How To Recovery From A Sports Hernia Without Surgery Step By Step

Looking to get in touch with our office? Send us a message here. We are in Costa Mesa CA but we can help people virtually very efficiently.  This week's episode is dedicated to guiding you through a comprehensive, step-by-step recovery process for sports hernias, all without the need for surgery. Whether you're an athlete or someone who enjoys staying active, dealing with a sports hernia can be daunting. But fear not! We're here to provide you with practical strategies and expert advice to help you bounce back stronger than ever. Join us as we break down each crucial step of the recovery journey, from understanding the underlying causes of your injury to implementing targeted rehabilitation exercises and techniques. We'll share insider tips and insights to help you navigate the road to recovery with confidence and efficiency. Plus, we've got an exciting bonus for our listeners! We'll be referencing a valuable resource during the podcast - a book that dives even deeper into the intricacies of sports hernia recovery. And guess what? You can access this book for free! Simply sign up for a Discovery Session with Sebastian, Dawne, or Mandy, and you'll unlock a wealth of knowledge that could change the way you approach your healing journey. Don't miss out on this opportunity to take control of your recovery and get back to doing what you love. Tune in to this week's episode and embark on a transformative journey towards a pain-free, active lifestyle. Sports Hernia Book Reference: https://p2sportscare.com/product/understanding-sports-hernias-unveiling-the-mystery-behind-groin-pain/ Sebastian's Groin/ Hip Books: https://www.p2sportscare.com/product/understanding-hip-diagnosis-book/ DOCTOR LINKS BELOW PREMIUM PODCAST LINK (for Clinicians only) FREE GROIN WEBINAR (LAYPUBLIC)   (00:00): Clinicians, thanks for joining the show. Just to let you know, this is a lay public friendly podcast. This is really not even for you, but if you're looking for a podcast for you and you wanna learn all the tips and tricks that we talk about on this show, subscribe to the premium version of the Restoring Human Movement podcast, and all the stuff that you'll want for your own clinical practice is in there. Take advantage. You won't be disappointed. Now, onto the show,   (00:26): You are listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now, your host, Dr. Sebastian Gonzalez.   (00:41): Hey, everyone, it's Sebastian, your host with the Restoring Human Movement podcast. Thanks for joining the Movement Movement. Wow, this has been a long time coming. I think this is about a year from the last time that we released an episode of the show. And it's not because I didn't wanna come back to it, but I'm gonna say the show was a little bit more work than I thought it'd be just to come up with new content all the time. So I'm gonna do my best this time too, to keep it within the parameters that we can do here at Performance Place. I'm gonna share some loads, see if I can get some of the other clinicians on Dr. Don and Dr. Mandy would be good additions to the show, and they have good information to share as well.   (01:16): In this podcast, we're gonna cover sports hernia. We're calling this How to Resolve a Sports Hernia Without Surgery Step by step. And obviously this whole podcast isn't gonna direct you for a hundred percent success, but I think it'll give you some good guidelines to follow. Unfortunately, at Performance Place, we have a bunch of people come in with very frustrated stories about their dealings with a sports hernia and the frustration of the lack of information on the internet, the lack of information on YouTube when they go to some of their doctor's office, physical therapists, chiropractors, whoever they may be visiting in a big town or a small town, they're very frustrated about the lack of information and knowledge. And, and this is nothing against them I always tell everybody who calls in that people have different disciplines of what they work with.   (02:05): And I think the best thing you can ask for with your healthcare team is the answer of, I don't know. I'm not sure how to deal with this. I'm not sure quite what it is, but hopefully I know someone who does. And that's all we can really ask of our healthcare team. We have expertise and specialties and so on. There's people that we refer to all the time here at our office in Southern California. So in this podcast, we're gonna go over the 10 steps that I think are the most important. I'm gonna give you some details on each step, but also keep in mind that we have lots of YouTube videos on these topics on YouTube. If you go to Performance place, SportsCare on YouTube, we're type in sports. Hernias. I'm sure probably one of our videos will pop up first.   (02:47): And we have other videos on related topics sorry, other podcasts on related topics too. We have a few sports hernias. I, if I believe, over 250 different episodes. We have. We also have one on testicular tightness. I think for females, we're gonna have a similar type of presentation, but it's more, in the Mons pus and other related things like groin pain and adductor tendinopathies and so on. So feel free to dig through all of the show, and we're gonna get right into it here. So the first thing to understand about a sports hernia, actually, you know what, before we get into it, let's just understand what it is. Okay? It's pain, tightness, or discomfort down into the pubic bone area. Okay? It's actually a fray of some of the fascia into the abdominal area, but really more precisely it's actually more pain into the pubic bone.   (03:38): I know a lot of people will say that there's associated symptoms of lower abdominal strains. They'll feel the adductor, they'll feel their groin, they'll feel their hip. Some people feel their low back. And personally, I think that some of these things are actually more of a testicular tightness, they're more of like a compensation. Like that's why people end up having a lot of other symptomology and, and patterns. Nobody's exactly a textbook case, although those variants to things and so on. And the reason why I think people have these things is because it's their own body's way of trying to get around the symptom. Typically, all we all have about one symptom generator, which in this case may be the pubic symphysis, but a lot of other compensation patterns. Everybody has their own unique way of getting around things, which may create stiffness, tightness, pain in other areas and so on.   (04:26): And so, step number one is don't panic. Nobody panic. This is not gonna be the end of the world. I know it's frustrating to find the information on it, but let's, let's all be logical about this. Okay? I think if we all can sit down and get a little pen and paper and just think about what is the plan of attack here? Alright? It's very common that people who have these types of problems, whether it be sciatica or low back pain or a disc herniation or different things that they're frustrated with, lose the ability to think logically. Okay? I think if all of you are active individuals, you've probably had an injury in the past. Let's think back, you know, 10 years ago, what was something that you were suffering with 10 years ago? I know for me, I was having a knee issue on the right side.   (05:17): I don't even feel that anymore. And so I think if you talk to enough people about it, you remember Jimmy. Jimmy, didn't you have that? Like, didn't you tear your ACL like a while ago? Yeah. How, how's it feeling? I don't even notice it. This is kind of how this is gonna be, all right. So right now it's gonna feel like the end of the world, and that's okay. Everyone has the right to feel what they're feeling, but just remember it will go away. And you can probably more than likely be just as physically active as you once were. I think the stereotype associated with sports hernia is, if you just need to rest it. And then, you know you do some activity and all of a sudden it comes back and so you rest it and, and so on. And then maybe you need surgery to correct it, and then you may never be the same.   (06:04): You know, it's kind of like that thought process, and that's not really correct. People who have the surgery, people who don't have the surgery, most of 'em get better. And if they decide to go back to their own, their old sport or what they did when they first bothered, it's completely up to them. I usually encourage people to think about what they actually like in life. You know, do you like going to work? Do you like going like I have a, I have an air bike at my house. Do I like air bike? It's okay, you know, but if I had some free time, if I didn't think cardiovascular fitness was important at all, and, and you know, I don't think I would, I don't think I'd jump on that bike. You know, I wouldn't go running. I don't really like running.   (06:48): I like sprinting. I like playing baseball. Some of you like playing soccer. Some of you like to pick daisies. Some of you like to play dodgeball or pickleball and so on. And going back to that, going back to what you like is super important because if we think about what you, how your life, your life will go, if you don't incorporate something back that you love that's physically active, you're gonna miss out on a lot of things. You're gonna miss out on the benefits, the cardiovascular benefits of that sport, you're gonna miss on the community of that sport. You're gonna miss out on just the overall mental feeling of, of winning or challenging yourself. Or I remember in pickleball where you make a good shot, oh, you know, like even table tennis, like, there's that feeling. I know in baseball, there's the feeling of sliding in and being the winning run in the bottom of the ninth.   (07:37): That is an amazing feeling. I felt it a couple times before. Where will you ever get that again? Okay? You need to think about what it means to be physically active, especially in a community sport for the rest of your life. And whether you go back to your old sport, 'cause you like it, or you go to a new sport because you wanna try something new is totally up to you. But I encourage you that whether you get the surgery or not, whether you still have pain or not, going back to your old activity is gonna be important. Number two is we need to get educated. Okay? I know there's limited information. I've heard your call and I have a book online that's pretty cheap. It was free for a while. We started charging for it a little while back, but it's called Sports Hernias.   (08:22): Understanding The Mystery Behind Groin Pain in Athletes, there's a few articles that we have at our website as well, P2sportscare.com. If you search sports hernias, you'll find it there too. And there's endless publications about sports hernias on PubMed. If you wanna dig into the weeds of it, PubMed is where you'll get most of the clinical information like the research studies and so on. And just remember that if you do choose to do that, there is actually misinterpretation or a verbiage on with the publication, which is really unfortunate. A sports hernia is not a hernia. It is, it is not a hernia. So when you start reading through these things, when they talk about things protruding through the abdominal wall, even if they're referring to sports hernia, that's not, that's not correct.   (09:11): There is no protrusion of abdominal contents coming out of the abdominal area or through the inguinal canal to the, to the scrotum that that's not happening. Okay? This is a whole different thing. So if you are reading through Pubmed and you find that, just find another one that's talking about something else, you know, 'cause it's, it's not that. But there are some really good publications out there. I created an in-services at our clinic. And so the in-service goes, goes over all the relative relevant information that's found recently, and we educate each other about the, the relative information. And so I found something a couple years back, and it only took me about two hours, and we found the stuff, it was all good. So I bundled it all in that book for you guys, which I will put in the link description.   (10:03): And remember, if you do, you do decide to consult with us. It's almost the price of entry. We give away a free book currently with our consultation, so you can always access it there too. We have YouTube videos on it. We have YouTube videos on the mechanics on it. We have YouTube videos about the exercise and stretches we typically use for it. So there's a lot of free information out there if you know where to look. Hopefully you're gonna start with the stuff that we have, because I know it's vetted and I, I know what we have on it. But there's other great articles out there online too. So just to let you, just to give you a good idea it should incorporate conversation about how to improve hip mechanics, hip mobility, especially internal rotation.   (10:48): It should include something about core and it should probably include something about how to avoid surgery. Those are all very probably gonna be more relevant articles. Not to say surgery isn't needed on some people, it is. But ideally, we all wanna avoid surgeries, and I'm assuming most surgeons want us to avoid surgeries as well. So let's do everything we can to not. I'll put some links in the description for that. Number three is establish a timeline for your pain and return to activity at least in a modified fashion. So establishing a timeline is, I think this is important to realize the value of different procedures or protocols if you, if they were successful let's just say if I went to driving school, you'd assume that within one month I would be able to drive, right?   (11:35): There's something kind of wrong. If I'm there for eight months, I would assume, and I haven't been to driving school in a long time. The same thing is, the same thing happens with treatment protocols too. Rest is one where about five to seven days, if decreasing activity or resting is not helping and it's still there, then that's probably not gonna work long term. If you go back to activity after prolonged rest and it comes back again, that rest probably isn't gonna work. There should be an expectation, at least I know in our office, the expectation of giving the right exercises and stretches to do as well as some activity changes is usually about two to three weeks. The person should feel 50% better. With acute cases or like recent onsets, that timeline may change a little bit. That's, in that case, the five to seven days rest, or maybe even 14 with some pretty severe ones is, is okay, you know?   (12:29): But after that, once it's kind of settled down and you're trying to return back to activity, usually two to three weeks is enough to actually get back to feeling sane about it again, like being able to go back to activity, at least in modified fashion. Now, when I talk about returning back to activity it's important to realize that you can scale your activity. I had a kid the other day who came in and we were talking about how he could scale his baseball practice based upon his hip pain. And so the only thing that bothered him was really fielding a ball. He was a shortstop. And so I said, does it bother you to get balls in the outfield? No. Like shagging balls, no. Hurt you to throw, no. How about hitting? How about running?   (13:11): How about all this? You know, you get the point, right? I said, you're allowed to do anything. I'm gonna if you allow me to, I'll call your coach and tell them you're gonna do everything except for field balls in the infield. It's not because you don't want to, it's because it hurts you to do so, and we're gonna modify it for a couple weeks, but I want you to go to practice. The reason why this is important, and, and this goes for anyone of any age, is if you wanna get back to that sport again, it's in your best interest to keep it around. Mainly because, and we saw this a lot during when everyone did the shutdown during COVID, is that we had a lot of kids who weren't in sports, and they went back to sports and actually not just to their one sport, but to double sports all in the same season.   (13:50): And they end up having various different injuries. And it's, it's my theory is because that we have a spike of exposure, and at least when we're talking about tendinopathies and tendon disorders, like that an exposure spike would really make a lot of sense. You probably see a lot more patella, tendinopathies and achilles tendon issues and so on. And we see this a lot through our recreational baseball league. If people don't play for six months and they throw, you know, really hard over the course of, you know, the first game and they hurt themselves, and it's not because they're damaged, but it, they, it, it spikes, it's a spike of exposure, it creates pain. And so ideally, it's better to keep yourself physically active and able through the recovery process, which hopefully shouldn't take more than a couple months.   (14:32): Anyways, number four, decreased triggering activities at least for a couple weeks or so. And so this is, especially for those early onset ones where if you've just, if you've just experienced the problem the best thing to do is just decrease the amount of things that bother you. Don't, don't worry about them and focus on things that you can do. Again, it's a different spin on the thing that we just kind of talked about. But for a lot of people that we've worked with in our, in our office, and even some of the virtuals, like they, they're really focused on the things that they can't do. Well, I can't squat. Well, I can't lunge, I can't run, I can't sprint, I can't, you know, I can't, I can't write, which is okay, but let's focus on all the things that you can do.   (15:17): You can still squat if you want it. Does it hurt you? No. Do it. You sure it's so safe. It's safe. Well, I mean, the body's pain mechanism or pain system's pretty appropriate for most people, especially early on in their injury. Yeah, I know when I touch a hot pan and it hurts, it's pretty appropriate. Maybe I shouldn't do that, but it's okay to touch a cold pan, right? Doesn't mean I shouldn't touch pans. So scaling your activity is important. And if you don't know how, this is where a strength coats or a personal trainer or your skills coaching your sport may have some suggestions too. I've met people who can't throw fast balls, but they can throw curve balls. I've met people who can run at a certain speed, say a seven minute mile, but they can't run an eight.   (16:03): I know an eight is easier, but the eight bothers them. So run a seven, like, you'd think that running faster would bother them, and it doesn't always I know a common thing that I see people having problems with is sit-ups with this. They're like, oh, I just, you know, I can't do this. I can't do leg raises. I can't do sit-ups. I can't get out of bed by sitting up. And then, then don't do it that way. Roll over, you know, do a plank. Don't, don't do that leg lower in exercise. Maybe do like a dead hang. I met somebody before that was having trouble with an AB wheel, you know, and so then like, I can't do this. And it's like, then let's try something else. You know, there's endless different ways, there's endless ways to stimulate that one, the, the musculature that you're trying to stimulate that exercise.   (16:50): And there's many different ways to do abs, okay? So it doesn't have to be with that one triggering activity. And, and I, I don't wanna beat a dead horse on this, but just do something different, but it doesn't mean stop doing things, which leads to number five, keep doing all your green line activities. This is, this is something that I think people really do suffer with again, is that they think that just because they're gonna rest for a couple weeks or "rest," it means they should stop doing everything. And it's not the case. It's not at all. And it doesn't matter if you're an athlete, it doesn't matter if you're a grandparent and you're in a retirement home, it doesn't matter. Like you should still be doing stuff, grandma's, right? You don't use it, you lose it, right? And there's certain things that you can lose quicker than others.   (17:39): I think I saw I wish I had the, the, the paper in front of me here, but I think that they said that strength you lose over the course of 30 days. You know, so you can technically not do any workouts to challenge, you know, hip strength for 30 days, and you'd be okay while you lose some ability to sprint after five. So think about that. What do you wanna do with your life? If you snapped your fingers in this sports hernia, pain went away, do you want to continue playing soccer or hockey? Well, then you better keep sprinting around as soon as you can, or at least some forms of sprinting. I know with hamstring tears and strains, or at least lower grade ones, that actually the mechanism that people get is actually more associated with when they actually hit top speed.   (18:29): So you can still scale in acceleration, not top speed. Like, I don't think I'd want 'em doing striders, you know, maybe not sprinting past, you know, 10 yards, maybe 20, you know, but like, it's top speed. So if you are working with someone who knows what they're, what they're doing with the mechanics of things, whether that be a strength coach or a physical therapist, or a chiropractor, or by the way, we're chiropractors. I don't know if you people know that on the show. Like we're sports chiropractors, so we do rehab and so on. So these are the things that we do too. They should know the mechanics and doing an examination with you will give you an idea of how to deem what's safe and what's not for you at least temporarily. And I do mean that temporarily you need to add the things back that they take away at some point.   (19:24): We've seen people where they've come once or twice to us, and I'm not gonna say we can't help them some if we see them once or twice, but the problem is, is that we're, it's still a work in progress. You know we remove things and we put things back. We add things like exercises, stretches to do, then we take 'em away. They're a medication. They're not intended to be used all the time. You're supposed to be taking these things away and getting the person back into normal life and that's what we wanna do. So ideally, even if you go somewhere a couple times, they say, don't do this. I think what they're really trying to say, if you really drilled it down and you asked them, is don't do this for a little bit like a week or two, the max probably a month.   (20:10): And then you should add it back in because if you stop sprinting, like say we do it for five, five days and you know, it's okay, you know risk reward, cost benefit. At some point, if you want to play soccer again, you will probably have to get back to sprinting again. And the challenging thing is to go from nothing to everything. Like we talked about when people were on lockdown, they did nothing to everything, and all of a sudden they had other problems, right? And so we wanna keep a physically able you, a physically able body, and a happy person while we're mending these problems with them.   (21:20): So, number six, which I kinda alluded to a little bit there, is get, assess and get diagnosed. Okay? there are other things that create pain into the testicle area or to sorry. Tightness is usually feeling tightness or discomfort in the testicle area. There's other things that can create groin pain or, or pubic bone, lower abdominal hip stuff, low back things. There's other things. So it's your clinician's job and clinician. I, by I mean, I mean that by physical therapists, sports, chiropractor, medical doctor, orthopedic, and like all these, everybody generally should know what we call a, a red flag screen. A red flag screen gives us an idea of does this person have something really scary? And if not, like, do they have cancer? Do they have an infection? Do they have and you know, things like that.   (22:14): Like things that need really urgent medical attention. And then, and then we basically put them in two buckets. Are they a surgical case or are they a rehab case? And you'd be surprised how many diagnoses are actually just rehab cases. Like we see people with hip impingement, sports hernias low grade label, tears of the hip sciatica disc injury addict or tendinopathy. I've even seen people with, with muscle tears, the old muscle tears, you know, they don't reattach 'em anymore. Hamstring strains with or without bruising. So there's a lot of different things that we can do, we can do rehab. Pretty much, I would say almost every diagnosis that doesn't seem like it's some type of infection or things that will kill you are usually gonna be a rehab based case. Now surgical intervention from my education comes down to function.   (23:09): If you're starting to lose function in areas like bowel, bladder change losing function of your foot or your leg numbness, tingling in areas like be beneath like your saddle area or, or like kind of odd things like those are, those are important things to, to make sure you don't need a surgery really really quick for because those are function related things. They're not always super painful. And those are usually things that progressively have like they happen quickly. Like injury happens now it's happening or like within a week's period of time. So those are things that are going to be a little bit more surgical based. So get diagnosed, get assessed. Usually it only takes about 30 minutes to do a good thorough physical assessment. A movement screen and stress test. The joints stress test the tissues, like there's a little sit up test that you can do for a sports hernia to see if it's actually separated there.   (24:06): You can see if the hip is part of it. You can see if a lack of hip internal rotation is part of it. You can see if the back is part of it. Some people actually have some of these problems in the front because of stiffness of the low back, because of an old back issue. So there's a lot of different things that need to be assessed, and we cannot separate the pelvis, the lower abdominal area, the adductor, the hamstring, the hip, the low back, even the mid back, and the whole leg. We cannot separate them. They all need to be assessed. I cannot stress that enough. They all need to be assessed because they all work together. The body is one muscle. Unfortunately, in dissection, they break 'em up into about 200 different muscles. So number seven, improve on deficiencies and movement patterns that could be root causes.   (24:55): Top of my list, and I'm not even gonna be super vague with this because this is stuff that we see all the time in internal core pressure. So intraabdominal pressure is usually really poor with these people. We also see that their mid-back mobility can also be very limited, especially in extension and inter and rotation either direction. And a lot of times the hip mobility, okay, a lot of times low back can be stiff around L five S one. And these are all things that we need we can improve on for the most part with people. And those, those are gonna be the deficiencies. But actually, you know, let me add one more thing in there too because it's, it's common that we'll find people who find, or people find us when they have a s sports hernia, but they've been back and forth with having someone diagnose it as like a hip leg or more hip impingement, which is not wrong, but there's a chance that that old thing that they've had for a while, which then, and they typically say, well, my hip doesn't hurt.   (25:52): It's actually over here, you know, my lower AB or my, or my pubic on or, or so on. And so the, the, the fact that it could be related is really high. It may not be a symptom generator, like I said earlier, it's more of, it's not functioning well. It's a deficit. Movement patterns are something that we oftentimes go look at on people, because you can see them oftentimes using their, using their low back as their hip, like it moves in unison. We need to be able to separate them a little bit. Then people, some people may have a dominant anterior tilt type of pattern in their pelvis. They like to stick their butt out and let their ribs flare out to the world. So moving patterns are something we can look at. Even the squatting pattern is something that needs to be assessed too.   (26:35): Number three I would walk an hour daily if walking doesn't hurt, I would walk a lot. I've ventured to say this, I've said this to a lot of people I've met. I think if people walked more, we would be out of a job or we'd see very different conditions. We do not walk enough. And the 10,000 step rule is very important. I've seen research on it. It looks very compelling. People who walk 10,000 steps have a significantly decreased amount of musculoskeletal pain. And I had someone ask me the other day, they said, well, so I ride a bike. Does that count? Well, I mean, it's not really the same thing. Like if we're talking about, and this is kind of the value of, of getting with someone to program a plan of attack with you, like a program is, I, I said you can keep the bike, but I think you should walk.   (27:26): And they said, well, why, why can't I just do one? Well, biking is better for cardiovascular fitness, right? Like, you feel like you're strained and he's, and he is. He's like, yeah. I said, great, keep it. Walking is better for greasing. It helps the spine get movement, helps the sit and the hip get movement. It helps ball socket dissociation of, of the hip versus like the torso. So it helped build a little bit of core or the anterior chain of the body. So they're different. They're not really duplicates of each other, okay? But you can certainly do both as long as they feel good in their green light, like we talked about earlier. Nine is you need to be able to train the leg. The leg is gonna be an important part in this. And you can do this one a few ways or two ways is gonna be the, the easiest anyways.   (28:13): You can start with building lean muscle or you can work on strength. The difference between 'em is generally speaking, it's gonna be rep range and weight. If you were to train for more strength, it would be more weight less reps. Generally, let's just say under five reps, it should be hard. For some of you who aren't really comfortable with that, which is okay, you can go the route of kind of like a bodybuilding style one, you can jump on a machine. You can do something simple like a hip thruster or, or even like a box squat or, or a split squat or something like that. As long as it's green light and you can load that up a little bit. And you can even go as low as 30%, one or max, which is probably gonna put you around 30 reps or so if you wanted to.   (28:58): But most people target around like 15 to 20 reps or so. It should feel like a good burn in the, in the appropriate muscles, which I'll talk about in a moment. And those are good ways to load the leg. I'm not gonna say we can't get super specific with this, but ideally a squat or a lunge or a hip hinge of some type, like a dead lifting pattern. Just pick the one that feels the best, like the cleanest first versus focus on the one that you can't do. Like I can't do, like I mentioned earlier because ideally you should be able to load the leg in with the appropriate response to the exercise. If we're looking at a more lean muscle type of approach, that reference, and you're gonna get more of a burn or a pump. What did Arnold say?   (29:41): Then, it doesn't count. The reps don't count until the burn starts. That'd be pretty true. In strength, you're just gonna feel, whoa, that was heavy. You won't even really feel a burn. So if you feel, if you're going the burn route, you should feel like, say we're gonna do squats, you should kind of fill your quads, right? Like, you shouldn't be filling your hamstrings and your calf and your groin and stuff like that. Because then we're allowing the compensation to continue, right? So if it's more of a quad dominant movement, you should probably have the quads doing most of the work. And there's different ways to skin this too, but like if I did a hip hip thruster, or if I did a glute bridge, guess where the target tissue is? Probably the glutes, right? You shouldn't fill this in your back or your hamstring or your quad.   (30:33): If I did a bicep curl, where's the target tissue? Probably the bicep. Doesn't mean other things don't work either, but that's probably gonna be the limiting, the limiting area, especially if you go the burn route. So that's what we call an appropriate response to, to the exercise. With strength, it's just gonna feel, ooh, that was, that was hard. Heavy feeling heavy. And that's, that's gonna be the appropriate response. You may just feel it everywhere. Like you picked up a couch, well, that was heavy, you didn't feel like it was in your quads. Number nine is keep your cardio up by any means possible. Or sorry, that's number 10, that's the last one. So keep your cardio up by any means possible whether you swim or bike or run or jog or skip or crawl on the ground.   (31:17): Get your heart rate up somehow. It's gonna be important if you're gonna get back into sport, like I did mention earlier. It's easier to help people who are already keeping some physical abilities, okay? And it doesn't have to just be cardio. It can be the lean muscle. It can be the strength, it can be for various reasons. They have more physical attributes that go towards their, their end all goal. So we don't have to, we don't have to solve their pain and all of a sudden get 'em up to cardio and then a flare up happens. And like, they've already kind of done that. Like they've already realized that they can do things despite the pain which is completely fine for most people unless it starts to ramp up. But ideally, and, and this is what I tell a lot of people on day one when I see them because some people are very open to doing things on their own, they just wanna be reassured that it's safe to do.   (32:10): Other people are very afraid of it, which is, you know, it's common. And I say, look, what do you wanna do? And they say, well, I wanna get outta pain. No, really? What do you wanna do? I wanna be able to walk without pain. No. What do you want? Like if you could snap your fingers and you would not have this problem anymore, what would you do again? Like you do the body of a 15-year-old kid? Well, I would you know, I'd go run a marathon or I'd hike a mountain or I'd, oh, good, good. Great. So let's just say that's what you want, right? Let's take two versions of you. Let's take the I call it the I rested version, and then we have the other version, which is the, I tested it version.   (32:55): I rested it versus I tested it. Two identical versions of you today. Let's just go 10 years from now and let's just say this is, say this is ongoing for 10 years. Which one of you think is gonna have a better life and a better ability to reach that goal that you just talked about? Well, probably the I tested it version, which I said, you, you're right. You know, and it's not that you're gonna be in pain forever, but building those attributes is gonna be important. And it's okay to have a little discomfort here and there. And I tell everyone that flare-ups are, are common and inevitable. You're going to have this again. Everybody's gonna have this again. If you've had it once, you're gonna have it again. And I don't mean that in a bad way, but I do mean in the most prepared way that if it was gonna rain outside, I really wish someone would've told me.   (33:38): So I dressed appropriately and I brought an umbrella. I mean, we can take preventative measures and be responsible humans if we know that something won't return. Almost everything that people have in the past will return, whether it be exactly the same or be a different manifestation. And this is kind of the trouble with only doing like a surgical approach with it. Like, you have to build, you have to build your amenities, you know whether you fix that area or not, it's still going to come back as a different manifestation. Some people may disagree with me on this, but I'm pretty sure there, there's quite a bit of research out there that says one of the largest predictors of future injury is past injury to the same area. And it may not be today, may not be tomorrow, may not be one month, may not be one year.   (34:24): And that's okay. Good management really comes down to having an appropriate amount of time in keeping your physical abilities up and keeping you attaining your goals and being happy. Like I would say that probably a flare up once every year is probably more than I would want someone to have. Certainly once every month is too much. Once every week is too much. But I would say, you know, if I could, if we could make it so you only have a flare up once every five or 10 years and you were doing everything else that you wanted to do, and when you had the flare up that it was actually, you know, maybe like a two outta 10 type of scenario, it just feels a little odd, you know, it feels a little stiff, feels like a storm is brewing. Like you feel it, like you feel like something feels a little weak and then you can get rid of it within a week's period of time.   (35:15): Would that make you happy? Most people answer yes, you know, and, and some people end up thinking well, like, oh don't, don't tell me this is gonna come back. I wanna be realistic with you. It probably will, but that's okay. You don't need to fix them, you don't, you don't always need to fix the fray or tear. You don't need to have your hip replaced. You don't need to have your cam shaved down. You don't need all that stuff. It's okay. Your body will find a way around it. And that's what rehabilitation is all about. It's not always about strengthening things. It's not always about, you know, moving perfectly. It's about what we call movement options. Your body has endless movement options and it moves around its current structures and its current scenario. It'll move around the pain.   (36:03): And the best example of that is last time people hurt their back, they don't round their back, they just bend over and, you know, all of a sudden, like they start, it's like they're doing that thing where they're behind the couch and just sinking. Like that's how they get to the ground. And that's not tau. That just happens. That's your body finding a way around the pain. It'll also find a way around the structure. If you have a cam in your hip, it'll find a way around that structure. If you have a sensitive tissue in your lower abdominal area or the pubic bone or the pubic synthesis, then it's going to find a way around that structure. Now, if you have bony growth arthritis, it'll also find a way, a way around the structure. At some point though, something like bony growth, it'll be, so, if it's really extreme, it's gonna be a little harder to work around.   (36:45): Like if your hip doesn't move at all anymore, how do we expect to take that workload that the hip did and, and share it amongst the other things without having a bunch of flare ups? I mean, it's possible. It's just harder. So the more deficiencies you have, the longer you have it, the more adaptation or buildup of bone soft tissues, fascia, muscle and deeply ingrained movement patterns that are compensatory, the harder it becomes. So the sooner you deal with it, the better. We would love to help you. Performance place. If you want our help we have consultations available. They're very affordable. If you click on the link in the video too, this is in a video. I've done so many YouTube videos, but if you click, if you, if you scroll down to the, to the description in this podcast, you'll probably find it.   (37:34): Or you can go to p2sportscare.com or call us at (714) 502-4243. We've seen so many people with sports hernias. It is crazy at this point. We've had people fly in to see us as well. And I don't mean to toot our own horn, but if you guys want help with this, we would love to be in your corner, help you out every step of the way to get through the initial flareup to get you through subsequent flare ups, find what your goal is and be able to program around that to get you physically active and happy again. So we'd love to do that with you. So we're on your team, let's handle this together. Let's do it. So if you guys are looking for help, again, reach out to us and subscribe to the podcast. We're gonna have more coming like this.   (38:21): We were gonna cover some running topics. We're probably gonna cover some low back and groin again. We may revisit some of the topics that we did of old back in the day because we we probably, we learned some new things. You know I know we learned some new things about nerves over the last year, which would be really nice to share. And I might have went over on time here today as well. Usually these are gonna be 30 minute podcast and I think I went longer, but got excited. I wrote this one out and I wanted to make sure that I hit all 10 topics thoroughly enough for you guys because we need more information about sports hernias. Gosh darn it. Alright everyone, we'll talk to you soon. Thanks for joining the show.