Zeena: Hey, everyone. It’s Zeena Dhalla, VerticAlign Posture Coach, and I have the distinct pleasure today to interview Matt Hsu who is the founder of Upright Health. Hey, Matt.
Matt: How’s the going Zeena?
Zeena: I’m good. How are you?
Matt: I’m doing very well this morning.
Zeena: I’m really happy and excited to have you here. I want to let everyone know that I have Matt’s bio in the blog post below and also in the description of this YouTube video. I’ve been following or stalking Matt now for a little over a year. What attracted me to you Matt was that you have some really amazing certifications and education in the posture and alignment universe in the world that we all live in. Since then I’ve been following your YouTube channel. And if you’re not following his channel, you really need to follow it.
He has the ability to take very complex concepts and simplify them and break it down. I always walk away with some really concrete information. So, Matt, I want to thank you for really putting out some amazing content out there in the posture world.
Matt: You’re welcome. Thanks very much for that.
Zeena: Please keep doing it because I want to keep stalking you.
Matt: All right.
Zeena: All right. So I asked Matt to come on and talk to me today because he has a program called the FAI Fix. FAI is the femoral acetabular impingement syndrome. It’s a problem that we have in the hips. It’s something that I don’t know too much about. I haven’t really dealt with it as much as you have. And so I want to talk to you about that today and I want to dive right in. I’m going to start by asking you to explain exactly what FAI is and who it really impacts the most.
Matt: I’m really happy to talk about this. This has been a passion of mine for the last several years. Basically, FAI the way it’s conventionally understood in the medical world is you have your hip joint which is a ball in a socket, and basically the belief medically is that the bones are growing long. So over time, you’ll either have part of the socket grow a little bit too much so runs into the head of the femur or you’ll have the head of the femur grow a little bit too much.
The belief is that you could also have a combination of these. And the belief then is that those over growth lead to premature impact when you’re trying to move the ball in socket. This is actually a relatively new diagnosis. The whole theory around this actually did not exist until the early 2000. It was basically put forward by some surgeons who thought they had found an explanation for labral tears or hip pain for arthritis. They thought, “Well, maybe these bone variations are what’s causing people’s problems.”
So they actually created a surgery where they could fully dislocated the hip joint, shaved down the bones and then put everything back together and fix it as far as they knew. And then the procedure developed into arthroscopic surgery, and now basically you do arthroscopic surgery on this hip pathology. The reason I use air quotes is because the basic theory is that those bones cause the problems. They cause labral tears, they cause the arthritis, they cause the pain.
On subsequent research over the last 15 years has shown that there’s no link between those bone chips and pain. There’s no link between those bone chips and movement problems. There’s no link between those bone chips and people actually experiencing any of the symptoms that these bone chips are supposed to cause. You’ll also find that the labral tears don’t seem to be linked and the label tears themselves aren’t even linked to people actually having pain and others [inaudible 00:04:01].
So there’s a whole host of things that in the conventional medical world are believed to cause people hip pain and that are believed to need and require surgery to correct. When you then look at all this research and see that there’s no links, it provides an opportunity for people to realize “Well, maybe there’s something that we’re missing in this whole picture.”
And with the FAI Fix, the program that I co-created with my friend, really good friend Shane Dowd, we basically looked at it as “How can we deal with muscles around the hip joint to make them control the hip joint better and to get them to stop sending pain signals?” So that’s basically what the program is all about. It is helping you figure out how to retrain the muscles around the hip to correct movement problems and to help you get more comfortable, more control, more strength, more range and ultimately get you back to enjoying the things you want to do.
Zeena: What kind of person experiences this pain? I know I’ve seen some research on athletes or people who sits. Can you clarify that?
Matt: So what’s interesting is that people who have the hip pain and who get the FAI diagnosis come from all kinds of backgrounds. With many arthroscopic surgeries and orthopedic surgeries in general, the big press, the big headlines usually come out around the pro athletes. Unfortunately, a lot National Hockey League players have been getting this diagnosis. They end up with severe hip pain, and the diagnosis is FAI and then they do the surgery.
So a lot of athletes get it. It’s becoming popular in that sense. But also a lot of people who are just sort of run-of-the-mill, Jockeys who are just sitting all day long, the muscles around their hip joints no longer work properly for reasons you and I both understand. You’re sitting on your butt all day.
Zeena: Yeah, exactly.
Matt: So you get the pain. If somebody sees the FAI bone chips in a X-ray and they do a couple different tests and they do an MRI, maybe they do some physical tests that check your range of motion, if they see these things and see positive results on all these tests, then they’ll say, “Well, you have FAI,” and then “the solution is surgery.” So it comes from any walk of life. You can end up with this hip pain. It’s really interesting because the activity level can give you hip pain.
I used to play a lot of hockey and I ended up with a lot of hip pain. And even with people who don’t do anything, who are very flexible they can still end up with hip pain, and still, everyone would get shunted into this same path of like, “Here’s your treatment it’s to shave this bone.”
Zeena: For people who are watching this who are like, “Gosh, my hip kind of hurt,” can you quickly tell me where that pain might be, so that way then I can go to Matt and try to get it fixed?” So they can say, “Oh, maybe I need to be doing FAI Fix.” So where is that pain exactly?
Matt: So the location that people get hip pain also varies a lot. Medically a lot of times they’ll talk about C-sign. So they’ll say like, “Oh, you’re making a C with your hand and then you’re copying around the side of your hip.
Zeena: Got it.
Matt: This is all totally fair game for where you might get hip pain. A lot of people get stuff through the front of the hip just right at the attachment of the top of the quads. They can get it on the inner thigh and the groin. This area actually…I’m just going to move the camera…we’re friends, right?
Matt: So right in here, is where I think it gets most disturbing for people. People will think, “That’s my hip joint and I’m having a lot of trouble directly in the hip joint.” One of the things I encourage people to do is crack open anatomy textbooks and really start looking at where things are because…I can’t tell you how many times this has happened and somebody has said, “Oh, it’s my hip joint,” and they’re pointing at really what’s the attachment of a muscle to the pelvis.
It feels really scary because this is just not an area that most of us are familiar with. We know where our biceps are but we don’t know what’s going on in the groin generally. We’re just scared of it. We keep it covered all the time. So those muscles can feel like, “Oh, you’re damaging something really bad,” but in reality, you can calm down. It’s just a muscle.
You can also get hip pain going around the butt, down the back here. It’s all really common. SI joint stuff. It can show up everywhere because basically, you have so many muscles around the hip joint that are going to affect your comfort levels whether or not you get the FAI diagnosis, hinges on the X-rays and MRI’s. Again, those things aren’t really linked to the actual location that you feel the problem.
Zeena: So I could realize that if someone again is watching this video who might have that pain – and by the way that was really helpful to be able to see – and they have gone and done the MRI, but they’re having this pain, I’m assuming it can’t hurt them to do the stretches and exercise you’re about to share with us. Because at the end of the day, if they’re sitting at their desk all day long, they need to be stretching, working and their muscles. Correct?
Matt: It’s pretty much correct. Yeah. What I tell people is you have a choice when the pain starts hitting. You could say, “Well, this is a huge major joint problem and I should just not move.” The reality is if you don’t move, you will not be able to move. So you need to identify the movements that are helpful for you at this stage and continuously refresh and figure out what new movements you can add to your repertoire.
If you consistently say, “Well, that hurts and I’m not going to do it,” then eventually and actually very quickly sometimes you end up not being able to do anything. People will often be afraid of moving because they think they’re going to do more damage, but I mean, you walk down the street every day and there’s a risk to doing that. If you are comfortable getting in a car and driving, you should be comfortable just moving your hip a little bit and exploring and learning how to use your muscles a little bit better. So yeah.
Zeena: That was incredibly well said. I say that to my clients all the time how important it is to keep moving and keep the blood flow moving. Exactly. So you have a TSR technique, correct? Is that correct? And what do you use in your FAI Fix program? Please tell us the TSR and how that all works?
Matt: Yeah. So the TSR are the initials for a different section of the program. So we talk about Tissue work, T and we talk about stretching, S and we talk about reactivation, R. So tissue work we’ve set up as the first pillar of the program. It’s basically teaching you how to do self-massage around muscles all around the hip joint. This is typically an area that’s really neglected. In the medical community, it has been extremely neglected.
I’m sure you’re familiar with how hard it has been for massage to even be taken seriously as something that could possibly help people with back pain. It took decades for anyone to take it seriously. But massage on the hip muscles can really help restore range of motion and function. That said, it’s not the only thing you need to do. Depending on who you are you may need other components.
We tend to find really active athletes like CrossFitters, weightlifters tend to get a lot of [bang?] back from doing tissue work to help relax muscles in a better way.
The next component with stretching really helps you reestablish range of motion in a bunch of different movements. So a lot of people, especially guys have trouble touching their toes. In life maybe that doesn’t seem to affect you so much. You don’t need to have a straight knee as you bend over to tie your shoes, but what it tells you is that the hamstrings are not able to do what they need to do to allow full hip range of motion.
So if you are, say, a soccer player or for me a hockey goalie and those muscles aren’t functioning correctly, then when you’re going to do a motion that requires it, you’re going to compensate and some other muscle takes the heat. So the stretching it to really help people identify areas where they’re tight and reestablish good range of motion in those areas.
The reactivation section is a section that people really…I think again in the medical community this gets under appreciated. We really focus on trying to get people to tune into muscles in a really mindful way and then gradually get those muscles to be much stronger than they tend to be for people.
So we really encourage people to first get mental connection to the right muscles and fire them in the right pattern, and then start building in a more complex movement that involves weight. And using that weight, you start to be able to turn on your hamstrings better, you get to turn on your butt muscles better and just learn how to coordinate motion so that you don’t compensate when you’re picking up a bag of groceries or you’re trying to jump over a wall. Whatever it is you’re trying to do.
If you’re trying to play golf or you’re trying to do karate, all those things require you to understand what muscles are supposed to fire and then get it to fire. It really runs the gamut on reactivation. It actually will start with simple stuff and then move into more and more complex stuff.
Zeena: I love that. I call that the sleepy muscles. I tell my clients all the time the muscles that are sleepy, you need to wake them up again. And as you know, I have a course too for back pain and neck pain. And a lot of the exercises in the beginning of my course are very simple but it’s about getting that mind to really connect to the body. You shouldn’t be talking or watching TV when you’re doing this. You should be really thinking about what your body is doing. And so I love that.
You’re in your space right now. So can you do some demonstrations for us and maybe show us…pick one T or S or R, maybe one of each, if you want us to fly through all of them? Just give us an example of what we’re dealing with when if you’ve got that hip pain or FAI – what’s in your course.
Matt: Sure, okay. So let me give you a quick rundown. Let me show you a little bit. So, with real simple thing that people can do here. I mentioned it earlier like athletes, a lot of crossfitters, weightlifters tend run into issues. For a lot of people if they’re doing a lot of running, biking also, a lot of times what will happen is the muscles at the front of the hip, the quads will tend to just start getting really good at firing and not so good at relaxing.
The consequence of that is it actually starts to affect the pelvis position. It will start putting you into what’s known as an anterior pelvic tilt which actually makes it really difficult to move your hip joint. You’ll lose range of motion pretty quickly. It will also tend to give you some issues on the front of the hip. You’ll start to feel like pitchers sometimes and possibly compressed in the low back and that’s not super comfortable either.
One of the exercises we recommend people start trying is actually using their foam roller. This is quad baller. Softball even works. Something to actually get to massage the front of the thigh here. Actually, let me show you my right leg so you could see it. Basically, it’s as simple as coming down right up on top of this, and gradually, slowly working your way through dense, difficult areas that just feel like they’re super painful.
It’s pretty safe. There’s not a lot of things you could hurt doing this. You just find the areas that are a little bit tight and you hang out on them. We generally recommend people do this for least two minutes to the five minutes. Take your time exploring and getting muscles to relax. Sometimes people will try to muscle through this. We really encourage people that actually let the muscle relax in two minutes just sort of letting butter melt rather than trying to stab through a stick of butter. Just let it ease through. Let it ease through.
So you basically run from the top of the thigh all the way down towards the knee, and just not on to the knee cap, then just searching for things like that. I think a lot of people have seen that exercise. It’s not like a crazy groundbreaking thing but what we do in the program is set up the sequence that makes that more effective.
After you’ve done tissue work like that, you want to be doing things to help open up that same muscle. An example of that in the stretching section if you’re focusing on quads is actually to do something like a quad stretch. So you can do something against the wall where you just re-establish…Can you see that okay Zeena?
Zeena: Yeah. That’s good. Looks good.
Matt: All right. Basically, you can get your knee back here. You get to put up on the wall and start coming up like this. When a lot of people with hip problems first start doing this, they’ll usually start coming out and go, “Oh,” and be stuck here. They may not even be able to get the foot on the wall. So you have to have regressions. We do have regressions in the program to help you be able to start working towards this so that you can start opening up the hip joint, opening up this whole thigh mass. That tends to be a really helpful one for a lot of people with hip pains.
After that, there’s window of opportunity for you to be able to activate your butt muscles better. Once you calm knees down, it’s easier for your body to use the posterior muscles and that’s when we start jumping into reactivations stuff like doing bridges which can be for some people quite challenging. It’s just being able to feel like you’re using the correct muscles back here. Once you feel the leg muscles working, you end up loading this, you end up switching to one leg, you end up doing harder exercises like deadlifts and things like that.
Another exercise that I don’t want to neglect is an easier exercise for people who have some hip issues especially people who are sitting a lot…really simple things that can help make this whole area more comfortable. So things like simple isometric contractions where you’re just locking the leg and then getting these muscles to firework really well. For people who are sitting at the office, you can just do something like this, and you’re trying to pull up in your hand is just your hand and arm are just stiff-arming here so that you’re feeling these muscles work. And then you can change the direction.
So you start to feel, “Okay, these muscles are working. Now you can go into the inside. These muscles are working. You can just find different angles, different positions that help you retrain the muscles to actually feel like they can work in different directions and different positions. Start doing those on airplanes. We made a video recently. Doing things like that on airplanes can make airplane rides infinitely more comfortable.
Zeena: And I love it. I love that because that’s something you can do when no one can see that you’re doing exercise so there’s no embarrassment factor when you’re at the office or on the airplane or anything like that. Now that was really great and I love that you have a sequence of things I work similarly which is why I stalk you. It’s really important.
For example, I come from a Pilates background and we do bridging all the time [inaudible 00:20:49] but it’s so much more powerful when you do a bridge after you’ve done a couple of things that will allow the bridge to work better. There’s just more power in it. So I appreciate that. Awesome. Give us the website for the FAI Fix.
Matt: The FAI Fix you can find at thefaifix.com. There is at the in front of it. So it’s thefaifix.com.
Zeena: Okay, cool. I do have one more question for you. I love hearing the personal stories from people. I you actually in person a couple months ago and you told me a personal story about what got you into all of this. And I know it has to do with your hip. So if you can really quickly tell us a little bit about your own personal pain journey.
Matt: Sure. If I keep the story just to the hips, as I told you earlier, I was a hockey goalie for a very long time. When I was 16 or 17, I pulled my hamstring and groin so badly that I was on crutches for several days and screaming in pain trying to work the clutch on my stick shift car. That actually just didn’t heal. When I was younger the doctors just told me to rest it and it would eventually get better, and it just didn’t. And I just compensated around it.
Over time it just started to manifest itself in different ways. My knees would start to feel funky and I just felt like it was unstable. I couldn’t do certain motions. It would hurt when I was sitting for a while.
Anyway, by the time I got to my mid 20’s, my hips deteriorated pretty badly to the point where just stepping over a bench like the one I’m sitting on here and just being able to do like this was just not possible. It would hurt way too much which getting in and out of the bathtub was a daily challenge because my hips would snap and pop and just feel terrible. It was like hard snaps in my groin every time I got in and out of bathtub.
And so basically I had to give up on a lot of activities. I really couldn’t safely play hockey anymore. Tying my shoes actually made my lower back hurt. Pretty much any activity that you can think of that you as an adult would want to do – just running, watching, jumping, whatever it is I couldn’t do it. There was pain everywhere else in my body as well.
For me, the journey that I’ve gone through in trying to solve my own issues has really helped open my eyes to a lot of things and also help me help other people see clearly what’s going on with the body and see clearly how you can gradually make changes that make your body feel really amazing.
Zeena: And surgery is just a much tougher option. If you can do a couple of exercises a day wouldn’t you rather do that? I know I would rather do that and I’m sure you’ll agree.
Matt: Yeah, I absolutely agree. I do want to say that I think for some people it is actually as simple as do a couple exercises a day. And then there are other people for whom it takes a while. We work with a number of people here at FAI diagnosis, and for some people, it does take months of really learning what’s going on with their body. It’s not a process that you can just say, “Okay, Done. It’s just like that.”
We’ve had people who took three, four, five, six months to really get a handle on what was going on for them, but once they really understood it, then they have control. The thing I point out to people is if you have a muscular skeletal problem and you’re going to see a specialist, the person you’re seeing if it’s a typical medical scenario, if you’re seeing that person for this problem, in your entire life you’ll probably see them for a total of 30 minutes. And in that timeframe, you have to ask yourselves if it’s reasonable to expect that they’re going to be able to understand the entirety of your history and the entirety of what your body can and cannot do and what it should and should not be able to do.
So you as a person live with your body 24/7. If you take the time to explore what’s going on, you’re going to have so much more information that’s going to be so much more valuable than what an outside source can tell you in 15 to 30 minutes.
Zeena: Absolutely. And back to the whole daily exercise thing, it’s like brushing your teeth. Once you figure out the benefits of brushing your teeth or the benefits of doing your exercises, then you keep doing your exercises, you can stay healthy forever until age 90 and 100. So it is far more powerful to have the control in your own hands.
Matt: Yes. Amen.
Zeena: Awesome. Well, thank you so much, Matt. I hope that people watch this and learn some stuff and go to your website and sign up for your program. Thank you for being inspiration to me and all the other people that you help out there.
Matt: Thanks so much. And you’ve been inspiring me as well with all you’re doing, so keep up your good work.
Zeena: Awesome, all right. We’ll end the little cheesy part of the video and I’ll see you online.
Matt: All right. Sounds good.