Speaker 1: Welcome to Moving Conversations, a podcast for movement professionals, by
Speaker 1: movement professionals. If you coach, train, or teach movement, pilates
Speaker 1: or fitness, then this podcast is for you. With more
Speaker 1: than sixty years of experience and fitness and pilates, your host,
Speaker 1: Brian Ritchie and North Saint John explored to science of
Speaker 1: human movement, diving deep into the facts, myths, and common misconceptions,
Speaker 1: hoping to spark thought and conversation about how we view
Speaker 1: fitness and movement. Now let's jump into Moving Conversations and
Speaker 1: welcome back to Moving Conversations. I'm Brian Richie joining me
Speaker 1: as always is Noise, Saint John, Morty, Nora.
Speaker 2: How you doing very well, Brian. It's a beautiful day
Speaker 2: here in California. I'm home for a few weeks, which
Speaker 2: is kind of novel and delightful. I'm enjoying it. I'm
Speaker 2: enjoying just like getting back to a nice, steady routine
Speaker 2: of working out and eating well and moving. It's been
Speaker 2: really nice.
Speaker 1: How about you about the same. Yeah, it's I'm going
Speaker 1: to be home for a little while. I actually look
Speaker 1: to my whiteboard and looked at I had a client
Speaker 1: asked me today, so when's the next time. I was like,
Speaker 1: I'm here for a little bit. This is nice, all right,
Speaker 1: I'm gonna be I'm gonna be home. And then it's like,
Speaker 1: oh then I got boom boom, boom boom, and it's like, okay,
Speaker 1: I've got nine more events this summer and they all
Speaker 1: start at the end of July. So I'm like, Okay,
Speaker 1: that's going to be a little bit busy for the
Speaker 1: second half of the year. But hey, that's what we do.
Speaker 1: And last year I was front heavy. This year, I'm
Speaker 1: back heavy, so you know, And it'd be really nice
Speaker 1: if we could just spread it out and just do
Speaker 1: a little chunks here and there. But sometimes you just
Speaker 1: got to do when people can fit us in.
Speaker 2: That's the thing. That's the joy, the joy of our life.
Speaker 2: And if you all think this is glamorous, because I've
Speaker 2: been talking to people who clearly think that being an
Speaker 2: influencer is glamorous a little bit of In one of
Speaker 2: our other podcasts, it's like, ye, no, people, I'm sorry, man,
Speaker 2: but flying for twelve hours, ending up in a foreign
Speaker 2: country where you don't speak the language, ending up at
Speaker 2: some funky hotel and I've had some odd hotels. I
Speaker 2: have to tell you, as Brian, where you know the
Speaker 2: host books use somewhere. One time I really realized, like
Speaker 2: not long after I walked in, this was an old,
Speaker 2: old folks home. Basically, oh yeah, you're talking me about that.
Speaker 2: I wanted a lobby, and there was all these you know,
Speaker 2: older people sitting in chairs, and there was like a
Speaker 2: you know, a little aquarium over there, and some plants
Speaker 2: over there, and a little table for things like I
Speaker 2: don't know, majeong or whatever they play over there. Uh.
Speaker 2: And it was not a I don't know, it was odd.
Speaker 2: It was great. It was a nice, little comfortable, one
Speaker 2: bedroom sort of apartment thing, but it was not what
Speaker 2: I was expecting. We'll just say that.
Speaker 1: I remember one place I got booked into and I
Speaker 1: stayed with the owner of the company and he had
Speaker 1: a room, I had a room, and we had a
Speaker 1: few other people working with us. It may well have
Speaker 1: been called Bob's motel. I mean, it was just it
Speaker 1: was in San Diego. It was a mile and a
Speaker 1: half or something from the convention center, and obviously booked
Speaker 1: on one of these cheap website sort of things. It
Speaker 1: was so uncomfortable. The females revolted and refused to stay
Speaker 1: in the hotel. We had to put them up across
Speaker 1: the street from the airport. If any of you have
Speaker 1: ever been to the San Diego airport, the planes literally
Speaker 1: fly over this hotel. I'm sitting in the parking lot
Speaker 1: of the hotel. I look up. I'm hearing the vehicle
Speaker 1: I mean start shaking. I'm thinking, what is going on? Thinking, okay,
Speaker 1: California earthquake was my first thought. And then I looked
Speaker 1: up and I swear I saw the belly of a
Speaker 1: plane that looked like I could have reached out and
Speaker 1: grabbed it. It was so close. And I looked across
Speaker 1: the street and there was the runway, and I thought, wow, okay,
Speaker 1: this is just the way it is. So yeah, glamorous.
Speaker 1: It is not always. Occasionally we get put up in
Speaker 1: very nice places. Occasionally we have wonderful experiences on flights
Speaker 1: and can relax, and other times you're jumping between flights
Speaker 1: and you're sitting between two I remember, oh my gosh,
Speaker 1: I was in Germany. It was one of these you
Speaker 1: can book half of your flight, you can say where
Speaker 1: you want your seat, but then you get to your
Speaker 1: next thing, and I'm on Luftanza and you don't get
Speaker 1: a choice. I am literally between two guys. And this
Speaker 1: was when I was a bigger man. I was probably
Speaker 1: two hundred and eighty pounds at the time, and I'm
Speaker 1: sitting between two people and they'd call me small.
Speaker 2: Oh god, oh god. So you're like, shoulders are scrunched.
Speaker 2: They've they've taken over the hit the arm rests right like,
Speaker 2: they've totally taken over the arm mass, They've taken over everything.
Speaker 1: Oh my god. I didn't need to see because I
Speaker 1: wasn't moving. I was not going to move during this
Speaker 1: wedged I was wedged in there and they're passing sausages
Speaker 1: between them to eat in front of my face, and
Speaker 1: part of me was to say sure. I mean, I'm
Speaker 1: sitting here, they're speaking German, and I'm thinking, oh my gosh.
Speaker 1: Fortunately it was an hour and a half two hour flight,
Speaker 1: so I said, I can make it for that long.
Speaker 1: But oh my gosh. So yes, glamours, sometimes our travel
Speaker 1: is not.
Speaker 2: Oh my god, that's that's a perfect image. I'm in
Speaker 2: that image.
Speaker 1: So last week. Last week we talked with Beth about
Speaker 1: hip replacements.
Speaker 2: Right and a fire hose download everything you ever need
Speaker 2: to know. It was like so a lot.
Speaker 1: Of information of information, Oh my gosh. And I mean afterwards,
Speaker 1: as soon as we sort of stopped the podcast, we
Speaker 1: started talking and saying, Okay, we need to follow up
Speaker 1: because there was so much information that it's hard to
Speaker 1: parse that much in such a short period of time.
Speaker 1: But we also want to talk about things like case studies.
Speaker 1: I've had countless numbers of hip replacements and literally from
Speaker 1: everything you can imagine. So I was thinking, Okay, it'd
Speaker 1: be a good idea. I'm sure you had the same
Speaker 1: to be able to break that down and go over
Speaker 1: these things and also talk about the differences between the
Speaker 1: techniques and the positives the negatives there are, and these
Speaker 1: are things that, let's face it, with our clients, a
Speaker 1: lot of times, if they're going to go into surgery,
Speaker 1: they look to us for guidance, for help for opinions
Speaker 1: because we see the rehab afterwards, we know the surgeries,
Speaker 1: and a lot of times they think, well, this doctor
Speaker 1: wants to do this brand new technique and I'm like,
Speaker 1: how many of the have they done? Five?
Speaker 2: Okay, it's called practicing, which at this point I would
Speaker 2: rather say they've done two hundred, I'm great, Okay, good,
Speaker 2: then I'm going to be two hundred and one. I'm
Speaker 2: happy to do that. To be number three or four
Speaker 2: of a new, brand new procedure. They're all excited about.
Speaker 2: They'll be paying extra attention. But their experience, Yeah, they're learning.
Speaker 2: Their experience isn't is it where it is with a
Speaker 2: more familiar routine.
Speaker 1: And you said the magic number. I had a surgeon
Speaker 1: client for a number of years and he said, you
Speaker 1: know what two hundred is proficiency? He said, after that
Speaker 1: is artistry.
Speaker 2: OK.
Speaker 1: But at two hundred, that's when you are as proficient
Speaker 1: as you're going to be with the technique. You become
Speaker 1: a master after that. But that's sort of the minimum number,
Speaker 1: almost like we've all heard the ten thousand hour thing.
Speaker 1: Whether or not that's true, I don't know. But he
Speaker 1: said two hundred in medicine, according to him, was the
Speaker 1: magic number. Anything after that. So he always told me
Speaker 1: ask how many they do? How many do you do here?
Speaker 1: How many years have you been doing this? Because if
Speaker 1: you hear someone's been doing this for only three or
Speaker 1: four years and they do, you know, one a week,
Speaker 1: few a month, maybe you want someone with a little
Speaker 1: bit more experiencing under the scalpel. Maybe that's just my thought.
Speaker 2: It's such good information generally, because so many of us
Speaker 2: don't know what to ask a surgeon. Oftentimes if it
Speaker 2: is something like a hip replacement, typically, well, there's a
Speaker 2: lot of ways as goes. But you start with like
Speaker 2: your GP or whatever your gatekeeper is on your insurance.
Speaker 2: They send you to some orthopedic person who may be
Speaker 2: a general practitioner who's specializing orthopedics, not a surgeon, right,
Speaker 2: They kind of talk you through the whole process. Then
Speaker 2: you end up at the surgeon's office, oftentimes seeing the
Speaker 2: surgeon briefly and then seeing their PA or their physician's
Speaker 2: assistant for every other session. So those questions, don't you're
Speaker 2: always get opportun to ask those questions. And I don't
Speaker 2: know about you, but what is the best source of
Speaker 2: even finding a good surgeon? I ask my friends, I
Speaker 2: ask the doctor friends that I know, right, like, how
Speaker 2: do you find somebody who's good? And of course then
Speaker 2: a surgery you probably want them to be on your
Speaker 2: insurance plan too, because that helps a whole lot spending
Speaker 2: for your fifty thousand dollars for a self pay surgeon.
Speaker 2: But those things are always a little tricky. So I
Speaker 2: think that's a really good just rule of fune, Like,
Speaker 2: how many of these have you done just out of curiosity?
Speaker 1: Yeah, And I don't know about you, but with my clients,
Speaker 1: all of them see the best doctors in the world,
Speaker 1: according to them. My guy's the best, My guys the best.
Speaker 1: I hear this, and maybe it's an error area that
Speaker 1: I'm in Washington, d C. High political influence. Everyone's trying
Speaker 1: to one up each other. Everybody has the best of
Speaker 1: the best of the best. And I see this doctor,
Speaker 1: I see this doctor, and they're the best. And you
Speaker 1: see these lists in magazines saying top docs and all
Speaker 1: of this, and I think, okay, well, not everyone can
Speaker 1: be the best. No, I want a really good mechanic.
Speaker 1: I don't need an F one mechanic working on my truck,
Speaker 1: but I want a darn good mechanic working on it.
Speaker 1: You know. I want someone working on my body who's
Speaker 1: done a ton of these, who's incredibly proficient, who's really
Speaker 1: good at answering my questions, and who's available to me
Speaker 1: and can answer those questions, and not necessarily someone who's
Speaker 1: the king of the world. When it comes to this
Speaker 1: because a lot of those bedside matters not the greatest
Speaker 1: and you may not get the questions answered that you
Speaker 1: really need.
Speaker 2: Well, you know, it's we talked a little bit about
Speaker 2: that with influence versus educators, Right, It's kind of like
Speaker 2: are they doing the work or are they talking about
Speaker 2: doing the work? Yeah, you know, because I know I
Speaker 2: look at a lot of those those best doctors of whatever,
Speaker 2: and generally there are things like plastic surgeons and things
Speaker 2: like that, which I understand because those those I mean,
Speaker 2: those guys have to market because they're generally not covered
Speaker 2: by insurance and it really is a product that they
Speaker 2: have to sell. But you know, hip replacement not so much.
Speaker 2: And that is really where you kind of want want
Speaker 2: the person who has a lot of experience with it
Speaker 2: and is really confident and confident with it, and they're
Speaker 2: again too referrals. If you've got a lot of clients
Speaker 2: who've had that, ask them, ask them who's you know,
Speaker 2: how did this turn out? Or you have a client
Speaker 2: who had really good results who is resurgent. Keep those
Speaker 2: names in your rolodex. Oh my god, yes, just really
Speaker 2: seriously dated me. Okay, not your rolodex in your phone,
Speaker 2: keep the contact in your phone under medical professionals, because
Speaker 2: that's really super helpful too, to have a list of people.
Speaker 2: We'll try this guy, try that guy. Maybe they're on
Speaker 2: your insurance. Whatever the situation is.
Speaker 1: No question. I think having that referral source is incredibly important,
Speaker 1: incredibly important. And in today's technology we talked about this
Speaker 1: with Beth. In today's new technologies, things are coming out
Speaker 1: all the time. I remember I had a client who
Speaker 1: was going for a hip replacement. He was in his
Speaker 1: early seventies, maybe mid seventies, and he was going for
Speaker 1: a hip replacement. And it was a new technique and
Speaker 1: this was before the anterior approach became much more utilized,
Speaker 1: and it was more truly a lateral approach. It wasn't
Speaker 1: the posterior ladder. It was a lateral approach. And this
Speaker 1: guy actually invented the technique, according to my client, and
Speaker 1: I thought interesting, and he showed me a scar and
Speaker 1: it was a very unique scar. It was like an
Speaker 1: almost like a seven. It was a right angle and
Speaker 1: it was small and it was truly lateral. And this
Speaker 1: guy had his version. And I've seen that there are
Speaker 1: other lateral approaches out there, and it was very interesting
Speaker 1: to sort of see that. But I've thought, Okay, how
Speaker 1: many has the person done? How good was it that
Speaker 1: my client had wonderful results? But he wasn't an athlete.
Speaker 1: He wasn't someone who was going to go out there
Speaker 1: and try and run or play tennis or golf or
Speaker 1: anything like that. He just wanted to be out of
Speaker 1: pain from arthritis. So with technology and a lot of
Speaker 1: people trying to you know, make themselves better, more proficient
Speaker 1: or whatever, techniques are going to be evolving. And we're
Speaker 1: in a state now where things are evolving a lot
Speaker 1: more robotics. I'm hearing a lot about that, especially when
Speaker 1: I'm in Asia. I'm sure you have.
Speaker 2: Yep, the other thing too, the robotics. There's also something
Speaker 2: that Beth mentioned which I thought was really interesting was
Speaker 2: a much better ability to visualize the acetabulum and the
Speaker 2: femur head and the geometry of that and replicate that,
Speaker 2: you know, through like three D printing other kinds of things.
Speaker 2: And that was fascinating because I know years ago it
Speaker 2: was kind of like, well, there's however many sizes and
Speaker 2: you're you're somewhere between a two and a three, But
Speaker 2: we don't have a two and a half, so we're
Speaker 2: gonna make a choice to give you a two or
Speaker 2: the three, right. I mean, that was that was kind
Speaker 2: of where it was, and that sometimes meant that the
Speaker 2: results weren't fantastic just because the hip didn't fit very
Speaker 2: well and didn't work out absolutely quite like the other one,
Speaker 2: or the mechanics changed between the two sides. So that's
Speaker 2: really wonderful. I mean, those are some those were some
Speaker 2: really good news that she brought that things have improved
Speaker 2: the player. There's much more customization, which is awesome because
Speaker 2: that will make a big difference in people's outcomes.
Speaker 1: I think I presume, I would assume.
Speaker 2: I do.
Speaker 1: I do know that twenty years years ago they said
Speaker 1: that quarter of an inch to half an inch of
Speaker 1: leg length discrepancy was fine and still functional, and that's
Speaker 1: still a successful surgery. And I thought, man, that's a
Speaker 1: large number. Anybody who's ever had a leg length discrepancy
Speaker 1: will know that a quarter of an inch can be
Speaker 1: huge on the low back, on your spine, on everything
Speaker 1: that comes above and below it. And one of my
Speaker 1: clients had after a hip replacement, I think it was
Speaker 1: a little more than half an inch and had to
Speaker 1: have every one of their shoes had a new sole
Speaker 1: put on. You'd never know by watching them walk, but
Speaker 1: sure enough they showed me their shoes and I thought, oh, yeah,
Speaker 1: they definitely had a different sole on one side to
Speaker 1: the other. And they said, yeah, it's a pain in
Speaker 1: the butt every time I buy new shoes, I gotta
Speaker 1: go and have this custom on the outside, not the inside,
Speaker 1: on the outside sole of the shoe to make it higher.
Speaker 1: And I thought, wow, all because they were sort of
Speaker 1: those in between sizes. She was in the matter of field,
Speaker 1: and she said, yeah, they brought in three from what
Speaker 1: the doctor said, and so they made the best determination
Speaker 1: based on what they saw. I thought, man, that's and
Speaker 1: when we think about hip geometry, you know angle of
Speaker 1: the of the femeral neck, you know the twist. Is
Speaker 1: it a little forward, is it a little backwards, is
Speaker 1: it turned? There's so many variations that you can't just
Speaker 1: go in and say, well, this is going to be
Speaker 1: everybody says the same. No, they're really not.
Speaker 2: No, not at all, not at all. So when I
Speaker 2: and again, you've you've probably worked with more hip replacements
Speaker 2: than I have. I've worked with a few, but I
Speaker 2: think you've worked with more of them for more time,
Speaker 2: and certainly more recently because I haven't worked with a
Speaker 2: lot recently. But one of the things that I often
Speaker 2: say about hip replacements is, and this is based on
Speaker 2: all the people that know that have had them, some
Speaker 2: of them are clients, some of whom are friends, it
Speaker 2: is when it is a successful surgery, it is a
Speaker 2: successful surgery. Yeah, you know, I have so many friends
Speaker 2: who especially went in in very good shape. These are
Speaker 2: general pilates, teachers, serious athletes, you know, movement people go in,
Speaker 2: have the surgery, do really good rehab on themselves, and
Speaker 2: come out able to do anything they want to do.
Speaker 2: You know, one of them that I often think of
Speaker 2: as a massive skier. I mean she does hella skiing
Speaker 2: and backcountry skiing several several you know days every winter.
Speaker 2: And this is like, this is what's possible, right, So
Speaker 2: I think that's the good news in a way, this
Speaker 2: is what's possible now with hip replacements. But and you know,
Speaker 2: in the butt is what I said in between there,
Speaker 2: which is she was in really good shape when she
Speaker 2: went in, and she did really diligent rehab on the
Speaker 2: back end, and she knew what to do, and she
Speaker 2: went way beyond what the physical therapist said. She went
Speaker 2: way beyond you know what the standard protocol is and
Speaker 2: really worked to regain as much function, stability, strength, mobility
Speaker 2: as she could after the surgery.
Speaker 1: I think we're in a We're in an age now
Speaker 1: that the baby boomers are more of our clients. I'm
Speaker 1: a gen X, but baby boomers are more of our clients,
Speaker 1: and I think they have, unlike their parents, I think
Speaker 1: they have greater expectations of what they're going to be
Speaker 1: doing for the rest of their lives. I think that statistically, yeah,
Speaker 1: they want to they want a hell ski, they want
Speaker 1: to go skiing. It's like I've worked for so many years.
Speaker 1: I'm retired. Now I want to travel. I wanta da
Speaker 1: da da da da da da da da da. And
Speaker 1: they have those expectations and to be limited by something
Speaker 1: like a hip replacement or a knee replacement or whatever,
Speaker 1: it's sort of like new I'm not going to be
Speaker 1: limited because I need I have things I want to
Speaker 1: do and need to do. I've got my bucket list
Speaker 1: and I need to do them. So I think previous
Speaker 1: generations were much more Oh, I'm sixty five, I'm going
Speaker 1: to retire. I'm going to sit at home now, I'm
Speaker 1: going to sit in my rocking chair. And that's not
Speaker 1: what we're seeing. We're really seeing the people who want
Speaker 1: to push their bodies.
Speaker 2: And also who are and this is statistically true too,
Speaker 2: hip replacements are happening a lot younger. Yeah in people right,
Speaker 2: that used to be like, you know, you're seventy two,
Speaker 2: you fail, you broke a hip, We're going to replace
Speaker 2: your hip. Now it's you know, somebody who's fifty five.
Speaker 2: They've been as serious whatever they've been doing, and they
Speaker 2: need a hip replacement because they want to keep doing
Speaker 2: what they're doing. But they're fifty five, and you know,
Speaker 2: any joint replacement that they talk about has a lifespan
Speaker 2: and sometimes they can last kind of forever, but sometimes
Speaker 2: they really don't last forever for a variety of reasons.
Speaker 2: And so the younger somebody is, the more you really
Speaker 2: want to make sure that that hip replacement, that prothesis
Speaker 2: is protected as long as possible, so you really maintain
Speaker 2: good mechanics there so that doesn't wear out any sooner
Speaker 2: than it needs to.
Speaker 1: And that's a great question you just brought up, is
Speaker 1: when do you do ooh a hip replacement because the
Speaker 1: traditional twenty years ago, I had this happen countless times
Speaker 1: where a client would suddenly come in with a cane
Speaker 1: and I'd say huh okay, and they say, yep. The
Speaker 1: doctor said, use this cane and when the pain gets
Speaker 1: too bad, then we'll do the replacement. And it usually
Speaker 1: was two to three months after they were given the cane,
Speaker 1: because they went in the doctor said, yep, the arthritis
Speaker 1: is bad. Maybe you're ready for it, maybe you're not.
Speaker 1: And usually it was a mental component. Usually the person
Speaker 1: wasn't really ready for it yet. They wanted to be
Speaker 1: out of pain, but they weren't quite ready for a
Speaker 1: surgery because in their mind this is so huge, and
Speaker 1: they were said, here, here's a cane. When the pain
Speaker 1: gets too bad and you're ready, we'll do the surgery.
Speaker 1: And so that was really a big question, is when
Speaker 1: do you do it? Now. I'm having clients approach me saying, look,
Speaker 1: I'm sixty five years old, I've just retired, my hip
Speaker 1: is killing me. I have so much I want to do.
Speaker 1: It's not the doctor says, I can probably put it
Speaker 1: off another four or five years, but then I'm going
Speaker 1: to be older and I'm not going to be as
Speaker 1: strong and this and that. Is it better to do
Speaker 1: it while I'm younger and I can recover faster, or
Speaker 1: is it better to wait? And it's one of those
Speaker 1: questions I'd say, I don't have the right answer for
Speaker 1: every single client, because everybody's different.
Speaker 2: My sister had a knee replacement about a year and
Speaker 2: a half ago, and it was exactly that question in
Speaker 2: her mind. So she was, let's say, howld on. She's
Speaker 2: probably seventy two or three at the time, and the
Speaker 2: doctor said, well, you know, yeah, your knee has has
Speaker 2: been bone on bone for a while at that point,
Speaker 2: so clearly it was in a pathological state where a
Speaker 2: replacement would be a useful thing, and a pain state too.
Speaker 2: She was, you know, on pretty regular anti inflammatories, and
Speaker 2: she she was that same calculus because she could. She
Speaker 2: was pretty functional again, she's a plate she plots, mover,
Speaker 2: she's a gytonic person. She's been a dancer her whole life,
Speaker 2: so she knew how to manage the pain and how
Speaker 2: to manage that knee pretty effectively. But she was like,
Speaker 2: m if I do it now, then I'm still I'm young,
Speaker 2: I'm energetic relatively, I've got good ability to recover. If
Speaker 2: I wait five years, I'm going to be in my
Speaker 2: late seventies. And that was really what you know, she
Speaker 2: did the same reason, the same reasoning. She's like, I'm
Speaker 2: going to do it now because I think I will
Speaker 2: have a better result that will last me longer and
Speaker 2: not put me back as far that's pretty much cannot
Speaker 2: to be true, Like it worked well for her.
Speaker 1: And I find that in general, there's a big difference
Speaker 1: between seventy let's say, seventy one seventy two and seventy
Speaker 1: six seventy seven.
Speaker 2: There really is. That's a big difference there.
Speaker 1: There's a big difference forty two to forty seven where
Speaker 1: the body you haven't got much same body had. There's
Speaker 1: not much difference in tissue quality.
Speaker 2: Even fifty five to sixty I mean, honestly, like it's
Speaker 2: in the seventies, nos things really are a little different.
Speaker 1: It is, And I'm seeing this with my parents. I'm
Speaker 1: seeing it with a lot of clients that when a
Speaker 1: client comes to me at sixty five to seventy it's
Speaker 1: sort of well, this is something you really need to consider,
Speaker 1: is what kind of life and what kind of quality
Speaker 1: of life do you want for the next four or
Speaker 1: five years. If the doctor says you can probably put
Speaker 1: it out for three, four or five years, whatever, what
Speaker 1: kind of quality of life do you want, yep. And
Speaker 1: if you want to have a very high quality where
Speaker 1: you can do everything you want and you want to
Speaker 1: go with your kids traveling and get up and down
Speaker 1: off the ground with your new grandkids and all of
Speaker 1: this kind of stuff, maybe earlier makes more sense. But
Speaker 1: if there's a huge fear, or if there's someone who
Speaker 1: is prone to infection, if there's other reasons to put
Speaker 1: that off as long as possible, well then those are
Speaker 1: considerations too, And we can't just jump into a single
Speaker 1: case of everybody should be doing it like this, right.
Speaker 2: Absolutely so, So, Bran, I want to bring up a
Speaker 2: couple of things here. So one of the things is
Speaker 2: Beth talked in a particular way, and I wanted to
Speaker 2: bring that up because you and I mentioned it a
Speaker 2: little bit, but I think it's really important. She really
Speaker 2: talked as if everybody is getting excellent care meaning that right,
Speaker 2: meaning that they've got a really good surgeon, and then
Speaker 2: they're given really good physical therapy PT and they're released
Speaker 2: from PT at the appropriate time once their strength, their mobility,
Speaker 2: their ability to do their daily life is at a
Speaker 2: certain level. Right, that's that's awesome, and that's wonderful when
Speaker 2: that happens. You like me, have had people where that
Speaker 2: was not the case, where they were that had hip
Speaker 2: replacement and they had you know, six weeks of PT
Speaker 2: and then they were really and they were still Yeah,
Speaker 2: they're still limping, they still don't have like range of
Speaker 2: motion back, they're not as strong as they want. They
Speaker 2: can't really go up and downstairs very well. They can't
Speaker 2: sit for lone like they This is a problem. And
Speaker 2: this is sometimes who you might get in a pilate
Speaker 2: studio is somebody who's really not at that ideally not
Speaker 2: the point where you should be working with them. They're
Speaker 2: a little early. It's just a client you've known for
Speaker 2: a long time and they trust you. They're going to
Speaker 2: come to you, maybe earlier than you would like.
Speaker 1: That happens constantly.
Speaker 2: Yeah.
Speaker 1: One of my mentors called it residual functional deficits, Okay,
Speaker 1: and that's really what it is.
Speaker 2: It is.
Speaker 1: Yeah, because they come out of physical therapy, they're given
Speaker 1: a certain amount of time. And I brought up the
Speaker 1: fact that's you know, sort of like, hmm, that wasn't
Speaker 1: one hundred percent sure. But I have had a number
Speaker 1: of people literally released from physical therapy. Days after they're
Speaker 1: released at home, they go home, they get home care
Speaker 1: for three visits. And what those three visits are, Here's
Speaker 1: how to use a walker, Here's how to get it
Speaker 1: in and out of you know, off the john, in
Speaker 1: and out of bed, into the shower. It's more occupational
Speaker 1: therapy than physical therapy. How to put on shoes basically,
Speaker 1: how to use a grabber to help put on your
Speaker 1: shoes or a shoe long, shoehorn. It's that sort of thing.
Speaker 1: They weren't really getting the same amount of physical therapy
Speaker 1: that you would get in a normal PTS office, and
Speaker 1: they were released and the doctor literally said, just start
Speaker 1: walking on it. Your body will figure it out. And Okay,
Speaker 1: when I was thirteen and I busted my arm, sure
Speaker 1: I didn't need physical therapy afterwards because I was I
Speaker 1: played baseball, I did this, I did that, and I
Speaker 1: figured out how to use my left hand again.
Speaker 2: Yeah.
Speaker 1: Absolutely, that's a little bit more of a challenge.
Speaker 2: The other thing we've talked a little bit about, and
Speaker 2: we'll talk more about it in our next episode. Which
Speaker 2: is on a prehab kind of concept for a new
Speaker 2: replacement or hip replacement. Is not only that, but if
Speaker 2: somebody has been in a painful situation with that hip
Speaker 2: for a period of time, chances are really good they've
Speaker 2: got some funky gait patterns happening anyway because they've been
Speaker 2: avoiding hip pain for god knows how long, which often
Speaker 2: means that you know they're tied in their ql. They're
Speaker 2: tied here. Their backs may be a little bit funky
Speaker 2: because they're just using their body in a very asymmetrical way.
Speaker 2: Often if it's a one side hip hip problem, and
Speaker 2: that means that all of that is still there after
Speaker 2: the replacement.
Speaker 1: That's the whole. That's the whack a mole we've talked
Speaker 1: about exactly. I my mother in law, she needed knee
Speaker 1: replacement for years. She put it off way too long.
Speaker 1: And guess what, she was walking up and downstairs using
Speaker 1: her low back. She was only hiking her hip. That's
Speaker 1: how she ben me to get all up.
Speaker 2: I mean, think about how you have to to not
Speaker 2: bend your knee. That's a big hippike.
Speaker 1: And yeah, after the surgery, her knees weren't the issue.
Speaker 1: Her back was on fire and suddenly that was the issue.
Speaker 1: So you're gonna see that. You're going to see that
Speaker 1: whack a mole or as we I say, you know,
Speaker 1: it's like layers. One thing gets better, it's got that
Speaker 1: next thing, and it's got that next thing, and you
Speaker 1: create these compensation patterns as you go through life.
Speaker 2: Yep.
Speaker 1: Absolutely, to avoid pain. We want to do everything to
Speaker 1: avoid plant pain and seek pleasure. That's the human experience.
Speaker 1: And if my knee is hurting, guess what I found.
Speaker 1: We're in Chicago walking around. Guess what. By the end
Speaker 1: of the day, I've got an arthritic big toe. It
Speaker 1: was hurting. Merathotics usually help for whatever reason. If I
Speaker 1: walk too much, it starts bothering. I was limping. I
Speaker 1: shortened my gait on my left foot. I realized I
Speaker 1: wasn't bending my toe as much.
Speaker 2: Yep.
Speaker 1: But I realized it because we study the body and
Speaker 1: I could feel, wow, my gait is really funky. So
Speaker 1: so I started taking shorter strides on both legs, trying
Speaker 1: to make sure I was walking a little more evenly.
Speaker 1: And I thought, but for the average person, that would
Speaker 1: just be a normal thing for weeks and weeks on
Speaker 1: end and what would happen. They would create those bad
Speaker 1: compensation patterns. So that's what we're going to see with
Speaker 1: someone who is going through this much pain for a
Speaker 1: long period of time and needs that hip replacement, that
Speaker 1: they're not going to just be able to snap back
Speaker 1: and immediately walk on it and suddenly figure it out
Speaker 1: because those other compensations are still there. You don't erase
Speaker 1: them just because you have the surgery.
Speaker 2: So that in mind, Like you know, when I work
Speaker 2: with a client post tip replacement, I'm looking at a
Speaker 2: bunch of things in terms of just assessing things. And
Speaker 2: again it could be a client like yours who's had
Speaker 2: really minimal care and is released into the wild, probably
Speaker 2: earlier than they should be, or somebody who even is
Speaker 2: maybe a year out but still not things aren't working well,
Speaker 2: you know, they're still really tight here, their gate's funky,
Speaker 2: they don't have endurance whatever it is. And this is
Speaker 2: a basic hip assessment, right. We look at mobility, we
Speaker 2: look at strength, we look at range of motion, and
Speaker 2: then we also I spend a lot of time, as
Speaker 2: I'm sure you do, on functional movement looking at gate,
Speaker 2: you know, looking at how are they walking, how are
Speaker 2: they sitting down, how are they getting up? And I'm
Speaker 2: thinking of your environment in my environment are fantastic for this. Personally,
Speaker 2: I'm a little bit in a love affair with the
Speaker 2: coraline right at this moment. And if I'm working on
Speaker 2: somebody with a hip replacement and I can get them
Speaker 2: on a coraline, I know, guys, this is a specialized
Speaker 2: piece of equipment that bounced body makes that's really quite wonderful.
Speaker 2: But all this standing up patterning gate is incredibly valuable
Speaker 2: whole body integration. But really focusing on gate and reciprocal
Speaker 2: leg motion like that is, you know, getting them back
Speaker 2: to walking well. Not walking but walking well is a
Speaker 2: really key foundation of what I'm trying to get them
Speaker 2: to do.
Speaker 1: Yeah, for me, a lot of it comes down to
Speaker 1: I want to get them stronger. I want to get
Speaker 1: them more mobile, YEP. I wanted to make sure that
Speaker 1: they can do some of the basics in life, like
Speaker 1: get them up and down out of a chair because again,
Speaker 1: we're going to see those compensations where they're going to
Speaker 1: You're gonna see them lean from one side to the next.
Speaker 1: And we've talked about this in our assessment thing when
Speaker 1: they just walk in watch how they move, how do
Speaker 1: they sit down? Do they use their arms? Are they
Speaker 1: pushing off with one side? Are they twisting? Are they
Speaker 1: doing all of these things? Because that's going to tell
Speaker 1: you a whole lot, and you can create your programming
Speaker 1: to sort of begin to work. I'm going to use
Speaker 1: a word work around it. It's not the right term,
Speaker 1: but I want to begin to erase some of those
Speaker 1: compensations by saying, Okay, I need to pattern them to
Speaker 1: use that left leg more. So we're going to focus
Speaker 1: a little bit more on that. I'm not a huge
Speaker 1: fan of people of the whole concept of equal on
Speaker 1: each side. If they're weaker on their left side, do
Speaker 1: an extra set of one leg exact? Why not?
Speaker 2: Ye?
Speaker 1: Yep, it's going to be stronger.
Speaker 2: The dominant side will never give up being the dominant
Speaker 2: side unless you really were ever side, and actually often
Speaker 2: will never anyway. But the only way to get the
Speaker 2: week side stronger is to work it period. Absolutely Again,
Speaker 2: working by laterally doesn't get you there.
Speaker 1: No no one thing that I wanted to talk about
Speaker 1: and bring up that. Beth talked a lot about the
Speaker 1: anterior replacement being more of the standard now in her practice,
Speaker 1: she works primarily, I believe you told me with one
Speaker 1: group of physicians or one doctor, I've got a number
Speaker 1: who send their people to me. So I can you
Speaker 1: right now that I've got sort of my you know,
Speaker 1: Casher people.
Speaker 2: Every option depending on the surgeon's preference.
Speaker 1: Yeah, and that's the whole thing. There are three different approaches,
Speaker 1: and I think we should spend just a few minutes
Speaker 1: talking about each because each has strengths and each has weaknesses.
Speaker 1: The anterior approach is sort of the newest approach, and
Speaker 1: about twenty years ago, the anterior approach was primarily there
Speaker 1: for revisions when they'd have to go in again and
Speaker 1: remove the appliance that's there, and you do not want
Speaker 1: a revision. It is no fun. But that was typically
Speaker 1: from what I've talked to a number of orthopedic surgeons,
Speaker 1: that was typically what they used for that because it
Speaker 1: was just easier. They didn't have to worry about dis
Speaker 1: locating the socket and all these kinds of things, because
Speaker 1: it was just an easier way to do it. The
Speaker 1: posterior lateral was what the gold standard was. That's what
Speaker 1: almost everybody did. And if if I had to do
Speaker 1: it today, I don't know which I'd want only saying
Speaker 1: that because with the direct approach, or actually be the
Speaker 1: direct anterior approach is what it's known as, it's the newest,
Speaker 1: it's the latest, greatest, uh as Beth said, it's supposed
Speaker 1: to because they're moving muscles out of the way in
Speaker 1: order to create access to the joint. When you move
Speaker 1: the muscles out of the way, you're not cutting through
Speaker 1: them necessarily as much, and recovery is supposed to be quicker.
Speaker 1: And I just read a meta analysis and it says
Speaker 1: that the first two weeks they seem to be recovering faster,
Speaker 1: but after twelve weeks they're all equal roughly.
Speaker 2: That's interesting, and that would makes perfect sense. I mean,
Speaker 2: if if you're not if you're not trying to knit
Speaker 2: tissue together, which you have to with the posteriu poster approach,
Speaker 2: you're cutting through issue which has to actually heal back
Speaker 2: together presumably right, has to kind of get organized. If
Speaker 2: you're only just moving things around, then yes, you're not
Speaker 2: having as quick recovery at least recovers quicker at the
Speaker 2: beginning because the tissues weren't damaged exactly.
Speaker 1: Perfect sense, but against makes perfect sense.
Speaker 2: Yeah, at the three months mark. Then things the tissues
Speaker 2: are presumably knitted back together, and so then you're kind
Speaker 2: of at parody, right, Is that's what they're saying.
Speaker 1: Interesting, Yeah, is that they're pretty much equal Now with
Speaker 1: the posterior lateral approach, they're cutting through the glutes. Okay,
Speaker 1: they're primarily cutting through the gluteaus maximus. It's more of
Speaker 1: a it's coming from behind and to the side. It's
Speaker 1: a longer scar. I've seen as short as like nine inches,
Speaker 1: as long as twelve. I mean, I've seen some really
Speaker 1: long large scars here. And it really is you talk
Speaker 1: about invasive, it's they're really going through their their traction.
Speaker 1: They're moving the sciatic nerve out of the way, they're
Speaker 1: pulling it aside, and they're cutting directly through and they're
Speaker 1: going in. They have to oftentimes cut through all of
Speaker 1: the smaller external rotators and then dislocate the socket and
Speaker 1: do all the work that they need to do. With
Speaker 1: a lateral approach, they're cutting through. Depending on the surgeon,
Speaker 1: sometimes they will just remove they will cut at the
Speaker 1: insertion at the tendon, the gluteous medius and move it
Speaker 1: out of the way. Sometimes they'll cut through the gluteous medias,
Speaker 1: depending on the surgeon, depending on their technique that they've learned.
Speaker 1: So each of these you're talking about additional time spent
Speaker 1: healing because they have to cut into muscle tissue. They
Speaker 1: have to. Now, the main difference that we find is
Speaker 1: with that in the lateral approach, when they have to
Speaker 1: basically mess with the gluteous medius. A lot of times
Speaker 1: I can leave a limp, if you don't get good
Speaker 1: care afterwards, it can really mean that side never quite
Speaker 1: catches up. That gluteus medius is always sort of a
Speaker 1: little weaker. Again, great physical therapy can help with that.
Speaker 1: What we do can help with that. But we do
Speaker 1: see and again I could not find I looked everywhere.
Speaker 1: I could not find any data that said a third
Speaker 1: of them are here and you know forty percent do
Speaker 1: this approach. Every doctor's a little different, so we don't
Speaker 1: have those numbers. I don't see a lot of lateral approaches.
Speaker 1: I think the posterior lateral is still kind of the
Speaker 1: big one that you know we're going to see versus
Speaker 1: the lateral. But when they are cutting through those muscles,
Speaker 1: that's going to take some time to heal well.
Speaker 2: And what happens when you cut through something, you end
Speaker 2: up with scar tissue, and scar tissue creates stability. That's
Speaker 2: its whole point, right, is to glue together pieces that
Speaker 2: are not attached anymore, but scar tissue. Also, depending how
Speaker 2: somebody build scar tissue, scar tissue can create stiffness, can
Speaker 2: create weakness, can decrease the glide in the fascial layers,
Speaker 2: and things can kind of stick to each other. Sometimes
Speaker 2: a lot of scarring that kind of goes through multiple
Speaker 2: layers and all of that can change those mechanics. One
Speaker 2: thing too, is if there is scar tissue, whether it's
Speaker 2: from actually cutting through the tissues like a Posteri pister
Speaker 2: lateral approach, or whether it's even just moving the tissues
Speaker 2: out of the way, probably disturbing them somewhat in that
Speaker 2: process with an anti approach. The way that from fascial science,
Speaker 2: the way the tissues heal the best is by being
Speaker 2: first being used in the way that they need to
Speaker 2: be used, kind of being released from the tension and
Speaker 2: getting rid of the gluey bits, so manual work or
Speaker 2: that kind of thing to get rid of the sticky
Speaker 2: bits that are not allowing it to move as it should,
Speaker 2: and then training it to move and to create fiber
Speaker 2: angles and fascial fiber angles in the direction of pull
Speaker 2: where you really want it to be. And that's movement, right,
Speaker 2: That's not being that's not being immobilized, that's not sitting
Speaker 2: in your chair. That's movement. And repetitive, regular, consistent movement
Speaker 2: is what makes those changes.
Speaker 1: And getting them to move as quickly as possible does
Speaker 1: seem to help. Now I'm going to say this the
Speaker 1: difference between them we talked the first two. We talked
Speaker 1: about this with Beth, the postier lateral approach. We really
Speaker 1: want to avoid certain ranges of motion and for how
Speaker 1: long everybody I hear different things based on different doctors.
Speaker 1: When doctor will say forever, another doctor will say three weeks.
Speaker 1: You hear different things. So, but the traditional for the
Speaker 1: post your lateral, you don't want to flex them above
Speaker 1: ninety you don't want to do internal rotation or come
Speaker 1: across the body past the midline. Those are the ones
Speaker 1: you want to avoid because if you think about it,
Speaker 1: that's how they dislocated the hip to remove it from
Speaker 1: the socket in order to do the replacement when they
Speaker 1: went in.
Speaker 2: The way that I remember that Brian is don't sit
Speaker 2: and cross your legs.
Speaker 1: Yeah, you know for a client.
Speaker 2: It's like it's like because they're like abduction adductionflection. Like
Speaker 2: just imagine you're lifting your leg up, you're going into
Speaker 2: more than ninety degrees of hitflection. You're going into probably
Speaker 2: some intern rotation, and then you're going into some a deduction. Right,
Speaker 2: that's exactly where that you pop that femur the most
Speaker 2: out of the socket.
Speaker 1: Right, that's kind of we're talking and we're talking about
Speaker 1: crossing your legs where you're here and not sort of
Speaker 1: just putting the ankle on the other knee, because that's
Speaker 1: external rotation.
Speaker 2: It's crossing it like lady like ladies cross.
Speaker 1: It, bingle like ladies in a skirt cross it. If
Speaker 1: that helps, exactly, that's that's the best. That's a great
Speaker 1: way to put it, because again that is what will
Speaker 1: sort of distract that out of the joint. Possibly. Again,
Speaker 1: I've never had someone have that happen, ah, but I
Speaker 1: have heard horror stories from physical therapists that have had
Speaker 1: you know, patients that have had that happen. But that's
Speaker 1: sort of one of those question marks of when do
Speaker 1: you when are you allowed to do that? When can
Speaker 1: you work those You just have to be monitoring that,
Speaker 1: especially in the plate setting, because we do a lot
Speaker 1: of a deduction and could that create some instability because
Speaker 1: that gets a lot is fairly stronger to create and
Speaker 1: gets stronger and there's not as much abduction maybe, But
Speaker 1: this is just something we have to work on balancing
Speaker 1: because we want both to be strong. We really want
Speaker 1: them both to be strong.
Speaker 2: So thinking about exercises like kneeling abdominal's facing back right,
Speaker 2: which is a traditional exercise at least in the balanced
Speaker 2: by the repertoire right there, you're going into hip flexion
Speaker 2: above ninety degrees. That's the whole point of it is
Speaker 2: to get to so as a little bit stronger, and
Speaker 2: that's where you're like, you'd want to be careful of that, right,
Speaker 2: you want this especially at the beginning. Now, I know
Speaker 2: I can think of one particular one of my instructors
Speaker 2: or educated that I know, teacher that I know, who
Speaker 2: had two hip replacements and she specifically asked for hardware
Speaker 2: that allowed her to maintain an unusual and of hip mobility.
Speaker 2: Huh So she she was a dancer and she wanted
Speaker 2: to basically be able to still like you know, lift
Speaker 2: her leg up above ninety degrees in like you know,
Speaker 2: And so the doctor chose a prosthesis and as a
Speaker 2: tagalam that basically allowed more range of motion.
Speaker 1: Wow. Yeah, that's interesting that that was.
Speaker 2: Novel to me. And she had again she said, both
Speaker 2: hipster places and had a very successful that's been very successful.
Speaker 2: Other things she's had issues with, but the hip replacements
Speaker 2: have been extremely successful. And she really had like amazing
Speaker 2: range of motion afterwards, which was a little scary to
Speaker 2: all of us who worked with hip replacements. But yeah,
Speaker 2: you do you if that works for you and you
Speaker 2: know how to manage that, go for it. I would
Speaker 2: never ever ever do that with a client, but I'm
Speaker 2: glad you can do it.
Speaker 1: Wow. Yeah, Because if you think about it, there are
Speaker 1: certain exercises and plots feeding straps that I've I mean,
Speaker 1: you've seen this before. People who are incredibly flexible, they're
Speaker 1: going to want to show off a little bit and
Speaker 1: go into larger ranges of motion. And people we all
Speaker 1: know these people who want to do certain exercises no
Speaker 1: matter what their bodies are telling them because I just
Speaker 1: love the way it feels. Okay, but your new hip
Speaker 1: may not. So you just have to sometimes be aware
Speaker 1: and remind yourself, okay, in this position that hip is
Speaker 1: going a little bit above ninety, maybe we restrict that
Speaker 1: range of motion for now, until we get heads, until
Speaker 1: we get you know, thumbs up from the physician. The
Speaker 1: thing I want to make mention between these three that
Speaker 1: I find the most fascinating and one of the most
Speaker 1: irritating for the clients is what happens if there's nerve issues,
Speaker 1: because and I say this because I've had a number
Speaker 1: of people that have had issues with a direct anterior
Speaker 1: approach that have nerve issues. There's something called the lateral
Speaker 1: frontal cutaneous nerve, and that nerve sometimes gets cut, sometimes
Speaker 1: it gets tractioned out of the way during the surgery,
Speaker 1: and then they end up with this numbness. And they
Speaker 1: say it's anywhere from twelve to eighty percent of people.
Speaker 1: Now that's a gigantic number. This was the meta analysis,
Speaker 1: So I'm just throwing the number out there. From what
Speaker 1: I've talked to physical therapists. They say, yeah, they say
Speaker 1: it about twenty percent of people. Sometimes the numbness goes away.
Speaker 1: I've had some people that it drives them baddie. They
Speaker 1: say it's like a little small nerve sized football about
Speaker 1: this big not where the scar is sort of anterior
Speaker 1: to the scar that's numb all the time. And anybody
Speaker 1: who's had siatic pain and numbness down the lake, it
Speaker 1: can be incredibly irritating. And some people it comes back,
Speaker 1: and some people it never does, and that numbness and
Speaker 1: throbbing and whatnot just sort of is persistent forever.
Speaker 2: Well, that would make sense when you nerves don't like
Speaker 2: to be messed with. And I always say, oh, nerves
Speaker 2: have a memory. Remember, they go up to your brain
Speaker 2: and they have a memory. And once they get insulted,
Speaker 2: sometimes they remember that insult for way longer than you'd
Speaker 2: hope they would.
Speaker 1: Yeah, And nerve issues with the postery or approach is
Speaker 1: about one to two percent because there is a sciatic
Speaker 1: nerve and sometimes when they're getting it out of the way,
Speaker 1: they traction it a little too hard, they do a
Speaker 1: little bit too much compression, and that can cause some issues.
Speaker 1: More more often than not, that does come back. The
Speaker 1: sensation comes back, you know, But they say anywhere from
Speaker 1: like one to two percent of people with that approach.
Speaker 1: Sometimes that does occur. But again that's a one small
Speaker 1: right that's very small.
Speaker 2: It kind of speaks to the robustness honestly, the phatic
Speaker 2: nerve versus there's a much smaller, uh you know, containous
Speaker 2: nerve in the front because you know, the satic nerve
Speaker 2: is pretty honk and then you can't kind of take
Speaker 2: a whole thing and just move it. And I suspect
Speaker 2: that the other nerve is a lot smaller and can
Speaker 2: get nicked without even realizing you're in it. If you've
Speaker 2: ever seen like those little tiny nerves that run through tissue,
Speaker 2: you know you have to look for it to make
Speaker 2: sure you're not doing something to it.
Speaker 1: Interesting, and let's think about this too. If you're doing
Speaker 1: the anterior approach, you're still cutting some tissue. You can't
Speaker 1: sort of go in there without going in there. So
Speaker 1: even though they say we're moving things out of the way,
Speaker 1: there's still fossil tissue you need to cut. There's still
Speaker 1: skin there's out of those tissue, and there is nerves
Speaker 1: running through that, there are blood vessels there are there's
Speaker 1: still there's still all of that that needs could be
Speaker 1: gotten through. Now. The interesting thing is that if you
Speaker 1: have a much higher BMI, they are much more reluctant
Speaker 1: to do an anterior approach, and I think just because
Speaker 1: those tissues are sort of in the way they say
Speaker 1: people with big, meaty thighs or people who have a
Speaker 1: much higher BMI, they're much more reluctant to do that.
Speaker 1: And could that be a reason why is there's they
Speaker 1: have to cut through a whole lot more and it's
Speaker 1: a little more difficult. I don't know, but they say
Speaker 1: that that's one of those big question marks that they'd
Speaker 1: rather do the posterior lateral approach. So again, these are
Speaker 1: all things that you know, I'd heard. I was reading
Speaker 1: those meta analysis and it was really kind of fascinating
Speaker 1: sort of seeing the actual numbers, but the main number
Speaker 1: was the outcomes at the three month marks, six month mark,
Speaker 1: twelve month mark. We're almost identical between all three approaches.
Speaker 2: Bran, it would be good to you know, again, I'm
Speaker 2: not sure how many nerds are really out there, but
Speaker 2: to put the fence for that in the show, because
Speaker 2: I think that sounds really interesting. That sounds like got
Speaker 2: like a really valuable thing just to have have in
Speaker 2: your back pocket and to be able to refer to.
Speaker 2: And and again I would say at least in my
Speaker 2: experience that the outcome apparently at least how much of
Speaker 2: them analysis says this, But the outcomes I think are
Speaker 2: as much based on how much so give given that
Speaker 2: they're all are are equal in the you know, in
Speaker 2: those those those time frames, that the results are really
Speaker 2: a lot dependent on what the person does, right, So
Speaker 2: I've got to assume that then it's not so much
Speaker 2: the surgery that's going to influence that outcome as it
Speaker 2: is how you, as a person with a hip replacement,
Speaker 2: or you, as a person teaching a person with the
Speaker 2: hip replacement, work that client back into as full a
Speaker 2: functional ability as you can. You know, good mobility and
Speaker 2: the hips, good strength, particularly in a deduction, uh, good
Speaker 2: range of motion. In terms of I imagine, and you
Speaker 2: can talk to this, I imagine hip extension gets a
Speaker 2: little limited with an anterior approach. I mean, that's what
Speaker 2: I would assume is and we know that that causes
Speaker 2: troubles all the way down the pike, especially honestly in
Speaker 2: the plate studio, where hip extension is kind of a thing.
Speaker 2: And if you're lacking hip extension, especially on one side,
Speaker 2: you're going to be pretty asymmetrical in terms of how
Speaker 2: you're moving and a lot of common exercises like bridging
Speaker 2: or knee stretch or other kinds of things.
Speaker 1: Now, what I've noticed, this is anecdotally, but also from
Speaker 1: the literature that I've read, is that for the anterior approach,
Speaker 1: those limitation it's sort of the opposite limitations of the
Speaker 1: Postier lateral. So you want to avoid hip extension and
Speaker 1: external rotation, but for a very brief amount of time.
Speaker 1: They usually say until the tissues really heal is when
Speaker 1: you want to avoid that. So you're talking weeks, you're
Speaker 1: not talking years. And from what I've seen, they get
Speaker 1: that range of motion back a lot faster because they're
Speaker 1: not doing as much damage. There's not as much scar
Speaker 1: tissue within the musculature because more of it was able
Speaker 1: to be moved out of the way that they do have.
Speaker 1: Sort of that range of motion comes back to them
Speaker 1: a little bit quicker. And again this is anecdotal. I've
Speaker 1: had a number of people who have had this, but
Speaker 1: that's sort of I've had more that I've had the
Speaker 1: Postier lateral, and for them there's a lot more restriction,
Speaker 1: and I will say functionality wise, I see it faster
Speaker 1: in the anterior approach, but over, Like I say, the
Speaker 1: course of six months to a year, it's about becomes
Speaker 1: about the same. But you're right, it's what you do
Speaker 1: with the person. It's what we're doing, the exercises that
Speaker 1: we choose, what they do on a regular basis, and
Speaker 1: what they can do consistently, because if they're not willing
Speaker 1: to work consistently, it's not going to work for them,
Speaker 1: and they're going to have limitations. And those limitations. I
Speaker 1: said this with Beth. You get one shot, do great
Speaker 1: physical therapy and to do great rehab. After that, you're
Speaker 1: really playing ketchup and it could take you two, three,
Speaker 1: four times as long to get back that same functionality
Speaker 1: as if you took it right from the start and
Speaker 1: did great rehab at the beginning and took it seriously.
Speaker 2: And this gets back to just you know saying earlier
Speaker 2: about when tissues are healing, when things are getting used
Speaker 2: to where they are right, everything's in a slightly different
Speaker 2: position than it was before. If you let that settle in,
Speaker 2: if you let that scar tissue develop, if you let
Speaker 2: those stiffnesses develop, like repairing, that can take forever. Whereas
Speaker 2: if you really start the movement and patterning the movement asap.
Speaker 2: And again there's all kinds of limitations. You know, the
Speaker 2: first six weeks you're pretty careful of a lot of things.
Speaker 2: Six six weeks to three months you're still careful, and
Speaker 2: then after that you're a little bit less careful. But
Speaker 2: basically like really getting the movement patterns, even if it's
Speaker 2: non weight bearing or very relieved, very relaxed, very simple.
Speaker 2: I think of like leg slide right, or even assisted
Speaker 2: leg slides or supported leg slides, just things that are
Speaker 2: getting that mobility going in the appropriate way, getting those
Speaker 2: tissues to respond. That's where you're going to rebuild the
Speaker 2: tissues in the appropriate way, as opposed to again letting
Speaker 2: scar tissue and stiffness develop that then you have to
Speaker 2: get rid of later.
Speaker 1: And this is what I love about the springs, because
Speaker 1: when you do use the springs on the Cadillac, I
Speaker 1: can give so much more assistance with range of motion.
Speaker 1: So I can get them to do a lot of
Speaker 1: ranges of motion that they're really not strong enough necessarily
Speaker 1: to do on their own at the beginning, whereas I
Speaker 1: can deweight them. And I mean you said it great
Speaker 1: in the last episode. By moving the bars in different places,
Speaker 1: you can change where that vector is coming off of
Speaker 1: the spring, so you can and by changing that it
Speaker 1: can give them assistance whether they need more flexion or
Speaker 1: a deduction or a deduction, whatever it is. You can
Speaker 1: really adjust it and fine tune it in a way
Speaker 1: that before I use the Cadillac, I mean I was
Speaker 1: doing it with bands with you know, trying to tie
Speaker 1: them up behind the person and trying to do it
Speaker 1: in some weird ways. The Cadillac is so good for that.
Speaker 1: It is wonderful.
Speaker 2: Yeah, all all the feed and strap stuff that's my
Speaker 2: go to goes to replacement, and really with any hip
Speaker 2: issue sort of if I'm doing prehabilitation and start there too,
Speaker 2: or anybody with a hip problem, it's like just getting
Speaker 2: the motion going with support, you know you can you
Speaker 2: can start. I was kind of like below zero, right
Speaker 2: because you're taking gravity off. So if I'm let's say,
Speaker 2: lifting my leg to the front in basic hipflexion, that
Speaker 2: might be too hard for somebody or cause a lot
Speaker 2: of pain. I add a spring to that, I deweight
Speaker 2: that leg, and then sudden they can do the movement
Speaker 2: and get that pattern back in their body, start to
Speaker 2: get the strength going, and then we just build that up,
Speaker 2: whether it's abduction, adduction, extension, or reflection like all those things,
Speaker 2: we have the the abilities to do on the table
Speaker 2: as supported as we need to, and that's been like
Speaker 2: my absolute go to.
Speaker 1: And what's great about it too, is you're actually strengthening
Speaker 1: the opposite side. So if I'm assisting with hip flexion
Speaker 1: as they put that leg back down, guess what they're
Speaker 1: actually getting their gluten hamstring focused on as well. If
Speaker 1: you're doing it an abduction, you're getting the A deductors
Speaker 1: firing as you pull that leg down, So it's a
Speaker 1: it's only benefit official. I have not had a person
Speaker 1: that I've been able to that I put on there
Speaker 1: that has not gotten benefit from it because it by
Speaker 1: deweighting it, it assists in so many different ways, and
Speaker 1: I can really adjust on how much of their body
Speaker 1: weight they're using, and even if it's a heavy spring,
Speaker 1: they're still getting a lot of you know, of that
Speaker 1: other side, so they're getting.
Speaker 2: Strength and support, right, So they're getting strength in one
Speaker 2: direction and mobility in the other direction, and again at
Speaker 2: whatever level they can tolerate, yes, And that's that's been
Speaker 2: my classic go to for people that are pre hip
Speaker 2: replacements where I'm just trying to get the muscles firing
Speaker 2: around the hip again, because a lot of times they've
Speaker 2: gone wacky, You've gotten a little dysfunctional because of pain,
Speaker 2: and just getting them going again, like waking them up
Speaker 2: in a way that they can do it without increasing
Speaker 2: the pain. And those things are that's just a wonderful
Speaker 2: tool for.
Speaker 1: That, absolutely, and something to keep in mind when you're
Speaker 1: working with these people. And again, I often will see
Speaker 1: them probably before they should be coming back in. I
Speaker 1: hate to say it, but they've been released from PETE
Speaker 1: or they've only gotten eight visits or whatever it is.
Speaker 1: Everybody has different medical insurance and different limitations, and some
Speaker 1: people just I had hated my physical therapist, so I
Speaker 1: want to come to you. We get that too, and
Speaker 1: when you're getting those people work within where they are today.
Speaker 1: And I say that because there's a lot of times
Speaker 1: when we we get bored before the client does, and
Speaker 1: we want to push them. In physical therapy, a lot
Speaker 1: of times they push them a lot harder sometimes than
Speaker 1: maybe they're ready for. Not always, but occasionally I see that,
Speaker 1: and then they come to me and oh my gosh,
Speaker 1: I'm in so much pain because of that. So I say,
Speaker 1: find what level they're at work with that, get them comfortable,
Speaker 1: make small adjustments, increase the resistance slowly, and they're going
Speaker 1: to get stronger. I take my time with it. I
Speaker 1: don't try and rush them through. Physical therapists often only
Speaker 1: have a certain number of sessions to get them to
Speaker 1: a certain level, so they have to move faster. I
Speaker 1: don't have to.
Speaker 2: I was going to say, we have the luxury in
Speaker 2: a way of really luxury. It be as progressive as
Speaker 2: it needs to be. Yeah, you know. And the other
Speaker 2: thing too is I've become much more of a fan
Speaker 2: of this. And I know many of you have trouble
Speaker 2: with getting your clients to do homework, but in something
Speaker 2: like this, homework is critical, absolutely critical that they do something,
Speaker 2: and it can be very simple things. You know, what
Speaker 2: I actually say is give them three things. Don't give
Speaker 2: them twenty. They will not do any of them. Nope,
Speaker 2: you give them three. They may do those three. So
Speaker 2: this is the three most important thing you need to do.
Speaker 2: And it may just be like standing at their counter
Speaker 2: doing heel raises right like that may be standing on
Speaker 2: one leg, work on balance and maybe walking around the
Speaker 2: block like like, just give them three things that they
Speaker 2: can do. That really helped to focus on getting the
Speaker 2: mechanics back, moving the leg in appropriate directions like whatever,
Speaker 2: whatever the.
Speaker 1: Thing is, and make them accountable for it, all them
Speaker 1: on it. Consistency. I remember I was teaching a class
Speaker 1: up in Canada and I was talking with one of
Speaker 1: the other instructors who was running the fitness facility, and
Speaker 1: he said, look, how many times a week do people
Speaker 1: come and see you? That's that one, between one and three.
Speaker 1: I think that's the average, But again, we charge a lot,
Speaker 1: so for some people it's once a week. He said,
Speaker 1: how can someone be consistent with once a week?
Speaker 2: Yeah? I agreed, they can't, right.
Speaker 1: And that that struck home for me a lot more
Speaker 1: than I ever thought it would, And I remember on
Speaker 1: the flight coming back, I thought, wow, that really sort
Speaker 1: of underlines the importance of homework, underlines the importance of
Speaker 1: making sure they're consistent when they're not in front of us,
Speaker 1: and then following up and asking them the questions, hey,
Speaker 1: did you do your homework this week? I did it once?
Speaker 2: Well, okay, great, okay, and let's try for two one
Speaker 2: next week.
Speaker 1: We're you know, I tell them every day and it's
Speaker 1: a psychological thing. If I tell them every day, I'll
Speaker 1: be lucky to get it three times. But if I
Speaker 1: tell them three times, I'm lucky to get once.
Speaker 2: Exactly. No, So just tell them every day. There's one
Speaker 2: of the teachers that I work with says something that
Speaker 2: I really like, and it's a little phrase I'm going
Speaker 2: to keep in my mind, which is that consistency is
Speaker 2: the currency of the body.
Speaker 1: Oh nice, yeah, And.
Speaker 2: It's like so true, right, Whatever you do regularly is
Speaker 2: what your body learns to do, period. And you know
Speaker 2: that if you've got a once a week is doing
Speaker 2: nothing else, their progress is pretty flat line. Like they
Speaker 2: might make a little progress, but it's pretty flat line.
Speaker 2: Twice a week. You get some three times a week, like, man,
Speaker 2: you could be like a rocket ship. So you know, really,
Speaker 2: consistency is what really makes the change. We just know
Speaker 2: that that's how the tissues work, that's how the brain works.
Speaker 1: Yep, one hundred percent. I couldn't agree more. Keep them
Speaker 1: honest about it, make sure they're doing their work, you know,
Speaker 1: and keep changing the homework too, because I find even
Speaker 1: I become a little bit complacent sometimes because I give
Speaker 1: them the exercises and they're doing it great, and then
Speaker 1: I have to remind myself after a month of it, well,
Speaker 1: it's time to change those.
Speaker 2: Right, I got upgrade. I got upupgrade.
Speaker 1: Exactly, So that's something I have to even remind myself.
Speaker 1: So we all sort of get into that those patterns.
Speaker 1: So keep them ones, keep them working, and get them
Speaker 1: moving as soon as they can comfortably, and that work
Speaker 1: comfortably whatever way they can exactly. There may not be
Speaker 1: comfort you got to get right.
Speaker 2: And that's the thing, is comfortable enough, And that can
Speaker 2: be a fine line, right, comfortable enough, not causing irritation,
Speaker 2: not causing inflammation, not causing a vast increase in pain.
Speaker 2: But they may not be comfortable. I mean, you know,
Speaker 2: like a lot of my clients are chronic pain clients,
Speaker 2: and everything they do hurts. It's just a matter of
Speaker 2: it hurts in the in the direction of getting better,
Speaker 2: rather than it just hurts and it's in the direction
Speaker 2: of getting worse. And that's you know, that's just that's
Speaker 2: always a tricky one.
Speaker 1: I think we covered this pretty well. I think there's
Speaker 1: a lot of information here. There is, you know, I
Speaker 1: think after the last session, or the last one with Beth,
Speaker 1: it was sort of Okay, this can't be covered in
Speaker 1: a single hour because there's so much and like you said,
Speaker 1: we are all in our own little bubbles. We all
Speaker 1: have our physicians who send people to us or the
Speaker 1: people that we see on a regular basis. We're not
Speaker 1: a hospital that sees hundreds of thousands of people a year.
Speaker 1: We have a small subset sect of doctors that send
Speaker 1: people to us, and so our experiences are going to
Speaker 1: be limited based on I'm in Washington, d C. If
Speaker 1: I was in Omaha, Nebraska, I'd probably be seeing different people,
Speaker 1: you know. If I was in Calgary, I'd be seeing
Speaker 1: different people. So we always have to remind ourselves of
Speaker 1: that as well. So that's just something to keep in mind.
Speaker 2: I want to really appreciate brand that I think a
Speaker 2: lot of what we've talked about here is in some
Speaker 2: ways not the ideal circumstance, right, Like the things that
Speaker 2: may show up nerve issues and different things that happen
Speaker 2: with different surgeries, and different things that we've seen happen
Speaker 2: with clients, getting clients way early in their rehab process,
Speaker 2: like those are also just kind of the reality that
Speaker 2: we sometimes face. I really appreciated that. I also really
Speaker 2: appreciated that meta analysis study, which is like, oh, that's
Speaker 2: all good information out there, So thank you for bringing
Speaker 2: that forward to to really bring sure.
Speaker 1: Sure, we'll put in the show notes so you can
Speaker 1: read it. I'll be honest. I read through and I
Speaker 1: need to read it probably four or five more times
Speaker 1: before I get one hundred percent of it, because it's very,
Speaker 1: very dense, and it's based on not a ton of studies.
Speaker 1: They're only like twenty four to twenty five. But let's
Speaker 1: keep in mind the anterior approach for hip replacements is
Speaker 1: still kind of new. Fifteen years ago, it wasn't done
Speaker 1: that much. I remember my first clients going into it
Speaker 1: and they're saying, oh, yeah, my doctor's only done four
Speaker 1: of them. I'm like, ooh, I don't know about that.
Speaker 1: Now they've got a lot more experience, so there's more
Speaker 1: studies that are being released on a regular basis. So
Speaker 1: there are some meta analysis out there, so you can
Speaker 1: look those up. I will put them in the ones
Speaker 1: that I saw in the show notes so that everybody
Speaker 1: has those now. I will say this, do us a favor,
Speaker 1: hit that like and subscribe button. I know I forgot
Speaker 1: to mention that earlier, but We really appreciate it. Every
Speaker 1: time you do. It helps us out a ton, especially
Speaker 1: when you comment. The majority of the people that listen
Speaker 1: to our podcast are not subscribers, so if that's you
Speaker 1: do us a favor, hit that subscription episodes may not
Speaker 1: float your boat, it may be sort of like I
Speaker 1: don't know if I really want to, you don't have
Speaker 1: to listen to it, but it helps us out. The
Speaker 1: more subscribers we have, the better it is for us,
Speaker 1: and we get this in front of more people, so
Speaker 1: we can really help some people. So we really appreciate
Speaker 1: every one of you for listening. If you want to
Speaker 1: reach out to us, do us a favor. We can
Speaker 1: do it through email, through Movingcombos at gmail dot com,
Speaker 1: or through our Instagram page Moving Combos. Those are the
Speaker 1: best ways get in touch with us. You can also
Speaker 1: check us out on YouTube under my name Brian Ritchie.
Speaker 1: So for Norah, Saint John and Brian Richie, We'll see
Speaker 1: you next week.
Speaker 2: Bye guys,