Understanding Low Back and Hip Pain: WIR 47
Beau Beard (00:01.597)
So the high level clinical talks that go on before the podcast of packaged peanut butter from Ohio and You don't you don't want to know I had to have it clarified and yeah, just live in the unknown live in the black on that one How we doing today episode 47? I know Alex is excited
Beau Beard (00:22.008)
So what I'm gonna do is I'm gonna put the microphone to my mouth and mm-hmm, because that's what Alex is doing. So. They just whined all night. Alex. And they whined when I woke them up. Alex isn't talking about his feet, his aching dogs. He was watching dogs. Dude, I got up this morning, let them out, and they were still whining. I said, you can go outside and there's food in your bowl. Why are you whining? Sounds like my kids. I put food in their bowl and they were.
cry and scream. I don't want dog food anymore. Actually, Kit would eat that. I eat dog food when I was little. I thought I was a dog from the age of three to five. Kit Beard. Dog. How we doing? It's Trent over in the corner. Troy wasn't with us last time. He has been on an episode. He has been. Yeah, he did a guest appearance when we had a crew shadowing from Parker where he's joining us from.
Non-name tag shirt there. Troy's our newest intern. He'll be with us till November-ish, something like about Thanksgiving time. Yeah, so we're excited to have him. So we got two guys in here and he might look kind of stretched from the lens kind of effect over there, but there's Trent. Still have color commentary at some point. Trent will be presenting a case that he treated all by himself in the state of Alabama because he's fully licensed. So look forward to that one as well. And actually can.
yeah. So let's get going. Do we have any updates from last time? I don't think we had any like specific patient. I mean, I was talking about shoulder cases. yeah. two. No life updates. Nope. Besides your TV sitcom with the dogs. Yeah. Yeah. It's going to be a long ride. Kind of their eight days. They didn't whine at all with me. Did they not? Nope. That's a first. They lost their mind this morning. Do you think? Okay.
Do you think animals pick up on like people's anxiety levels? So how do you sleep? How I know they wind. So are they at your house or you stand at their house? Okay. How do you sleep at their house in general? Okay. Okay. Same as normal, which is not great. So I just wonder, cause we also have like the boy wonder that can go to bed at like 8pm and just be dead to the world. They usually are.
Beau Beard (02:50.062)
Do they not whine or you just don't know if they whine because you're dead to the world? have no clue. All I know is when I go to bed, I wake up to an alarm. That's about all I know. That has not happened. We'll find out the answer to that one. Seth is in a house fire and doesn't make it out. I have been woken up by them, but it's because they lost their mind to them. a dog something like that started barking. So they're crazy. Oh, they're losing it.
No. Yeah. They just like lose. Yeah. I mean that didn't happen at all though. These are what kind of dogs? I don't know. I really don't. Rescues. They're great. There used to be four. Yeah. Now there's two. Okay. These are the two most hyper ones that are left. We've dogs that for them a lot. So it's like. They're usually pretty good. Yeah. They were just they were nuts last year. And believe it or not these guys do have a full-time job as you know physicians besides dog sitting. So yeah.
That's what we're going to talk about next. At least I have one with people who show up on the schedule. So we know who you are if you didn't show up the other day. I'm going to add you. Today's podcast, episode 47. By the way, if you didn't hear some of the amazing commercials from last time, we have partnered with Rock Tape. So if you're listening to this, you'll hear a commercial here pretty soon.
partner with them, so I'm gonna just say thank you to Steve Capriancu for, as always, facilitating pretty much anything that is asked of him that betters a profession, which of course this podcast is doing. But you get 20 % off of any of their online or live education, and then we will have products in here any day, it might be today, and we gotta figure out a way to give those things away. So.
Why don't you guys be thinking about that and if we can think of a clever way to give away, we don't, I know what we're getting, we're getting a bunch of tape and ISTM tools and the vibrating cups and their vibration device. Yeah, so think of a way that we can give that to somebody that's listening and yeah, we'll figure that out by the end. That's your guys job, you're on it. You got the next 40 minutes. Today's topic is low back versus hip pain.
Beau Beard (05:07.946)
And in our world, this is just kind of a, I say almost a daily thing that you're trying to figure out because low back pain is so common. But then if we looked at it from just a McKinsey standpoint, we know that a lot of like hip pain is derived from the back and vice versa. So what we wanted to talk about today is to, guess we could just clear the air and say from a patient standpoint, if your back hurts, you don't always know that it's your back. your hip hurts, you don't always know that it's your hip. And that's why it pays
Well, it doesn't pay, you gotta pay somebody usually to check it out. Cause you could be rolling on a lacrosse ball till the cows come home, maybe making something worse to be honest with you if you have a nerve that's irritated, which we'll talk about. And if you have back stuff, you know, it's not always your back. And then how do you figure that out? Yeah, there's a ton of YouTube videos. mean, our stuff, other people's stuff to help self-assess. But I can't tell you how sometimes it seems really easy and it's kind of almost like, well, how didn't they just end up?
not doing that thing that we had them do, because it's like they're kind of doing it a little bit already, or they just didn't lean into it hard enough, or they got led completely stray by some, you know, another professional, something online, whatever it is. So world-class assessment usually leads to better results. And if you show up to your appointment, then it does. So any general conversation before we dive into like specific cases on this, or like hot tips, hot takes for a clinician or a patient before we get into the specifics of the case?
If you have a hot low back ASAP, get the room for Dr. Graham over here. That would be my specialty. If don't know what's hot, you'll know. You haven't had it yet.
Beau Beard (06:48.286)
Or do we want to start? Do we want to start with cases or some rules of thumb of like things that were like, yeah, that's 100 % your back or that's 100 % your hip?
Do we want to the picture of like putting people into one of two categories, usually by age and presentation? that's a good one. I mean, this isn't an assured thing, but yeah, let's say under what do we, mean, statistically, I guess we should have looked this up, but I would say statistically under the age of 55. Yeah. 55 for sure. Nowadays people are a little more active. Well, maybe not more active. Yeah. Our population, maybe so.
If you're under the age of 55, the likelihood of it being, it's your low back, if we determine it's your low back, of it being disc versus something that's called stenosis, which we'll define here in a second, is just more likely. Then you start tipping over the age of 55, it becomes more likely that stenosis, is if this pin is your spinal cord and then the vertebral column goes around it, it's just getting smaller as we age, the likelihood of it being stenosis, which is that, whether that's around your spinal cord or where the nerves exit the spine.
becomes more likely because you've had a lifetime of beating your spine up, which is just common, just like that. Beating it up from sitting like we are, most commonly area of degeneration in the human body is L5S1, right? think that's what he's gonna say. That was just an echo. We think it's from sitting, we don't know, right? Could just be how the human's built. But that's a good way to kind of paint this as like, well, where do you fall in that?
category because then if you're looking up the wrong stuff online or if you've been told that and let's say you're 80 and somebody's saying they want to do some sort of disc procedure, a microdisctomy or something like that or let's say you're, yeah, maybe that's not the right option but the other thing is like if you have a legitimate disc injury, I'm not going to say always but more than likely you had an injury.
Beau Beard (08:49.998)
It's not usually this catastrophic, like I woke up and I have a disc injury and I've got like searing pain all the way down my leg and I'm like not able to control my foot. Right, that usually, and I'm saying usually, because sometimes yeah, you can have like, I picked the sock up, right? Well, it was a thousand times picking the sock up that way, or it was deadlifting 315 with not the best form in the world or falling on the trail and catching yourself in a weird awkward position or having.
kid on your shoulders in two bags and trying to lean into a golf cart, whatever it is. Usually a mechanism there where you're like, that's when that thing hit and that's when these symptoms came on. wasn't this slow, gradual build. That's where we always talk from the clinical side. History is a huge part of our assessment. A, because we want to get to know you and know what your goals are and know how you got there, but also we're paying attention to all the things because then that may start subcategorizing when we're like, we have a
35 year old guy that is a CrossFit athlete, but he comes in and we're like, oh, we would assume it's disc based on what his paperwork said and his age and all that stuff. And then pretty soon, you it's not like nothing makes sense from his history. And then again, the assessment either backs that up or, you know, negates that. So yeah, I like that. mean, anything to add and just general rules like that. That's a good way to approach this stuff from the patient side. Yeah. I guess people like we had a, had a new one yesterday who's, who's 64 and she's definitely in the stenosis category.
Prior to us talking about it, I didn't know what that was. Had low back pain with bilateral symptoms. That happens at night. And she plays tennis, pickleball. But she had been told, you she had two epidurals, both of which on the intake, she said didn't work. When I asked her, she said, oh yeah, I felt good for like two days. And then it came back. So she had been led to believe, well, it's probably not my back if those didn't work. Which they did just for
two days and then you went, you still moved the same way that you did. But it's also stenosis. you're not, it's not the same. There's not a huge inflammatory component when you have this like what becomes a truly mechanical issue because you're losing space in the canal. Right. And kind of how we were talking about with your other patient that you're talking about the hip surgery, her left hip has now, I don't know what it would have been like before, but it definitely does not have near the same external rotation as another side. And that changed pretty dramatically after we flexed her.
Beau Beard (11:15.746)
bunch. And granted, she wasn't having the ridiculous symptoms in the office when she came in. But she was thinking low back and a disc like that. That's the extent of her knowledge with the low back, which was not the case for her. And most people in her scenario that that age, for sure. Yeah. But the epidural was something that I had just seen people come in with that. they're like, Yeah, I had an epidural and it didn't work. Meaning they're not
out of pain right now, but it might have helped temporarily and that at least showed you, your back is part of this. It doesn't mean that the epidural is the answer. Did have something on that? Yeah, for the epidural, that might be a good conversation. How long should it take before they get relief when they get one? it be immediate? Most people with true, ridiculous symptoms, yeah, it's almost immediate. And a lot of people will tell you when they take the
needle, mean, they take it literally up to the nerve and then back it out. As soon as they do that, they start to feel pressure that mimics like it's like us pushing on a trigger point. Like they'll be like, I can start to feel that. And then like 10 minutes later, they're like, oh, like pain's gone. And that's if you're at the, again, we always say like epidurals are, yeah, we hope it's therapeutic. It's also diagnostic. If you ever are looking down the barrel with spine surgery and you have symptoms going down your leg or in your arm and somebody hasn't done an epidural diagnostically,
to determine is that the cause of your pain and we can basically abolish that pain by bathing it in analgesic agents and anti-inflammatory agents, I would not have surgery. Because we have people all the time with imaging findings that look conclusive, get an epidural and they're like, it didn't touch it. Or it was a day and it's right back and then you gotta be like, God, is that surgery gonna have an effect? Because same thing, somebody has a microdiscectomy, what do they say if that was the thing they need? Book up all my symptoms right now.
You also, I think if you're in the stenosis boat, that I don't know, maybe you, maybe you could say you have referred somebody out for it, but in the three years that I've been practicing, I'm not sent anybody out for a surgery for stenosis. the conservative outcome is, is good in a weird way though. Like a, basically a spinal fusion is designed for stenosis. think about it, right? Like that's like.
Beau Beard (13:42.412)
The first surgery that I saw or like was sat in on was a cervical like multi-level fusion. And that's what they do. I mean, there's cut off the whole posterior aspect of the spinal column, right? And going, you see the, I saw the spinal cord just back out and it's like, that's how much pressure was on it, right? So it's technically designed for something like that. Cause what are you doing? You're basically just opening the canal up and creating a cage. What do we see it used for, you know, repeated disc issues or something to the point where like, we've
don't know, hemi laminactomy or laminactomy, let's go ahead and you know, just fuses things. So you do what? Just open up the canal or the lateral frame. yeah, I I've never referred somebody out. I've also sounds heady, but it's like how stenosis is I've never had somebody that we couldn't like back down to tolerable not saying to abolish everybody's symptoms. But also, I don't think I've ever seen some somebody over the age of 85 that's coming in here with like stenosis stuff.
The timeline of your spine is, you you're going to have more soft tissue and true neurologic issues like we said before the age of 55. Then you run into this degenerative change window. But eventually all that stuff kind of goes away and you'd be like, well, how does that go away? Your spine, if you have early degenerative change, say you're 50 and we determine, it's stenosis based on like, well, I'll just talk about my patient here after this. Based on like just life, right? You an injury, sports you played, activities you did. And it's like, oh, just happened to you sooner, right?
Well, eventually your spine fuses, you get your own fusion. like, well, you didn't gain any more space. You also don't have mechanical ability to like irritate it as much. So like a lot of the symptoms will like go away like much later in life. And that's kind of one of those things that it's like, you know, can you live with it? And he had to say that, but like you, if you can't get them moving, right. Based on how, if I had somebody that's 85 and like, Oh, you don't have any movement from like L3 down. It's like, well, am I not gonna send an 85 year old into a major surgery?
I'd be pretty, you I wouldn't want to do that. I kind of brought up, just sorry, not to end this synotic talk. The reason I just asked about the epidural stuff is because I've had, I have two patients currently that I'm like, like I was pretty adamant that it was not a disc that was causing their pain. In my opinion, like both of them are like, they have some low back and or ridiculous symptoms down their leg that is like being hip driven for sure. And they both went and got epidurals. And I was like, I don't think that epidural is going to do anything.
Beau Beard (16:04.748)
And they both are like, yeah, I don't think it's gonna do anything either. They're both like a month and a half out and then they both go, yeah, you know, like I think the epidural is starting to like kick in. I think it's starting to work yet we have like not touched their back and except an adjustment. Yeah. And I mean that doesn't, yeah. So I mean a week, some, I mean some PMR docs will be like, it might take two weeks. I just, you'd have to explain that to me neurophysiologically. I could understand a day or two because two weeks. Yeah. But like,
I mean, you're literally injecting it into the site. like, that's like telling me that like, if I needed peptides in my tendon or my knee, that if I injected it right in my knee, like two weeks later, the peptides started working my knee, I'd be like, why didn't inject my shoulder? Like, why do I have to do it right? Like, you know what I mean? So in that now, if you took a steroid pack, I could see like, the next week after the packs done, you start getting a kind of down, you know, downhill effect, but
Yeah, I mean, you'll hear people all the time, like, I think it's just they start moving different or they do something different. They're not doing the thing that pisses it off. It's been a month and a half and then they correlated to that. you're like, I mean, you also hear it the other way. Somebody has it. They do get symptom relief right away. And they're like, dude, that thing lasted for six months. It's like, well, was it that? Cause then they're like, oh, my pain's coming back. what happens with those most often is what? When you got another epidural and they're in here, why? That one didn't work the same.
It's like, you probably just didn't change anything like you did after the first one. See, I think they have a shelf life and then normal shelf lives, what two weeks takes effect right then. And that's all based on basically anesthetic, like metabolism. Right. Cause you mentioned that they start doing something different. Like one of them was a football player stopped playing football because his back started hurting so much. now he's just like working out and still doing some sprinting, but he's not taking repeatedly repeated hits over and over and over again. And he's like, yeah, my back's down.
volumes down and then another one was golf some bowls a lot but you know doesn't he finally eventually was just like yeah I'm gonna start like working on like some like weights and started like going to the gym sort of like actually lifting and doing stuff on his left leg and he's like this is like 60 % better yeah and I'm like I mean we always say like rehab is a huge part of its novelty it's just something different right and then a lot of people don't seek novelty when something happens they just shut stuff down
Beau Beard (18:21.644)
Right? So that's, it's still different, but it's not a novel thing. the interesting thing, like what if you, I mean, I'm not ever going to do this, but let's say somebody had back pain has been going off for like six months and you're like, it's not that bad, but they're like, it's just, it's a nuisance. Right? What if you just taught them to juggle or something? I mean, I know that sounds crazy, but like a neural pathway, they have to put a focus on something. You're like, I want you to do this three times a day. I almost guaranteed you'd see changes. It's no different than like, you know, trying to.
like quit smoking and then you just have a diversionary like activity, right? It's like, oh, there's not a anti-smoking campaign for like doing improv, but it's like, well, I started doing improv instead of smoking. I just had time to vote it there. And it's like, oh, I got this improv anti-smoking campaign. Like, you know what I mean? So yeah, going back to what you're saying, I'll talk about a case real quick and then I'm gonna, I Alex has some cases, but I had a...
guy that's younger than your typical person for stenosis. He's in his mid-50s but super active, which is kind of, you're like, it could be either or. I've seen him for the past two, three years for right hip complaint, which from day one, I said, you need a hip replacement. Or you're looking down that pretty quick. And he had already, I think, had a consult and they basically kind of told him the same thing from ortho. And I was like, I don't disagree, but I'm willing to try, right? But you kind of hit a level where you're like, might not be easy.
hyper-motivated try, did everything I had him do. And I'd say over the course of three months, we got to the point where he was split squatting and all these things. And his hip wasn't like drastically different range of motion, but pain was decreased. He could walk a little bit better. We also worked on his knee, which he had an Achilles rupture, which maybe was the cascade for his hip. So we got his knee moving. And then we got him to the level where I was like, hey, you're doing a lot of stuff in the gym. Your hips move a little bit better. You're having less symptoms from what you're telling me, from sitting to sleeping to walking.
go do your thing, but I go, if you have a bad flare up, like my next thing would be not come back and see me. Like you need an ortho console because like, I just don't know how much I got in the bag. That's going to like, you know, if this stuff stops working, like we got you doing big stuff. So kind of in a funny, like just, a funny story. So he comes in a couple of weeks ago for a followup. and I'm looking at his note while him and his wife are there. And I was like, I have a referral to an ortho from January of this year.
Beau Beard (20:42.414)
And I go, did you never go? He goes, I had a referral. I go, yeah, like why did I send a referral in? I go, ah, you called in and you had a bad flare up. And I remember telling our front office staff, like I told him he has to go to the ortho if he has a flare up just to check stuff out. And he goes, I did. And his wife, then it was like a little kid getting in trouble. She's like, you were supposed to go to, you know, all this stuff. And I was like, oh my God, I'm getting this guy in trouble. So I go, hey, I'll look at it today. But basically he came in this time with what?
chief complaint of not necessarily low back pain, but like some low back pain, but radiating symptoms down both legs. And I was like, okay. So he's like, now this is becoming not necessarily a bigger issue, but like I have these two things and I want to, you know, make sure that my back, nothing's wrong with my back. I go, well, how's your hip? He goes, oh, it's terrible. Like, I go, so it's no better. He goes, no, like I can only walk about a mile before it just shuts me down. And also I was like, So we start checking his back out and his back.
didn't move terribly. Like we could get him doing some flexion based stuff, but we had to be clever because his right hip doesn't move at all. And I said, Hey, I'm going to give you this stuff to work on. I don't think I necessarily need to work with you locks. I just need to basically go like third, fourth visit with you. What I do with somebody normally just see how you go, right? Like go a little more aggressive. And he was like, well, what do you think the longterm is? go, your hip is still the impediment to your back getting better.
just, and we don't have to go into the biomechanics lab, but like your hip is the roadblock for your back because like walking, like he's just slamming into his low back all the time because his hip's so bad. So he goes, what you saying? I go, you still, you need a hip replacement, a hundred percent. And he goes, I go, we'll get an image. We'll get an x-ray just to kind of validate that for you, which was not good. So I get the image and then just a couple of days ago, he called in wanting to know if I could do an MRI on his back. And I had a conversation with him and I said,
Hey, I don't think you need an MRI because it doesn't really change anything right now. You're not looking down the barrel of a back surgery. And we talked, we had to have the conversation of you're in an age bracket where based on symptoms, what you told me, what's also changed, which we'll talk about in a second with your exercises, you have stenosis. Like we wouldn't send you for a surgery. We would work the conservatively. We're going to run right back into that hip. So you got to have the hip surgery. Well, the hip console is way out. Hip surgery is even further. I was like, okay. So I made a call that we don't normally make of
Beau Beard (23:08.846)
I'm gonna try to send you into one of our pain management specialists and hopefully getting up at your own, maybe it's a steroid pack to back that down. But like, don't think you, I wouldn't treat them for it. I go, that's just like, it's almost being negligent. Like why would I keep treating your back when I know it's your hip, even though there's this timeline? The big key there was I asked him in the conversation, I go, so you said your back's worse since you've been doing the exercise. I go, how's the pain in your leg? He I don't have pain in my legs anymore. Which in our world is like, oh.
Okay, so we got all your symptoms in your back. You're saying your back's worse when you do the exercise, which is like Jefferson curls and flexion based stuff. go, our next step would literally be get your hip and your mid back moving to offload your back. can't do that with you. So he is the extreme case of, you know, this mobile stable, you know, interconnected kind of mechanical scenario, like
He's also the one where you can unequivocally say, cause he was worried like, well, maybe some of my stuff and my hips come from, was like, dude, it's, did you see that X-ray? Come on. Uh, but yeah, if we get his hip moving, I don't want to guarantee, but I almost guarantee all his back stuff goes away. If we just get him walking, because he offloads his spine tremendously. He's starting to walk like a cowboy from his hip, like there's motion in his spine. That's not supposed to be occurring in those planes and day to day stuff. So he's the extreme case where you're like, okay,
I know which is which, but then they're still playing off one another. That's the key with his case is like, yeah, this hip is part of it, but it's not like such a confusing pain like case. You know what I mean? Yes, we'll see, but consult still like three weeks away. The hip surgeries are supposedly like four months away. I don't know. So we don't have to get clever with it. you sending him somewhere else? Yeah. He was so hesitant about the surgery and we literally have one of the best hip replacement surgeons in the U S right here.
I don't think he'd back down. Cause I had to talk him into it that's like, we literally have one of the best. I mean, the next place I'd go to Nashville, I'd have him go to Chicago. So it'd either be Rush or it'd be Belmont. I mean, had he listened to you in January, you already had it. I still think he should have had a her replacement two years ago. I think he would have like been doing so much. That's the hard thing to tell people. Like I just, you know, basically talked my step mom into a knee replacement. She's miserable right now, less than two weeks out. That's kind of part of it.
Beau Beard (25:36.872)
You're gonna be in pain, but I mean her back was hurting her whether it's true or not the surgeon told her it's one of the top five worst needs you've ever seen he's one of the top knee replacement surgeon in the world or the US Is that true? I don't know but it's like your quality of life will go up if you can get a joint that works So other stuff doesn't get beat to hell and that's this guy and that's why it's Tommy Go you're gonna start beating stuff up to where you do need a knee replacement, right? Or your back gets so bad that like Conservatively, it's not gonna get better
And I understand, wouldn't want to fake hip. I but I would hope somebody would like beat me over the head with enough information. like, dude, you got to do this. Right. Yeah. Cause that's not going to change. Yeah. I think I layered Hamilton, like had a hip replacement and I mean, it was waddling around for years. And then finally they're like, if you want to keep surfing, like you have to do this. And I mean, that's just, it was kind of last try. was like, you're gonna take surfing away. Okay. I go get surgery, you know, not came from multiple list frunk.
fractures, change of mechanics downstream, kind of like this guy. Hip gets torn up and pretty soon, I mean, you watch him do like, know, farmer's carries and he looks like, you know, caveman or something. So yeah, when it's time, it's time. And I tell most people, you'll know when it's time. Obviously some people like beat their head against the wall until it's, you got to really talk them into it. What cases you got? I know you got some where it's maybe harder to tell what was going on up front. gonna talk about one case. Trent.
Might be able to add some in here because he's been with me for pretty much his whole case. This is a 24 year old male, was a collegiate wrestler in Kentucky. And while he was wrestling, he tore his meniscus, bucket handle tear on the right side, had limped around on it during the season for a while and then eventually had surgery on it once to repair it. And then
continued having issues, so they eventually removed it. That would have been probably two years ago, maybe a year and a half. And after he had that second surgery, he started having low back pain. And then the low back pain progressed to full blown radiculopathy down his leg. He went from being a very active, cleature wrestler to not being able to do much at all. He works a sales job, so he sits in the car driving a lot and he's up walking a good bit between.
Beau Beard (28:00.666)
And so I started seeing him about five, six weeks ago. And at that point, low back stuff had been going on for about a year. And he can't really stand or walk for more than 10 to 20 minutes. He's got localized pain around the SI joint radiates down to the back of the knee. And then see what else we had here. Had done three
steroid epidurals, most recent being four months ago. He had gotten some relief from them, All at the same level or they changed stuff up? He also had had an MRI previously that showed a disc protrusion L5S1, but the neurosurgeon said, don't recommend that you have surgery. You're young, you're active, you don't have any, you know, myotome loss and none of that.
which I was glad that he said not to do that. But you know, he just was continuing to be frustrated that had been going on for so long. And he was like, I don't even care about my knee anymore. And his knee, we'll get to that. But had had chiropractic care in the past, some traction, but nothing really with any sort of active care, we get temporary relief. So he comes in, antologic and positive.
straight leg raise, slump, milgrams, stork, lot of things hurt. big thing when we're putting him in, like when I was doing the straight leg raise, if we open that left side, so low back is left side, the knee was the right side. When we open that side and straight leg raise or slump, he improves. He's able to express more range of motion before he gets searing pain in his back and glute.
The right, I was kind of thinking about the right knee as it may have been a preceding factor to why he started to bug his back because he was continuing to wrestle and train on that knee. He didn't have full knee extension on the right side and didn't have full hip and turn orientation on that side. And initially, tried going after that to see if there was any effect on the back.
Beau Beard (30:24.684)
It didn't really change it over here. And then when I started working on his back, it didn't really change his knee or his hip. it left me, all right, I'm not going to chase this side. I'm just going to focus on the back. So over the next few visits, basically, we found that he was restricted in sacral mutation.
And I was talking with Trent about this last time. said, like, when we were talking about, you know, where his limitations, he is somewhat of a flexible guy. So when I get him passively and press on those joints, they don't feel super restricted, but then you watch him do a press up or you watch him do something and he, like, it's not, it's like he won't let himself go into further range of motion. So the first day I had, I had done several sets of prone press ups with him to rule out.
that derangement there and that worsened his symptoms. So I stopped doing that. We moved to a static dynamic opener on that left side and then sent him home with a lateral shift against the wall. That was his most helpful intervention to relieve pain, improve range of motion, some of those painful tests and the thing that he could do while he was out at the work and driving to and from.
Over, let's see, I've seen him nine times. progress has been slow, but he, like was at the point where he just like, I need to see some progress, anything. And he came in this last time and he's like, man, I'm freaking stoked. I'm working out five days a week or so. He's not doing anything crazy strenuous compared to what he was doing as wrestler, but.
He me he wants to get into running and he's like, I just never think that I could run. Now he's able to stand up and walk around at work for a couple hours before he has any issues. He's not having problems sleeping, laying down. But all of it now is just localized in his glute. And so playing off of the theme of opening this side, in addition to loading his hip, three visits ago, probably I started to kind of jump the gun.
Beau Beard (32:48.206)
I was like, all right, I want to try to create some contralateral nerve tension to alleviate over on this left side. So I put him in a single leg deadlift up against the wall. Honestly, his hip hinge, he's pretty, just does not know how to do it. For him being a high level athlete, was like, wow, that's not great. So I backed that down and we started a kneeling, like just a high kneeling sit and then moved to a kneeling deadlift.
to where he could start working on a hip hinge on the complaint side. And then as this last visit, Trent had him take him through a diagonal single leg deadlift on that side, which he couldn't tolerate several visits ago, but at this point now he's able to do it. And he got in the position and he was like, man, this feels fantastic. This is exactly what I feel like my hip needed to do. And Trent picked the perfect thing for him because
He could feel his hip. He was opening up that side where he's getting compression over on the nerve roots. Um, then he got up and walked around and he's like, yeah, it felt pretty good. So we didn't do that with any load, just, just body weight. Um, but you know, from the beginning, he was, he, like one of the first few visits, he said, you know, I'm seeing improvement, but I'm afraid to say that I'm hopeful because this has gone on for so long. I don't feel like it's going to, it's going to change. Um, but
Sure enough, slowly but surely he's it's where he's increasing function and he's having less pain. He goes, now my back still, or my, I still get pain in the glute, but we're able to, he has ways to manage it and he's increasing how much activity he's able to do outside of the office. So, any, yeah. You said before, like earlier, you had tried a diagonal single leg deadlift, like previous visits or something, and he couldn't tolerate it?
Yeah, he just started getting, he got some pain in the glute with a little radicular down into the thigh. And again, it didn't look great. So I said, we're just not gonna, we're not gonna go there yet.
Beau Beard (35:01.678)
So how much, and he was having low back pain too, right? Initially, yeah. Then it just shifted down to his glute. Yeah.
And Mike, I mean, obviously there was somewhat of a derangement or some sort of like movement dysfunction in his back. How much of this do you think was actually coming from his back, like the ridiculous stuff? Yeah, that's so also didn't mention he like before the two things that helped the most were the lateral shift. And then I would put him in a just like a lumbar cat cow. He could do that at home and create motion in his back. And he was like, yeah, that that I get a lot of relief of.
after it's not long lasting, but it's not was relief in his back or everything. Like hip. Yeah. Yeah. so, so that's where, that's where I was when I was telling Trent, on this last visit, I was like, yeah, I, I think with his, low back, as far as the movement goes, it's more just how he controls it versus truly like, feel somebody who's 20 years older than him and has a super stiff lumbosacral junction that I guess could have just been him.
overtime, that guy overtime. yeah, because I was thinking initially first day, if I put this guy in prone extension and go through a press up with overpressure where he needs it, like that's going to do it. And it was not the case. And it didn't really make symptoms worse while he was doing it. It just got done and definitely worse. Why do you think the cat cows are so
like impactful in terms of symptom relief. And that's super simple. And it's also not technically directionally like specific. So like, why do you think that was just like, he's not used to moving it at all. And how long does this pain, how long has that stuff been going on with his like back hip, left leg prior to seeing me? Yeah. Yeah.
Beau Beard (37:05.92)
And he had pretty much cut out most movement. Like when he would go to the gym, he'd go there for 20 minutes and do seated exercise. And that's about it. Yeah. you think any of it was, he's not having to stabilize around that hip at all? Yeah. I also, you know, I always try to go back to like, you know, neurology is king by far. So then if he had a low back thing, it sounds like he did. mean, imaging, protrusion had true ridiculous stuff, but then the radiculopathy, like we've talked to him meeting before, like kind of stopped, you know, above his knee.
then you're like, man, a load in his hip was lightening him up at first, right? Then just moving his back. Yeah, the opening was specific, but then like catecholates like, oh, I get relief of all the symptoms to a certain extent. So that's like central sensitization. And then like the concomitant, like I had an injury, I changed stuff in the periphery to help protect the injury where that's trigger point tone. Then I change how I move in my back, maybe because I just remove stuff or I literally lock it down. think sometimes I, we get,
too mechanical sometimes you're like, this is causing that like extensions bad because you know, it's a central disc or you know, like we get too mechanical versus like, that's why I was asking a question. Why do you think that cat cows? could be just moving his backs, mechanic reception, which from a central sensitization component will like decrease anything coming from that vertebral level. And then like maybe loading a set, maybe still had like tension and trigger points. And so he's like, I really like that feel.
And then the question, that's why I asked, like the question is, are those, you know, referred pains like, is that nerve, is that trigger point? I said, yeah, I a trigger point, including me, but it didn't refer, including him, didn't refer down to that spot actively when I held on it. But like we said, an impossibility to have a nerve be irritated and the nerve just stop, right? So that's where you always got to think, like, you can have central sensitivity. Cause again, that's just like pinging around off of like outputs, right? And what are outputs? It's not necessarily nerves, it's also muscle, right?
peripheral, cutaneous nerves. So that's where it's always like, you're trying to play the detective role of, hmm, like almost how dumb could we make it rather than super mechanical specific, like, like, oh, they can't move their back. So sometimes we always go with extension because we, kind of, or you're taught McKenzie, we sit all the time. So we kind of have a reason, but you could just be like, well, I'm just gonna have moved their back. So I still remember the first RTP seminar ever.
Beau Beard (39:32.398)
that was in Denver, Project Move. I've told you guys a story. They had everybody in the crowd stand up and do a toe touch, right? And then they basically just systematically went through the room and if you could touch her toes and sat down, whoever was left, would do, we all got to pick who was ever up there, right? Like breathing or eye focus, whatever. And we got down to one and she couldn't touch her toes. I it was just literally like a foot away from her toes. It looks like she put the brakes on you. You're of like, oh.
You know, some people are now saying, oh, she needs to go deadlift, you know, cause the crowd's screaming and Phil Snell was one the instructors and he's like, do you dance? And she's like, no. And he goes, do you know what salsa is? And he's got his, you know, multicolored pants on. And he's like, starts doing salsa and he goes, did anybody have any music? And somebody turns their phone on and she dances for like a minute and then like nails the floor. And everybody's like, what the hell? And whatever that was, cause now there's a big emotional response, like embarrassment in front of a crowd.
doing some completely novel, but then just moving her spine in like 3D, right? That's what he was, but he's doing all of that, right? Which one, who knows? Nobody knows. But super general versus we were all throwing out super, it got more specific because it got to one person, but the N1 needed the most general thing that anybody did. So it's kind of like, that's what we should all hopefully kind of do is you're like, if you can rule out injury, right? You're not like, oh, you got ridiculous stuff and we're just like, hey, let's do the salsa. And they're like, oh, I'm dying.
But you're like, does your back move? Well if it doesn't move in a single plane, but just I've said it time and time again, Gregor is like a joint restrictions equal opportunity, you know employer. It's restricted in all planes of motion usually if it's a true joint restriction. So it might need motion all over and it might respond really well versus derangement is Coincides with the restriction but like now we're saying hey you have a directional preference which would mean that like was it a true joint restriction?
Right? Or do I have a movement that's not great, which seems more motor control almost, right? Like I've picked something to shut down. So again, what causes joint restriction? Good luck. I don't know. so yeah, my mind's just kind of going around because there's never a right answer. You're just like, what is it? Right? Cause you can get somebody out of pain and still like not know that's frustrating thing about our career. They walk out and you're still like, I really don't know. And they're doing better. And that's
Beau Beard (41:49.998)
the dirty secret of all this stuff. like, so you're trying to not have those where you feel pretty like, yeah, we went down this path, but then you kind of get smacked sometime and somebody comes in and they're like, other ways, right? They're not doing good and they go do something crazy and they're like, that made you better, right? Or vice versa, like that made you worse. And you're like, that doesn't make sense. So yeah, I'm just curious, but like I said, God's doing better. The one question I wanted to ask you, do you think you'll ever go back to his knee?
Good question. I know that's kind of outside of this topic for this podcast. I haven't checked his knee extension in a few visits. mean in terms of, so I always think of a case of a runner that lives in your guys' that I treated and she had had left hamstring stuff that had shut her down for like two years. Like anytime she had volume or went to run fast or run a race, like her left hamstring just lock up.
I looked at it and was kind of one of those where you're like, nothing seems wrong on that side, right? Everything seems okay. Two prior knee surgeries, think a meniscus surgery and then a follow-up scope and then her knee was just stiff as bricks and then legitimate like weakness around there. You're like, you haven't done enough. We didn't touch her left hamstring, but it wasn't like whiz bang. It wasn't like I did right knee stuff and like her left, it took like a little while, but like she's one of those people like I'll still see her on. So she's like, yeah, I no problems. And it's like, you needed long-term change for a long-term.
change. Yeah. So I just wonder sometimes like it's not audit based or like, his knees cause his left back. But it's like, might've led to it. And also be the thing you want to go to last or expect like, Hey, you still need to work on that thing, man. Yeah. Cause I mean, if he wants to get into running, yeah, if it was just that not thinking it's going to cause a left low back pain, just check the box. Yeah. Yeah. Just, I think that's a good thing to think of. Like it took a while to get there. Maybe it's not audit based. Maybe it's like, Hey, we're just getting stuff moving.
And again, maybe you don't start there because you're like, yeah, there's bigger fish to fry. Yeah. Cause if I just mope the heck out of his knee and I came in and, Hey man, your knee is moving a lot better. And he goes, you have my back still sucks. Or you're like, I think it's gonna take months for this to, know, do you go backwards just cause you have some, I don't know. yeah, it's not a, I mean, some of the knees that I've seen that are, yeah, that needs to move a lot more. It's not that it's a minor probably. Yeah. So, yeah.
Beau Beard (44:18.67)
Just something for everybody to think about. If you think there's a cause and it still exists towards the end of care, why not go after that thing? Maybe that's just, go do this for three weeks and check in with me, see how it is. Yeah, do you guys have any thoughts on that one or anything around the low back versus hip? Again, so the stat is around 75-ish percent of hip pain is coming from your low back. So that's where it always pays if you're like, I've got hip pain.
And depending on where it is and how it acts and what caused it, almost always at least ruling out your low back. And again, if you're just kind of listening to this from the patient side, that can be really tough to do on your own. Well, how do you do that? It's not always easy in our world. it's like, you're just trying to be systematic so you're not five weeks into some treatment plan. like, god, that was my back? I wish I would have started there or at least looked at it or thought about it. You had mentioned you were a...
You mentioned you were trying to do like some Contralateral tension. Yeah, when you did that single like deadlift were you doing it on the right side then? and then this time you switch to the left. Yeah
weeks, three weeks apart. So you did right side single leg deadlift and he got left side. it sounds like. No, no. he started, we tried doing it on that side. That's I went to the opposite side because he could tolerate that. And then I was thinking a little pull the nerve roots over to the other side. So I'm kind of like this upper limb tension. Um, yeah, no, I didn't, I didn't send him home with that on that side.
Six months.
Beau Beard (45:58.798)
With assessment was contralateral tension palliative? No. Like what made you want to go that way just to try it out? No, I didn't tension him contralateral, like as a repeated movement to see or anything.
Beau Beard (46:18.21)
Yeah, I mean, maybe I probably will ask him to come back on because I'd love to have kind of a conversation with Shaqlok again. But this time from just what we said, I understand that he is one of the most well studied and then well versed in his realm. Maybe we get him on with some other people. But I'm still curious about like, can you actually do what they're saying you're doing? I mean, that's with all stuff, right?
If I adjust something, is it actually doing what we think it's doing? I think we've had enough to know your store motion, you don't change the place of it, how long that motion lasts, it's dependent on a lot of different variables. Same thing, so if we're like, I wanted to pull the nerve root, can you do that? What would be the things that would have to be in place for that? The spine would have to be able to move, especially locally. Tissues would have to move pretty much perfectly.
right from a myofascial distortion standpoint, if like all those things are perfect, yeah, we'd think it moves like we would expect it to. Perfect doesn't exist. So that's like my other question. Then it's like, is that even the thing? Right. And I think that's the more you get into it, the more you realize like nobody understands you go back to like very basic science and you're like, so complex, you almost gotta be simple, right? You can't go in and be like, I'm moving that thing. And then you think you are, and you're like,
And why do I say that is? You'll focus on somebody's big toe, their big toe is the exact same and everything changed. And you're like, damn it, what? But that's your focus point, stuff changed, why? Because your nervous system, you're like a neurologic sponge that's just like interacting with the world and then we don't understand the interactions. That's where I think like people like Eric Cobb, like not that they're better than anybody. Sometimes I appreciate the way they look at it, because they're like all of its neurologic input. So just pay attention to the input instead of thinking so much.
in the periphery, which again, Shacklock's in that realm, but that's still peripheral nervous system largely. So just think there'd be great conversation, be a great conversation between somebody like Eric Cobb and Shacklock. Hey, you're working on, you know, Shacklock in the periphery, right? We're having a spinal cord is, you know, maybe as central as it goes besides pain mechanisms. And then, you know, Cobb's saying, well, I'm using the body's inputs to have a central, like truly central effect, I don't know, you know, to change stuff in the periphery, range of motion, tissue tone, all that stuff.
Beau Beard (48:35.758)
I think you can spin yourself around and around, but I think it always goes back to for me, which sounds super old school, especially for what we do in here, like get joints moving, like get tissue to calm down. Now how you do that? There's a million ways, right? And then what we're always trying to do is like, where do we need to get the stuff moving and get it calmed down versus like, is it his right knee or is it left hip, low back? All right. That's the, you know, those are the, maybe not the tough things, but there's a lot of options on everybody. I, uh, yeah, I think one thing that's important too, like
with that guy just from shadowing and stuff is he was eating food, you know, not super great for his diet and drinking a lot of alcohol. So he did see some pain flare ups with that too. Alex had that conversation about, Hey, we need to go more anti-inflammatory here for a minute. And then it was able to decrease his pain. He could get in the gym, he's moving more. So I wouldn't be surprised if we go back, test his knee range of motion.
And it's all cleared up just because he was able to exercise for the last couple of weeks. get it moving. That's like one thing. Like everybody's like, is there anything that I can do to like, you know, help this along a little bit quicker? And I'm like, you drink water? Like I'm the worst guy. He has that water bottle all week though. I got it from a gas station on back from Coleman. was a, it's a good, it's called Life Water. It's giving me life. I had two of these, but.
We're down to one. He's looking for his sponsor. But yeah, it's just like do you drink water like hydrate some those – hydrate some tissues and also just like I don't know, you're not – you reduce some inflammation. You take those two things, exederation like tissues like muscles and bones and crap, start moving around a little bit better. Well, I told the guy that I talked into the – I say talked into like was trying to get to realize needed a hip replacement.
I mean, it's same thing. goes, what else could I do? And we had talked about dietary shifts and he's like, I'm doing all this stuff pretty good. I go, I've literally had people where I think they need a joint replacement and they don't have it because they do like an autoimmune protocol or they clean their diet up. And it's not that it's perfect, but it's such a drastic change, even range of motion and stuff. So you're like, I would have not expected that. But again, your body is neurophysiologically responding to stuff. And I mean, that's the stuff you put in your body and the stuff you do to it, you know, that you do and then is done to it.
Beau Beard (50:57.582)
Yeah, I just think sometimes we don't, that's fundamentals. Like you drink water, do you eat good food, do you sleep, do you move at all, right? Do you move that area at all? And do you need to get more specific or more general as you go? And most people, becomes, we start specific, right? We look at how you move, how stuff moves, and then pretty soon you get out and what do we talk about? We want to have people leave the office healthy. It's like, well, I know you're out of pain, but like, let's eat a little bit better, let's sleep a little bit better. So I'm not saying that you can't start there because people want to get out of pain.
And it's going to take a while from like, just knock out some gluten and see if your back pain goes away. That's not what we're saying, but like you can't live a certain way and then expect everything to feel awesome all the time. Yeah. So, I don't know, like, this is again, just a while. I mean, some experimentation, like on my end, guess, but like, I got a guy that always gets like a back pain and leg cramps and everyone's on the golf course and just talking about hydration. just like on observation, I just always notice every time I like looked at
He always wore shorts and stuff. His skin is just super dry and we live in a very humid place. It's just uncommon. So was asking him, do you drink any water on the course? I mean, obviously you have the Michelob. was like, I mean, it's not really water, but it's close. And I was like, he's like, I do drink a decent amount of water. I was like, do you ever do any electrolytes with it? And then he's like, no. So we point him towards the element and he literally takes one or two packs of those. He takes one pack before he plays and then does one on the course and like.
He goes, yeah, I don't have any back pain or any like muscle cramps or anything like that on the course. And I was like, you how specific to then do I get on like biomechanics and moving or was it like a fundamentals of like, he needs some hydration before he goes out there. His skin looks better. It's not as like dry every time he comes in. I'm like, So if you talk to some like, you know, I'm saying fashion nerd in a loving way. mean, that's like, you know, there's the, so we looked at like fascia research and this is an untrue. People laugh that sometimes like hydration or fascia is a state that you can like change.
Basically three ways to do that drink water eat foods that hydrate your tissue You move which moves fluid gradients around your tissue or you do things your tissue to move that around which be like self-massage getting a massage stuff like that We tend to lean on that stuff. Maybe not even thinking that we're doing, you know, fascial hydration stuff, but that's stekko in essence Yeah, what are the much bigger place drink water to move right and they'll be like, well, I'm golf and stuff It's like yeah, like constant moving around an area that maybe can't
Beau Beard (53:22.476)
move as well because there's a decreased like fluid gradient there, what do you get? I mean, that is truly where you get into the classification within StECO world of like creating like adhesion with a, know, fluid matrix that doesn't exist in that area and then trying to create frictional movement around it. So yeah, I mean, again, can't start there. People come here with an expectation. We do have powerful tools to eliminate pain. I just, the further I get into my career, I'm like, I've told you guys this all along, don't.
tell yourself a biomechanical narrative that's like untrue just cause it seems to make sense because you get led astray. So I think the more general you can be, you probably pick a better patterns cause you're like, I see a lot of people that aren't drinking water and they show up with this kind of like a symptomatology. It's around sports, poor recovery, whatever it is. I see people that, you know, even inflammatory diet show up with like this kind of thing. And you're like, I'm going to mention this to more people instead of just leaving that till the last thing while I do all my other stuff. I think that's the play.
in general, because we're just wildly unhealthy anymore anyways. So hard to treat people that are, you know, walking around as an inflamed toadstool. Cause you're more so trying to catalyze also your treatment. Yeah. Like, you know, I'm not trying to hold out on you. It's like, I'm trying to help like get as much like not throwing the kitchen sink at you, but like, yeah, what can I do that is very specific, but also like some general guidelines to help catalyze some of those things. And if it's more or less, I don't want to say free, but like drinking water doesn't cost much.
element costs a little bit of money. If you got to eat a little healthier, maybe it doesn't cost any different. Are you just buying different food? I think sometimes we think I'm going to do this lifestyle. It's like supplements and stuff. like, that should be the last thing. In my opinion, do you eat crap and then take vitamins? Why? Some people are like, oh, that's why you need to. It's like, I would say no. No. The offset doesn't exist. Same thing. Do I have people come in and it's like, I'm going to take
steroids to decrease inflammation. So I go play golf and be like, why are you playing in the first place? Right. It's a golf or judaya. And it's like, well, the steroids are just, you know, yeah, putting the fire out. I like people, I was talking about this, this morning with a lady in my business group and people joke that like we eat the same thing all the time, right? We have a very, when we cook at home, there's not a lot of variety. Nick Saban does it. Yeah. Hey, I'm an Auburn fan. I'm just saying anyway, it just like,
Beau Beard (55:41.748)
I am reminded when I'm around other people, because sometimes they'll order breakfast or they'll bring stuff for breakfast there at that group. I'm like, yeah, people really don't, really don't start the day well with what they're going to do nutritionally. And then if we got to eat somewhere, they see us maybe eating something like, wait, you eat that? said, yeah, I 89, 89 % of the time during the week when I make my food, it's the same four or five things, but it's a, know, I'm getting all the protein that I need. I'm getting in the fibers.
trying to drink enough water. And then when I got to eat, I don't have to feel like, I can't have that because it's gonna negatively impact my health. Like, sure. It's more freeing eating the same thing that I know I'm getting nutritional value from so that way on the weekends, like I can't enjoy my ice cream or a burger or something. And I don't care. And what they're also saying is if they saw that they had an issue with like dairy or something, you'd also be like, I just don't make those. I'd still eat other stuff, but it's like.
I think we get way too wrapped up in that of like, oh, gluten is double. I was like, maybe, maybe for you, but also like, how do you even know gluten's the issue if the rest of your diet sucks too? You don't even know if that thing caused it. And that's what, that really is like a pet peeve of mine now is like, it's that thing. It's like, at the rest of your diet. Your body can't figure out what is the trash, right? The whole thing is just dumpster fire.
Yeah, that's where sometimes elimination diet and then you do add in things. like, that does affect. That's the only way you can figure it out. Like you had to clean everything up first, which in essence is a good way to wrap it up. That's what we're trying to do with the movement side. You're trying to say, there's a lot of stuff going on, right? Like nothing's perfect on anybody for the most part, but in your scenario, based on your history, based on what you're presenting with today, I think we need to start here and try to see where it goes. But then you might be like, Hey, you do need to work on that knee down the road because that's how you get here. Or Hey, you're good.
Like you can go back to things as usual or, you know, don't, don't deadlift like that anymore. That's not a, that's not a good choice. anything to leave with on that, hopefully confuse people about their low back and hip pain. So they just sit at home and fear and, you know, stop moving and create centralized pain and, know, have psychotherapy at some point. You hit that book now button. But you have to show up.
Beau Beard (57:58.954)
Yeah. Just good life advice there. Yeah, you got to up. adjusting going on in these hallways. Okay. Did you guys think of a way to give stuff away? I got a good one. What you got? What's the idea here? All right. So obviously we use rock tape stuff here, know, tape, utensils, cups, types of things. So you can, let's see, DM us the number of times you think we're going to use those rock tape items.
out of the four practitioners here over the next two treatment days. And Troy and I will be tallying it up. Okay. And then also- you have to be following- Yeah. Follow us, subscribe, give us a review, send us your driver's license, social security number. I would also say if you're a clinician, take a picture or a video of yourself using that and we'll DM it to us or send it to us email or whatever.
And then we'll share that because again, this should be kind of, if you're not using it, yeah, do what they said, because you're not using it you want to try the stuff out and maybe get some of the stuff. But if we're using it, like we can give you, you know, different tools for free or class. We can give away a class here and there for free because we also have a 50 % off, but that's not just a code we can give away. But that code, you guys should know it's going to show up in the commercial, but it already did about 20 minutes ago. So you heard it already.
But yeah, that's rock tape, 20 % off and go look for that. last words of wisdom, sage advice, I'll give you a word that our front desk lady told me. You're saving money by not buying it. You heard it here. Listen to that one. You it here. didn't weep. You're saving money by not buying it. For going on the wizard theme. That's the wizard word I'm right there. You got to stay blessed and see you in a few hours. See you.
