Latest / The Driven Athlete / The SI Joint: Hidden Culprit Behind Your Back Pain | Ep 90

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The SI Joint: Hidden Culprit Behind Your Back Pain | Ep 90 · The Driven Athlete

• 0:00
  Speaker 1: If you're a driven, active person who wants to reach and pursue a higher quality life with some ambition, then guess what this podcast is for you.
• 0:07
  Speaker 1: This is the Driven Athlete Podcast.
• 0:10
  Speaker 1: What's up y'all?
• 0:13
  Speaker 1: Welcome back to the Driven Athlete Podcast.
• 0:14
  Speaker 1: This one is mainly just super focused on the sacroiliac joint, the SIJ, the SI joint.
• 0:23
  Speaker 1: So the sacrum is the tailbone, all right, and the ilium is one of the bones of your pelvis.
• 0:31
  Speaker 1: So in the back of the pelvis, against your tailbone, the ilium articulates with the sacrum, all right, and there's a little bit of movement there.
• 0:41
  Speaker 1: That's been documented heavily in the research and literature for cadaveric studies and all the literature, studies and research.
• 0:48
  Speaker 1: So there is a little bit of movement there.
• 0:50
  Speaker 1: It's millimeters, it's tiny, but it has a key.
• 0:54
  Speaker 1: It's a key player with taking forces through your leg with like running and lunges and step-ups and Bulgarian split squats and and golf, like in sports and lacrosse, like everything sports.
• 1:07
  Speaker 1: So the sacroiliac joint, it's an articulation of the pelvis and the tailbone and your back and it's a big source of pain.
• 1:19
  Speaker 1: It's a common source and culprit of a pain generating area.
• 1:27
  Speaker 1: The pain generating source is the sacroiliac joint and the question is like why?
• 1:32
  Speaker 1: So let me explain this Do you have a ton of.
• 1:37
  Speaker 1: It's a big joint.
• 1:39
  Speaker 1: There's big bones and big muscles that connect from your hip to your pelvis to your tailbone, from your lumbar spine, just above the sacroiliac joint, your spine, just above your tailbone, you have a ton of muscles that articulate and connect above and below and you also have large ligaments that also connect of your sacroiliac joint, your sacrum, to your pelvis and there's a lot of interplay of those muscles and joints of the hip, the knee, the ankle and then also above in your spine.
• 2:11
  Speaker 1: So the sacroiliac joint is just a common pain generator source that we have to investigate.
• 2:19
  Speaker 1: We wouldn't be doing our job and leave any stones unturned if we didn't investigate the sacroiliac joint.
• 2:24
  Speaker 1: When somebody comes in with pain in their back, all right.
• 2:27
  Speaker 1: When somebody comes in with pain in their back and they come see us say, hey, doc, I got a pain in my back, it's been going on my swing, we're like the three working hypotheses that we have is is it coming from the lumbar spine, is it coming from the sacroiliac joint, or does it come from the hip, from the sacroiliac joint or does it come from the hip?
• 2:46
  Speaker 1: So those three things we have to weigh first, all right.
• 2:48
  Speaker 1: And then when we ask questions and we get a good idea of what's causing the pain and why and what generates it with their activity, looking at their movement patterns, their range of motion and palpation, all those things combined is what hones us into a diagnosis and in this case, if it's a sacroiliac joint, we're going to take action.
• 3:05
  Speaker 1: So we have to figure out what area, which direction is the sacroiliac joint involved and dysfunctional, and how are we going to intervene.
• 3:18
  Speaker 1: So the sacroiliac joint, like I said, there's a lot of large muscles that connect to it.
• 3:23
  Speaker 1: In the front we have our psoas muscle.
• 3:27
  Speaker 1: It's our iliopsoas muscle.
• 3:29
  Speaker 1: It connects to the lesser trochanter of your femur and it originates from the psoas belly, from lumbar vertebrae L234.
• 3:36
  Speaker 1: And then the iliacus originates from the ventral side of the ilium and those two muscles converge to one insertion point at the lesser trochanter of your femur and that's just a major player with like force production for hip flexion and trunk flexion.
• 3:50
  Speaker 1: So like maybe, like imagine doing a V-up or a sit-up or a crunch, the psoas is heavily involved with making that action happen.
• 3:57
  Speaker 1: Or a runner, as they run and they're driving their knee up for running, the psoas is a key player with that, all right.
• 4:07
  Speaker 1: So the psoas is a key player with that, all right, so the psoas is one of them.
• 4:09
  Speaker 1: The quadratus lumborum is one of them.
• 4:10
  Speaker 1: That's a muscle in the back, on the side, like on the lowest lower side of your lumbar area in your back, and that connects from your lumbar vertebrae and your 12th rib to your iliac crest.
• 4:18
  Speaker 1: All right, so that is another key player.
• 4:20
  Speaker 1: Um, all the erector group muscles, multifidus, longissimissimus iliacostalis, and then the spinalis also plays a role because that connects to your tailbone, your sacrum and then down in the hip.
• 4:31
  Speaker 1: I mean you have all your glute muscles.
• 4:32
  Speaker 1: There's actually six muscles that insert onto the greater trochanter of your femur that originate from the ilium in the pelvis or into the sacrum.
• 4:41
  Speaker 1: So I mean there's like a ton of big muscles that create a lot of force production through your hips and your pelvis and your and your lumbar spine.
• 4:52
  Speaker 1: So imagine if somebody has low back pain with split squats, lunging, running, agility, changing directions.
• 5:01
  Speaker 1: In the demographic that's really's really seems to be, it's just very commonplace is youth athletes, because they're still usually not as coordinated.
• 5:11
  Speaker 1: The stability isn't top notch lump core stability, hip stability, pelvic stability.
• 5:18
  Speaker 1: It's not exactly as good as it could be right, not a pro athlete if they're 16 years old, 15 years old, 18 years old, right, and there's a lot of force being put through their ground, reaction forces and impact forces through their leg that translates up through their pelvis and their low back and their hip.
• 5:37
  Speaker 1: That repetitively accumulates and can create issues.
• 5:43
  Speaker 1: All right, imagine, with that there's muscle activation and recruitment disparities.
• 5:50
  Speaker 1: Some muscles can be very dominant and naturally strong and then also in the body, other muscles that are working just hand in hand with them, those muscles can be maybe more dormant and not as readily recruitable and activated.
• 6:04
  Speaker 1: All right, that's what would be a muscle imbalance.
• 6:07
  Speaker 1: When we say like muscle imbalances, that's what you mean.
• 6:09
  Speaker 1: It's a neural, muscular, neural recruitment problem.
• 6:11
  Speaker 1: It's a neural, muscular, neural recruitment problem.
• 6:13
  Speaker 1: It's a neural problem, it's a recruitment issue is what we would say.
• 6:18
  Speaker 1: It's not like a strength problem, because we've seen plenty of people that squat over 300 pounds, 400 pounds, and they have SI joint pain, they have sacroiliac joint issues and they're like well, you're weak, but no one likes hearing that.
• 6:32
  Speaker 1: But it's not like they're weak, it's just that they have a disparity in recruitment of these muscles that are key players in this region of your back, your hip and your pelvis.
• 6:44
  Speaker 1: So imagine if an athlete, an active person, also to postpartum moms this is also a super common thing sick or iliac dysfunction, just because instability is really common after pregnancy and the birthing process is super.
• 7:00
  Speaker 1: It's tremendous, it's incredible and there's a lot of trauma that's involved.
• 7:06
  Speaker 1: There's traumatic changes that happen and with that women are already naturally a little bit more unstable.
• 7:12
  Speaker 1: They're more mobile than men.
• 7:20
  Speaker 1: Men are usually stiff and tight.
• 7:21
  Speaker 1: Women are usually like a common place that they're more mobile, so they're set up for more dysfunction in these kind of areas, especially when they do active activities, lifestyle activities, and also with pregnant women, there's a hormone relaxin that is flowing through to accommodate the growth and the changes in their joints and their bones, articulations and the muscles to allow things to expand and then also facilitate the birthing process, and that just sets up things for being really hypermobile.
• 7:51
  Speaker 1: Okay, so stability is really important for them.
• 7:55
  Speaker 1: So imagine you have an active person or a mom that they want to exercise and they're doing their thing and they have back pain on one side of their back, right in their tailbone, on the right side or the left side, and it's just been progressively getting worse and they're putting a lot of forces through their legs.
• 8:13
  Speaker 1: When they do lunges and when they do squats and when they jog and they run, there's a lot of forces being placed through their hips.
• 8:18
  Speaker 1: Side to side, things can accumulate.
• 8:22
  Speaker 1: And if some muscles are very strong and dominant and other muscles are more dormant and not recruitable and they're working through those disparities in muscle recruitment, those muscle imbalances, what do you think is going to happen?
• 8:34
  Speaker 1: Joints are going to get tugged on in specific directions over and over and over again, because they're getting pulled in one way and the other ones that counteract that aren't helping enough.
• 8:44
  Speaker 1: So they're getting pulled in one direction over and over again.
• 8:47
  Speaker 1: The sacroiliac joint, the pelvis, can get influenced to be more asymmetrical and dysfunctional, going one direction or the other direction.
• 8:56
  Speaker 1: It could be rotated a little bit forward or anteriorly or it could be rotated posteriorly.
• 9:01
  Speaker 1: The sacrum can also rotate a little bit side to side and that would be like sacral torsion, which we don't get into in biomechanics.
• 9:08
  Speaker 1: On that, but just painting a picture that there's large muscle groups that are pulling and tugging and influencing the sacroiliac joint to be pushed or tugged in one direction or the other over many, many accumulated events and that can lead to.
• 9:23
  Speaker 1: I don't know what's going on.
• 9:24
  Speaker 1: My back hurts.
• 9:25
  Speaker 1: I didn't like fall or get in a car accident, but now my back's been hurting for a couple of weeks now and it's just getting worse and I can't run or whatever, right, so that's a common thing we hear all the time.
• 9:35
  Speaker 1: So if you're battling this pain, please don't hesitate to reach out.
• 9:38
  Speaker 1: This is like this is our bread and butter man.
• 9:40
  Speaker 1: This is what we do.
• 9:41
  Speaker 1: So sacroiliac joint dysfunction can accumulate and it just gets worse.
• 9:47
  Speaker 1: But that disparity in strength recruitment, that's what we have to fix too.
• 9:53
  Speaker 1: All right, so how do you fix this?
• 9:56
  Speaker 1: Let me one more time, one more thing.
• 9:58
  Speaker 1: What does it feel like?
• 9:59
  Speaker 1: All right, so how do we diagnose this?
• 10:03
  Speaker 1: Well, we ask them a lot of questions.
• 10:05
  Speaker 1: Where is the pain located?
• 10:06
  Speaker 1: What does it feel like?
• 10:07
  Speaker 1: What makes it hurt worse?
• 10:08
  Speaker 1: What makes it feel better?
• 10:09
  Speaker 1: What does it feel like?
• 10:10
  Speaker 1: What makes it hurt worse?
• 10:10
  Speaker 1: What makes it feel better?
• 10:11
  Speaker 1: What does it feel like when you sleep?
• 10:12
  Speaker 1: Any exercises in particular make it hurt worse.
• 10:13
  Speaker 1: Was there a time recently where it was like that was the pain?
• 10:15
  Speaker 1: How's it feeling right now?
• 10:17
  Speaker 1: All right, let's take it through a range of motion.
• 10:19
  Speaker 1: When you bend over a lumbar range of motion, hip range of motion testing, functional movement testing, and we're looking at their mechanics and where we're noticing our compensations are at.
• 10:34
  Speaker 1: And then we go through objective orthopedic tests.
• 10:35
  Speaker 1: When we purposely try to shear or provoke symptoms, we can isolate like, oh, this rules it in or rules it out, ruling in a diagnosis versus ruling out a diagnosis, and then palpation and all of that kind of combined would be a part of the, would be the evaluation and that helps us determine, like where the pain is, what the problem is and then why it's based on what you're telling me, why it started, how are we going to fix it and then how are we going to keep it from coming back.
• 10:57
  Speaker 1: That's the recipe, all right.
• 10:59
  Speaker 1: That's like an evaluation.
• 11:00
  Speaker 1: So, based off of that is determining, like what we're going to do, right.
• 11:04
  Speaker 1: So what do we do?
• 11:06
  Speaker 1: What's the recipe?
• 11:06
  Speaker 1: To fix a sacroiliac dysfunction?
• 11:07
  Speaker 1: We have to intervene manually.
• 11:08
  Speaker 1: To fix a sacroiliac dysfunction, we have to intervene manual.
• 11:11
  Speaker 1: I think the missing link is manual therapy.
• 11:14
  Speaker 1: We have to fix the biomechanical problem.
• 11:16
  Speaker 1: It's a biomechanical problem and that needs a mechanical fix, all right.
• 11:21
  Speaker 1: So the mechanical fix is manual therapy and we have to put it back in a more symmetrical path plane.
• 11:29
  Speaker 1: All right, we have to put it back in a more symmetrical way.
• 11:31
  Speaker 1: And then, after intervening with manual therapy, we have to follow up with soft tissue, with some of the muscles that are going to be really guarded and tense because of this position change that's been going on for a couple of weeks now or months.
• 11:44
  Speaker 1: So imagine the sacroiliac joint there's a position change.
• 11:46
  Speaker 1: What do you think the muscles are going to be like where that are connecting to those areas that are not lined up as much as they could be?
• 11:54
  Speaker 1: Right, they're not symmetrical like they should be.
• 11:56
  Speaker 1: What do you think the muscles are going to be like when they connect to that altered position?
• 12:00
  Speaker 1: They're going to be guarded, so they're going to be tight and guarded, or they're going to be chronically over, lengthened and that length, tension relationship in the muscle tissue and ligaments is going to cause pain and that's's part of it too, right?
• 12:14
  Speaker 1: So we have to fix that biomechanical fault position problem first with a mechanical solution, which is manual therapy, and then we follow up with soft tissue.
• 12:24
  Speaker 1: That's relevant, which where we at the clinicians that come and mentor with me and for a fellowship, training and stuff, and we ask them we had.
• 12:31
  Speaker 1: We always act like we're grilling them, like what is your?
• 12:33
  Speaker 1: We get to back this up with a biomechanical rationale why are you choosing this intervention?
• 12:37
  Speaker 1: Why would you not choose this intervention?
• 12:39
  Speaker 1: And then to give a clear answer of a rationale, biomechanically, of why they're choosing one thing versus the other.
• 12:45
  Speaker 1: So we do soft tissue work after the joint intervention to get the length, once the length tension relationship is better, and then get the muscle guarding just to settle down and make things more pliable and with hyaluronic acid, blood flow and getting fibers to be more aligned in parallel so they can glide better for pliability and in blood flow right.
• 13:12
  Speaker 1: Dry needling can be really helpful as an intervention on that as well, with stripping and cupping.
• 13:17
  Speaker 1: Those are our go-tos.
• 13:19
  Speaker 1: Okay, all right, then we set things up for success and we've maybe positioned things from a soft tissue and a joint standpoint better.
• 13:29
  Speaker 1: At this point we stand people up and we say let's retest the thing, the movements that made it hurt 15 minutes ago or 20 minutes ago when you first came in after before we did this manual therapy stuff and they retest and they feel better.
• 13:43
  Speaker 1: It's like perfect, we're on the right path.
• 13:44
  Speaker 1: So this is actually a really common thing we just had.
• 13:47
  Speaker 1: This has happened to hand multiple times An active person comes.
• 13:52
  Speaker 1: In this particular case, this athlete was a 17-year-old football player in a local high school that was having chronic hamstring strains and we were like, did you change anything?
• 14:08
  Speaker 1: Like did you feel a pop in your hamstring?
• 14:11
  Speaker 1: We're doing all these hamstring tests just to rule it out, to do our due diligence.
• 14:15
  Speaker 1: And all of them were negative.
• 14:16
  Speaker 1: No, no, no, no.
• 14:18
  Speaker 1: Hamstring really wasn't in that tender to touch.
• 14:20
  Speaker 1: We couldn't.
• 14:21
  Speaker 1: If somebody pulled their hamstring like it's going to hurt with like resisting a hamstring curl, he had no pain.
• 14:27
  Speaker 1: So it's not the hamstring, but it feels like the hamstring.
• 14:30
  Speaker 1: All right, we got to investigate upstream up the kinetic chain and anyway, going into this, my hypothesis was I bet it's going to be sacroiliac joint.
• 14:42
  Speaker 1: That's my first thing, my first working hypothesis.
• 14:43
  Speaker 1: You have a 17-year-old with insidious onset, low back tightness and a hamstring pain.
• 14:48
  Speaker 1: All right, my first hypothesis and he's an athlete with football, I'm like my first working hypothesis of diagnosis is going to be sacroiliac joint, followed by lumbar spine referred pain followed by a legit hamstring right.
• 15:03
  Speaker 1: That's my third working hypothesis.
• 15:04
  Speaker 1: I don't think it's hamstring.
• 15:07
  Speaker 1: When he comes in, rule out it's not hamstring.
• 15:11
  Speaker 1: His resisted hamstring curl didn't hurt.
• 15:14
  Speaker 1: Hamstring palpation doesn't hurt, it's just tight.
• 15:16
  Speaker 1: That's not right at the origin, right at the insertion, right at the belly, all the places that'll be hot, not so it's not the hamstring.
• 15:25
  Speaker 1: And then we start testing.
• 15:26
  Speaker 1: With all this being said too, we're testing his moving patterns and his range of motion and all the stuff we mentioned before and some special tests of orthopedics.
• 15:35
  Speaker 1: This is his SIJ.
• 15:36
  Speaker 1: It was his sacroiliac joint.
• 15:38
  Speaker 1: We intervened, manual therapy to get it more symmetrical and positioned in a more advantageous position and we didn't even touch his hamstring, we just intervened at the sacroiliac joint of his pelvis.
• 15:49
  Speaker 1: We just intervened at the sacroiliac joint of his pelvis.
• 15:51
  Speaker 1: We stood him back up and we retested the range of motion testing that caused it to increase symptoms.
• 15:56
  Speaker 1: When he first came in he had no pain, he was better and we didn't even touch the hamstring and we educated.
• 16:02
  Speaker 1: We're like his dad was there and he was there.
• 16:04
  Speaker 1: We didn't even touch the hamstring and your hamstring feels better.
• 16:08
  Speaker 1: It's because the hamstring wasn't the problem.
• 16:09
  Speaker 1: The hamstring was actually chronically lengthened because of the difference in length, tension, relationship, positioning from the sacroiliac joint, because the hamstring attaches to the pelvis.
• 16:20
  Speaker 1: It doesn't attach to your femur or isn't originate from the femur.
• 16:22
  Speaker 1: Only one part of a small muscle attaches from the femur of the hamstring group and that's the short head of the biceps and that's not a huge key player to begin with, but anyway, that's beside the point.
• 16:36
  Speaker 1: It originates from the ischial tuberosity of your pelvis.
• 16:39
  Speaker 1: So we didn't even touch the hamstring and he felt better.
• 16:42
  Speaker 1: So we're accurate.
• 16:44
  Speaker 1: Let's continue this trajectory.
• 16:46
  Speaker 1: We're pretty confident.
• 16:47
  Speaker 1: We're confident.
• 16:48
  Speaker 1: This sacroiliac joint.
• 16:50
  Speaker 1: Now let's solidify these changes with corrective exercises.
• 16:53
  Speaker 1: We have to stabilize the pelvis, the lumbopelvic region, your hip and your glutes and your core, and sometimes the psoas needs to be strengthened too.
• 17:01
  Speaker 1: It can be shortened and weak, not just lengthened and weak, or shortened and guarded and tight and overly strong.
• 17:09
  Speaker 1: It could be either one of those.
• 17:10
  Speaker 1: We have to figure that out.
• 17:10
  Speaker 1: But anyway, in this particular situation we needed to stabilize and strengthen this lumbar pelvic region, some core stability, and we do that with sling exercises, all right.
• 17:21
  Speaker 1: So the sacroiliac joint if you consider all the key players that attach to the sacroiliac joint and the pelvis and the tailbone, the sacrum, there's lots of muscles that span multiple joints from multiple areas that we would call slings and they globally stabilize the pelvis.
• 17:41
  Speaker 1: All right with translational forces and translational activity like sprinting and lunges and box jumps and agility and changing directions and lateral movement stuff like that.
• 17:51
  Speaker 1: So core stability and sling exercises and glute activation, that seems to be the best recipe to fix underlying sacroiliac joint dysfunction and pain.
• 18:02
  Speaker 1: But imagine if somebody just came in and they were like my hamstring hurts, and then somebody, a clinician, just was like oh, let's work on your hamstring and they don't touch the sacroiliac joint because that was the problem.
• 18:14
  Speaker 1: What does that look like?
• 18:15
  Speaker 1: I'd tell you exactly what it looks like.
• 18:18
  Speaker 1: The athlete doesn't get better.
• 18:20
  Speaker 1: They just massage their hamstring.
• 18:22
  Speaker 1: They're stretching the heck out of their hamstrings.
• 18:25
  Speaker 1: And stretching their hamstrings is not the problem.
• 18:26
  Speaker 1: It's actually already chronically over-lengthened, so stretching might be making it worse.
• 18:29
  Speaker 1: So we didn't stretch his hamstrings at all.
• 18:37
  Speaker 1: You don't need to stretch and warm up before you play, but that's not the pathology.
• 18:40
  Speaker 1: Hamstring tightness isn't your pathology.
• 18:41
  Speaker 1: We're going to focus our efforts and treat other things.
• 18:43
  Speaker 1: But that leads to if someone just does that and they're not investigating an underlying root cause like the sacroiliac joint dysfunction, them not getting better, an underlying root cause like the sacroiliac joint dysfunction, them not getting better, and they're just hobbling around, meandering around at these practices, not being able to practice, not being able to play and this is where we live vicariously through our patients, and we get it.
• 19:01
  Speaker 1: And that's where we're passionate about what we do is because there's a short window of opportunity for athletes to showcase themselves and enjoy the process of playing sports with your friends and stuff.
• 19:11
  Speaker 1: A lot of developmental benefits come from sports and there's a short window of time that athletes can do that and if they're hobbled and disabled by pain and an issue, it's going to shorten that window and they're not going to be able to play as much and the opportunity is over.
• 19:29
  Speaker 1: I've had plenty of teammates and athletes and my friends in the past that they had some kind of pain that just didn't go away and they were just lingering and meandering around like I'm waiting for this doc visit.
• 19:38
  Speaker 1: I'm waiting for this image.
• 19:39
  Speaker 1: My trainer told me to rest this PT that I'm seeing, told me to ice it.
• 19:43
  Speaker 1: I'm stretching my hamstring.
• 19:44
  Speaker 1: I'm not better, I can't play.
• 19:46
  Speaker 1: Coach is like hey, when are you going to play?
• 19:47
  Speaker 1: Sorry coach, sorry coach, I'm not ready yet.
• 19:48
  Speaker 1: I can't play.
• 19:49
  Speaker 1: Like well, it still hurts.
• 19:50
  Speaker 1: Well, you're up some dirt on it.
• 19:51
  Speaker 1: Play anyway.
• 19:52
  Speaker 1: It's like I want to what do you think?
• 19:53
  Speaker 1: You know, all the teammates are like hey buddy, when are you coming back?
• 19:59
  Speaker 1: Hey man, we need you.
• 20:00
  Speaker 1: When are you coming back?
• 20:01
  Speaker 1: I want to, I want that's what that happens, and it sucks.
• 20:03
  Speaker 1: I've been there.
• 20:04
  Speaker 1: It's like I'm trying everything I can.
• 20:08
  Speaker 1: That's why we're passionate and enthusiastic about what we do is because we understand that and we've been there, I definitely have, and that's why I like doing this there is an answer and there is a solution.
• 20:16
  Speaker 1: As long as the underlying systemic red flags are ruled out, then it's a neuromuscular, biomechanical problem and that's what we do, so let's get after it.
• 20:24
  Speaker 1: We have to diagnose you accurately, and that changes the trajectory and the lens in which we perceive this diagnosis, changes the trajectory of treatment and of how we're going to fix it.
• 20:33
  Speaker 1: All right, and the question we asked our fellowship trained docs of physical therapy that come train with me as mentees.
• 20:40
  Speaker 1: I asked them when you intervene like this, are they progressing?
• 20:46
  Speaker 1: And then, if they return back to their sport, is the pain coming back?
• 20:50
  Speaker 1: If they were like, hey, dress out and play 100%, is the pain returning?
• 20:54
  Speaker 1: If yes, then you didn't fix the problem.
• 20:56
  Speaker 1: It was an inaccurate diagnosis and we had to fix the problem or the interventions weren't accurate.
• 21:01
  Speaker 1: Either one of those.
• 21:02
  Speaker 1: But let's deep dive, let's figure this out.
• 21:04
  Speaker 1: We have to dive into the matter.
• 21:05
  Speaker 1: But there is a solution.
• 21:06
  Speaker 1: And things don't just hurt for no reason.
• 21:08
  Speaker 1: And there's no reason why a healthy individual who doesn't have any other underlying red flags and systemic problems should be hampered by pain that's not getting better.
• 21:20
  Speaker 1: It's neuromusculoskeletal and that's the problem.
• 21:23
  Speaker 1: That requires a biomechanical, movement-based diagnosis to fix it.
• 21:26
  Speaker 1: Combination of manual therapy, soft tissue work and corrective exercises to fix the underlying compensation patterns.
• 21:32
  Speaker 1: And that's how they get better.
• 21:34
  Speaker 1: So if you have any questions, man, reach out.
• 21:36
  Speaker 1: We want to help you.
• 21:37
  Speaker 1: We're always open to comments, questions, concerns, conflicting opinions.
• 21:41
  Speaker 1: If you have any suggestions on this podcast, man, I'm always open for ideas and if you're battling any pain or if you know anybody, please share this.
• 21:49
  Speaker 1: We'd love to help them.
• 21:50
  Speaker 1: We can at least talk on the phone and see what's going on and then, uh, at least maybe direct them to somewhere else.
• 21:55
  Speaker 1: Right, we might not be always be the right people, and we can at least talk on the phone and give them some insights.
• 21:58
  Speaker 1: So don't hesitate to reach out.
• 22:00
  Speaker 1: Call us at 5, 6, 1, 8, 9, 9, 87, 25, or email us at team, at athlete rccom.
• 22:07
  Speaker 1: We're located here in West Palm Beach, right off Palm Beach Lakes Boulevard, next to the Tanger Outlet Mall, the Palm Beach Outlet Mall, just east of 95.
• 22:14
  Speaker 1: So we're right here, central.
• 22:15
  Speaker 1: So give us a shout and we'll catch y'all next time.