73. Understanding Lower Extremity Pain with Pradeep Chopra, MD

Episodes have been transcribed to improve the accessibility of this information. Our best attempts have been made to ensure accuracy,  however, if you discover a possible error please notify us at info@bendybodies.org

00:00
Dr. Pradeep Chopra
Just because somebody has back pain, you don't just assume that it's your SI joint or your disc or whatever. Like I told you, no one has a normal MRI. There's no such thing as a normal MRI. So you look at the muscle, it's easy. You palpate the muscles, you push around, and all of a sudden they're going to jump up and say, yeah, that hurts a lot, and you can feel a knot there. And that's because your muscles are trying their best to stabilize your joints, stabilize you as you move around. You're right. 
00:40
Dr. Linda Bluestein
Welcome back every Bendy body. To the Bendy bodies. Podcast. I'm your host and founder, Dr. Linda Bluestein, the Hypermobility MD, here to provide you with accessible information and inspiration about hypermobility disorders like Eds, HSD, Marfan Syndrome, and so much more. Combining my medical expertise and personal experiences and my passion for the science and clinical treatment of symptomatic joint hypermobility, I also treat patients and coach clients to optimize their quality of life. So let's get after it. As always, this information is for educational purposes only and is not a substitute for medical advice. Today, we are so excited to have my friend and mentor, Dr. Pradeep Chopra, back with us for yet another great conversation. Before I welcome Dr. Chopra, let me introduce my friend and yours, Jennifer Milner, former professional ballet and Broadway dancer who trains hypermobile artists to work to their fullest potential. She knows a thing or two about being a Bendy Body. 

01:40
Dr. Linda Bluestein
We are so fortunate to have Jen here today co hosting this episode. Hey, Jen. It's so good to have you here. 

01:46
Jennifer Milner
Hey, always good to be here. 

01:48
Dr. Linda Bluestein
All right. And Dr. Pradeep Chopra is a Harvard trained anesthesiologist, double board certified in pain management, and anesthesiology director of the center for Complex Conditions and Assistant Professor Brown Medical School, with a special interest in chronic complex pain conditions and their associated coexisting conditions. Dr. Chopra, hello and welcome back to Bendy Bodies. 

02:12
Dr. Pradeep Chopra
Thank you. Happy to be here. 

02:14
Dr. Linda Bluestein
Wonderful, wonderful. And we previously spoke with you about pain in the abdomen, the head, the neck, spine, chest, and upper extremities. And I strongly encouraged listeners to go check out those episodes as well. And today we're going to talk about pain in the lower extremities. So can you start out by telling us why this is an important topic for people with symptomatic joint hypermobility? 

02:37
Dr. Pradeep Chopra
Pain anywhere is pain, and that can make anybody's life miserable. And the problem with the legs is. 

02:43
Dr. Pradeep Chopra
That they are weight bearing joints, and. 

02:45
Dr. Pradeep Chopra
These are weight bearing appendages. And so you can't do much. So the joints in your legs have to not only be mobile, but they also have to be able to tolerate the weight of your body. That's the thing. So your joints, like, let's say your knee, has to be mobile enough for you to walk, but at the same. 

03:06
Dr. Pradeep Chopra
Time be strong enough to support your weight. And you have to remember that when. 

03:11
Dr. Pradeep Chopra
We walk, we don't walk on 2ft. We walk one leg at a time. So you put all your weight on the right leg first, and then you. 

03:20
Dr. Pradeep Chopra
Put all your weight on the left leg. 

03:23
Dr. Pradeep Chopra
So your knee joint on the right side, for example, your knee, hip and ankle have to be able to bear your entire body weight, not half your body weight. And then your left side has to be able to bear all of that and all this while you're moving and walking. And that's the beauty of the human body, that it's designed to do that with the legs. I like to start with the feet. 

03:53
Dr. Pradeep Chopra
First, because if your feet and ankles. 

03:55
Dr. Pradeep Chopra
Are not stable, then that makes your knees unstable. And most often your knees are unstable to start with. And then that throws your hips off, and then that throws your back off. 

04:08
Dr. Pradeep Chopra
So it's like a Jenga tower. 

04:10
Dr. Pradeep Chopra
If one piece is missing or lost. 

04:13
Dr. Pradeep Chopra
Then everybody else falls apart. 

04:15
Dr. Pradeep Chopra
So let's talk about the feet and ankles. Firstly, the feet. I would say almost 90% of people with Eds have flat feet. 

04:27
Dr. Pradeep Chopra
Okay? 

04:29
Dr. Pradeep Chopra
Remember something. You look at flat, whether your foot is flat or not is when you're putting weight on it. When you're standing. I always get this argument, but my feet have beautiful arches. Yes, that's when you're not standing on them, but the minute you stand, they're flat as a pancake. 

04:42
Dr. Pradeep Chopra
That's the difference. 

04:43
Dr. Pradeep Chopra
The other difference, the flat feet, is that your arch. So we have an arch in our feet. Think of your arch as a bow and arrow. The bow part of a bow and arrow and it's got a springy action. So when we walk, that springy action gives you that bounce as you walk. And that makes you take larger steps. 

05:04
Dr. Pradeep Chopra
Now, if you don't have that, if. 

05:06
Dr. Pradeep Chopra
The string on the bow is broken and you have flat feet, then you're. 

05:09
Dr. Pradeep Chopra
Just walking like Donald Duck. Splat, splat, splat. 

05:14
Dr. Pradeep Chopra
That leads to its own problems. The other thing that happens in Eds is that the flatness is not just the arch. The flatness is also in the forefoot, the front of the foot. And if you see if a person with Eds looks at their feet, they'll see that the front of the foot. 

05:29
Dr. Pradeep Chopra
Is when they stand, splays out. So it looks like a spatula, it. 

05:36
Dr. Pradeep Chopra
Splays out and the arch disappears. So let me just address the front of the foot flatness real quick, because that's easy. Whenever you buy shoes, make sure that. 

05:45
Dr. Pradeep Chopra
They'Re wide, because your shoes should have. 

05:49
Dr. Pradeep Chopra
Enough space for the front of your. 

05:51
Dr. Pradeep Chopra
Feet to spread out. 

05:54
Dr. Pradeep Chopra
Correcting the arch of the foot is not always necessary. I've learned this the hard way, where I've insisted on correcting it and people have felt. 

06:10
Dr. Pradeep Chopra
Can try. 

06:11
Dr. Pradeep Chopra
Most shoe manufacturers now include a bit of an arch in their shoes. So brands like Asics, Brooks, especially Hokas. These brands include an arch in their. 

06:25
Dr. Pradeep Chopra
Shoes and that really makes them very. 

06:27
Dr. Pradeep Chopra
Comfortable and that's why they're so popular. Now if you have a shoe which doesn't have an arch, you can buy one of these and try it and you can buy an El cheapo brand from the pharmacy and try it and. 

06:42
Dr. Pradeep Chopra
It should make you feel good right away. It's not a question of getting used to it. As soon as you put it into. 

06:51
Dr. Pradeep Chopra
Your shoe and you wear that shoe, the first step you take should feel good and if it feels good then that's great. And if you need a shoe insert for your flat feet, one of the better brands that I found is called. 

07:05
Dr. Pradeep Chopra
Pedag P-E-D-A-G. That's P-E-D-A-G it's a German brand. 

07:11
Dr. Pradeep Chopra
It's kind of semi custom built. I think you can look at it on Amazon or you can look at their website. It's a German brand. They do last a while. 

07:20
Dr. Pradeep Chopra
They're not super duper expensive because the. 

07:24
Dr. Pradeep Chopra
Problem with these inserts is that you have to change them on a very regular basis. There's no rule. Most people say once a year but you can go longer. 

07:33
Dr. Pradeep Chopra
But remember once they become really mushy. 

07:37
Dr. Pradeep Chopra
And flat then you can throw them away and get a new one. But like I said, most shoes nowadays have an arch built into them which is awesome. The other problem sorry, when you have a flat foot, what's the problem about that? The problem is that when you stand. 

07:53
Dr. Pradeep Chopra
It makes your foot curve outwards. So the foot if you look at. 

07:58
Dr. Pradeep Chopra
Your if somebody looks at your ankles from the back when you're standing, you can see that the ankle sort of curves outwards. And that is where the problem is, because, remember, your weight comes down your. 

08:11
Dr. Pradeep Chopra
Leg, and as it comes down your. 

08:13
Dr. Pradeep Chopra
Leg, when it reaches the ankle, it should go straight down into the ground. But if your ankle is turned outwards it's not getting that proper weight transmission and that leads to ankle problems and. 

08:24
Dr. Pradeep Chopra
Ankle issues and that's the reason why. 

08:27
Dr. Pradeep Chopra
We need to correct our flat feet. Just to recap flat feet, you check flat feet by standing on a hard ground or a flat surface. 

08:38
Dr. Pradeep Chopra
That's how you check it. 

08:39
Dr. Pradeep Chopra
You don't check it by looking at it. If you eyeball it's going to. 

08:42
Dr. Pradeep Chopra
Look great but the minute you stand it goes flat. 

08:46
Dr. Pradeep Chopra
There are two types, the front is flat, the front of the foot is flat and that whenever you buy shoes, you buy wide shoes and for the other one you get your arch. You can get an arch insert if your shoe doesn't have one already. But it's really important to correct your. 

09:04
Dr. Pradeep Chopra
Flat foot because as I said, a. 

09:06
Dr. Pradeep Chopra
Flat foot will arch out or turn outwards and that kind of causes the weight to be transmitted in an incorrect fashion which leads to ankle damage. 

09:15
Jennifer Milner
And can I put a hack in here? 

09:18
Dr. Pradeep Chopra
Sure. 

09:20
Jennifer Milner
Because I work with a lot of people who do have the flat feet, high arches, when their feet start moving. And they do find relief with some sort of arch support, especially in my younger population, like teenagers, early 20s. They find that relief even with just a drugstore sole insert. But they do not want to take the effort of taking the insert out of their Chucks and putting them into their Uggs or whatever the case might be. So I encourage them. The inserts are $15. Buy three or four pairs, leave one in every single shoe that you need them in, because if you're not using them, you're wasted money anyway. So if the only way you'll use them is if they're already in your shoes, then buy a few low cost ones and then at least you will have them in your shoes, so you'll actually use them. 

10:10
Dr. Pradeep Chopra
That actually is a great hack. 

10:12
Jennifer Milner
Thank you. 

10:12
Dr. Linda Bluestein
Agreed. 

10:13
Dr. Pradeep Chopra
Yeah, that is a really good hack, because that's what I used to do was I used to keep moving my Pedag from shoe to shoe, but it's. 

10:21
Dr. Pradeep Chopra
Really not worth it. 

10:22
Dr. Pradeep Chopra
Just get a few. Plus they last longer because you're not putting all the wear on hair one pair. So that's a really awesome hack. Thank you. That's going to be called the Hack of the Day. 

10:36
Jennifer Milner
Well, the podcast is early. We just started, so don't give away the podcast. 

10:41
Dr. Pradeep Chopra
I don't think I'll be able to beat that hack. So let's move up to the ankle. Now, ankle instability. Now, ankle instability is not just particular to EDSS. I've seen adults, a lot of adults with ankle instability. So one of the advantages of waiting for a flight at the airport is that you sit down and watch people's ankles. 

11:06
Dr. Linda Bluestein
Oh, yeah. 

11:09
Dr. Pradeep Chopra
And you look at that one has Eds and that one has oh, my goodness, those ankles. It's common in non Eds patients to have weak ankles or unstable ankles. Again, ankles don't have any muscles padded around them and they are super weight bearing joints, so they do tend to get unstable as life goes on. Now, EDSS, of course, have born with unstable ankles. And how do you know that? Very simple. You lift up their foot and you can actually grab onto the sole of the foot, the bottom of the foot. 

11:44
Dr. Pradeep Chopra
And turn the ankle. 

11:45
Dr. Pradeep Chopra
If not, you can just ask them. When you walk, do you ever find you roll yourself rolling your ankles? Do your ankles roll? 

11:52
Dr. Pradeep Chopra
And they'll say, oh yeah, I roll. 

11:53
Dr. Pradeep Chopra
My ankles all the time. And that is kind of critical because you don't want to roll your ankles. 

12:00
Dr. Pradeep Chopra
And I'll explain that to you in. 

12:01
Dr. Pradeep Chopra
A second, but you really don't want to roll your ankles because every time you roll your ankles, you are separating that the lower leg has two bones to it the tibia and the fibula. And the tibia and the fibula make a joint at the ankle end and then they also make a joint at the knee end. What happens is this companionship between the tibia and fibula is very parallel, almost parallel. And when you roll your ankle, these two bones separate. And when they separate, there's a nerve at the top near the knee joint. 

12:37
Dr. Pradeep Chopra
And that gets banged by the fibula. And that nerve is called the peroneal nerve. 

12:43
Dr. Pradeep Chopra
So the peroneal nerve gets hit every time you roll your ankle. The two tibia and fibula separate slightly. The fibula separates more than the tibia. And when they separate, the fibula hits. 

12:54
Dr. Pradeep Chopra
Against the peroneal nerve just below the. 

12:56
Dr. Pradeep Chopra
Knee on the side. And that nerve is responsible for two things. It's responsible for sensation down the leg into the ankle, into the foot. But more importantly, it's responsible for lifting. 

13:12
Dr. Pradeep Chopra
Your foot as you walk. 

13:14
Dr. Pradeep Chopra
So when we walk, the first thing we do is we do what is called the heel strike. 

13:18
Dr. Pradeep Chopra
We put down our heel and then. 

13:20
Dr. Pradeep Chopra
We lift the foot, the front of our foot up. And that lifting of the front of. 

13:25
Dr. Pradeep Chopra
The foot is done by the peroneal nerve. 

13:28
Dr. Pradeep Chopra
And if the peroneal nerve is injured by repeatedly rolling your ankle, then it. 

13:33
Dr. Pradeep Chopra
Does not lift up the foot and that's called foot drop. 

13:37
Dr. Pradeep Chopra
And these patients will then tend to stumble on their toes and you can ask them that question. Have you ever noticed that when you've been walking for some time that you stumble on your toes? 

13:47
Dr. Pradeep Chopra
And they'll all agree to that? 

13:49
Dr. Pradeep Chopra
In the past, I used to look at the bottom of their shoes and you could see the wear and tear. 

13:53
Dr. Pradeep Chopra
But now the soles of the shoes. 

13:56
Dr. Pradeep Chopra
Are so beautifully made that you don't. 

13:58
Dr. Pradeep Chopra
See any wear and tear. 

13:59
Dr. Pradeep Chopra
But you can ask them, like when you walk for some time. When you walk, they have to be walking for some time to irritate that nerve. And they've been rolling their ankles for some time, which then causes them to. 

14:09
Dr. Pradeep Chopra
Have a foot drop. 

14:11
Dr. Pradeep Chopra
And the easiest way to treat an unstable ankle is to wear high top shoes. High top shoes. What they do is high top shoes with laces. What they do is they stabilize your ankle. They act like a brace, but they look nice. So I didn't realize that there are high top shoes and then there are. 

14:30
Dr. Pradeep Chopra
Not so high top shoes. So there are shoes which are supposed. 

14:36
Dr. Pradeep Chopra
To be high top, but don't go. 

14:38
Dr. Pradeep Chopra
Too high up above the ankle and. 

14:40
Dr. Pradeep Chopra
I don't know what they're called. And then you have the ones that go a little higher than that and you want that one, the one that goes higher. And it should have laces so you can tighten your laces and that stabilizes the ankle and that avoids your ankles from rolling and that then avoids you. 

14:56
Dr. Pradeep Chopra
From tripping on your toes and also. 

14:58
Dr. Pradeep Chopra
Helps with the pain in your leg. 

14:59
Jennifer Milner
And it seems like just such a small thing, like if your ankle is going to roll, I mean, you can still sprain your ankle with high top shoes, right, but it's much less likely. And it's such a small thing, but it really does help a lot. 

15:12
Dr. Pradeep Chopra
Yes. 

15:14
Dr. Pradeep Chopra
I was having a problem with my patients because I used to recommend these ankle braces, which really looked ugly. And not only that, they had to buy a new pair of shoes because the brace would be thick, and so they had to buy a new pair of shoes. And then that's when I was sitting at the airport and I looked at this woman walk by with high top shoes. 

15:31
Dr. Pradeep Chopra
I said, well, that'll work for my unstable ankles. 

15:35
Dr. Pradeep Chopra
So there are a few brands out there. Doc Martens is one brand, but almost all basketball sneakers are pretty high top, and any of those can work for you. 

15:49
Jennifer Milner
They are, but I will also say most of the high top sneakers, like the basketball sneakers, and even the Doc Martens do not have the built in arch support that the Hocas or some of those other brands would have. So that's where we have to go back to finding an arch support insert that you can use that you can both worlds. 

16:10
Dr. Pradeep Chopra
Yeah. 

16:10
Dr. Linda Bluestein
And then it can be hard to get the arch support in the high top shoe, too, right. 

16:15
Jennifer Milner
So you have to make sure if you find a pair of flat sold high top shoes, take an arch support with you to try them on or make sure you can return them because they will make a difference in how they fit. And every time I put an arch support in the lace up high top sneakers, it starts to push on my arch, the laces do. So you've got to play around with that. But they definitely help. 

16:37
Dr. Pradeep Chopra
Yes, and you're absolutely right, and that's been my experience. So when you do buy high top shoes, you have to figure out how tight those laces have to be. Some of those bindings may not have. 

16:51
Dr. Pradeep Chopra
To be as tight, because after all. 

16:54
Dr. Pradeep Chopra
The ankle joint needs to move. But you'll figure it out soon. And like I said, some shoes don't have high top sorry, shoe inserts. 

17:03
Dr. Pradeep Chopra
And that's when you buy them from Jennifer's shoe insert shop. 

17:09
Jennifer Milner
There you go. I'll start my own shoe insert shop. 

17:11
Dr. Linda Bluestein
I'm thinking for people who Doc Martens are yeah, those are really popular nowadays, right. I see people wearing Doc Martens, and they can be fairly they're going to the ballet like they're dressed up. So that's cool. That style wise, there's a lot more options. But for people who maybe that's out of their budget, don't you think that even if you're wearing a more compressive type sock that maybe will give you a little bit more proprioceptive input? And that way, okay, it's not the same level of support, but maybe it might give you just a tiny bit of an advantage or make it slightly less likely for you to sprain your ankle as compared to having nothing. Just a thought. 

17:53
Dr. Pradeep Chopra
See, you're absolutely right, because one of the issues with Eds that I had in the beginning was compliance. 

18:04
Dr. Pradeep Chopra
I was completely blind to compliance. 

18:06
Dr. Pradeep Chopra
Guys are completely blind to fashion. They'll wear anything. They'll take a piece of leather and tie it with a string and walk around as shoes. Obviously, a lot of my Eds patients are girls, and they're young girls and teenage in their 20s. They rather limp around than wear some ugly brakes on their ankle. 

18:30
Dr. Pradeep Chopra
I can tell you that. 

18:32
Dr. Pradeep Chopra
And so compliance became a big issue for me. And so I had to look at something that would appeal to them. And the high top shoes just made a lot of sense. But I didn't realize till a patient actually showed me a high top shoe that wasn't really a high top shoe. It sort of like was a mid high top shoe. And then I realized, oh, no, that won't do. You really need higher than that. And so just be careful about that part. 

18:58
Jennifer Milner
Well, and when we're talking about cost as well for shoes, I get it. I know fashion. I know people love some people love shoes and love to collect them. For me, because of my body, I would rather buy one really great pair of shoes that's going to cover a few different uses than to buy four different pairs of shoes that are $30 that aren't going to be as supportive to my feet because I'll end up not wearing them. I'll wear them once. My feet will hurt. My ankles will hurt, and I'll put them to the side. But if I spend whatever it costs one good pair of doc Martens, I look cool. I probably don't look cool, but I feel cool. You look cool. Or spending great, good money on hokas, rather than buying a few different pairs of cool looking sneakers that aren't going to last as long and aren't going to give. 

19:46
Dr. Pradeep Chopra
Converse. Converse. Let me just explain. Converse. You just described Converse. Those are not shoes. 

19:53
Dr. Pradeep Chopra
Those are tarp wrapped around your feet, okay? 

19:57
Dr. Pradeep Chopra
And people do look at girls, do look at me weirdly when I say converse is not a good idea. 

20:02
Dr. Pradeep Chopra
But converse does make high top, and. 

20:05
Jennifer Milner
You put an arch support. 

20:06
Dr. Pradeep Chopra
Compromised myself with that. I said, okay, converse, high top will do. 

20:11
Dr. Pradeep Chopra
Yes. There you go. 

20:12
Dr. Pradeep Chopra
But anyway, so we've talked about how. 

20:14
Dr. Pradeep Chopra
To stabilize the feet, okay? 

20:16
Dr. Pradeep Chopra
We've talked about how to stabilize the ankles, and this should solve at least half the problems with your legs. 

20:24
Dr. Pradeep Chopra
That's the thing. 

20:24
Dr. Pradeep Chopra
Remember, your problem starts with your having unstable ankles and feet, which then goes on to your knees and then to your hips and then to your back. On the knee part, there are only two issues. 

20:37
Dr. Pradeep Chopra
One, is that knees hyperextend, okay? 

20:41
Dr. Pradeep Chopra
So they go backwards a lot. Not everyone, but most people does go. 

20:45
Dr. Pradeep Chopra
Hyperextend a lot back. But the question here is, if it hyperextends, should we correct it or not? And the answer is no. If it hurts, if it's painful, then you should consider correcting it. And there's a catch to how you correct it. 

21:03
Dr. Pradeep Chopra
Which knee to correct? Because what I tell patients is fix your ankles and your foot first and see if it makes a difference to your knees. If that helps your knees, you're all set. If it doesn't, then let me know which knee hurts more than the other. And here's the catch that physicians have to solve. A patient may come in and say. 

21:27
Dr. Pradeep Chopra
My right knee hurts more than my left knee. 

21:30
Dr. Pradeep Chopra
But when you examine them, their left knee is much more hypermobile or hyperextended than their right. 

21:38
Dr. Pradeep Chopra
So what do you do? 

21:39
Dr. Pradeep Chopra
Your right knee doesn't hyperextend, but it hurts. Your left knee hyperextends and is hypermobile. So which one are you going to treat? And in this case, I choose treating the right knee. Because what's happening is, because their left knee is unstable, they tend to put. 

21:56
Dr. Pradeep Chopra
More weight on their right side, and. 

21:59
Dr. Pradeep Chopra
Because they put more weight on the. 

22:00
Dr. Pradeep Chopra
Right side, the right knee hurts more. 

22:02
Dr. Pradeep Chopra
And so I tend to treat the right. 

22:04
Dr. Pradeep Chopra
Sorry, I'm sorry, my bad. 

22:07
Dr. Pradeep Chopra
I treat the unstable knee even though it doesn't hurt, which would be the. 

22:11
Dr. Pradeep Chopra
Left knee, and that will take care of the right knee. 

22:15
Dr. Pradeep Chopra
And that's how you have to do it is you really have to figure out, because they might say, but I don't have any pain on the left knee. 

22:23
Dr. Pradeep Chopra
And that's the problem. 

22:24
Dr. Pradeep Chopra
It's not coming from your left knee, but your left knee is making you so unstable that your right knee has to do all the work to stabilize you. So you stabilize the left knee, which, even though it's not hurting you, still stabilize that well. 

22:35
Jennifer Milner
And isn't that something that you see a lot of with knee issues? As you said yourself, there's not a lot to talk about with the knee. It's either hyperextended or it's not as far as pure hypermobility goes. But the knee is the joint that gets caught in between the hip and the foot or the ankle. And so a lot of knee issues can come up that may not be a result of hypermobility in the knee, but are a result of hypermobility or biomechanical dysfunction because of hypermobility in the hip or in the ankle. And I've had so many clients that go see a physical therapist and say, my knee is bothering me. And they say, well, let's look at your feet, or let's look at your hips. And they're like, no, it's my knees that bother me. Well, the knee is just the poor kid that's stuck in between these two fighting grown ups, right? 

23:17
Jennifer Milner
So it's really important to look at that? 

23:20
Dr. Pradeep Chopra
Yes, absolutely. 

23:22
Dr. Pradeep Chopra
I've actually had people have back surgery. 

23:26
Dr. Pradeep Chopra
And it didn't help. 

23:27
Dr. Pradeep Chopra
And when they come into the office and you look at them and you. 

23:29
Dr. Pradeep Chopra
Say, like, how long have you had. 

23:30
Dr. Pradeep Chopra
This pain in your and this is non eds. And then you find out that the issue is actually there's a big bunion in their foot or their knee is completely off. But anyway, so this is the tricky part. You don't just treat what hurts. This is against the rule. The squeaky wheel gets the oil. This one is the non squeaky wheel gets the oil. So because the left knee is hypermobile as compared to the right, but you still treat the left knee because you're transmitting all your weight to the other side. But just from my experience, I can say that most people, when you fix their feet and ankles, their knees kind of behave themselves. There are a few exceptions where I've had to get a brace for the knee and I don't like doing that. 

24:17
Dr. Pradeep Chopra
Because no one liked to wear a knee brace. 

24:20
Dr. Linda Bluestein
What about for people who have extremely mobile patellas? And if they have, like, say, patella alta or some other condition where they're dislocating their patella a lot. It seems like this is a not uncommon thing with either dancers I've seen or patients that I've seen in various different scenarios having surgery, having, like, a lateral release for recurrent patellar dislocation seems like a very common procedure that people have had. I would love to know your thoughts about that. 

24:52
Dr. Pradeep Chopra
So the patella is yes, the patella is hypermobile in most patients with the IDs, almost all of them, but it's not a problem at all. 

25:00
Dr. Pradeep Chopra
It doesn't. 

25:01
Dr. Pradeep Chopra
And if it is super hypermobile that it's causing a problem, it's an easy fix. You can actually get little braces or even little straps that will hold the patella in place. If you happen to wear a knee brace, almost all knee braces have a little donut hole in the middle that. 

25:19
Dr. Pradeep Chopra
Holds the patella in place. 

25:21
Dr. Pradeep Chopra
If you are not wearing a brace, there are straps, there are little straps, very discreet little straps that you can put around your kneecap and it keeps a kneecap in place. But most often the kneecap, if the patella is going to be a nuisance, the problem will show up on the front of the thigh, not at the patella. Because, you know, the front of the thigh has four muscles. That's why they call the quads. So there are four groups of muscles and all four of them meet at the patella. And so if your patella is swinging around from left to right, then these muscles are being tugged. So, for example, if your patella swings to the right, then the left side of the quad, the left group of the quad muscle gets pulled. If the patella goes to the left. 

26:07
Dr. Pradeep Chopra
Then the right side of the quad gets pulled. 

26:10
Dr. Pradeep Chopra
And so oftentimes these patients will complain of pain in their thighs rather than at the kneecap itself. I haven't seen good relief from patella release surgeries. And the best thing is, if it. 

26:25
Dr. Pradeep Chopra
Is a bother, you can get these. 

26:28
Dr. Pradeep Chopra
Tiny little knee patella bracing, elastic things you can wear around them, and they keep the patella in place with the knee. So, just to recap, if you have a hyperextended knee, by the way, the term used for hyperextended knees is banana knees. 

26:48
Jennifer Milner
That's medical. 

26:49
Dr. Pradeep Chopra
They look like bananas. So knees generally behave themselves once you get the ankles stabilized, the ankles and. 

26:58
Dr. Pradeep Chopra
Feet, they will behave themselves. 

27:00
Dr. Pradeep Chopra
If the patient comes back and tells me, look, I did all this. I'm wearing these high top shoes, my knee still hurts, then I will ask them which knee, they'll tell me which knee. I look at the knees and then decide on which side is going to. 

27:11
Dr. Pradeep Chopra
Get a knee brace. 

27:13
Dr. Pradeep Chopra
Now, a small little hack on the knee brace. Now, most knee braces, you have to. 

27:19
Dr. Pradeep Chopra
Sort of pull it up from your feet. 

27:21
Dr. Pradeep Chopra
You put your foot through it and then you pull it up like a stocking all the way up to your knee. Now, that is not an easy job because this is a tight strap. And with having hypermobile fingers, it's not an easy job. There is one company that actually makes. 

27:38
Dr. Pradeep Chopra
A knee brace that you can wrap around your knee. And of course, I can't remember the name. Now give me 1 second, it'll come to me. Oh, yeah, it's got a dark name. 

27:53
Dr. Pradeep Chopra
It's called the gripper. Okay, well, I guess it grips your knee gripper. It's made by a company called Medspec, M-E-D-S-P-E-C. But in any case, all knee braces have to have a few features. 

28:07
Dr. Pradeep Chopra
One, it should have a strap on the top, in the front, and in the back. 

28:13
Dr. Pradeep Chopra
Remember, the leg is conical in shape, especially the thigh is conical in shape. 

28:18
Dr. Pradeep Chopra
So these braces tend to slip down. 

28:21
Dr. Pradeep Chopra
So it has a strap in the. 

28:23
Dr. Pradeep Chopra
Front and it has on the top. 

28:25
Dr. Pradeep Chopra
At the thigh level, it has a strap in the front and it has. 

28:28
Dr. Pradeep Chopra
A strap in the back. 

28:30
Dr. Pradeep Chopra
Below the knee itself, it should have a strap in the front and a strap in the back. So these four straps will keep the brace from slipping down. It has a hole in the front, a little donut hole that keeps the kneecap in place. 

28:45
Dr. Pradeep Chopra
It has a hinge on each side. 

28:48
Dr. Pradeep Chopra
Usually a metal hinge that keeps your knee from hyperextending. That's critical, that's really important. And you can't see it, but it keeps the hinge keeps your knee from hyperextending. 

29:01
Dr. Pradeep Chopra
And that's great. 

29:02
Dr. Pradeep Chopra
A good brand will make it adjustable. They'll give you this little Allen wrench, which you can then unscrew it and then sort of get the right angle because you should be, under normal circumstances. 

29:16
Dr. Pradeep Chopra
Be able to flex the knee. You don't want. 

29:19
Dr. Pradeep Chopra
It straight like Frankenstein walking around. So you should have some flexibility to the knee so you can adjust and what angle is best for you? 

29:28
Dr. Pradeep Chopra
You can adjust it. 

29:29
Dr. Pradeep Chopra
I recommend the gripper because you don't have to pull it up the leg, it just wraps around and has all the features that I just talked about. 

29:40
Dr. Pradeep Chopra
That's great. 

29:40
Jennifer Milner
We should open up a hypermobility store. You have so many great tips from your years of working with people and, you know, all the good brands and all the things that work really well because it's been road tested so much with your patients. 

29:52
Dr. Pradeep Chopra
Actually, there is a hypermobility store. 

29:56
Dr. Pradeep Chopra
John Furman from Eds Awareness, right? 

30:03
Dr. Pradeep Chopra
Dr. Blues? 

30:04
Dr. Pradeep Chopra
Yeah. 

30:04
Dr. Linda Bluestein
Eds awareness chronic Pain partners. 

30:07
Dr. Pradeep Chopra
If you go to their website, Chronic Painpartners.com, he has a store where. 

30:16
Dr. Pradeep Chopra
They. 

30:16
Dr. Pradeep Chopra
Keep Eds recommended, so recommended by EDSS as different things. 

30:22
Dr. Pradeep Chopra
I don't know if he has these. 

30:23
Dr. Pradeep Chopra
Braces or not, but he does have some amount there. 

30:26
Dr. Pradeep Chopra
That's great. 

30:27
Dr. Pradeep Chopra
Some of these, like the pillows and things like that, they do have them. And these are all that have been recommended by our other Eds patients. 

30:34
Jennifer Milner
That's great. Before we leave the knee, I wanted to go back to something you said about how should someone stand in hyperextension or not stand in hyperextension. And you said if it's not feeling any issues, if it's not causing any pain on either side, then you don't necessarily correct it. What about for me, when I see people standing in hyperextension, I usually see a compensatory strategy for their weight, for their gravity, for their plumb line, somewhere up and down the chain. So if I see them hanging in their hyperextended knees, they might be hanging forward on their Y ligaments and their hips. They might be jutting their head forward or something. So would you look at everything before you decided to let them hang in their hyperextension, or what do you usually do? 

31:18
Dr. Pradeep Chopra
Yes, I'm glad you brought that up. If I see that they have no knee problems, but I see that they have a lot of hyperextension, it's the same rule. I bring that up again. When you stand, always break your knee a little bit. 

31:31
Jennifer Milner
Okay? 

31:31
Dr. Pradeep Chopra
So it's not tightly hyperextended. 

31:34
Dr. Pradeep Chopra
Just a tiny bit. 

31:36
Dr. Pradeep Chopra
And that's all that applies to that same rule about keeping your joints within range of motion. Sorry, under your range of motion. 

31:46
Jennifer Milner
Under your range of motion. 

31:47
Dr. Pradeep Chopra
If they're not squeaking, if it's squeaking, then we have a different story here. So then that takes me to the hips. Now, hips in general, as I mentioned earlier, that hips are very stable joints. Inherently, they're very stable joints. They are deep socket joints with a ton of muscles around them, and they don't have a great range of motion. I mean, most hips, hip joints move forward and backwards just a little bit to the sides. And the idea was that, well, if you're going to be chased by a saber toothed tiger. You better run fast. 

32:23
Dr. Pradeep Chopra
You don't want your hip subluxing then. 

32:26
Dr. Pradeep Chopra
And that was the idea of evolutionary idea of having strong hip joints. If a hip joint is subluxing, then the culprit is somewhere else. The culprit is usually in the leg somewhere. 

32:40
Dr. Pradeep Chopra
And that's the one that we watch out for. If they're subluxing. One of the one of the other. 

32:51
Dr. Pradeep Chopra
Things that I and I don't know if so in terms of hip joints, there's no great brace for it. 

32:57
Dr. Pradeep Chopra
There is one. It's very elaborate and it's a pain. 

33:01
Dr. Pradeep Chopra
In the neck to wear it. And it really doesn't help a lot. It's almost like shots. You wear the shots and then it sort of stabilizes your hip joint, but they're not really helpful. But if a super stable joint like the hip is subluxing, then the problem is somewhere else in the leg, and. 

33:18
Dr. Pradeep Chopra
You look for that. 

33:19
Dr. Pradeep Chopra
Either it's the ankle or the knees. 

33:21
Dr. Pradeep Chopra
Or something like that. 

33:25
Dr. Pradeep Chopra
I don't know if this is common, a condition called FAI, femoroacetabular impingement. 

33:32
Jennifer Milner
I think it is common. 

33:34
Dr. Pradeep Chopra
I've seen it in EDS, only I've not seen it in non Eds patients. But I can't tell you for sure if this is a completely EDS thing or not. 

33:44
Dr. Pradeep Chopra
But. 

33:48
Dr. Pradeep Chopra
There are three different types of FAI. This is called femoroacetabular impingement, and there are three different types. 

33:56
Dr. Pradeep Chopra
But essentially the head of the femur. 

34:00
Dr. Pradeep Chopra
Is too big for the socket. 

34:03
Dr. Pradeep Chopra
That's what it boils down to. 

34:06
Dr. Pradeep Chopra
And the treatment is surgical. And it does work well. If it's done by an orthopedic surgeon who's familiar with FAI surgeries and the. 

34:18
Dr. Pradeep Chopra
Nuances of Eds, it does help. 

34:22
Dr. Pradeep Chopra
And not just because you have an FAI. You should get surgery done. If you have an FAI and it's. 

34:28
Dr. Pradeep Chopra
Squeaking, that's when you have the surgery done. So there's a philosophy in medicine. 

34:33
Dr. Pradeep Chopra
You treat the patient, not the MRI. 

34:36
Dr. Pradeep Chopra
And if you see an FAI on. 

34:38
Dr. Pradeep Chopra
An MRI, but the patient has no hip problems, you don't touch. 

34:43
Dr. Pradeep Chopra
It is. 

34:43
Dr. Pradeep Chopra
There are three types of FAIS, but basically it boils down to the head of the femur not fitting properly into the cavity of the acetabulum or the hip cavity. And from that you have a few different problems. Usually it's a hip pain. 

35:02
Dr. Pradeep Chopra
Hip pain shows up in many different places. 

35:07
Dr. Pradeep Chopra
It can show up in your groin, it can show up on the side. 

35:10
Dr. Pradeep Chopra
Of your thigh, and it can show up in the middle of your buttock. 

35:15
Dr. Pradeep Chopra
Now, if you have a pain in any of these areas and you don't know if it's a hip or if it's just a muscle, and if you. 

35:21
Dr. Pradeep Chopra
Walk and if the pain gets worse. 

35:23
Dr. Pradeep Chopra
Then it's probably the hip. If you walk and you kind of sort of limp a little towards that. 

35:28
Dr. Pradeep Chopra
Side, then it's probably a hip joint pain. 

35:30
Dr. Pradeep Chopra
These are the things to look at. 

35:33
Dr. Pradeep Chopra
And I think to just wind up. 

35:36
Dr. Pradeep Chopra
On the lower extremity, I'm going touch base on the sacroiliac joint. 

35:41
Dr. Pradeep Chopra
The si joint? 

35:42
Jennifer Milner
Yes, please. 

35:44
Dr. Pradeep Chopra
The sacroiliac joint. So the pelvis is made up of three joints that connect to each other. 

35:49
Dr. Pradeep Chopra
To form a ring. 

35:51
Dr. Pradeep Chopra
And in the middle of the ring live all the organs, the urinary, bladder, the uterus and all that stuff lives in the middle of it. 

35:58
Dr. Pradeep Chopra
And on the outside of this ring. 

36:03
Dr. Pradeep Chopra
Is the socket for the hip joint. And the si joint, or the sacroiliac joint, is remember I told you. 

36:10
Dr. Pradeep Chopra
There are three bones? 

36:11
Dr. Pradeep Chopra
So the one bone that's in the middle of your lower back, almost in. 

36:17
Dr. Pradeep Chopra
Your bum, that's called the sacrum. 

36:19
Dr. Pradeep Chopra
And the sacrum makes a joint with the bone on the left and it makes a joint with the bone on the right. And that's the joint. These are the two joints that start to hurt. Now, sacroiliac joint pain is not peculiar to Eds. It is common in non Eds patients. 

36:37
Dr. Pradeep Chopra
Also most often seen in women, because. 

36:42
Dr. Pradeep Chopra
The pelvis expands with childbirth and then it goes back in place. But in Eds, it may not go back and fuse as well after a childbirth. So they're left with an si joint pain. It can also happen with pain from your leg. So if one of your legs is painful, it can set off your si joint pain. Or actually it makes your hip I'm sorry, your pelvis uneven. And so it seems like your one leg is shorter than the other, which makes your pelvis a little bit uneven. And so the joints, the sacroiliac joints start to hurt. There are two ways to treat it. There are three ways to treat it. 

37:23
Dr. Pradeep Chopra
One is to look for why is. 

37:25
Dr. Pradeep Chopra
There an si joint pain? Is there something wrong in the knee, on the foot or the hip that's. 

37:30
Dr. Pradeep Chopra
Causing the pelvis to tilt a little bit? 

37:33
Dr. Pradeep Chopra
And if you can't find that, then you look at the si joint itself and it could be that the si joint is just inflamed. In that case, it would need a couple of shots, steroid injections into the sacroiliac joints, that could help. It can be treated. It really hurts a lot. And you've tried everything and nothing's making a big difference. Then you can look at what's an si joint brace. 

38:02
Dr. Pradeep Chopra
And this is where I need to explain. 

38:04
Dr. Pradeep Chopra
There is an old brace, it's called the Si belt. 

38:08
Dr. Pradeep Chopra
Do not touch that, okay? 

38:10
Dr. Pradeep Chopra
Don't even go for that. That's a piece of useless piece of junk. There's a company, a German company that has come out with a brace for the waist and the si joint, a combined brace. And it's designed for women, because women's pelvis are different. And so it's designed for that and it holds the pelvis in place. But it's not the best solution, holding the pelvis in place, because the pelvis needs to have some movement in it. And that would be the other thing to try. 

38:43
Dr. Linda Bluestein
Excuse me, are you referring to the Bauerfiend sacral lock or something different. 

38:46
Dr. Pradeep Chopra
Yes, I'm talking about the Bauerfiend, not the sacral lock, but the lock. 

38:51
Dr. Pradeep Chopra
Oh, okay. 

38:52
Dr. Linda Bluestein
My sacral lock is sitting just a few feet from me. So I was curious. 

38:56
Dr. Pradeep Chopra
Sacral lock is another one you can use or you can use. They have another version. So what Dr. Bluestein is talking about is a company called Bauerfiend. B-A-U-E-R-F-I-E-N-D. It's a German company. They make braces. They make really great braces. And they came out with this design called the Lumbo Lady. So it sort of stabilizes the lower back and the si joint, and it's designed for women. 

39:26
Dr. Pradeep Chopra
Now, there are some bozos who I'm. 

39:30
Dr. Pradeep Chopra
Referring to orthopedic surgeons who think that putting a screw into the si joint will fix the problem. That is by far the worst idea I have ever seen, because as we walk, the si joint needs to have some movement. 

39:47
Dr. Pradeep Chopra
It should rock a little bit, and you cannot fuse it. 

39:53
Dr. Pradeep Chopra
You cannot put a screw in it and fuse it for good, because once you do that throws the mechanics of your entire spine off. You start developing lower back pain. Your hips start to hurt. 

40:06
Dr. Pradeep Chopra
Everything starts to hurt after that. 

40:09
Dr. Pradeep Chopra
I have never in my life no one does it, actually. There are just a few cases. There are just a few people who have no clue what they're doing. They'll fuse it. 

40:20
Dr. Linda Bluestein
Yeah, there's people that are still doing it. And I had somebody recently. 

40:24
Dr. Pradeep Chopra
Yeah, there are. Are we allowed to swear on the podcast? 

40:30
Dr. Linda Bluestein
Go for it. We can always take it out. 

40:32
Dr. Pradeep Chopra
There are some bleep orthopedic surgeons who will have really no brains. They'll say, oh, your si joint is causing pain and it's loose. Let me go and take some screws from Home Depot and screw them up and fix your si joint, and you'll be good to go. And then they show up in our office. Oh, Doc, my back hurts, my knee hurts, my everything, right? And then you're like, oh, the si joint got fused, and there's not much you can do about it. Leave it alone. 

41:00
Jennifer Milner
And this is such an interesting conversation for us to have because the discussion about the si joint has come such a long way. I mean, when I started out 20 some odd years ago, there were people saying that would stand on the hill and fight. The si joint is not a joint because it doesn't have any movement to it. It's a connection. Like, they couldn't even come up with a name for it. And now everybody agrees it's a joint, even though it has, what, five to ten degrees of motion. It's not a lot of motion, but it's critical motion. And looking at how the si joint moves, how it coordinates with the rest of your spine, and more importantly, what we've talked about in earlier discussions when were talking about the upper extremities. In our last podcast, we talked about muscle tightness and what is that trying to protect? 

41:44
Jennifer Milner
And so often when I have people come in with low back pain, I'm like, well, let's look at what's tight, let's look at what's going on. And they'll have really tight glutes that may be super hypertonic, but not really efficient, or they might have one piriformis that's really strong and one that's really weak. And so figuring out what's trying to hold on instead is much better than, as you said, stick a screw in it and hope for the best. But it's usually a sign that there is some sort of imbalance of too much looseness versus too much tightness. And one will usually follow the so it's a really important conversation to have because it really does affect a whole lot of the body, that si joint and that sacrum movement. 

42:26
Dr. Pradeep Chopra
Jennifer, I am blown away by what you just said because the glutes and the piriformis are so annoying. Those muscles, especially the piriformis, is a really annoying muscle for what it does. 

42:41
Dr. Pradeep Chopra
What its function is, and the degree. 

42:44
Dr. Pradeep Chopra
Of pain it causes. It's just not worth having a piriformis. 

42:47
Jennifer Milner
Muscle take it out. 

42:49
Dr. Pradeep Chopra
Yeah, if I had a way of sending kind of a request to God and like, hey, the next set of human beings that you create, can we just get rid of the piriformis muscle? 

42:59
Dr. Pradeep Chopra
It really doesn't do a lot. 

43:00
Dr. Pradeep Chopra
So you're absolutely right. Just because somebody has back pain, you don't just assume that it's your si joint or your disc or whatever. Like I told you, no one has a normal MRI. There's no such thing as a normal MRI. So you look at the muscle, it's easy. You palpate the muscles, you push around, and all of a sudden they're going to jump up and say, yeah, that hurts a lot, and you can feel a knot there. And that's because your muscles are trying their best to stabilize your joints, stabilize you as you move around. You're right. The piriformis muscle is a super. I especially hate it because I've had. 

43:40
Dr. Pradeep Chopra
Piriformis pain and it's not fun. 

43:44
Dr. Pradeep Chopra
It's a muscle that's deep down in the buttock. 

43:47
Dr. Pradeep Chopra
It connects your sacrum. 

43:49
Dr. Pradeep Chopra
That's the bone in the middle of your butt to the hip joint. 

43:54
Dr. Pradeep Chopra
So there's one on each side. 

43:57
Dr. Pradeep Chopra
Piriformis is called piriformis because it's pyramid shaped. And the problem is that muscle goes into a spasm because either you moved your hip in a wrong way or did something to it, and you now overstretch the piriformis muscle, and now it's excruciatingly painful. 

44:14
Dr. Pradeep Chopra
This pain is usually in the buttock. 

44:17
Dr. Pradeep Chopra
And it's very excruciating. The other problem is that just behind. 

44:22
Dr. Pradeep Chopra
The periphery muscle is the sciatic nerve. And so when it goes into a. 

44:27
Dr. Pradeep Chopra
Spasm, it presses on the sciatic nerve. And so now you have pain shooting. 

44:31
Dr. Pradeep Chopra
Down your leg, and that, too, is an excruciating pain disc pain. 

44:36
Dr. Pradeep Chopra
Also causes pain down the leg, but it's not half as bad as the pain from the piriformis muscle causing pain. 

44:43
Dr. Pradeep Chopra
Shooting down your leg over the years. 

44:45
Dr. Pradeep Chopra
It's very easy. 

44:46
Dr. Pradeep Chopra
When you walk into the room, you'll. 

44:48
Dr. Pradeep Chopra
See the patient sitting one button. 

44:50
Dr. Pradeep Chopra
They'll be leaning onto their left side. 

44:52
Dr. Pradeep Chopra
And you can right away say and then you ask them like, what hurts? And oh, my back hurts. And Doc, I have this disc herniation and I have side effects going down my right leg. And you do a couple of maneuvers and you aggravate the piriformis muscle and there you have it. The diagnosis is really simple. The treatment is also equally simple for me. I can do some injections into the piriformis muscle and break the spasm and stretch it. Otherwise you can sit on a golf. 

45:18
Dr. Pradeep Chopra
Ball or a tennis ball, depending on the size of your butt. 

45:22
Dr. Pradeep Chopra
You can sit one of those and sort of stretch the piriformis muscle. So the way to stretch it is you bring the affected ankle, so let's say it's on the right side. You bring the right ankle onto your. 

45:35
Dr. Pradeep Chopra
Left knee, the unaffected knee, and just lean forward and you'll feel that pain. 

45:43
Dr. Pradeep Chopra
In your butt, hold it for 2 seconds and then straighten back up again. 

45:47
Dr. Pradeep Chopra
All the while keeping that golf ball or your tennis ball. 

45:51
Dr. Pradeep Chopra
I don't think I've ever met anyone who's needed bigger than a golf ball, like a football or a softball yet. I'm sure there might be some people, but mostly the tennis ball is good enough. And when you put pressure on it. 

46:07
Dr. Pradeep Chopra
It'S like a pressure point and the. 

46:09
Dr. Pradeep Chopra
Pressure point then loosens breaks the spasm. 

46:12
Dr. Pradeep Chopra
And then you stretch it and eventually we'll let go. 

46:16
Dr. Pradeep Chopra
That's the way to do it. If it's super painful and you want some relief right away, lie on your. 

46:22
Dr. Pradeep Chopra
Back and then you move the affected leg away from you little bit away. 

46:28
Dr. Pradeep Chopra
From the midline, like about 20 degrees away from the midline to the side. 

46:33
Dr. Pradeep Chopra
And turn the foot outwards and after. 

46:36
Dr. Pradeep Chopra
About 1015 minutes the muscle will start to let go. But that's not the cure, that's just temporary. 

46:42
Jennifer Milner
Just a temporary, yeah. I will add to that when I have someone come into me who has si joint pain and they'll say, I really feel the pain on my right side. I'll go through a few different things. There's lots of different places where they. 

46:54
Dr. Pradeep Chopra
Could be really tight, but I would. 

46:57
Jennifer Milner
Say 70% of the time one of the most effective things I can do is strengthen the left piriformis and try to get the left piriformis, the non painful, the non squeaky wheel side, as you've said, with the knees to start working. And I'll do a little bit of release for the right piriformis, but then I will ignore the right piriformis and strengthen other muscles like their deep rotator muscles, make sure their hamstrings are doing the extension work. They need to on the right side to try to get the right piriformis to feel safe and like it can release and let go. So strengthening the opposite piriformis from where there's pain and then trying to strengthen the muscles around it so the piriformis doesn't feel like it's quite so alone is often a great first step for people with those issues. 

47:40
Dr. Pradeep Chopra
For me, that I found that's a really great idea. 

47:43
Dr. Pradeep Chopra
I never thought of that. That's a really good idea. Yeah. 

47:49
Dr. Pradeep Chopra
This condition is very painful and this is the one that drives a lot of people to the emergency room. Disc pain is not this painful. 

47:58
Dr. Pradeep Chopra
But I mean, disc pain does cause. 

48:00
Dr. Pradeep Chopra
Pain down the leg and all that. 

48:01
Dr. Pradeep Chopra
But it's not as acute as a. 

48:03
Dr. Pradeep Chopra
Piriformis muscle because it's a muscle squeezing your sciatic nerve. So it's both a muscle spasm and a sciatic nerve pain. 

48:09
Dr. Pradeep Chopra
I think that's do you have anything. 

48:11
Dr. Pradeep Chopra
Else in our lower extremities? 

48:13
Jennifer Milner
I have a question in the pelvis and I think Dr. Bluseine wants to get back to the ankle in a second, but really quickly, because I have seen this a few times. Can you talk about pubic synthesis? I see it especially in hormonal like pregnant women, and I've seen it in a few of my athletic dancer clients with a subluxation of the pubic synthesis with hypermobility. 

48:33
Dr. Pradeep Chopra
That's actually pretty painful. So what Jennifer is asking is the pubic synthesis. Remember the ring? The pelvis is a ring, we talked about that. 

48:42
Dr. Pradeep Chopra
And on the back it meets the. 

48:45
Dr. Pradeep Chopra
Sacrum and bone called the tailbone, it meets that, but in the front the bones meet together. 

48:52
Dr. Pradeep Chopra
They sort of right at the pubic. 

48:55
Dr. Pradeep Chopra
Area they meet together and oftentimes well, when you're as old as I am, they actually fuse. But in Eds it can actually separate. And when that separates, then that causes pain in the back because then that throws the whole pelvic ring off. 

49:14
Dr. Pradeep Chopra
So it caused pain in the pelvic. 

49:15
Dr. Pradeep Chopra
The si joint area, it causes pain in the usually this happens when there's something severely off on the hip joints. 

49:23
Dr. Pradeep Chopra
Or the legs, that's when it usually happens. 

49:26
Dr. Pradeep Chopra
And to solve this problem, you really. 

49:30
Dr. Pradeep Chopra
Need to have a brace for that. I don't know if surgery is a. 

49:38
Dr. Pradeep Chopra
Good option or not, I don't know. But just thinking of the mechanics, I think if it is so separated that you can't bring it together or just can't make it stay together, then surgically. 

49:50
Dr. Pradeep Chopra
Treating it would be the way to go. 

49:52
Dr. Pradeep Chopra
But otherwise that Bauerfiend lumbo lady or even the sacral lock will do the job. 

49:59
Dr. Pradeep Chopra
That makes sense. 

50:01
Jennifer Milner
Absolutely. Well, and this whole conversation about the lower extremity has just been so interesting. And I keep thinking about what you said at the very beginning, about how the lower extremities not only have to function well for themselves, but also have to be able to bear the load of our entire body. We have to be able to stand one leg and be able to bear the load of our body and we have to be able to do it as efficiently as possible and sort of going through it joint by joint and seeing how closely connected they are. The ankle affects the knee affects the hip, the hip affects the foot. And then the pelvis sits in there going I'm sorry for so many things that are happening. You have given us some really great hacks and we are so grateful once again for you sharing your knowledge with us and for continuing this series as we kind of talk through the whole body with you. 

50:49
Jennifer Milner
Thank you so much once again, Dr. Chopra, for being on Bendibodies Podcast with us. 

50:54
Dr. Pradeep Chopra
Thank you for inviting me. It's a pleasure to be able to help, not just help your listeners and give them some guidance on what to do and what not to do because there's not a whole lot of help. 

51:06
Dr. Pradeep Chopra
Out there and it's nice to be able to. 

51:10
Dr. Pradeep Chopra
So thank you for I know setting up a podcast is not an easy job, and it's an expensive venture, and I really appreciate you guys doing that out of the goodwill of your hearts. And may God bless you for doing that, because the information that I give you over here is not just coming up that I cooked up last week. It's 30 years of treating Edsers and. 

51:37
Dr. Pradeep Chopra
Figuring out solutions because when I started. 

51:40
Dr. Pradeep Chopra
Out, there were no solutions. It was like, right, eds is very rarely found and they have loose joints, period. 

51:48
Dr. Pradeep Chopra
And then they go on to the. 

51:48
Dr. Pradeep Chopra
Next condition and that was all we knew. 

51:52
Dr. Pradeep Chopra
So it was an invention of many. 

51:54
Dr. Pradeep Chopra
Many treatments and things like that. 

51:56
Jennifer Milner
And that's why we're so grateful that you have shared your amassed wisdom with our listeners. We really appreciate it. 

52:03
Dr. Pradeep Chopra
Yes. I'm just oozing with wisdom. 

52:09
Dr. Linda Bluestein
You are joke, but you are. 

52:11
Dr. Pradeep Chopra
You need to wear earplugs now. 

52:15
Jennifer Milner
Keep all that wisdom. 

52:18
Dr. Pradeep Chopra
Need to we need to beat Jennifer's Hack of the day. She set the bar too high. 

52:24
Jennifer Milner
I set the bar too high. You guys are going to have to come up with a better hack. 

52:27
Dr. Pradeep Chopra
Yeah, we'll have to come up with a better hack than that. 

52:30
Dr. Linda Bluestein
Exactly. I know. I'm going to be thinking between now and then, I'm going to be trying to think of as many hacks as I possibly can. 

52:38
Dr. Pradeep Chopra
Yeah, just hack yourself through till our next podcast. 

52:44
Dr. Pradeep Chopra
Right. 

52:46
Dr. Pradeep Chopra
Any one of those hit off as being the highest hack. We've got to be Jennifer's. She set the bar way too high. 

52:51
Jennifer Milner
You've got to. I set a high bar. That's right. I did. Well, everybody make sure you tune into our next podcast so you can hear who wins the Hack of the Day. And until then, we will see everybody later. 

53:05
Dr. Linda Bluestein
Thank you for listening to this week's episode of The Bendy Bodies with the hypermobility MD podcast help us spread the word about joint hypermobility and related disorders by leaving a review and sharing the Podcast. This helps raise awareness about these complex conditions. Visit Bendibodiespodcast.com and follow us on Instagram at bendy bodies. We love seeing your posts and stories, so please tag using hashtag bendybuddy. You can also find me Dr. Linda Bluestein on Instagram, Facebook, Twitter and LinkedIn, all with the hypermobilitymd. This podcast is for general informational purposes only and does not constitute the practice of medicine or other professional healthcare services, including the giving of medical advice. No doctor patient relationship is formed. This is not intended to be a substitute for medical diagnosis or advice. Do not disregard or delay obtaining medical advice for any medical condition you have. The opinions shared are that of the guest and do not necessarily represent the views of the hosts or any particular organization. 

54:09
Dr. Linda Bluestein
Thank you for being a part of our community and we will catch you next time on the Bendy Bodies Podcast.