Latest / The Driven Athlete / Biomechanics Behind Non-Traumatic Wrist Injuries | Ep 93

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Biomechanics Behind Non-Traumatic Wrist Injuries | Ep 93 · 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?
• 0:12
  Speaker 1: Y'all?
• 0:12
  Speaker 1: It's your man, dr Kyle.
• 0:13
  Speaker 1: Welcome back to the Driven Athlete Podcast.
• 0:17
  Speaker 1: I have not touched on this yet.
• 0:19
  Speaker 1: I wanted to dive into it a little bit.
• 0:20
  Speaker 1: I've been having a couple of patients recently with this issue and I wanted to be like oh, a little bit.
• 0:28
  Speaker 1: I've been having a couple patients recently with this issue and I wanted to be like oh, I wanted to send them content.
• 0:30
  Speaker 1: I realized I didn't have anything on the wrist.
• 0:32
  Speaker 1: So wrist dysfunction, wrist strains, wrist sprains, it's a common thing with impact racket and club sports, like golf, of course, tennis, lacrosse barring any like traumatic injury, as in like they fell on it right or they banged it on something.
• 0:46
  Speaker 1: They slipped and fell and then landed in an awkward way.
• 0:49
  Speaker 1: That would be a traumatic injury.
• 0:50
  Speaker 1: But barring that, it's like where does wrist issues come from?
• 0:54
  Speaker 1: Where, um, a young athlete who's training a bunch for golf literally just called this week and they were like um, their parents talked to me.
• 1:01
  Speaker 1: They were like our kid's been practicing a ton and out of nowhere we've had we've been getting wrist pain, like she, this, this, this athlete has been experiencing pain in the wrist, so nothing happened.
• 1:15
  Speaker 1: I was like, did anything happen?
• 1:16
  Speaker 1: This is a classic story we hear pretty often where it's like I know that we can recall, right, nothing happened traumatically, where it was like one big swing and boom, hit like a root or hit a really fat shot and then like something sprained right then, but rather just like an accumulation of a lot of repetitions in time.
• 1:36
  Speaker 1: All of a sudden my wrist hurts right, that would be non-traumatic wrist pain.
• 1:43
  Speaker 1: That's a common thing that we see.
• 1:45
  Speaker 1: That is our bread and butter, that's what we do, that's what we work on.
• 1:49
  Speaker 1: It's non-traumatic, non-specific pain that seems to be obscure, not really can't find any answers.
• 1:55
  Speaker 1: The MRI x-rays are unremarkable, but I'm having a lot of pain.
• 1:58
  Speaker 1: What do you do and why did it start?
• 2:00
  Speaker 1: How do we fix it?
• 2:01
  Speaker 1: And then, how do you prevent it coming back?
• 2:03
  Speaker 1: Like what's the underlying reason for the issue?
• 2:05
  Speaker 1: Right, so that's our bread and butter, that's what we do.
• 2:09
  Speaker 1: Back pain, shoulder pain, wrist pain like that, like that's our wheelhouse, all right, that's where we thrive.
• 2:16
  Speaker 1: We're the specialists that people call to fix that.
• 2:19
  Speaker 1: So, with this common story.
• 2:22
  Speaker 1: I've been playing golf a lot and all of a sudden my wrist hurts.
• 2:24
  Speaker 1: Or lacrosse, or tennis, pickleball or whatever Like what do I do Oftentimes with this?
• 2:47
  Speaker 1: It's a combination in a or striking of the ball or whatever you're doing.
• 2:50
  Speaker 1: So it's undue stress on one particular region or area of the wrist that is overcompensating and taking the brunt of the movement or the impact and the stability requirements through that impact phase of the sport or the swing repetitively.
• 3:07
  Speaker 1: And if there's mobility and range of motion, mechanical disparities of mobility and strength disparities, muscle imbalances, what we would call that.
• 3:19
  Speaker 1: So there's joint imbalances like range of motion, flexibility imbalances in certain joints elbow, wrist and shoulder, hips and pelvis and the trunk that we can't neglect because it's a full body sport.
• 3:32
  Speaker 1: It's a full body movement, swing right, and then a lack of strength and stability where some things are required too much to produce the force and not enough of other things are contributing to produce the force for the swing.
• 3:45
  Speaker 1: So imagine if one particular joint is taking on a lot of the brunt of the impact, not getting help elsewhere or dispersing the forces through the impact, and then the muscles that generate the force are all coming from one particular region, in one area, what do you think is going to happen?
• 4:01
  Speaker 1: That one particular spot is going to get overwhelmed and that's going to cause pain.
• 4:06
  Speaker 1: So it ends up being the straw that broke the camel's back over an accumulation of many, many repetitions and episodes.
• 4:11
  Speaker 1: So it's a recipe of overall flawed mechanics all right, Joint mobility disparities, muscle strength, stability disparities, imbalances, with undue stress being placed on one particular area over and over and over again, and that creates pain.
• 4:31
  Speaker 1: In my opinion, a cop-out answer, a weak answer, a lazy answer is overuse.
• 4:37
  Speaker 1: My question with that would be with this, it's a lot of volume that athletes practice, for sure.
• 4:44
  Speaker 1: My question would be this particular athlete that's developed this wrist pain out of nowhere, are they doing an excessive amount of repetitions, more than their colleagues, more than their friends, more than their competitors?
• 4:56
  Speaker 1: Are they all practicing somewhat similar?
• 4:57
  Speaker 1: And if they are, then why is this one athlete developing wrist pain whereas the other ones aren't?
• 5:03
  Speaker 1: Then why is this one athlete developing wrist pain whereas the other ones aren't?
• 5:07
  Speaker 1: If it was overuse, just like blanket coverage, overuse diagnosis, then why doesn't everybody get the same wrist injury or some kind of an injury at the same time frame, 12 weeks into the season, six months into the season.
• 5:19
  Speaker 1: Why doesn't everybody get injury like that?
• 5:22
  Speaker 1: If they're all doing kind of the same amount of practice and volume, it's because it's not just overuse, it's all the other recipe stuff that we mentioned just two seconds ago.
• 5:30
  Speaker 1: All right, flawed mechanics in a swing, which is not what we do.
• 5:33
  Speaker 1: We're not golf pros or tennis pros, but we are biomechanics in pain and we can pinpoint and isolate an answer in some structures of like.
• 5:41
  Speaker 1: This is what the painful structure is.
• 5:43
  Speaker 1: This is the pain generating tissue and this is why it's getting overwhelmed.
• 5:49
  Speaker 1: And watching you move and groove, I can tell there's joint disparities of range of motion in your shoulder, scapula, thoracic spine, pelvis and hips and disparities in your elbow and wrist.
• 5:56
  Speaker 1: All right, for like strength requirements and mobility and stuff, all right.
• 5:59
  Speaker 1: So all those things kind of combined end up being the recipe that lead to nonspecific, non-traumatic wrist pain, specifically wrist pain for this particular podcast.
• 6:09
  Speaker 1: So what are those structures that get irritated?
• 6:13
  Speaker 1: People usually ask what's the pain and what they're asking is like what is the angry tissue?
• 6:19
  Speaker 1: What's angry?
• 6:20
  Speaker 1: What's the painful tissue?
• 6:22
  Speaker 1: Right, and it's usually some ligamentous structures, the soft tissue that spans.
• 6:30
  Speaker 1: You have tons of bones in there.
• 6:31
  Speaker 1: Right, you have eight carpal bones.
• 6:33
  Speaker 1: You have two forearm bones and you have five metacarpals and they all articulate together.
• 6:39
  Speaker 1: All right, the best mnemonic that I've heard for remembering the carpal bones is so long to pinky.
• 6:44
  Speaker 1: Here comes the thumb and those are the eight carpal bones.
• 6:48
  Speaker 1: They're like little rocks or pebbles in your wrist that help with joint, that just produce the mechanical movements in your wrist, but they articulate with the forearm bones called your radius and your ulna, and then the distally or further away, the metacarpals.
• 7:01
  Speaker 1: All right, and there's five of them for each five finger.
• 7:04
  Speaker 1: So those are the articulations of the joints.
• 7:08
  Speaker 1: So between all those joints you have ligaments that connect to each individual bone in multiple areas.
• 7:13
  Speaker 1: All right, so there's a ton of ligaments in your wrist between the distal forearm bones of your radius to ulnar, your radial ulnar joint, the radial carpal joints, the ulnar carpal joints and then the metacarpal carpal joints.
• 7:29
  Speaker 1: All right, the carpal metacarpal joints.
• 7:31
  Speaker 1: So there's a ton of ligaments and they connect to every single bone.
• 7:33
  Speaker 1: Okay, so there's a ton of ligaments in there and they all can get some of them can get irritated if they're being chronically overstretched and strained with the repetitive impact motions in the positions that the wrist is enduring this impact, all right.
• 7:47
  Speaker 1: However, ligaments are passive structures, as in.
• 7:51
  Speaker 1: They don't produce stability, they just maintain passive stability.
• 7:55
  Speaker 1: All right, you can't strengthen ligaments with exercise, but what I mean okay, let me take this a different way you don't create more dynamic stability through ligamentous structures.
• 8:05
  Speaker 1: The ligaments don't create dynamic stability.
• 8:07
  Speaker 1: General rule of thumb is a joint is only as strong as the muscles that surround it and that span over the joint.
• 8:14
  Speaker 1: So it's dynamic muscle stability and muscle strength and activation or timing of turning things on at the moments they need to be turned on or turning them off when they need to be turned off more, and re-regulating the recruitment patterns.
• 8:28
  Speaker 1: That's ultimately what creates stability around a joint.
• 8:31
  Speaker 1: So the ligaments get a lot of weight.
• 8:36
  Speaker 1: With diagnosis as in, like what's the painful tissue?
• 8:39
  Speaker 1: Well, it might be some ligamentous strain.
• 8:41
  Speaker 1: For sure we would call that a sprain, some ligamentous strain.
• 8:46
  Speaker 1: For sure we would call that a sprain, ligamentous sprain happening from repetitive, undue overstretching of the ligaments that are trying to hang on for dear life.
• 8:51
  Speaker 1: But too much stress is being placed upon them.
• 8:53
  Speaker 1: And why would be too much stress be placed on the ligaments?
• 8:55
  Speaker 1: Because the muscles that surround it aren't producing enough stability instead.
• 8:59
  Speaker 1: So it inherently goes to just requiring the passive stability of the ligaments that span the joint to make sure that your wrist doesn't dislocate, right, it just keeps things intact.
• 9:09
  Speaker 1: So the ligaments get overwhelmed for sure.
• 9:12
  Speaker 1: You also have joint capsules and all around the same areas and the soft tissue of the joint capsule is a thin membrane that unsheathes the joint for another layer of stability and that joint capsule can get irritated.
• 9:22
  Speaker 1: And you have nerve endings all up in the ligaments and the joint capsules, so they're going to get irritated and they're sensitive.
• 9:27
  Speaker 1: And the other thing, of course, you have tendons.
• 9:29
  Speaker 1: Okay, so the tendons get overstretched and strained too.
• 9:32
  Speaker 1: Particularly in the wrist there's another structure called the TFCC and that stands for triangular fibrocartilage complex and that is a web and a matrix of fibrocartilaginous structure right, collagen fibers, fibrocartilaginous, some cartilage, fibrocartilaginous in nature and makeup, and it suspends the distal ulnar carpal joint.
• 9:57
  Speaker 1: All right, so the ulna is the joint, the bone, sorry, the forearm bone, that would be on the inside If you're staying with your palms out like this.
• 10:05
  Speaker 1: The ulna is on the inside and it continues down to your elbow and that's the point of your elbow is the olecranon of your ulna.
• 10:11
  Speaker 1: So it continues down and it actually does not extend all the way to meet your carpal bone at your wrist joint.
• 10:16
  Speaker 1: It's a little bit of space and that's on purpose, with evolution, the way that the humans developed.
• 10:21
  Speaker 1: What suspends and maintains stability for that space is the TFCC.
• 10:26
  Speaker 1: So it suspends the ulnar joint to the carpal joints that they articulate with and it creates a little bit of passive stability to allow mobility and range of motion.
• 10:39
  Speaker 1: If you ever notice this is called ulnar deviation, where you bend your wrist towards your ulna and then when you bend your wrist towards your thumb, that's called radial deviation.
• 10:47
  Speaker 1: You have a lot less radial deviation available range of motion when you bend this way, but you have more range when you bend to the ulnar side.
• 10:54
  Speaker 1: Ulnar deviation.
• 10:55
  Speaker 1: The reason is because the ulna does not extend all the way to the wrist and it's suspended by the TFCC and it allows more range of motion and mobility.
• 11:02
  Speaker 1: Classic signs and symptoms for the TFCC that's involved is clicking, popping and pain wrist clicking and pain with impact or pain with weight bearing, especially pain when your wrist is an extension like this, when it bends backwards and then put pressure through it.
• 11:17
  Speaker 1: That would be classic signs of like the TFCC is involved, right, so like pushups would hurt or impact activities in a golf swing and add clicking with that and some swelling and pain with range of motion, that all would indicate and lead to us hypothesizing a diagnosis that the TFCC is involved.
• 11:36
  Speaker 1: I like to say involvement like that.
• 11:39
  Speaker 1: It gets involved, it gets frayed, it gets stressed and it can get sprained and overly stressed.
• 11:49
  Speaker 1: Right, we can't structurally change anything with that from our standpoint, because we're conservative sports physios.
• 11:57
  Speaker 1: Right, wrist surgery is not always indicated and it's highly there's not always necessary.
• 12:05
  Speaker 1: Okay, if we think about, with imaging and an MRI is how you would get an investigation and a diagnosis to see what structures in the wrist are involved or if they're noticed to be sprained or torn.
• 12:21
  Speaker 1: It just involved frayed, right, an MRI is going to be the thing that's going to indicate that and discover those structural abnormalities.
• 12:30
  Speaker 1: Okay, um, and this just gives us information very often, and what the research describes is that a lot of people have, uh, tfcc or maybe even in the knee, the meniscus in the shoulder, the labrum, those are all be similar structures that provide stability.
• 12:47
  Speaker 1: The same way, um, that they have involvement of those and they didn't even know they had it Fraying, tears, a breakdown that is a super common thing where those structures get broken down with repetitive microtrauma and microstress, injury, microstresses over many, many episodes of sports and activities.
• 13:07
  Speaker 1: They get frayed and broken down over a long period of time until like one aggressive movement or just one more, one more practice.
• 13:15
  Speaker 1: At this point now it's the straw that broke the camel's back, to where symptoms and pain are coming into the equation.
• 13:21
  Speaker 1: But not knowing that, like the structure, the MRI might have looked the same three years ago compared to now, or even two years ago, unless they rapidly ramped up their volume of practice or play or whatever and they were really aggressive and super unstable.
• 13:38
  Speaker 1: Through that, changes can happen quickly, totally.
• 13:40
  Speaker 1: But for non-traumatic, non-specific wrist pain, the TFCC can get frayed and there could be evidence of micro tears in there for sure.
• 13:50
  Speaker 1: The question would be like were those tears already existing or did this one movement?
• 13:55
  Speaker 1: Recently was there one big impact where it was like boom, like oh man, it hurt really bad.
• 13:59
  Speaker 1: I fell, it was a big twisting motion in my wrist and like that's, I heard a clip, I had a pop, like it dislocated my wrist or something.
• 14:06
  Speaker 1: That would be much different.
• 14:07
  Speaker 1: That's traumatic versus non-traumatic, non-specific pain.
• 14:18
  Speaker 1: The question would be like were those tears in the TFCC there already, and now we're just having enough irritation of the nerve endings in the capsules and the ligaments and the soft tissue and the tendons that now we're having pain.
• 14:24
  Speaker 1: So if that's the case and the tears were already present years prior let's say a year prior but you've only been having pain for two months, three months, maybe nothing significantly has changed in the last 12 months, but you only got a pain for three months, four months.
• 14:40
  Speaker 1: What happened the remaining eight months prior to that?
• 14:43
  Speaker 1: That would suggest that, like, the structure was still the same and you had no pain then.
• 14:48
  Speaker 1: The structure is the same and you have pain now.
• 14:51
  Speaker 1: So is the structure.
• 14:52
  Speaker 1: The problem Is the structural deformation, the structural derangement, is the structural involvement of, like tears, fraying, breakdown.
• 15:04
  Speaker 1: Is that the actual problem?
• 15:05
  Speaker 1: Because those breakdown, fraying and structural damage was already there prior and you had no pain then, but now you do so.
• 15:14
  Speaker 1: Does that require, then, a structural intervention, like a surgery, to change that?
• 15:17
  Speaker 1: The suggestion would be no, all right, and we see this very often.
• 15:21
  Speaker 1: All right, so we don't have to jump to surgery, all right, but sprains and strains can happen totally and it would just indicate that it's repetitive microtrauma over many, many episodes that lead to breakdown and then enough for the nerve endings involved in the ligaments and the capsules and the tendons to get painful enough to create pain and then you have an inflammation event that happens, a standard cascade of inflammatory reactions that cause more proliferation of pain and sensitivity and then lack of range of motion and then with more fluid present in the joint that can create more clicking and popping.
• 15:57
  Speaker 1: So the clicking and popping is usually from more fluid in the joint versus an actual structural derangement.
• 16:01
  Speaker 1: That's a common thing too.
• 16:03
  Speaker 1: So MRIs would find some micro tearing, micro fraying, increased signaling, increased edema, which is swelling, increased swelling in the joint.
• 16:11
  Speaker 1: That's what it's going to find, but not significant enough to be like.
• 16:15
  Speaker 1: Here's a glaring problem.
• 16:17
  Speaker 1: Right there you need surgery Totally.
• 16:19
  Speaker 1: That's oftentimes what we find that the radiologists find in the MRI that they send to us and we read it too, of course, and we check it out.
• 16:26
  Speaker 1: And then it correlates what we find clinically with an exam, an evaluation on the wrist.
• 16:30
  Speaker 1: So that's what we would find structurally.
• 16:36
  Speaker 1: Okay, and that's what the TFCC is.
• 16:38
  Speaker 1: It's called a triangular fibrocartilage complex.
• 16:39
  Speaker 1: It just suspends the distal ulna on the carpal bones on the wrist, all right.
• 16:42
  Speaker 1: So here's something else we find All right.
• 16:44
  Speaker 1: Here's the key.
• 16:44
  Speaker 1: Now, what do you do?
• 16:45
  Speaker 1: What do you do with this information?
• 16:47
  Speaker 1: My wrist is still sprained, okay, now what?
• 16:50
  Speaker 1: Well, we have to identify the biomechanical faults and the biomechanical compensation patterns, and usually there's a link with the shoulder girdle, the shoulder blade, the scapula and the shoulder complex that's lacking in some kind of mobility and strength and stability.
• 17:05
  Speaker 1: There's usually a scapular shoulder link to distal pain in the wrist and the elbow for golf and tennis and pickleball, lacrosse, whatever.
• 17:13
  Speaker 1: So, speaking of just like the wrist and golf right now, there's usually a link in the shoulder.
• 17:19
  Speaker 1: We got to check that thing out.
• 17:22
  Speaker 1: It's a full body.
• 17:23
  Speaker 1: Motion in the shoulder is the main proximal stability requirements for the rest of the arm down the chain that produces the force when you swing the club.
• 17:33
  Speaker 1: Okay, so we can't neglect and we can't leave that stone unturned, to investigate the shoulder and the scapula and you know what there's usually.
• 17:41
  Speaker 1: That's the main.
• 17:42
  Speaker 1: One of the main things we have to focus on is scapular stability or mobility for certain individuals.
• 17:47
  Speaker 1: So it's either a mobility disparity problem, too, and a stability strength problem.
• 17:51
  Speaker 1: There's also some soft tissue restrictions that limit motion and also play with muscle recruitment strategies.
• 17:59
  Speaker 1: All right.
• 18:00
  Speaker 1: So you have a lot of muscles in your shoulder.
• 18:02
  Speaker 1: Some muscles are very dominant and strong and some muscles are inactive and more dormant.
• 18:08
  Speaker 1: So that would be a recruitment disparity problem.
• 18:11
  Speaker 1: That's what we call muscle imbalance.
• 18:13
  Speaker 1: It's a muscle imbalance.
• 18:14
  Speaker 1: It's not like a strength problem, it's just more of like a recruitment problem.
• 18:17
  Speaker 1: What's recruited first to produce this torque or this force, especially rotation for golf?
• 18:23
  Speaker 1: So we have to create more balance in that and we have to do some soft tissue work on the joint, on the soft tissue restrictions that are limiting motion and keeping things tight and bound down, and then strength activation exercises.
• 18:35
  Speaker 1: We also can't neglect the joint, the shoulder joint and the glenohumeral joint and the scapular movement, all right.
• 18:43
  Speaker 1: So we have to do manual therapy.
• 18:45
  Speaker 1: We find ourselves doing manual therapy on the scapula and manual therapy on the shoulder joint itself, soft tissue of the surrounding musculature and soft tissue restrictions.
• 18:54
  Speaker 1: And then muscle activation, strength exercises to fix the underlying problem that's leading to the compensation patterns downstream in the wrist that's creating undue stress repetitively in one particular area.
• 19:05
  Speaker 1: All right, that's the link.
• 19:07
  Speaker 1: All right, let's take it a step further.
• 19:08
  Speaker 1: We also can't neglect that spine rotation, mobility, spinal mobility and range of motion.
• 19:15
  Speaker 1: There has to be enough of the thoracic spine to create rotation and enough in the hips to create unallowed rotation.
• 19:22
  Speaker 1: Where a lack of rotation, mobility there, something else is going to make up for that, and it's usually going to be the shoulder being hypermobile in some directions or hypomobile in other directions.
• 19:32
  Speaker 1: And then guess what else is going to make up for it down the chain, the wrist.
• 19:36
  Speaker 1: And then one more thing on top of that that we can't neglect is just flawed mechanics.
• 19:41
  Speaker 1: All right, and that's swing mechanics.
• 19:43
  Speaker 1: Like in the tennis swing or golf swing, something mechanical is flawed and not as efficient as it could be to disperse the right forces throughout the joints at impact.
• 19:57
  Speaker 1: And part of that is a timing issue, as in like, what fires first, what's moving first in the golf swing?
• 20:03
  Speaker 1: And that's not what we do.
• 20:05
  Speaker 1: We're not golf pros, but we are biomechanics and pain, and we can link it back of like oh, this makes sense and this makes sense.
• 20:10
  Speaker 1: These movements and mobility drills and corrective strength exercises will help you be a better golf at your swing.
• 20:16
  Speaker 1: It'll help amplify and facilitate the right swing mechanics that you're working on with your golf coach.
• 20:20
  Speaker 1: Does it make sense?
• 20:21
  Speaker 1: And that's our role and that's our lane, all right.
• 20:23
  Speaker 1: So we're not golf pros, but we are biomechanics and pain.
• 20:26
  Speaker 1: That's what we do, and we can link together and connect why certain areas are having pain and where the other areas are being neglected All right, and those compensation patterns and disparities and imbalances lead to chronic issues over time.
• 20:40
  Speaker 1: Anyway, that's what we do.
• 20:43
  Speaker 1: Okay, so that's a little breakdown on the wrist and the hand of in golf, to be super just, concise, and a little bit of education on some of this stuff and surrounding structures and I've done another podcast previously, so check it out on golfer's elbow and tennis elbow and the same kind of talk.
• 21:03
  Speaker 1: Right, usually athletes are too, if they're novices or if they're changing their swing mechanics or something.
• 21:10
  Speaker 1: A common theme is they're too wristy, they hit the ball with their wrist or they try to like finish the ball, the job, with the wrist, so they're producing too much force with their wrist because of a flawed swing mechanic thought, but there might not be able to even and that causes pain, or they just they might not be having enough range of motion in the hips, the pelvis, the thoracic spine, the shoulder, to even get in the right position to have, not to have the best of swing mechanics and not have flawed mechanics.
• 21:38
  Speaker 1: So that's what we investigate and we do and that's what we intervene with joint mobility, soft tissue restrictions, muscle recruitment, strength activation and timing, and that's kind of the stuff that we'll work on.
• 21:48
  Speaker 1: But so, anyway, check out those podcasts too.
• 21:52
  Speaker 1: If you're a golfer and if you've had elbow pain, wrist pain, check out the elbow ones.
• 21:56
  Speaker 1: That I did too.
• 21:57
  Speaker 1: It's a very similar talk.
• 21:58
  Speaker 1: There's a scapular shoulder girdle link of lack of compensation patterns.
• 22:03
  Speaker 1: And then core right, we talk about the spine, but also the core, core stability, rotational core strength, rotational core, production of the force, timing it with the hips and the pelvis, rotation, enough thoracic spine mobility to allow it to happen, the right shoulder positions, the right shoulder stability and scapular strength, and then that produces the force to allow the wrist to not have to take the undue stress repetitively.
• 22:29
  Speaker 1: So that's what we do and then that's we intervene manually.
• 22:32
  Speaker 1: But then we also intervene with corrective exercises, without doing that, like there is no other solution.
• 22:37
  Speaker 1: That is the solution.
• 22:38
  Speaker 1: Like if nothing changes, nothing changes and a person is just going to repetitively do the same thing over and over again.
• 22:44
  Speaker 1: They're going to reinforce the same movement patterns consistently.
• 22:47
  Speaker 1: What's that look like five years down the road?
• 22:49
  Speaker 1: More pain, more limitation.
• 22:52
  Speaker 1: And they're like.
• 22:52
  Speaker 1: That's not for me.
• 22:53
  Speaker 1: Every time I play it hurts.
• 22:54
  Speaker 1: Every time I work out, it hurts Like there is a solution.
• 22:57
  Speaker 1: If it's neuromusculoskeletal, there is a solution of why, of how to fix it, and then an answer of like why does it hurt?
• 23:04
  Speaker 1: Versus like I'm an anomaly and it hurts for no reason.
• 23:07
  Speaker 1: I'm just, I was born to not be active.
• 23:09
  Speaker 1: It's not true Ruling out underlying red flags and systemic pathology, that we don't do.
• 23:15
  Speaker 1: If it's been ruled out, that means it's neuromusculoskeletal and that's what we fix.
• 23:20
  Speaker 1: So we'd love to help you.
• 23:21
  Speaker 1: All right, we're passionate about helping people and we live vicariously through our patients.
• 23:28
  Speaker 1: We enjoy what we do and we get fulfillment, which means we try hard and we critically think to like actually get the results people are looking for.
• 23:33
  Speaker 1: Because ultimately, the proof's in the pudding If somebody's seeing a person, if it's another practitioner a surgeon, doc, other practitioners, whatever and they're not getting better the proof's in the pudding If you're better or not, that's the number one thing people are looking for.
• 23:51
  Speaker 1: Is the result right.
• 23:52
  Speaker 1: But anyway, this is what we do.
• 23:55
  Speaker 1: We're specialists in this.
• 23:57
  Speaker 1: So we would love to help you and if you have any questions, feel free to reach out.
• 24:00
  Speaker 1: Any comments, questions, concerns or conflicting opinions about the podcast, please reach out.
• 24:05
  Speaker 1: Man, we're always open and take a seat, step into my office, let's have a conversation, where I'm always open to having discussions.
• 24:11
  Speaker 1: So give me a call.
• 24:12
  Speaker 1: 561-899-8725 is the best way to reach us and have a conversation about what you're battling or what you have issues with in pain.
• 24:20
  Speaker 1: If you want to get that fixed.
• 24:21
  Speaker 1: Or you can reach out to us.
• 24:23
  Speaker 1: Dom, the best email is probably our team email, which is team at athlete rccom.
• 24:29
  Speaker 1: So we'd love to hear from you.
• 24:31
  Speaker 1: We hope you do Also subscribe, like, share this podcast with people that you feel like would enjoy it or find it interesting or might help them.
• 24:40
  Speaker 1: It'll also help with the algorithm of like what content is being shared with the right individuals and might help them Right.
• 24:47
  Speaker 1: So anyway, we'll, we'll, we'll hopefully hear from you all soon and we'll catch y'all next time.