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[00:01:12] Welcome to Untold Physio Stories Podcast. Your perfect commute resource with

[00:01:26] physiofaliers, successes, interest in cases and more from the physio and rehab world.

[00:01:34] With your host Dr. Andrew Rothschild and Urson Rallyhiosome.

[00:01:43] Three, two, one. Welcome back to Untold Physio Stories Podcast.

[00:01:48] And when you're host Dr. E with motor manual therapy,

[00:01:50] intermibility system in motor rehab mastery, my co-host is back and with me tonight

[00:01:56] at Dr. Andrew Rothschild. How's it going Andrew?

[00:01:58] Good Erson, how are you doing?

[00:02:01] Good, it's been a while.

[00:02:02] It has.

[00:02:04] Man, lots of asynchronous.

[00:02:06] Flareus about how you said that you wouldn't have that

[00:02:11] wouldn't have had to hear about the airport hero head.

[00:02:16] I've just got dry now walking by.

[00:02:19] Well, look at these two poor fools.

[00:02:22] Blinders on.

[00:02:24] Yeah.

[00:02:26] They look helpless.

[00:02:28] Well you're much nicer than me.

[00:02:30] Yeah well you know I got some Starbucks and I got a five-star Google review so

[00:02:36] fantastic.

[00:02:37] Yeah, it's a good paid for it.

[00:02:40] So you have a story for us tonight.

[00:02:42] I do.

[00:02:44] What's going on?

[00:02:45] And this was, this is something I've never seen in 18 years of practice and

[00:02:52] I looked up to when this happened to see what the incidents was and it's incredibly low.

[00:02:59] And yeah, I sent you a photo so you include that hopefully in the post when we post about this

[00:03:05] this this episode.

[00:03:07] But I have a patient, I just well I just I should just finish things up with him.

[00:03:11] So I've been seeing I S S song for a couple months to almost three months.

[00:03:17] Younger than me actually so early 40s he had a hip replacement

[00:03:22] and I had seen him which was very surprised about because I had seen him a couple of years

[00:03:26] earlier he had had an orthoscopy done and he had done well.

[00:03:31] But so surprised you know for someone that young that whoever he saw what

[00:03:38] happened.

[00:03:39] Not that directly a hip orthoscopy?

[00:03:42] Hip orthoscopy yeah.

[00:03:44] Okay.

[00:03:45] Yeah, he had done that done a couple years prior.

[00:03:48] It had done well like a label tear some cleanup.

[00:03:51] But it was one of those ones that it wasn't life from memory it wasn't like a traumatic incident

[00:03:57] was more just a you know overuse type thing.

[00:04:00] But it's still one of those ones where I was like I wonder how he would have done

[00:04:05] just conservative not having had surgery but I didn't see him of course to laugh at the surgery

[00:04:11] and then same thing here he just had a hip replacement but at 43

[00:04:16] he's very lean, he's a pretty active person is a lawyer

[00:04:19] he's not overweight nothing like that he's very healthy so it was just surprising.

[00:04:27] But when I saw him after you know just within the first week after surgery

[00:04:32] he was having a lot of anterior thigh pain like really like knee pain really was having

[00:04:38] trouble straightening the knee.

[00:04:40] Like could not even do like a short arc quad because it was just so painful but he also just

[00:04:46] like he couldn't do it.

[00:04:47] He was very very very apprehensive like a lot of apprehension about moving

[00:04:52] you know even like with passive moving motion of his hip and like you know all directions really

[00:04:58] guarded.

[00:05:00] And I think I'm a second visit is when I took this photo he had crazy quadriceps atrophy

[00:05:08] like beyond just normal post surgical atrophy which even with the hip replacement you're not

[00:05:14] really expecting a lot of atrophy especially in the quads.

[00:05:17] He had sort of that you know the anterior lateral approach and but it was just

[00:05:24] you know it was very striking quadricep atrophy.

[00:05:27] And my only sort of you know rationale was that there was somehow there was some sort of trauma

[00:05:37] to the femoral nerve whether it's just from inflammation whether from the surgical procedure

[00:05:42] itself don't know.

[00:05:44] The dot the surgeon when he had a fault with the surgeon the surgeon really didn't confirm

[00:05:49] anything wasn't really sure but it was just you know and you'll see from the photo it was

[00:05:54] just really dramatic quad atrophy.

[00:05:56] He has kind of skinny legs anyway but this is still significant.

[00:06:00] Ended with the pain and the difficulty he had

[00:06:04] with like you know leg extension you know very very you know obviously we'll be limited

[00:06:10] needs then sorry hip extension you know photo while anyway

[00:06:14] we're even doing like mild very unaggressive hip extension which is really really uncomfortable

[00:06:19] and it took him a long time to be able to do even a straight leg raise so that's why the

[00:06:24] you know the rehab for someone very young with a hip replacement took over three months

[00:06:28] just because it was it just had this extra layer to it that he really couldn't do it.

[00:06:32] He couldn't do an eccentric like he couldn't go down a step without significant pain and

[00:06:37] just could not did not have the eccentric control you know squats were very difficult

[00:06:43] you know just it took a while before he could even do a full you know resisted knee extension

[00:06:49] so we you know most of our rehab really was obviously hip range or motion but then

[00:06:54] really just working on quad strength was was such a big thing and he really has made

[00:07:00] you know significant improvement.

[00:07:02] So it was a point that seemed like it was more like inflammatory related almost like a

[00:07:06] neurodynamic you know issue from a mobility standpoint but the fact that he had such pain as well

[00:07:12] not not just weaknesses you expect from like a you know a reticulopathy versus like a

[00:07:17] ridiculous pain example in the spine. This was like the same version but like just in the

[00:07:22] the femoral nerve just essentially from you know the hip to the knee so yeah it was this

[00:07:28] very wild man and never seen anything like it.

[00:07:30] So I mean this picture that you said me is this before or at like this is a second day

[00:07:39] but this is the second day that I saw him so this is like maybe a week a week and a half post-op

[00:07:45] okay so you don't have an after.

[00:07:48] This is after the surgery yeah no I mean you don't have like a current like a current

[00:07:53] three month yeah he went out of town on vacation so I wasn't it may not be his last visit so I

[00:08:02] didn't you know I don't know those ones I had didn't and I don't have a recent photo but I

[00:08:06] need to get one to compare.

[00:08:08] Yeah for sure so the surgeon never really I mean did you suggest that he had some sort of

[00:08:16] femoral nerve trauma yes result of the surgery?

[00:08:19] I would have a patient.

[00:08:20] The patient?

[00:08:21] The anterior approach?

[00:08:22] Yeah anterior interlateral approach yeah yeah and the incidence is very very you know the

[00:08:28] incidence is like less than a percent it's very very low.

[00:08:32] For this to happen.

[00:08:33] Yeah for this to happen but yeah you know as one of those things like you know we talked about

[00:08:38] should you get an EMG test and I was like you know you could get one but it's not kind of really

[00:08:42] change what we do.

[00:08:44] I was like I'm fairly confident this is what it is because there's really not much else I don't

[00:08:47] think it can be given what you've had done and what your presentation is.

[00:08:52] But I was like it's not going to change what we do it'll just confirm the diagnosis but it

[00:08:57] maybe give us an idea from a prognostic standpoint what we might expect you know from a duration

[00:09:02] for some things to recover but he was like yeah I'm not really worried about it.

[00:09:07] I mean I think he was just I think the surgeon was one of those ones like

[00:09:10] you know maybe he didn't want to admit that it happened or was just you know would be surprised

[00:09:17] because again it just is not so very common but it seemed really clear that this is what it was.

[00:09:22] It almost seems like it would be more common.

[00:09:27] I actually surprised that it was as low as when I looked up the data I was actually surprised

[00:09:33] it wasn't a little higher just with that anterior approach but it is pretty low.

[00:09:38] So yes that's a good thing.

[00:09:40] Yeah yeah that is good that is good.

[00:09:42] Yeah I'm surprised so you I mean he responded to basic strengthening just like

[00:09:46] so there wasn't like significant nerve insult it was my least irritable.

[00:09:51] Really on it seemed like it's like oh boy how is this going to go but I think part of it also

[00:09:55] was just he's you know just his you know more anxious demeanor a lot of apprehension a lot of

[00:10:01] guarding you know he was more just really a he was very you know guarding me from doing a lot

[00:10:06] of movement so it was initially a slow a slow slog and so I was I was like I don't know how long

[00:10:12] it's going to take but all the sudden once we got through that first month and really sort of

[00:10:16] gain some confidence that things were okay started to cease and progress and then it really kind

[00:10:21] of just then I knew it was just a me a matter of time from a nerve healing standpoint which as

[00:10:25] we know can take you know six months longer sometimes I mean he's not all the way there

[00:10:30] and he's not he's not as good as he could be or definitely would be without having that happen

[00:10:35] from just a hip replacement but he's definitely doing significantly better.

[00:10:40] Yeah yeah that's good. He's pretty he's pretty he said his wife has noticed that looks like

[00:10:45] his leg I should have taken a picture last time I saw him but his then his wife noticed that looks

[00:10:50] like his leg was like almost back to the same I don't think it's quite that far yet but it's definitely

[00:10:56] definitely better. Yeah well if he went on vacation and maybe and he did a warm climate maybe

[00:11:01] his wife can just take a picture for the after-part system. That's so we like to post it this week.

[00:11:06] He's in Costa he's in Costa Rica I have his number I can text him. Yeah perfectly perfect perfect

[00:11:11] perfect. No but in a hammock keep it keep it keep it clean here. Yes I know yeah

[00:11:16] I'm the only show this isn't made with show my gosh I do want I don't want to see that

[00:11:25] yeah all right so hey thanks for the case you know it's funny because I'm good like

[00:11:30] uh

[00:11:31] Deja Vu did you send me this picture and we just never talked about it?

[00:11:36] Yeah what that's very possible okay you literally after as Lily has your saying that I was like

[00:11:43] did I send that back when it happens I think that was when I first happened I wanted to do an

[00:11:47] episode on it and then it just that just didn't happen so I must have sent it to you like if you

[00:11:52] might notice exactly it would be probably within the first month that I saw him so yeah

[00:11:59] oh let me just scroll up my thread here let's see uh

[00:12:05] it's a bunch of it's a bunch of threads that saying we can't make it

[00:12:08] I can't make it okay how about tonight no I can't make it let's do asynchronous

[00:12:16] well we text a lot maybe it's on maybe it's on Google chat or something about on

[00:12:19] i'm message now here's one of my dog pass in the way um and now I'm reliving all this grief

[00:12:25] on his trauma yeah do you have a new dog right I do man yes I am about to go upstairs you know we're

[00:12:32] in the uh this one's having a bit more um potty training issues uh or last I feel like our last

[00:12:39] golden only had like one or two accidents this one's had like four or five but every single time

[00:12:44] it's pretty it's almost the owners fault you know it's like oh hey who's going out the dog in an

[00:12:48] hour right I thought you did oh he just pooped that's what he he's barking at his poop now that's

[00:12:53] what he's doing but we did switch to a raw diet um on the advice of the breeder and some other

[00:13:03] people we know who've lost dogs really early the cancer and they said that um you know one of

[00:13:08] the big advantages to this raw diet is like their their stools are more firm and they don't smell

[00:13:14] and I can I can actually tell you they really they don't really smell it's kind of amazing

[00:13:20] so not nearly as bad as it could be I mean it's it smells about as bad as dog bark if you know

[00:13:26] what that smells like because which is like not nearly as bad as human bark like it I would say it's

[00:13:31] like 10% of human bark yes it does not tend to smell too bad yeah it's like kind of amazing

[00:13:37] human bark smells so so awful yeah I don't know what it is like every time clean enough like this

[00:13:44] isn't that bad so now yeah it's like his stool actually I treat bppv and I tell the patient though

[00:13:50] like if you vomit I am walking out of the room I will say that to the I will send it to patients

[00:13:55] like why I this could happen but also this is what else is going to happen and I've been very thankful

[00:14:02] that that is not it's only happened once ever um I've been vomited on not vomit on but the patient

[00:14:09] vomiting just from you know from business from bpvv okay okay let's listen if I'm I mean I've been

[00:14:15] vomiting on I've been vomiting on I would go I would go home like I'm done yeah I mean I don't

[00:14:22] even know what I did I don't know if I can change a shirt or what it was like she's like I'm sorry

[00:14:26] just had burger king it was like burgers on me I'm done and you'll see all the more you know

[00:14:33] I don't even eat meat now you just vomited meat all over me especially if it was big like yep I'm out

[00:14:37] of here all right well that's not even really an untold video story because I just told it but uh

[00:14:44] yeah many of you guys maybe you guys have encountered this super rare phenomenon of

[00:14:50] from our own or insult which I'm frankly again surprised considering a lot of these are

[00:14:55] answer-allateral approaches and surprises doesn't happen more often let us know or if you've

[00:15:00] been vomiting on let us know come on and maybe it'll be a more interesting story than mine mine

[00:15:05] wasn't bpv it was uh it was just severe pain and I was doing repeated motions with them

[00:15:14] and she was gross yeah it was gross it was gross actually what I remember I ran to go get her

[00:15:19] garbage can and when I ran back in the room she missed a garbage can didn't hit me oh that's

[00:15:24] even worse yeah all right well talk to people find you and you're people gonna find me uh

[00:15:33] Instagram or Twitter at a Rothschild PT all right it's awesome yeah I was just putting together

[00:15:39] the physio around table websites and I noticed it still said spear physio so I was like I have to go

[00:15:44] check what this is now I don't even know it's been there's been years now I've kept with the

[00:15:49] a Rothschild now for okay okay after that I thought my I thought this was a little old all right

[00:15:55] hey make sure to subscribe to until physio stories give us a five star rating on apple and