Latest / The Steep Stuff Podcast / The PT Hour EP. 2 | Dr. Sean Rimmer, Insights into Hip & Hamstring Injuries

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The PT Hour EP. 2 | Dr. Sean Rimmer, Insights into Hip & Hamstring Injuries · The Steep Stuff Podcast

• 0:00
  Speaker 1: What is up, fam?
• 0:01
  Speaker 1: Welcome back to the Steep Stuff Podcast.
• 0:02
  Speaker 1: I'm your host, james Lariello, coming to you guys after a refreshing week off.
• 0:08
  Speaker 1: You guys might have noticed that I haven't had a podcast out in probably about a week, not since last Monday or the Monday before.
• 0:16
  Speaker 1: I took a nice little break and come into you refreshed and revamped and ready to rock and roll following the holidays.
• 0:24
  Speaker 1: Guys, I got a really exciting one for you and none other than for his.
• 0:28
  Speaker 1: I think it was his fourth or fifth time.
• 0:30
  Speaker 1: Well, put it this way, we started the podcast with Sean Rimmer, so we're going to end the year with a podcast with my good buddy, sean Rimmer.
• 0:37
  Speaker 1: Sean's coming back on the podcast.
• 0:39
  Speaker 1: This is going to be the PT hour, round two or episode two.
• 0:42
  Speaker 1: We're going to be talking all about hamstring injuries and kind of those gluteal tendon issues, very common injuries and overuse injuries that athletes will have.
• 0:53
  Speaker 1: Really excited to talk about this, really excited to have Sean back on.
• 0:56
  Speaker 1: These are kind of some of my favorite conversations.
• 0:59
  Speaker 1: Just one of my good buddies, a good training partner, a good dude and one of the best PTs, if not the best PT in the game, so really exciting to have this conversation with him and bring this one to the world.
• 1:13
  Speaker 1: So, without further ado, I hope you guys enjoy this one.
• 1:16
  Speaker 1: The PT hour, round two on hamstring injuries it's time.
• 1:34
  Speaker 1: Thank you, ladies and gentlemen, we are live.
• 2:26
  Speaker 1: Sean Rimmer.
• 2:26
  Speaker 1: Welcome back to the Steep Stuff Podcast, my friend.
• 2:28
  Speaker 1: How are you Doing?
• 2:29
  Speaker 1: Great man.
• 2:29
  Speaker 1: Thanks for having me.
• 2:30
  Speaker 1: It's like I was just here.
• 2:31
  Speaker 1: Dude, I love doing these man.
• 2:34
  Speaker 1: This is, uh, you are, I think, yeah, you're the most.
• 2:37
  Speaker 1: Uh, you're the most.
• 2:38
  Speaker 1: I don't want to say the most, you're the most.
• 2:42
  Speaker 1: I don't know.
• 2:44
  Speaker 1: You're the guest that comes on the most.
• 2:45
  Speaker 1: Let's put it that way.
• 2:45
  Speaker 1: I think this is my fourth Cause.
• 2:48
  Speaker 2: I was the first one.
• 2:49
  Speaker 1: Yeah, we did two, three.
• 2:50
  Speaker 1: This is four.
• 2:51
  Speaker 2: Yeah, yeah, yeah, I love it.
• 2:52
  Speaker 2: This is fun.
• 2:52
  Speaker 2: These conversations are amazing yeah.
• 3:01
  Speaker 1: Yeah, what's good?
• 3:02
  Speaker 1: Good, good stuff there.
• 3:04
  Speaker 2: Life's going great.
• 3:05
  Speaker 2: Um, you know it's kind of the off season for, you know, the trail running side, so I'm enjoying a little bit of a mix up there doing some Nordic skiing, um, heading up the gym more, really trying to focus on my practice in business.
• 3:18
  Speaker 2: Obviously that's something that's a passion project for me and something I'm really, you know, excited about and coming in the next year.
• 3:24
  Speaker 2: And and then family man yeah, um, you know, some people know this, some people not, but I have a.
• 3:30
  Speaker 2: We have a new young one, six weeks old now.
• 3:33
  Speaker 2: So that's been a huge priority, but um already got out for a few uh stroller jog, so stoked about that.
• 3:40
  Speaker 1: You're going to be that guy.
• 3:40
  Speaker 1: I was just uh, who was I?
• 3:41
  Speaker 1: I was Steven yesterday and he was talking about how he did this turkey trot and he's like some guy with a stroller whooped my ass or took it out super fast.
• 3:50
  Speaker 1: I was like that's going to be Sean I don't know, maybe We'll see.
• 3:53
  Speaker 2: We'll see when that time comes.
• 3:55
  Speaker 2: A lot of races don't even allow strollers.
• 3:57
  Speaker 1: Oh, really, I'm get out and run and you know she's out there with me.
• 4:12
  Speaker 1: It's gonna be a blast.
• 4:12
  Speaker 1: So there's this guy, what's?
• 4:13
  Speaker 1: His name, he lives in denver I think it's kyle patari, if I remember correctly.
• 4:14
  Speaker 1: Uh is like an a mat.
• 4:15
  Speaker 1: He runs for ultra.
• 4:15
  Speaker 1: He's like a master stroller jogger, like the guy's a free.
• 4:16
  Speaker 2: What does that even mean?
• 4:17
  Speaker 1: like he's just a freak athlete with a stroller.
• 4:20
  Speaker 1: I don't know where I saw that out or read it up, but I'm pretty sure it was that guy.
• 4:24
  Speaker 2: There's like um.
• 4:25
  Speaker 2: I've seen like records where people do like marathons like sub two, 30 with strollers, I think like that is somewhere around that range is like the record which which?
• 4:35
  Speaker 1: is insane.
• 4:35
  Speaker 1: It's impressive.
• 4:36
  Speaker 1: I feel like you never have to stop.
• 4:37
  Speaker 1: You can just like store your gels and everything you got on like the top section there is one benefit, storage on side of things, but um yeah from everyone I've heard and talked to about pushing that, pushing the strollers.
• 4:49
  Speaker 2: You know if there's any sort of incline or hill, it's and you don't get the arm swing action.
• 4:53
  Speaker 1: It's totally different oh yeah, I never thought about that.
• 4:56
  Speaker 1: Yeah, maybe it'll help my uphill running yeah, watch you get like because you're already a really good uphill runner.
• 5:00
  Speaker 1: Are you gonna spank me the next time we go out because this stroller that?
• 5:05
  Speaker 2: I'm gonna see you out there with a stroller that's right.
• 5:07
  Speaker 1: Oh, you know me, you know me, that's right.
• 5:09
  Speaker 1: Let's try this out I'm always willing to adapt and change.
• 5:12
  Speaker 1: Dude, you know that.
• 5:13
  Speaker 1: Oh, yeah, yeah, dude, I, I can feel you so deeply on the gym.
• 5:17
  Speaker 1: I've been taking that pogo exercise you've been giving me and I've been taking that to like a whole new level.
• 5:22
  Speaker 1: I think I do Pogo's like three or four times a week now, like with bar and without.
• 5:26
  Speaker 2: It's in Pogo is obviously just one variation of plyometric, but there's so many you can do and and it's so fun to vary and just really work on really stiffening the muscle to get out of that tendon, because if you're so powerful and in creating force quickly off the ground, it's going to translate so well to running, especially when you're fatigued, where we start to lose that.
• 5:47
  Speaker 2: So like such an important piece to train in and you don't have to do a ton of it Like we've talked about, but like I'm excited that you're.
• 5:53
  Speaker 2: Oh, dude, I love those in.
• 5:55
  Speaker 1: I've got them saved on.
• 5:56
  Speaker 1: And for those of you who, uh, who are interested in like learning new exercises and stuff, like that Sean's website or son's instagram one potential pt check that out there's, like there's a good video on the pogos.
• 6:06
  Speaker 1: You've got quite a few amazing videos for your exercises.
• 6:08
  Speaker 1: But, like, I've got the pogos saved, I've got a few of the other ones saved, but like, yeah, man, I've been hitting those hard.
• 6:13
  Speaker 1: Um, you know what I've been doing too, and I got this from um, from jeff, and I don't know how, like I I feel like this works for me.
• 6:23
  Speaker 1: I do like, if I'm deadlifting right, I'm super max on my deadlifts, hitting max weight, and I'll do like one to three and then I'll immediately transition to box jumps after for that extra power.
• 6:36
  Speaker 1: Does that actually work?
• 6:39
  Speaker 2: There's been some studies that look at that, and so it's like you think about it with the, the both of those movements are kind of similar.
• 6:47
  Speaker 2: Are you doing a hex bar or is it?
• 6:48
  Speaker 1: straight bar.
• 6:50
  Speaker 2: So you think about a deadlift in general it's it's a lot of hip engagement, so working that hip flexion to extension at the top, but you have some knee bending too and similar to like a powerful jump.
• 7:01
  Speaker 2: It's going to look reflect more of a deadlift pattern than like a full squat pattern.
• 7:06
  Speaker 2: So by you getting a ton of recruitment to a lot of the hip extensors, the hamstring, you're almost like pre-tensioning than that getting the motor units um firing, and so that's almost going to allow that box jump that you want to be explosive and powerful, to have a lot more recruitment set.
• 7:31
  Speaker 2: So, in theory it should provide more power engagement to the box jump, um, and so that's kind of where that, you know, couplet of movement was put together and it makes sense.
• 7:37
  Speaker 2: Um, obviously you don't want to be doing 20 max effort, dev lifts and then do that.
• 7:41
  Speaker 2: That can't be a exhaustion.
• 7:43
  Speaker 2: But, um, yeah, I mean that's.
• 7:45
  Speaker 2: I think that's a great duo of exercise to do together for power.
• 7:48
  Speaker 1: Yeah, I do.
• 7:49
  Speaker 1: It's crazy, like I don't know.
• 7:51
  Speaker 1: I've been like couple and I'm trying a bunch of different things and like that's one of them, do a little extra pop in the leg, man.
• 7:59
  Speaker 2: I'm to be springy and be powerful, and you know it's.
• 8:03
  Speaker 2: It's not directly like running obviously running as a power sport, especially the short distance mountain running, but it's not the same.
• 8:11
  Speaker 2: So when you really get to hit that top end for a very short period of time, it still helps.
• 8:16
  Speaker 2: You know anything slightly lower when you're going to be running uphill and so doing that training is just so important.
• 8:22
  Speaker 1: Yeah, yeah, man, it's man.
• 8:24
  Speaker 1: I'm excited for a lot of the gym action in the off season building getting strong.
• 8:29
  Speaker 1: We got to get you out on the.
• 8:30
  Speaker 1: I know we were talking on our.
• 8:31
  Speaker 1: I've got this.
• 8:32
  Speaker 1: Like me, stephen Brad, have this like Thursday incline session, so you better pencil in 3 pm on Thursdays to get you out on the incline.
• 8:39
  Speaker 2: I'm trying.
• 8:39
  Speaker 2: I'm trying A few weeks.
• 8:41
  Speaker 2: I'll try to get as long as I know ahead of time I'll I'll try to make it yeah.
• 8:45
  Speaker 1: We got a popular time For those of you that follow me on Instagram.
• 8:48
  Speaker 2: there's a communal meeting at the In-N-Out Burger on Garden of the Gods after those Instagram stories of the In-N-Out Burger is literally pulling me into wanting to do the incline more than than anything else I'm like, oh I want to deserve that after I push the incline hard.
• 9:02
  Speaker 1: Dude, I can't believe you've never been there.
• 9:03
  Speaker 1: Oh my God.
• 9:04
  Speaker 2: Don't tell this that's live man.
• 9:06
  Speaker 2: Don't, don't say that out loud.
• 9:07
  Speaker 2: It's embarrassing.
• 9:08
  Speaker 1: It's legitimately like.
• 9:10
  Speaker 1: You know what, dude, when I put that on my story history, you know how many people like message me.
• 9:13
  Speaker 1: It looked so good Like there's people that I know me and we're like yo.
• 9:21
  Speaker 1: That looks amazing it did.
• 9:23
  Speaker 2: That's why I'm like oh man, that that sucked me and I was like serious fomo, just from that.
• 9:28
  Speaker 1: Yeah, oh man well, dude, I don't want to bury the lead too much.
• 9:31
  Speaker 1: We're here for uh, round two, episode two of our pt.
• 9:36
  Speaker 1: I wanted to call this the pt diaries, but that's a little weird, call whatever, call the pt.
• 9:40
  Speaker 1: What did I call it originally?
• 9:41
  Speaker 2: there's something pt something it was the pt hour.
• 9:44
  Speaker 1: PT hour.
• 9:44
  Speaker 1: All right, that's right.
• 9:45
  Speaker 1: Sorry, it's been a long week people.
• 9:47
  Speaker 1: Yeah, so we're here for the PT hour, episode round two.
• 9:51
  Speaker 1: A lot of things to jump into.
• 9:54
  Speaker 1: One of the things I know we wanted to talk about was gluteal tendinopathies proximal hamstring injuries yeah, so proximal hamstring.
• 10:02
  Speaker 2: Tendinopathies, yep injuries yeah, so proximal hamstring tendinopathies.
• 10:04
  Speaker 2: Yep.
• 10:05
  Speaker 1: And femoral stress, femoral bone stress, injuries as well.
• 10:08
  Speaker 2: Correct.
• 10:08
  Speaker 2: So up by the hip the femoral neck.
• 10:11
  Speaker 1: So are these all around the hip kind of?
• 10:14
  Speaker 2: Yeah, so I want to just dive into.
• 10:21
  Speaker 2: There's so many things that could come from hip pain or pain around the hip and running, but I wanted to talk about a few different running related injuries that I see pretty regularly and also some things we want to know what's directly causing it and also what it looks like recovering, and so these injuries I'll tend to see come on within running, versus people who just start to have pain from something else but they feel it running, and so you know we talk about just to define this first, running related injuries.
• 10:51
  Speaker 2: Um, typically any of these injuries come on as a result of running and training, with other factors mixed in, versus, you know, say, someone with back pain from a sit job and then they run and it's like I have back pain that's not really coming from the running, and so these are going to be more specific to the runner themselves Interesting.
• 11:10
  Speaker 2: So you know we've talked about this in the past a little bit in podcasts, where you know it's so common, just with the nature of running, that tendons and bones tend to become irritated.
• 11:22
  Speaker 2: Um, and you know it doesn't happen in every runner, but these are just very common injuries we see, so I always want to highlight those and make sure people understand what we're dealing with.
• 11:32
  Speaker 1: Yeah.
• 11:32
  Speaker 2: All right?
• 11:33
  Speaker 1: Well, let's jump into the first one.
• 11:34
  Speaker 1: Man, what is what the hell is a gluteal tendinopathy and how do I avoid it?
• 11:38
  Speaker 1: What does it feel like?
• 11:38
  Speaker 2: And what do I?
• 11:40
  Speaker 2: Do if I got it, so it sounds like you've never dealt with one, and that's totally okay, I mean, maybe I don't know, you're my PT, so you would know from what I remember, I don't believe so, but yeah, great question.
• 11:50
  Speaker 2: So we'll talk about the first part, gluteal.
• 11:52
  Speaker 2: And so when most people think of the glute muscles we ha, they think of maybe glute max, um, which is the big butt muscle on the backside, um, but we also have glute meeting, glute men, which are more on the side of the hip and a little bit towards the front side of the hip, and so the gluteal tendinopathy we'll be talking about is more from the glute medius.
• 12:13
  Speaker 2: Okay, so that's that muscle that's really been common in mainstream, you know, on the internet and and blogs and all that over the years, where people see the hip drop and they're like, oh, that's the muscle at fault.
• 12:27
  Speaker 2: And yes, that muscle is supposed to help stabilize the lateral hip and pelvis.
• 12:33
  Speaker 2: But oftentimes I'll see the gluteal tendinopathy in that region come on for a vast different reasons, not just because the pelvis is dropping, and so when look at talk about the tendinopathy portion, that relates to, again, pain in the tendon.
• 12:50
  Speaker 2: So the muscle of the glute meet on the outer part of the hip attaches up throughout the pelt on the side of the pelvis bone and then the tendon kind of streamlines into just above the outer portion of the hip.
• 13:04
  Speaker 2: So typically when we're seeing pain in this region it's very focal right Tendinopathies are usually going to be right in the area of the tendon.
• 13:11
  Speaker 2: We're not going to get pain radiating anywhere or stemming from a different area, and so that tendon on the outside tends to get irritated and overloaded from from training, from biomechanics, from a lot of different factors and causes pain in that typical area, and so that's typically what we'll see.
• 13:29
  Speaker 2: Now I'll typically see this more in females.
• 13:34
  Speaker 2: That's just tends to be the nature of things, but it doesn't mean you can't get this being any gender, and I'll typically see this in kind of that middle age to older female, so anywhere from 40 to 65.
• 13:45
  Speaker 2: There has been research to show that it is more common in perimenopause women, which again kind of around that age anyways, and so those are always factors that come into play when we're looking at and diagnosing things.
• 14:00
  Speaker 1: Interesting.
• 14:01
  Speaker 1: So if I'm starting to feel it, where am I feeling it?
• 14:04
  Speaker 1: What am I feeling?
• 14:05
  Speaker 1: Is it sharp, is it dull?
• 14:06
  Speaker 1: Is it jumped into that for me?
• 14:09
  Speaker 2: Yeah.
• 14:09
  Speaker 2: So if we think about like an assessment for these injuries I think that's an important question I'm always asking, right, what are the?
• 14:17
  Speaker 2: What are the nature of symptoms?
• 14:19
  Speaker 2: Right, and, to be honest, everyone's subjective complaints can be different.
• 14:24
  Speaker 2: So I've had people say, hey, this feels like it's more of just an ache.
• 14:29
  Speaker 2: I've had people say tendinopathy is burning, and then I've even had at times where it's things that may be more irritable, that it can be sharp, and so that's something I always tend to take with a grain of salt, cause it's not always like it's an ache, it's not one of burn yeah.
• 14:45
  Speaker 2: It can vary, and so the location is key, right, we want to know is it within the area of the tendon?
• 14:50
  Speaker 2: Because if someone has pain in, you know, the front of the hip, I can almost guarantee it's not going to be a glute medius tendinopathy.
• 15:00
  Speaker 2: And so the location's really key.
• 15:02
  Speaker 2: When we talk about behavior, of symptoms, that's more of like how does it act throughout the day?
• 15:09
  Speaker 2: How does it act with running?
• 15:11
  Speaker 2: Those are going to give me a big lens into any type of tendinopathy.
• 15:14
  Speaker 2: And so rule of thumb with tendinopathy behavior, typically in beginning of the run, when you're not as warmed up, things maybe feel more irritable, more stiff, and then we'll typically start to see something like a warmup phenomenon where things may become less irritable or pain may even go away, and sometimes throughout a run that can be like that until the end.
• 15:40
  Speaker 2: Other times we'll see again pain a little more stiff in the beginning, warms up.
• 15:44
  Speaker 2: Other times we'll see again pain a little more stiff in the beginning, warms up, but then gets more irritable at the end, and again similar phenomenon.
• 15:51
  Speaker 2: We get that up and down swing, rarely though it does happen.
• 15:54
  Speaker 2: Things progressively get worse, but depending if it's like a tendinopathy that's really irritated, that may be the case, but usually it's not.
• 16:05
  Speaker 2: It's more of like that warmup period and then otherwise, with tendinopathies I'll typically see like first thing in the morning, or if someone has been like sitting for a while and they get up it's like, oh, that's, that's really stiff and irritated, and then they get moving around and things warm up.
• 16:22
  Speaker 2: Um, now, when we get into talking about bone again in a little bit, that's different, and so me trying to understand that behavior of symptoms really helps to give a lens into again really what tissue it is and then also the severity, right, yeah, and the irritability of it, and that's going to help us dictate what we need to do for adapting training load and then treatment strategies.
• 16:48
  Speaker 1: Do you see this flare up more in like I don't know, like runners running steep stuff or pun intended, or like flat stuff, marathon runners, like what type of like modality athlete?
• 16:59
  Speaker 1: Do you see this flare up in more, or does it even matter?
• 17:01
  Speaker 2: That is the million dollar question.
• 17:03
  Speaker 2: Um it for this type of pain it doesn't really matter.
• 17:08
  Speaker 2: Um, what I will say common trends I've seen is again, you know so many times we talk about like training error, where it's, if we look at two main things, right, think about, like any tissue injury or tissue irritation we have, like, are we going above load capacity too much, and when then we're not allowing the recovery?
• 17:28
  Speaker 2: Or are we increasing too much um frequency or um duration of training, more than the body's prepared for?
• 17:37
  Speaker 2: And not that the tissue is at fault, but it's more of like, hey, there's just a capacity issue or, um, we're just doing too much, basically, and we don't allow the recovery.
• 17:50
  Speaker 2: And then we get in this pain cycle.
• 17:51
  Speaker 2: And what happens when we get in that pain cycle?
• 17:54
  Speaker 2: Then that threshold that was once higher is now lower.
• 17:58
  Speaker 2: So things that like going down the stairs, going for shorter runs, we start to fear, feel more irritated in these areas because we're just keep pushing into that.
• 18:07
  Speaker 2: And that's where you know my expertise or someone else's come in, when they're listening to all that history with people and understanding their training and understanding them as humans, that we can start to make changes to their training and maybe make changes to increase capacity in that muscle group in the gym or in that region and build that threshold back up, so then we can get them back to their previous baseline of doing more and tolerating more, right?
• 18:34
  Speaker 2: So, to answer your question, for this type of injury, not as much of hey, it's an uphill, downhill, um, it's more of just like a, you know, overload type thing.
• 18:45
  Speaker 1: Interesting, okay.
• 18:46
  Speaker 1: So overloading, what if you're so?
• 18:48
  Speaker 1: Like, what can I do in the gym to like help prevent something like this?
• 18:52
  Speaker 1: Like, what am I doing?
• 18:53
  Speaker 1: Lift wise.
• 18:54
  Speaker 2: So as runners you know that's the.
• 18:57
  Speaker 2: The lateral hip is a really important area, I think, to be strong in um that doesn't mean you're not going to get pain, but I think if you have more capacity there then it's going to help.
• 19:10
  Speaker 2: So there's a million things you could do right.
• 19:11
  Speaker 2: I tend to like getting people upright, right, so working that lateral hip but being in a standing position.
• 19:16
  Speaker 2: So I'll do a lot of um.
• 19:19
  Speaker 2: You know slow walking March carries where people do a heavy kettlebell or dumbbell in one hand.
• 19:26
  Speaker 2: So say, if we're working the right hip and we hold the weight in the other hand and we do a slow walking March, it's going to challenge the stability of the hip on the other side, um, and it's also kind of a functional pattern to runners.
• 19:39
  Speaker 2: So I really like that variation.
• 19:41
  Speaker 2: And then I'll also get people doing a barbell marches too, where we even get more load on the backside and then also do some sort of weight shift march pattern.
• 19:51
  Speaker 2: And then the other thing I like to do is a barbell or Smith machine, um, lateral toe tap, which is basically up tall.
• 20:01
  Speaker 2: You have a slight bend in the hip and knee cause that's going to relate to maybe running, where we're not just totally upright and then the other leg slowly taps out to the side and then comes back.
• 20:11
  Speaker 2: So we challenge a lot of things in the leg, the stability at the foot, the quadricep and then the lateral hip, from any big changes in movements.
• 20:19
  Speaker 2: Um, it just helps prepare the tissues a little bit more for those specific positions.
• 20:24
  Speaker 1: Interesting.
• 20:24
  Speaker 1: Yeah, what was the type of carry you showed me?
• 20:27
  Speaker 1: I still do these to this day.
• 20:29
  Speaker 1: 25 is to like 50s in each hand.
• 20:32
  Speaker 1: Yeah, and it's the big step with like one leg.
• 20:35
  Speaker 2: Was that when you were on the balls of your feet?
• 20:38
  Speaker 2: Yes, yeah, so those are called creeper walks yes, I love those.
• 20:43
  Speaker 1: Sorry, probably totally unrelated, I just put two and two together there on that.
• 20:48
  Speaker 2: No, so I got those years back, that exercise, years back, from another physical therapist, chris Johnson, who's just great in the running scene and, um, you know, has been around for a while.
• 20:59
  Speaker 2: So you know, shout out to him, but he, he really loved that exercise where, again, you're moving it calls a creeper walk, cause you're moving very slow, almost like if you're creeping up on someone, um, but we're towards the balls of our feet with a bent hip and bent knee, so we really get slow, controlled, heavy loading to the plantar flexors, the quad and then the hips, um, and then obviously carrying the external load.
• 21:24
  Speaker 2: It just, you know, helps raise the capacity in those tissues.
• 21:26
  Speaker 2: But it's pretty safe too, cause it's it's slow moving, um, and obviously you can just put the weights down if you need to do.
• 21:33
  Speaker 1: I do those religiously, by the way, I love it.
• 21:35
  Speaker 1: It's a great movement.
• 21:36
  Speaker 1: It is.
• 21:36
  Speaker 2: Yeah, I like to mix it up, I like adding those in Um, yeah, and if you haven't tried them, you know, try them out.
• 21:42
  Speaker 2: Body weight first and and you can try adding some weight to if the, if you feel confident in the movement super legit.
• 21:59
  Speaker 2: Um, all right, do you think about gluteal tendinopathies?
• 22:00
  Speaker 2: Is there anything we missed on those, or I think that's the main gist.
• 22:01
  Speaker 2: I think the biggest thing to to note and we'll talk about the proximal hamstring tendinopathy too is it's okay with these types of issues If it, especially if it's diagnosed, and we know that's what we're dealing with.
• 22:07
  Speaker 2: It's okay to keep running Right.
• 22:10
  Speaker 2: A lot of times I'll see people um, they'll kind of go two ways.
• 22:14
  Speaker 2: They'll either do like, hey, I'm going to take off completely and great, you're going to feel better, but then as soon as you go back to run again, you're back to square one and you just wasted time.
• 22:23
  Speaker 2: So if you can start intervening by adding loading exercises that meet you where you're at and then also modify your training where we're still running it or doing some sort of activity, but maybe to the not to the same degree where before, we can then build off that and get that threshold back up to where it was, so that's the biggest thing.
• 22:41
  Speaker 2: It's okay to have some discomfort.
• 22:43
  Speaker 2: Typically I'll tell people like no pain's great, but we can have up to a five out of 10 pain and be okay, um, as long as it's not really bad after, um, that 24 hour window after is is is telling um versus when we talk about bones.
• 22:59
  Speaker 2: That's a different story.
• 23:00
  Speaker 2: We don't want to have any pain, right yeah?
• 23:03
  Speaker 1: Interesting.
• 23:03
  Speaker 1: All right, let's get onto the one that I'm I'm the most excited for, my my favorite one, the ham, the old ham the proximal hammy.
• 23:11
  Speaker 1: Um, yeah, dude this one's good.
• 23:14
  Speaker 1: That one is my favorite.
• 23:16
  Speaker 2: These can be tough with people too.
• 23:17
  Speaker 2: I see these a lot, especially out here, because these tend to come with people doing a lot of uphill and steep uphill oh, my favorite.
• 23:29
  Speaker 1: Watch out.
• 23:30
  Speaker 2: James.
• 23:31
  Speaker 2: So we talk about the proximal hamstring tendon.
• 23:45
  Speaker 2: So the proximal means closer to the center of the body, kind of near the pelvis, versus distal would be further towards the feet, and so we talk about the proximal hamstring tendon.
• 23:49
  Speaker 2: That's going to be closer to our sit bone of our pelvis, our ischial tuberosity versus the knee.
• 23:55
  Speaker 2: That's more of the distal um insertion, and so this is going to be typically people are going to have that posterior or backside buttock pain or just below the buttock pain.
• 24:07
  Speaker 2: Um, it's typically going to come on with with running and usually I'll see this with spikes in uphill running.
• 24:14
  Speaker 2: Okay, interesting, um, because if you think about it mechanically, there's this tissue gets stressed more when we have more degrees of hip flexion, which is the thigh becoming closer to the trunk, and trunk flexion, which is the trunk basically moving forward.
• 24:31
  Speaker 2: So think about when you're going uphill, steep things, that incline, um, some of the local peaks, because of the steep grade you got to have kind of that forward lean and you're putting a lot of force through the legs, especially the hamstring and glute, and that tent, that tissue can tend to get irritated.
• 24:48
  Speaker 2: Now, the unique thing about the proximal hamstring is this tends to be more of a compression based irritation.
• 24:56
  Speaker 2: So the tendon thinking of as like a very thick band of tissue, um, though it's being pulled upon from the muscle and force moving uphill, it's the compression of the tendon being pushed against the bone as we're bending the hip and the trunk forward.
• 25:14
  Speaker 2: That's almost what irritates it.
• 25:16
  Speaker 2: More Interesting and so, you know, similar to the gluteal tendinopathy, we obviously want to rebuild capacity again in that tissue to help raise its threshold so it can tolerate more.
• 25:28
  Speaker 2: But we also need to tend to modify training.
• 25:30
  Speaker 2: So typically that means running still okay, but usually it's going to be less uphill.
• 25:35
  Speaker 2: Typically that means running still Okay, but usually it's going to be less uphill, um, so flatter, even some downhill running and typically slower running too, because running with faster speeds just demands more out of the hip and more out of the hamstring in general and there is a potential risk that that can pull and compress more up at that.
• 25:52
  Speaker 2: Um, insertion point Interesting.
• 25:55
  Speaker 1: Yeah, do you see?
• 25:56
  Speaker 1: I mean, do you see a lot of these pop up in athletes like just before they're getting ready for like the ascent and stuff like that?
• 26:01
  Speaker 1: Is that where it is a busy season?
• 26:04
  Speaker 2: I mean I'll typically see it kind of in the summer frame, because that's when people are typically doing more uphill or training for a big race.
• 26:12
  Speaker 2: Yeah, I mean it can still happen anytime of the year depending on what the person's doing, but that's typically what I'll see.
• 26:19
  Speaker 2: So you're right, people building for mountain race, especially when they're coming from doing more road or flatter things, um, also, just how people tend to run their position, um, if people have a ton of forward lean when they're going uphill, um, that's going to put more load through there too, and if they don't have as much capacity there and they're doing a lot, things start to get irritated.
• 26:41
  Speaker 2: So, those are big things we look at as well.
• 26:43
  Speaker 1: What do you recommend, Because I do a lot of RDLs Now I do a ton of RDLs after some of the issues that I had with hip flexors and stuff but do you recommend good mornings RDLs?
• 26:55
  Speaker 1: What do people do for these?
• 26:57
  Speaker 2: Yeah.
• 26:57
  Speaker 2: So when you think about again the hamstring, you you know, when you think about popular exercises, you think about hip flexion, extension movements, so RDL, basically even more of hip dominant movement versus maybe like a hamstring curl or like maybe people doing the hamstring slider plates on the ground.
• 27:15
  Speaker 2: That's going to be more knee dominant.
• 27:17
  Speaker 2: So, depending on how irritable the tissue is, we may start with something that's not doing as much bending at the hip and trunk, because though that's the area we want to get loading again.
• 27:28
  Speaker 2: That may be irritable at first.
• 27:30
  Speaker 2: So maybe we start with something more at the knee or more isometric right.
• 27:35
  Speaker 2: So isometrics are more of a, a load of the muscle tendon unit, but in a, in one position, so we're holding it and so finding a position that may feel better to them.
• 27:45
  Speaker 2: But yes, ultimately I love RDLs, I love deadlifts, um, anything of those variations.
• 27:51
  Speaker 2: It doesn't have to reinvent the wheel, we just need to load the tissue and do it progressively.
• 27:54
  Speaker 2: But also, if there's things we can do that mimic also the position of running uphill right, so I'll get people in, like the Smith machine, and put them in that similar position and load it up and we'll do holds or we'll do some contractions there that meet the specific positions of running uphill, but we're going to put more load through there, so I know we're prepared to do more of that Interesting so obviously we want to load the tissue, but I want to also get more specific to what they're going to be doing too.
• 28:25
  Speaker 2: And then reflecting and training.
• 28:26
  Speaker 2: We're gradually building back to doing more uphill, doing uphill faster, all of those things that are going to put more load through it.
• 28:33
  Speaker 2: So it's really just me trying to help them manage the loads but also build up so they don't have a longer setback.
• 28:39
  Speaker 1: Just kind of guiding.
• 28:40
  Speaker 1: I gotcha Exactly.
• 28:41
  Speaker 1: Is there grades for these?
• 28:42
  Speaker 1: Cause I know, like the like, a level of like grade tendinopathy, like I don't know, like almost like a tear, like grade one, grade two.
• 28:58
  Speaker 2: Is there the same thing for tendinopathies as of now?
• 29:00
  Speaker 2: No, um the the grades are typically for actual tears, right.
• 29:01
  Speaker 2: So um ligaments and muscles and the tendons, they'll grade that.
• 29:03
  Speaker 2: But um, to basically like how much is torn?
• 29:05
  Speaker 1: yeah right, but tendinopathies specifically is more of a general term of pain in the tendon, um, and maybe there's some tendon damage there, but it's not graded based on how much of his torn or separated yeah, I would imagine to like I don't know, I just think about like from a power perspective, like very rarely were you ever see an athlete like a runner, even like a mountain runner, like at the highest level.
• 29:28
  Speaker 1: I feel like that's like generating enough power to tear, tear a hamstring.
• 29:32
  Speaker 2: I think it's more I mean maybe, um, I would say there is a more of a chance, especially the high level runners, more of a chance like downhill, especially if something is a little bit more, uh, technical because, if you think about how hamstrings typically tear and usually see it in, you know, field sports or there's much higher velocities of movement.
• 29:53
  Speaker 2: Um is a higher velocity of running for sure.
• 29:56
  Speaker 2: So again, let me higher level runners, elite running downhill, that's going to put a lot more load, but also people are have typically have longer strides there and that's going to put the hamstring in a more lengthened state.
• 30:07
  Speaker 2: And then if you think about like an unstable um surface right While you're running fast, if you're overreaching there and then you also hit an unstable surface and you need to kind of react, if that pole is really strong and you're almost not prepared for it, then I I'd expect things to potentially happen where you can tear a strain, a hamstring.
• 30:28
  Speaker 2: But just in general we don't see that as much in our sport.
• 30:32
  Speaker 1: Yeah, yeah, no, it's just interesting to me and like I don't know, I just think you know.
• 30:37
  Speaker 1: Like I said, from a power perspective, I know you and I have the funny instagram thread going where I basically send you all these hamstring tears, or like christian mcafree last week with his pcl I was watching that game.
• 30:48
  Speaker 2: Yeah, I was like, oh my god, dude, it's uh wild, it is wild and it's I think it's fascinating to see some of these injuries come about.
• 30:53
  Speaker 2: It's uh wild, it is wild and it's I think it's fascinating to see some of these injuries come about.
• 30:56
  Speaker 2: It's like okay, what was the mechanism?
• 30:58
  Speaker 2: What's their previous history?
• 31:00
  Speaker 2: Why did this happen?
• 31:01
  Speaker 2: And um, yeah, it's, it's wild, yeah, it's unfortunate, it is terrible.
• 31:05
  Speaker 1: Yeah, it's interesting too, like I don't know, like especially in our sport, like what comes up and like how you know to mitigate certain things and like what you can do with them and versus you know, I don't know.
• 31:15
  Speaker 1: The hamstring is an interesting one too, because it's like I don't know, do you recommend.
• 31:20
  Speaker 1: This is where I was going with.
• 31:21
  Speaker 1: This was stretching.
• 31:22
  Speaker 2: Like because.
• 31:23
  Speaker 1: I feel like for a hammy in a lot of way, like I don't know.
• 31:26
  Speaker 1: I feel like if I'm cramping I'll have calf cramps but never hamstring cramps.
• 31:30
  Speaker 1: But I know a lot of people do get like cramps in the back of that leg area.
• 31:35
  Speaker 2: So when I think of stretching now, I almost think of stretching as just we're loading the tissue by lengthening it and I am indifferent about stretching.
• 31:47
  Speaker 2: If it's helpful for people, great.
• 31:49
  Speaker 2: If people feel like, hey, it's not doing anything or it's harming me, then it's not worth doing.
• 31:55
  Speaker 2: But I almost think about it as a load right.
• 31:58
  Speaker 2: So think about an RDL, right?
• 32:00
  Speaker 2: An RDL is a lengthening contraction of the tissue under body weight load or added load, and so technically that's stretching the tissue.
• 32:10
  Speaker 2: If you're just doing a hamstring stretch, I should say yes, it's maybe passive.
• 32:13
  Speaker 2: If you're just doing a hamstring touch uh stretch, I should say yes, it's maybe passive if you're leaning into it, but we're still just loading that tissue, just differently.
• 32:21
  Speaker 2: Right so it's still a load through there.
• 32:23
  Speaker 2: So, you know, I almost think of that as a continuum of hey, if you have hamstring pain, for whatever reason, and we're stretching and it feels helpful, well, yeah, we're just starting to load that tissue.
• 32:34
  Speaker 2: Um, you know whether we're stretching and it feels helpful?
• 32:36
  Speaker 2: Well, yeah, we're just starting to load that tissue.
• 32:37
  Speaker 2: Um, you know whether we're actually lengthening anything?
• 32:39
  Speaker 2: Truthfully, is there's been a lot of research to refute that?
• 32:43
  Speaker 2: Um, it's more of a neurologic response if we see that change.
• 32:47
  Speaker 2: Um, but again, it's just our body adapting, adapting to what we're doing by by loading it yeah, yeah, strengthen, like stretching is so much.
• 32:56
  Speaker 1: I had david sinclair on the pod the other day, body adapting, adapting to what we're doing by by loading it.
• 32:56
  Speaker 1: Yeah, yeah, dude, strength and like stretching is so much.
• 32:57
  Speaker 1: I had david sinclair on the pod the other day and one of the things he said to me we were talking about strength in general he goes, yeah, like once I get past, like being sore.
• 33:06
  Speaker 1: He goes like I'll see my miles drop, like 10 seconds a mile once I get say that again he's like he's like once I get past like soreness, like once I'm able to get past the soreness of lifting, he's like my miles will drop like 10 seconds a mile.
• 33:19
  Speaker 2: I was like interesting, well think about it this way it's like you have your optimal depending on what speed you're trying to go.
• 33:25
  Speaker 2: You have your optimal mechanics of how much range of motion you are able to use to optimally run your fast speed.
• 33:34
  Speaker 2: And so if there's some soreness or a little more stiffness, that may change our range of motion.
• 33:41
  Speaker 2: We have um at that time, but it also may change how much motor recruitment we have at that time too, because of things being sore and you needing that recovery.
• 33:51
  Speaker 2: So you know it makes sense.
• 33:53
  Speaker 2: I I, when I'm really sore, I do like to do some sort of active mobility or stretching to make me feel better moving.
• 34:01
  Speaker 2: But I'm not someone who is deliberate about you know, a stretching routine or anything particular like that Cause for me.
• 34:07
  Speaker 2: It just I don't see it worth helping me that much to make it worth my time versus like a strength training program Interesting.
• 34:15
  Speaker 1: Yeah, I don't know.
• 34:16
  Speaker 1: I'm fascinated with the hamstrings dude, like what a cool.
• 34:19
  Speaker 2: Oh, it's such an important muscle group that you know.
• 34:24
  Speaker 1: All right, so let's get into.
• 34:25
  Speaker 1: So I've been fascinated with the hips a lot lately.
• 34:28
  Speaker 1: I, um, I follow a lot of different sports and one of the ones I follow is, uh, fighting right MMA.
• 34:33
  Speaker 1: Oh yeah, shano Malley just had he's a he was the former bantamweight champion Just had a.
• 34:37
  Speaker 1: Um, what was it?
• 34:40
  Speaker 1: Uh, not a femoral neck tear, labrum tear in that area.
• 34:44
  Speaker 1: Um, so like labrums.
• 34:47
  Speaker 1: Like dude, like I had no idea what a labrum was until two weeks ago.
• 34:50
  Speaker 1: I was like what the hell?
• 34:58
  Speaker 2: So, anyway, labrum rooms I again I've I see people with those, but those typically don't come on from running unless there's like a trauma where you fall and you know your leg gets in this funky split position.
• 35:05
  Speaker 2: Um, you know, we'll typically see those come out actually as an injury at a in a sport that demands a lot, of, a lot of the hip, like getting closer to those end range rotations or flexion extension, um, because really the labrum is an extension of the internal joint, almost like surface area, because the ball and socket, like the bony articulation, the ball is bigger than the socket and so it almost just gives more surface area around that.
• 35:37
  Speaker 2: But it's, you know, uh, car, cartilaginous fiber, um, fibrous tissue that helps stabilize the joint, and so when we get to those extreme ranges under load if it were past capacity, there we get, we get the tear Gotcha Right.
• 35:52
  Speaker 2: So hockey goalies, ufc fighters were in these crazy positions higher risk running Not so much.
• 35:58
  Speaker 1: No, no, no, I just I love sports injuries this is interesting, all right.
• 36:02
  Speaker 1: So where does the femoral neck play in that?
• 36:04
  Speaker 1: Like, what is a femoral neck?
• 36:05
  Speaker 2: Yeah.
• 36:06
  Speaker 1: Is that like more of the head, like where the ball joint is?
• 36:09
  Speaker 1: Yes, I got it.
• 36:11
  Speaker 2: So let's think about this Um logically right.
• 36:13
  Speaker 2: So, the femur is the thigh bone right.
• 36:16
  Speaker 1: Right, right right.
• 36:16
  Speaker 2: So that's where that comes from.
• 36:17
  Speaker 2: You were right, the ball, that's the head of the femur, right?
• 36:21
  Speaker 2: So we know anatomy.
• 36:23
  Speaker 2: The neck is right below it.
• 36:24
  Speaker 1: Right.
• 36:24
  Speaker 2: So the neck is basically the junction between the ball and then the femoral shaft, which is our thigh bone.
• 36:37
  Speaker 2: So it's this area that's deep within the hip, but it kind of is at an angle that goes from where it attaches in the hip to our thigh, and so that is a common area we'll see in runners.
• 36:47
  Speaker 2: Um, and the interesting thing is, most people I tend to see who have this don't realize it and they think it's more of a hip flexor issue.
• 36:57
  Speaker 2: Interesting Almost every time I've seen someone come in with this hip pain, they come in thinking, oh, I have, like this hip flexor irritation and I've been stretching and doing things but I'm just not getting any better and it just keeps hurting more as I run.
• 37:11
  Speaker 2: And to me in my head that's like a huge red flag, because anything in the front groin region that comes on gradually or somewhat insidiously which means like no true mechanical uh mechanism of injury, especially in runners Um, I almost have to like rule that out before I can consider anything else, right.
• 37:35
  Speaker 2: And so when I hear that, I'm always like, oh, please don't be this, um, because it's one of those injuries that can set you back for a really long time or even get you out of running completely depending on the severity of it.
• 37:48
  Speaker 2: Yeah, so the reason why that area is so important to get understood if it's truly a femoral neck bone stress, injury or something else is because that site is high risk, which means it doesn't get as good blood flow.
• 38:07
  Speaker 2: So a longer risk for delayed healing, but then also that bone just has to take so much load from running.
• 38:17
  Speaker 2: So between running, walking, being on your legs and then less ability to heal, there's a higher risk.
• 38:23
  Speaker 2: This is going to take longer to recover, and so the one thing that's important to note about this injury is there's two sites, um, on the femoral neck that will typically see an injury.
• 38:34
  Speaker 2: There is a compression site, which is the bottom side.
• 38:39
  Speaker 2: So think of, like, um, you're bending a pencil.
• 38:42
  Speaker 2: Right, if I go to bend a pencil and the bow is at the top, the top is going to be more tensile and the bottom is going to be more compression.
• 38:49
  Speaker 2: The bottom side getting more compression that tends to be able to heal easier.
• 38:54
  Speaker 2: Uh, where we can actually treat it conservatively with non-weight bearing for extended period of time and then gradually progressing back, loading um versus the top side, the tensile that tends to not heal so well because it's being almost pulled apart when we walk subtly, if there's already a stress fracture or stress re reaction basically going on, we need to offload that and there's a high risk where we need surgery if there is a fracture there and the downside of that type of injury the tensile side is that there's a high risk that we don't return to sport or running.
• 39:32
  Speaker 2: You know, and unfortunately I've I've worked with someone who had that injury a few years back and it got misdiagnosed for so long and it became a full fracture and, yeah, it stink, they they were.
• 39:45
  Speaker 2: They just never got looked at to a point where they recommended imaging until it was too late and they ended up having surgery and they recovered, being able to do a lot of things in daily life, but they were.
• 39:57
  Speaker 2: They didn't get back to running and this person was in their thirties and it's it was pretty rough.
• 40:02
  Speaker 2: You know we tried doing a lot but you know it was getting to a point where they could barely, you know, run a mile without it still being irritated.
• 40:10
  Speaker 2: So you know these are things that are serious and we really want to make sure we can catch if we, if they're there.
• 40:16
  Speaker 1: What are the symptoms you're feeling?
• 40:17
  Speaker 1: If you're feeling something like that, like when do I know immediately, like you said, to something a lot of people, strangely, will think it's like something with the hip flexor, is there any differentiator, anything like you would pick out that would be kind of stick out to you, that you know?
• 40:32
  Speaker 2: Yeah, that's a great question.
• 40:33
  Speaker 2: I, I, I think the location's important.
• 40:36
  Speaker 2: So when I'll see these, they'll typically feel in that front groin area where the hip flexor is, but they'll feel like it's deeper, which is insightful.
• 40:45
  Speaker 2: Sometimes I'll see people say it's on the outside of the hip too.
• 40:48
  Speaker 2: I just it's not as common.
• 40:49
  Speaker 2: But the important thing is to note is there's no again mechanism of injury where it's like I I was sprinting and I felt a pole, or I stepped off a rock and I felt this pain.
• 40:59
  Speaker 2: It's it's a gradual onset where it tends to progressively get more irritated the more running we do, as well, as if it becomes so irritated with running, it also can linger into walking, where it just doesn't feel as good.
• 41:13
  Speaker 2: And so those are just very simple things, but to me that's a huge red flag.
• 41:19
  Speaker 2: That again, we need to prove this or not and make sure we know what we're dealing with before we do any type of return to running or treatment strategy.
• 41:28
  Speaker 1: What are?
• 41:28
  Speaker 1: Those surgeries look like Like what are they going to do to fix that when you go in there?
• 41:32
  Speaker 2: Yeah.
• 41:32
  Speaker 1: So, bill.
• 41:34
  Speaker 2: Typically, especially if it's a um, if it's a fracture of the tensile side, basically they'll use a pin to go through there, basically to stabilize the bone and screws Um.
• 41:47
  Speaker 2: But there's an extensive non-weight bearing period where people can be non-weight bearing for up to 14 weeks with that and so after that it's again a very progressive, very gradual and cautious return to walking, to loading, very gradual and cautious return to walking, to loading Um, and if we're lucky, maybe some running, but that's not even guaranteed, and so basically just stabilizing the bone, um, in that area with, you know, a pin and screws, yeah.
• 42:16
  Speaker 1: Damn dude.
• 42:16
  Speaker 1: Yeah, that's the.
• 42:17
  Speaker 1: That's.
• 42:17
  Speaker 1: That's not good, that's terrible, scary.
• 42:21
  Speaker 2: One thing I'll say, though, that I didn't mention, and we've talked about this a little bit in the past.
• 42:24
  Speaker 2: But if this is an injury we're concerned about, we almost always have to at least discuss symptoms of red S, which is again that relative energy deficiency in sport, which is related to a low energy availability.
• 42:41
  Speaker 2: And so you know what's going on nutritionally, what's going on with menstrual cycle, um, how our energy levels, um, all of those things, because any bone around the hip, pelvis, spine, anything more proximal, has a higher degree of what we call that trabecular bone, which is more hormonal, right, it's, it's more sensitive to energy levels and it's got a higher, yeah, it's going to.
• 43:09
  Speaker 2: Basically, our hormone changes are going to have a bigger influence on that versus, um, higher levels of cortical bone.
• 43:16
  Speaker 2: So think, like our, our tibia, our femur, our metatarsals, all those Um.
• 43:21
  Speaker 2: So when we have that stuff going on, we almost like that's where I'm I'm talking about it with them, about what's going on, um, nutritionally, um, if I'm, you know, referencing them to a dietician or, you know, sports med doc, all of those things, because if we're not touching on that, then there's a high risk of this returning again, no matter what we do.
• 43:43
  Speaker 2: And this, almost these injuries need more of that team approach, because if we're not touching on that, then I'm doing them a disservice.
• 43:51
  Speaker 1: Yeah, do you see a lot of them Like and let me ask you this more, so it's probably kind of a loaded question, but cause I know where I'm going with this Is it more like former cross country, like run athletes or like track and field athletes.
• 44:05
  Speaker 1: Do you see that pop up in or?
• 44:08
  Speaker 2: It varies.
• 44:09
  Speaker 2: I mean, I've seen some of it with that.
• 44:11
  Speaker 2: Um, the biggest thing I'll say is I, these types of injuries I've only seen in females.
• 44:17
  Speaker 2: Yeah, Right, and there's something to say there.
• 44:19
  Speaker 2: Um, you know, for whatever reason, females, when I've seen running, at least this is improving, but in the past it's been.
• 44:28
  Speaker 2: You know running is helping with a point to body image and you know diet obviously affecting body image, Right, and what types of diets are important to note.
• 44:40
  Speaker 2: So you know vegan, right, when maybe you're not getting as many total calories or carbohydrates in.
• 44:46
  Speaker 2: Um, as well as some other interesting things I've seen is some people who have maybe some GI disorders, so IBS, Crohn's, Celiac, think about that, because if we're not getting as much nutrients into our bloodstream to utilize that, then that's going to affect how our tissues recover and utilize energy as well.
• 45:07
  Speaker 1: Wow.
• 45:08
  Speaker 2: So all those things are factors, but the biggest trend I'll say is more on just females in general, that where I see these more with interesting man.
• 45:16
  Speaker 1: What a crazy injury.
• 45:17
  Speaker 1: What a terrible it's it stinks and I have.
• 45:20
  Speaker 2: I hate ordering imaging for this, but I know it's essential because that's MRI is really the gold standard for us to know what we're dealing with and what degree of injury it is.
• 45:29
  Speaker 2: Um, but I hate when I get results back.
• 45:33
  Speaker 2: That says it, because I hate having that conversation with people.
• 45:36
  Speaker 2: Um, but it's if, if we think about it, in the long run it's the best thing we're finding out.
• 45:43
  Speaker 1: Yeah, not for sure, and hopefully you know, depending on what type it is, whether it be tensile or uh, the other one, compressive you can, kind of you know, hopefully at some point in time get back to running.
• 45:55
  Speaker 1: Hopefully that's always the end goal Is there anything you think we didn't didn't hit with that.
• 46:02
  Speaker 2: I don't think so.
• 46:03
  Speaker 2: Um, those are just some big injuries, I see, and I think again, important to differentiate.
• 46:09
  Speaker 2: Um, the only thing I would say actually is with the bone stress injuries and I've talked about this in the past is when we know this is what we're dealing with.
• 46:18
  Speaker 2: And that's why it's helpful if you are dealing with pain sometimes to see someone if things aren't getting better, because if this is something more concerning, like a bone stress injury, it's better to get things checked out and rolled out versus continuing to do things on it.
• 46:30
  Speaker 2: But bone stress injuries of any degree we really don't want to have any pain with because we're just doing more harm than good in that situation.
• 46:39
  Speaker 2: So if we have any sort of pain with walking arm, than good in that situation.
• 46:45
  Speaker 2: So if we have any sort of pain with walking, we need to be using crutches or deloading.
• 46:47
  Speaker 2: If we have any pain with running, we really shouldn't be running.
• 46:49
  Speaker 2: So that's the biggest differentiator and once we know that's the injury, we need to be pain-free with all activity.
• 46:54
  Speaker 2: Gotcha.
• 46:56
  Speaker 1: Yeah, Well, dude, we hit.
• 46:58
  Speaker 1: Uh, I kept you on time.
• 47:00
  Speaker 2: You're 45 minutes on the dot baby and I've answered all the questions in the past too, so I'm impressed and so you get new, uh new questions at the end of of bigfoot or aliens did I ask you about ai.
• 47:13
  Speaker 1: Yet maybe I can't remember you may have.
• 47:15
  Speaker 1: Probably what did you?
• 47:17
  Speaker 1: Did you give me your walkout song?
• 47:19
  Speaker 1: I see it's.
• 47:21
  Speaker 1: It's funny Like we're we're amigos so like.
• 47:23
  Speaker 1: I like forget, I blur the lines, cause I see you way more than you're, like you're on the podcast, but I see you a lot more than that.
• 47:29
  Speaker 2: Like I'm going to have to think about that one.
• 47:30
  Speaker 2: I definitely don't have a definitive answer on a walkout song, although I wish.
• 47:34
  Speaker 1: I did.
• 47:42
  Speaker 2: Dude, are they any good?
• 47:43
  Speaker 2: All right, I will say this, and you heard it here first.
• 47:45
  Speaker 2: I've said this before, but I think this is the year.
• 47:46
  Speaker 2: This is the year I'm going to listen back to this in a few months from now, once they're in the Super Bowl.
• 47:51
  Speaker 2: I have a feeling they're going to be there.
• 47:53
  Speaker 2: Okay, I'd love for them to win I hope they do, but I just have a feeling they're at least going to be there and it's going to be insane, are you going to throw a Superbowl party?
• 48:02
  Speaker 2: I'm going to do something, all right.
• 48:03
  Speaker 2: All right, I'll be looking forward.
• 48:04
  Speaker 2: I'm looking forward to that.
• 48:05
  Speaker 2: I'll bring the beer.
• 48:08
  Speaker 1: Actually, you heard it here first.
• 48:09
  Speaker 1: Uh, outside of the Superbowl party, I'm planning a one year pod party.
• 48:13
  Speaker 2: Dude, now that we, that's gonna be awesome I might push it to april.
• 48:22
  Speaker 1: Okay, there will be kegs, it will be fun.
• 48:24
  Speaker 1: Well, hopefully I get the invite.
• 48:27
  Speaker 1: Oh, you will, you will.
• 48:29
  Speaker 1: You were episode one, dude.
• 48:30
  Speaker 1: You're episode one and I think you're 51.
• 48:32
  Speaker 1: I can't remember.
• 48:33
  Speaker 2: I got what are you at now actually?
• 48:35
  Speaker 1: dude.
• 48:35
  Speaker 1: Uh like we're zeroing in on 100 by by march.
• 48:41
  Speaker 1: Like by march, when we hit the one year, it'll be 100.
• 48:43
  Speaker 1: That's insane.
• 48:44
  Speaker 1: That includes, like everything, all the race previews, the whole shebang.
• 48:47
  Speaker 2: Dude, like just congrats to you, cause I've, you know, heard about this since you started talking about it in the beginning until now, and it's just amazing the growth and the energy you've put into this and it shows, and you know, I think when I listened to podcasts or any type of media that promotes something, you can sense the people who really care and have this as a passion project versus.
• 49:09
  Speaker 2: You know, this is something I enjoy and I want to put energy in it, but it's different when you go all in and you're you're going all in with this and it's awesome.
• 49:18
  Speaker 2: Oh, dude, thank you so much man, I appreciate it.
• 49:19
  Speaker 1: I appreciate, I love the uh, the synergy, because you know we've got the run potential pt, you're building this beautiful business and you know we can have these amazing conversations because there's so much crossover and running and just a lot of you know it's, it's cool.
• 49:32
  Speaker 1: I think the craziest thing for me is, like all of my like really close friends, like you steven, like brad, everybody's building something really cool, right like this inspiration.
• 49:43
  Speaker 1: Yeah, like I can energy exactly, and you're around these people that are building these incredible things, and it's like you, just you do you draw energy from that.
• 49:50
  Speaker 1: So, yeah, man, it's, it's, it's, it's weird because, like sometimes people will stop me now and be like hey, like like I've been stopped on the incline a couple times and I'm like, oh hi, you know it's, you know that's a little weird, um, but other than that, it's, it's, it's kind of cool.
• 50:05
  Speaker 2: Yeah, I'll tell you what you know.
• 50:06
  Speaker 2: I'll get people saying to me like oh, like you know, I just was up going up the incline or I went up Pike's peak and I really loved the podcast, like I was listening to yours and a few other episodes, and you know that stuff's just really cool to hear.
• 50:20
  Speaker 2: It's like you know you're.
• 50:21
  Speaker 2: You're building a sense of community too, and connecting with more people and providing good content, which is awesome.
• 50:28
  Speaker 1: Yeah, no, it's amazing.
• 50:29
  Speaker 1: I'll give you a quick stat as of today.
• 50:31
  Speaker 1: Hold on, I'll give you a.
• 50:33
  Speaker 1: This is a.
• 50:34
  Speaker 1: Not too many people know this, so where are we all time?
• 50:39
  Speaker 1: Over 50 countries.
• 50:44
  Speaker 2: Really.
• 50:44
  Speaker 1: Over 2,000 cities.
• 50:46
  Speaker 1: That's pretty wild, isn't that wild?
• 50:47
  Speaker 1: That many people have heard your voice, my voice, like what the fuck and good for you, because I hate listening to my voice.
• 50:53
  Speaker 1: Same, dude Same.
• 50:54
  Speaker 2: Good job on keep putting yourself out there.
• 50:56
  Speaker 2: That's not easy.
• 50:57
  Speaker 2: Yeah, that's wild.
• 50:58
  Speaker 1: Well, dude, I don't want to keep you.
• 50:59
  Speaker 1: Yeah, that's wild.
• 51:00
  Speaker 1: Well, dude, I don't want to keep you.
• 51:01
  Speaker 1: I know you got some family in town you want to get back to.
• 51:03
  Speaker 1: So, bro, thanks so much for coming on.
• 51:04
  Speaker 1: Looking forward to in Q1, knocking off episode three, heck, yeah, and yeah, man, I'll see you soon, as always, I appreciate it, my friend.
• 51:14
  Speaker 2: Thanks, bro, what'd?
• 51:15
  Speaker 1: you guys think.
• 51:15
  Speaker 1: I hope you guys got a lot of value out of this one.
• 51:19
  Speaker 1: Always a fun episode, always a great conversation with Sean.
• 51:20
  Speaker 1: He just brings so much knowledge and information to the table that I hope you guys were able to extract a ton of value out of this.
• 51:26
  Speaker 1: Like I said, the whole point of this series is to be able to bring you guys some value and hope you guys understand and identify different overuse and tendon and all different kinds of injuries that you guys might be popping up.
• 51:37
  Speaker 1: Especially now that we're in the off season, people are probably doing less, loading a little bit less and maybe doing some high intensity stuff, and when you do that it could definitely bring in some overuse injuries or some just bring new injuries to life.
• 51:49
  Speaker 1: So yeah, guys, if you happen to be experiencing any of these injuries or looking for a PT, if you are interested and you happen to be on the front range area, definitely give Sean a shout out.
• 52:00
  Speaker 1: His website is runpotentialptcom.
• 52:03
  Speaker 1: You also can find him and just shoot him a DM on Instagram.
• 52:07
  Speaker 1: That's going to be at runpotentialpt.
• 52:09
  Speaker 1: His name is Dr Sean Rimmer, ptdptocs.
• 52:12
  Speaker 1: The guy's got a lot of letters after his name.
• 52:15
  Speaker 1: He's a very accomplished dude.
• 52:17
  Speaker 1: So, yeah, definitely one of my most exciting episodes.
• 52:20
  Speaker 1: Definitely love hanging out with Sean and looking forward to doing many of these in the new year.
• 52:24
  Speaker 1: Guys, this is the last episode of 2024.
• 52:27
  Speaker 1: Kind of wild, kind of crazy.
• 52:29
  Speaker 1: This adventure has been a really fun one and I'm definitely looking forward to all the exciting things down the corner, around the corner not down the corner, jesus, around the corner that we'll be able to bring you, guys in 2025.
• 52:41
  Speaker 1: So stay tuned and we'll continue to be covering this great and amazing sport.
• 52:45
  Speaker 1: And, yeah, actually this Friday I got a dope one coming out for you.
• 52:49
  Speaker 1: I'm not going to tell you who it is, because it's an exciting one.
• 52:51
  Speaker 1: So, yeah, guys, happy new year, enjoy, party hard, thank you.