting um tweaked again in the future.
27:26
SPEAKER_00: Or if for some reason something does happen, it's more equipped to handle and manage and tolerate an out-of-system thing, uh, activity or event that happened, and it's not gonna overreact with this huge cascade of events, right?
27:39
SPEAKER_00: Or imagine if like somebody comes and sees us and they're like, I don't know what I did, but I exercised and then later that day I went for a walk on the beach and I felt like a little bit of irritation in my knee, nothing crazy.
27:50
SPEAKER_00: Two days later, now it's like swollen, it hurts.
27:53
SPEAKER_00: I can't move it as much, it's really tender.
27:55
SPEAKER_00: I can't go downstairs.
27:56
SPEAKER_00: And then a couple weeks later, we're able to get them, they feel better.
28:00
SPEAKER_00: They're like, I'm improved.
28:01
SPEAKER_00: A couple weeks after that, they're like, I have no pain, and I'm back to do my, I'm like, I'm back.
28:05
SPEAKER_00: Like I don't have any issues doing what I was doing previously.
28:08
SPEAKER_00: Cool.
28:09
SPEAKER_00: What if we progress this and continue to work on purposeful strengthening exercise that leads to the best resiliency?
28:16
SPEAKER_00: And I think, in my opinion, for physical health, resiliency is the key for longevity and the ability to tolerate tweaks, out-of-system activities, things that bumps and bruises and things that it's like my body handled it well.
28:32
SPEAKER_00: How well can you bounce back?
28:33
SPEAKER_00: All right.
28:34
SPEAKER_00: So we're imagine if this person happened again, um, their knee would manage it way better after like imagine six months worth of purposeful strength and stability training and range of motion and mobility.
28:44
SPEAKER_00: I all the appropriate stuff that we would do, they would handle it way better.
28:48
SPEAKER_00: Their knee wouldn't blow up and have a huge cascade of inflammatory irritability responses.
28:54
SPEAKER_00: And we see that all the time.
28:55
SPEAKER_00: Like we work with this is not blown smoke.
28:57
SPEAKER_00: Like we worked with patients within that boat.
28:59
SPEAKER_00: Where imagine another another exec uh perfect example is somebody that's like, I don't know what I do with my neck.
29:04
SPEAKER_00: I must have slept funny, and now I can't like turn my neck.
29:07
SPEAKER_00: It hurts to turn.
29:08
SPEAKER_00: I have pain.
29:09
SPEAKER_00: Like it's down my trap or down my shoulder blade.
29:11
SPEAKER_00: It's a classic referral site for referred pain, neural referred pain and neural irritation.
29:16
SPEAKER_00: And they're like, now I'm out for like six weeks, man.
29:19
SPEAKER_00: I can't even do anything, like everything hurts.
29:21
SPEAKER_00: Or imagine if somebody was purposely strength training and they uh worked on shoulder, neck, a core stability, just general systemic blood flow, cardiovascular strength, full body strength and exercise.
29:35
SPEAKER_00: The goal is if they do sleep funny and they tweak it some way, when they wake up the next day, they're like, I'm a little sore, but I'm fine.
29:42
SPEAKER_00: Next day, I feel all right.
29:43
SPEAKER_00: I'm a little bit sore, but it's already getting better.
29:45
SPEAKER_00: Versus, oh, I'm out for six weeks and I can't even do anything and everything's already jacked up.
29:50
SPEAKER_00: It's like, how easily can you bounce back from something out of system and unforeseen that happened where your joint like freaks out and a huge over response versus like I handled it well.
30:00
SPEAKER_00: I'm a little sore, but I'm good.
30:01
SPEAKER_00: I'm back to normal, like after a day.
30:02
SPEAKER_00: It was just like maybe a couple days.
30:04
SPEAKER_00: I'm like just sore, but now I'm fine.
30:06
SPEAKER_00: That's a way better way to live with living a dynamic active lifestyle.
30:11
SPEAKER_00: Where I think the key with that is resilience.
30:14
SPEAKER_00: And that's built with purposeful strength progress progressions and cardiovascular exercise totally and mobility work and a range of motion totally, a purposeful, appropriate approach to these things that leads to built resiliency over time of how well can your body handle unforeseen things and how well can it bounce back.
30:33
SPEAKER_00: That's just what I've come to the conclusion of at this point in my current walk of life and working with patients that we've worked with and have the really the done some of them really well.
30:41
SPEAKER_00: The patients that have done really well, that seems to be the the end, that's the North Star.
30:46
SPEAKER_00: That's like the goal.
30:48
SPEAKER_00: And uh that seems to be the best method.
30:50
SPEAKER_00: But anyway, so that that's the the the conversation we had.
30:52
SPEAKER_00: And this patient was very appreciative and got some answers with it.
30:57
SPEAKER_00: So hopefully it shed some light for y'all too and some base a better understanding, you know.
31:00
SPEAKER_00: And if you have any specific questions, like please don't hesitate to reach out.
31:04
SPEAKER_00: We're always open to having comments, uh conversations with patients and people that are in pain or battling some kind of issue.
31:10
SPEAKER_00: At least we can point you in the right direction and shed some light on maybe what you have going on.
31:14
SPEAKER_00: The best way to reach us, though, is our phone number.
31:16
SPEAKER_00: All right, 561-899-8725.
31:20
SPEAKER_00: If we don't answer, please leave a voicemail.
31:22
SPEAKER_00: But we can at least chat on the phone um and uh and shed some more light on your specific issue.
31:28
SPEAKER_00: And uh and please share this with people if you feel like they'd be helpful for them too, because it could uh really help them in an impactful way without knowing.