Episode #73 Why Your Body Routine Might Be Holding You Back from Full Recovery

Unlock the secret to starting your mornings with purpose and energy—and discover how simple habits like sun exposure and intentional planning can transform your entire day. If you’ve ever felt overwhelmed by the chaos of daily life or struggled to get your day on track, this episode reveals practical, science-backed strategies you can implement immediately. Join Dr. Pawen Dhokal and Dr. Dustin Glass in a candid conversation that goes beyond typical advice. They share their personal routines, including the power of morning sunlight, the importance of planning the night before, and how small habits can have a profound impact on mental clarity, physical health, and overall productivity. You’ll learn why consistent morning rituals can boost your hormones, improve focus, and set a positive tone for the entire day—whether you’re an athlete, busy professional, or simply someone looking to elevate their daily routine. We break down tangible tactics such as:

• The significance of sun exposure at sunrise for hormone regulation and mood enhancement

• How committing to non-negotiables in your mornings can create lasting positive change

• Practical planning tips to unload mental clutter and gain clarity before stepping into your day

• Insights on integrating meditation, gratitude, and intentional movement into busy schedules

• How habits like ultrasound, shockwave therapy, and supplements like bromelain can aid recovery from stubborn soft tissue issues

Plus, they delve into high-level sports medicine insights—like injury prevention for female athletes, understanding structural differences influencing ACL risk, and how proactive prehab can prevent lasting damage. If you’re an athlete, coach, or health enthusiast, you'll discover the critical importance of proactive care and personalized strategies to optimize performance and recovery. This episode isn’t just about health—it’s about mindset, discipline, and leveraging small wins to unlock your full potential. Perfect for anyone eager to reclaim control over their mornings, improve their health, or stay ahead in performance. Whether you’re a busy parent, athlete, or wellness seeker, these insights will inspire you to start each day with clarity and intention. Get ready to shift your perspective and take actionable steps today—because the best version of you begins first thing in the morning.

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Transcript

SPEAKER_00 0:00

Welcome back guys. This is the second opinion. We're a sports medicine podcast. I'm Dr. Dokal. I'm Dr. Glass. DG, you're looking good, as I said earlier. I made a little joke. You're looking good camera-wise and you're looking good regular, you know. Like I was about to ask if you've been running or working out or something, or using like your daughter's red light mask. Like what's happening, bro?

SPEAKER_01 0:19

Yeah, no, I've been uh taking advantage of the sun. We're getting a little more right now down here. I don't know what it's like up there, but uh we're getting some sun. The last couple days has been in the 90s, so um I try to I try to start my morning by um eating my breakfast and doing my meditations and my reading my um different books first thing in the morning as the sun's coming up over my uh uh um fence and uh yeah so I get a little um little raise that way, but my daughter gives me crap because she follows on her phone what the UV pattern's like. And so every every day I'm out there every morning and she'll come before school and she'll see my shirt off sometimes. I'm just basking in the sun or you know, whatever. But it's like eight, nine, ten in the morning, and she's all dad, the UV's like zero. I'm like, no, I'm glowing, I'm getting I'm getting all this UV, you don't know. And sure enough, I looked it up and it's like zero and stuff, but I gotta believe it's doing something good for me, and um, it makes me feel good if nothing else.

SPEAKER_00 1:20

So um, yeah, but she's just there's a reality to just allowing the sun to hit your face and your body. Like, of course, there's chemical processes and the vitamin D, and we won't, you know, at least I don't feel like going down that path and nerding out about it, but just on the feel good, it's great to start your day. I love it. My bedroom window, one of them faces east, and so like it's bright in my room early, but like as soon as that sun comes up above the tree line a little bit, it is like a laser whop, you know. Yep. I feel like I'm like in the great pyramid or something, it's like the summer solstice and the sun just comes right through that shaft or something, you know, because it it is uh a little bit annoying for a second until you're up and then you're outside, and you know it's it's great, get some fresh air. I love that you start your day that way.

SPEAKER_01 2:06

Yeah, well, by intention, right? Like you have to have the intent to do something and you have to um commit to it and have uh you one thing I learned from Kobe um back in the day was uh you you you don't negotiate with yourself, so you make the commitment the night before, the day before, the week before, whatever, and you stick with it so you don't negotiate because when you wake up in the morning, of course, you rather go back to bed, you rather do whatever, but if you have certain non-negotiables every morning to start your day, it's a good way to do it. And you know, we all know how important it is to start your morning off with water, and uh a lot of a lot of what we read is get outside first thing for that first uh sunlight, let it hit your face, let it hit your eyes, and get the hormones regulated right away. So uh by design, I've been um making sure that's one of my non-negotiables. Um, even if I can't do the full 20-30 minutes of everything I like to do, I get out there and uh look up to the sun and um give my gratitude and uh start my prayers and my meditation.

SPEAKER_00 3:11

So yeah, I love that, dude. It's you know, even if you're not religious or you've never meditated before, um, honestly, I think there's a lot of value to just starting your day off peacefully, quietly, whether that's going for a walk, spending it with your dog, being intentional with your kids, and just being present versus and I understand some jobs do require that. I feel like I was working at a time that just, you know, that's what it is. You wake up to a bunch of texts and you gotta look at them, but ideally you either get up 20 minutes earlier so you have that quiet time, or you don't start that way. And uh I find myself, I'm curious about you, is if I don't end the day and with like a list to of what to do the day before the the next day, the following day is what I'm trying to say. Man, it's really easy for that day to get away from me, you know, where I'm busy doing all the things that I have to do, but I don't feel like I stacked any bricks. I didn't build any foundation of what I want to create. Does that make sense?

SPEAKER_01 4:16

Yeah, for sure. And it's something I've struggled with and uh um am not very good at the night before. I know how important it is. They basically say it's like your roadmap, you know, it's start you you have to know where you're going. Um you can't just kind of wake up the next day and you know hope you got it, you know, and all in your head and know exactly where to go. Um so having that um discipline of doing it the night before, I know it's important. I just um am not very good at it. I wish I was. So I'm glad you're planning I can start tonight.

SPEAKER_00 4:49

Yeah, how do you typically do it? Because you're pretty, as I see it, you're pretty organized and you definitely have a lot on your plate. You're one of you know four, five, six people that I know that are have a lot of responsibility and you handle it well and make it look easy, you know, and I know it's not easy. Yeah. So, like, what is your method? Because I I couldn't I couldn't operate that way, but that's just because once I write it down, I feel like I sleep better, it's offloaded, and I kind of know what I can knock out, and sometimes in the first hour or two hours of the day I can do some things. Whereas if I don't have that list, I get up, I do the morning stuff, work out, dog, and then you know, time's slipped away and I haven't really accomplished anything. So, what what's your method on that if you don't mind me asking?

SPEAKER_01 5:34

So, my morning I've always been a morning person um ever since I know growing up. Yeah, I know. But that started with my dad. My dad used to get up early and uh he would make an hour drive commute into LA every day for 30 plus years um so we can live south of there. And um, so I would and being an only child, I'd want to get up and uh see him off in the morning, so I would get up, you know, 4, 4.35 um to see him off. Um a lot of times go back to bed, but it was just the habit of getting up to see my dad and uh see him off for the day, and then um, and then as you know, we started hunting and fishing more, you know, you got to get up early to hunt and fish, and so um I was always just kind of you just answer the bell, you know, regardless of being tired, not tired. If you want to, you know, get it done, you got to get up and answer the bell. So uh morning's always been my time. So, long story short, so that's what I do in the morning. So I'll sit outside at the table, got my dog there, got my tea or coffee, got my different books that I read, and one of the things I do is write out my day, um, and that's my morning planning time. So that's good too. Yeah, so but I like the idea of unloading and uh dumping things off your head when you go to bed. Um, so that's kind of so I I am wanting to incorporate that.

SPEAKER_00 6:56

Yeah, it just works for me. I think it's different for everybody, you know. I just I think uh I'm unique in some ways, and those unique ways are superpowers, and some of those unique ways are probably things that have been challenging in my life, you know. So it uh I found uh that that works better for me, you know. That's that's really it. So um I don't even know how we got off on that tangent, really, to be honest, because we had some topical things to talk about, but I always I always enjoy just the real conversation because it um gives me good reminders a lot of the times. Like something the other day we were talking about where I was like, Oh, I needed to hear that, you know.

SPEAKER_01 7:36

Yeah, and vice versa. We were talking about that. I and um and I remember you saying, Hey, thank you for that reminder, and I and I followed it up by saying, you know, hey, I needed the reminder too, just hearing me say it was a reminder to me too. So, you know, even though I was kind of helping you with something or trying to remind you of something, it was, you know, a reflection for me as well. So um, but I yeah, I purposely wanted to acknowledge that after you thanked me, was to I wanted to um put it out there for myself too and recognize that it was important for me too to say it out loud as a reminder too.

SPEAKER_00 8:18

Yeah, I mean we gotta keep each other accountable. I think that's what you know good friends do and family does and teammates do, you know. And yeah, even classmates and uh you know anyone that you have a relationship with, and so I always appreciate the yeah, just the truth and the honesty, you know. Yeah. Um I have a uh patient case uh this week that came in, Dustin, just to switch gears because I do want to get your opinion on it because it it's not a stumper, it's just I know you'd find it interesting. And so um the issue is there's a high school aged male who has um it looks like a lump on the side of his quad, and you'd think that it's like calcified, but it's uh feels very like soft, but it doesn't feel like there's a fluid, you know. And he had surgery as a young kid where they removed like tissue and part of the IT band to replace something like in his knee that needed that tissue, right? So that's kind of the the background without getting too specific on it. And the injuries healed, you know, he's a athlete, I would say. And uh the remaining issue is that there's this mass like this lump, you know. And I haven't seen any imaging on it recently, but everything's healed. And we're trying to just see if we can get that to be more symmetrical and remove the I wouldn't call it swelling. I wouldn't call it a you know, there's not edema. There's definitely like a soft and like a sulcus where the tissue was removed, like it's actually part of the IT band, is gone, right? Um so two questions off the bat. Have you encountered something similar? I know you've probably seen all sorts of surgeries where things have been cut and removed, and but I haven't seen something that is so dramatic, especially in somebody so young, which gives me encouragement that we can enact some positive change. Um and whether you have or haven't, what are you what's your initial thoughts on that? And do you have any questions?

SPEAKER_01 10:30

Yeah, so my question would be um how long ago was the surgery and how long after the surgery did that show up? Is it relatively new, or was it after a year or so of the healing process and rehab done? That's what was left over, kinda, um, or is it just something that's popped up recently and did it pop up recently after some kind of trauma or training? Or um, and then the other question is there, and I don't think because you would have mentioned it, but is there any kind of redness, warmth to it? Um, does it move freely under the skin or is it fixated? Um, it is it tender to the touch? Um, those are all kind of the differentials that we go through. Um because there's only so many things that it can be. Um, I have come across a number, as you know, being soft tissue uh practitioners, that's people come in with all kinds of things. Um, that's not as common, um, but that those are kind of the differentials that I go through. So, can you answer any of those? And has um when was the last time he had imaging? You said you haven't seen any, but have they imaged it specifically and has it said anything? Have they said anything?

SPEAKER_00 11:43

So um surgery was eight years ago, and the mass has been there post-surgery. Surgeon said it's normal for this type of procedure. Um it still seems excessive to me. Like when I saw it, I was like, that wasn't the primary thing that they came in for, you know? Right, that was just something. And I was like, yo, we should take a look at this. Like, are you you happy with this? Do you want to like are you good? Like, you want to leave it? You want to try to um it was actually one of the things that they had mentioned of like, hey, you know, we want to have a discussion, or can you examine and give me some feedback? So uh the mass has been there basically since surgery. The last imaging was months after the surgery, or say within a year, so nothing recent. He's a late teenager, um I think like a sophomore or junior, so that's the age age bracket. So it's still growing, and um yeah, muscular and athletic, so it's not like he's just no muscle mass, and so everything is soft. Like he's a strong kid, you know.

SPEAKER_01 12:50

Has it changed in size at all?

SPEAKER_00 12:53

It hasn't changed, it stayed pretty steady. Um I've done a few I've had two treatments with him where I've done a few things, and there's been some minimal feedback on it, but nothing that's like oh, I think we're like, you know, chipping away at it, you know. So I'm still like I mean I have a treatment protocol, so that protocol is really like an eight to ten session thing. We're two in, but you know how it is. Sometimes you I feel like I get a vibe just after one or two sessions of you know, this is the spot or this is what we're doing. So did I answer your questions? You threw like seven at me. I got like a three capacity bro.

SPEAKER_01 13:36

Yeah. So um can you grab it and move it? How big is it? About like about a quarter size, dime size?

SPEAKER_00 13:43

No, it's uh it's significant. I'd say it's um about four inches, you know, like the better part of his quad, right? So quad through IT band into like the hamstring. So it's a good four inches in height, I'd say, and probably six inches in length.

SPEAKER_01 14:04

And that's pretty big.

SPEAKER_00 14:06

Yeah, and so like the first little ridge, it's it feels I'd say an inch to two inches, depending on where it is. So the first more proximal, closer to the hip, if the if you say, Oh, this is where the lump starts on the side of the quad where the IT band is. I wouldn't say I wouldn't say it's mostly in the lateral hamstring, I'd say it's more lateral quad and IT band, and as it tapers down to the knee. So it's like mid-thigh and then tapers down to about three inches above the knee. Does that make sense?

SPEAKER_01 14:40

Yeah, is it underneath the IT band or is more lateral, you said?

SPEAKER_00 14:45

Um so if you are looking at feet this way, hips this way, right? Here's feet, it is like three quarters, it's IT band and three quarters above superior if you're laying down prone. Uh so more quad and IT band, that's 75%, 25% hamstring. So it's it's not quite like midway in the leg, it's more lateral quad, I would say. So I've seen like a calcification lateral quad. That's what I initially I was like, oh, this is gonna be hard. Yeah. Squish, like like a you know, memory foam or something. Yeah.

SPEAKER_01 15:23

Um but it doesn't seem like where the bursa would be underneath the IT band.

SPEAKER_00 15:31

Negative.

SPEAKER_01 15:32

It's lower, right? Yeah. Yeah. Um and it doesn't sound like a lipoma. That's way too big for a lipoma.

SPEAKER_00 15:41

Way too big. Like, yeah, approximately if I divide it into like, you know, the mass into 50%, it's like half of it is kind of lumpy of like some tissue type, but not a specific, it doesn't feel tendinous, doesn't feel muscular, it doesn't feel like it's just adipose, you know. It's uh which to people listening that probably sounds weird, but yeah.

SPEAKER_01 16:03

When they did the last MRI, did it show anything?

SPEAKER_00 16:07

Nothing unremarkable. He said uh that the surgeon said the lump is normal, that's just what happens when you remove part of the IT band. Sometimes it you know, I said, Well, it's not like an Achilles where it rolls up and bands, you know, like the the IT band, even if they s snipped it and took it completely, they would have to like attach it to where they cut it in both parts, right? And they didn't take the whole IT band, they just took if the IT band is like uh you know, like a dollar bill or something, they took half the dollar bill, right? So it's not totally cut through.

SPEAKER_01 16:45

Um so since we don't know exactly what the so I would do more imaging at some point um just to see what kind of material it was. Um can it can it be drained? Um then I would do ultrasound, a diagnostic ultrasound, somebody that's trained in that to see the biggest reason I'm saying that is just to see what kind of fluid it is, um because the treatments I've seen that help for stuff like that. I've had a couple cases that are similar, not as big. I mean, that's pretty big, even if it was half of what you said, that's still pretty big, right? Yeah, um so and not like a normal lipoma or um, like you said, uh um calcification after dropping a bar or something. But um uh the things I've seen that help, um one, um ultrasounding the area, using like uh um uh the ultrasound wave to free up any tissue underlying that might be sticking. So I've used an ultrasound on that area. I've also used um um shockwave. I've done a recent case almost similar um to uh that has helped that. Um and then the third one I've seen help with other soft tissue things like lipomas and lymphatics is the hyperbaric has helped with that after a few sessions. It's really um seen inside out type thing to get the inflammation to drop with the tissue. So um those are the three things I've seen. Uh obviously, you're doing cupping and I mean I'm assuming cupping to do the distraction and trying to free that up, and uh um kinesio tape doing the star pattern of kinesio tape where it will suck it up um and uh create this kind of lift. Um that's what I would do where we rip it in the middle, pull real tight, put it right over, and then do like three to five more pieces and just form this like um cup that sticks to them, you know.

SPEAKER_00 18:43

And you put it on pretty tight too, right? Like you're you're gonna be able to do that.

SPEAKER_01 18:45

So if I do with that cupping one, I'll do like maximum tension and place it right over, and then I'll go at an angle and at an angle, and sometimes I'll do a couple more, but yeah, maximum stretch for that one. Um I know I know uh rock tape is saying for most conditions the stretch isn't as important anymore like we were originally taught, um, but this is a different type of um uh uh treatment or technique. So we're trying to leave it on there. The other thing um I would be tak I would uh from internal out is bromolane. Um I would supplement with bromolane because bromolane is a proteolytic enzyme that breaks down protein bonds, and I would have them take it away from meal. It's a natural anti-inflammatory, but it also, like I said, breaks up that um uh protein bond. So if if there is some extra protein bonds that are not needed creating this pocket of fluid, if we can soften those up almost like marinating a steak, it's the same kind of enzymes you use. So um that's another, and I usually like my patients to take it at nighttime um because I pictured if it's scavenging those protein bonds, why not at rest when we're just kind of you know recovering, anyways, let it go in there, free it up, and then I take my omegas in the morning for stuff like that. And then there's some topical transdermal creams too that um I would typically have rub on that area to help with microcirculation, like an L-arginine, citrulline um type transdermal um uh cream that goes right in at the source.

SPEAKER_00 20:27

Dude, those are all great things. So I'm glad we have these discussions for two reasons. One, um for people to hear how we're thinking when we're approaching a case, you know, because I've had a couple people in the last month who asked me casually about something, and then just like you know, you're having a conversation, getting to know somebody if you're on a date or you're meeting somebody new, it's just kind of the same thing. You have a lot of questions, you know, and so uh for people to hear kind of how we're assessing that I think is important. And then, you know, for me clinically, the two things that you hit on that hadn't yet occurred to me was using rock tape in the star formation versus um I do sometimes like a little bit of a different technique where I almost like web it by cutting the strand, uh, you know, putting like two cuts so it has like four things and you can kind of web it more like a like an edema dispersement type of situation, you know. Um that's a good one.

SPEAKER_01 21:27

Like we use an octopus for the player people listening, it kind of looks like an octopus, and you bring the finger-like projections down to the area and you put the patch up by the lymph at the lymph node and you draw it towards the lymph. It's a great so yeah, I would have done I totally forgot about that one too.

SPEAKER_00 21:44

So no, it's great. And even like the bromaline, I was thinking of a few other supplements that I recommended, and just on my drive was thinking about him. Um and so I'll make a mental note of that and bring that up. But yeah, so we're along the same path. Sometimes We have these conversations and there's just something that I hadn't thought of where you'll bring it up, or maybe vice versa. Just a different angle, you know, and um it's also nice to have some things reinforced. Like, okay, there's like I said, certain things just have a course, like you're not gonna heal a broken bone in one week. That just takes time, and so this is a thing that's been around for years, and I know we can enact some positive change, improvement, and so that's where we'll start, you know? Yeah, aka the low-hanging fruit. Let's get that, let's squeeze what juice we can out of there. In this case, it might be edema in lymph, so maybe figuratively or literally, but like yeah, the like lymph node um and lymphatic system was something that I had questions on and that we're going to address every time. And you know, I guess my takeaway on it, Dustin, is that it's interesting oftentimes how frequently we'll have a procedure, people will have a procedure, or have something medical happen. And they know that it's not a hundred percent, you know? But because somebody said, like, hey, this is the best you're gonna get, or this is the cap, you just kind of accept it. Like, I have a few family members that had knee replacements, they're kind of gimpy and limpy, and I'm like, hey, what's going on? Like, what's up with the PT? Well, that you know, that's hey, that's kind of just what it is. It's like, no, that's not you don't have to be the average when average is trash, like you can actually be elevated, and for a lot of things you can be back to a hundred percent. So no, nothing on uh this young kid or his dad who's super nice and you know, really interested in trying to resolve it. It's just they've gone down other avenues, traditional, like the surgeon said it's normal, the PT did PT, he's good and strong, he has full range of motion, so like you know, but I'm like, do you like that? Like, do you want to try to get all things being equal? Do you want to get rid of that? Like, should we try to, you know? Yeah.

SPEAKER_01 24:10

So well, I bet if you had a conversation with his ortho, or you called him up and let's say in a perfect world, you you, as the other doctor, call up the ortho and say, hey, you know, I I know you I know this is what you said and what you did, but this was eight years ago. Would you expect this to still be here eight years? I guarantee you he'd be like, no, not at all. You know, I was just talking about after the first year or two, maybe three years, it might be lingering, but it should be out by now. That's interesting. You know, and then you know, but these patients get stuck in the pattern, like you're saying, because they they hold it as gospel that that's what they said, and is what it is.

SPEAKER_00 24:49

I mean, always get a second opinion, always at least get a second opinion, you know, like no plug for our podcast, but it's so important to and now with AI, like you know, people were like googling medications and stuff, like don't do that anymore. Like use AI and also like still follow up and check the resources, you know, like how you ask and what you ask. But my point is that there's a lot of information out there, and you can also use AI to help you find human resources. I don't just mean use AI to be like, what can I do? Is this lump always gonna be here? And you take a picture and you know your prompts are trash and it gives you trash information. Like, go and find some specialists, go and find somebody else who's had the same things as you and ask them who they saw, right? So that's what I encourage more than anything because not that we have all the answers, but that's not it at all. We work collaboratively with all uh medical specialties, and that was kind of my point to him was let's let's give it a good run. This is my expectation, this is what I see, this is my experience, this is my timeline, it and if we don't make the progress that we want to, then we need to figure out where I can get you to, whether that's acupuncture or uh lymphatic specialists, or go back to your ortho, or like I'm now a part of your team, you know, like we're gonna figure it out.

SPEAKER_01 26:19

Yeah.

SPEAKER_00 26:20

And once I know you work that way too.

SPEAKER_01 26:22

Yeah, exactly. And you you said a couple things that uh trigger some things in my head, but once this gets you see a change happening, one thing that they can do, two things that they can do on their own, two um mini trampoline type work to help with lymphatics, you know, so that opens up things like the little rebounders, you know. And if he doesn't have one of those, he can just oscillate, you know. It's kind of fun to show in the office because they it looks goofy and the teenagers think you're being funny, but you just show them kind of you know, I went to one seminar, the guy actually invented a whole technique, called it bobology, and basically just bobbing all around. It was a very interesting seminar. You can imagine everybody just shaking around and bobbling around, but he had a lot of research to back it up, so it was pretty interesting. So um that the rebounder, but another thing that a lot of the athletes like uh are the voodoo straps or the voodoo wraps and uh rock tape uh rock tape has a good one, um rock floss, um, so the blood flow restriction uh technique um that might be a cool one that he can do, wrap that quad from you know distal to proximal, do a few squats, do whatever he does, and to see if that also as you're freeing it up, that might be a good technique I just thought of too.

SPEAKER_00 27:38

No, that's great. I I'm I'm really encouraged because there's uh half a dozen things that we're going to do over the next six treatments, and we're gonna just see how his body responds and adapt accordingly. Uh if you ask me in four more treatments where we'll be, I know the direction. We're not going east, we're going west. But where exactly we'll end up, I'm not sure. We're gonna adapt and you know do what's best, and um I like that approach, and yeah, I'll definitely report back and let you know what we're finding. I'm using PEMF on them, I'm using the ARP wave, soft tissue work, like cupping, like you said, and um and we're monitoring, we're giving them rest and kind of seeing how it responds.

SPEAKER_01 28:21

And so yeah, and during the treatment not to cut you off, but during the treatment plan, I like to remind the patient, especially kids and their parents there, is listen, you know, this is our goal, this is what we're working on. We're gonna restore the function, things should start improving. But you also got to remember that that's been there for eight plus years or whatever, or not even that, whatever the timeline, whatever the timeline is, it's there for a reason. The body doesn't just do random stuff just because there's a reason that that had formed due to some kind of so for the body just to give it up, uh you know, just because we're asking it to, that's not the norm. You know, that's not how the body works. So we have to re-educate the body that hey, why whatever reason you have this going on right now, um, we're recognizing it, you don't need it anymore. Let's help you get rid of it and not need to have whatever why whatever it's there, let us restore that function so it doesn't need to be there.

SPEAKER_00 29:17

No, well put for sure. I like that. Well, I'll uh keep you in the loop on you know how things progress with that. I do want to touch on just one two quick little topics before we jump off. Um because I think you'll find it interesting having daughters. I read a study this week and it said that female, especially teenager female athletes in particular, have a two to eight times higher incidence of ACL injury than male counterparts. And I knew it was higher in females, you know, maybe hormonally, maybe you know, strength and muscle. Did you know that fact? And what are your thoughts on that real quick?

SPEAKER_01 30:02

Yeah, um, years ago when my daughter was playing a lot more soccer, I was asked to come talk to the one of the clubs and um lecture on that whole point to the the club directors and to the parents and everything. So what I found with that, and the reason there's a there's a number of reasons, but the main reasons you touched upon one of them, the hormonal um changes. So definitely in that age group, you know, 13 and on, or 12 and on, depending on you know where they're starting their menstrual cycle. The hormones are basically when they increase like that or change, they're changing the one of them causes the ligaments to be a little looser, a little more lax um by design. And when inflammatory levels go up too during the hormonal fluxes, we know that inflammation leads to instability and loss of function as well. So just having that going on during that time, they're more susceptible. But anatomically, um the two things that were discovered in a lot of the research was the hip-to-knee ratio, which we call a Q angle. It the wider and the more um angle angulated that Q angle is, the higher incidence, and it women have wider hips, so their Q angle is greater, so the Q angle has a correlation to ACL injuries, and then also um inside the knee um where the ACL and the PCL cross, there's two little ridges. If you look at a knee on the tibia, there's two little like ridges um on that plateau, and um and that also is different in females, leading to more of a like a cutting edge, so they're more susceptible as well on that. So those are like three two well, basically all three they can't change, you know. You can't change any of those, but what you can do is if it is during your you know, if you're playing and it's that time of month, just be more susceptible, maybe put on a knee sleeve or knee or something, or change your training patterns up a little, not as ballistic or not as much cutting that day. Just be aware of it. Yeah, if you're playing a game, it is what it is. You definitely can't change the cue angle. So if you are a player with wider hips to narrower knee ratio, then what you really want to do is get in with a good uh prehab strength and conditioning program to learn uh injury prevention type exercises to build up all the structures around it to give you a fighting chance. So um because again, you can't and the internal uh mechanism you definitely can't do anything about. So again, it's all about um learning learning it and then um preparing yourself as best as possible with strength and doing ballistic moves, ballistic training, um, instability work, um, work on your proprioception. So the because every joint has proprioceptors, and if if the proprioceptors are off a little, when you do change of direction or whatever, and if it's an uneven surface or you step on somebody's leg, if you haven't trained that proprioception, there it's gonna fail a lot easier, and then the ligaments are more susceptible. So, so a lot of balance training, a lot of proprioceptor training, and um change of direction and uh plyo type stuff, so ballistic type stuff. Yeah, anyways, we could go on and on.

SPEAKER_00 33:28

No, no, that's I love that. That's great information, actually, and I like the technical you know explanation on it, even down to the condyles and the you know how it affects the ligaments. Um my takeaway, which you hit on, was just that it's perhaps more important for female athletes to get that prehab work because the takeaway for any listeners really is that you can do something about it. It's not just like, oh, if you're a female athlete, you're gonna blow your ACL at some point in time. No. If you know that uh I would get assessed, and if you have you know a higher probability or propensity to put more pressure on certain structures, yo, you can you can improve that for sure, you know, through body work, through strength training, through all the things that you mentioned. So um I'm glad that you brought that up because it's it is about prevention, it's easier to really figure out what a weakness is and try to improve that. That's a way shorter road than having something blow or pull and then trying to one make it pain-free, two, make it functional, and then strengthen it on top of it. It's really triple the work, you know.

SPEAKER_01 34:40

Yeah, and that um uh that kind of um what you just said was having the knowledge, knowing what to do with it, kind of leads us up into some topics that we're gonna touch upon in the future too. So to give a little teaser to our um audience, but talking about biometrics and in and and studying the biometrics of different things for recovery and for performance care is uh one of the topics we're gonna be talking about, what that looks like um and and um how to apply it.

SPEAKER_00 35:11

So yeah, that's perfect with the things that we talked about that are on the schedule because I know you're gonna bring uh uh some good insight to those things, and a lot of them actually are super interesting. Like I really want to have uh just a genuine conversation with you about some of these topics that are emerging in 2026, whether it's with new sports med tech or whether it's with AI or whether it's just studies that have reinforced things that you and I have known for a couple decades about prevention or about you know things like red light, you know. So um, anyways, I got a few superstar athletes that are waiting here to be treated. So I'm gonna run, Dustin. What uh what's on your agenda for Saturday?

SPEAKER_01 35:56

Uh more stuff like this, just uh prepping and uh getting ready for our next couple weeks of doing this. I'm gonna take advantage of that, and um, yeah, that's uh and then putts around the house, play with the dog, that kind of stuff.

SPEAKER_00 36:11

Yeah, that's great, dude. Nice. Well I'll hit you up on uh on the way home. Let's catch up about some work stuff and some life stuff, and um we'll tap in here at our next episode soon. But we have a lot of exciting things to uh hint on in the future, and I will leave it at that for the moment, you know. But I'm excited for the next few weeks with for us and the conversations that we're gonna have. And um yeah, I appreciate you carving out time.

SPEAKER_01 36:43

Yeah, you too. Thank you, brother.

SPEAKER_00 36:46

Of course, anytime. But to our listeners, we appreciate you. Uh this is Second Opinion, we're a sports medicine podcast. I'm Dr. Dokal. I'm Doctor Glass. And we will catch up with you guys soon. You guys be safe. If you have any questions or anything you want us to cover, leave a comment. And uh if you found something interesting, we are trying to grow our audience, so feel free to share that with uh anybody else who's like minded about sports health or wellness. We