Inside Youth Gymnastics: Load, Snapping Hips, And Smarter Recovery with Dr. Kayla Keck DC

Hip pain doesn’t usually arrive in gymnastics with a dramatic fall. It creeps in through invisible volume, deep-range demands, and recovery that can’t keep up. We brought back clinician and former gymnast Kayla Keck to unpack why youth gymnasts develop overuse hip pain and how to fix it without guesswork or gimmicks.

We start by challenging the labels—hip flexor tendinitis, glute med tendinopathy, labral issues, and the umbrella of snapping hip syndrome—and shift focus to causes. Kayla explains how “warm-up” reps often outnumber routines, why repetition is both a performance need and an injury driver, and how to use a simple rule: keep your healing rate just ahead of your injury rate. Expect practical tactics you can use today: logging onset thresholds, capping reps before symptoms spike, and celebrating can-do lists that build momentum instead of fear.

Snapping hip gets a clear, no-drama breakdown. Pain-free popping is often benign; true catching, painful clicks, or getting “stuck” may need imaging. Most athletes can change their symptoms by changing mechanics. Kayla shares core-first drills that stop the low back from stealing hip motion, end-range strength work that stabilizes big split and kick positions, and posterior chain strategies that take pressure off the front of the hip. We also get honest about what makes progress stick: longer one-on-one sessions for precise coaching, cutting two-a-days during flares, and prioritizing sleep and fueling so recovery can finally win.

There’s a deeper layer too—identity beyond the gym. Encouraging small joys outside training lightens mental load and often improves performance. If you’re a coach, parent, or gymnast chasing healthy, durable hips through meet season, this conversation delivers a map: track the load, train the core, own end ranges, and move forward on purpose. If this resonated, subscribe, share with your team, and leave a quick review so more athletes can find it.

you can find Dr. Kayla Keck DC on her website: 

https://p10rp.com/

Instagram: 

@p10rp or @drkaylakeck

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Transcript

Welcome And Topic Setup

SPEAKER_00 0:00

Hello, everyone, and welcome to the Art of Prevention podcast. And now for round two, I have coming back to the podcast Kayla Keck, who is based out of Dallas, Texas, or the area around Dallas. And today we're going to be talking about a very special topic, which is hip pain in gymnasts. Kayla specializes in treating gymnasts as well as other youth sport athletes. And I'm really excited to pick her brain. So, Kayla, just for everybody who hasn't listened to the first podcast, can you tell us a little bit more about yourself, where you're at, your practice, et cetera?

SPEAKER_01 0:47

Yeah, uh, thanks for having me first. So excited to be here again. Um, yes, I'm Kayla Keck. I have a practice in McKinney, Texas, so just north of the city. Um, and it's called Perfect Tenry Happen Performance, and I'm specializing in gymnasts, dancers, um, but also all other youth sports as well. Um, I was a gymnast myself, followed my passion of being injured myself into helping these um men and women get to where I think that we can be. Um and yeah, super excited to be here and talk about one of my favorite things.

SPEAKER_00 1:20

Uh which is hip pain, right? No, I'm just talking about gymnasts and how we can we can help these individuals out because they do so much. Um, so tell me a little bit more about your experiences in treating hip pain and gymnasts. Why is this such a prevalent thing? Because I had good results with one gymnast in the area, and then their coach reached out to me and they're like, hey, we need some more of this information. And so when they said that, we lined up a workshop so we can give some information, and you were top of mind of somebody I needed to reach out to to pick your brain to really just learn more selfishly from myself so I can give this information to my patients.

Why Hip Pain Is So Common

SPEAKER_01 1:59

Awesome. Well, thanks for thinking of me. Um, I think the biggest thing with hips and gymnasts is we're not seeing a lot of, and this doesn't mean never, but we're not seeing a lot of acute injuries in the hips. It's a lot more of the overuse type of pains that you're gonna see in the hips, and this is solely due to the movements that are required by gymnasts and the weird positions that they're putting themselves in under momentum, under, you know, these massive ranges of motion that are required from the hips, and they're doing a lot of them. Um, so we kind of talked about this, but there's like split jumps, there's leaping, there's aerials, there's all these things, and they all require a lot from the hips and a lot of different deep ranges of motion. Um so put all those things together with the amount of things that they're doing, so numbers-wise, right? Um, their volume of skills, it's a lot. Um, so put all that all of that together, and it's the perfect recipe for what we would consider an overuse injury. So we're definitely seeing more on the overuse injury side of things than we are seeing like an acute hip pain on a gymnast, which doesn't mean it's never, but um, I would say, you know, a higher percentage of the time we're working with a gymnast who's probably had some type of finicky hip go hip thing going on for a while, and it just kind of comes to a head. Maybe they started increasing their numbers, maybe we're at a different part of the season, and now the hip is just like, okay, we've we've had enough. And so that's usually when I see them is like, okay, we've probably had this all summer, but now we're increasing our numbers, it's it's time to compete, we're putting routines together, and the volume just becomes too much. Um, so that's my experience with hips most of the time. Um, and then sprinkle in a couple weirdos, you know, weirdo cases here and there, but yeah.

SPEAKER_00 3:43

Yeah, I feel like one of the reasons that they reach out oftentimes is they notice that they have to keep modifying things. And it's like, you know, one of the things that my clients would tell me is I wasn't able to do perform this movement anymore. And after a competition, I would be really sore. The thing the other thing is these these athletes are just so incredibly tough, and they're so durable, but training 10, 15 or more hours per week, and you also have the rigors of like being a teenager, usually. And it's like you've got school, you've got social activities, things like that. You're maybe not getting enough sleep, partially because the school schedule is so wonky, maybe you're coaching on the side, all these different things. It's like sleep gets interrupted, and that just really is a recipe for develop these longer overuse style injuries versus the acute, which is like, oh, you fell on your hip and now your hip hurts.

unknown 4:39

Right.

SPEAKER_00 4:40

Absolutely. So what are some of the common diagnoses that you see when somebody presents to your office? Because oftentimes by the time somebody comes to see myself or you, they've been to traditional PT, they've been to the ortho, they've been to their primary care physician, and they've gotten like a label, but like I'll have people come in, they're like, oh yeah, they've told us like these labels and these diagnoses, but we don't know what's going on. We still have a ton of unanswered questions.

Labels vs Causes Of Pain

SPEAKER_01 5:08

Yeah. I'll hear a lot of like tendinitis. So they'll say, I have a glute medius tendinitis, or a you know, hip a very umbrella hip flexor tendinitis, or maybe they're more specific with the psoas or with the rec femme, or you know, you might hear like hip pointer pain or something like that. Um, or you know, the more actual diagnosis of maybe we have a labral tear or labral pathology or something like that. Um, because yes, I I also like when I am I'm the one that they're coming to see after they've kind of exhausted other things, you know? Um, and they'll see that a lot. They'll they'll go to the ortho and they'll get these diagnoses, but then they don't really get any direction on on what to do after that. You know, they're like, okay, cool. Like I now have been labeled with this, let's just say as the labor tear. I now have a labor tear. Um, okay, what do I do from here? You know? Um, and maybe they've done a round of traditional PT and like it mark, you know, it gets a little bit better, but nothing super marginal, and they go back into their gymnastics and it's it's hurting again. Um, but they still were labeled with whatever diagnosis they have. And so they they come to me and they're like, what do I do? You know? Um, yeah, so I I think the biggest thing is I see just these like really generalized diagnoses. Um, yeah.

SPEAKER_00 6:28

And what would you say are some of the causes of this hip? Because people get the labels, they get the diagnoses, you know, hip snapping syndrome, you've got a labral tear, you've got a hip pointer, etc. But then it's like, but why is it there? And that like and that seems to be the thing that's not addressed. And I know that this is a tough thing, and I and I don't mean to like you know paint you into a corner and say, like, why is it there? Okay, but yeah, from our best guess, like and from your experience, like why is this there and why is it so prevalent in gymnasts?

SPEAKER_01 7:01

Load management and volume management.

SPEAKER_00 7:07

Okay, expand, expand, yeah.

The Load Management Problem

SPEAKER_01 7:10

So gymnasts are notorious for you. They're tough as nails. Um, they push past their limits every single time, right? When they come into our office and they tell you I'm in five out of ten pain, they mean 15 out of 10, right? And they've probably been in that pain for a really long time. Um, so what happens, and and this just comes with the nature of gymnastics, and it's been this way since I was a gymnast 100 years ago, but you have a hard time, you don't want to be hurt, right? Injury in gymnastics specifically is is unfortunately seen as a weakness, right? You don't want to be the gymnast that, you know, is in it's meat season and you can't compete because you're injured, or you know, you really want to be doing this thing, but you can't because you're injured. So they will push through and try to power through, you know, they'll do all of the passive things you can think of, ice, heat, rub some dirt on it, put some icy hot tape, all the things. They'll do all of this, um, but they're not actually getting to the the root cause of the issue, right? They're not fixing why this is happening. Um, and a lot of that comes with load management. Um, we kind of talked about this in the last podcast, I think, but gymnasts, gymnastics coaches and gymnasts are are some of the best in the world at their sport-specific conditioning, right? They are really good at matching their conditioning to what they're doing. The issue with that is there's no cross-training at all, right? There's it's it's sort of frowned upon to do anything else when you're a gymnast. Like all you do is gymnastics and like you get everything done in the gym, and that's all you have time for, right? And then really, I'll I'll come back to this, but really that is all they have time for because a lot of these gymnasts that I'm seeing are in the gym like 25 to 30 hours a week and sometimes more than that in competition season. And so it's like for me to be like, hey, you need to be, you know, we need to really be working on load management. We need to be, you know, increasing your strength and we need to be adding some strength training and stuff like that, it's like where, you know, and how is that going to be beneficial when they're already doing these million hours in the gym, you know? Um, but unfortunately, if we don't prioritize load management and really strategizing their volume, um we get to the point where we have to pull away so much that we then do have time to add these, you know, implement these things in, which is of course not where we ever want to get to. We want to be able to kind of do these things in a nice relationship where we don't have to stop one thing to do the other. Um, but because these gymnasts are tough as nails, they wait a long time, especially when they're things like this, or it's like it's really an overuse injury, right? It's just too much. We have completely surpassed the integrity of the tissues, and we are just like our rate of injury is way higher than the rate of healing, no matter what we do, you know. Um I forgot what your question was. I started rambling.

SPEAKER_00 10:18

The I think the question was more just why is it there?

SPEAKER_01 10:20

Oh, yeah. Okay, so yeah, I mean, my my number one thing there is literally just like a load management strategy and like really figuring out volume, which is so hard to do, right? Like something because I'm fortunate enough to have some great relationships with coaches, and the issue that you know we run into is like when I have somebody who's injured, and then we're working our way back into you know, regular we're we're in our nice little return to play, return to sport, right? Um, this is what we run into is like, especially if we're in the midst of competition season, like something that's super important for gymnasts is repetition, right? Like you get comfortable on the beam because you did it a million times, right? You can do it in your sleep, you've done those skills over and over and over again. But then on the flip side of that, when we are in that injury zone where we're trying to, we're in the reloading process, we run into this issue where it's like maybe they're not ready to compete now because they've had to limit their numbers. I say limit your numbers during competition season like four million times a day. Like, please limit your numbers. I will go so far to like sit down with pen and paper and write down exactly what they should be doing on each event, right? Because what happens is if they're going, let's I'm gonna use Beam as an example. You go to Beam during practice, you have a warm-up, right? Whatever that is, it's gonna be different for every level, every gymnast, but you have a warm-up, and then you have like skill-specific warm-ups, and then you have, you know, break like skills, so you have to like break down each skill in the routine and you do those, and then you might have routines. So maybe you only did three routines, but how many repetitions did you do leading up to those three routines? Right. So it's it's like and that doesn't like register to a gymnast in like how much they're actually doing because everything before those three routines was just a warm-up. Right. But when you're looking at when you're looking at it from a a a volume control, that's a lot. You know, you have this gymnast who's who's coming back, they're they're we're really focusing on the management of their return and figuring out how they can return for a long time rather than just like for the next week. And they're doing 150 reps on one event, you know, and it's like maybe that was a lot, but you know what I'm saying? It's just like they don't realize how much they're doing because to them, until they're doing the actual routine, nothing else counts, right? Like another great example of that is like vaulting, like that's so much on your body. Like you're sprinting down the runway, you have to pound on a springboard, then you pound through your wrists and your shoulders, and you have all of these progressions to warm up before you even do the actual skill that you're trying to get to. So you might only do five vaults, but how many things did you do before that? You know, and that goes on every event. Every, I mean, do the same thing with floor. You warm up and then you, you know, split yourself into just skills and then you do routines. So when I ask, like, how many did you do? They'll say like three. And I'm like, okay, well, like, what did your warm-up look like? Right? Like, how many of this skill, maybe that, you know, let's just say on floor, their double back really hurts. Okay, like, well, how many times did you actually do that today? You know? Um, so we're just having a very severe load management issue, right? Like our volume, really, just in gymnastics in general, our rate of injury is always going to be there, right? Like the movements that the gymnasts are doing are not without injury, right? Like there is injury happening in every single one of those movements. What we hope happens is that the rate of healing in their body, whether that's just from normal recovery things like sleep, you know, days off, rest, which we know is that those things aren't happening, um, nutrition, those types of things, um, we hope that that allows our recovery and our rate of healing to stay higher than our rate of injury. I use this concept a lot of like comparing our rate of healing to our rate of injury. Um and it helps because it's like a nice visual that that they can see. And I'll use this a lot when like I have somebody who is improving, and then they might get a little bit ahead of themselves and they'll start like way going back into the gym, like they may have been doing pre-injury, and then they come back and see me and they're like, it's hurting again.

SPEAKER_00 14:44

And I'm like, right?

SPEAKER_01 14:46

Right, right. And so we back it up, and I'm like, what did you do at practice today? And a lot of times they're like, Well, I did everything, you know, without any restrictions. I didn't think because it felt good, you know. Well, then after they're like, it hurts again. Well, yes, it does, because I I use the analogy. We have rate of injury and we have rate of healing. We want rate of healing to always be a little bit higher than our rate of injury, right? In gymnastics all the time, our rate of injury ends up being up here, and our rate of healing is just like trying and trying, trying to get up to our rate of of injury. Um but a lot of times when we're living in this world where it's like, it feels good, so I'm just gonna go back. It feels good, so I'm just gonna go back. It's like we let the rate of healing get right underneath the rate of injury, and then we like go full throttle, and then the rate of healing drops, right? Or the rate of injury goes up. Either way, we're just we're separating those two. When those two need to play this like really balanced game, um, I feel like that's a good like thing to explain to them because then they can see like, okay, that's why it hurts again, right? I like totally went off the rails. I wasn't paying attention to, you know, I wasn't listening to my body. Um, because something I'll say a lot is like, if we're in that process of like feeling good and going back into gymnastics, that doesn't mean rip the band-aid off. That means like really, really follow our loading rules, really follow our volume rules, keep limiting our numbers. Even if you did three and it's not hurting, don't do four, right? Keep it at three. Maybe you know, maybe next time we add a fourth, but it's so easy for them to be like, oh, I've been injured, but now I'm feeling good. So I'm just like, I'm good.

SPEAKER_02 16:25

Yeah.

SPEAKER_01 16:26

The other thing that happens is like, I'm sure that you see this a lot too, is like we will get to like 90% better, and they'll stop doing their homework, they'll stop coming in, you know, they just completely abandon the things that got them to 90%, and then I'll see them in a month, and they're like, it's bad again. And I'm like, hmm, interesting.

SPEAKER_00 16:49

How has the homework been going, by the way?

SPEAKER_01 16:51

Yeah, what have you been doing? Just everything? Great.

SPEAKER_00 16:55

I've been practicing.

SPEAKER_01 16:56

Yeah, okay, correct.

SPEAKER_00 16:58

Yeah. If we could dive into tactics for a second with load management, this is something that I deal with climbers all the time because climbing is just like I go and I hang out with my buddies and I'm trying stuff, and now my finger hurts. It's like, okay, how many tries do you and they're like, I don't know. It's like, how long were you out there? Six hours? Okay. So were you rapid firing off of like eight different projects that are totally at your limit? So tactically, how do you have them track and manage their load? It's extremely hard. That's good.

SPEAKER_01 17:33

Um, I would say, as a whole, this is a whole, right? Like um, I'm not great at this because it's different gym to gym, gymnast to gymnast, level to level, week to week, month to month, season to season. Like there's so many nuances and oh no, can you see me?

SPEAKER_00 17:59

I can still see you.

Counting Reps That Don’t Count

SPEAKER_01 18:00

Okay. I might have to run and grab my charger. I just got a 10%. Um, but there's just so much differentiation from you know, gym to gym, gymnast to gymnast, coach to coach. It's super hard to just have one way to manage load, right? I think I do better when like when I'm working individually with each athlete, right? Because you can really break down, and that's that's what I was saying. I I really do this when I'm when somebody comes in and they're hurt, and now we're, you know, on the mend and we're really working on that return to to sport. I will map it for them. We will have a powow and we will talk about these are the things that I want you to be doing. And I want you to keep like a journal, right? I want you to tell me how you felt during these things. Um, and it's really case by case on you know what I can do, pretending I'm a gymnast. What I can do might be different than what you could do, you know? And so just keeping that and kind of having n equals one there and like really figuring out what works for each gymnast, I think is really, really, really important. I was gonna say something and it was really important, it slipped out of my head.

SPEAKER_00 19:09

It'll come to me. Oh no, I I I agree with the like, especially keeping a journal. It's like first thing we need to do is we need to just start tracking and figure out when do you have onset of discomfort, you know, because if you get onset at 10 repetitions of vault or 10 repetitions of loading your shoulder in an overhead position, then what if we do eight? Yes. And we get away with that for a while, we get some small victories, get you to do vault without pain. You know, in other sports like like track, it's almost easy because they've really got it written out, you know. It's like, oh yeah, I went to practice and I did this, this, this, and this, and then I went to weights and I did this, this, and this. Uh, not that I'm speaking from experience with the Patelotinopathy case from that high jumper that I've got right now, but it was like, oh, it was like with that. Like they've got their whole plan for the day written out, and I was like, and then it's so easy to just say it was this.

SPEAKER_01 20:06

Right.

SPEAKER_00 20:06

If you hadn't done this, I would bet you a hundred bucks that you wouldn't have had this flare up in your symptoms. And then we go to the next week, they've got everything written out. It's like, don't do this one portion of it, and then lo and behold, things improve.

SPEAKER_01 20:22

Absolutely. I remember what I was gonna say, and I again I think we maybe touched on this the last time we talked, but in a gymnast specifically talking more about what they can do is important. Um and ignoring like the language of you can't do this, right? Um I found that to be super helpful. And you kind of talked about earlier, um, you know, how have I changed my treatment from when I first started to now? And it's it's in my language a lot, right? In my communication with them. Um, and what I found is their response to things they can do, it's the same thing, right? But to them, if we write down these are the things you can do, instead of saying you can't do this, you can't do this, make sure you're sitting out of this, don't do this, that's like discouraging and completely just tears them down, right? But like you said, if we can celebrate the small victories and be like, look how much you did, that's exciting to them, right? Then they're they're bought in. They're like, okay, whoa, I'm I'm doing it, you know, we're improving. Um, and also that's really helpful if we are, you know, taking note of all that. Um, it's really helpful for them to look back at and be like, no, I did do things this week, you know. They're it it maybe I'm not compute, you know, at my full potential, whatever, but I was able to do XYZ without any pain at all, right? Where before I couldn't do anything. So I think it's just important in the way that you speak to them um to just make sure it's like more of a can do rather than a these are the things you can't do, you know.

SPEAKER_00 22:58

Yeah, I think especially in the midst of a treatment plan, a lot of people will frame this as gap versus gain. It's like look at how much function we've gained and how much symptom relief we've gained over the last few weeks versus the gap between where you're at right now and like where you want to be. It's like we need to focus on what you've gained and then get more gains versus just getting frustrated, going out and just trying to have a quote unquote normal gym session and then flaring up your symptoms because then we're gonna lose some of that gain. We're gonna do two steps forward, one step back instead of just plodding along, getting one step forward each and every day.

SPEAKER_01 23:36

Yes.

SPEAKER_00 23:38

Um, the other thing I'd love to chat about is the snapping hip syndrome. Yeah. So that is something that I've seen in my clinic. I know that you've seen it a ton. Um, and I've had clients come in and they're like, they they told us we've got snapping hip. And it's like, duh, it snaps when they're moving their hip around. What is going on? So, Kayla, what is going on with snapping hip syndrome?

SPEAKER_01 24:01

I think that there's uh the answer is who knows, right? I'm actually gonna pull up um, I want to ask ChatGPT, yeah. What the definition of snapping hip syndrome is because I know it's gonna give us this umbrella. Let's see. It says oh, sometimes called dancer's hip. Didn't know that.

SPEAKER_02 24:22

Oh, cool.

SPEAKER_01 24:23

Um, a condition where you feel or hear a snapping or popping sensation around the hip during movement.

SPEAKER_00 24:30

Right.

SPEAKER_01 24:31

Awesome. Um, I think this is also honestly, I hate I hate that. That's so dumb, right? Like a thank you, obvious.

SPEAKER_00 24:39

I'm so afraid Chat GPT is gonna replace us, you know? It's right.

Healing Rate vs Injury Rate

SPEAKER_01 24:43

Uh this is definitely a good reason not to replace us. Um so I think, you know, with any syndrome, um, they take an umbrella of symptoms, and in this case, it's all you have to have is snapping in your hip. Um, and then you have snapping hip syndrome. Okay. Um I think the issue with that just becomes like you've now labeled yourself that you have something wrong with you. Um when really, uh to be honest, my hip still snaps, and I'm 30 and I am not a gymnast and it doesn't bother me at all, right? Like it's it's it can be completely normal, right? Um, but I think what's important is figuring out why is it doing that and what can we do to make sure that it doesn't cause injury or further injury. Um, and how can we keep performing at our full potential without letting whatever is happening um hinder that, right? Um I think there's a couple different like common things that we can put under snapping him syndrome. Um the number one thing I think you'll you'll hear is like it might be the ileosoas tendon sort of you know flipping over as they go from flexion to extension. Um just a hip flexor, tendonitis in general, having a tight hip flexor, those types of things. Um I think that's what you're gonna hear the most, most likely. Um I was just trying to see if there's anything else in here. Um the other things that kind of fall under this syndrome, I suppose, would be, you know, labral pathology of some sort. Do we have some type of tear there? Do we have a loose body in the joint? Is that what we're snapping over? Um I think what's the most important thing to do when they come in with the snapping hip syndrome is to figure out, well, why is it doing that? You know? Um sort of taking the snapping hip syndrome away from it and actually figuring out why. You know, because I I personally don't really care if the hip is snapping if it's not harmful to the gymnast, right? Um, and there are strategies that we can we can do to get the hip to stop, stop snapping in some cases. In some cases, maybe that's just their anatomy. Maybe, you know, that's the way their acetabulum is rotated, and and that's their anatomy, and maybe that's just what we're gonna have to deal with, right? Um, the most important thing for me is is the hip functioning at its its full capability? Um, and is it keeping everything around it safe, right? Do we have enough range of motion? Are we strong at our end ranges of motion? Are we able to get into those ranges without pain? Um, do we have you know stability coming from the core? All of these things are way more important than just like the snapping of the hip.

SPEAKER_00 27:21

Yeah. What are some of your tells when a client comes to see you that this is a hip snap that we have to address versus hey, it's okay. Like reassure, reassure, reassure, and let them know like you're you're gonna be a you're you're still a good person, you're gonna be fine. Your your hip makes a little bit of sound, but it's all right, versus, hey, we actually do need to address this.

SPEAKER_01 27:46

Um, that's a great question. I've had a few where I've been like, oh, we need to take a deeper look in here. I want to actually see what's going on in the hip, rather than being like, we can totally manage this with some pressure control. We can totally manage this with some deep range of motion training. Like, and those are the ones that that's our wheelhouse. I I want those, right? We want the ones where it's like, cool that your hip is snapping, but like we have a million things that we can do to, you know, make sure that it's not harmful. Um, something that I'll see in something that's maybe a little bit more like ortho route, um, like catching. Like if you have it, maybe you're doing the movement and and rather than just the snap, you feel like it's getting caught on something, right? Like it's it's kind of giving you this like like a hitch in your giddy up. Um that's something I don't like. Um in some of my dancers, um, I've had two specifically who will actually get stuck in a range of motion, right? Maybe they're doing like a high kick, whatever, and their hip will get stuck, right? Um, those are the things that I'm like, there's probably a loose body in there, right? There's probably something in there um that we can't manage conservatively, right? Um, or maybe we can, but I do want to take a look to make sure that it's it's it's not something that is, you know, stuck in the joint and and completely us doing things is really probably just gonna make it worse, right? Um so really like the click uh clicking, catching. Um if there is, and this doesn't have to mean that I need to send ortho, but pain with popping is more important to me than just popping. I think pain doesn't mean everything, but if there is pain with that specific movement in the popping, that's worth exploring more, right? I it it doesn't mean we have to go get a labral surgery or anything like that, but it does mean we need to put our our spy glasses on and figure out what's going on in there.

SPEAKER_00 29:45

Yeah. When you have someone that comes to you and let's say they're they're not experiencing that that catching the the deep like clicking and and all these like kind of flags that we may need to make a referral and get some imaging. How does Taylor convert somebody from having a painful hip snap to a non-painful hip snap and fully function?

SPEAKER_01 30:08

Of course, it depends on the patient, right? Um, but my first place I start is core stabilization, right? What's happening, what's happening at their core? Are they able to maintain um a stable core with movement of the hip, right? Are they able to go into hip extension without lumbar extension? Usually no. That's the first place I look. Are we able to use our pressure system in our core to move? The answer is usually no. Um, that's the first place we look. Um sometimes that's all we we kind of talked about this, right? We have longer appointments. Sometimes our first appointments are spent there, right? Um, but I think figuring out um your question was how do we how do we help the person that like we know can be helped conservatively?

SPEAKER_00 30:59

Yes.

SPEAKER_01 30:59

Okay.

SPEAKER_00 31:00

So definitely go-tos, you know.

SPEAKER_01 31:02

Yes. Uh so definitely core stability. One of my favorite positions to put them in, there's two of them. Um, I'll put them into like a dead bug position, but I'll elevate them. Um and so their hips are going off of the table. I won't cue anything and I'll just have them do like one leg off of the table. And I want to see what happens, right? Nine times out of ten, you're gonna have leg comes off the table, you have low back way off the table, you have rib cage flare, and you have a snapping hip, right? Um, then we'll play around with that. If I can I coach them, can I cue them to keep the ribcage down? What happens then? One, they're gonna have way less hip extension, right? Their hip's not gonna go down as far. Maybe it doesn't go down so far that you have no pop at all, right? Maybe they still have a little bit of pop, but then you start coaching them into okay, let's get 360 degrees in the belly, let's use that system, and maybe the pop completely stops. Sometimes it's not, right? I always call that my magic trick when that does happen. And I'm like, mm-hmm, there we go.

SPEAKER_00 32:01

It's always nice when you can pull a rabbit out of a hat and it's like that's all for today. We really reduce that hip snap. Like this is like a sign that we can help you, number one, yeah, and then number two, like this is part of the root cause.

SPEAKER_01 32:14

Right. Um, so that's the that's the first position I'll put them in. Um, the other one, and and this is really just for a visual that I like to give them, um, is when we're talking range of motion. We we kind of mentioned this earlier, but um a lot of gymnasts are just super, super overdeveloped in their anterior chain. So quads, hip flexors, all of those things are just going to be like they want to do everything. Um, if you put them into like a lumbar locked position, so flip them over, use the same table that you were just doing the dead bug on. I have them go into like a lumbar locked position and I'll have them shoot one leg out. So their lumbar spine can't do anything here, and I'll have them lift the leg, right? We want to see like at least 180 degrees there. Most of the time we'll be like down here, right? So that's completely taking out the low back, and you're seeing like, okay, you have no like motor control over your hip extension, right? So they have the flexibility, yeah, they don't have the control.

SPEAKER_00 33:12

So lumbar lock position is basically hands and elbows, right? And um, you're looking face towards the ground, and then you're just trying to stick your leg straight out behind you.

unknown 33:24

Yes.

Tracking And Individual Plans

SPEAKER_00 33:24

And what you're saying is that a lot of your gymnasts, even though they're extremely flexible, they literally aren't able to stick their legs straight out behind them and just straighten it out behind them. And it you see a nice bend in their hip, and that's because their hip flexor is one, overly tight and trying to do all the work, but it can't do any work in that position. And their low back can be tight and also compensating. Also, because a lot of those hip flexors go and connect to the low back, hence why you're you probably start using it in the lumbar lock position. I'm using that literally next time I see this.

SPEAKER_01 33:59

I have an example. Um, I'm just trying to I have a million, I'm trying to find a good one. Um I know I have a lot. I have a clinic video folder and it needs serious attention. There's just a lot going on in it.

SPEAKER_00 34:21

Well, I I really like the idea, and while you find that I'll just kind of expand on what you've already been talking about. Um, it's like you you create a pattern that your brain naturally goes to to perform a movement. And what you're saying is that gymnasts will use their hip flexors in the front of their hip, use the quad muscles in the front of their thigh in order to perform a lot of their exercises. And they've been cued into that, and for whatever reason, that is just their go-to strategy. So, one of the ways in which we can decrease that tension is one, we have longer appointment times, so we'll be able to do all that manual therapy work to decrease the symptoms, give them relief, but then if we're gonna actually attack the root cause and keep this from coming back, we need to teach them how to also utilize the muscles in the back of the body. So the glutes, the hamstrings, all of these different areas, uh, so that then they can just balance out the muscle activity between the front and the back of their body.

SPEAKER_01 35:26

Yes. Exactly. Of course, when I'm looking for this, I can't find it.

SPEAKER_00 35:31

Oh, always, always how it is. Whenever, whenever you need to find something, or like uh whenever you need to use Zoom and it always refreshes like what happened earlier. Exactly. So, yeah, I mean, I think that the way that we practice is something that can be helpful in getting us better outcomes. Um, what are some of the other benefits that you've seen with our longer appointment times? Like as far as like diving in and then educating, like, hey, this is like your understanding as far as why this is happening, and then here's how we're gonna fix it over the long term.

SPEAKER_01 36:01

Yes, I think the I I get this question a lot. Um, and your cash as well, right? Okay. Um, I get the insurance question a lot, right? Why don't you take insurance? Um, here's my answer. I refuse to spend less than 45 minutes with each of my patients. I refuse. There's nothing that I can accomplish in less than that time, right? Um, if I were, I want to watch, I want to see what is happening, right? Especially in these in my gymnast population. Um, the coaches are amazing, but the coaches are coaching a number of girls, right? They can't possibly, you know, this isn't a dig on them. They can't possibly watch every single thing every one of the gymnasts is doing, right? No, no. In a conditioning setting, right? Um, I'm gonna use the hollow position as as my example here. Um, the hollow position is the number one must-have in a gymnast, right? That is it's the hollow body position, it's the ability to keep ribcage over pelvis, it's the ability to really expand their core. That is the number one must-have position. You're going to use that in so much of your gymnastics, and getting into that is super important. Most of my girls cheat on that, right? They're not, their ribcage is flared, they're doing like more of a pike, they're not able to stabilize their core, right? Um, so when I have somebody one-on-one, it's it's so I can make sure that we are doing, we're not only doing, but we're doing correctly, right? Perfect practice makes perfect, right? And if I was, you know, only spending 20 minutes, we might make some progress, but I wouldn't be able to have the attention to detail that I do. I wouldn't have to, I wouldn't have the opportunity to be as hands-on with these girls and and guys as I would like to, right? Um and so I I refuse to sacrifice my time um in the effort to like make things less expensive or like see more people or something. Like I just I it you get so much more out of a longer appointment time and it's worth it, right? We we can see it in the changes that we make in the office, right? Like you said, you might, you know, maybe I have a gymnast who comes in and they just do not understand what I'm talking about when we're talking about 360 breathing. That might take us 15 or 20 minutes to just get through that, you know? And I'm not willing to sacrifice, like, okay, just we'll worry about that later. We're moving on. Like, no, that is a foundation piece of of what we need to do moving forward, right? So I I don't I don't want to sacrifice that in an effort to just like get more done.

SPEAKER_00 38:41

And then how many times have you had that light bulb moment with 10 minutes left where you're like you have this realization of like, oh, yeah, like you've got these general things going on, but you specifically also have this, and we need to actually address this. And now we're gonna change your exercises, you're gonna do this for the next week instead of that. And so now, like, we've been able to take that time and really maximize it. And basically, like, like sometimes you're like, oh man, maybe 45 minutes is too much, and then you really get into it and you're like, oh my gosh. Like, we went down to the to the last second of that appointment, diving into the specific thing for you.

Can-Do Language That Builds Buy-In

SPEAKER_01 39:19

And that is that is me every time. I'm like, okay, 45 minutes is is is a long time. And then I'm like, oh my gosh, we have two minutes left, and I have 35 more things I want to give you, you know. Um, especially as we get down to like the okay, we're making progress, we are like maybe towards the end of our our plan, and I'm like, okay, but there's still so many things, right? Because it's like an onion. I always describe it to my girls, like you're an onion, right? We we peel back layers and then it uncovers other layers, right? It's like we might find out that you have no core stability, great. But then we also find out that you're, you know, I don't know, like your it's your shoulder flexion as well, or maybe it's your hip extension, or maybe you're not rotating well through one of your hips, or whatever it might be, but we just like start to peel back these layers and you're like, okay, light bulb, like this is all making sense. This is exactly why this happened. And I think having the longer appointment time and allowing us to have that one-on-one time fosters that, right? It's like the communication and the trust that you build in that time is so worth it than just to like breeze through a 15, 20 minute appointment, you know? Um, I also have great feedback from parents who are like, we would do this all day over, you know, an insurance based clinic where maybe our copay is only$30, but they're in the, you know, and I'm not dogging on them, they get do great things too, but maybe it's a group setting, you know, where it's like again, no one on one time and they're just like doing their own thing. Of course, they're getting something done, but we just don't have the attention to detail that you have in a one on one. Setting.

SPEAKER_00 40:58

Yeah. And the other thing is like people that do more need more. And a gymnast definitely falls into that category.

SPEAKER_01 41:04

Correct.

SPEAKER_00 41:05

And then also the importance of establishing a plan and then carrying out that full plan.

unknown 41:10

Yes.

SPEAKER_00 41:11

One of the things that's changed for me is, you know, I used to go basically session by session and I would try and fit in every single thing within like one session. Versus now it's like, no, no, no. Actually, we need to really focus and nail down these concepts. And it might just be breathing. It might just be the core stability piece. And it's like, for this next week, I want you to really focus on that while you're doing all of the other crazy things that you have in your life and get really good at that. So then we can build upon that next time. And actually, my outcomes have really improved with that.

unknown 41:44

Absolutely.

SPEAKER_00 41:45

And I'm sure that you found the same thing.

SPEAKER_01 41:47

100%. I I love that you brought that up because in the beginning I would do the same thing, right? A gymnast might come in and they're like, my low back hurts, my knee hurts, my ankle hurts, my Achilles hurts, and my wrist hurts. And I'm like, okay, let's do it all. Right. And then I'm like, okay, well, we like really got nothing done out of all, you know, all of that. Um, and so now I'm like, okay, well, what is our lowest hanging fruit? Like what is what is going to give us the most change out of all the things you just said, right? Like what was probably the number one thing you had that didn't like, you know, snowballed into all these things because you see that all the time, right? And I I said that and like it's funny, but like most gymnasts have 35 things that hurt, right?

SPEAKER_00 42:24

Oh, for sure.

SPEAKER_01 42:26

Especially during the season, they come in and they're like, I'm like, how's it going? And they're like, like they just have a baseline, right? They're like, like it's it's okay. Like, you know, my knee hurts, my back hurts, my shoulder hurts, but like they're just like they're all like baseline, you know. And I'm like perfect. That's great.

SPEAKER_00 42:42

Yeah. And I always tell people, you know, we can, you know, pardon my friendship, but we can we can half ass two things or we can whole ass one thing. Correct. And when I tell people that, they're like, let's whole ass this one thing that's like really bugging me. And oftentimes that can be a driver of compensation that is then also flaring up and exacerbating other things. And it's not like, you know, when you go to like other practices and they're like, oh no, you're gonna get a you're gonna need a different referral for us to work on that or anything like that. It's like, no, like we want to focus on this one thing, and then we're gonna get to those other things later. And maybe we will give you one or two little tidbits of things to do, or we can do some manual work or something like that, but we don't want to get too distracted and we want to solve these issues one at a time and then see how they're connected also.

SPEAKER_01 43:29

Absolutely. And you'll see that all the time, right? That kind of comes with the onion. It's like, you know, maybe somebody comes in with low back pain and hip pain or shoulder pain. And, you know, I may decide, okay, I think the low back pain is is, you know, not only what's bothering them the most, but also probably what's like causing the other things, you know. Um, and so you kind of just like start to peel the onion and then it becomes this puzzle that's really cool.

SPEAKER_00 43:54

Yeah. In terms of injury prevention, like if you were to talk to, you know, I've got a workshop coming up with some gymnasts. If you were to talk to some gymnasts and some coaches, what would you tell them as far as, hey, how do we prevent your hip from either becoming painful or getting worse?

Snapping Hip: When To Worry

SPEAKER_01 44:14

Uh the biggest thing, and I'll spend my life figuring out the best way to do this, is differentiating injury from soreness. Right. Um I see this a ton where they're like, well, I just thought it was sore. I and you know, it just was sore, sore, sore, sore. And then like, I'm like, no, like now it's falling off, you know? Um so really getting them to figure out like red flags of pain is something I talk about a lot. Um, like what are things to look for that probably means it's more than soreness, right? Um, one is sharpness. Soreness should not be sharp, right? We should not have any type of soreness. How many times have you like worked out in the gym and then you're sore and it's sharp? My my answer is zero, right? Like maybe I am sore and I move a little way and it's sharp but it goes away immediately. That's that's different, right? That's different. But in the gym, if you have sharp pain, it's telling you something, right? You should you should listen to that. Um lingering pain, that's not soreness, right? If you did a really hard leg conditioning day on Wednesday and the following Wednesday you're still feeling some type of something in your hip, that's not soreness, right? We've lingered too long. It's gone on too long. And I think early recognition is the is the true answer here, right? If we can get our hands on something earlier than six months into it, it's a win, right? Um, because that happens a lot. They're like, oh yeah, like it's it's kind of been it's kind of been bothering me for like six months. You know, this summer I kind of felt something in my knee and then it just you know kept getting worse. And it's like six months ago, this would have been super easy to fix, you know, super easy to manage. And now we're six months in, and maybe it's not anymore, you know. Um can you pause for two seconds? I'm just gonna grab a charger so I don't lose you.

SPEAKER_00 46:04

Okay. All right, and we're back.

SPEAKER_01 46:11

Um, yes. So oh yeah, you we were talking about like you have the thing coming up and what would you share with them? Um, yes, I think the biggest things are recognizing what is pain versus soreness. Um how to communicate that is also really important, right? Teaching them that and really reinforcing that injury does not mean weakness. And the sooner we treat an injury, the better the outcomes, right? If we can get on top of something right away, those outcomes are way better. The prognosis of something that we hop on immediately is gonna be way better than something we've waited waited around six months to fix, you know?

SPEAKER_00 46:53

Yeah. As far as like timetables, also like it's like, yeah, if you have unending soreness for six weeks, like maybe it'd be beneficial to have you know a little bit of a load management where we cut some of the hours or cut some of the volume of the movements that are causing that soreness because we know that the body's a compensating machine. You know, if your quads are sore for literally, you know, six weeks unendingly, and you never have a single practice where they're not sore, then you're going to start using other things that aren't fatigued, and maybe they're not designed to take the brunt of that load. Um because gymnasts also get some pretty gnarly injuries, you know, like Achilles tendon ruptures, um, hip flexure ruptures. And it's like if you just keep not listening to the signs that your body is telling you and the signals that you're getting from your body, your body's going to start giving you stronger signals.

SPEAKER_01 47:49

Yes. That's you you brought up a great point of like pulling back in the gym when things are happening like that. I have a lot of gyms that do two-a-days. And so my number one, like again, lowest-hanging fruit is like, okay, you're injured. There's no reason for you to be doing two-a-days, right? Like, there's not a reason for you to go put yourself at risk again when we're not even really ready to be doing the one practice, right? Um, pulling away from that and allowing your body to rest, right? The other thing that I think is super important, and I emphasize this so much. Um, there are things that you and I can't do, um, and nobody else can do for the girls, right? The first thing is sleeping, right? Like that's on them to make sure that they're getting ample amount of sleep, right? They're growing. A lot of these girls are, you know, of puberty age. Like there's so much going on in their bodies and they need the rest, right? And they're not getting it. So that's number one. Number two is nutrition and hydration. Like those things are so, so, so, so, so important. And I think we're putting, we're seeing the importance of it now. And I think there are more resources now than there once were. But really understanding fuel and using fuel for recovery and using fuel in the gym is incredible, right? And it's it's super life-changing when they find that when that's a light bulb for them, and they're like, oh my gosh, like when I fuel properly, I feel better, right? I compete better. I'm not injured as much. Those things are super, super important to talk about, right? Um, yeah, trying to think of what else.

SPEAKER_00 49:25

I I think one thing I'd love for you to touch on as somebody who um was once a super high-level gymnast, and now you're like a regular person. And it's like, well, Kayla was a regular person, like there was a there was a normal person in Kayla the whole time, right? And sometimes thinking about that, that full identity, the full context of like, hey, you have a whole life to live, potentially after your gymnastics career is over. Simone Biles is entering an era of like being a person, you know, and not just gymnast Simone Biles, you know. So, what are the longer-term implications of like addressing injuries and making sure that we do address them fully so that you're not still dealing with things? Like, I'm still dealing with old running injuries, you know, and it's like, boy, if I could hop in a time machine and like address those in while I was in high school or college, I would certainly do that. I would do that in a second.

Core First: Practical Fixes

SPEAKER_01 50:24

100%. And I could not agree more. Um, I'm 30 and I have a terrible, terrible, terrible knee that will eventually need a knee replacement. And it's because of mismanagement of my injuries when I was younger. And so that's also why I'm here. You know, this is what got me here because I know that I mismanaged that. And it came from, you know, a place of perfectionism in the gym, and I didn't want to stop. But then it also came from mismanagement of injuries. I didn't do the right things, I didn't have the right resources. Um, and so I think just explaining the long-term implications of listening to your body, right? Um, and and you kind of talked about, you know, life after gymnastics, and gymnastics is a great sport example to talk about this, right? There's no NBA for gymnastics, there's no MLB, right? It's like you go to college or you go to the Olympics, and like Simone Biles is a great example. Like, there's still going to be an end to her career, you know? And I think the important thing, uh the there's so many things that come along with that, but finding an identity outside of gymnastics while you're in gymnastics is super, super important. I see the identity crisis happen all the time. It happened in me. It happens in everybody, right? You make the pros and cons list, you decide to quit gymnastics, and then it's like, holy shit, I don't know who I am, right? I don't know how to manage my body. Maybe you gain a little bit of weight because you don't know, you know, you just don't have you have nothing, like you just completely have tied your personality and your person to gymnastics, and then you stop and it's like, shit. Like there are so many things, you know, that I don't, you know, I didn't know that I liked or didn't like because all I did was gymnastics. So something I actually do when I notice this happening with a gymnast who I'm like, oh, you are tied into gymnastics, right? Like your identity is gymnastics. We'll talk about like I want them to name something they did this week that had nothing to do with gymnastics that they enjoyed, you know? And a lot of them will say, like, well, I had a sleepover. Cool. It was probably with a gymnastics friend and you guys probably talked about gymnastics, but at least you are doing something outside of the gym, right? Maybe it's reading a book or maybe it's shopping. I don't care, but like what was something you enjoyed doing, you know? And I think that's super important when you, you know, again with someone by else, she made the mental block culture, she emphasized it and she made it seen and she felt, you know, she made so many of these gymnasts felt seen that, like, oh my gosh, like what what's going on with me is not just in my head, you know. But I I find when I have a gymnast who is struggling with mental block, finding those things outside of the gym is so, so, so important, right? How do I untie my identity to gymnastics so that I can give my brain a break, right? I'm not a mental health specialist and there are amazing people out there, but I do think that having hobbies outside of gymnastics is super, super, super important, especially when you're dealing with something like that, because it's heavy. Like there, I've had gymnasts who are dealing with mental blocks and they're like, I wake up thinking about it and I go to bed thinking about it. Yeah, you know, and so untying yourself and figuring out something that you do love outside of that, I think is super important.

SPEAKER_00 53:33

I totally agree. And then the irony is it'll also make you better at gymnastics.

SPEAKER_01 53:38

Oh, a hundred percent. A hundred percent. And they don't see it in the moment, right? They don't understand. Yeah, because they're like, if I'm not doing gymnastics, then I'm not getting better. But it's like, no, you are.

SPEAKER_00 53:47

If I'm not obsessed, then how can I be the best? Right. Um, and I think it is like, you know, you and I may not be the best person to answer these questions, but it's like if you're a gymnast or if you're a runner or if you're a climber and you ask yourself, what am I without gymnastics running or climbing? And you don't have a good answer, then you need to start figuring out how you can answer that question effectively.

SPEAKER_01 54:13

100%.

SPEAKER_00 54:14

Well, Kayla, we're coming at probably a little bit over an hour, and I want to just say thank you so much for sitting down with me today. If there's one more piece of advice that you can give to gymnasts, especially gymnasts dealing with hip pain, what would that be?

SPEAKER_01 54:27

Oh gosh. One piece of advice is so like I know.

SPEAKER_00 54:30

It's like the ounce of prevention at the very end. Like, what's that one ounce?

SPEAKER_01 54:34

I think my one ounce is it's never too early to speak up.

SPEAKER_00 54:41

Love that.

SPEAKER_01 54:43

You you owe it to yourself to to speak up and to take care of yourself.

SPEAKER_00 54:48

Amazing. Well, where can somebody find some of your content or reach out to you for either a consult or just to follow some of the great things that you're doing?

SPEAKER_01 54:59

Yeah, my Instagram is at dr Kayla Keck. So my first name, Kayla, and then last name, K-E-C-K. Um, and then my website is P10, the number 10, rp.com. Um, and both of those have access to me. Um, feel free to slide in my DMs. I'm always available for conversations there. I do virtual appointments, so if you might not be in the DFW area, that's totally fine. Um, I love to work with gymnasts everywhere.

SPEAKER_00 55:27

So amazing. Well, thanks again so much. Uh, definitely gonna have you on again in the future. I don't know, maybe about shoulders or something like that.

SPEAKER_01 55:36

Cool.

SPEAKER_00 55:36

I'd love it. All right. I hope that you enjoyed this episode of the Art of Prevention podcast. If you did enjoy andor benefit from some of the information in this podcast, please be sure to like, subscribe, and share this podcast. Or please give us a five-star review on any platform that you find podcasts. One thing to note that this podcast is for education and entertainment purposes only. No doctor patient is formed. And if you are having any difficulty, pain, discomfort, etc., with any of the movements or ideas described within this podcast, please seek the help of a qualified and board certified medical professional, such as your medical doctor or a sports chiropractor, physical therapist, etc.