The Joe Rogan Experience - #945 - Dr. Roddy McGee

Episode Date: April 12, 2017

Dr. Roddy McGee is a Board-Certified Orthopedic Surgeon, fellowship trained in Sports Medicine and is part of the Total Sports Medicine Center in Las Vegas, Nevada.

Five, four, three, two, one. I'll start. Hello, ladies and gentlemen. Hello, Dr. McGee. That sound is not me peeing. If you're hearing that, you're like, what? Is this a podcast in a bathroom? No, that's coffee.

How are you, buddy? Good. Thank you for having me. Thanks for being here. For folks who have heard me rant and rave about the fantastic results that I have had getting treatment on my shoulder where I was that close to getting surgery, it's this gentleman, Dr. McGee, who's fixed me up out of Las Vegas, Nevada. And now we're here to talk about it. Yeah, I appreciate the chance to be here. You ran out of very short words today.

He was very talkative before the podcast, folks. That's how it goes, man. Well, now I'm hearing myself. Oh, is it weirding you out? Yeah, a little bit. You can take them off. We can take them off if it's too weird. You've never done a podcast like this before, right?

You did John Dudley's, which was excellent. We can take it off. I might have to. Okay, let's take it off. I don't want to freak you out. Is that better? This is a little more like a normal conversation. Okay, I don't want to freak you out.

To me, it's better because I can hear if things are wrong. What's the notes, Daddy-O? What do you got there? Just a couple of things I jotted down. Just make sure to give you all the information you want to hear. Well, I just want to tell you that I feel super fortunate to have met you and to have been treated by you and to be able to have these conversations with you in your office, which is why I wanted to have you here to talk to you because, I mean, I was having

some really significant shoulder issues before you treated it and it's amazing the results and what, you know, I mean, what I've avoided, avoided in shoulder surgery. Yeah, I mean, you've had a tremendous result. So obviously, we're very thankful that you're able to get that benefit. And I think we're, in my community of orthopedic surgery and sports medicine, you know, we're very excited about the possibility and eager to continue to learn about it and see what it can be and how it can help and what it does best for what. Now, where's all this stuff coming from? Like, where is this science coming from and how has it evolved over the last few years? Well, a lot of the stuff

that we're using is not new in terms of the tissue or that type of thing, but it's actually the application for orthopedic sports medicine. So you could go back decades to when it's been used in plastic surgery for corneal ulcers is one of the original applications of placental tissue. So the idea of it isn't necessarily new. It's just that as we've gained more understanding in our community of orthopedic surgery, now we're starting to see what the applications can be. Now, when you say plastic surgery, what have they done with plastic surgery? Mostly helping with wounds. So that's been the big application, wound healing.

And the potential for there to be wound healing without scarring. So that's one of the things that we'll get into. How do they do that? It's part of the mechanism of how the cell helps the process of the healing. But we'll talk about that for sure. Now, when they extract the placental tissue, they're doing it on young women who have had cesarean sections, correct? Sure.

So it bypasses a lot of the ethical concerns that a lot of people had during the Bush administration, which kept them... Okay, so let's, you said a couple of different important things there. So let's start breaking that down a little bit. So the first thing is, you know, where does it come from? It comes from a young, healthy mother. In this case, what we're talking about, this particular category of biologic treatment or cellular tissue. This comes from a young, healthy mother that's having an elective C-section and prior to the delivery has agreed to make a charitable donation.

And then they have been screened. And there is a process that must be followed by the American Association of Tissue Banks. And they have a series of blood tests that they have to go through. And so you're checking to be sure that there's no communicable disease, you know, for example, hepatitis or HIV, things of that nature. And so once that has been cleared, and they're an acceptable donor, then they go through the delivery, the tissues collected. And as you said, this is stuff that typically would go in the garbage. So essentially, the, you know, the ethical and the moral dilemma shouldn't exist for that portion of it, because, you know, otherwise, it's just garbage.

Now, that's taken by the company that has harvested, and they have their processing center, which also has to be evaluated and approved by this AATB, American Association of Tissue Banks, to be a facility that is up to their standards. So they have a sterilization process, the tissue is not contaminated, their packaging is appropriate, their, you know, their shipping is not causing problems with the tissue. So you have to meet all these standards. It's very stringent. And so if you have that, if a company has that approval, then they meet the standards allowed so that that stuff can then go either to an office or to a hospital.

so now the the next thing of what you said um let's talk a little bit about uh president bush and that whole discussion so first of all that is about embryonic stem cells okay an embryonic stem cell and that's you know that doesn't have anything to do with what we're doing an embryonic stem cell is when the the sperm and the egg join and begin to form the beginning cells of life. And there's initially two cells, and then it divides into four, eight, et cetera. In the first five days of life, that's called a blastocyst. And those cells can be harvested, and they are what we call totipotent. That means they can become anything. They have the ability to transform into any line of tissue or organ.

Or in the case of that first five days of life, those individual cells can actually become a complete organism. So that's where we had the cloning of the sheep. So that's what happened. So they took the cells in that first couple of days, and then they had a process to allow it to continue to grow. And so you had two different, from a single sperm and egg, you had two organisms, complete mammals, created. So when you say this blastocyst is that how you

say it that's just the term for the initial you know the ball of cells that's formed and how many cells is in a blastocyst well they're dividing over the number of days and doubling each time so then you know hundreds thousands not by that time no hundreds you're 16 you know 32 so if you have 32 how many different organisms can you make off of those 32 cells? Technically, if you have a totipotent cell, every individual cell has the ability to become a complete organism. Whoa. So that could be one blastocyst could be 32 different people. I guess potentially.

Wow. I don't know if that experiment's been carried out. But theoretically at least. Theoretically, yeah. Wow. So now when they have like frozen embryos and people do things like that, when they decide they want to have kids later in life and they freeze their embryos, how the hell are they doing that? What's that about?

And I'm not like a reproduction specialist, so we might be getting, you know, out of my But those frozen embryos, a lot of times they don't get used, right? I don't know. I don't know how that works. Because I know there's been battles, like people have had battles with their ex-wives and shit. Yeah, I think I've read a little bit of stuff like that. Yeah, it's very strange. I mean, my understanding of it would be that if you're freezing it with the intention of maintaining the cell viability,

and so somebody has demonstrated that you could then thaw that cell and it still has the opportunity to divide, produce, and become a living thing. Wow. I was thinking like for the non-viable ones or the ones that don't get turned into people, they could probably use those as well, right? Well, that's a big debate. That was the thing, right? That was the big George Bush thing. Well, okay. So let's back up on that because I think there's a lot of misconception about that. And I hear like very strange comments made about it all the time in the media. So the thing that George Bush signed in 2001 stated that the federal government was not going to supply money for embryonic stem cell research. That's it. It was not a ban on stem cell research. So for all of that time, I mean, private equity companies and any private investor could have and probably has been spending the money

to continue to research that and develop it and find it. So I always find it interesting when I hear on TV, oh, like our country has been set back a decade because they signed this, you know, bill. So you feel that's wrong? Yeah, that's so, but all he said was, we're not going to dedicate federal money to it. Right. That's different than a ban on any study. But how much research does rely on federal funding? I don't know. I mean, there's, there's private funding for all kinds of things. Is it more common now than it is before, or has it always been the case where there's a lot of private funding?

So President Obama in 2009 lifted the ban on the federal funding. So federal funding has been going on for it since then. Interesting. Yeah. Interesting. So what is the difference in terms of the viability of placental stem cells that you would get from a woman in a cesarean section versus something that you would get from a blastocyst? And it's actually to our benefit in orthopedics not to be using that line of cells because those cells, starting from that time point, have the ability to have teratogenic potential. So what that means is they can potentially form tumors. So that makes it obviously a big disadvantage because now we're adding our risk to what we're doing. Once they've gotten to the point where it's a part of the whole, you know, we call this like a human placental stem cell or mesenchymal stem cell. And that includes the placenta,

the umbilical cord, the Wharton's jelly is a mucus type substance that's around the arteries of the umbilical cord, the amnion or the amniotic sac, which is the inner layer around the baby. And then the outer layer is called the chorion. Now, all of that has cells in it that we would put in the category of mesenchymal stem cell or mesenchymal stem cell. And what that means is they have a specific line of tissues that they can become. So now back to when I was explaining the formation of the blastocyst becomes a morula, becomes an embryo eventually. So in that process, you have this ball of tissue, and then it starts to kind of fold in on itself, and then it

starts to layer out into these three layers. So you have endoderm, ectoderm, mesoderm. Each of those kind of is directed towards a certain line of cells and tissues. The mesoderm and what the mesenchymal stem cells can become are all of the things that we care about in orthopedics. So cartilage, bone, muscle, ligament, tendon. So we have that whole line of cells that this particular cell has the potential to become. So when we talk about a stem cell, by definition what it means is, one, it can divide and become another stem cell. So it can duplicate itself so that now you have another cell that can divide and become another cell. Or it can divide and differentiate into a cell that then has the characteristics of the things that you're hoping it will become.

Now, that's a directed and ordered approach in embryology. And in the case of treating an injury, what we're hoping is that that can differentiate into the injured tissue. And how long have they been doing that? Well, studies on that have been going on for at least 10 years. So I want to say maybe back as early as 2007. Now, we've been, if you go, you know, way back to the early days of arthroscopy, and that would be like the late 70s and early 1980s. microscopy, and that would be like the late 70s and early 1980s. And I don't know exactly what year, you know, he would have started doing this. But Dr. Stedman at in Vail, Colorado, and he was

in Reno and Lake Tahoe area before that. They would this he's the one that developed the microfracture procedure. I don't know if you're familiar with that. You've had a couple of knee surgeries, so I don't know if you've heard that term. I have, but I don't really recall exactly what it is. Sure. So basically, if a patient had a small cartilage defect, he took a small, an awl, or what looked like a tiny little pick, and made a puncture into the bone. And what that did is it releases marrow

elements along with blood. And they were able to see with time and, you know, there were occasions when they got to have second look arthroscopy that that cartilage could fill in. Now, they also found that that didn't become the native cartilage, it becomes something called fibrocartilage. So when you look at it under a microscope, it looks different compared to our normal cartilage. Appearance like physically looks the same, but under the microscope looks different. What is the difference? Well, the main difference in what's applicable is that it doesn't have the same structural properties. So it was more easily able to kind of come off with a sheer force. So just picture like your knee bending. Yeah.

You could kind of flake off or, or in some cases just didn't form as well as, you know, you would want. So, so that experience, um, and I, you know, having conversations with the guy that I trained with, his name is Larry Lemack in Birmingham. He noted just over his career that he always felt like patients that had worse arthritis, but they would do this microfracture procedure on in knee arthroscopy actually would do better than patients with less arthritis, but that they didn't do the procedure. with less arthritis, but that they didn't do the procedure. And so it had always been in his mind that somehow that marrow stimulation was providing something that was helping with either healing or pain relief. And it's only now that we start to understand, you know, because the bone marrow has some of these mesenchymal stem cells available also.

And we'll kind of talk about the differences and stuff like that. So it's essentially like a crude version of stem cell available also. And we'll kind of talk about the differences and stuff like that. So it's essentially like a crude version of stem cell transplants, like... Yeah, I think that's a good way to put it. Yeah. I mean, our hope is that we're using cells that can, again, change into other things that we want. And when did they start applying this on people, like in terms of not just tests and studies, but actually in practice, like what you do? Well, in orthopedic sports medicine, I don't think I started to hear about it until around

2012. So that was the first year that I was in practice. And I attended a conference in Las Vegas, and it was called the Emerging Techniques in Orthopedics. So they were kind of talking about what's the newest and, you know, most forward-thinking ideas that are coming through. So a company presented and one of the physicians presented information showing that they had harvested fat tissue from patients' abdomens and injected into their knee for patients that had knee arthritis. And they were showing new growth of cartilage and actually improvement in some of the x-rays. So when you look at an x-ray, there's some characteristics that we look at that define what arthritis is. So if the patient has narrowing of the joint space or they have bone spurs, things like that,

they were actually seeing more space between the bones on some of these serial x-rays. So, you know, I saw that and that was just like so incredible and something that I never heard about, read about, or, you know, had encountered before. And that's really what kind of sparked my interest. And what are they doing with the fat? Because I've heard that they do stem cell fat injections. Yeah, so they harvest the fat similar to like a mini liposuction. Right. And then they're, you know, they either spin it in a centrifuge

or there's a, you know, these syringes that you can pass it through a filter and then you re-inject it. And what you're trying to do is, again, take advantage of the fact that there's these mesenchymal stem cells in the tissue. And like what, can they just, are they just taking the fat? Like when they spit in the centrifuge, like what does that accomplish? It just separates out the cells. So then you can, you know, inject the portion that you want. So we do that. Do it visually? You've had it with PRP. Yeah.

Yeah, exactly. I've had it with Regenikine, which is like a form of PRP. Correct. Yeah, where they heat it up and it becomes like a yellow serum. Right. That's the platelet layer of the blood that you're looking at. Okay. Yeah.

So the red cells separate out, and you can easily see that in the tube. And what is the difference in the results from someone who does that? Because I know quite a few people have done it that way. They've had injuries treated where they suck the fat out. There isn't any research to differentiate like one of these treatments versus another yet. It's just not available. So it's all anecdotal in terms of like talking to patients? It's happening. I mean, people are collecting the data, but it's just not, you know, it's not at the mature stage where,

um, you know, where it's available and we have, you know, published stuff to look at. Do you personally know of anybody who's had really good results using the fat method? Um, yes, actually, uh, a physician friend of mine In Memphis, Tennessee Her name's Dr. Laura Lenderman She has utilized that quite a bit And she's been very happy with The patients that she's treated

And naturally some people do better than others But You know The rigorous study of this though Is still yet to come That's really fascinating. Have you considered trying that? Definitely.

But you don't so far? You just do the stem cells? I haven't had anybody specifically request it. Maybe somebody wants to lose a little fat and fix their knees? Yeah. I mean, that's probably taking things in a direction I don't want to be going. But the fact is that there are a number of different options in terms of where these sources of the cells can come from. Bone marrow has certainly had a lot of use and continues to be used.

Daniel Cormier had that done. That's what he told me, yeah. Yeah, he had it pulled out of his hip, and he said it was brutally painful. Then he was walking with a limp for like two weeks. Obviously, it's a procedure. There's pain and there's morbidity. There's a consequence to putting a sharp object into the bone and drawing that bone around. Morbidity.

Yeah, so that means a bad thing. I don't like that word. No, we don't like it either in medicine. Morbid is a bad word. We have conferences called Morbidity and Mortality, and that's where you basically own up to things that you've done a terrible job with or explain why somebody has died as a result of your care. And it's an awful thing to go through, and it's critically important to be able to evaluate yourself and understand what things happen when they don't go the way that we want them to. So it's an important exercise that physicians go through to, you know, review cases. Oh, I can only imagine. Yeah.

You know, I mean, especially if you're dealing with people that are broken apart. I mean, essentially, as an orthopedic surgeon, you're dealing with people whose bodies have failed, right? Your limbs have failed. Ligaments have torn off the bone. Knees have exploded I mean you've told me some gnarly stuff in terms of the kind of injuries that you've had to treat and I could only imagine some of them things yeah yeah and so your time doing this with placental stem cells how long have you been doing that it's been a couple years so essentially you did

mine i think how long ago was it i think it was july of 2015 yeah so i kind of came in pretty pretty early yeah jeff davidson the doctor from the ufc he was the one who told me about it because he had shoulder surgery and um he was very stiff and had real problems after the shoulder surgery and was just very unhappy with his range of motion and the pain that he's experiencing. And then he got some stem cell treatments and it just all went away. And he trains a lot. Yeah. He trains really hard. He's very fit.

I was pretty impressed with, you know, what he told me about how he was, what he was able to get back to after, you know, he had been treated with, uh, that type of injection. Yeah. Yeah. So he told me, and then, um, I was like on the fence. I mean, I'd seen an orthopedic surgeon and the only thing that was keeping me from getting surgery is, you know, he put me through all these, um, stress tests where he pushed down on my arm and all this, and I resisted all of them. And he's like, this is, it's kind of odd that your injury is this bad, but you have so much strength in your joint still. Yeah. Like maybe you should hold off a little bit before you get the surgery.

He's like, cause I thought that when I examined you too, because I really couldn't reproduce your pain. Yeah. So, and that, and that's, that's another reason. And I probably would have been in the same boat as the first guy in terms of, you know, trying to make a decision about surgery. Because, you know, if your physical exam doesn't, you know, show that somebody has some significant deficit, it's hard to make the jump to take somebody to surgery. Well, during normal everyday life, there'd be like zero pain. The problem is what I put my body through has nothing that resembles normal everyday life.

Between jujitsu and kickboxing and kettlebells and archery. There's just so much explosive movements and so much weight-bearing movements. You're doing really high-demand stuff. Yeah. So in that case, that was one of the reasons why I was thinking. Because I don't want to walk around with a compromised body. I'm like, if I have to just get surgery and then take six months of rehab or whatever, like what is the, for a type of shoulder injury that I had, what is the rehabilitation time? Um, you know, for sure,

probably three months. I mean, it can be longer than that. It depends on the patient. Somebody like you that one of the things that we have trouble with, with some patients, they've never even lifted weights, for example. So for them, the rehab, the recovery and rehab, we're introducing things to them that they've never seen or done. And they don't understand the difference between, you know, being sore and pain that they should be conscious about. And it's challenging. It's hard work. And it's uncomfortable. And so some patients, you know, they struggle to get through that part of it.

And it naturally will take longer to improve. So it's harder for them to get their motion. It's longer, much longer for them to return their strength. Now you already have like a significant baseline level of strength. So, you know, much easier in your case to bounce back. And then also the things that you would do in rehab, they're so rudimentary, you know, you would move through that very quickly. And then, uh, once you're at the point where you have had enough tissue healing and it's safe to progress you, you know, through higher level exercises, then you could really push it. And you would. I mean, you would be committed to it, dedicated, diligent.

I mean, we'd almost have to hold you back. Yeah, that was another question I had. How often do you have people where that is the issue? Like I know you've treated a bunch of fighters. And when you treat MMA fighters, is that an issue where you're trying to like slow them down? All the time you've got to let people know. And one of the lines that I'd say to all my patients regularly is you've got to respect biology. Like you have to allow the healing to happen.

I know you feel good. I know you're moving good. And you're ready to go. You want to be back on the court, on the field, things like that. But if we don't take the proper progression, you know, we risk having you re-injure and then you're right back in that same boat. We only want to have you miss the most limited block of time that you can. So I never want to – I don't want people to miss one more practice game, you know, match workout or whatever, then they have to, uh, but same time, we don't want to

put them in a situation that's unsafe. So it's always a, it's a balancing act. So in your time of doing this, have you had people that didn't respond to this particular type of therapy? Yeah, definitely. Yeah. And were they the people that we talked about before that don't exercise and aren't in good shape or is it across the board? So, you know, I would have to go back and look and kind of critically evaluate each case. Certainly, you know, we worry about the patient that has lower, like, baseline fitness, like

their overall health is poorer, you know, and what their response might be. But I think that's information that is still, you know, to come. But definitely, I mean, some of the people that have responded the most dramatically, like, for example, you and John Dudley, I mean, you guys are fanatical about your nutrition, you're working out regularly, you're doing all kinds of things to optimize your chance to not, you know, in this case heal, but in other instances perform. And I have to believe that that has, you know, that's a huge factor. Yeah. I would wonder what, how much of a factor it is if your body is conditioned in a way to constantly generate muscle tissue and breaking down and rebuilding and

it's always constantly under stress? Definitely has to be a part of it. You know, I think it's not the typical realm of my specialty to be looking at all those other factors. But I think with all of the information that's becoming available, one of the cool things for me has been it's forcing me to have to learn about it. It's forcing me to have to take a look at, you know, how can we do better? You know, what are we ignoring? And I think if you're not looking at every aspect of that wheel, then you're missing a chance to do as good as you can for each patient. And it might be things that we have to do before somebody even has treatment. We might have to bring them up to some baseline level with a number of different things, you know?

Um, and so, and the other side of it too, is we're, we're in a, we're in a system now where there's so much information, you know, one person can't be your source for everything. So you really have to have a good team all around you. Um, I think that's really important. So I find myself more and more seeking help and just saying, Hey, I just don't, I don't know enough about this. Like, can you, can you help me with this or explain it better? Or, you know, can I have the patient talk with you and, and maybe get some more information? And I think that may give them even better a chance to do well. Just because the options and the possibilities are so comprehensive. And time.

So, you know, in a typical orthopedic practice, you don't have a ton of time to go through all of this with every patient. And so you just have to make sure that you're providing resources and getting them as good information as available. One of the things I thought was interesting, you were telling me that there's been really good results with people going into a sauna directly after treatment. Well, I don't know that there's been good results. I think it's interesting, and the things that you've talked about for other applications in terms of heat shock proteins,

there's some belief that that may either assist the cells in proliferation or their ability to, you know, have as robust a response as possible. You know, that's not proven. That's hypothesis. You know, but I think it's interesting. And again, it falls into the category of a lot of these things that we're talking about where the science, the basic science is there. Like we understand how it happens in the embryo, in the developing child. We know what it does in a lab. Like we can add these things to a Petri dish and watch it, watch these changes happen. But nobody has demonstrated this in a human, in a clinical trial where we're treating an injury. So we have to be very careful about that. In fact, the FDA is very clear that we cannot be making those claims.

Companies can't be making those claims about their products, and physicians cannot be making claims and marketing their practice to drive people to them stating that these things are happening. Now, when you talk about heat shock proteins, I don't know if you can answer this question, but is there a difference between the heat shock proteins that you receive from, say, like a steam shower, like a steam room versus a sauna versus even a hot bath? I've heard people saying that you get heat shock proteins from a very hot bath.

And I think there would have to be some kind of biopsy or blood test and, you know, sample, like have people go through each of those things and control for all those factors. Right. But the whole idea is just being involved in an environment that's extremely hot where your body is like, what is this guy doing? And then it produces the heat shock proteins to try to compensate. Yeah, as a protective mechanism. So just the knowledge of this, I mean, this is really interesting because people have been using saunas forever and it was all sort of anecdotal. Oh, the sauna makes me feel great. And I would look at them like, well, what are these assholes doing? They're going to go in there and sweat. I always thought it was people that were just like

lazy and they didn't want to lose weight. And so they went in the sauna and they thought they lost weight in the sauna. Yeah, I really did think that. They're just dropping water. But talking to Dr. Rhonda Patrick, and she was explaining the benefits of sauna, where there was one study where mortality decreased 40% from all causes through daily use of the sauna. Yeah, all-cause mortality was less. Yeah, 40%. Here it is right now. Using the sauna four to seven times per week, associated with a 40% lower all-cause mortality was less. Yeah, 40%. Here it is right now. Using the sauna four to seven times per week associated with a 40% lower all-cause mortality

might be heat shock protein. ScienceDaily.com. Fascinating stuff. Yeah, you can click on it. Click on it, young Jamie. Here we go. Just get a little larger there. I mean, Journal of American Medical Association.

So serious stuff, right? I mean, it's a peer-reviewed journal. Yeah. You know, you can assume that there may be some validity of the information. Amazing. Yeah, I mean, if that's correct, if all I have to do is get in a sauna and I, you know, can decrease my chance of death from all, you know, all diseases by 40%. Like, yeah, cancer, heart attack, leukemia. Amazing. Here's a, what a suitable replacement. Hot bath won't be as robust, but can increase blood flow, elevate heart rate, increase heat

shock proteins. So she's saying it just won't be as robust. She's never taken one of my baths. So it's, you know, a simple thing to find out or like what you could do yourself is check your heart rate, blood pressure, temperature. You know, just like just take those as like a baseline. Right. After each of those, you know, sessions and see if there's difference. How much does your body temperature elevate during those things and how much of it is the surface of your skin? You can't elevate your core temperature too much or you're gonna have that's what i'm saying enzymatic breakdown like there's bad things are gonna happen yeah i wonder like what the line is the point of

diminishing returns where the sauna becomes detrimental versus beneficial yeah and i wonder like how cryotherapy comes into play with that as well, because cold shock proteins also show some great benefit in reducing inflammation. And yeah, it's just an amazing time for all the different options that are available to people. You know, I think at the same time, one of the things that we have to be conscious of is, you know, being responsible about how we use this information and what we're telling patients. And, you know, I think there's a lot of misinformation and a lot of people taking advantage of that. And so, you know, we want to try to avoid that. We want to try to give people good information so that they can ask the right questions and they can evaluate places where

they're going to see if they're comfortable with what they're being told and what's being offered. So I think there's something like 200 plus regenerative medicine clinics that have popped up in the last couple of years. Hmm. And that means at least 40 of them are bullshit. By my math. I mean, maybe. Maybe 80. Maybe more than that.

Maybe 90. by my math. I mean, maybe, maybe 80, maybe more than that. Maybe 90. Well, I just think people have to be cautious and careful about, you know, what they're reading, what they're saying. And some of these places have received direct letters from the FDA saying, Hey, you can't say that. Right. You can't be making claims. Um, so let's go over some stuff. That's definitely beneficial. Like platelet rich plasma, PRP injections. People have had real benefit from that, right? Sure. So that has some validated outcome studies.

There's a comparison study with PRP on tennis elbow or lateral epicondylitis, comparing that to corticosteroid injections, which is a common treatment for attempt to give pain relief. corticosteroid injections, which is a common treatment for attempt to give pain relief. In the particular study that I'm thinking of, they had, you know, 73% of the patients that received PRP had relief of their pain compared to about 50% of patients with a steroid injection. So that's a head-to-head study comparing treatment and, you know, the advantage seemed to be to PRP. Now, what is the difference between the results, I don't know if you even know this, between the results of PRP and Regenikine? I don't know much about that product, actually.

I mean, I know what it is. I know that it was going on in Germany. I know a lot of people traveled to Europe. Pete Manning, Kobe Bryant, all those guys flew in. Alex Rodriguez, I think. Dana White did, too the president of the ufc he went in there for tinnitus and you know and uh found through uh intramuscular injections there's a deep relief of uh tinnitus yeah so that i mean that's great and again there there may be great applications for all of the different things that fall into this category of biologic treatment.

Time is going to tell us what things pan out clinically to be best. I mean, you can look at all kinds of factors and we can draw conclusions from that. But ultimately, the proof is going to be when we have, you know, robust clinical studies that compare treatment. And, you know, we have follow-up physical exams and we have follow-up imaging to see exactly what's happening. So we know what we are hoping for. We know what we want to see. We want to see that, yeah, we have this cell that has the potential to differentiate into other tissue and actually causes healing. But nobody has demonstrated that yet. There are some studies. I mean, there's, there's 35 studies,

29 are animal, there's six, six or seven that are a human trial. I, I just saw this review paper and I don't, I didn't know if the review paper had been written before one of the more recent clinical trials was published. So one was on knee arthritis, and the others were on mostly foot and ankle stuff. The most recent is from USC and in combination with a doctor that's in Indiana. USC and in combination with a doctor that's in Indiana. And they looked at patients that had a knee arthroscopy and they resected part of the meniscus. So we call it a meniscectomy. And part of it was essentially cut out. So there was a tear, they cut out the bad tissue, they left the remaining healthy tissue. And they did an MRI and they measured on the MRI the volume of meniscal tissue. Then they injected the patient with a bone marrow aspirate.

So in this case, it was the BMAC or bone marrow aspirate. Which is stem cells extracted from bone marrow like the way Daniel Cormier had done? Correct. Okay. So they injected that into the knee. And then I think, I want to say it was four or eight months later, I think it was eight months, they re-imaged the knee and they found that there was a 15% increase in the meniscal volume. So the patients had apparently grown meniscal tissue.

I had a meniscus scope on my left knee from an ACL injury that I had. I had ACL surgery, but there was still some meniscus damage. And then at the time of the ACL injury, they tried to stitch up the meniscus. Oh, okay. They just tried not to cut it out. And it was a problem for me for several years. And then finally it tore. It became a bucket handle tear where it locks.

So it locked my knee out. Brutally painful. In the middle of a jiu-jitsu class. It was really bad. So I had to get it scoped. And then once I got it scoped, it was functional. But it would provide me with maybe every couple weeks it would be painful there would be something going on it would ache it would be a problem you shot some stem cells in there a year ago i've had zero

problems with it since zero nothing it's like like i don't even acknowledge that i have a knee that's weaker than the other knee anymore it doesn't even feel like that anymore. My left knee feels exactly like my right knee now. It's crazy. Like, I mean, for a decade plus, I had pain in that knee. One injection, a year later, nothing. And it was almost within two months, within two months after the injection, I felt like a significant difference. I was like waiting for those days because those days when I pushed it hard, particularly after kickboxing, there's something about those like hard pad work, like kicking the pads. I was going to say any particular things that you were doing that made it feel the worst. That was the big one. It was just striking. Because striking is just jarring

and there's just so much. And I just think there's just, there was laxity in the knee. Is that a word? Yes. Why does it sound wrong? No. I know it's a word.

I say that a lot. But it sounds wrong. No, I use it. It sounds wrong. It sounds like a laxative. It sounds like I'm making up a word. You know, I was laxity from my laxative. But that kicking motion would always, you know, and it would just hurt.

I would put ice on it. I'd just go about my day. I'd be like, well, it's fine. It's not swelling up too much. And now it's something you don't think about? Dude, it's zero. I ran a trail yesterday in the mountains. Like brutal, steep trail for two miles.

I have zero pain in it today. So this is the kind of thing that I think gets a lot of us excited about what the potential is. You know, you've got a patient here that you had a meniscal tear. So you had attempted a repair. We know that about 15 to 22% of those fail the meniscal repairs. You know, it's a disappointing number. You know, we like things to be much higher than that. But that's what the facts are. That's what the, you know, larger scale studies have told us. And to anybody that has a meniscal injury, that's a risk worth taking. Because if you know what it feels like to have a bucket handle tear and someone says,

hey, you have an 80% chance of success. You're like, I'm in. Yeah, I'll take it. Well, also for the, this is what we know. This is why we will take the risk. So for a young person that has the tear, you know, we want to preserve that meniscal tissue and for as long of their life as we can. So certainly you are willing to risk it. And even you sometimes might attempt to repair something that you think even has a lower chance just because they're young and you want to preserve that. Why you want to preserve it is we know that if you even resect a small amount of the meniscal tissue, like say up to 25%, it will change the contact pressure in the knee. So they do these, you know, color pressure studies where it shows you the amount of force and its distribution.

And with a normal meniscus, it's evenly distributed into the, you know, on the medial femoral condyles, the end of the femur, and then the tibial plateau is the top part of the shin bone. So when those come together with a normal meniscus in there, the pressure is even. If you resect part of that, now you see this point loading. So you see these hot spots where there's a much greater amount of pressure sort of like when you go to a restaurant and you're sitting at a table and it's wobbly and you have to stick a napkin under one of the legs um is that a bad analogy maybe probably bad analogy i'm not following you but you know what i'm talking about i've done that when you're eating it's like yeah and then the guy comes and

he kind of twists the one leg a little higher. Or he puts a piece of wedge under there. I know what you're saying. Yeah. I don't know. It's not the best analogy. If that makes sense for you, that's fine. I tried. I swung and I missed.

Let's continue. That's all right. But the point of the story is that we know if we cut part of that out, your cartilage is going to have some wear and tear over time. Now, whether or not you develop symptoms from that is hard to, it's hard to predict. Well, I'm pretty sure that that's what was going on with my knee because, because it was uneven and the jarring action of kicking a heavy bag or kicking pads. So I think the, what I was trying to get to, and I was taking the long path to get there was that, you know, in the past, what we might've said is, eh, you know, you had an ACL tear, you had a meniscus tear, you know, your knee's crappy, sorry.

Like, you're going to have some pain. And what are you kickboxing for at your age anyway? I've heard that. This would be the attitude, right? And really what that means is I'm uncomfortable because I don't have an easy solution for you. So I'm going to blame you for it. Well, there's also people wanting you to adopt their lifestyle or them to think that your

lifestyle is foolhardy. There's definitely that. I mean, I had a conversation. They're trying to find an easy solution so that you don't come back into the office and complain about something that we don't have an easy solution for. Also, I think they're trying to talk sensitive. That might be true too. In their mind, you know, like if you don't do martial arts and you see some knucklehead who's out there.

You have lower risk of having to come to my office. That's true. It's also, you see someone who's doing this and hurting themselves and you tell them, hey, look,

you've got to stop doing that. You know, because you think you're doing the right thing by telling them that. Right. But, you know, you're essentially telling someone

that all that stuff that makes you feel amazing. Yeah. Who alleviates stress, builds confidence. It makes you. It's part of your soul. Yeah. Yeah. It's you feel amazing. Yeah. Alleviates stress, builds confidence. It makes you. It's part of your soul. Yeah.

Yeah. It's a big part. Yeah. So how am I supposed to rip that away from you? Well, for some people it becomes a really, I mean, obviously with certain injuries. Yeah. But. Some people we have to have the hard discussion.

It's like, look, I know you want to keep doing this. I know you think you're heading that direction, but this is over. Well, when they do replacements now, because I know a guy who's got a knee replacement, and one of the things he was saying, actually, I know quite a few people. One of them was on the podcast. His name is Dan Pena, and he was saying that the problem is with his knees is they only bend this way now. They don't move side to side. There's no lateral movement in the knee.

Okay. Like there's no wiggle room. All right. Well, like you can't go side to side. Like the knee just goes straight up and back like this. Okay. The artificial knee. Does that make sense?

No. You got skeptical hippo face. Well, there's... It depends on a lot of factors. Maybe for him. There may be other patients that don't have quite as much stiffness in their knee. But no one who gets a hip replacement is doing triathlons. They shouldn't be.

Or a knee replacement, rather. They shouldn't be. Yeah. So it's limited use. With 100% certainty, that implant will loosen and fall apart. Huh. Why can't they make a knee, a fake knee? That's as good as a real knee. Hmm. That's a long question. Are they lazy? No, I wouldn't think so. Certainly, uh, certainly lots of motivation and, uh,

you know, economic reward. Oh my God. If they could fix a knee and turn a knee into a superior knee to the knee that you have now. So, I mean, it's like an overall question, right? Why can you not replace something better than you can repair it? Wouldn't we want to be going more towards repair and renewal? Right. Regeneration would be the best. We're hoping that we can, you know, figure something out for that. But that's what's interesting. The knee replacement, you have a metal component that you're either, you know, cementing to the bone or you're,

you know, applying it to the bone and having bony ingrowth into the implant. So there, there's an interface between that implant and the body and to come up with something that would never allow that to separate. I mean, that's, you know, how would you do that? Yeah. I know a guy who had bone cancer. It's a really kind of a terrible story, but he lived near a golf course and the golf course used these horrible pesticides, and it leaked into the groundwater, and all the people in his neighborhood got cancer. Like a huge epidemic of cancer in his neighborhood, and he got bone cancer. And they replaced one of his femurs with a metal rod, and it causes him significant discomfort. We did some of those in my training.

Did you? It's a pretty gnarly surgery. What's that about? Talk to me. Total femur? Yeah. I cut someone open like a fish and stick a new leg in there. You literally do.

It's an incision about that long. Whoa. He's making his arms about, what, spread your arm about four feet, three feet? Well, it's the entire length of however long your thigh is. Aichi. Wow. Yeah. Okay.

It's gnarly. Yeah. They all get infected. They doihuahua. Yeah. Okay. It's gnarly. Yeah. They all get infected. They do? It seems like it. Wow. Now post-op, like right away or you mean in time? Over time.

Yeah. Just because your body's rejecting it doesn't have to do with it? It's not really rejection. It's just you got this big hunk of, you know, this sort of slime layer that can't be, even with antibiotics, you know, blood can't get to the metal. So you form this layer and then it's just, once it's contaminated, you can't control it. Whoa. So the metal on the leg, the fake leg, just gets slimy? Not so much that it gets slimy. It's just the stuff that's produced

by the bacteria adheres to the metal. Oh. And it's just so much metal in the body. There's so much opportunity. Do you know what I mean? Yeah. So what do you do when it gets infected? Gotta open them up again? Clean it up? You do. You try.

But the end of the line is the limb has to go. Whoa, daddy. Jamie almost threw up. You got an image? Pull it up. Pull it up.

You're a doctor. How dare you? How dare you say don't pull it up? This is what you do, man. I'm feeling bad. I didn't have my pictures ready. I didn't know we were going to get the total femur. What?

Go large with that, sir. Why? I want to see that. I don't even. Holy Jesus. That's making me sweat. Whoa. My God.

First of all, what am I looking at there? So that's the femur. That's a metal femur. Just Google replace femur and look at the first picture that comes up. The legs opened up there, and you have to make measurements. And so it's basically a total knee and a total hip, and then all of the bone in between has been replaced with that metal. Wow.

And then your foot's just attached to your regular shin below it. Correct. And what is this normally used for? Like how often? What is this? So that would Like how often, what is this? Uh, so that would be in the case of, uh, infection and you know, there's the cases that we had were usually multiple fractures below a hip replacement and then, and then below, uh, a longer stem hip replacements. Finally, you've got just no bone. The other reason would be infected bone that you

had to resect. And then still another reason would be in the case of tumor where you're doing limb salvage. Yeah, that was this gentleman's. Now that one above, Jamie, where it's got like they're spreading it apart far. Yeah, right there. What's going on there? What's all that stuff on the outside? That orange stuff? Oh, so that's called ioban and it's a thin film that we cover over where we're making an incision in surgery. It's to help prevent infection. So we naturally

have staph and other bacteria on the surface of the skin and you put this sticker cover on top of the skin and then anything that's around the wound is contained. It says play video. I think you should listen to them. Click on that. Let's see what that is. Yeah, let's around the wound is is contained it says play video i think you should listen to them click on that let's see what that is yeah let's see who this is oh it's just a picture that that says that i can visit page click play video there we go oh i'm scared you

nervous oh daddy whoa boy, that seems really odd. I like to do surgery through incisions better than about this big. Yeah, little tiny incisions. Now, that seems odd because that seems like a very old person. Like I'm looking at the lack of muscle tissue, either very old or very unathletic. Yeah. And this is like – It's a good evaluation.

That's incredibly traumatic then. I mean, that's – how does someone recover from that? It's slow. Now, is there a potential use of stem cells in the case of like, is it possible to regenerate a bone? I know they've built a woman a artificial bladder through stem cells. Theoretically, bone is one of the tissues that is a part of that line of the mesenchymal stem cells. Right. That's what I'm saying. That comes from the mesoderm.

So you think that could be something down the line that they could be able to accomplish? I mean, replacing that femur and its cartilage covering at the knee and the hip, I mean, I think that's, at this point, a fantasy. Yeah, but isn't that what they said when, if someone came up to the person that had the telegraph and said, hey, do you think one day I'll be able to send dick pics from this thing? They're like, well, right now, that's a fantasy. Right? Don't you think? Probably.

Most likely, you know, they would look at you like you're a crazy person. Well, when I was, this is an embarrassing story to admit but when i was about 13 i went next door to my neighbor's house and he was kind of a computer nerd at the time but you know computer nerds at the time were playing with like commodore 64 right and he's like dude look at this um i can hook my computer up to the phone and i can type on the screen and my friend down the street will see what I wrote. And I was like, that's the dumbest thing I've ever heard, dude. Can we like go play football? Like, what are you talking about?

So apparently I'm not a very forward-thinking guy because obviously we're doing that quite a bit now. I had a Showtime special in 2005, a Netflix special actually that eventually wound up on Showtime. Showtime special in 2005, a Netflix special actually that eventually wound up on Showtime. But I had a joke in there about cell phones, about people sending you a text message. And the part of the joke was like, it takes you four presses to get an S. Right. Like, why don't you just call me? Because like it was before anybody had figured out how to make an actual keyboard. And I'm like, why are you making me read? Like, this is so stupid. I thought it was just like a dumb trend that was going to go away.

And now if someone calls me, I'm like, what the fuck are you calling me for? Like, it's very strange what's happened in just 12 years. Yeah, it's a total shift in how we communicate with people, right? A massive one. I mean, how disruptive to your life is it to have to like send emails now i mean to sit down and like type and eat like email respond back so many emails you like people email me with like a bunch of questions it's a big chore it's like homework i gotta sit down it takes a lot of time yeah whereas you know a text is like a quick response

like hey i don't know i, I'm so used to email. I send a lot of emails. I have so much email. Well, I do all the booking for this show too. I mean, well, I have a guy, Matt Staggs, who contacts people, but I reach out to a lot of people as well. So like a lot of the booking and the different things that I do, I contact people. Sure. And, you know, the best way to do it is through an email.

It's like, hey, you know, I would really love to talk to you about this or that. I have a question about that. But these are brief emails, I would bet. Sure. And, you know, the best way to do it is through an email. It's like, hey, you know, I would really love to talk to you about this or that. I have a question about that. But these are brief emails, I would bet. Sometimes, yeah. But I've gone, I've had some, yeah, that's the problem is the volume. The sheer volume I get is just unmanageable to the point where people think I'm ignoring them. I'm like, man, I'm not ignoring you. I didn't even see it.

It just got lost in the tsunami of emails that came in. Like if I go on vacation, I hardly communicate. I barely do anything. Maybe I'll put up a social media post and, you know, just to like, because it's kind of a part of the job, right? But I don't pay attention to emails. I just leave them alone. And then I get home and I'll go, oh, my God, there's 2,000 emails. I'll have 2,000 emails in a few days. I'm not, I'm not exaggerating. Do you go through all

of those? I do my best. I look for my friends. Yeah. You know, I look for people that are important and, uh, look for, uh, acquaintances that I like and, you know, work related stuff. Yeah. But it's a mess. I have several email accounts too, which helps. Like people that are important to me get the big one. You don't get the bad one. I don't know. Don't worry about it. I like you.

I don't think I have any. If you do, I'll give you the real one. Just want to let you know. I won't tell anybody. People don't like to be on the outside. You tell them about that and they're like, which one do I have, bro? Yeah, right. Why worry about it, man?

What list am I on? Why worry about it, man? Yeah. Yeah I on? Why worry about it, man? Yeah. Yeah. If you have to ask the question. Yeah. It's not good. I wonder when it's going to pass what we're doing.

I mean, when it's not going to be this. It's not going to be typing. Like, what's the next thing? What is, you know, it's definitely not going to be videos where you force people to watch. The beautiful thing about an email is I can kind of scan it through. What's this guy saying? Not interested.

Next. Have you messed around with like dragon dictation? Yes. Yes. It's amazing for notes when you're in a car or when if I have an idea in my head and there's no way I can type it on my phone that quickly. Have you ever seen how good it works? No, it's very good.

Yeah. No. Well, just what comes with your phone. Like the most recent versions very good. Yeah, no. Well, just what comes with your phone. Like the most recent versions of it. Yeah, like this right here. Check this out. Dr. Roddy McGee

is an amazing human being. He has fresh breath and his hair is wonderful. Look at that. Perfect. Perfect. Perfect. Yeah, 100%.

That's incredible. That's pretty good. I mean, it really is incredible. And you could do that in your car if you have an idea so you're not some asshole that's texting. Because sometimes, like Neil Brennan had the best analogy for it. You know who Neil Brennan is? Stand-up comedian, co-creator of the Chappelle Show. He had the best analogy.

He goes, my notebook is essentially like a net for catching ideas. And you've got to catch those ideas as quick as you can. you can i'm like oh it's a good way of looking at it so like if you're if i'm in a car and i have an idea i'm like oh my god i got to get this out before i forget so i start repeating it to myself and then if i'm at a red light or something i'll press that record button very responsible of you i'm i'm very responsible when it comes to texting and driving. That's good. I just, I think that is one of the most infuriating things. It's fucking terrible. Yeah.

It's like, you're going 60 plus whatever miles an hour. The amount of distance that you cover in a glance where you are not looking at the road and things can happen at any moment. Yeah. Just to me, it's super disturbing. Yeah. Anyway, it's super disturbing. Yeah. Anyway, back to the grind.

What do you got there that you would like to cover? Well, so, okay, so we touched a little bit about, you know, all of the elements of the care of the person, right? So it has to be more than just giving you a shot and sending you on your way. Right. If you truly have an injury and we're trying to recover you, then what also comes along with that is the appropriate rehab protocol. And none of those are defined yet for, for what some of these things that we've done. Um, but we're trying to develop that and, and dial it in and hone it down for me, for me right now, the easiest thing is to try to adapt it from a surgical rehab. And I'm not a physical therapist, obviously,

so I try to collaborate with those guys and girls that are smarter than me in that avenue. But the principles are the same, right? So you have an injury that you're trying to heal. Now, in some cases it's, you know, we've created the injury or we've done the, the thing that the patient has to recover from. In the case of an injection, you have an injury, you've, you've done the injection and now we need the effect to happen. Um, whatever it is that we're hoping that will be so, but then you can't ignore the fact that if somebody has a bad shoulder, well, we may decrease the pain, but if their motion is poor, if their strength is poor,

if it's not functioning correctly, then how can we be achieving the best result if we're not also attending to that? Right. So it's a multi-step. No doubt. And then the more that we're learning about all these other factors, I mean, like again, for you, I mean, you're paying attention to your sleep, you're paying attention to your nutrition, you're on, you know, a variety of supplements that are, you know, meant to help a lot of these processes. And I think we're going to get better and better at it. Diet has got to be pretty critical as well, right?

It's got to be hugely important. Especially like staying away from inflammation, enhancing foods or inflammatory foods. Yeah, no doubt. So yeah, I think it's got to be critically important. And we try to share that information with people. There's for athletes uh like a website that you can pull up and we can share is the college and professional athlete uh dietetics association i think it is collagen professional college and professional athlete i was like what collagen professional athletes i don't even know what that means. We all have collagen. Right. Collagen. Yeah. So these guys have some great information and good infographics that we utilize. That looks good.

I'm not a dietician, so I have to rely, again, on people that have good information. I think these guys have a good, reliable source, and they've got great infographics if you go to educational resources there you go yeah so this will pull up some different things. Balancing exercise-induced information. Now, here's a good question because it's pretty much universally agreed that rest, ice, compression, elevation, all those different things that people have said in the past, that there is benefit to particularly icing things. But there's some debate. Yeah, there's a lot of debate about that.

Right? There's some debate now. There's like a definite anti-ice community out there. Yeah, what is that? Do you think it's legit? Well, there's not a downside to it. To ice? I don't think so.

I mean, we've used it regularly. And so, I don't know. There's definitely a group that, and I don't know all of their arguments against, but. Misha Tate, the former UFC Bantamweight champion, she had a podcast with this guy who was the anti-ice guy.

Yeah. Like, that's his whole thing. Is he a flat earth guy too? No, but he doesn't believe in dinosaurs. He does not? No,

I made that up. Yeah. It fit. I don't know. I mean, so you, I believe he's a doctor, but he,

you know, he might be a fucking veterinary works on cat infections or something i don't know but he i don't think there's a downside i'm kidding about that too so in my opinion you know i've definitely had athletic injuries uh i was a pitcher previously we routinely iced our shoulder and elbow after pitching um i did it as a matter of routine it felt good it felt better when i did it right when i didn't but here's the question it felt good at the time but it is that feeling good in any way slowing the healing process hard to know i mean that's where it gets weird right yeah i don't know to be frank god damn it

you're supposed to know you're the you're the fucking super genius doctor guy if you don't know we're doomed get back to me so uh what else i'll get you some good information thank you appreciate it what else you got here um so know, I think one of the interesting things about this whole topic and the possibility of healing from utilizing this type of treatment is how it allows you to go through the process of healing without this fibrovascular response. So the typical healing cascade has an inflammatory phase, proliferative phase, and the maturation phase. So in the inflammatory phase, you have neutrophils and white blood cells and these enzymes that are present that are trying to start the process. Then in the proliferative phase, you're having what's called angiogenesis. And that means the development of new blood vessels and vasculature to the area. And your body's producing fibroblasts and you're laying down

tissue in this sort of haphazard manner. So it's just kind of piling on in there. So it's just kind of piling on in there. Then the maturation phase is when you have remodeling. So that scar tissue is changing over time and developing into tissue that's more like or is the native tissue. So that occurs over a period of time. And then a lot of times during that process, before you're fully matured in the healing, you're back to activities. So let's just take an example. Like when you sprain your ankle and then you start feeling better and maybe you go back to basketball within a couple weeks.

At that point, if you've actually torn one of the ankle ligaments, you don't have native ligament tissue that's the same structural properties. It's not as strong. I mean, you might be developing the strength around it, but it's not like the native tissue. Now, the hope is that we can demonstrate. Now, we know that this is the science. This is what it's supposed to do. This is what it does in the developing fetus. We see it in kids. You know how when your daughter was real young, she scratched her face. They heal like Wolverine. It was like gone like the next day.

So healing without scar has to do with not forming this fibroblast or fibrovascular response and, and fibrotic phase. Now, what the cool potential of this to me is if we can skip that and we can have more complete healing and quicker resolution to the native tissue, then you're going to have those, the same properties. You're going to be stronger. You're going to be better, you know, technically and hopefully, you know, clinically this pans out that you would be more resistant and lower risk for repeat injury. Because that's really our goal is in treating patients is get them back to their activity and decrease the chance that they have to miss more time. And how do you know how much to inject into these? Nobody knows. Oh, Jesus. Nobody knows that. This is one of the big questions that will be discovered with, again,

rigorous studies where we can look at what should the dosing be, what should the frequency of the treatment be, and what should the protocols before and after be. It's not defined. And anybody that's telling a patient that they have exactly what it should be, I mean, be wary of that because that has not been discovered yet. So we're trying to, we're trying to take, you know, we're taking the information from our experience and applying it that way. It's, it's not the, it's not the best way to go about this. And it, it's one of the things that PRP suffered from is that all of the things, everybody was using it for so many different things and, and just kind of hoping that it was the magic bullet, that it was going to treat all the things that we had difficulty

treating. Um, and even all of the studies that were coming out, you know, people were using different centrifuges and applying it for different reasons, different protocols, just a mishmash of information. It wasn't valuable. How does platelet-rich plasma work? So it has growth factors and cytokines and the platelets release proteins and things, and those things help mediate that inflammatory response and help the healing process. I mean, that's kind of the basics. Do you think that they could work in a symbiotic fashion with like this kind of... There's information that adding PRP to some cellular treatment like bone marrow fat or the placental tissue and that line of treatment can help expand the cells. Ooh.

So that gets us to an important point, which is expanding the cells has been done and is not currently legal in the United States. So there was a place, and they do it in other countries, but here, if you more than, this is a mouthful, if you more than minimally manipulate the tissue, then that is not under the guidelines of the FDA for use of human cellular tissue products. So they were taking, for example, bone marrow and plating it and growing more cells,

bringing the patients back two weeks later and injecting them with this, you know, super production of cells, which probably is great. But we don't know. We don't know if that's safe. And that has to be, you know, that has to be taken through the appropriate process. So you can't necessarily recommend someone taking PRP while they're taking some sort of a stem cell injections. So here's the difference of that. Okay. A manufacturer can't say that we have a product that is a combined PRP stem cell injection.

Right. And it does this. Right. That's illegal. But if you are a patient. I can't put on my website. Right. I have the magic potion.

It's PRP and amniotic fluid and tissue. We inject it and it can heal anything. I admire how responsible you are, how you keep cutting me off whenever I was suggesting some ridiculous thing. But would there be a benefit for a patient, potential benefit, who is getting stem cell injections and also gets PRP at the same time? Or is it just theoretical? It's theoretical right now. Yeah. But potentially. Definitely.

There's potential and it's encouraging to, you know, that the possibility is there. It appears to be safe there. You know, we don't have adverse reactions to it. We don't have adverse reactions to it. And the point that I wanted to make is that a physician can prescribe something and use it off-label. Right. So the FDA doesn't regulate the practice of medicine. I can do that in my office, but I can't make claims about it. And I can't put it on social media and on my website and say, if I'm going to do this and I'm going to fix your shoulder,

like come here if you have a meniscus tear, because we do this injection and it's going to make you better. That's illegal. I understand. So, but I, if somebody comes to my office, you know, I can elect to do that because both things are available. We have permission, you know, to use them, but we're using it off-label. I understand. Now, when you say maximize cells, that's the term you used? Maybe. What is it?

The term you used about PRP in conjunction? We think that it can increase the proliferation of the mesenchymal stem cell. Oh. PRP in conjunction? We think that it can increase the proliferation of the mesenchymal stem cell. Oh, and how much of a time period would it have to be between the injection and the PRP? That's undefined again. So what would you assume? The way that we're doing is we would do the injection at the same time. Oh, I see. Yeah. Putting it in there together. So we only have a narrow window from when we take those frozen cells and then we thaw them. You know, we have a short window when we can then inject them. And then there's, you know, maybe between 7 and 21 days that those cells are viable in your shoulder or your knee, wherever we inject it.

So if someone gets that injection and does PRP, they would have to essentially get that done within those 7 to 21 days to have some sort of a benefit of what you're saying. Theoretically. Yes. That, yeah, that that's, uh, that's how I would do it currently, uh, based on that information. It's fascinating stuff. Yeah. What else is out there? Well, so, um, we just, I thought it was important to talk about the, it's called section 361 of the public health service act and this is the definition from the fda on the use of human cell tissue and cellular tissue products so it has to match these criteria so you have to have minimal manipulation that means you can't add things to it you can't combine it with other stuff. You can't, like I was saying, you can't, you know, put it in the lab and grow it and add things to it and then bring the patient back and

treat them. This isn't part of it, but you can't treat patients on a different day. It has to be at the same time, whenever you're harvesting the cells or utilizing whatever it is you're using. whenever you're harvesting the cells or utilizing whatever it is you're using. It has to be something called homologous use. And what that means is whatever tissue you're taking has to have the intention of the purpose of that tissue for when you put it into somebody's body. So, for example, if you have a fracture that's not healing and I take a bone graft product, so cadaver bone, and we're going to use that to help heal your fracture that hasn't healed, that's homologous use. We're taking bone, we're using it to become bone or to be the scaffold for bone to heal and grow. row. So it can't be combined with something else. And it can't have it can't be intended to have a systemic effect. So now, all of these things that I'm explaining, these are rules for manufacturers and what they can, what the rules are for them to be able to market their product. So for example, you can't take amniotic fluid and say, this is a

product meant for IV infusion for treatment of whatever, diabetes. Right. And that is something that people do in other countries, right? They're doing it in other countries. You can't do that in, you technically can't do that. You can't manufacture a product and put that on the labeling, but that's what it's intended for. But do they do that in America, IV stem cells? I've been told by patients that they've gone to places that have suggested to them that that was going to be the treatment. Right. And what is going on there?

I'm not aware of it. How does that even work? Do you know? It's not your wheelhouse? No, and nobody knows if it does so it's just experimental it is i mean all of this do you know boss rootin is former ufc champion do you ever treat him i have no allowed to say that um boss i don't think i can say talk about any patient that unless uh they tell you you can set it or they're sitting in front of me talking

about it anyway okay yeah i give you permission. It's HIPAA violation. I understand. I just want to say for the record, I give you permission. Boss Rooten went to, where did he say he go? To Peru or something like that? Went to the jungle. Some dude killed a chicken and then shot some stem cells into him. Chicken blood right in his vein.

He was saying it was fucking amazing. Have you ever heard Dwight Boss talk? He's like, it's like the energy was coming out of my body. Like, ah, he said that he literally felt like, like some guy in a Kung Fu movie where energy was like shooting off his fingertips. He said it was amazing. Like the emperor. He's not the only guy that said that, you know, Dan Bilzerian. Do you know Dan Bilzerian is the Instagram guy with the boobs and the butts he told me the same thing he said that when he got it done he said it's amazing he goes to Mexico to get it done hmm not

recommended but this is he can't talk about it off air he'll be a little chatterbox just you wait maybe Yeah, maybe. Well, what I'm interested in, what I was thinking before you threw me off there, is he going with a specific intent of treating something or is he just like looking for the fountain of youth? I think he fucks so much. He doesn't have any sperm in his body and he's trying to kick I don't know yeah that guy's an animal but I think he's got a series of injuries I know that because he's had regenechine for his neck he put it up on on Instagram like with Instagram stories he was videoing himself while he was getting injections in his neck which I I've had. Regenicine injections, yes. It cured my cervical disc bulge.

What? Yeah, yeah. That and disc decompression, spinal decompression, you know, with like a harness where they're pulling on your neck. I had a bulging disc in my neck that was pushing on my nerves. Yeah, completely resolved. Like on an MRI, it doesn't exist anymore, where I was getting numb hands because the ulnar nerve was being pressed upon.

Yeah. Yeah, it works. That's nuts. Well, some massive anti-inflammation properties. I just don't think that it has the same healing potential. It seems like it reduces inflammation in a giant way. What's going on with, by the way, I had Regenikine shot in my knee too. That's what you told me.

It didn't really have the same effect. It worked a little bit. So patients like yourself that have had a number of injuries and a number of treatments, one of the things that's got me enthusiastic about the potential of all this is when somebody tells me, look, I've had this, this, this, this and this and then i had this what we're talking about and that it was just completely different game changing i'm just 100 better and different look my right shoulder is not 100 but it might be 90 you know and it's strong as fuck like i could do a lot of shit with it like it doesn't you do some insane stuff yeah yeah and it's it doesn't bother things that i probably wouldn't recommend but no pain like

why you can what i could do um i take these 90 pound kettlebells and i do windmills with them where you you know you're pressing overhead you know what a windmill is i do yeah dropping down like that so your shoulder's rotating i don't do that with 90 pounds but i know what it is but the if the fact that i can do that with a shoulder that was on its way probably to getting surgery on is just amazing. My bow. Probably the most impressive thing was that push-up with the wheel thing. What's that thing called? Oh, the ab wheel?

No, it's like a little roller that you had your hand on. Oh, yeah, those things when you go forward. Yeah, what's that called? The comfortable Havoc creates it. They're sliders, you had your hand on. Oh yeah. Those things when you go forward, what's that called? The company of old havoc creates it. There's sliders, havoc sliders. Okay. Uh,

H A V Y K sliders. There's a video of it on, see, there's a video on my Instagram, Jamie, um, from quite a while ago, but it was post,

post, excuse me, uh, injection. Um, it's from way back. I want to say at least a year ago I was doing that, but, um, yeah, there's my range of motions a hundred percent. I mean, at the most it's uncomfortable

in certain things, but for a big one for me was archery because, um, you know, I really enjoy it. I do it all the time and it's very meditative to me. I just love archery. So for me, like, the idea of not being able to pull my bow back, it was really disturbing. I was like, God, I'm going to have to get the surgery done. Yeah, you've been pretty committed to it for a while now. Yeah, and I'll shoot 100-plus arrows a day,

and I'm pulling back 84 pounds. It's an 84-pound compound bow, and I'm shooting it 100 times a day and it's no pain i did it yesterday oh like for hours me and my friend cam haynes who you know you met yeah who came to and talked to you as well um you kind of indirectly got me uh into it i don't know into archery through john john dudley, I know. You're shooting all the time now, right? Yeah, so John got me this unbelievable, you know, Hoyt carbon spider bow. It's like, if you want to see any of my friends, like, make the greatest faces you've ever seen, I just pull this thing out, and it's like, you know, some space-age weapon.

It looks like a bow that Batman would have. Yeah. Or Chewbacca. Yeah. Or Chewbacca. Something like that. I would say Batman, but yeah. But yeah, those bows, they're amazing.

It's incredible. And I've only been able to go a couple of times, but I'm definitely hooked. It's the most amazing meditation. I love it. It's because it's you, when you're focusing on that shot, you literally have no room for anything else. It's, it requires so much concentration. You're concentrating on the front hand position, front shoulder position, where, where the string touches the tip of your nose, the corner of your mouth. And, and John is just an amazing coach yeah so you know totally unfair i get that's the bow the first bow that i get to shoot with and then

john gives me the first lesson that i've ever pulled a bow back he's standing there right with me he's an olympic coach by the way he used to coach the olympic team he's amazing yeah i mean he that guy can take he's a great guy too. And he can take years off of people's learning. I mean, he's absolutely taken years off my learning curve. Yeah. I'm going to sneeze. I hate when you say you're going to sneeze and then you put a lot of pressure on yourself.

And you're like, man, I might not. I just look like a weirdo for a few minutes. Did you find that video? No? It's in there. I swear to God. So here's another kind of crazy thing about the placental-derived treatments is that they actually have antimicrobial properties.

Whoa. So this is crazy. I mean, we kind of know this, you know, one of the functions of the amniotic membrane is to protect the developing baby, right? Mm-hmm. But, and one of the things it does is protect it from infection. But what they were able to demonstrate was that when they they've actually introduced bacteria like literally injected bacteria onto these membranes and then they come back and and check and it it

it has destroyed the bacteria so huh so ability to resist scar formation, move through the fibrotic phase of healing, and then also the antimicrobial properties. It's pretty amazing. So that would be super beneficial post-surgery, right? Because that's a giant issue, staph infections and the like. It's one of the things that, you know, frightens us most about, you know, doing our procedures is, you know, can we prevent infection? doing our procedures is, you know, can we prevent infection? Yeah. It's a giant issue where people, I mean, I know because of the nature of, uh, martial arts, it just, everybody I know is at surgery, like pretty much. And the big issue is post in, uh, post surgery infections. Yeah. Well, those guys are, they're getting abrasions and everything like that on the mat. So then they're colonized with MRSA or any number of whatever funk is in that gym. I tell everybody, if you are a grappler, this is super important,

I want you to look up Defense Soap. Defense Soap is a soap company that was created by my friend Guy Sacco. What is it? It is all natural soap that promotes healthy bacteria it doesn't destroy the healthy bacteria but it's all tea tree oil eucalyptus oil this shit is amazing and i used to get i've gotten staff at least twice i used to get ringworm all the time well not all the time but got it a couple of times and until I was like super diligent about washing myself like immediately afterwards. But once I started using two things,

probiotics, which is huge, um, acidophilus, eating yogurt and drinking kombucha. And then the next one was defense soap. Probably not, but it's, it's a little bit of something. It's a little bit of something. I's a little bit of something. I just think it's good to have probiotics. I like kimchi. I try to take my probiotics in multiple forms. This stuff that I was drinking when you got here, kombucha, I love this stuff. I drink it all the time. Is there a particular flavor that you like or do you mix them around?

Well, you've got to be careful because I'm a low sugar guy. So like the grapes, there's some of them that are delicious but they have a lot of sugar sure this this multi greens does not have a lot of sugar and let me see what it's got i think it's something like 10 grams per serving or something like that really that sounds high i think i've seen them lower oh two yeah that's two grams so yeah that's what you want the grapes high. Mm-hmm great business But the tastes wonderful, right? It does taste yummy. That's the problem This does not taste so good But you know you're getting something good in it and this is the important your way through it The important stuff is that you get the strong kombucha. This is the brand that I really like I don't work for them

They're not a sponsor GT's kombucha GTS. This stuff is awesome, but you have to be over 21 because it has more than one half of 1% alcohol by volume because of the fermentation process because it's so strong. I see. So they make you show your ID. Interesting. They actually pulled it from Whole Foods.

I don't know if you know this. See, I thought that's where I've seen it. Yeah, they have it back. But they pulled it from Whole Foods until Whole Foods had to put some regulations in place to keep... You would literally, if you were eight years old, you could drink one and not get drunk. I mean, it's not like you're going to get drunk off of it, but

just due to regulations, you have to have a certain... Letter of the law kind of thing. Exactly. What else you got? Got a lot of papers there, buddy you got drawings and shit charts and graphs have to think about probably a bunch of stuff you say don't let joe talk about this don't um what other questions have you come up with along the way one big question i wanted to talk to you about was something that i had a discussion with Dr. Davidson about recently. And Jeff was telling me that the most recent procedure with stem cells is injecting them directly into the discs for people that have

degenerative disc disease and that there's some really promising results. I've heard anecdotally of a number of very positive outcomes with treatment like that. That's amazing. Again, you know. Too early. I love the fact that you're very conservative about this. I really, really, really do appreciate that. Although I'm giving you a hard time. I've really wrestled with it because, you know, again, our whole training is based on, you know, we need to do things that have an evidence base for our patients. I mean, this is kind of the foundation of what we do.

And so, but we're in a unique situation. So we have patients that, one, this stuff is available and it's legal to do, and it's there and people know about it now. So they, they're seeking the information, they come to us. And even, you know, even before we started talking about it, you know, it started to be like here and there. And then all of a sudden it's like two, three patients a day now, even more are saying, well, what about, what about stem cell? Can I have stem cell? And, uh, like, okay, well, you know, then we have to back up and like have the whole discussion, like, okay, well let's talk about what that is and what maybe it can do. And,

um, so people are seeking the treatment it's available. Um, but we don't know, we don't have a lot of information. So we just have to be forthcoming and say, look, this is experimental. We've had encouraging early results. I can tell you anecdotal stuff. We've even seen images where somebody had, you know, full thickness rotator cuff tear. Eight months later, what looked like a healed rotator cuff on an MRI. Now, did that happen on its own? Well, we know that that happens at a lower percentage,

but it is possible to heal. It's just a lower percentage. Did it happen because of the treatment? You know, that hasn't been established. So I have to really explain all that. And the other category too, that patients will come and they'll explain an injury. And I've had to turn away a lot of people that were fully ready to come in and have treatment. And they were fine with paying out of pocket because, of course, it's not covered by insurance because it's experimental, because there's no data yet. That's not true. There's not no data, but there's not enough data to support treatment for, you know, certain conditions. But, you know, I've had to tell people, I don't think this is appropriate even to try, even if you want this.

And usually the category is, excuse me, if it's something mechanical. So I think this makes intuitive sense to people. So for example, had you come to me and you said, Hey, you know, I dislocated my shoulder seven times. And can you just put an injection in there? Well, the problem with that is that the in that case, in this example, the ligaments of the shoulder have been stretched and disrupted. And in the case of a dislocation, there's oftentimes a labral tear that comes with that. Now, I don't believe, and I could be proven wrong over time, but I just don't believe that an injection on its own would magically decrease the volume of the capsule, you know, tighten the static structures in the shoulder and resolve

the pain for that patient. Now, let me stop you right there while I still have this in my head. Sure. I believe there was something that came up a few years ago where they were doing something where they were heating up the inside of the capsule and shrinking. Thermal capsuloraphy. What is that? It was very popular. Was. You said was. Yeah. Now it's close to malpractice oh jesus yeah so it's interesting the way these things go so there was a huge wave of um interest in this and essentially what guys would do is they're looking inside the shoulder you have a radio frequency wand and you're using that to heat the tissue and you can watch it literally shrink in front of you. Then Richard Hawkins is a very

accomplished orthopedic surgeon, kind of iconic guy that's done tons of research. He was also went in Vail, Colorado, now in Carolina. And he published a paper that showed a very high rate of failure from these procedures. And so as a result of that, it's fallen out of favor. So, but it was done very frequently on lots and lots of shoulders now high rate of failure was like 40 percent okay but here's the question is that because you're talking about already compromised joints right which is a very complicated joint the shoulders very joint. There's certainly a number of reasons why that could have failed, but there was a lot of problems with basically damage to the tissue from the radiofrequency. Oh, so it was weakening things.

Yeah. I see. Yeah, so that went away. What was the benefit of it? Well, you could watch it, and you were seeing the decrease in the volume of the capsule. So where structures had become loose, you were watch it and you were seeing the decrease in the volume of the capsule. So you were where structures had become loose. You were seeing it become tight at the time zero period. What about doing that in conjunction with some sort of a stem cell therapy?

Does that make sense? Yeah. I should be a doctor, right? You're very close. You're only 10 years in close. You're only – Ten years in school. You're only 14 years away. 14.

Yeah, that's all. 14 for regular people. Give me 20. So why did they think that it would work in the first place? What was the idea behind it? There's early published papers that were saying that the outcomes were better if you used it. Wow. So it's murky.

I mean, there's things that over time we discover that what we thought we were looking at, you know, we didn't fully understand. And how long did it take before it became malpractice or problematic? That's an exaggerated term. Problematic. I don't know the exact year that his paper was published, but it was before my residency training. I graduated medical school in 2006. So it was before that that people weren't doing that anymore. Okay, so I'll bring you back around.

So when someone has had, like if you talked to some dude who played football or something, had multiple shoulder dislocations, like what would you do to him? You would encourage surgery? or something had multiple shoulder dislocations, like what would you do to them? You would encourage surgery? So the, you know, the typical course for recurrent instability of the shoulder would be a stabilization procedure. Now, a lot of that's based on the exam and what you see on imaging. Some people can do well with a simple shoulder arthroscopy, and then you pass a couple of stitches, you repair the labrum, you can tighten the capsule at the same time. And young patients progress really well through that. Um, when there is, you know, more complicated problems such as the, there's bone loss on the front of the socket.

problems such as the, there's bone loss on the front of the socket. So when you have a dislocation, the head goes forward, it, it goes out the front. That's the typical, an anterior shoulder dislocation is the usual one. And then as it tries to come back into place, the head bangs into the glenoid or the socket. So you can, you'll tear the front of the labrum, you'll stretch the front of the capsule, but then you can also get a dent in the front of the labrum, you'll stretch the front of the capsule, but then you can also get a dent in the back of the humeral head. What is the correct procedure? I keep throwing you off track, but when someone does have a shoulder dislocation, what are you supposed to do?

Are you supposed to pull on it or just take them to the hospital? There's probably no harm in doing that. There's, there's a great technique called the Zahiri technique. Spell it. Z-A-H-I-R-I. And it's just the name of the guy that wrote the paper. Um, but it's essentially, it would be a really easy thing for you to learn because it's kind of a leverage thing. Like jujitsu? Yeah. So it's a way to, um, leverage the, the arm so that you can get the muscles to relax. It's easy on the person and you can actually do it awake and like at the field. So I actually did it on a, uh, uh, professional steer wrestler, um, at the rodeo how hilarious is it that you can be a professional steer wrestler like well i was amateur for a few years but yeah no they're they're they're pretty serious about stuff super serious you were talking about your uh bucket handle meniscus the first rodeo cowboy that i took care of had a flipped bucket handle meniscus tear and he came in the the day that

the national finals rodeo was starting and he was also a steer wrestler by the way and had been a previous i think he was a champ or he he won a bunch that's for sure um so they basically they taped his knee you gotta come closer they taped his knee yeah in about 30 degrees of flexion and he competed the whole nine days. Whoa. Just roped up knee. Just taped it up, got on his horse, and was jumping off and throwing 600-pound steers on the ground.

Jesus Christ. Yeah. Those guys are crazy. I watch that stuff on TV. I've never even been to one live because I'm terrified. You need to come. I don't. We did an episode of Fear Factor. We made people ride bulls made them ride it that's right that's you can die i mean that's

nice you can die no matter what you're dealing with a goddamn steer that's what i'm saying that's what i'm saying you can die getting on top of a steer is not a bull right oh it's been gilded right no no we had bulls no no no steer wrestling is different right steer wrestling is the they grab them they take off yeah you're a steer and the guy and the horse take off at the same time you jump off you grab it you grab by the horns and turn its neck and throw it on the ground and then they wrap that yeah see with steer is a bull that doesn't have any balls right yeah that bull's not the same animal they're younger than the ones that they cop they chop their balls off before they get a chance to mature.

That's why when they. The bulls are terrifying. So I've been right down next to the bucking chute and it's like frightening. I actually had a claw to dirt get, one of them kicked it up and it hit me in the head like a baseball. I mean. Yeah. See, they're little babies. Yeah.

And they have no balls. So this guy jumps off. What a dumb. And you turn on the head. That is so whack. What a dumb... And you turn on the head. That is so whack. What a stupid fucking thing to be excited about. I did it. I wrestled that thing that I was trying to get away,

grabbed him by his natural handles, and I took him down. Look how quick... Look at their move. It's like a Darce choke, and the cow's like, What in the fuck, man? Why is this even happening?

Look, the cow's like, What is going on? I gotta get out of here. Look how they always do it the same way, too. It's similar to like a choke hold. Oh, what a dumb fucking thing to be excited about. They grab the neck and flip them on their back. It's outside of your world, but I'll tell you that these are some of the nicest guys I've ever met in my life, honestly.

And they're some of the toughest athletes in the world. Oh, yeah. I would imagine those guys are tough as hell. You have to be. We had a dude on Fear Factor. They compete through every injury. There is no injury that they don't, that they won't compete. You have to. You're always broken up. I mean, you have to. We had a dude on Fear Factor that had nine. And also, they don't make money if they're not competing.

Right. We had a dude on Fear Factor who was a steer champion, was a rodeo champion. He had nine shoulder surgeries. His shoulder was just sliced all open. And I don't know how often it's dislocated. He goes, pfft, any time. I could open up a car door and it'll pop out a socket. I'm like, yikes.

Yeah, it's bad. Yeah. So back around to where we're at. What do you do? How does the Zaheer technique, can you describe it? Did I say it right? Zaheeri? Zaheeri, yeah. Zaheeri technique? So one of the guys that we trained with in our My Sports Medicine program in Alabama showed us this, and it was like one of the first things that we reviewed at the beginning of

the year. And so basically you have the person lying flat on their back and I would hold your wrist and then I loop my arm under your arm and then grab onto mine for, for leverage. And then I literally just sort of lean back and I'm using the muscles in my back. So I'm not pulling with my arms. So a small person can do this on a very big athlete. And you're fine because you're using all of the strongest muscles in your body. Right. So you literally just lean back and you hold traction in that position. So you've got the arm is positioned like this.

You got to describe to people that are listening. The arm is in front of the person while they're lying on their back. And, again, I have my right hand on your right wrist if it's a right shoulder dislocation. Well, let's just see a video. You got a video of it? It's really hard to find it, but I'm going to hopefully guess that this is maybe it. Hopefully. Yeah.

Oh, okay. Let me explain to people at home. What this is like is if you were trying to give someone an arm bar, you get a hook on the left side. And so the hook is your left. If you're trying to arm bar someone on their right arm and you were in side control, you would hook it with your left arm. And then you would trap it in place.

And what a person does when they don't want to get arm barred, their defense is this. They grab their hands together. And so you loop your arm in that and pull it back like that. So that would be real similar to what you're doing. You're using the left arm. You're connecting it like this. And then you're actually just using traction.

Yeah. So the treater, in this case, on the right side, he's just going to lean back and hold and you just wait and in about 10 seconds it pops in place the the deltoid and the pec and the biceps relax and it just slides in oh that's interesting you can actually do that and i mean the kinder way to do this is you know with some anesthesia right but a lot of times you can do that, and they're perfectly comfortable. And they're immediately better when the shoulder's back in. Well, they're not completely better, but the pain's relieved from the initial event.

Now, you told me when you looked at my MRI that you think that my shoulder was dislocated at some point in time. I don't remember exactly your MRI, but if you had a tear of the front of the labrum, and you had any evidence of that little dent of the front of the labrum if you had and you had that any evidence of that little dent in the back of the humeral head then then that would be consistent with that injury I just do not remember ever having a dislocated shoulder but I've had I've been camorra you've had a bunch of times I bet you've had it slip maybe a little bit well when you just the nature of your shoulder locked you know there's been a many americanas in my past and kimuras and all these different like hardcore you know the thing

you were on the receiving end yeah yeah before um this injury i never did americana you could definitely have at least a subluxation of the shoulder for sure i'm sure i'm sure and you fight it off too because you don't want it to happen so you're resisting. Before this injury, I didn't do any shoulder exercises. I just worked out. But I didn't do any specific exercises just to strengthen my shoulders.

I think that was a big mistake. And I kind of emphasize that with people. Doing external and internal rotation exercises, doing like, I'm a big fan now of inverted kettlebell presses. Yeah, that's been one of my more favorite lately. It's definitely a challenge. You don't need much weight. Yeah, this little 40-pound Ironman kettlebell, I use this one.

It's amazing. Yeah, that's a lot of weight for that exercise. That's pretty good. Well, it's just they say you should be able to do 50% of your max weight. Okay. Or is that 50% or 90%? I forget what they say. Forget me.

Don't listen to me. Well, it depends on. I think I said 90. Yeah. Obviously, in the injured patient or the person that's recovering, they're going to be starting with much lower loads. Much lower. And all the focus is on the motion, your posture, engaging your core, keeping your ribs down, and having the full motion. The strong first protocol, I think what they're trying to say is in order to have really powerful shoulders,

you should be able to do 90% of your max kettlebell press. Like say if you can max kettle press 90 pounds. Now that's with the handle and the bell down, right? Yeah, with max. That would be your max. Like a one rep max? Yes. Or what you would pretty much, maybe you could do two or three if you really had to.

But you know you're talking about a lot of weight. What you would normally max out at. There's a protocol that this guy Pavel Tatsulin follows. That's really kind of interesting. You know Pavel, right? Well, he's the kettlebell guy, right? He's the guy that brought him. They call him the godfather of kettlebells in America.

The guy that I train with talks about that all the time. Yeah. The, the idea behind it is, um, don't do your, the, like if you could do 10 reps, you do five and you, you wait a long time and then you do another five and you wait a long time and then you do another five and you never worked a failure. And that working to failure is actually not healthy. It's not smart and you don't really get stronger that way. My recommendation is that for, and, and, and this is coming from not, this isn't from the orthopedic surgery world. This is what I've read from strength and conditioning people. The thing you want to avoid in doing something to failure is with load and a skill activity. Right. So for example, like a clean,

uh, or, you know, a snatch or something like that. Things that involve coordination and where you have to time everything. If it requires sound mechanics and you're doing it with load, it's bad to do that to failure because what happens as you fatigue is your mechanics are going to break down and that's where you're going to get hurt. Well, what Pavel talks about is that strength is a skill and that all these different things, think of them as a skill and then don't do things to failure. And if you're looking for, you know, endurance or something along those lines, you want to do lightweights and you do want to do multiple repetitions. It's not what you're doing

when you're trying to get stronger. No so it's this but there's you know a lot of different arguments one way or another i mean talk to power lifters they're like that guy's a pussy you gotta do it to failure yeah i don't know talk to crossfit people they want to do 100 reps you know yeah so now there there are activities that you can train to failure and there's no risk so for example like like pull-ups i mean when you fail you just you just can't get up right like you're just gonna come off the bar right the battle ropes you're just gonna fatigue out like there is you're not gonna hurt yourself right but they even believe that when you're doing chin-ups like if you're doing pull-ups or chin-ups um that when

you're doing it you shouldn't go to failure. You should just stop close to it or halfway there, and then take a long time off and then do another five reps. Say if your max is 10 reps. Get to five, stop, take a break, do another five. Stop, take another five, 10 minutes, do another five. Keep going. You're working on form, and your muscles are performing these actions in a

very clean smooth delivery and that this is the best way to recover or to build strength and that you just do it more often don't do it to failure once a week and then be a wreck for like three or four days afterwards because you know that feeling when you when you lift weights and you lift weights for a week or you lift weights and you lift weights to failure rather and you're sore for so long right can't get anything done this idea is you do more frequent workouts and you don't go to failure well that don't go over five reps I think one of the biggest mistakes that we see and reasons that people show up in my office, it is because of overload and, and, you know, no time for recovery from the training that you're doing. So you don't see

people periodizing and incorporating the times when they're just allowing rest. I mean, you can't be working at max capacity all the time. Right, exactly. It's a big thing with fighters, huge. Keeping them from working hard is so hard to do. Yeah, so I try to emphasize with, and we have to really talk about this with our ACL rehab, because that's a group that, you know, they're so eager to get back, you know, if they're a competitive athlete, that, you know, you've got to remind them that, look, we have steps to go through. And I always say, you got to work smart, not hard. Like, you know, we have a plan and there's a reason why this week

may not be a whole lot of work. I mean, your body needs rest and recovery in order to put stress on it again, so that we can continue to make your progress. Otherwise, at some point, you're either going to plateau, you're not going to be some point, you're either going to plateau, you're not going to be making changes, you're going to get frustrated, or you're just going to get hurt. Right. All right, we've got to bring this home. So anything else we need to cover on this?

I don't think so. I think we got to talk about quite a bit. Yeah, we really did. Thank you very much for doing this. I really appreciate it because this is – we've always had these really cool conversations when I visit you in your office, and I'm really glad we got a chance to do this. Now, if people want to get a hold of you and they want to seek treatment, please give them the necessary information.

Oh, sure. So our website is www.totalsportsmedicine.com. I like how people still say www. Yeah, you probably still get there, right? Yeah, you can just, totalsportsmedicine.com. Yeah. Yeah, you can probably still get there, right? Yeah, you can just totalsportsmedicine.com.

And then we have information on there in terms of how to contact us, and we'd be happy to get additional information to patients if they have questions. Awesome. Well, again, thanks for everything you've done for me. It's been a lifesaver, and I've had massive benefit. Thank you very much for allowing me to come down. My pleasure, brother. Thank you. Dr. Roddy McGee, ladies and gentlemen, and that's it for this week. We'll see much for allowing me to come down. My pleasure, brother. Thank you.

Dr. Roddy McGee, ladies and gentlemen. And that's it for this week. We'll see you next week. Bye-bye.