1:31:14
External rotation of the hip, same thing as in the shoulder. And this actually segues nicely into what,
1:31:19
into the whole concept you were talking about. Like the body is like a mirror image. The hip is like the shoulder, right?
1:31:24
The ankle is the wrist. The foot is the hand. The knee is the elbow, they're two hinge joints,
1:31:30
they function that way. Well, with the shoulder, you've got that mobility that comes from having all that freedom of motion
1:31:37
but the stability is lacking. Well, the same thing with the hip, like you've got mobility, but if you don't fully stabilize it
1:31:43
by training all the muscles of the hip and if you don't strengthen the external rotation of the hip, then you're going to have issues.
1:31:52
Like it's not biomechanically going to work the same way. If you think of the body as a series of bands
1:31:58
pulling in different directions at different levels of tension, you're being pulled into one direction or the other
1:32:05
just by the balance of tension from one weak area to one dominantly tight area.
1:32:11
And you need to make sure that you can sort of balance this out in order to eliminate some of the adaptations
1:32:16
and compensations that happen. So what I say, when we look at sort of the body as a whole,
1:32:25
most often wherever you're feeling the pain is absolutely not to blame.
1:32:30
There's not to blame. It is somewhere above or below as you hint to that. You're talking about, the knee is my favorite example of it.
1:32:38
Whenever you have knee pain, patella tendonitis which I have forever.
1:32:43
I've had bad, bad cases of tendonitis where squatting is very difficult for me. It's not the knee, the knee is literally a hinge joint that
1:32:52
there's minor rotation capabilities in the knee but it's a hinge joint. And it's being impacted by the hip and the ankle
1:33:00
and the foot, as I said before, how critical the foot is. If you thought of the knee being
1:33:06
like the middle of a train track, where the femur down your thigh and your shin down below your knee, where the train track,
1:33:13
well, what would happen if the foot collapses at the bottom? All of a sudden that train track on the bottom
1:33:19
gets torqued just a little bit. Well, who's going to feel that the most, the area where it's torquing, which is at the knee.
1:33:25
So the stresses are going to be felt there meanwhile the problem is the foot or the problem is the ankle. People that are chronic ankle sprainers
1:33:32
are almost always going to wind up having back pain because the ankle sprain causes weakness
1:33:38
in mal adaptations in the ankle that then gets connected through the chain. Because now once I distort the ankle and the shin,
1:33:44
now the knee is trying to maintain its ability to hinge smoothly. So it toques on the femur to do that.
1:33:52
Well, the femur is now inside the hip joint pulling on the pelvis and the pelvis is out of whack. It's really is fascinating.
1:33:58
Like it's one of my favorite things about how the body works is like how interconnected it is
1:34:04
and how one little thing somewhere causes repercussion somewhere else. And the easiest way to find out what your problem is,
1:34:12
is to say, okay, I know where my symptom is, but I got to find someone who can help me find the source somewhere else,
1:34:17
because it is going to be usually either above or below. Mostly, usually below 'cause it usually translates up the kinetic chain.
1:34:23
But usually it's going to be below where the real source is. So people with low back pain usually have hip issues
1:34:30
weaknesses, tightnesses, flexibility issues, it's almost always below.
1:34:35
When you get into really high performance athletics though, it almost works the other way.
1:34:40
Like where we have pitchers, who can't, I'm always fascinated by guys that have Tommy John issues
1:34:47
in their elbow, right? Pitchers. Like if you can't externally rotate the shoulder
1:34:53
that we talked about, again, the ability to get your shoulder back into external rotation. Well, your arm has to get to a certain position
1:35:01
for release of the baseball. And if it can't get there, if you can't externally rotate the shoulder to get there
1:35:06
then the elbow has to sort of torque more in order to allow the arm to get back further.
1:35:12
And it will try to take some of that motion from a joint that's not really, again, it is the hinge joint, really capable of doing that.
1:35:19
So it starts to stress that media level ligament to get a little bit further back because the shoulder's not working
1:35:25
and that just ultimately places strain on the elbow. So when you see a guy that has pain
1:35:31
that floats around, a pitcher that floats around their arm, all that is is sort of this balance of compensation.
1:35:36
Once his elbow starts hurting, then he can't get the range from the elbow,
1:35:41
so he tries to dig a little bit further back into external rotation and then the rotator cuff gets inflamed and then he feels that's inflamed,
1:35:48
and by the way, during that time period, it takes some of the strain off the elbow so the elbow feels better. Then he decides, okay, now I got the extra rotation,
1:35:55
but I'm getting too much of that so now he starts straining the elbow again and then keeps going through this cycle. So your body is very smart
1:36:03
and it's going to compensate every single time. It's going to find the compensation but there's no guarantee that that compensation
1:36:08
doesn't leave you with a whole host of other issues. - Yeah, it's fascinating. In another lifetime, I would've gone and been a PT
1:36:15
although it sounds like the community among PTs online... - I don't know what they, listen, we're good people but it's like...
1:36:21
- Yeah, scientists and neuroscientists can get into pretty intense battles. Coming from the academic community,
1:36:26
the etiquette is so different online because I would say, I think in person people would probably behave a bit differently.
1:36:31
- They shake your hand and say, hello. - Yeah, they shake your hand and say, hello. And there's also, look, I'll just be very direct about this.
1:36:39
There are a lot of people online for whom their only content is pointing out the misunderstandings
1:36:45
or alleged flaws of other people. It's like the bulk of their identity. Which to me is sort of a sad existence
1:36:51
but there's always more to gain by thinking about what's possible, and what's new and what's good. But teach their own demise or win.
1:37:00
- I mean questioning what's out there is healthy, it's normal, is great, it actually sparks conversation.
1:37:05
But as you said, some people's existence is solely to find things to nag about
1:37:11
and not actually with the goal being to advance anything, but rather just to. - Yeah, in the world of science
1:37:18
being skeptical but not cynical is encouraged. But I always say that
1:37:23
the longer that somebody's in a career path that's certainly in science or medicine and they realize how hard it is to do various studies.
1:37:31
Once they publish a few studies, generally they sort of get a better understanding of how the various things are done.
1:37:38
In any case, along the lines of pain and pain relief
Tool: Properly Holding Weights & Deepening Grip
1:37:44
and misunderstandings about the origins of pain in the body, one of the great tools that I picked up from your content
1:37:50
which is benefit I know a huge number of people is I think I used to hold weights
1:37:55
sometimes in the tips of my fingers as opposed to in the meat or the palm of my hands. And I had elbow pain.
1:38:01
And I always thought that, I felt it most on tricep exercises and pushing exercise and I thought I was doing those exercises wrong.
1:38:07
Turns out toward the end of my pull ups or my bicep work, I was letting the weight or the bar drift into my fingertips.
1:38:14
And the mere shift to making sure that my knuckles were well over the bar
1:38:19
or that the weight was really in the meat of my palms has completely ameliorated that
1:38:24
for reasons that you point out and maybe you could just share with us why that is you have this kind of finger pull exercise.
1:38:30
Usually when someone says, pull my finger, it's like a bad middle school or elementary school joke... - Yeah, we would say push your finger.
1:38:36
- [Andrew] Right, right. - You know this is fascinating. This is because it just shows again how intricate the body is
1:38:42
and how responsive or over responsive it can be to something so little. And what you're talking about is that when you grip a bar
1:38:50
whether it be through a curl or whether it be through- And this is mostly pulling exercises because the tendency for the bar is going to be to
1:38:57
fall out of your hand not like with a pushing exercise where it's kind of you're pushing your hand into the bar. So on a bench press say.
1:39:04
That bar can drift just by gravity doing its thing or fatigue of the hand grip strength.
1:39:12
Can start to drift further away towards the distal digits. Through those last couple knuckles
1:39:18
that we have on our hands. And though our hand can still hold it there,
1:39:24
the muscles are not equipped to handle those types of loads. And that can start at a very, I'm not going to say light,
1:39:31
but like it could start at dumbbell weight. 40 pounds, 30 pounds, even 25 pounds or something
1:39:38
depending upon their overall strength levels. But then when you start to apply it to something like your body weight with a chin up, right?
summarize this :1:39:46
'Cause that's natural for the bar to somewhat kind of float down towards your fingertips. And it actually is a little bit easier
1:39:53
to perform the exercise with that sort of like false script little hook grip at the end because you're not going to engage the forearms
1:40:00
into the exercise, you're not going to start pulling down. But at the same time while it could help you to perform them
1:40:07
better by getting the back more activated, if you have weakness in these muscles. 'Cause it's not a thing that happens to every,
1:40:13
it's not one of those upright road type things where I think this is happening to everybody. This is happening to people
1:40:19
that have these inherent weaknesses in these muscles. You or haven't done enough of the gripping
1:40:25
in the meat of the hand for long enough but it starts to put that stress on these muscles
1:40:33
that are ill-equipped to do this and to handle this and it starts to it's particularly on that fourth finger,
1:40:38
which is part of the muscle we call the FDS, a flexor digitorum that is just too much for it to handle.
1:40:45
And that comes all the way down and meets right at the media level. Right on that spot that you can say feels like someone's knifing you right in the middle
1:40:51
in that medial level. And medial epicondylitis or they call it golfers elbow is something that a lot of us deal with in the gym.
1:40:59
It's one of the most common inflammatory conditions people get from the gym and it all comes from this positioning of the dumbbell
1:41:07
or barbell or hand on a pull-up bar over time. So the easiest thing to do is just grip deeper
1:41:13
so that what you're doing is you're using more leverage from the palm to encapsulate the bar
1:41:19
or the dumbbell or whatever and you're not putting that pressure really distally right on that last digit
1:41:25
because that's where that FDS muscle is most strained. So you just almost eliminating that from the equation.
1:41:33
And it's one of those exercises that the load can exceed its capacity pretty quickly.
1:41:39
So that like, maybe it's only capable of handling 30 pounds and then when you're doing a chin up
1:41:44
and it goes and it drifts so far that it's now you say you're a 200 pound guy you've got let's say 100 pounds through one arm
1:41:51
and 100 pounds, this is simplified math that obviously is offset by other muscles, but 100 pounds to one arm 100 pounds to the arm,
1:41:58
100 pounds off of a muscle that can handle 30 is not going to take many repetitions to strain it
1:42:03
and you're going to feel that maybe by the time that a set's over or certainly by the time that workout's over or the next day
1:42:08
you wake up and you've got that notable stabbing pain. Whenever someone feels that the best thing would be to determine,
1:42:15
okay, what exercises would I do that were pulling and where the bar could have drifted deeper or further from the meat of my palm into my fingers
1:42:24
and figure out a way to deepen that grip. When that happens though, the best thing to do with most of these inflammatory conditions
1:42:30
is not do any of that stuff for a little while. Not ever, just for a little while. There's always things that you can do around it.
1:42:37
I'm not saying ever do I say, like, don't go to the gym or don't find something you can do, but I'm saying that particular exercise
1:42:44
that you feel the pain on while you're doing it, never a smart idea to do that exercise when it's inflamed.
1:42:51
If you are doing exercise and it hurts, you probably shouldn't do the exercise because another reason
1:42:57
for the variability of exercise is there's so many other options that you can do
1:43:02
that will train similar muscles or even the same motion and not cause that stress. So, I mean, a cable curl would be much easier to do that on
1:43:11
than let's say a chin up where you don't have the control over the weight like you do by moving a pin on a stack.
1:43:16
So I think that is a common thing that people find and the best thing to do is just figure out
1:43:23
how deep you gripping in that bar. You're going to find that, oh my God, I didn't realize that because it was just. Even though you might start a set in a good position