Scar Work in Long-Term Knee Pain: Week in Review 55

Most athletes don’t realize the hidden factors impacting their performance — until a tiny scar or scar tissue messes everything up. In this groundbreaking episode, we dive into how fascial adhesions, scar tissue, and nerve feedback loops can sabotage even the most talented athletes, often without obvious injury. The FARM team unpacks real stories from elite sprinters and distance runners who defy conventional wisdom with surprising breakthroughs—showing how subtle tissue restrictions and altered feedback can hold back years of progress. You'll discover how fascial cupping, scar mobilization, and intra-abdominal pressure techniques can dramatically improve movement, reduce pain, and reignite performance—sometimes in just one session.

Full Transcript

Beau Beard (00:00.802)

Let's start with that. What's that you got? Texas Tanner. Chase Jackson. She went where'd he go? she. Yeah, she. Don't don't assume. she is now world number two in the woman shot put with a twenty point six six meter shot. at the twenty twenty-six Pavo Nermi Games Continental Tour. Twenty meters. Is that like sixty-six feet? Twenty meters, sixty-six, thanks to my handy dandy track calculator.

That's gonna be

I'm gonna guess sixty six.

Sixty seven feet nine and a half inches. Not bad. And Ryan Krauser goes over twenty three. So it's like the the gap between the men and the women is slowly because of his well, I guess his is seventies. But seven she identifies a woman or is it a woman? I know. I mean the one thing that like sets her different than most of the other shot putters is that she always has like this elaborate makeup thing. It's like almost like you know what like kids get at like carnivals where it's like the face makeup. She does like that, but like with her eyes, flashes, her forehead.

It's like an intricate setup. What's her name? Chase Jackson. Chase Jackson. She used to be Chase Ely, I believe, before she got married.

Beau Beard (01:19.618)

But like if you look at like on this war paint, buddy. Yeah. That's less than what I thought. It's different every time too though. There's a Chinese dragon on that one. I was picturing a clown face. Not entirely clown face, but like it's just very I don't wanna say over the top, but it like sets her different with What do you got, Alex? You got some stats for us? Mm. Well, we'll save the we'll have the joint discussion about the enhanced games in the sprinting world right now. But

I guess Simeon Burnbaum, probably the most notable. Right now, track and field is going through regionals, so NCAA's will be next week or the week after. And Simeon Burnbaum's out of Oregon. He originally he was in dead last in the fifteen hundred going to the last lap and won. Pretty handily, closed in like fifty low. So it it's cool seeing that kind of speed at the same time we were just talking about. I again don't know the guy personally.

But I just I'm seeing, especially in the fifteen hundred right now, all these guys that just have all these big egos. And I mean, sure. He's been backing it up. There's some other guys that have bigger egos that haven't won every race that they're in. And I'm just like, look, people people respect class and humility. So first of all, we're distance runners, we're already a step below. Class and humility does not pay for sponsorship, likes, coverage. Well, they're getting like this world.

Yeah, but that's attention. So that's a yeah. So there Cam Haynes is talking about this on his podcast with him almost maybe getting a lifetime ban from USTAF via Sage Canada that at the end of the day, like PR, especially nowadays, is still PR. And like the easier way to get PR nowadays is negative, which sucks. Yeah. Just easier. Yeah. Which if we switch over to the sprinting side, yeah. We've seen what I shouldn't say negative. We're not saying like go beat your wife, but like Yeah.

Being I don't know, cocky, being the villain, like that's just easier. We're not saying do something bad. We've just seen it more so on the sprinting side over the years, right? That's been a more characteristic theme. And I've got some opinions there. US is definitely holding true. We've had two get arrested in the last probably year or two. Yeah. one of which we'll talk about here in the enhanced games, which was hopefully, you know, from the beginning, I've been a hater of it because I just think it's you know

Beau Beard (03:48.246)

It was anticlimactic. I didn't at the least well it was anticlimactic. I didn't want it to be a promotional thing. If it went well, kids go, you know what? I can But we kinda knew it wouldn't, which is why I wanted it to happen. Sure. And we saw a dud in your life. Yes. But some people say that it was like a hit and like that they're gonna just go off from Yeah, the fact that they still discussed world records being possible, I was like, All right. So only one will get into this. We you know, Fred Curley, who has run nine point seven six

One of the fastest times in US history for men's one hundred. supposedly did that when he was clean, supposedly was clean during this race and ran nine nine three in the prelim, nine nine seven, or nine nine eight in the f in the final. Which, you know, sure, is fast. But if you compare it to anything else that he's done in his career, let alone the rest of the world, it's not close to a world record by any means. and, you know, it we you would just think, all right, well, everybody's on these performance enhancing drugs.

that are forbidden from being used because they're supposed to have that performance enhancing edge and all across the board. One world record was broken amongst all the sports that competed in the games. And in fact, many of the performances were underwhelming on the men's and women's side. Yeah. so I'm glad in that since yeah, kids are hopefully seeing that and going, Maybe I shouldn't do drugs. Maybe I should just try to work hard. and Ethan pointed something out really interesting in the men's hundred collegiately we saw this week.

Well, so there is the was it Auburn? It was the Auburn. He went nine eight seven four. Nine eighty four in the West Regionals. Yeah. No, East Regionals, 'cause it's Auburn. Wynn Legal. Yeah, Went Legal. It was number it's n I think it's now number one world lead right now. And then Sam Blaskowski, for those who know Universe of Wisconsin Lacrosse, he's like a big name in that realm. shout out to my Midwest boys.

Uh-huh. He went nine eight nine in his collegi or not his collegiate in one of his pro debuts, which is now number two all time. And then ironically D three guy, yeah. So UW Lacrosse is not like a big school. It's a big school for D three, and they're like a powerhouse in D three, but the fact that both of those guys went faster than Fred Curly in the enhanced games without in win legal conditions. In win legal. And that was the first time that Sam Blaskowski's ever went nine eighty nine eighty nine win legal. The last time he ran that fast of a time was a five and a half win.

Beau Beard (06:13.858)

This was like a one point two and point seven. It was negligible. So it's just kind of ironic that like either these guys are juicing that aren't in the enhanced games or Fred Curly's just not that fast when he's juicing. How old's Fred Curly? Twenty seven. Upper end for sprinting sixty two though. Yeah. Yeah. Yeah. So there's a lot. I mean, there's a ton of variables and all that stuff. But yeah.

Anything else in the running world. I guess we've had since our last podcast. High school has died down. They had their state meets, their national meets. Cross country will their training, they'll gear up for cross country in the fall. By two months. Local update, Kokodona, David Tosh, our local trail legend, got into Cocodona. Mm-hmm. He'll be the next year. Seventy five, seventy six. But he'll be the oldest competitor next year.

That's crazy. And he did when did he do Moab? Was that two years ago? Two years ago made it to the we were debating this last night. Someone said like two twenty something. I know he made it really far and then he basically had the runners lean and just timed out. He didn't stop. He just didn't make the net last check or the checkpoint. So hopefully, David, if you're listening or somebody, which we've talked to him this, he needs to do some ancillary training to not have that happen again. So he knows that. Yeah.

My last stat I have is Simon Hammer. He's a decathlete. He has set a world lead and a national record for Swiss with an eight seventy seven eight or eight thousand seven hundred and seventy-eight points. And he had multiple personal bests within the different events as well. I'm pretty sure long jump was eight meters, fifty. Believe so. It's certainly

PR, but I thought it was a world record. It's his personal best for sure. I don't know if it's a Decathlon world record, but yeah, 2026 851 with a one wind. So his progression over the past ten years has been significant. He's Swiss? Yeah. Mm-hmm. quick update, switching to the patient side. Last time I talked about the

Beau Beard (08:25.132)

The gentleman that thought you needed a shoulder replacement did not. I saw him last week. He was up to swimming like fifty laps, no pain. was able to like dead hang for like thirty seconds. He was working on active hangs, he was doing sets of ten seconds. He's doing some push ups, you know, just general weightlifting, he's doing some pressing stuff. and funny enough, he still was like, I'm optimistic that I won't have to have a surgery. I mean

I mean I just like I was like, shut up, shut up. And then he's still like, Well, it still hurts if I lay on that side. So I'm like, we just go in and like jab on a trigger point every spinais. I was Do you feel like that? He goes, Yeah, exactly. I like, Yeah, like, well then funny enough, his wife is a physician, which I didn't realize. And he goes, Can she just like stick needles? And I go, Yeah, whatever, cool. Yeah, if she if you want her to. And he's like, Okay. but yeah, I kind of just to kind of put a bow on that, I was like, Your job is now to just build capacity, so I'm not gonna see him for a month. And I

My only job is if your shoulder gets so painful at night or painful doing something, not that we probably change anything, just mitigate pain, right? Like I can come in and we dry needle, we can do stuff. So that's a good tip for people listening. Like kind of your job s usually starts with pain mitigation, right? Or modulation to get them not to alter movement. But then also like you're gonna run in as Clayton Skag said on the last episode, he calls it signal. Like they might have more they might just train, they get a trigger point, they sleep and then all of a sudden they're not moving their shoulder the same.

Okay, come back in so we can get your shoulder moving the same. It doesn't mean I start all over, like, what's going on now? Same thing. Just your shoulder's cranky. It's been fifty years of not great shoulder stuff. So I think it's just a good tip. But yeah, he's doing great. Okay. But still thinking somehow in the back of his mind he needs surgery, which is just laughable. But whatever. I was gonna ask if you had him doing soft tissue stuff for I hadn't up front because I knew what he was expecting. I was like, I'm not gonna do a whole lot of that. We did like some mobilization of the shoulder, like posterior shear and

His thoracic spine was what we were like doing soft tissue on. And then that's the first time I've done like soft tissue on a shoulder. Well, no, I did some like ART stuff on his lap because it was just, I mean, densification and stuff in there. But yeah, it's just you become a pain modulator symptom as they run into that signal, which I like that. nothing wrong with doing that. That's not, you know, yeah, it's rubbing the boo boo for a good reason to keep them on the path. Right. And then not change their movement. Yeah. Just think of your I mean, I mean, I've been waking up and if I

Beau Beard (10:49.986)

Flex my bicep literally over my like bicep tenant, it'll just like wow for like a second. And I'm like, Yeah. Like but then I'm like, it's not there. But if I started avoiding that range of motion, I'd be like, Okay, I gotta do something about this. Yeah. But I'll literally go right back into it and like cold ISOs and stuff, be like, Okay, I'm fine. Doesn't feel perfect all the time, but every once in a while I'll get a pretty strong like ye. Yeah. People are like, What is that? I don't care what it is. I just work around it. If I can't, I'll get it work done. Yeah. Yeah.

Alright, so what do we got? You guys got any updates? Did you have one? Yeah, so the guy with the shoulder that we got the MRI on. I saw him after we got the MRI and I haven't seen him since this meeting just 'cause he's in Hawaii for a work trip and I'll terrible. Terrible life to live that you're in Hawaii for the next like s a week. So if you're listening to this, I hope you're doing well and you're doing your exercise. Yeah, I should have, but I could afford anyways,

We talked about like what the MRI results showed and like my expectations for him, kinda like what we talked about in last visit. And we started doing some dead hangs and active hangs with him just to like see if like a distractive force will allow that shoulder to relax. And he was able to tolerate it with thin reason. So we just kinda modulated how much w pressure he was using through the hang and we're keep keeping everything the same in terms of like exercises. It's just like, hey, like we gotta just be a little bit more diligent in expectations of this could take.

Three to six months and not like a month. So now you just gotta see all your response. Yeah, exactly. Yeah. But haven't seen them since that visit. Okay. All right. Ready? Yeah. Tee it up. All right. Case presentation, like just history first and then we'll go through the sheet. Not a lot of history. Just kind of general what they're coming in for. Yeah. Yeah. forty eight year old female. Trying to create like a mystery novel out of these podcasts where we're not just for the way we're doing it now. We used to be Ethan and I were talking, sorry to cut you off.

These used to be very much more patient forward. Like we talk about a case like a spondilo. You'd be explaining like what a spondilo is, what we did. That's not very fun for me. so now then we started doing like a little more in-depth. Now we're trying to do is say, Okay, yeah, we're gonna go depth, but we want you to draw some conclusions before we do reveals to A, see our process, but B, see how you think about stuff different. And that again, nobody's wrong or right. It's just like different conclusions based on information, the system you use. So yeah.

Beau Beard (13:15.662)

48-year-old female, chronic history of left anterior knee pain. she's pretty active, works out in a group fitness class setting four or five days a week. and sorry. Through the triage of the the worksheet first. So not an injury. She can move her knee and her hip injuries. Well, read the question. So again, if somebody's never listened to this show before, we have

We have a a system sheet that reads like this. So Alex will read the question and then give his answer to the question based on this lady's left anterior knee pain. Yeah. So is there an injury present? No. And there we're just saying, is there like tissue damage, a path anatomy? Like, nope. It's gone on for a long time. She had had MRI before, that didn't reveal a tear. And she had actually had an orthopraphic surgery to clean it out, which gave t temporary p relief five or six years ago.

And real quick, if you're a patient listening or a non clinician, also I would keep listening and not zone out and be like, this is for clinicians. No, it's not. It's to show you an approach from within our clinic walls that's hopefully allowing you to realize that we're not just saying, you have patellar teninopter or anterior knee pain. Here's our here's what we do. Yeah. And then here's your sheet of exercises we give for knee pain. that's not good.

Like you deserve better. So we're literally trying to, you know, draw the curtains back and be like, Hey, this is how we think about it. This is how we got to where we were for the clinicians and a patient. So hopefully you realize like we're really trying to take our time and think a lot and you know, treat you as the individual. Yeah. Yeah. Yeah. And this case will definitely not be a tricky cutter. She would have followed the knee protocol, yeah, worksheet.

So yes, had had the arthr arthroscopic surgery five or six years ago, temporary relief started getting worse a year and a half ago. her knee does move, so it doesn't move. She has full range of motion. and only so it was non-painful range of motion with the exception of knee flexion and prone. so she didn't have pain supine, but did have pain in prone. does it move above and below. Her ankle moves as does her hip, has full range of motion of both.

Beau Beard (15:37.976)

Can they move it? Yes. Her knee, that is. can she apply it to specific movements and skills? No. do you want me to elaborate there? Yeah. Like tell us a little bit about what you tested or what you asked her. Yeah, so she had kind of told me that when she does certain movements in the gym that are single legged, they're harder on that side than the other. And when I watch her do those things, her foot does not want to stay in contact with the ground. Her toes will literally all flare up and it'll be really wobbly.

Her you know, lunges, step ups, those kind of things, in in the at least the fitness setting. walking up and down stairs was a thing that she would notice it at home. Same movement. and then obviously things that are plyometric. Like she had really reduced how much of that she would do in the gym. and for other reasons doesn't really run anymore, but had gotten to a point where running was also not super fun.

Which I'll want me to get into some of the other pertinent medical history that relates to this. It's not her knee. Some of the reasons with running that she wasn't doing that, she's had five I didn't list all of them. I think it's five to nine abdominal surgeries. partial colectomy. She's had some kidney issues, she had like kidney stones, and she's had some other just there's a lot of disruption. Yeah. Yeah. So

That's all happened pretty much over the last twenty years. So she's had to have some revision revision surgeries and so that's that's going to play into the rest of the case here. and her husband's also physician, so she's she's been like guided some and but he's also come here to see us, so he's been trying to get her in here for a while at this point. and so her on exam, I already talked about

pain audit, knee flexion and prone. orthopedically, she had pain with thessalis. But that was a pain on she had pain and prone. Pain and pain. But four range or she had limited range of motion too or full range of motion. Slight. Like less than or she, you know. It's different than the other side. Yeah. Tension. Tension because supine she had full range of motion. and then a single leg pogo. No pain with two, but single leg. Cool. Some pain. Functional audit recfrim trigger point, which she did not have on the other side. And

Beau Beard (18:06.956)

reproduced down into the anterior knee. she also not first visit, but would kind of come and go vasus lateralis that would refer down as well. and then I we were talking about this yesterday with your patient with the scarring. And you do use that as an audit. you're gonna see that that comes into consideration with the rest of the case. I didn't use her

scar presentation, I guess, like the coloring or the puck. From her near abdomen. Sorry, all knew abdomen. Yeah. She has very minimal you can't even see the arthroscopic from her knee. But yeah, there's there's a lot on her abdomen. and so we after hearing all of that with the history, I was like, we need we need to start centrally here for me to just see if anything changes below. because there there is still some things that we need to do downstream.

By way of watching her do those, I watched her do a lunge, I watched her do squat. and yeah, she lifts all the toes whenever she's doing any that. And she doesn't do it on the other side. So, we started with just some simple I actually had done she had limited range of motion in her lumbar spine extension and l lumbocycronutation. So we I did some press ups and that did change the rectus femur trigger point a little bit. So I think I sent that home with her one visit.

And outside of that, the big thing that we ended up doing for her was I cupped all of those scars around her abdomen and the trigger point was gone. before we even did any sort of other abdominal work through intra abdominal pressure and diaphragmatic breathing. but when she saw that, she was like, Whoa, that's insane. And and she goes, My husband told me some weird stuff probably had. and I was like, Well, I mean, you did present a pretty good opportunity for that. And so

I told her, was like, hey, I'll do this kind of thing. Cause it's not the most pleasant, you know, cupping, she can't really do it at home. it's not super comfortable. And I was like, look, I'll do that here. And at home, we're gonna, because you need to be able to stabilize yourself better essentially anyway, but you can sort of get those scars to mobilize from the inside out. We're gonna do some of this intra abdominal pressure and breathing. That was the first thing I sent her home with. and she's continued to do because it again really reduced that trigger point.

Beau Beard (20:28.61)

And it's been incorporated into the movements that we've started doing for loading her actual leg and and working on that awareness with her foot. So in a half kneeling position, we just started there trying to make sure that if she could lift off the ground, that she didn't let those toes like that right foot or left foot. The left forward, yeah, the right back. Yep. And yeah, that was that was pretty hard for her to do. So just table assisted, split squat hovers, trying to maintain contact with the ground and her foot.

and then I encouraged her because her her gym owner is cool with it too. Like I encouraged her to work out barefoot so that she could feel that. She does do some at home too. So she's like, Yeah, I can do barefoot. And then if we need to wear them at wear shoes at the gym, she had bought some wider toe box shoes so that she could feel the ground better. started doing that. It was still difficult for her to feel it. Obviously, it was harder on that side to do than the other side, but she started gaining more awareness of it and very quickly.

would come back in visit to visit and that trigger point wasn't there. there were some times where she was gone for a longer period of time on travel and you know, she'd come back and and then that was there. And she's like, yeah, I just I didn't do as many of my my exercises or we were we were walking a lot when they traveled abroad. And I was like, okay, well we'll just get back to knowing what you need to do. And didn't change a lot wildly throughout all of that. I've seen her seven, eight times at this point. And we're at the we're at the stage now where we're doing

step downs from a box or sing single leg squat, stepping down from a box, lateral squats, and starting to move into some plyometric loading now as well. That's kind of the next the next visit. But she's able to she's like, I I pretty much for the most part now can do single leg movements in the gym without issue. It still feels a little harder on that side, but honestly that's probably good for her to to feel that there's a difference and you know, this has been going on for twenty years. And so

at least the abdominal surgeries and she recently had a she had another colon procedure that was done so she kinda had to take some time off of doing some of her exercises and then that again it was just a another opportunity for her to see all right if I don't stay on these things then they do start to creep back up. Mm-hmm. but yeah, she's been I I think it was cool to see that she having her husband had experience here. He was also he was I he's a

Beau Beard (22:53.356)

really good advocate for what we do. and I had actually I met her that day because I was giving a talk at her her gym doing a workshop for hip mobility. Mm-hmm. And she was like, Yeah, my husband's been trying to give me in, so I'm gonna schedule with you. And to see like where she was a little skeptical at the beginning, but then very quickly said, Okay, all right, this is this is obviously different here. So yeah What for people listening, what do you think? What's the cupping doing

That changes the trigger point. Hmm. Yeah. So my thought is just fascial adhesion as she's moving across those slings there. Cause it's I mean, it's her whole abdomen, but if we think about the left anterior hip cross into the right, a retorso, whenever she's in a split stance, that sling is gonna be stretched. Cause she would get that knee pain if that leg was forward or the leg was back. now in a bilateral squat, she didn't have that. Mm-hmm.

If she did a bunch, I bet she would have. But I took her through five or ten reps and she didn't have any issues. But immediately in the split stance in the lunge, she got it. And so that's that's my thought. Is that the the fascia between those areas? Yeah. I think that's part of it. Then the other, you even said like you're using like inter abdominal pressure and breathing for because like Capo always says like interoceptions upstream approprioception. Like that's a more important feedback loop. So again, if you have like abdominal wall scarring and then we know that.

affects syndrome stabilization, but it's also just a feedback, right? So maybe the increased tone is just a lack of feedback, generalized area. You get better feedback just from cupping and you know, whatever you want to call that. Novel inputs. Yeah. I just wanted you to kind of thought process that and then like any legitimate like pelvic floor incontinence issues. That's a good question. We may have discussed that at the beginning, but I don't remember. No chief complaint stuff. I'm sorry. No like she didn't complain about it though.

No, she didn't she didn't mention it. I mean she she did mention that she goes to the bathroom a lot more because of the colon surgeries like she has smaller and more frequent bowel movements. Yeah. So why do you what do you think why did her foot start doing that just on that side? So what's the Yeah, that's a great question. I don't know. Like I don't know when that started. That was my question about pelvic floor, because you just see a distinct like like

Beau Beard (25:16.054)

you know, increase, I don't know, high threshold strategy around a foot with like public floor issues and then have the surgery on that side. And that's why I wondered if she had any public floor stuff. And is the thought there you're basically trying to make up for like as because there's less feedback around the abdomen. That's what I think. You're trying to as close to that region create competitiveness and tension and feedback maybe even of like 'cause again, I think that's what we don't realize a lot of times is like a trigger point.

Nobody really again, I'm finally, after I don't know how long I've had the whole timeline, I'm gonna do that trigger point historical video, like tracking a hole down. Nobody still knows why they really occur, why why they exist and how much they you know hold water in terms of pain and stuff. But you gotta think, well, we know like an isometric, isometric neurologically potent. Like it's it makes your central nervous system work harder than just like eccentric concentric load, just cause to hold that tension. So then we also gotta think, well, why

Would your body lay down a trigger point or increase tension? It might not be just like stabilization, might just be feedback, which then is again, that's upstream of stabilization, right? A ferrin input, upstream, right? So that's again the cupping, improved stability or whatever, you know, decreased tone because of input. It's like that's good to know because you can also use that both ways. somebody's working harder, high threshold strategy. Yeah, we could call that stability, maybe just input.

The more I flex my muscles, the more my brain feels it. And it's not necessarily I'm using my bicep to stabilize my shoulder, right? Just is like drawing feedback. I think that's huge to know. So you're not chasing your tail on a mechanical thing. You're just like, like they lack feedback. Cool. That's easy. The other thing is use it to your advantage. How do you do it? You can use the same thing. So let's say she's lifting her toes. What could you do? Very easily have her do isometric presses on the ground. Lo and behold, that what's that look like? Foot stabilization, right? And you try to get not necessarily

the other muscles to work, but synergistic action. Right. But you could use that. So we could who's to say you couldn't just have her sit there and crush her toes into the ground, even if it looks not ideal for a minute and then have her try a split squat and just be like, is that any different? And all of a it's like, it is. And then you can check a trigger point. So there's all different ways to get feedback into the system. But as Rich Olm always says like everything is a fair and input, right? That's just that's all we're doing. Well it was manual therapy, exercise, XYZ.

Beau Beard (27:39.758)

one note that I had is just when you see somebody has, you know, history of like colon surgeries, you know, things like that, IBS in particular, like they are always going to have a central stabilizing issue. You just got to realize whether it's an inflammatory reaction, endometriosis, all these things. Anything that's messing again with your interoception is going to affect like how you have motor output.

So one of the things, like it might not somebody might not have colon surgeries, but if somebody said, I've had IBS for 20 years, just have them whatever you want to call it, the little, you know, pelvic rock test from TPI or even if it's in a cat cow position, have them do that. You're gonna be like, you're not very good at that. Mm-hmm. Right. You're just la imagine if I I don't know, I guess you can't have IBS in your foot, I trying to think of correlate. Anywhere where you would have altered like tissue sensation, irritation, right?

any of those things it's gonna alter your output. So that's something to note when you hear that in a history of like, okay, I wanna just like make sure I really suss that out. Right. Like you had the scars and stuff, like you said, you're like, I knew I was gonna kinda work in there. Mm. But even if she didn't have the surgeries, it's still warrants like, IBS, okay, let's just see. Maybe they are good, but I'd always test that stuff. Yeah. Yeah. Question for both of you, just like with what you guys have seen with scars, especially in the abdomen, how often are guys needling those, if at all?

That's so funny enough, so I've had that little back thing for a while and now my hips probably like ninety percent better. But I have a scar right over my greater shirk hander on my left side from having a titanium rod in there when I was nine. And my wife was working on it the other day, and like the top part of the scar, like you could lift off the bottom half. She's like, dude, this thing does not move. And she'd work on it and like a lot of my pain would go away. That's been like that forever. So I think when you're needling where we kind of like, you know, go around it or even

underneath of it, like that's a scar that's very stiff, right? It's not moving, it's keloided, right? You're trying to get a collagen reaction. Like you're literally trying to change tissue. Other than that, it's all surface level, whether that's cupping, hands on, having teaching the patient how to do scar work around it. cause nine times out of ten, especially when a scar is new, you have to start really, really light, right? obviously with new ones so you don't disrupt the scar and you don't make it worse.

Beau Beard (30:01.698)

But if the scar moves in all directions, right, that doesn't necessarily mean per se that it's perfect. You might just have altered feedback, right? Because you built some sort of compensatory behavior. But you need to test that. So you should be able to lift the skin, move it like you're drawing on an asterisk and it moves evenly. And it shouldn't like, you know, you don't feel any bumps, ridges, things like that. Now, is that gonna happen to everybody? No. Some people key worse. We know that can be, you know, ethnicity based, it can be genetic based. All those things are gonna change it and it's like perfect is

You know, that's N of one at that point. so yeah, I needle when stuff is really stiff, it's different, right, on certain portions of scar. yeah. So then with that, like how are you going more like obliquely into like the abdomen? 'Cause obviously you don't want to like perforate anything. Or it's in the abdomen. I mean well, any scar. So if the yeah, if I if you're if I have the sheet of paper in front of me and the needle's going perpendicular to the sheet of paper, when you're doing a scar, you're coming in at I'd say

Greater than a forty five degree angle, or I guess less if you're at the skin level. 45 degrees, because you're trying to go like underneath that scar right beside it and literally like create a collagen response. So have you guys seen the videos of the micro needling that's jumping for like stretch marks now? No. It's like this little device that has like, I don't know how many needles. Like it looks like a tattoo gun, but a bunch of needles. And I mean go look at the videos, whether it's real or not, but they'll just go on a stretch mark and just like boom, and the stretch marks just disappearing.

Why? Because you're basically just like disrupting the collagen and promoting like a synthetic or a synthesis on the back end. and they're doing that for heel pain now and stuff. And they've done that in surgical realms. I mean, that's the toe pass procedure. That's like 50,000 needles or something. so these things work. Test it first, right? Do you need a collagen response or a pain response? Do you need a collagen response or an input response? Right. I think I want to scar to move and I want to see the input. I would say.

I could go in there and just push on your abdomen, you're gonna get a temporary response. But if the scar's still all janky, okay, go work on the scar and get that to the you know, last a longer time. Yeah, I think for her it would have been tough to target. so much. Yeah, just general. Yeah. Yeah. Yeah. The reason I ask is that the but the patient that you and I, Alex, were talking about yesterday, she had an umphalical when she was a baby, and they obviously had to surgically repair that. And like she

Beau Beard (32:26.722)

showed the scar to me yesterday and like it's like puckered, involuted on itself, and like very fibrous around the scar. So I was just curious like once I'm able to needle like if that'd be something I should be looking Teaching her. In that scenario, so there's three things there. So where your abdomen, like you highly protect your abdomen, right? Emotionally and physically and all this stuff. So that's why it's like working there is sometimes like it's hard because like people are bracing, they're ticklish, whatever.

So in that scenario I'd be teaching her how to do all that stuff and I'd actually I'd probably see how far can it go with her doing it. And that's then she can do it twice a day and be working all around it and then all of a sudden you're like, Hey, it's this one little area is gnarly, then I go in. Yeah, that's what we started with yesterday of just like giving self pressure as you do intra abdominal pressure to kinda like direct into that. And that made changes in all of my audits. So like that's where we're starting, but I was just curious like when you would intervene with needles. Yeah, and it depends where it is too. I mean, that's you know, not a great place to stick a needle, but

Well and there's other giant scar because it's like it goes underneath both like parts of her breasts and then it goes like down midline. They like create And that's why we have massage therapists. So some like for various reasons. Say I'm a male, I have a female, she's had some sort of breast augmentation, I'm finding out that she's having a bunch of myofascial, you know, basically I mean, whether it's run amok fibroid stuff, right, or whatever. I might just be like from a comfort level, like, hey, it's gonna take quite a bit to get that to change.

I bet you're more, I would assume more comfortable with a female doing that. And I'm not going to work on your breast tissue in a scar fashion. Just sit here. That's not what I do. Yeah. So you want to do that? If they don't, they'll be like, you're gonna do it. And then if that's not enough, then okay, now I'm left with the referral or is it me? But I just always think of the one case where I had the guy that was barely spoken English. this was I don't know if your interns at the old office. No, this is before that. This guy came in and

basically couldn't communicate enough. All he could do is kind of show me what hurt. So basically going into back extension, he was almost buckling. And his wife came in with him because he was in flexion antalgia, right? And at first you're like, ooh, this is kind of gnarly. So I don't know why. And I don't even know how I got there. But in that first visit, like I probably just doing a full exam, I'm going through, I'm going through and I don't I'll honestly 'cause most people I'm not palpating their abdomen, right? Yeah.

Beau Beard (34:48.44)

But I palp it and I'm like, do you have scar? And I'd ask about surgeries, but again, it's hard to communicate with. so he lifts up a shirt. It literally looks like somebody just took like a knife, like a K bar knife, did this, and then made like a Z. And I was like, God, what is that from? And it did not look good at all. And he's in his pride 30s. So his wife was with him and she basically got out like he had a spleen, called a spleen actomy, had a spleen removed. Mexico, someplace, look like back alley surgery. It was an early scar.

So I just like, and I'm messing around with it. When I messed around with it, it was painful to mess with the scar. This has happened 15 years prior or something. Like, that's weird. So I go, hey, let's do something. I mean, even him getting up off the table is hard. He stands up, I grab that scar, he bends back, and he's like, I mean, zero pain. And I was like, So again, why didn't he have pain for 15 years? And all I mean, all the variables come together at the right time. So I literally worked on that scar.

Couldn't reproduce his pain with any other test. He was standing up straight. I mean, he was walking around like, you know, and then like he was a little sore. Like he'd be like, you know, dull are or whatever. So I taught him how I never saw him again. I'm assuming he's better. I don't know. But he literally was a guy that just showed up that day, like unannounced, did that. And I was like, ooh. So it always pays. I'm not saying we're like, you always treat a scar, but test. Yeah. Right. And then you're what is that? It could just be feedback. He created some weird pattern. He did something that disturbed that pattern. Now he's got pain.

I get input, hopefully it keeps input, and you're just like, was that an injury? No. Yeah. Not in the least. Is it weird? Yeah. But that's probably the most profound pain relationship I've ever seen. I don't know if that was your first case like that, but that was biggest response. And again, it's not like so when you hear this, do not think I'm saying that scar causes pain. It's the relationship of the feedback and does that make sense? Because I think some people listen to like Eric Cobb.

Right, which I love. And he'll always be like, you know, a tattoo or something, and he'll do something, somebody's movement changes. Realize he's not worried about the pain, it's the relationship of the nervous system input output. Right. Of like you just stuck, you know, thousands of needles into a spot, had trauma for three hours, now your body's like, right. Then the actual physiologic, like scarring and all that stuff on top of it, add all that together. Yeah, it's different. It's just different. Right. Yeah. Anything else on that one?

Beau Beard (37:11.71)

Trying think of anything else on scars. So yeah, a quick primer, if you're not versed in it, because I don't think it's something you need to take a class in. So with a scar, there's a couple ways to think. Like let's say somebody is their stitches are out, they've got a new scar. Let's say it's an ACL scar or something like that. when it's in that phase where it's still healing and you're having, you know, histamine reactions and stuff like that. If the my pin is the scar, you're never working over the scar in that up front. You're always working around it.

And you'll lightly kind of a little more pressure than like lymphatic massage, you're working around the scar until it basically like pinkens up. So a common thing with a scar is it is white. Like that's how my we would say that's a little avascular response. You're just working until it pinkens up or reddens up. And you'll find some areas won't. That's where I would work harder or longer or maybe needle. So you do that until that scar is fully healed because we don't want granulation responses and all that stuff to run amuck.

Then we will gently start working across the scar, right? And now is where you're going to start testing, like we said, the multi-directional movement of the surface level scar or skin. And then by that time, you're just trying to, you know, once it's fully healed, then can I lift it up? It lifts up evenly. And then you're trying to get that all better. But again, the tough thing is if somebody is new, you can't work over it, you're going to disrupt it. Also, if it's very sensitive, like some people, it grosses mouth to touch a scar, it's weird feeling or it hurts, treat it the same way as a new scar.

Work around it, do all the stuff and then work backwards. That's my I mean, we're talking two minutes max work, depending on the s size of the scar, I guess. But if you do it too much, you're just gonna piss it off. If you do too little, it's not enough. So it's like we just think until it you get a like an erothermatic response around the scar and then you're done. And then you can do that probably two or three times a day max. So that's just like a quick primer. There's way more than that. Not talking needling at all, because that's not our place to try to teach on here, but like all these things have a place and then cupping can be effective. I would not

The first thing I would do is not stick a cup on a scar and just like rip it around or do some testing, some light input, then some easy cupping. Maybe you cup around the scar, right? Then eventually, yeah. Have I cuffed over scars? Yeah, because you can get those puppies a move and you know, if they're invaginated and things like that, yeah, you want to get those moving. Yeah. For patients that don't like to touch their own scar, could you use tweak tape as well? I can, but I make Yeah. I'm just get over yourself. I mean that's a that's a

Beau Beard (39:37.782)

a broken link and that is sometimes a lot of like the dysfunction. It's like they have created like a it's not a fear avoid well, what is a fear avoidance behavior kind of I mean a lot of knees for whatever reason. They're like, gross like the literally like gag. Like gross me out. Gross me out like touch it. And then the oop I don't like it. And then I'm like, okay, that's what you're gonna do. And if they don't really don't like it, have them work around. Whether the scar works perfectly or not, that integration of you feeling it, because you gotta think, you know

The idea is maybe getting a little outdated, but the idea of cortical smudging, right? I hurt a place, I heard it multiple times. I get this kind of, you know, parietal cortex smudge where I don't move it as well or le lose feedback because that's like kind of a it's like efficient. Like you don't have to think about it, I guess. Scar is literally that. You change the input, you change the tissue matrix. Then let's say it doesn't move awesome, or it's over a very common one as what, a knee replacement. So now you don't get the

mechanoreception from inside the joint. Now the scars all weird. You don't like touch. I mean, think of how decreased feedback there. So I'm thinking of one lady in particular, like, that's kind of all we did was like some scar work and then have her start going through some like step ups and split squats and stuff. And she's like, Yeah, it's kind of better. I was like, okay. No, I told her to keep working out and like progression. So like see you later, but it's like that was pretty easy. And she's here over here thinking she needs a revision surgery. You probably just needed to cut your scar.

It's kinda wild. And I know people like, that's bullshit. It's like I don't not necessarily, man. And I didn't also didn't realize the scar on my leg was still kind of numb until Sloan started working on it was like, I don't really feel that bottom, the portion that was gnarly. Like I don't really feel it the same. So that was I didn't even realize that. Yeah. Interesting. Very. And for those listening, my left leg has always been different. And I always equate that to like pit sort of like

Maybe the feedback's never been integrated appropriately. And then that makes it harder for stuff to work. So again, if I lack AFAR input 30 years later, why would I expect it to be the same? So I'm not saying that's gonna fix it, but maybe I do see some changes in single leg, like doing a pistol on this side is laughable compared to my rat game. It's just way different. So and that's probably a variety of reasons. But yeah. That's enough of my sob story. I'll quit crying like campaigns.

Beau Beard (41:58.712)

Called it Crying Games, his podcast advers TBI, where he was just sobbing. He's a little bitch. All right, anything else?

We have a special episode coming up. We do. We do. We have some special guests. We do. It's gonna be a big one. Four special guests. I was talking to Alex about this this morning. Thought, what if we did that one live? obviously people may not show up live for We can, yeah. We can so via Riverside, we can do a live broadcast. I think we have to pick a platform. I have only done it once. Yeah, we'll think about it. Maybe we'll put a vote on social media

I'm sure people would like it. It's a weird time of day, maybe for life. I know, that's why I was like, probably not. But we might get a few to put some Q and A's and watch a suffer. But we'll see. Are you gonna don't give it too much? Hurt suffer. Yeah. It's all you need. Yeah. Yeah, we'll leave it at that. So we'll see you next time.