DR. CHRIS LIVESTREAM | ORTHOPEDICS, SPORTS MEDICINE, & REHABILITATION



own Chocolat hey everybody duck Chris orthopedic surgeon and sports medicine physician and welcome to my livestream thank you guys very much for showing up I greatly appreciate you being here and I'm looking forward to having a great conversation with you guys again this week I know I wasn't here last week I was away at military training but I'm back now and I'm ready to go so there's a few things that I want to cover just before we get started so for all those people who are new to the channel be sure to make make sure that you subscribe hit the notification bell if you are a returning member of the interne army you know exactly what you need to do you just need to you just need to like this video and share share this video or this stream with a friend and that being said I also want to make sure that you guys know that I have a new video that's out on Channel and that's about some of the top health and fitness channels that you may not know about so if you haven't watched that video already be sure to go do that and then before we get to the questions there's just a few things I want to let you guys in on first of all I want to tell you about a couple of the videos that we have coming up that are in the pipeline right now so a few of the things that we're working on we have a soccer injuries to video that's coming up we have a park or injuries video we are working on a skateboard injuries video because many of you who have been asked for skateboard injuries we also have a video which is less about injuries but it's also about how to achieve success how do you qualify success and how do you get there so we have that coming up as well and lastly we're also going to be working on a tennis injuries video so those are some of the videos that we have coming up in the pipeline so if you guys have any particular video that you want to see any type of injuries or whatever just be sure to let me know in the comments section or reach out to me on instagram or Twitter at Stephens with a Zen at the end and then you can you know let me know what you what you're interested in and we'll try to accommodate that in the future and the last thing before I get to the questions that I want to let you know is that we're starting a new initiative on the channel for my business which is called human 2.0 dot-com and what we're doing on there is we are creating an exercise library so I know a lot of people have been asking us about exercises that we can do and that type of thing so this is what we have been working on in the in the background for that business so what we're doing over there is that we are creating exercises and that people are interested in and we are putting them up in an exercise library on our human 2.0 Channel so you can go check that channel it's human 2.0 all in words and you can check that on in YouTube and you can subscribe to that there's no cost to you or just putting those exercises up there so if you want to know more about exercises in particular you can go check that channel so that's all of the the background stuff and and and all of the administrative stuff so now we can get to the questions so the first question that we have here is from Anthony deublin and this question says I was recently diagnosed with ankylosing spondylitis do you have any tips or tricks to relieve pain okay great questions thank you very much and Anthony thank you very much for the donation I greatly appreciate that so ankylosing spondylitis espana lightest is a disorder which affects primarily the spine and usually it occurs more in young males than in females but it can affect both and this is it sort of falls in the category of autoimmune type of disease so there are several conditions which are autoimmune or our newly dat conditions and what we mean by that is that these are conditions that are affected or are brought on by changes to your immune system so typically what will happen is that somebody will have had some type of virus or sometime some type of cold or illness and prior to that illness they were perfectly normal and then after that illness their body started to mount an immune response to the virus but also because that virus happened to look similar to some of the cells in that person's body that the immune system didn't recognize the cells in its own body as being its own and it started to kill those cells and so that ends up causing some type of disorder depending on what type of cells that are damaged and in this particular case for ankylosing spondylitis we have cells that are the cells that are part of your spinal system or your spinal spinal column and the cartilage and the bone in that are involved in that system those are the ones that are affected in this particular case and you can have pain and stiffness of the involved joints and typically for ankylosing spondylitis it's primarily the joints of the spine but it's also the joints of the SI joint where the spine joins the pelvis and the two halves of the pelvis joined together so those are the joints that are primarily affected there can be some other problems problems with the eye as well and problems with expansion of the chest cavity for which makes makes these people have some difficulty with breathing but at any rate it's primarily the spine is affected so the question is do you have any tips or tricks to relieve pain well Anthony so the biggest thing for this type of disorder is that you want to maintain your flexibility and mobility as best as possible because this ZZZ is associated with stiffening of the spine and earlier–the Rytas of the spine early degradation of the joints in between spinal vertebrae and the pain that's associated with this comes from the stiffness of these joints so although it is difficult you want to try to maintain the flexibility as much as possible so this means that for somebody like yourself who has this disease you need to spend an extra amount of time on a regular basis working on spinal mobility so this means working on stretching rotating bending and extending your your spine and the muscles of your back you want to make sure that you keep the muscles of your upper and lower up upper and lower back and your core you want to make sure that you keep those muscles as toned as possible and you really want to work on in including rotation through the transverse plane into your stretching and your workout routine so these are the things that you want to do to minimize pain it's hard to say for certain whether these things will completely eliminate pain and and is probably likely that you know you may not be able to totally eliminate all of your pain doing these things but certainly if you maintain the flexibility of your spine as best as is possible and you ensure that the supporting musculature of your back muscles your core muscles and the muscles of your thigh suppose the front the back of your thighs because all of these muscles work together to help stabilize your spine as long as you maintain the strength of those muscles as best as you can this both the flexibility and the strength will help to minimize your symptoms as much as is possible and so if you want your symptoms to be you know very minimal then that's what you're going to do okay so a great question thank you very much for that Anthony all right so Roscoe says that I have knee pains under the kneecap any advice on how to kill the pain so great question Roscoe and this is a common question this is actually one of the things that I see people for most commonly in my practice well the most common thing that I see people for that is a non surgical thing and so when you're talking about pain under the kneecap this is what we call anterior knee pain and certainly this is something that that can come on just by itself or it is something that can be precipitated by an injury or some kind of musculoskeletal issue that you have in your lower extremity and so I won't go into this too much because we actually have a video for this on our other channel human 2.0 so if you want to go check that out you can check that and we'll put be sure to put a link down in the description so that you know exactly where that is but basically the pain that is associated with the pain that's associated with anterior knee pain or paint behind kneecap is usually a function of an imbalance in the muscles of the front of the thigh so the the muscles on the front of the thigh are called the quadricep and that's because there are four muscles okay and so those muscles all attached to the top of the kneecap and and the kneecap travels through a groove called the TRO clip when you flex and extend your knee so in order for your knee to travel through the middle of the groove and not have too much pressure one side of the other the forces the forces between the muscles of the quadricep all have to be balanced so that the kneecap isn't pulling more to one side than to the other it's track tracking straight down the middle of the group so the forces have to be balanced so when you have an injury sometimes the quadricep will kind of go on vacation for a bit or it will stop functioning for a bit and when this happens it is quite easy for the muscles to become imbalance in other words one part of the muscles or one group muscles becomes more strong than the other people must so when this happens the kneecap doesn't track straight and so this causes a a couple of problems so number one it produces extra tension on the side where the muscles are stronger and so this produces extra pressure on the bottom of the kneecap as it travels down the groove on the side away or the weaker side you have abnormal tension in the muscles because now the the muscles on the strong side are pulling the kneecap away and it's on the side where it's weaker the muscles are trying their hardest to pull it back but they can't so now that it's generating a lot of attention on this side as well so you end up getting pain over there as well so the the trick or the problem or the the the thing that you have to correct here is that imbalance between those muscle groups and quite frequently it's the muscles that are on the inside part of the knee the muscles that we call the VMO or vastus medialis oblique asar typically the weakest so we have to make sure that we can strengthen those muscles but obviously because both the VMO and the other muscles of the quadricep they're all on the front of the thigh when you strengthen one group of muscles you're going to be strengthening the others so it in order for you to correct the the imbalance you have to make sure that you focus your training or focus your strengthening more so on the VMO than on the other map other muscles of the quadriceps so that's very difficult to do so oftentimes a lot of patients come to me in with this and they say oh I've been strengthening my quadriceps and I've been doing leg extensions so leg extensions are a exercise where you sit on the bench you put away here you straighten your legs and and you strengthen your quadriceps but this is what's called an open chain and this is because it's if we think of your legs and the weight that you are moving as parts of a chain if the leg if the weight is touching the front of your leg and it's not touching the bottom of your foot you have not completed a chain between your muscles your leg your foot and and the resistive force if it's only on the front it's an open chain if it's touching the bottom of your foot down here this is called closed chain so open chain exercises although they do strengthen the quadriceps they don't really allow us to control where we're focusing our the amount are the majority of our effort and so both the VMO and the other muscles are going to be strengthened they're going to be strengthened strengthen equally and and probably actually the lateral muscles the ones that are already strong will probably be strengthened more because they're already strong so they're just gonna take over so in order to preferentially select the VMO or the inside muscles you need to do what's called a closed chain so closed chains quadricep strengthening exercises are things like squats lunges step ups basically those those there's there's a couple others but I'm having a membrane fire here so I can't think of them at the moment but so those are closed chain because your foot is oh and like press so your foot is touching either the weight or the floor so that's those are closed chains so for closed chain or for VMO strengthening you want to use closed chain and the big thing is you want when you're using these methods to strengthen your quadriceps you basically want to make sure that the muscle that you're strengthening so the VMO which is the tear drop on the inside part of the thigh okay you want to make sure that that is in line with the mechanical force so basically if you draw a must if you draw a line from your belly button to your foot you want to make sure that when you're doing a strengthening exercise such as the leg press squat step up or lunge you want to make sure that the VMO muscle is directly in line with a look the imaginary line from your belly button to your foot if you're if the VMO is inside of that line no good you're strengthening the the other muscles that are already strong and that's gonna be a problem if you are if your muscle is in line perfect that's what you want and basically when you look down at your at your foot your knees should be over the outside edge of your foot that's that's the that's the easiest way to think of it and when you do that that's gonna help strengthen the VMO so having said all of that there's basically two things that ice prescribed for my patients who have anterior knee pain and keep in mind both of these things are gonna hurt a little bit when you first start doing them but if you bear with it you're going to end up strengthening the VMO and getting rid of your answer your knee thing so the first thing that I do is a squat hold and again if you want to know how to do a squat properly you can check out don't remember what the video is but it's one of my earlier visi it's one of my earlier videos on the dr. Chris channel where I talk about body weight training and if you go to check out that video it'll show it'll tell you exactly how to do the squat hole properly but basically spark holes so I prescribed squat holes in the bottom of the squat position ten minutes per day and you don't have to do all 10 minutes at once but basically I say you have to do minimum of one minute increments okay so ten one minute increments throughout the day as you get stronger you'll be able to do 5 2 min increments and and so forth and so forth until you could potentially do a 10 minute hold no problem and that is the number one exercise that I prescribe for patients and then the number two exercise that I prescribed for them is a stretch which is a quadricep stretch which is called the couch stretch and for more information on how to do that check out the human 2.0 channel because we've just put up video on quadricep and hip flexor flexibility and the couch stretch is the other exercise that I prescribe for people and usually with combination of those two exercises I tell them to do them about three to four times a week and I usually will send people off about three months and then they come back to see me and and after that time usually we'll expect to see some change in their knee pain and over time they get stronger and the need paint and as they get stronger the knee pain dissipates so that's a long answer but thank you very much Roscoe great okay so society's rejects podcast says I am really tall and have broad shoulders and a big chest so when I run I come pounding down and it hurts my shins do you have any running advice so well it depends on how tall you are and how heavy you are my first bit of advice for people who run is don't run and I kind of say that a little bit tongue-in-cheek but sort of not so if you if you look at what our Anatomy is like we're not really designed to run or run in the in in the way that people think of running so basically the way that our bodies are designed we are designed do two things we're designed to walk and we are designed to sprint so the the jogging or the long distance running that people do all the time and many people are quite good at we're not really designed to do that and so although we do it that's not really what our bodies of design support but having said all of that so if I'm gonna answer specifically what to do with your shins so first of all when you have shin splints shin splints that is basically what's called a periosteum so if you look at each bone if we were to do an anatomic dissection and look closely at the bone each bone is covered by a very very thin layer of tissue tissue which is called the periosteum and it's like having a saran wrap around the bone and then any muscles that attach to the bone they don't attach to the bone they attach to the periosteum so if you have been doing a particular movement and you've been doing it repetitively then you may have basically an overuse type of injury of the attachment to the periosteum and that's called a pareo status and that's what a shin splint is so it's peri our status on the front of the shin and that's because either the quantity of running that you're doing or the way that you are run and so the muscles on the front of your shin or your tibia those muscles will become irritated and that's why you get this pain so first of all we need to address your running technique so there are different types of running okay so you can be a forefoot strike and mid-foot strike or hind foot strike so those basically the three different types of running so you need to have somebody who is a running coach or somebody who's an experienced runner look at you while you're running and have you and then tell you what type of running you do are you a four foot mid foot or a hind foot straight so that's the first thing then number once you know what type of running runner you are you then need to make sure that the Footwear that you are wearing for running are appropriate to the type of running that you are going to be doing in other words if you are a hind foot strike running you're not you shouldn't be wearing minimalist shoes when you run okay you should only be doing that if you are a four foot or a mid foot type run so you need to have someone assess your running and you need to make sure that your Footwear matches the type of running that you have then number three you need to have somebody who's more experienced and running maybe a running coach analyze how much running you're doing to make sure that the volume is appropriate okay and so depending on your level of conditioning your experience your body habitus or in other words the shape of your body they can tell you whether the volume of running that you're doing is appropriate and number four they can also look at your running gait make sure that you have an appropriate running gait because a lot of people run but they have no training and running and oftentimes they have a very poor gait but they spend more time jumping up and down and not propelling themselves forward so that can also cause significant pain so those are all technical things having to do with running then you want to make sure that when you are running number two cursors first of all when you're running you want to make sure that you have an adequate dynamic warmup in case of the two you the muscles that you're going to be using in running and you do that no static stretching here only dynamic stretching and you just basically when you do a dynamic warm-up you go through the rules that you're going to be using in the activity that you're doing and you do so in a very gentle manner and then you gradually work your way up to your workout pace and then this will allow you to slowly bring blood flow to those muscles and then it will also bring warmth to those muscles to make them pliable so that they can better do what you want them to do so so that are the first thing you're going to do and then after you are done running you want to make sure that you spend time stretching out the muscles that you've used so you want to make sure that you spend a lot of time stretching the muscles of your lower extremity and this doesn't mean just the big muscles such as the quadricep or the hamstring this also means the the muscles of your lower extremity so below the knee both on the front and the back so the calf and the two parts of the cap on the back and then the Tim ant and all the muscles of the anterior compartment on the front so you want to make sure that you spend time doing that and when I say it's time if you have gone for a significant run and when I say significant I'm talking to anything five kilometres or more you should be spending half an hour 30 minutes to stretch so and for all you Americans let me see five kilometres is three miles so anywhere from three to six miles if you've done that kind of length run then you need to be spending probably about 20 minutes at least half an hour of stretching for your lower extremity and your upper extremities as well when you have been doing that so in particular for the the shin splints you want to make sure that you spent quite a lot of time doing stretches for the anterior aspect of your lower sherman so some examples of this so you want to one of the things that you can do is you can kneel on the ground with your toes pointed behind you okay and you can do this and then do you want to go from being upright in this position and you want to try to lower yourself down so that you can bring your heels close to your butt okay if you can sit with your heels touching your bum and your toes pointed behind you then you can work on this spending time in this position and when I say time I'm I'm thinking of one to two minutes for each stretch that you do so in other words you're going to get into that position fine try to get to the furthest extent that you can stretch and then wherever you are in that position you're gonna stay in that position for one to two minutes that's the amount of time you need to spend on each repetition of the stretch okay and then you were to repeat that two to three times and when you stretch here's the thing people don't understand so when you stretch I always tell people I always tell my patients this is something you're trying to get your body to make a change and your body is only gonna make a change if it is if there is some if it is prompt to do so by some level of discomfort so in other words there needs to be you need to be outside of your zonal comfort when you do this so when you're stretching on a scale of 0 to 10 zero is no pain whatsoever and 10 is where you you would pay me money to cut it off right now with a rusty butter knife that's ten usually when you're doing stretching you should be in the six to seven range in other words you should be having the kind of like your eyes kind of go like this a little bit and you just got a really concentrate cuz it's like it's not terrible pain but it's it's it's uncomfortable and then you want to hold it for one to two minutes and the thing that you'll find is that for the first 30 seconds it's gonna be really intense and then if you just sit there and rest and just breathe easy you'll see over the next 30 to 60 seconds things will just start to loosen and all of a sudden you'll have more range than what you had when you started so this is and this is because it takes time for the muscles to loosen takes time for the soft tissue the tendons to loosen up and allow you a larger range of motion for most people if I were to take you to the or put you to sleep and not have your brain in the way I could stretch most people way further than they could ever stretch when they're away so you got to give your muscles time to ease into the stretch so for anterior tibial pain or parry off site of the shins shin splints that's what you should be doing kneeling on you're kneeling on you're kneeling with your toes pointed behind you and then trying to sit down onto your heels with your bum and doing that for one or two minutes two or three times after your run but in general when you run you should be spending about twenty to thirty minutes doing proper lower extremity stretches okay a spider-man asks Oh spider-man asked I have osgood-schlatters in my knee what can I do to make it better okay when we talked about this before but I'll try to quickly summarize so osgood-schlatters is basically a problem that occurs because of increased tension in the anterior chain basically the quadricep and the hip flexor muscles on the front of the thigh and in particularly or in particular where the patellar tendon attaches on the tibia so if you have your thigh and then you have the shin as the muscle come over and attach onto the front of the shin if you are growing very very quickly as a young adult and you have a lot of tension in the thigh muscles because your body is still growing and the the bone is not is not entirely solidified where the patellar tendon attaches the bone can actually grow out because of the tension so the muscle is pulling really hard because it's tight because you're not very flexible and this will pull on the growing bone at the tibial tubercle and it basically causes the tibial tubercle to grow out so people who have us with ladders end up having a bump a larger bump the normal on the front of the tibia just below the knee and that that could be quite painful so the biggest thing for osgood-schlatters because this is a problem that is occurred or that is caused by abnormal tension due to very rapid growth you want to make sure that you maintain your flexibility of the quadricep and the hip flexor as much as possible and you want to be doing spending a lot of time doing quadricep and hip flexor stretches because these are the things that are going to decrease the tension in the anterior chain and they are going to minimize the amount of tension that's on its appeal typical so one stretch that is excellent for this again is the couch stretch so please check out hugh 2.0 calm on youtube check out our channel and that you'll see the couch stretch there that will help and the couch stretch is actually good for both of the muscles of the anterior thigh so that is this is going to be both the quadricep and the hip flexor okay so both of those muscles that are tight and both of those muscles are the ones that need to be stretched so if you I'm not going to talk about exactly how to do the couch stretch here but most definitely check out our other channel we'll put a link in the description human humor 2.0 comm check out our exercise library we have a video there for the couch stretch and you can do that usually what I would tell people if they have this type of problem you want to be doing the couch stretch about three to four times a week it's a very intense stretch very intense so it's not something that you're going to be doing every single day because that you're just gonna end up making yourself more sore but you do want to do it three to four times a week and when you're doing the couch stretch you basically want to do two to three reps per side each for about two minutes and you probably want to spend a total of about 15-20 minutes just on the couch stretch so you would do it on both sides okay so osgood-schlatters work on flexibility of the anterior thigh and muscles and to do so you want to work on couch stretch for the quadricep and the hip flexor go check out our video on who 2.0 okay okay DeAngelo Cedeno asked how do bone bruises work okay well it's a good question DeAngelo and so a bone bruise or a bone contusion it is an area where the the bone has suffered a contact or a blow and basically it's a blow that has of a force that is not great enough to break the bone but it is below that and so instead of the bone breaking you do have some localized damage on a microscopic level so if you were to look at it with a microscope you would see that some of the actual bone cells some of the haversian canals that's a structural component of bones some of those would be damaged and in response to that you would have an influx of blood influx of blood to that area wherever the force had been imparted so what you won't really see anything on the bone itself okay but I can tell you a bone bruise is quite painful and sometimes the pain from a bone bruise can last anywhere from three to four months what you will see however if you were to look at the bone under magnetic resonance imaging if you were to look at it under MRI and you were to look at I believe t1-weighted films so or maybe to teach it note it would be teaching ladies so if you were to look under t2-weighted and that just make MRIs can be weighted differently in other words they can be they can be sensitized to look for different things and we call that waiting and so there are a number of different ways of sensitizing the MRI images so that we can see different things you can do you can have fat suppressed images or you can have t1 waiting or TT waiting and it's a lot of complex physics but just basically know that t1 weighted films I have to double check is that I can't remember if I have this backwards now but the t1 weighted films will look at fat they'll show fat very well whereas t2 weighted films will show water or liquid very well and so blood tends to have a lot of plasma so there's a lot of water or fluid there or sorry a lot of aqueous solution or water based solution and so there if you look at a t2-weighted film of bond after we've had a bone bruise you'll be able to see that that area of Bourne lights up and that tells us there's a significant amount of edema or fluid that is present in that area and that is where the bruises and again if you were to look at the bruise on if you were to look at the bone on the outside this is not something that you're gonna really see very well because it's more on the inside part of the bone but basically as I said a bone bruise is caused by a force that was not enough to break the bone out right and cause a fracture but it was enough to damage the bone on a microscopic level and so you have an influx of blood into that area where the blow occurred and that's what a bone bruise is and it hurts because basically you have increased pressure within the bone at that spot and you have some localized damage to the structures of the one at that spot so that that's the reason why and that's why it hurts okay great question great question bump up well hello to all of you little goat both Jacqueline maca Tora hello hello thank you very much for showing up I greatly appreciate Eric Rivera asks what about a video about what to eat for specific body type goals so it's it's kind of a good question edrick um and I'll tell you why so the thing is people are always worried about what they look like they want to have you know they want you know they want to get jacked they want to have a specific body type and so they're doing so they'll work out to attain those goals and yes working out will change the way that your body looks but it working out is secondary because the thing that really matters to how your body looks is diet and and it's how you eat not only what you eat but it's how you eat and when you eat so basically if you're thinking about specific body type goals well I'm going to assume that you're trying to be basically just lean cut and and ripped which is kind of what most people want and and the thing is there's a couple of basic principles for eating that apply to everybody and to most favorable body types that people want you before I tell you what those are I gotta say this though there is no specific there is no real thing about oh I'm gonna work to tone my abs and then not not lose weight anywhere else or I'm gonna try to cheat my my butt or my legs and not shape anything up there is none of that people genetically are programmed to deposit fat into in particular places so depending on what your genes say okay so there are there are different trends so some people are programmed to deposit fat only around their midsection so you'll see these people they'll be big in fat but they got skinny arms skinny legs some people our program and rather than around their midsection to put it all in there but or in their legs or whatever so that's genetically predetermined so you can't change where your fat is going to be deposited so thinking that you're gonna change that with exercise or a diet that's a no-no that's not gonna happen um so that's the first thing to know but if you're looking at trying to create a more fit body type well there's a couple of general principles so number one we eat more than we need to so most people consume more calories than they require so you you need to probably eat less number two we most people eat way too much processed food and this is true of any Western society that's the United States Canada we eat way too much processed food so you need to minimize the amount of processed food that you you eat and the reason why is because in order to make processed food last longer and in order to make it taste better they put way too much sugar in way too much fat and way too many other chemicals and preservatives that your body just does not need so you need to eat less processed food my general rule of thumb is this for people so number one try to make everything that you eat from scratch okay try to make it all from scratch that's the easiest thing to do because then you know exactly what goes into it number two if you are going to eat processed food look at the label okay if you look at the label and if it has more than five ingredients put it down don't eat it if it has more than five ingredients put it down also if you look at the label and you cannot pronounce any of the things that are in it then don't again put it down don't eat that okay it should have simple ingredients you should be able to pronounce them and you should recognize them and it should not have more than five ingredients those are the things that you should eat the easiest way to know what are the things that you can eat when you go to a supermarket is any generally the stuff that's around okay cuz you go to the supermarket to have your produce you have your meats and all that stuff it's usually around the outside you know your eggs melt all around the outside the stuff that's in the middle on any of the shelves in the middle generally you do not want to eat that stuff okay because if you look at the ingredients that one five ingredients a lot of is preservatives sugar and you don't want it all so when you look at the labels the things that are in that the things that are included in that food are listed in order of their percentage volume by weight okay so in other words that means that if you look at the label and it says fruits rip toast glucose okay that's the first ingredient then it means that per serving by weight sugar fructose glucose is the most abundant ingredient in that that thing so if you pick up something to eat and it has fructose glucose modified corn syrup sugar there's a couple other terms there that I don't remember right now but if it has any of those things in them the first ingredient put it down don't want to eat it okay because the sugar content is is way too high okay so so those are some of the specific things um that that you can do with respect to that then also you want to make sure that the the time that you eat you generally don't want to eat after 8 o'clock in the evening okay so none of that and you want to make sure that you consume lots of water so the only things that you really need to drink our water tea and if you drink coffee coffee that's about it you don't really need to drink anything else and you shouldn't be drinking fruit juices way too much sugar don't drink those soda or pop as we call in Canada too much sugar don't drink that alcohol on occasion you can drink it but it's it's really empty calories and and it's a ton of sugar so you don't really need it so so those are the kinds of things in general if you are trying to get though and those remember I'm not a dietitian I'm a physician but those are just general rules and I think those are applicable to anybody if you are trying to gain mass and you're trying to get bigger then obviously you want to try to eat more protein okay and when you are consuming more protein people think oh I got to have a ton of these protein protein shakes and all that kind of stuff you don't really need that you're gonna end up having you will end up having more more protein that you were peeing out like you'll just make more expensive pee so don't don't do that you could easily consume some protein just by normal means by eating a little bit more meat a little more chicken breast a little bit more fish little just a little bit more red meat whatever and that'll be fine okay so you don't need to consume a ton of protein stuff but you do need to consume more protein and you need to also make sure that in order to get bigger you're not just eating protein you're actually working out because you your your muscles need to be broken down to some extent to have the amino acids and the protein to repair them and if you're not doing that then again you're just making an expensive piece so if you want to make expensive people right ahead but in other words you don't really need to do that okay so a great question edrick it's Kyle says hey Chris I was just wondering what a lung contusion is I saw a hockey player get injured and they call it a lung contusion but I don't know what it is okay it's Kyle it's a great question it's a little bit outside of my realm of expertise but I can give you a general description so just like we talked about a contusion on the bone a lung contusion is a similar thing so basically what has happened to this particular athlete they have received a blow to their chest okay that could either have been a check from a stick from the puck or from the them hitting the ice for the boards or the net whatever but basically their chest has come into contact with something that is hard or something that has been moving very very very quickly that force has been when when they were struck on the chest Bank okay the force went through the chest wall and guess what behind the chest wall you have your lungs and so when that force was imparted onto the chest wall the chest wall then went bang into the lungs or the lungs because of the the players movement went bang into the chest wall either way it doesn't really matter either the chest wall bang into the lungs of the lungs banged into the chest wall and because of the force of that blow there was a blunt force injury to the lungs and you had a instantaneous collection of blood at that area or where the the lung was contacted and if we were to open the chest and look directly at the lung you would see that there would be a big bruise on the surface of the lung so that would and that would be superficially on the lung and most likely depending on the amount of force that wasn't applied to the lung the the contents of the lungs so the alveoli and some of the internal structures of the lung would also be bloody or show bruising and this is what would be known as a lung contusion so that's the answer to that question okay so so Jacqueline Mac iturra says you see here I'm starting to have muscle problems with my arms legs knees and wrists am i starting to have muscle pain or what that's hard to say Jacqueline because you know we don't have a lot of information we don't know whether that's after activity we don't know what something that's just come on by itself or if it's come on after an illness or what so that's that's kind of very V and it's hard to say um what I would suggest for somebody like yourself who has this type of problem that's very generic I would first go see my family physician to make sure that your basic general health is good and that you do not have any kind of systemic illness which might be causing such widespread muscle pain symptoms so that's what I would do first and sorry I can't give you more detailed information but as I said I don't really have much to go on and it doesn't sound to me like this is specific joint problem or specific area problem this sounds to be more systemic okay but thank you very much for the question okay moss baller asked this osgood-schlatters ever go away I've had it for like five years now well this is a we've talked a little bit about osgood-schlatters already and osgood-schlatters is a disease which comes from abnormal growth and so generally speaking after you are done growing then most people who have had osgood-schlatters this is a problem of adolescents usually that goes away so they don't normally have pain with it anymore after that so that answers that question so and processions the sports kicker thank you very much says you have a great channel thank you very much for the donation I appreciate that that was very nice of you I try my best okay so let's go on to the next question okay so Annika the Clausen says I'm a 13 year old active soccer player and I have jumpers knee my doctors and family keep telling me stop playing but does physiotherapy help and should I really stop I am using a knee brace every day so so so the knee pain that you have there that's the similar same type of thing as the answer your knee pain that I talked about before and so jumpers knee is a combination of inflexibility in the quarter set and then imbalance between the muscles of the front of the thigh so basically the answer that I gave before for anterior knee pain which is to do squat holds ten minutes per day one minute increments at the bottom of the squat check out my video on me to point zero no check out my video on body weight exercises on dr. Chris to learn how to do the squat better and and then check out hugh 2.0 to learn how to do the couch stretch those two things ought to cover it now now let me see I don't see the quest for the next question okay so oh okay so Craig stop says hi dog I think I may have developed back epi Sakuragi act lipoma how are they diagnosed and treated well that's a good question so Craig stop so for those people who don't know so lipoma is a benign tumor of the fat tissue and anybody can get them and you can get them basically anywhere and so the the question is how are they diagnosed and treated well generally speaking like comas so first somebody's usually going to notice a bump someplace of varying size and they're going to wonder what that bump is and then they're going to go seek medical attention so one when they do that their family doctor will usually refer them on to a specialist if they haven't already done imaging and the specialist will do imaging and this the type of specialist that you get referred to depends on the area where the lipoma was noticed so the in Europe teeth or a case if the lipomas noticed in the low back then usually you'd be referred to probably an orthopedic surgeon or a spinal surgeon who was neurosurgeon and those people those people would first look at it to see what it looked like on physical exam and then after that they would do some type of imaging and usually because this is a soft tissue problem we would do an MRI magnetic resonance imaging and when we did the MRI we would be looking for the quality or the type of image that is produced by that that lump in relation to the other type of structures around so when we look at the magnetic resonance imaging we want to see this bump doesn't look like fat is it the same color spot does it look like muscle is it the same colors muscle or does it look like thing else like liquid or like bone and then depending on what it looks like so in case of a lipoma it's going to be ice so dense or it's gonna look in other words it's gonna be the same color as the fat around it so we'll be able to see that and we'll know that it is a fat based fat based tumor then we'll want to look at it to see whether it has features that make it benign which means good or features that make it look bad and so we'll want to make sure that it's circumscribed so that basically means that it has a shell around it and it's localized to one spot it doesn't have parts of it that go out into other excuse me into other tissues and we'll want to make sure that it's one consistency all the way through the color is the same all the way through and doesn't have various different parts in it so so these are things that we'll we'll want to assess so that will help us with the diagnosis and then generally speaking if the light Puma if we see that it once we've characterized it and we know whether it's benign or whether it's malignant meaning cancerous and we see where it's located then I'm depending on what type of area it is that we determine who's the surgeon that takes it out we will usually do a resection of it and if it's benign we'll just resect it and we'll use what's called very close margins meaning that we don't have to take extra tissue out and if it's malignant then we may have to do a large resection on block meaning we take it out and a lot of tissue all around it to make sure that we get all the cancerous tissues or in some particular cases we may have to do other things they may have to have radiation or chemotherapy if it's something other than that but that's those are basically the steps for diagnosis and and treat okay so um let me see here okay I'm not sure what's your you find a good question here so just looking through all the names okay bran Liebling so uh so gran says I had surgery to repair my lady Berman rotator cuff from my shoulder about seven weeks ago how long until the pain fully goes away in full range of motion I'm in physiotherapy but I still have some pain so great question Graham Briana and this is something so normally at seven weeks after a rotator cuff surgery I would expect that you would just come out of your sling a couple weeks ago so usually for I tell my patients it's going to take them about six to eight weeks for them to gain their full range of motion and then they can work on strength out for that so they'll have pain during that time of varying levels the time the pain will decrease over time and as long as the pain is continuing to get less and less that is then I wouldn't really worry on your part now if you don't have a full range of motion yet any time that you're working on range of motion particularly to the extremes of your range of motion so full forward elevation or full abduction external rotation if you have when you're working towards those things at the extremes you're gonna have comfort but again like I said before discomfort on a scale of zero to ten you can expect that to be around three I'm sorry you can expect that to be around six or seven that's kind of the discomforts you have you should be having discomfort when you work on those things but day to day if your arm is quietly shouldn't really be having too much discomfort okay rocker double-o fifty-seven says hi doc so but a year ago I tore my MCL ACL when I went to the orthopedic surgeon they told me that the injury has healed but they are worried about the meniscus is there are tests that they can do to see basically I'm wondering if a scope surgery is the only way to see if this is still injured or is there another test they can perform to avoid surgery certainly there's another test so we can get a lot of information by doing a magnetic resonance imaging or MRI of the knee and this is apart from doing the arthroscopy itself that MRI is the next best thing now not all MRI machines are created equal so if you have an MRI machine that has a smaller magnet such as a 1 or a 1.5 tesla magnet tesla refers to the strength of the magnet then the images are not going to be as good but if you have a stronger 4 mag magnet such as a 22.5 or 3 Tesla magnet then the images should be quite good and if you have a skilled orthopedic surgeon or a skill msk musculoskeletal radiologist to read that they should be able to look at the images from the MRI and they'll be able to tell you whether the meniscus is still injured or not so mr. and Nou mr. McMahon says I have a really big bump underneath my knee for about a year whenever I bend it for too long it hurts and I can't see the bump so you don't know exactly what it is but I'm assuming based on what your description is that you probably have osgood-schlatters you should probably go see your family physician to get referral to pediatric orthopedic surgeon to have that diagnosis confirmed and then the information that I gave the other two people about osgood-schlatters and its treatment will be pertinent for you hey Manuel Vega says I would recommend that you mention these live streams in your videos because they are really interesting to listen to great idea Manuel I think I'm gonna do that thank you very much um okay oh and yes for the people who were asking about the couch stretch or the couch that's what I was talking about that made sure for all you people that you check out our just for runners video on cue 2.0 channel that will you'll find the couch stretch there and that'll help you guys out with your issues okay hi doctor do you know any page where I can watch surgeries and that's MOH doc I can't say that but anyway that's a great question and the site that I use to watch surgeries is called you met edu MPI comm not sure that you have to be whether you have to be a physician or not to watch surgeries there but you can watch surgeries there okay tying in the end says I'm a volleyball player and I recently developed knee pain I was told to start wearing a knee brace but why great question well ty I usually volleyball players so they're gonna have jumpers knee which is basically anterior knee pain which we've described at length already so again once we post this video you can rewind and watch the first part of the video where we talk about answer your knee pain but that basically is going to apply for you so big things for you are stretching your quadricep and hip flexor so working on flexibility of the muscles on the anterior or the front of the thigh and then strengthening the VMO so squat holds are going to be good for you as well okay and then oh so I'm a doctor I'm a basketball player and I have always have my wrist injured I can perfectly fine but then I take about five shots and it starts hurting what could it be I know there's not a lot of info but wow that's a good question so if you've not had suffered a trauma to your wrist then it's unlikely to be a fraction okay because you there would be no reason for it to be for the bones to be broken but it is quite possible that you may have suffered a sprain at some point in time through something that you were doing with basketball it may not have been injured to the point where you thought well I broke my wrist but you may have kind of stretched things more in one direction than your body can tolerate but at any rate one of the things that you can work on and and this is true for a lot of people in a lot of athletes we don't spend a lot of time working on wrist flexibility and mobility so one of the things that you can do to help with that with the discomfort that you're experiencing is to work on wrist mobility and and so there are a number of exercises that you can do to both improve the range of motion and the strength around your wrist so the mobility around your wrist and there are several exercises that that you can do some of which I can describe for you but again this is something that you instead of spending a lot of time describing them you can check out our videos on wrist exercises on human 2.0 Channel but some of the exercises that you can look up our first knuckle push-ups fin and push-ups Torche push-ups and what else yeah so they start with those three those are different kinds of movements and you don't necessarily need to do the whole push-up movement but these are types of exercises that gymnasts use to prepare their hands and their wrists for all of the work that they do in handstands and in their tumbling so these exercises I prescribed these to my patients all the time for use to help strengthen and improve the mobility around their wrists so so those are the things so now we're getting into an hour so I'm a thing I'm gonna ask I'm gonna answer a few more and then I'm gonna call it a day okay so BAM can bamm-bamm cam 22 says broke my tibia fibia and ankle in a spiral fracture in a high school high school game seven years later I have no pain but my ankle feels so stiff and like it always needs to crack every day any advices so great questions quite frequently after fractures of the ankle assuming that everything was healed appropriately and in that anatomic fashion quite frequently after these types of fractures people have some decreased range of motion in their ankle and most frequently the the ankle range that is lost is dorsiflexion in other words when your toes come up and that's the same thing as when you are bringing your your knee forward over your foot so people lose dorsiflexion after they've had an ankle injury so and this is because the posterior chain and this is including all the muscles from behind the knee down through the heel and into the bottom of the foot so that's the gastroc and the soleus the Achilles tendon which is the distal part or the far part of those muscles and then the plantar fascial across a foot that's because all of these structures are very tight and and in addition sometimes you have some scar tissue in the front of your ankle so the two things that are important for you to work on is on flexibility to the posterior change so that's stretching the calf muscle so that's both the gastroc and soleus those two muscles behind the Mullane and in order to stretch the soleus you need to have the knee bent and in order to stretch the calf you need to have the knee straight so stretching the calf gastroc and soleus and then also stretching the plantar fascial so the planner fracture can be stretched by running a lacrosse ball or a golf ball under the sole of the foot and that helps to soften that up and then the gastroc and the soleus you can stretch by doing various stretches with either the leg straight or the knee straight Bente you can also the foam rolling of the camp but for more information on that check out our stretches for runners video on human 2.0 that would give you all the information that you need to do do and the the biggest thing that you need to know for for this is that you've had an extended period of time or you've lost range of motion around the ankle it's going to take a long time in order for you to regain that motion so don't just do these stretches and then expect that it's going to come back after like you know week or two weeks of doing it it's gonna take months if you work on this to get it okay and so let me see so one more question so Carlos Keano asks doctor I have lower back pain from deadlifting bad if I don't stretch my lower back it will hurt all day how can I fix it well Carlos first thing I gotta say is you played yourself brother because one of my last videos was dead lifting and how to do it properly so that's an issue so go watch that video that's the first thing you should do so that you know exactly how to deadlift problem and and why dead lifting poorly is a problem but more importantly so hopefully if you deadlift it incorrectly hopefully you haven't done anything will no lasting damage to your your back so hopefully you have just strained the muscles of your back and that you haven't done anything to divert intervertebral discs and such as disc herniation or a disc protrusion so assuming that you haven't done that then basically you've strain the muscles of your lower back which is fortunately it's a non-surgical issue and that's something that can be treated so number one you got to work on strength stretching of the the lower and the upper back as well because they all kind of work together so you got to work on flexibility but more importantly you need to work on strengthening of the low back muscles strengthening of the core the abdominal muscles and the transverse abdominus so the muscles at the side and the obliques you have to work on strengthening of the muscles of the front of the thigh and the back of the thigh because all of these structures work together to help strengthen you are to help stabilize your back and your spine so first of all you have to well actually number one we'll watch go Westby number two give your back a rest take some time off from dead lifting so that you can allow your muscle potential muscles strain too so number three you've got to work on flexibility of the upper lower back and of your hamstring the posterior chain so your hamstring muscles and your gluteals as well and then number four you need to work on strengthening of the back muscles the core muscles the muscles on the front and on the back of the thigh so those are four things in general that you need to do if you need work on if you need to know how to do flexibility you can check out our exercise on hua 2.0 calm or sore on our YouTube channel for under the human 2.0 chat so go check that out so that was the last question we're going to wrap it up today thank you very much for everybody participating I freaking love these and I freaking love you guys the intern army you guys are amazing so once again if you new please subscribe hit the notification bell and if you're not new share this video with somebody who you think could benefit from this knowledge all right and as always that's gonna work for dr. Chris not your everyday goodnight everybody

2 comments

  1. Thanks for answering my question. I’m an active individual and my ankle has really been bothering me with how stiff it is. Appreciate the advice

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