Why Hip Impingement Shouldn’t Automatically Mean Surgery

If you’ve got hip pain that keeps you from doing stuff you want to do, one of the diagnoses you might get is femoroacetabular impingement, or FAI. Which basically means the bones that make up your hip joint aren’t the “right” shape. So they cause you problems when you move in certain ways.

If you ask an orthopedic surgeon what to do about it, there’s a good chance they’ll recommend surgery. Literally shaving down your bones to make them fit together better.

Which leaves a lot of people wondering if there’s a less invasive option.

In this episode Jarlo talks with Shane Dowd and Matt Hsu of the FAI Fix guys. They discuss Shane’s journey of getting diagnosed with FAI and searching for non-surgical ways to get moving again. Together he and Matt created a system of assessment and treatment that helps you get back to the activities you love without surgery.

Click here to see all our podcast episodes.

Resources mentioned

Got ROM – Shane DowdUpright Health – Matt HsuThe FAI FixDealing with Injuries

Transcript of Why Hip Impingement Shouldn’t Automatically Mean Surgery

Jarlo Ilano:: Hey, everybody, this is Jarlo, GMB fitness. GMB, of course, stands for Geezers Mending Bones. That’s Geezers Mending Bones fitness. Really happy to have Shane Dowd and Matt Hsu, here today. They’re the FAI Fix guys. So Shane has gotROM.com, is that correct?

Shane Dowd: Yes.

Jarlo Ilano: And Matt from Upright Health. We have them on here talking about hips, hips, hips, hips, but specifically FAI, which is femoroacetabular impingement. That’s a diagnosis some people get from various medical professionals. And they’ve done really well in helping people both in programs. I was talking to Shane a little bit about private coaching and all of that. That’s what we’re here to talk about. Shane, how are you? You’re in Columbia.

Shane Dowd: I am doing well. I’m in Bogota, Colombia. Yes. Recently married to a beautiful Colombian wife.

Jarlo Ilano: Oh, that’s awesome. Yeah, the warmth there sounds pretty good to me. We’ve had a bad run cold weather up here in Seattle.

Shane Dowd: Yes. It’s a little different there.

Jarlo Ilano: And then, Matt, you’re from the Bay Area, you said?

Matt Hsu: I’d say we’re really right in the heart of the Silicon Valley. We’re in Redwood City, and it’s been pretty cold and rainy here recently, too. There’s quite a flu running around, so luckily I’ve managed to stay mostly healthy.

Jarlo Ilano: I think San Francisco is the Seattle of California, right?

Matt Hsu: That is correct.

Shane Dowd: I think it’s actually Seattle is the San Francisco.

Jarlo Ilano: I remember I was down in Monterey like a few years ago. We were doing a seminar, and it was literally 30 degrees colder than it was in Seattle. At that point I was like, “What is this? California? This is not it. It’s not right.”

Matt Hsu: Yeah.

Jarlo Ilano: Anyway, really happy to have you guys on. I think we can have a really nice conversation to help some people out. First, to get things started, what the heck is FAI? What is it?

Matt Hsu: Shall I fill that one?

Shane Dowd: Take it away?

Matt Hsu: All right, here we go. FAI, you’ve already mentioned, Jarlo, it’s a femoroacetabular impingement. It’s a funny diagnosis. The idea is basically that your bone shapes in your hip joints are bad, they’re misshapen and that results in you having hip pain. It’s a diagnosis that was actually not in existence until the early 2000s when a hip surgeon presented his idea in some published papers and said, “Hey look, I can fix this. We just got to take people’s femurs out and shave down some bones.”

Jarlo Ilano: I have my own opinions about that, but I’ll just let you guys talk a little bit more.

Matt Hsu: I definitely want to hear your opinions on it too. Basically, yeah. The surgeon published some papers said, “We’ve already done hundreds of these surgeries, and it works pretty much every time. And so other surgeons should do the same thing to fix hip problems and here’s how you do it.” Since then, it’s become a really big diagnosis for people and especially in the fitness world. People who are doing CrossFit and high volume, high intensity exercise, when their hips start to hurt, a lot of times they’ll go and get an X-Ray and then an MRI. And it says, “Hey your bone shape’s not so good. That’s the problem. Let’s go in and fix it surgically.”

Jarlo Ilano: Right.

Matt Hsu: Here I think Shane maybe is a good voice to take over because Shane has the bone shapes. He hasn’t had the surgery.

Shane Dowd: Yeah. Basically, I’m the guy that Matt was just describing; I was an Olympic weightlifting coach in a CrossFit gym, as well as a strength coach and a corrective exercise kind of guy in the gym and massage therapist. I kept re-injuring my back and my SI joint because sometimes these things don’t always show up immediately in the hip. It’s in a related area. My back kept getting injured and I didn’t know why.

Shane Dowd: At one point I was doing a power clean and got so injured in my back. I have it on video. My form was perfectly neutral, spine braced, Stuart McGill would be happy. Everything was flawless in the technique. But just because I did have some asymmetries in the rest of my body, I still ended up injuring myself and was like incapacitated for a month, had my girlfriend putting on my socks and shoes because I couldn’t do it myself. All that stuff, which led me on this long journey of self-discovery to see what was wrong. And it turned out it wasn’t the back, it was the hips.

Shane Dowd: I was told I had FAI, ended up ultimately getting x-rays and MRIs and had cam morphology, which is a type of bony ‘deformity’, and labral tear, cyst, all that jazz in the hip. But as I just started mindfully exploring movement, stretching, self-massage, physical therapy, tons of different options, I came out of all my problems and that’s when Matt and I crossed paths and ended up talking about, “Hey, I got funky hips. You got funky hips.” Eventually we were like, “Hey, I think there’s a lot of other people that got tight hips, bad hips, painful hips. We should help these people, because we both figured out a good methodology to help people with hip stuff.”

Jarlo Ilano: All right.

Matt Hsu:: Yeah. My hips were horrible by the time I was in my mid-20s. I mean, most people don’t believe me, but I think more and more it’s happening where our sedentary lives are getting young people into a lot of hip pain. I was part of that first generation which people were just like, “Man, I can’t even jog one block because my hip and my knee are hurting so bad.”

Matt Hsu: For me, it was tough. It was really tough. When I realized Shane also had such issues, and we realized like, “Hey, there’s a huge demand for help here, because it’s really hard to find reasonable, non-invasive help really anywhere.” It can be really difficult. Just going to the doctor, the answers from my perspective, were really unsatisfying. It is basically, “Just rest.” Right?

Jarlo Ilano: Right. I think you hit on it a little bit earlier on when you said, first of all, it’s the new diagnosis in the last 20 years. I remember actually when they came out with that, because that was a couple of years out of PT school at that point. But I think there’s a couple of ways to think about this too is like, yes, there’s a sedentary lifestyle and everyone’s attached to their computers and their phones and all of that too. But at the same time, especially with the CrossFit phenomenon and stuff and the movement, then they’re being asked to do these activities which are fully new, right? Olympic weightlifting, all that stuff used to be… It still is niche of course, but it’s way more prevalent now than it used to be.

Jarlo Ilano: When you talk about a clean and jerk and the snatch now, because of CrossFit and because of all the visa now, not just like gold gym, but these kind of boutique things. People are more aware of being able to squat. Being able to learn and being able to crawl around and do all these things. It’s less of a unique thing. Now you have this kind of confluence of people aren’t doing things right. They’re sitting down all day, and then they’re being asked to do these.

Matt Hsu: The hardest thing.

Jarlo Ilano: Yeah. I think that comes along with it. And then what you said, Matt, about the dissatisfaction going to a doctor, or even another healthcare professional. They’ll give you drugs, they’ll give you some Advil. They’ll tell you to rest. Or they’ll give you an X-ray and say, “Oh, well it’s your bones. No wonder, it’s your bones.” That’s my problem there, because pain science is not true, it’s absolutely not true.

Matt Hsu: I’m glad you mentioned that. Yeah, the pain science shows that bone shapes… I mean, if we just look through medical history, there are so many examples where the trajectory is, initially a surgeon will say, “Oh, your back hurts. That’s because the bone is rotting, or the disc is bulging,” whatever it is. And then 20, 30, 40 years later, you look at the science, and they go, “Oh, maybe the surgery wasn’t such a good idea.” We’re at the 20 year mark with FAI roughly. We’ll see in the next 10 years.

Jarlo Ilano: Right, exactly. And come on now, how much more invasive can you get the cut into somebody’s body and think, “Okay, let’s see what happens.” Now, this is not to say, and this is sort of rambling, but you guys see that, and you talk about this all the time, it’s not to say… For example, Shane, you do have that morphology, right? You do have it.

Shane Dowd: Right.

Jarlo Ilano: It does affect, say, your squat form. It affects how you can generate power at different angles. We’re not saying that, no, it doesn’t exist. It doesn’t exist that this bone shape in this particular way that the head of your femur is seated in your pelvis doesn’t affect how you move. It does. What I like reading about from your guys’ site and all of your stuff is that, well, yes, you acknowledge that and then you do assessments and you work your way around it.

Shane Dowd: Exactly. Yeah. It’s that old… I’m not necessarily a religious guy, but the old serenity prayer of like, “God grant me the thing, or give me the wisdom…” What is it? Let’s see, “Let me change the things that I can, accept the things that I can’t, and the wisdom to know the difference.” We’re not saying that bone shape doesn’t matter whatsoever, and every surgery is completely invalid. The only thing that matters is that your muscles and movement.

Shane Dowd: Like I wrote in the article that we wrote about this for GMB that, “There are several things that matter to the bones and your muscles, their tissue quality, their extensibility, your motor control, the way you move. But the pendulum has swung so far in the direction of the bones are what matter most. And surgery is the only thing that fixes it. That we just keep presenting the more middle path perspective of, ‘Hey, there’s other things that matter in terms of pain and the way you move and how you feel.’”

Jarlo Ilano: Right. Well, let’s bring this back to a starting point of say, someone listening. You can say that, “Okay, you’ve had some hip pain or you have some hip problems. And then yes, you go to a doctor and they give you this diagnosis.” There’s also the other people where they haven’t gotten to the doctor yet, they’re googling. They’re like, “Oh man, maybe I got femoroacetabular.” The worst thing in the world. Don’t go to WebMD and find out you have cancer, everything cancer.

Jarlo Ilano: The two perspectives for me is, you’ve gotten the diagnosis again, whether the diagnosis tells you anything or not. Or you have these problem that fit the FAI. Maybe you squat down, and you’re like, “Oh, what’s that pinching in the front of my hip.” My questions for you guys is, what are your kind of screenings for a person having any of these issues? And what do they do from that?

Matt Hsu: That’s a super good question. With our program and just the way I think all of us on this call work, is to look out what somebody’s function is. With the FAI fix we have, I think it’s 15 maybe 16, a bunch of self tests that basically give somebody an opportunity to test either a range of motion or test a strength of a group of muscles, test a specific movement pattern and see how it feels and see whether they have the control, whether they have the extensibility, like Shane was saying, whether they have just a basic level of strength.

Matt Hsu: I think it’s really important for people to realize just how complicated it can be. How much one muscle needs to be trained. It’s one thing to say, “I always stretch my hamstrings.” But then do you have hamstring strength? Do you have the ability to use your hamstrings when they are stretched? One of the big things that Shane and I talked about when we first created the program was really helping people differentiate between whether you’re somebody who tends to be really loosey goosey and really flexible or if you’re somebody who’s doing so much weightlifting, you can’t touch your knees anymore without major compensations.

Matt Hsu: Just helping people go through a number of different motions that maybe they don’t do in a normal day, and that they don’t do at the gym. But they are motions that are necessary that tell you whether muscles around the hip joint are capable of doing certain normal basic requirements. And you start from there. I’ll be the first to tell you that the self tests don’t cover every single possible scenario, because your hips are capable of amazing, amazing things. It’s really difficult to come up with the whole thousands self tests that would be necessary, but yeah. We just start off with some basic things and then go to some harder things so people can solve their own issues. It’s not dependent upon whether they have a diagnosis or not. It’s just, “What is your function? Let’s start improving your function, and then let’s see how your hips feel.”

Jarlo Ilano: I think that’s massive, because bringing it back to physical therapy and where I came from. I started school in ’95. I finished ’98. That’s over 20 years ago. I’ve kind of gone through a bunch of this where it was either you have diagnosis-related impairments, specific spondylolisthesis, the slow back pain. And then the pendulum swung over and to straight up the evidence-based, “Can you do this movement, do this movement?” Versus a straight up diagnosis. Then now we’re coming back to, “Well look at your control and your…” It’s hilarious to me, because it goes back and forth, and this was one of the reasons why when I was reading your material I was like, “This is it, this makes sense to me.”

Jarlo Ilano: It’s the same thing people that have been with GMB for a while, they know what we do. We have our thing, we assess, we address, we apply, and then we always circle back through it. What you’re describing to me is very familiar, because it always comes down to that, to me. You’re not your diagnosis. Now again, we’re not saying, “Oh, that doesn’t exist.” We’re saying, “Yes, perhaps you have bone changes. Perhaps you have arthritic changes. Perhaps you have even cartilage damage. But what are you going to do? Just give up?”

Jarlo Ilano: This is what we mean by physical autonomy. If we do the correct things, if we are patient with ourselves, if we assess it, and don’t get stuck in our pathology that someone is telling us we have. That’s one of the things I wanted to draw up from you, was like, when someone comes up to you or even messages you or asked you about what they have, like, “I was told I have this.” “I was told I can’t do this.” To me those are the worst things ever.

Shane Dowd: Tell me what I can do.

Jarlo Ilano: Right. If you’re a doctor or a therapist or personal trainer, and you’re telling someone, “You can’t do this.” Man, you better tell them what to do otherwise, or really explain it well. Because otherwise, you’re almost giving them a pronouncement.

Matt Hsu: Yeah. It’s a death sentence, it’s what it is. It’s, “Just stop living your life.” Is what that is.

Jarlo Ilano: “Stop living your life. Oh, it hurts when you do that. Don’t do that.” That old joke. It’s terrible.

Shane Dowd: I get amazed at how much a ‘diagnosis’ from a doctor or someone in a white coat or a physical therapist can impact the psyche of someone. When I actually got my X-rays and MRIs, it was mostly out of curiosity. I had already come out of my hip problems, but I was like, “I’m going to go back and just see what the imaging is.” Got the X-ray and the MRI and stuff like that. When I got the report back from the doctor, and her voice sounded so serious like, “You need to go get checked out.” I read the medical language and it was subchondral cyst on the bone and all the stuff. It freaked me out, even though I had literally been trail-running and doing the splits the day before and it had zero pain.

Jarlo Ilano: Absolutely.

Shane Dowd: Some of that doesn’t have more of a background if they receive ‘diagnosis’ like that. It can be very disempowering rather than empowering.

Jarlo Ilano: Absolutely. It’s the nocebo effect.

Matt Hsu: Nocebo, that’s right. After Shane did his investigation with the doctor, I went to go do one too, just to see what kind of diagnosis I could get. It was a fascinating process. I got an X-ray, I got the MRI done. In many levels I learned a lot of things from this process. I learned what it’s like to even sit in an MRI machine for 30 or 45 minutes. I was just thinking, “Wow, if you already have hip pain and you’re just laying here on this hard plinth, on this little board for five minutes, that’s not going to feel good. It’s going to make this worse.”

Matt Hsu: Long story short, the doctor that I saw was a sports medicine expert and he told me after all this testing, he’s like, “Well, what’s concerning is you do have some mild arthritic changes in your hips. That’s really concerning because you’re in your… I think at the time I was in my mid-30s and he’s like, “That’s really concerning that is showing up so early. You should probably stop lifting weights, stop any kind of martial arts, stop running, stop doing all these things.”

Matt Hsu: It was so interesting. I couldn’t believe the things he was saying, because he didn’t have the context. For me, the context is I stopped doing a lot of things in my late teens and early-20s. By my mid-20s everything was worse, and things didn’t get better until I was reintroducing movement and reintroducing mobility works and stretching, some strength. I had to be doing all those things to build myself back up. To being able to play hockey, to try doing Capoeira, to do body weights. That was what was making my hips feel better.

Matt Hsu: If I took his I would just end up right back in that helpless, broken chronic pain state. I was blown away and I asked him like… I was kind of testing to see what would happen. I was like, “Well, should I consider surgery?” It turns out he’s a nonsurgical sports medicine specialist. He’s like, “I wouldn’t tell you to get the surgery, because you probably also have some labral tearing, and you already have a little arthritis. So, doing anything to your hip is probably not a good idea on all your activities because you don’t want to damage it further.”

Matt Hsu: In my mind I was thinking, “Wow, like the nonsurgical specialist is just telling me to do nothing.” And it’s just going to make me worse too, to the point where you would end up… Eventually, if you’re just the average person taking this advice, you’re going to end up in way more pain and you’re going to get into more of a panic as the pain gets worse. And that’s when you end up making that choice of, “Well, let me consult with the surgeon who’s the joint expert, who’s going to hopefully fix this problem.”

Jarlo Ilano: Right. I think a lot of it, just like you said, it’s contextual, too. You already went from a place where you weren’t doing anything. Going back to that, is that going to suddenly change your symptoms? Probably not.

Jarlo Ilano: I think I have to say this, and I’ve said it more than once. We’re not saying don’t go to the doctor. We’re not saying don’t go to your healthcare professional, because there’s a reason why you do it. If you’ve been to therapy, all of these things, they’re called red flags. Because it could be fricking cancer, it could be a tumor, it could be any of these things, you don’t know. It could be your organs. There’s a lot of reasons why we have pain, why we have these referred symptoms, and you just straight up got to make sure that you rule those out. But at the same time, don’t go there and go, “Okay, I’m ready for my surgery now.” These are the extreme things. These are extreme things and we’re not about extreme things.

Matt Hsu: Yeah. You definitely want to rule out the giant red flags, but I think for a lot of people… I think it’s always helpful to remember those giant red flags are pretty rare. If it’s there, okay, you got to deal with that. If it’s not there, then again, take your body into your own hands; start fixing yourself.

Jarlo Ilano: Yeah, exactly. It’s worth the appointment just to know that it’s not that. Then at that point, you can make all of these other choices and decisions. You can work with a PT, you can work with a trainer, you can work with a chiropractor. Whatever you decide is best for you. That’s a big part of what I see from you guys too, is this kind of autonomy, it’s choices. We all make choices for ourselves.

Shane Dowd: Exactly. One thing that I wrote in the article to go along with this podcast is that; it’s about empowering the person to become their own best therapist in the long run, so that you don’t have to go run to someone else to fix you and something breaks down and it’s less mysterious. It’s like, “Oh my God, my hip hurts.” And you just cover your eyes and run to Jarlo and say, “Fix me.” It’s you work with Jarlo because he has studied kinesiology anatomy and biomechanics for years and can teach you some things that you don’t know, and you also are learning what your body is asking for, what it needs, where it likes to move, where it doesn’t like to move, how it likes to be massaged, what muscles get tight. And the only way you can do that is with self-exploration, with massaging your body, stretching your body, strengthening your body. It goes hand in hand with working with a really competent professional. It’s not one or the other.

Jarlo Ilano: Right, absolutely. And then, Shane, even before the call we’re talking about it. You’re in Columbia now, but you can do your work from wherever in the world. Same thing on the opposite plane. If you’re a client, you’re looking for things, you’re not limited to your geographical area anymore. You can go and you can google and you can search. You can look up you guys, and work on what you want to do. And it’s great. It’s absolutely awesome.

Matt Hsu: Can I interject something there? It’s rare that I get this opportunity as it is for many people to talk to somebody who is on YouTube who inspired them.

Jarlo Ilano: Oh, that’s…

Matt Hsu: Yeah. This is actually something that we tell clients a lot is, you need to be looking at stuff that’s inspiring you to move better. It’s probably like five or six years ago, I remember watching a video of you, Jarlo, you’re in a deep squat and you’re doing hip rotations, doing internal rotation.

Shane Dowd: I remember that video.

Matt Hsu: You remember that?

Shane Dowd: Yeah.

Matt Hsu: I was like, “Dude, how come I can’t do that? What is the deal?” That is something that I constantly use. I’m like, “Have I gotten Jarlo-level hip internal rotation?”

Jarlo Ilano: Poor thing.

Matt Hsu: “When I’m in squats” Thank you for that video. It was awesome.

Jarlo Ilano: Oh, thank you. Well, one of the things, if we talk a little bit more about this is, me and Ryan and Andy, when we made this basically in this fitness space in the internet was very young at that point. This was 12 years ago or so. Putting out YouTube videos like that or putting… I won’t say nobody was doing it, but it was… now everyone they’re doing it. And it’s not unique and it’s not… When we were doing, we were like, “Oh, I’m just showing what I do. This is what I’ve been doing.” And I was like, “Let’s just put it up there. Maybe people find it interesting.” And yeah, I’m always like, “Wow.” It still amazes me now. I’m like, “Wow, okay, this is great.” This is what we built it from, and thanks for being there too.

Matt Hsu: Yeah, man. It was really helpful to… I think as a practical thing for people who are dealing with hip pain, whether they have some diagnosis or whatever, on a practical level, I think one of the most important things you can do is realize that if you see somebody doing something with their hips, they’re moving in some way that you as a human being, as a fellow human being, have the capacity to do that same thing if you are willing to put in the time and the effort. Also, knowing that your path to get to that may not be the same as what their path was. I say that because I know sometimes people get stuck, because maybe they see like, “Hey, Jarlo can do this thing. Let me just do the Jarlo 3000 workout. That’s going to make me Jarlo.”

Jarlo Ilano: That’s wrong. Straight up wrong. Yeah, [crosstalk 00:28:19].

Matt Hsu: Nobody can be Jarlo, straight up.

Jarlo Ilano: We always talk about this and you guys do in your materials too is, work from where you are. You should have a goal. You should have someone you want to emulate and you have to realize the adaptation, the adjustments you have to make. They need to be done or else you’re going to hurt yourself. It’s funny because I just… We’re going to put up an advanced ‘hip mobility stretches routine’. I’m doing it because some people need that, like a very small percentage and maybe probably you guys could benefit from it. I think I’ve shared some things on my Instagram the other day. But not everyone’s going to be able to do it.

Jarlo Ilano: Also, we have beginner routines. We have other things like that. We have the level that you’re at. But it’s merely a demonstration like what you meant to say, Matt, like, “Wow, maybe I should be able to do that.” What kinds of things should I do to get to that point? That’s more of what we’re trying to do versus… That’s what I mean by it’s wrong. If you try to jump in to some of this stuff, Matt, that you do, Shane, you do, and me, it’s not good man. You’re going to make whatever you have worse. I don’t want to answer those messages like, “No man, I didn’t say that you do that.” Don’t do it.

Jarlo Ilano: Coming back a little bit more to, Shane, when you were having the diagnosis and you’re exploring these things, when was the point where you’re like, “Oh this is working if I keep doing this?” Did you have that kind of moment where like, “Oh wow”?

Shane Dowd: I had thousands of little moments like that. It’s like what you were talking about earlier, how it’s really important that when you’re trying anything to make your hips better, a stretch, an exercise, a mobility drill… And this comes from physical therapy, the test and the retest that take a before-picture and an after-picture. Do it frequently to tell what is the exercise or the thing that’s really helping.

Shane Dowd: I got in the habit early on of, before and after every mobility drill I would check in with my hips. I’d massage something, check in my hips. Do a stretch, check in with my hips. This allowed me to see that I was trending in a good direction. It wasn’t like one miracle moment where my hips went from terrible to like, “They’re healed.” Like, “Praise Jesus.” It was a lot of little micro moments where I’m like, “Oh, I’m trending in a good direction.”

Shane Dowd:: There were some crashes, some setbacks, some stock market crashes, but I could still see if I looked at the bigger picture that, “Oh, this is going in a good direction.” And slowly but surely as you get more skilled, as I got more skilled at doing tissue work, stretching, strengthening on my body, the crashes became less and less than an hour, basically nonexistent because the awareness has increased.

Jarlo Ilano: Right, just with the practice of it all. I think for me, when people talk about mindfulness and being mindful, that’s what it is. The constant reassessment, it’s not some woo-woo thing where you just have to meditate and do all these things. Mindfulness just means paying attention. And seeing where the trend is, whether it’s up or down and actually having that patience of, “Okay, I need to do this a few more days in a row to really know.” That’s another thing too. You can’t just do it like a day or two where you’re like… You have to put some time and ride those things. Because you’re going to have what you said is catastrophes. Well, maybe it’s because you were too intense on that movement. It’s not maybe don’t throw away that movement. I think that’s a really hard thing to get across to clients, whether you’re in person with them or over email or even conversations like this, because it takes time. It takes the trial and error, and it takes those repetitions for them to really understand it.

Matt Hsu: I mean there are some stretches where you do it and you think, “No, no, it’s not. This is not going to work.” Because I did it three times, but maybe it takes 15 times to even feel the right muscle doing something. Maybe it takes 15 days before you even start to feel the right sensation in the right spot. I think that’s something that people definitely are not taught in, say, PE class, like a normal physical education scenario.

Matt Hsu: I went to a gymnastics gym once. Just open gym to go mess around just to see what it was like a couple of years ago. There were these kids there who were probably eight years olds. These were the buffest, eight-year-old kids I had ever seen.

Matt Hsu: Yeah. But when you think about those kids, you probably don’t have to teach them paying attention closely to their stretching at that point. You’re teaching them like, “Here’s the position, get this position. Here’s this position, get this position.”

Matt Hsu: The mindfulness that we’re talking about for these elite youth athletes is going to be different. The demand for mindfulness is different for a child who’s developing flexibility versus a grown adult who’s spent 20, 25, 30, 40 years being stiff, and are now having to reconnect to their muscles. I know there are these great YouTube videos of young gymnast kids doing stretches, stuff like, “Here’s how you get your hamstring flexibility.” But for us adults we got to approach it differently. Approach it slower. Be more patient. Really feel into it, right?

Jarlo Ilano: Yeah. That’s the nuance, where are you in this scope of practice; “Are you younger? Are you older? Have you had problem before? Have you had no problem before?” And that’s the nuance of all of this. And that’s the nuance of guidance. So when you’re coaching someone or you’re training someone or treating someone, if you’re a therapist, it’s not telling them what to do. It’s not giving them a handout of six exercises and saying, “Go here.” The true guidance is working within that. Because you can have the same couple of people and give them the same exercises and have totally different outcomes. [crosstalk 00:35:07] But you can also have the same great outcome if you work with those two different people with the same six exercises and adjust it according to that. And that’s good bone therapy. But it’s a good training. It’s good every training.

Shane Dowd: And I would add on to that, that even in the same person you can have different outcomes, depending on where they’re at in their journey. For example, when I started I was the weightlifter muscle guy with a lot more muscle mass. And what I needed at that time was a lot of deep targeted tissue work and stretching to make my hips feel better.

Shane Dowd: But then as life changed, my priorities changed and I wasn’t in the gym as much. I found that later on when I was more like a yoga lifestyle, doing lots of stretching, lots of that kind of stuff, I actually found that my hip started to not feel good when I drifted towards that end of the spectrum.First I was the buff weightlifter and then I became the skinnier yoga guy. I actually found that I needed to re-add, reintegrate some strength training and stability training back into my routine to find my optimal middle. There’s not one hip impingement routine. There’s a set of principles that you can follow, but then there’s some exploration that you’ve got to do.

Jarlo Ilano: Yeah, that’s super important, super important. And that’s the whole continual assessment. Even within yourself. I’m getting a little bit older, turned 45 last year. It hit me more, say, a year and a half ago because I liked squatting. I love it. Heavyweights, everything, bam, bam, bam every day, all these things. Man, I could still do it, I could. But then I couldn’t recover because I’m doing other things. Now if that was the only thing I would do, yeah, I could probably still do it. But I like teaching martial arts, training, doing all this stuff. Even the whole cliché, I like hiking around with my kids, doing that stuff.

Jarlo Ilano: I don’t have to give up the squatting. I don’t, I did yesterday. But I have to give up what I used to be able to do before and go, “Okay, I don’t have to do 350 pounds today.” I don’t. But 10 years ago I was like, “Man, no way I’m going to do this.” So you have to look within yourself and be patient with yourself.

Matt Hsu:: I think what you just brought up is probably one of the hardest things for most active people to deal with. I think for me, that has been a real struggle, and it was a real struggle. In my late 20s, early 30s, I was feeling like, “Sweet, I’m good. I can play hockey, I can lift heavy weights, I’m going to keep lifting, keep doing squatting, heavy deadlifting, go play hockey three times a week, all that stuff.

Jarlo Ilano: Whatever you want?

Matt Hsu:: Yeah, whatever. Then at some point, I think it was in my mid 30s, I realized the hockey, the weightlifting, working with clients, all this stuff, “This is a lot of stress.” I’m not recovering, my body is tightening up. I don’t feel as flexible. I don’t feel like my hips are moving correctly anymore. And I realized like, “Hey, I might actually have to dial this back.”Jarlo Ilano:: Right. It’s super hard. Like you hit it right there, “If you were able to do it before, why can’t I keep doing it?” That’s massive. That’s massive. And that’s why the real good program, good trainers, they cycle. You cycle through. And we’re not saying give it up. Don’t give it up. “You should stop doing those things, Matt. You should stop doing it totally.” No way. But we can cycle through it. You can do it. It’s just now you’re thinking in terms of the year versus the week.

Jarlo Ilano: I don’t want to talk about me all the time. But I did that this summer, I was like, “Okay, this is my weightlifting three months.” And I was good. I didn’t get rid of all the other stuff, I just toned it down. Then now I’m not doing that. I’m like, “Oh, I’m lifting like twice a week, barely. Twenty minutes.” But I’m doing all my other stuff. So I think if we can get people to think about that a little bit more, I think that’ll help rather than just like, “Oh, don’t do this. Maybe just do this.” No, you can do everything. You just got to be over time now, though. It’s going to be over time.

Shane Dowd: I think it’s important to say that all three of us on this call have training backgrounds. And we know the science of how to load and de-load your body and which training variables you can change. “Oh, just changed the volume and the intensity and the depth and this and that, and the other thing.” Most people don’t have a sense of that.

Jarlo Ilano: Absolutely.

Shane Dowd: One, I think it’s important to let people know that nothing in life is black and white. Don’t squat if you have hip impingement, it’s what type of squat to what depth, with what stance, with what shoes, with what implement can you do. It’s not, “Don’t ever do the splits if you have hip impingement.” It’s, “Don’t push past really bad pain.” Explore the positions, maybe try different styles of stretching that maybe agree with your body a little bit more if you have something bony going on. So it’s like, no, for anyone listening to this, that there’s many variables that you can train. It’s not, “Don’t do this ever again. Don’t squat ever again.” I mean, it’s, “Don’t sit on the toilet. Don’t sit on a couch.” It’s likeJarlo Ilano:: Exactly.

Shane Dowd: But if you’re someone who likes to move, likes to be in the gym, know that there’s a lot of variables. And if you don’t happen to know off the top of your head what they are, google, YouTube, reach out to one of us and we’ll let you know, “Oh, you can do trap bar deadlifts, you can do Romanian deadlifts, you can do [black belts 00:41:17], you can do lunges variations, you can do single leg deadlifts.” There’s so many things that you can do practically that still allow you to train and feel like an athlete without having to completely give up all the things that you love.

Jarlo Ilano: Absolutely. And it’s more than just… right now we’re focused on hip than FAI stuff, but it’s everything; knees, shoulders, back, even your general wellbeing, really. Yeah, absolutely.

Matt Hsu: Yeah. I think to piggyback on that, I think it’s really important for… there’s going to be some people out there who are going through either hip, shoulder, back thing that flares up every time they do their favorite activity. This goes right in line with that is, you have to learn what your body needs to be able to do the activities you love.

Matt Hsu: So if you’re doing the activities you love right now, and every time you do it, your body is in a lot of pain, you’re probably going to need to step back and assess yourself. Figure out, “What’s the missing link? What’s the weak link here that I need to work on, so that when I do the thing I love it doesn’t result in me lying on the couch for three days?”

Matt Hsu: Again, for active people, for athletes, that’s very difficult to digest. And also, it’s very important to do because it means you’re going to get back to the thing you love. Sooner if you can figure out what the weak link is, sooner.

Jarlo Ilano: Absolutely. We talked a little bit about patients and things like this. I did a podcast with one of our trainers, Rose. She’s over in Santa Cruz. And we talked about that and our pain, we were talking about chronic pain and what do you do when something happens and how do you get back into it? A lot of it is that, it’s not just simply, “Well, we got to stop and never do it again.” It’s having this really systematic approach of figuring out what it is, getting back into it. Figuring out what it is, getting back into it, and all that stuff. And that’s what I’m hearing a lot from you guys.

Jarlo Ilano: So those last two things, what you, Shane, said about, where you were in the journey. And also realizing that it’s not a black and white, “Don’t do this. Don’t squat. Don’t do splits.” That’s another thing too that was with the FAI thing, or do you have hip anteversion or retroversion? All that. When people say these things is bad because they’re being sincere and like, “Man, maybe I have this because I can’t squat like this.” I just go, “Ah, it doesn’t really matter, man.” I can’t say that though, because I can’t… you’re being an asshole if you just totally dismiss their concerns. But it’s true, though.

Jarlo Ilano: And here, Matt, what you said about being active and being used to being able to do a thing and now you can’t. That’s massive. Those are really important concepts for everyone to get their heads around. With that, now to wrap everything up, what are one or two really important takeaways that you would want someone to get out of your material, and what we’re talking about here?

Shane Dowd: I have three practical things that come to mind that I think would immediately make a difference for people. One is, to figure out what’s going on in your body. I remember back when it was like a mystery, what was wrong and that was the most debilitating and disempowering thing to not know why this was happening to me. It’s just like, I don’t know, it just starts hurting when I do stuff.

Shane Dowd: One of the best ways to figure out why it’s actually happening, because there is several reasons probably, is to start a… you could call it a mobility practice, I would call it like exploration and mobility practice of mindfulness practice. But basically doing… in our FAI Fix program, it’s basically powered by what we call the TSR system, which stands for Tissue Work, Stretching, and reeducation or strength training or reactivation training.

Shane Dowd: So I like those three things because if something’s going wrong with your body, what can you actually do to make yourself feel better? You can’t give yourself a chiropractic adjustment. You can’t give yourself acupuncture. You can’t perform surgery on yourself. What can you really do? You can massage muscles, you can stretch them, you can strengthen and you can learn how to move better.

Shane Dowd: If you just have a daily practice, it could be short, it could be long, whatever you have available, where you’re pressing on things, you’re massaging things in different ways, with different tools and different implements, and I’m not just talking about foam rolling. That’s like the 101 course, it goes much more profound than that. Same with stretching, explore stretches, like touch your end ranges, see how your hips feel in this direction and this direction. And don’t just like static-stretch and just hang out there. There’s nothing wrong with static-stretching, but get into a stretch like position, and then explore, contract the muscles. Do some contracting the agonist muscle, the antagonists, like just playing around, explore. It’s like a game. Make it very GMB like.

Shane Dowd: Then also strengthen things. There’s usually some under activity of some muscles, some weakness. If you do that diligently and regularly; massaging things, stretching things, strengthen some things, and you’re doing these tests and retest regularly, you’re going to unravel the mystery. The reason why your hips hurt starts to become clearer and clearer and clearer. If you also can do that, that’s like an internal practice, like you’re doing all those experiments on yourself.

Shane Dowd: If you also can have the outside help of someone like Jarlo, Matt, myself, an outside pair of eyes that can tell you, “Oh, you thought you were in neutral pelvic position when you were doing that hip hinge, you actually were highly anterior pelvic tilted.” Maybe that would help. I didn’t know that when I first started. And I needed a coach to look at me and be like, “Hey dummy, look what you’re doing on the video there.” So that outside help is really helpful along with that internal TSR mobility practice.

Matt Hsu: I agree with everything. Times two on that. I think what I would want to add to that is the mental side of all this is… we’ve talked about, you have to stay motivated. One way that can be helpful to keep yourself motivated is to first set an ambitious goal. This is something that we talk about with all of our clients. We have it in the FAI Fix, it’s, the first thing is to set some goal that actually inspires you. Whether it’s, “I want to be able to play hockey without pain once a week.” Or, “I want to be able to do a Jarlo-level internal rotation in a deep squat. Whatever it is, find the inspiration that makes you go, “Yeah, I should be able to do that. I want to do that.”Matt Hsu:: Then you’re not going to hit that right away. When you hit the frustration, which will come, when you hit those moments of frustration, I really encourage people to do what Shane was talking about earlier on this call, which was, look at the trends. And so, if you rewind one month, and then rewind, three months and rewind, six months, 12 months, mentally, looking at all those snapshots and seeing like, what was I able to do a year ago? What was I able to do two years ago? Am I improving? That can make such a big difference if you just get present to what kind of changes you are making.

Matt Hsu: I know for me, I used to hit these lows, where I’d just be like, “Man, I’m not ever going to be able to do this. I’m not getting anywhere.” Then I would just look back, even like a month and be like, “Well, okay, maybe I’m making progress. And maybe I’ll put in the work today and do it some more.”Jarlo Ilano:: The perspective is hard. The perspective is super hard.

Matt Hsu: Yeah, really is. I’m glad to hear you say that. I think for humans, we tend to be really focused on what’s the short term future? Now and then like five minutes into the future. That’s where I think we excel with our attention.

Jarlo Ilano: Yeah, absolutely. I talked about this with a couple of friends; it’s also the emotionality of this. I think physical and things that you actually really enjoy and just passionate about too. Physicality and even in your other hobbies and things like that, you become this attached to it. And that’s why the perspective is hard, because you want it so much. It’s hard to have that patience perspective. And that nuance Shane had just talked about, too, it’s like, play with it and explore with it and do all these things.

Jarlo Ilano: That’s really what we’ve been trying to get over the years. So a lot of people would say, “It almost doesn’t matter what kind of training you like to do.” It’s, “Do you enjoy it, can you be consistent with it? Can you play with it, and still have progress?” We’re not saying don’t make… Just be happy with where you are, that’s not what we’re saying. You have to have that goal you talked about, Matt. That goal and get there, but it doesn’t mean you have to be so hyperfocused that you just lose all perspective and you’re like, “Oh, man, I’m not getting it.” Because that’s the path to just fully burning out and not getting anywhere, right?

Shane Dowd: Yeah, it’s-

Matt Hsu: Oh sorry, go ahead, Shane.

Shane Dowd: I was just going to say, it’s that mythical and hard to attain, but nevertheless true. Have a big goal, be 100% committed to it. And at the same time 100% unattached about getting there. Like, if you stumble and fall and you don’t get there, smile, start again. Start something new.

Jarlo Ilano: Right. It’s hard. That’s why it’s really useful to have a coach or a training partner, even someone on the outside just helping you with that.

Matt Hsu: Yeah. I think, you mentioned earlier that you like to hike with your kids and I just had a kid. And the experience of having a kid has gotten me much more compassionate to people who are grown adults who have kids. Because the time that you have available to work with your body, to pay attention to your body is a lot more limited than if you’re 20 years old and single.

Matt Hsu: So for those people who are parents out there, I think it’s really important to know, if you want to make progress, you do need to set aside time and also know, “Hey, you probably can’t maintain six hours of training every day.” [crosstalk 00:52:29] It’s not going to happen. So be compassionate with yourself and adjust and be realistic.

Jarlo Ilano: I think even acknowledging that is super important. And again, we’re not saying you’re never going to make progress, you’re never going to do that. That’s not true. Awesome. Well, thanks so much guys. Really, really great conversation, had a lot of fun. For everyone again, this is Shane Dowd, Matt Hsu, FAI Fix guys. But in our show notes, we’ll give you links. Also too, Shane and had mentioned that had a blog post. You’re going to do, I guess, a blog post for us, that should be out soon, or maybe at the same time as we release this podcast, and lots of other things. Thanks so much for taking the time, guys, really appreciate it.

Shane Dowd: Thank you so much, Jarlo.

Matt Hsu: Yeah, Jarlo, thank you so much for taking the time in this chat and for uploading random videos of yourself in the garage. I mean, you’ve been an inspiration to thousands.

Jarlo Ilano: Well, thanks. That is my job now; random videos in the garage.

Jarlo Ilano: All right. Take care, guys.

Matt Hsu: All right, take care.

Shane Dowd: See you.

Jarlo Ilano: Goodbye.

Matt Hsu: Bye.

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