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Welcome to The Dr. JJ Thomas Podcast! Here I'll be talking all things physical therapy, raw and unplugged, giving you the unfiltered insights you've been searching for in your cash-based physical therapy business. If you're caught in the grind of the traditional model, swamped with paperwork, or feeling like you're not reaching your full potential as a physical therapist, this podcast was created just for you.
So in our practice, one of the things we stress is I want to treat the thing that they don't expect me to treat first. Because if I'm gonna prove to them that this thing that I think is related, in John's case, it was the hand, I better not touch the thing that actually hurts, if that makes sense. Welcome to the doctor JJ Thomas podcast. Hey, everybody. Welcome to the doctor JJ Thomas podcast.
Dr. JJ Thomas:I'm JJ Thomas. Today, we're gonna talk about a really cool clinical scenario that came up with one of my patients. The reason I wanna share it with you guys is because I think this case example is does a really nice job of highlighting how important the questions we ask our patients are in giving us the information that we need to be able to give them back, the treatment that they need in order to get better. So to give you a little bit of background, this particular clinical scenario happened with happened to be with a pretty amazing athlete, John Runyon junior. He is was a former, offensive lineman for the Green Bay Packers, and he's now he's with the Giants this year.
Dr. JJ Thomas:We're really excited, to see him in action a little closer to home for me. He's an awesome, awesome just awesome person, by the way, outside of, outside of being an amazing athlete. But the reason, the reason I'm bringing him, this clinical scenario to us today is because the conversation that we had about some elbow pain he was having, really helped highlight where I needed to work in order to make his elbow feel better. And it's different than you might have expected. So, John came in one day, and he's like, JJ, he's like, you know, he's like, I've had this, like, really kinda nagging elbow pain for quite a while.
Dr. JJ Thomas:And, you know, he's a lineman. Like, he's exploding off the line with his elbow all the time. And you know elbows, they get, like, shaken off pretty aggressively, oftentimes, according to him. And so he said, he's like, you know, it's not uncommon to get elbow discomfort. He said, but lately the elbow discomfort I've been having is when we're doing, he said they were doing with his strength and conditioning coach, who's awesome by the way, they were doing some explosive bench press with the Olympic barre.
Dr. JJ Thomas:And they've been doing it, you know, through a periodization cycle, so he had it every week for a little while, and he was noticing that every time he did that his elbow would bother him. So my next question, in my mind I'm thinking, okay, it's a bench press action, it's explosive, maybe it's a deficiency in the tricep. There's gonna be a pretty heavy demand for tricep there, and that would potentially create elbow pain. So my next question was, do you also have the pain when you're doing push ups? I know they, at the time, were also had another day where they were doing pretty, high load of push ups.
Dr. JJ Thomas:He said, you know what, JJ, Push ups don't bother me at all. And I was like, So that takes away my tricep theory, right? Because now push ups are high tricep activity, but they didn't bother him with push ups at all, only the explosive bench press using the Olympic bar. So I'm like, what about if you're using, you know, a dumbbell? He's like, I don't notice it so much, I really only notice in those explosive ones.
Dr. JJ Thomas:And it's it's fairly heavy load. And he's like, but you know what else does bother me? And and I said, tell me, John. And he said, pull ups. So, all of a sudden, this light bulb went off in my head, and I'm like, that's very interesting.
Dr. JJ Thomas:Pull up is not a, it's not a tricep dominant, in fact, it's, you know, it's more lat and bicep dominant, obviously, right? And so I'm thinking, well, that's interesting, but the common denominator between pull ups and Olympic barre is the barre. So now it got me thinking, I'd better clear his grip. So I said, let's look at you, John. I have some ideas, let's let's start doing some testing.
Dr. JJ Thomas:Okay? So I felt his elbow, I didn't feel any bony end feels, he didn't have pain with a resisted tricep, he didn't have pain with a resisted anything at the elbow. Didn't have pain with a resisted anything at the wrist, anything at the finger flexors, like, could not reproduce his pain. Of course, I wasn't having him do his activity of the of the Olympic, like, Olympic bar. In retrospect, I could have walked him down here and had him on the on the pull up bar, but I didn't.
Dr. JJ Thomas:But what happened was elbow range was decent, no pain with resisted testing, no bony no, no end feel blocks. When I tested his wrist extension and his finger mobility essentially, so, so supine and full wrist extension passive range of motion, and I don't know about you guys, but whenever I do this, I always feel what's happening at the thumb, Because, especially with gripping activities, the thumb is so important. And in John's case, when I checked his range of motion, his thumb was very tight. So his ability to abduct the thumb in full extension was very limited. And his finger, flexors were a little tight as well.
Dr. JJ Thomas:So I said, John, I'll tell you what, if we're gonna test this theory, I think it's coming from your hand. But if we're gonna really test this theory, I'm gonna have to treat that first. And then maybe not even treat the elbow, just so that we can see if the relationship is there. And for those of you listening, this is not atypical for how we treat here at Primal. We we teach this in all our primal foundations courses, so if you're interested in learning it, please, by all means, check out our website, primalhq.com.
Dr. JJ Thomas:And this is how all of our therapists practice here. We we we really investigate through our conversations, and then take those questions, those very deliberate questions, and we direct them to our testing to either prove or disprove a theory. I don't care if it's right or You know, I'm not, I have no preconceptions into, like, I don't need to be right all the time. What I need to do is make sure that that I'm testing the right things, and then I will be right all the time. So in our practice, one of the things we stress is I want to treat the thing that they don't expect me to treat first.
Dr. JJ Thomas:Because if I'm gonna prove to them that this thing that I think is related, in John's case it was the hand, I better not touch the thing that actually hurts, if that makes sense. So it's a kind of a foreign concept for some people. They think, oh, oh my god, JJ, you own a cash based practice. What the heck? How do you get people to come and pay you money when you're not even treating the thing, touching the thing that they came to you for.
Dr. JJ Thomas:Well, the truth is they come to us because they value our expertise, right? And if I'm gonna do right by my patients, what I have to do is find a very specific, deliberate way to prove to myself and to them that the thing that is regionally interdependent, that I think is actually foundationally responsible for their symptoms, is in fact responsible. So that's what we did with John. I needled his hand, specifically the adductor pallisus, both at the thenar eminence and between the first and second metacarpals where it attaches onto the second. I also did, like, flexor pallisus brevis, I did abductor pallisus.
Dr. JJ Thomas:I think I actually also did some extensor pallisus way up in the forearm here. Essentially, I treated him, and a future session, a future episode, we're actually gonna talk about, approaches to needling that I use in terms of in and out technique versus the use of e stim with, needles in situ. But I did a lot of in and out technique, so that I could very frequently test, retest that range of motion, and get a good feel onto how that palm was opening up. So we essentially improved his capacity for his grip strength. He left that day with great range of motion.
Dr. JJ Thomas:I wasn't able to retest. As I said, I didn't have a great reproducible sign, but the cool thing was that he was, in his training schedule, he was he was scheduled to do that explosive bench work the very next day. He texted me, he said, JJ, my elbow has not felt this good in so long. He was about, I think he said he was about 80% after one session and I didn't touch his elbow. I literally just treated the hand that day because I knew if I treated both of them, then in both of our minds we would question, was it really the hand, or was it really because I messed with the elbow?
Dr. JJ Thomas:So, yeah, I just treated the hand. He got about 80% better on just one visit of just doing the hand, and I believe it was mostly the thenar eminence definite deficit. And then 2 more sessions and his hand was good to go. So, so much fun working with these athletes. They always are such good, historians.
Dr. JJ Thomas:They know exactly what symptoms aggravate them, or I'm sorry, what activities aggravate them. They can tell you the diff they can differentiate, oh, it hurts when I'm explosive benching, but it doesn't hurt when I'm push upping. So that information is like gold. When you can listen to that information and and use it, so that use it very, deliberately in your own thought criteria for what does that tell me? Why in the world would push ups not hurt, but the explosive bench would?
Dr. JJ Thomas:And then the minute he said, oh, it hurts with pull ups too, I'm like, ah, there's my common denominator, it's the grip. So, that was it. I just thought that was a really cool example of how we investigate things here at Primal, and I wanted to share that with you guys. So hope you found it valuable. Looking forward to working with you more in the future, and if you wanna hear more from us in terms of other ways to evaluate your patients really effectively, check out our website, primalhq.com.
Dr. JJ Thomas:Take care.