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Scot: The podcast is called "Who Cares About Men's Health." We talk about health things here to make it seem normal, and also to educate you as well. And we're some guys that are not afraid to say we care about our health. It's cool to care about your health. My name is Scot. I am the manager of thescoperadio.com, and I care about men's health.

Troy: And I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah and I also care about men's health.

Scot: No, Troy, say like you mean it. Come on. One more time, with feeling.

Troy: Scot, this is Troy. And I really care about my health and men's health. I love men's health.

Scot: Perfect. A little less sarcasm next time. And we have Dr. Chris Gee on. Go ahead. Say your thing.

Dr. Gee: How do I follow up with that, right?

Troy: You could do it a little more sincerely than I did.

Dr. Gee: Yeah, I'm Dr. Chris Gee. I'm a sports medicine physician for the University of Utah, and I care about men's health.

Scot: Today's topic: forward head posture. It's something that you see . . . do you see this a lot now? I mean, with people in their phones and their devices, looking at monitors, computer monitors, do you just walk around and go, "Oh my gosh, look at that person, look at that person, look at that person"?

Dr. Gee: For sure. Once you start thinking about it, I think we all start to adjust our posture a little bit, and I'll start talking about it to patients and notice they start to sit up more appropriately and take notice.

Scot: All right. So I'm going to make a confession. I'm going to try to keep this somewhat reasonably timed. I have this forward head posture. I think I've had it my whole life. Some other names for it, by the way . . . these are good. Have you heard other names for it, Dr. Gee?

Dr. Gee: I've heard the dowager's hump. That's one I've heard.

Scot: Yep. That's great as a guy.

Troy: Scot has a dowager's hump.

Scot: Yeah, as a guy, that's exactly what you want to hear about yourself.

Troy: Dowager. Didn't we figure dowager is like an old British lady or something like that? It's a British term for some hunched over old lady.

Scot: I think so. It's an old lady. So some other terms that they use, they call it text neck, iHunch, iPosture, nerd neck, poking chin posture, computer neck, and tech neck. I could imagine programmers looking at their monitors all day. And if your eyesight is little bad, I suppose you're probably sticking that head out just a little bit more.

Troy: I like tech neck. That's a great one.

Scot: I don't like any of them, Troy. I look at people that have the proper posture, and I'm just jealous of them all the time.

Troy: I like the term. I like the term "tech neck." I'm not asking for tech neck, but I like it.

Scot: They have that rounded hump. So I've been trying to untangle that, Dr. Gee. And I know that this is a problem that a lot of people have. So where should we start? Now, I'm going to confess, I have been doing some exercises, but I want to hear your take.

Dr. Gee: So just a little anatomy, when we look at our spines, they're not straight up and down. They actually have a normal curve. So in our lower back, it actually curves kind of with the apex of the curve towards your abdomen. In your back, your upper back, your thorax, the curve goes the opposite direction, kind of with the apex towards your back. And then our necks do the opposite. They kind of curve towards the front.

Now, what that ends up doing is when we relax our posture, when we allow our muscles to not contract, we basically start to slip or exacerbate some of those curvatures. And so our neck curves more to the front, putting our head more forward. Our back curves out, causing that hump effect.

And this is really a problem because so much of what we do logically is in front of us, and as we're focusing in on smaller items, phones, and desktops, and computers, we allow our shoulders to rotate forward, and we allow our head to move forward. And we basically lose a lot of that appropriate posture in our neck and back, and it exacerbates this and causes a lot of pain and dysfunction for people.

Scot: I mean, for me, a big part of it obviously . . . I saw a picture of myself just a couple weeks ago from the side that somebody took, and I'm just like, "Oh my God, that's terrible." I don't want to have that the rest of my life. But I also put this in the category of nagging health issues, and you can tell me . . . it sounds like you're saying the same thing. You've got a structural compromise, right? So we start making accommodations. Then, as a result, muscles stop doing the job that they're supposed to do. They atrophy or other muscles get tight, and they're not able to do the job they're supposed to do. Is that kind of what's going on there?

Dr. Gee: Exactly. If you're not using a muscle routinely, it's going to lose its strength and its control. It's not going to go away entirely. It's just not as strong. And when you look at our spines, they are surrounded with muscle. So if we tend to be looking more at something in front of us, our neck is going to pull forward, and we're going to be using the neck muscles in the front, but not in the back, and we're going to lose some of that control. And it's going to naturally go into that position where it's kind of head forward, hunched back position that none of us like to see in ourselves.

Scot: Is part of that now because when it gets worse and worse, those back neck muscles are getting weaker and weaker, so to make it better, do you just strengthen those?

Dr. Gee: Yeah. It's one thing when you . . . everybody can kind of sit up straight and bring their shoulders back. But there are some things that we should be doing to kind of keep these muscles strong. And you want to balance them. You want to think about your neck muscles maybe in the front are getting extra work. They're stronger. The muscles in the back of the neck are getting weaker.

And so you want to work on stretching those anterior muscles and strengthening the posterior muscles, or the muscles in the back, so that you effectively, if you looked at your spine kind of in cross-section or across it, you would see that the muscles that are in the front are as equally strong as in the back and they can hold position throughout the day without getting fatigued and getting into that position.

Troy: So, Chris, I'll share with you one thing, and I don't know if it's something you've tried or have used with anyone who has had this issue, but something that's helped me is a Pilates exercise. And it's called swimming, if you just Google "Pilates swimming."

So basically, you're lying flat on the ground, stomach on the ground, you lift your back legs up, and your front legs are up, and your head is back, and then you're kind of up and down alternating like you're swimming.

And I'll tell you, I've dealt with this, and have dealt with a lot of thoracic spine pain, mid-thoracic pain. I know we've talked about it before. I don't know if you've used this or recommended similar exercises or have other things you've recommended for people, but it's one thing I've tried to do that seems to help.

Dr. Gee: For sure. That's a great exercise. As we're looking at these areas, one of the other things that we'll often see is we tend to focus less on our backs and more on our anterior parts of our bodies, obviously. So, for example, in the arm, you always want to have your big biceps, right? Nobody cares as much about their triceps. And the same thing with your upper back, your thorax. You want to have a nice healthy pec muscle, but we care less about what our backs look like.

And so, because of that, we tend to have a lot more musculature there. Like you talked about in that Pilates swimming position, you're basically stretching out the anterior chest, getting those muscles kind of stretched in the pec, but at the same time, strengthening the back muscles that are going to pull your shoulder blades back, open up your chest, and get you in a better position.

So yeah, a couple of things I'll have people do is . . . you can do this in your office, or your home, or wherever. Basically, you put your hands on either side of a doorjamb and lifting your arms up to about 90 degrees and just kind of step into the doorjamb and just let that stretch your anterior chest. You'll feel kind of a pull in your in your pec muscles, your chest muscles.

You can even do it more by bringing your hands up kind of to that 90-degree position. So you bend your elbow 90 degrees with your hand up over your head, and your arm out to 90 degrees as well. And then doing that. Letting that stretch the anterior chest can be helpful.

And then working on strengthening those back muscles like Troy was talking about, there's a number of different ways you can do that. I like the swimming kind of thing. I'll have people sometimes lay down just flat on the ground, so you're on your face, and you can work on having your arms straight out to the side, and just even just lifting them up off the ground, almost like a leg lift but for your arms. You're just lifting them up off the ground. That's going to stretch the chest, strengthen the back. You can even add weights to kind of lift up some of that.

Those things can be helpful to open the chest, strengthen the back, and get you where you need to be.

Troy: This has come up before too. I've even seen just some studies that looked at just simple back exercises, essentially doing the same thing you're talking about with that motion on the ground, but just while you're sitting at your desk, just moving your shoulders back and trying to touch your scapula together behind . . . just reaching back far. And that seems to at least also give you a little bit of a stretch and maybe some strengthening in the back as well.

Dr. Gee: Exactly. So when I've had patients that are coming in and they've got a problem with this, I will basically have them set a reminder on their phone. Sometimes, it has to be every hour, sometimes a couple times a day, just their alarm goes off and they say, "Oh, yeah, I need to do my exercises."

Those are super simple where you're sitting at your desk, you just sit up a little more straight, pull your shoulder blades together, and you do that four or five times, just tightening the muscle between your shoulder blades. That'll help to kind of open that up.

And then I'll even have them do some chin translations or kind of pulling their neck back. So this might be a little weird to describe. But what people can do is you basically want to not extend your neck, so you're not tipping your head back, but you're pulling your head backwards.

So imagine if you stand up against a wall, and you push your head back against the wall, so you're kind of pushing it back there. You can do this with your hand behind your head. You can kind of push back and just work on pulling your head back, and then you push it forward to kind of stretch the muscle and pull it back and push it forward. Almost like a cobra strike. But those can be really helpful.

Troy: I was going to come up with something else. I was going to call the chicken head. It's like a chicken walk.

Dr. Gee: There you go.

Troy: That's not nearly as cool as the cobra strike, so I like your word better. Let's go with cobra strike.

Scot: If you're going to try to cure your dowager's hump, you need a really cool exercise.

Troy: Do the cobra head, the cobra strike. Exactly.

Scot: So yeah, I went into a physical therapist, and they gave me some exercises to do. But what I really like what you said that I think can help somebody as they're working through these exercises . . . because you can find I think a lot of the ones online. And if you want to have somebody work through it, then a physical therapist appointment is great.

But it's this notion of stretching and strengthening. So you're stretching one muscle and you're strengthening the opposite muscle, which, as I start doing the exercise, it took a couple weeks, but I started becoming more in touch with, "My pectoral muscles were tight," or I started coming in touch with some of my back muscles that apparently must have been tight as well.

I just really had to stick with it for a couple weeks. Now, how long is it going to take me to actually get over this?

Troy: That's a tough one, and it depends a lot on how good you are or consistent you are about doing these things. If you think about it's taken you your entire life to this point to develop that posture, it's going to take you some time, sometimes some months, to correct that posture and to get yourself into a position where you naturally just sit in that pose.

And that's where I tell people, too, sometimes they're starting off doing these exercises hourly, but sometimes it can get down to where maybe towards the end of the day, you have an alarm go off on your phone, and you go, "Oh, yeah, just check your posture. Just make sure you're doing all right," and pull yourself back up where you need to be.

Scot: I'm noticing, too, after doing the exercise, I became more aware too of my posture when I was walking, or when I was sitting, and when I'd stick my head out. I have a weird thing where I actually tip my head back. Does that make any sense?

Dr. Gee: Yeah. I mean . . .

Scot: I've got a picture of it if you want to see. But when I'm walking or sitting, instead of just having a nice straight kind of thing going on, I tip my head back. I don't know. Am I trying to support the weight by resting it on my spine or what?

Dr. Gee: Just neutralizing the size of your head maybe?

Scot: I don't know.

Troy: Your gigantic head.

Dr. Gee: Yeah. A lot of times, what I tell people is it's important to think about those things. And the fact that you have a picture and you've looked at that and said, "Hey, I'm doing this," those are very insightful.

A picture is worth a thousand words sometimes. When you see yourself sitting in a certain way, and you said, "That's my posture?" and then you realize, "Okay, I need to adjust this." And sometimes it's a different muscle group that you need to strengthen so that your posture brings back into a normal way that's not going to cause arthritis and problems down the road.

Scot: I guess what it is, is I'm constantly looking at the sky or something, as opposed to if I kind of get back into the position that these exercises have taught me that I should be in, I'm looking more straight forward or even down just a little bit.

Troy: Well, do you think you're looking back to try and compensate? Is that your way of being like, "I can't hunch over. I've got to tilt my head back"?

Scot: No. It's the way I've been carrying my body, and I don't know what started it. I don't know if it's a result of this dowager hump, and now this is just three or four steps down the chain of degradation. I don't know.

Dr. Gee: Yeah, that's interesting.

Troy: You're a medical mystery, Scot.

Scot: I am a medical mystery. True.

So as I've been doing some of these exercises and even becoming more aware of my posture and trying to get my head from that forward position back into more of a neutral position, am I going to notice some muscular tension/soreness? Is it going to get fatiguing after a while when I'm sitting the right way after I've done it wrong for so long?

Dr. Gee: That's a great point. And yes, you actually should. Like I mentioned another time, if you are working out a muscle appropriately, you're stretching it, you are kind of breaking it down a little bit, and causing it to hypertrophy and get stronger. And so if you're doing it right, you're probably going to feel a little bit of soreness in that area. It might be a little tired. I wouldn't expect it to be painful. But if you feel like, "Ah, my back is a little tired from doing this," that shows me that you're kind of doing the right thing.

Now, over the long term, as those muscles get strong and they get balanced out, you should have less pain in your back because of the fact that now everything is equal. You're not over-pulling one direction or another. And that will prevent a lot of pain down the road.

Scot: And I'm noticing it between my shoulder blades kind of gets tired after a while. Would that be one of the places?

Dr. Gee: Yes, very much so. The rhomboids are a group of muscles that sit in between your shoulder blades. And they tend to be pretty weak in most of us just because of the fact that we pull our shoulders forward, we stretch those muscles out, and they don't really get activated as much as they should.

And so, yeah, feeling a little bit of soreness in there is fine. You can always use a little heat and ice to kind of calm some of that down. But most of the time, that's a good sign that you're using the right muscles and starting to get these stronger.

Scot: What about that bump, the actual physical bony bump process, that's sticking out? Sometimes I've noticed that now starts getting kind of sore in and around there. I don't think it's the bump itself. I think it's the muscles, but . . .

Dr. Gee: Yeah, exactly. There are muscles that go right alongside the spinous processes, which are the little bumps that stick out on your neck. And they're going to get activated. Their tendons attach right on to the bone, and so as they get used, that's going to get a little sore sometimes.

And it is normal . . . I should stress to people that the C7, kind of the bottom of your neck, top of your chest naturally does stick out a little more because of the change from one angle to another within the thorax to the neck. So it's impossible to make that perfectly straight, or it shouldn't be perfectly straight.

But working on building those muscles around there will get you in a good position to offload the weight of your head and neck, and allow them to prevent degeneration and arthritis and those things.

Scot: So it seems like if somebody is suffering from this . . . I think, for me, becoming aware was the first step. And believe it or not, it was those stretches and exercises . . . it took a couple weeks. Then I started becoming even more aware as a result of those stretches and exercises, and I'll catch myself periodically throughout the day and I've got to straighten stuff out again.

So becoming aware, I'd imagine, is the first thing, and then start doing some of those stretch and strengthen exercises would be the next step. Does that sound reasonable?

Dr. Gee: Totally. Yeah, just being aware of what your posture is. And sometimes . . . well, a lot of times . . . things like this, with a podcast to just make you think of it and go, "Oh, yeah, I should improve my posture." And then you start working on doing some of those exercises. That's going to remind you when you get into a bad posture, you're going to feel it a little bit more and, "Okay, straighten things back up."

Troy: And the thing I like about this, too, Chris, it's not like you're always thinking about your posture. I think for so long, I always felt like, "Oh, I have to think about it. I have to roll my shoulders back or walk around with a book on my head to practice my posture," or something. It's more like, "Hey, let's just stretch in the right spots. Let's strengthen the right spots." And then it sounds like the posture then follows naturally as you balance out that stretching and strengthening.

Dr. Gee: Yeah, exactly. It's really one of those things that as the muscles get stronger, they're going to hold it in a better position and they're not going to let that crouch forward as often. And so, yeah, being aware, gradually increasing the strength and stability, you're going to notice that posture improve over time.

Scot: Some very good tips today. Thank you very much for helping me through this. I'll keep doing my stretches and my exercises. And thank you for caring about men's health.

Dr. Gee: Yeah, excellent. Glad to help out.

Scot: Our core four we talk about is nutrition, activity, make sure that you're mentally healthy, and get that sleep. And this falls in the mental health category.

I wanted to talk about an article I found that is titled "Five Strategies for Cultivating Hope This Year." This is from a website called The Conversation.

First of all, Troy, do you know the difference between hope and optimism? There is a difference, and I found this fascinating.

Troy: Maybe hope is more focused on a specific thing, like you're hoping for something, where optimism is more just your general outlook on life and what happens to you.

Scot: Yeah, you're pretty close. On the optimism, you got that part right. According to this article, optimism is a general expectation that good things will happen in the future. So it's about expecting good things. However, hope is defined as the tendency to see desired goals as possible.

Troy: That's interesting. It's kind of like optimism is more . . . yeah, like you said, it's more your outlook, but hope is more something that drives you to action. I like that.

Scot: And optimism, too, comes with a very dark side, which is you tend to then avoid the negative and the real sometimes, and that's not necessarily mentally healthy as well. Sometimes you do have to face that type of stuff, those roadblocks and failure, where people . . . With hope, they realize that stuff is going to happen, and they deal with it, as opposed to optimism perhaps avoiding it.

So this article, hope versus optimism, talks about then how you can cultivate hope. And the first thing you need to do is just do something. So imagine an act and start with goals. So pick something, and then decide that you're going to do it, and set some goals, set a path to help you get closer to that outcome that you want. So the first thing is just do something and start with goals.

The second thing . . . I thought this was fascinating. Nobody likes uncertainty, right? You kind of want to know what's going to happen. But number two in this article is harness the power of uncertainty. And they say that uncertainty is a reason for hope because it gives you the ability to perceive the possibility of success. It's not written in stone, "You're going to fail at this. Nobody has ever done this before." There's a chance that you might be able to achieve this. So that uncertainty actually helps feed hope.

Number three, manage your attention. They say hopeful people did not necessarily seek out emotionally positive information. However, people high on hope spend less time paying attention to emotionally sad or threatening information.

Number four, seek community. Don't go it alone. You've heard the saying "you are the five people you surround yourself with." So try to avoid negative interactions with people and connect with others who hold us accountable and remind us why our struggles matter.

And then number five, when you're trying to cultivate hope this year, according to this article in The Conversation, is to look at the evidence. So hopeful people stake their trust in data, particularly in the evidence of history. For example, the example they gave here, which I love, anti-poverty activists drew hope from knowing that historically, when people join together in resistance, they are actually able to create change.

So that is the article. That's the summary. I highly encourage you to go to theconversation.com and read "Five Strategies for Cultivating Hope This Year." But it's been a year where I think all of us could use a little bit of hope. And I think also that differentiation between Are you an optimistic person? I want to strive to be an optimistic person," it might not be bad, but I think striving to be a hopeful person is better.

"Just Going To Lave This Here." It might have something to do with health or it might be something completely random. Troy, go ahead and start for us.

Troy: Scot, I'm just going to leave this here. I was thinking recently about one of my teachers, one of my attending physicians in med school. This guy's name is Tyler Cymet. Great teacher. Great guy. But he seemed like he definitely wanted something named after him in medicine. You hear these different things, and they're named after different physicians or different researchers.

So he had named something on his hand after him. He called it the Cymet bump. And it's on your ring finger. It's the place where your pencil rests. I guess if you rest your pencil or pen on your ring finger, the bump you get there. He submitted it to a medical journal, and they rejected it. I looked him up recently, and I found out he finally had something named after him. It was some rare syndrome that's on his Wikipedia page.

So following in Dr. Cymet's footsteps, I have found something I am going to name after myself, and I discovered this on myself recently. It's on my thumb. It's on my right thumb. I don't know if you experience this as well. Maybe this is a phenomenon more unique to Utah where we have very dry weather and cold dry winters. But on my thumb, on the middle part of my thumb right next to my thumbnail, it's where I tap my phone as I'm typing with my right hand or tapping on my phone, I've got what I'm now going to call the Madsen fissure. It's a crack on my thumb, next to my thumbnail.

I probably need to really do more of a survey here to find out if other people have the Madsen fissure. But if so, I'm going to submit this to a medical journal, the Madsen fissure. Just keep your eyes out for it.

Scot: So the definition would be the crack in the skin that occurs from living in a cold, dry, arid climate when you use your cell phone?

Troy: Yes. Essentially, yes. So I will go down in history as having a crack named after me.

Scot: Oh, wow. I'm so proud.

Troy: You should be.

Scot: Just going to leave this here. I found kind of a new squat form thing that you could try. It's called a dumbbell drop squat, although I use a kettlebell. You take the dumbbell or the kettlebell, and you put both hands on it, and hold it between your legs. So you're standing up straight. I guess you kind of hold it straight in front of you. You're standing up straight, and you hold it next to your body right in front of you, so it's right in front of your hips, I guess. And then you just squat straight down so it goes down in a straight line.

And what I like about that is . . . I've done traditional barbell squats, that sort of thing. This squat kind of forces you to be in a little bit better form, so you can kind of learn your form. So if you've struggled with your squat form before, this is a good way to kind of do this exercise to get what it should feel like. It's kind of tough, because you end up staying in a little bit more of an upright position.

But anyway, I thought that was cool. You could Google it if you want to, a dumbbell drop squat. But perhaps something new to add to your exercise regimen, especially if you don't feel a lot of confidence about doing back barbell squats and eventually you want to get to the point where you can.

Troy: That's a kettlebell squat then.

Scot: Well, the way I saw it, it used a dumbbell, but I used a kettlebell because that's what I have.

Troy: So either way, it works.

Scot: Yeah, you could do it either way. Exactly.

Troy: Okay, nice. I have not done that. I'll have to check it out.

Scot: All right. Time to say the things that you say at the end of podcasts because we are at the end of ours. First of all, if you want to get in touch with us, you can do it in a lot of different ways. The way that would be kind of cool is if you called 601-55SCOPE. That's 601-55SCOPE. Leave us a voicemail with your message, your question, your feedback, whatever. But there are other methods as well.

Troy: You can contact us, hello@thescoperadio.com. We're on Facebook, facebook.com/WhoCaresMensHealth. Our website is whocaresmenshealth.com. Also, subscribe anywhere you get your podcasts. We're on Apple, Google Play, Spotify, Stitcher, Pocket Casts, whatever works for you.

Scot: Thank you for listening. Thank you for caring about men's health.

This is a transcript for the main segment of the show. You can read it if you like, but we encourage you to subscribe and listen for the full experience. It's more fun that way.

Scot: The podcast is called "Who Cares About Men's Health." We talk about health things here to make it seem normal, and also to educate you as well. And we're some guys that are not afraid to say we care about our health. It's cool to care about your health. My name is Scot. I am the manager of thescoperadio.com, and I care about men's health.

Troy: And I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah and I also care about men's health.

Scot: No, Troy, say like you mean it. Come on. One more time, with feeling.

Troy: Scot, this is Troy. And I really care about my health and men's health. I love men's health.

Scot: Perfect. A little less sarcasm next time. And we have Dr. Chris Gee on. Go ahead. Say your thing.

Dr. Gee: How do I follow up with that, right?

Troy: You could do it a little more sincerely than I did.

Dr. Gee: Yeah, I'm Dr. Chris Gee. I'm a sports medicine physician for the University of Utah, and I care about men's health.

Scot: Today's topic: forward head posture. It's something that you see . . . do you see this a lot now? I mean, with people in their phones and their devices, looking at monitors, computer monitors, do you just walk around and go, "Oh my gosh, look at that person, look at that person, look at that person"?

Dr. Gee: For sure. Once you start thinking about it, I think we all start to adjust our posture a little bit, and I'll start talking about it to patients and notice they start to sit up more appropriately and take notice.

Scot: All right. So I'm going to make a confession. I'm going to try to keep this somewhat reasonably timed. I have this forward head posture. I think I've had it my whole life. Some other names for it, by the way . . . these are good. Have you heard other names for it, Dr. Gee?

Dr. Gee: I've heard the dowager's hump. That's one I've heard.

Scot: Yep. That's great as a guy.

Troy: Scot has a dowager's hump.

Scot: Yeah, as a guy, that's exactly what you want to hear about yourself.

Troy: Dowager. Didn't we figure dowager is like an old British lady or something like that? It's a British term for some hunched over old lady.

Scot: I think so. It's an old lady. So some other terms that they use, they call it text neck, iHunch, iPosture, nerd neck, poking chin posture, computer neck, and tech neck. I could imagine programmers looking at their monitors all day. And if your eyesight is little bad, I suppose you're probably sticking that head out just a little bit more.

Troy: I like tech neck. That's a great one.

Scot: I don't like any of them, Troy. I look at people that have the proper posture, and I'm just jealous of them all the time.

Troy: I like the term. I like the term "tech neck." I'm not asking for tech neck, but I like it.

Scot: They have that rounded hump. So I've been trying to untangle that, Dr. Gee. And I know that this is a problem that a lot of people have. So where should we start? Now, I'm going to confess, I have been doing some exercises, but I want to hear your take.

Dr. Gee: So just a little anatomy, when we look at our spines, they're not straight up and down. They actually have a normal curve. So in our lower back, it actually curves kind of with the apex of the curve towards your abdomen. In your back, your upper back, your thorax, the curve goes the opposite direction, kind of with the apex towards your back. And then our necks do the opposite. They kind of curve towards the front.

Now, what that ends up doing is when we relax our posture, when we allow our muscles to not contract, we basically start to slip or exacerbate some of those curvatures. And so our neck curves more to the front, putting our head more forward. Our back curves out, causing that hump effect.

And this is really a problem because so much of what we do logically is in front of us, and as we're focusing in on smaller items, phones, and desktops, and computers, we allow our shoulders to rotate forward, and we allow our head to move forward. And we basically lose a lot of that appropriate posture in our neck and back, and it exacerbates this and causes a lot of pain and dysfunction for people.

Scot: I mean, for me, a big part of it obviously . . . I saw a picture of myself just a couple weeks ago from the side that somebody took, and I'm just like, "Oh my God, that's terrible." I don't want to have that the rest of my life. But I also put this in the category of nagging health issues, and you can tell me . . . it sounds like you're saying the same thing. You've got a structural compromise, right? So we start making accommodations. Then, as a result, muscles stop doing the job that they're supposed to do. They atrophy or other muscles get tight, and they're not able to do the job they're supposed to do. Is that kind of what's going on there?

Dr. Gee: Exactly. If you're not using a muscle routinely, it's going to lose its strength and its control. It's not going to go away entirely. It's just not as strong. And when you look at our spines, they are surrounded with muscle. So if we tend to be looking more at something in front of us, our neck is going to pull forward, and we're going to be using the neck muscles in the front, but not in the back, and we're going to lose some of that control. And it's going to naturally go into that position where it's kind of head forward, hunched back position that none of us like to see in ourselves.

Scot: Is part of that now because when it gets worse and worse, those back neck muscles are getting weaker and weaker, so to make it better, do you just strengthen those?

Dr. Gee: Yeah. It's one thing when you . . . everybody can kind of sit up straight and bring their shoulders back. But there are some things that we should be doing to kind of keep these muscles strong. And you want to balance them. You want to think about your neck muscles maybe in the front are getting extra work. They're stronger. The muscles in the back of the neck are getting weaker.

And so you want to work on stretching those anterior muscles and strengthening the posterior muscles, or the muscles in the back, so that you effectively, if you looked at your spine kind of in cross-section or across it, you would see that the muscles that are in the front are as equally strong as in the back and they can hold position throughout the day without getting fatigued and getting into that position.

Troy: So, Chris, I'll share with you one thing, and I don't know if it's something you've tried or have used with anyone who has had this issue, but something that's helped me is a Pilates exercise. And it's called swimming, if you just Google "Pilates swimming."

So basically, you're lying flat on the ground, stomach on the ground, you lift your back legs up, and your front legs are up, and your head is back, and then you're kind of up and down alternating like you're swimming.

And I'll tell you, I've dealt with this, and have dealt with a lot of thoracic spine pain, mid-thoracic pain. I know we've talked about it before. I don't know if you've used this or recommended similar exercises or have other things you've recommended for people, but it's one thing I've tried to do that seems to help.

Dr. Gee: For sure. That's a great exercise. As we're looking at these areas, one of the other things that we'll often see is we tend to focus less on our backs and more on our anterior parts of our bodies, obviously. So, for example, in the arm, you always want to have your big biceps, right? Nobody cares as much about their triceps. And the same thing with your upper back, your thorax. You want to have a nice healthy pec muscle, but we care less about what our backs look like.

And so, because of that, we tend to have a lot more musculature there. Like you talked about in that Pilates swimming position, you're basically stretching out the anterior chest, getting those muscles kind of stretched in the pec, but at the same time, strengthening the back muscles that are going to pull your shoulder blades back, open up your chest, and get you in a better position.

So yeah, a couple of things I'll have people do is . . . you can do this in your office, or your home, or wherever. Basically, you put your hands on either side of a doorjamb and lifting your arms up to about 90 degrees and just kind of step into the doorjamb and just let that stretch your anterior chest. You'll feel kind of a pull in your in your pec muscles, your chest muscles.

You can even do it more by bringing your hands up kind of to that 90-degree position. So you bend your elbow 90 degrees with your hand up over your head, and your arm out to 90 degrees as well. And then doing that. Letting that stretch the anterior chest can be helpful.

And then working on strengthening those back muscles like Troy was talking about, there's a number of different ways you can do that. I like the swimming kind of thing. I'll have people sometimes lay down just flat on the ground, so you're on your face, and you can work on having your arms straight out to the side, and just even just lifting them up off the ground, almost like a leg lift but for your arms. You're just lifting them up off the ground. That's going to stretch the chest, strengthen the back. You can even add weights to kind of lift up some of that.

Those things can be helpful to open the chest, strengthen the back, and get you where you need to be.

Troy: This has come up before too. I've even seen just some studies that looked at just simple back exercises, essentially doing the same thing you're talking about with that motion on the ground, but just while you're sitting at your desk, just moving your shoulders back and trying to touch your scapula together behind . . . just reaching back far. And that seems to at least also give you a little bit of a stretch and maybe some strengthening in the back as well.

Dr. Gee: Exactly. So when I've had patients that are coming in and they've got a problem with this, I will basically have them set a reminder on their phone. Sometimes, it has to be every hour, sometimes a couple times a day, just their alarm goes off and they say, "Oh, yeah, I need to do my exercises."

Those are super simple where you're sitting at your desk, you just sit up a little more straight, pull your shoulder blades together, and you do that four or five times, just tightening the muscle between your shoulder blades. That'll help to kind of open that up.

And then I'll even have them do some chin translations or kind of pulling their neck back. So this might be a little weird to describe. But what people can do is you basically want to not extend your neck, so you're not tipping your head back, but you're pulling your head backwards.

So imagine if you stand up against a wall, and you push your head back against the wall, so you're kind of pushing it back there. You can do this with your hand behind your head. You can kind of push back and just work on pulling your head back, and then you push it forward to kind of stretch the muscle and pull it back and push it forward. Almost like a cobra strike. But those can be really helpful.

Troy: I was going to come up with something else. I was going to call the chicken head. It's like a chicken walk.

Dr. Gee: There you go.

Troy: That's not nearly as cool as the cobra strike, so I like your word better. Let's go with cobra strike.

Scot: If you're going to try to cure your dowager's hump, you need a really cool exercise.

Troy: Do the cobra head, the cobra strike. Exactly.

Scot: So yeah, I went into a physical therapist, and they gave me some exercises to do. But what I really like what you said that I think can help somebody as they're working through these exercises . . . because you can find I think a lot of the ones online. And if you want to have somebody work through it, then a physical therapist appointment is great.

But it's this notion of stretching and strengthening. So you're stretching one muscle and you're strengthening the opposite muscle, which, as I start doing the exercise, it took a couple weeks, but I started becoming more in touch with, "My pectoral muscles were tight," or I started coming in touch with some of my back muscles that apparently must have been tight as well.

I just really had to stick with it for a couple weeks. Now, how long is it going to take me to actually get over this?

Troy: That's a tough one, and it depends a lot on how good you are or consistent you are about doing these things. If you think about it's taken you your entire life to this point to develop that posture, it's going to take you some time, sometimes some months, to correct that posture and to get yourself into a position where you naturally just sit in that pose.

And that's where I tell people, too, sometimes they're starting off doing these exercises hourly, but sometimes it can get down to where maybe towards the end of the day, you have an alarm go off on your phone, and you go, "Oh, yeah, just check your posture. Just make sure you're doing all right," and pull yourself back up where you need to be.

Scot: I'm noticing, too, after doing the exercise, I became more aware too of my posture when I was walking, or when I was sitting, and when I'd stick my head out. I have a weird thing where I actually tip my head back. Does that make any sense?

Dr. Gee: Yeah. I mean . . .

Scot: I've got a picture of it if you want to see. But when I'm walking or sitting, instead of just having a nice straight kind of thing going on, I tip my head back. I don't know. Am I trying to support the weight by resting it on my spine or what?

Dr. Gee: Just neutralizing the size of your head maybe?

Scot: I don't know.

Troy: Your gigantic head.

Dr. Gee: Yeah. A lot of times, what I tell people is it's important to think about those things. And the fact that you have a picture and you've looked at that and said, "Hey, I'm doing this," those are very insightful.

A picture is worth a thousand words sometimes. When you see yourself sitting in a certain way, and you said, "That's my posture?" and then you realize, "Okay, I need to adjust this." And sometimes it's a different muscle group that you need to strengthen so that your posture brings back into a normal way that's not going to cause arthritis and problems down the road.

Scot: I guess what it is, is I'm constantly looking at the sky or something, as opposed to if I kind of get back into the position that these exercises have taught me that I should be in, I'm looking more straight forward or even down just a little bit.

Troy: Well, do you think you're looking back to try and compensate? Is that your way of being like, "I can't hunch over. I've got to tilt my head back"?

Scot: No. It's the way I've been carrying my body, and I don't know what started it. I don't know if it's a result of this dowager hump, and now this is just three or four steps down the chain of degradation. I don't know.

Dr. Gee: Yeah, that's interesting.

Troy: You're a medical mystery, Scot.

Scot: I am a medical mystery. True.

So as I've been doing some of these exercises and even becoming more aware of my posture and trying to get my head from that forward position back into more of a neutral position, am I going to notice some muscular tension/soreness? Is it going to get fatiguing after a while when I'm sitting the right way after I've done it wrong for so long?

Dr. Gee: That's a great point. And yes, you actually should. Like I mentioned another time, if you are working out a muscle appropriately, you're stretching it, you are kind of breaking it down a little bit, and causing it to hypertrophy and get stronger. And so if you're doing it right, you're probably going to feel a little bit of soreness in that area. It might be a little tired. I wouldn't expect it to be painful. But if you feel like, "Ah, my back is a little tired from doing this," that shows me that you're kind of doing the right thing.

Now, over the long term, as those muscles get strong and they get balanced out, you should have less pain in your back because of the fact that now everything is equal. You're not over-pulling one direction or another. And that will prevent a lot of pain down the road.

Scot: And I'm noticing it between my shoulder blades kind of gets tired after a while. Would that be one of the places?

Dr. Gee: Yes, very much so. The rhomboids are a group of muscles that sit in between your shoulder blades. And they tend to be pretty weak in most of us just because of the fact that we pull our shoulders forward, we stretch those muscles out, and they don't really get activated as much as they should.

And so, yeah, feeling a little bit of soreness in there is fine. You can always use a little heat and ice to kind of calm some of that down. But most of the time, that's a good sign that you're using the right muscles and starting to get these stronger.

Scot: What about that bump, the actual physical bony bump process, that's sticking out? Sometimes I've noticed that now starts getting kind of sore in and around there. I don't think it's the bump itself. I think it's the muscles, but . . .

Dr. Gee: Yeah, exactly. There are muscles that go right alongside the spinous processes, which are the little bumps that stick out on your neck. And they're going to get activated. Their tendons attach right on to the bone, and so as they get used, that's going to get a little sore sometimes.

And it is normal . . . I should stress to people that the C7, kind of the bottom of your neck, top of your chest naturally does stick out a little more because of the change from one angle to another within the thorax to the neck. So it's impossible to make that perfectly straight, or it shouldn't be perfectly straight.

But working on building those muscles around there will get you in a good position to offload the weight of your head and neck, and allow them to prevent degeneration and arthritis and those things.

Scot: So it seems like if somebody is suffering from this . . . I think, for me, becoming aware was the first step. And believe it or not, it was those stretches and exercises . . . it took a couple weeks. Then I started becoming even more aware as a result of those stretches and exercises, and I'll catch myself periodically throughout the day and I've got to straighten stuff out again.

So becoming aware, I'd imagine, is the first thing, and then start doing some of those stretch and strengthen exercises would be the next step. Does that sound reasonable?

Dr. Gee: Totally. Yeah, just being aware of what your posture is. And sometimes . . . well, a lot of times . . . things like this, with a podcast to just make you think of it and go, "Oh, yeah, I should improve my posture." And then you start working on doing some of those exercises. That's going to remind you when you get into a bad posture, you're going to feel it a little bit more and, "Okay, straighten things back up."

Troy: And the thing I like about this, too, Chris, it's not like you're always thinking about your posture. I think for so long, I always felt like, "Oh, I have to think about it. I have to roll my shoulders back or walk around with a book on my head to practice my posture," or something. It's more like, "Hey, let's just stretch in the right spots. Let's strengthen the right spots." And then it sounds like the posture then follows naturally as you balance out that stretching and strengthening.

Dr. Gee: Yeah, exactly. It's really one of those things that as the muscles get stronger, they're going to hold it in a better position and they're not going to let that crouch forward as often. And so, yeah, being aware, gradually increasing the strength and stability, you're going to notice that posture improve over time.

Scot: Some very good tips today. Thank you very much for helping me through this. I'll keep doing my stretches and my exercises. And thank you for caring about men's health.

Dr. Gee: Yeah, excellent. Glad to help out.

Scot: Our core four we talk about is nutrition, activity, make sure that you're mentally healthy, and get that sleep. And this falls in the mental health category.

I wanted to talk about an article I found that is titled "Five Strategies for Cultivating Hope This Year." This is from a website called The Conversation.

First of all, Troy, do you know the difference between hope and optimism? There is a difference, and I found this fascinating.

Troy: Maybe hope is more focused on a specific thing, like you're hoping for something, where optimism is more just your general outlook on life and what happens to you.

Scot: Yeah, you're pretty close. On the optimism, you got that part right. According to this article, optimism is a general expectation that good things will happen in the future. So it's about expecting good things. However, hope is defined as the tendency to see desired goals as possible.

Troy: That's interesting. It's kind of like optimism is more . . . yeah, like you said, it's more your outlook, but hope is more something that drives you to action. I like that.

Scot: And optimism, too, comes with a very dark side, which is you tend to then avoid the negative and the real sometimes, and that's not necessarily mentally healthy as well. Sometimes you do have to face that type of stuff, those roadblocks and failure, where people . . . With hope, they realize that stuff is going to happen, and they deal with it, as opposed to optimism perhaps avoiding it.

So this article, hope versus optimism, talks about then how you can cultivate hope. And the first thing you need to do is just do something. So imagine an act and start with goals. So pick something, and then decide that you're going to do it, and set some goals, set a path to help you get closer to that outcome that you want. So the first thing is just do something and start with goals.

The second thing . . . I thought this was fascinating. Nobody likes uncertainty, right? You kind of want to know what's going to happen. But number two in this article is harness the power of uncertainty. And they say that uncertainty is a reason for hope because it gives you the ability to perceive the possibility of success. It's not written in stone, "You're going to fail at this. Nobody has ever done this before." There's a chance that you might be able to achieve this. So that uncertainty actually helps feed hope.

Number three, manage your attention. They say hopeful people did not necessarily seek out emotionally positive information. However, people high on hope spend less time paying attention to emotionally sad or threatening information.

Number four, seek community. Don't go it alone. You've heard the saying "you are the five people you surround yourself with." So try to avoid negative interactions with people and connect with others who hold us accountable and remind us why our struggles matter.

And then number five, when you're trying to cultivate hope this year, according to this article in The Conversation, is to look at the evidence. So hopeful people stake their trust in data, particularly in the evidence of history. For example, the example they gave here, which I love, anti-poverty activists drew hope from knowing that historically, when people join together in resistance, they are actually able to create change.

So that is the article. That's the summary. I highly encourage you to go to theconversation.com and read "Five Strategies for Cultivating Hope This Year." But it's been a year where I think all of us could use a little bit of hope. And I think also that differentiation between Are you an optimistic person? I want to strive to be an optimistic person," it might not be bad, but I think striving to be a hopeful person is better.

"Just Going To Lave This Here." It might have something to do with health or it might be something completely random. Troy, go ahead and start for us.

Troy: Scot, I'm just going to leave this here. I was thinking recently about one of my teachers, one of my attending physicians in med school. This guy's name is Tyler Cymet. Great teacher. Great guy. But he seemed like he definitely wanted something named after him in medicine. You hear these different things, and they're named after different physicians or different researchers.

So he had named something on his hand after him. He called it the Cymet bump. And it's on your ring finger. It's the place where your pencil rests. I guess if you rest your pencil or pen on your ring finger, the bump you get there. He submitted it to a medical journal, and they rejected it. I looked him up recently, and I found out he finally had something named after him. It was some rare syndrome that's on his Wikipedia page.

So following in Dr. Cymet's footsteps, I have found something I am going to name after myself, and I discovered this on myself recently. It's on my thumb. It's on my right thumb. I don't know if you experience this as well. Maybe this is a phenomenon more unique to Utah where we have very dry weather and cold dry winters. But on my thumb, on the middle part of my thumb right next to my thumbnail, it's where I tap my phone as I'm typing with my right hand or tapping on my phone, I've got what I'm now going to call the Madsen fissure. It's a crack on my thumb, next to my thumbnail.

I probably need to really do more of a survey here to find out if other people have the Madsen fissure. But if so, I'm going to submit this to a medical journal, the Madsen fissure. Just keep your eyes out for it.

Scot: So the definition would be the crack in the skin that occurs from living in a cold, dry, arid climate when you use your cell phone?

Troy: Yes. Essentially, yes. So I will go down in history as having a crack named after me.

Scot: Oh, wow. I'm so proud.

Troy: You should be.

Scot: Just going to leave this here. I found kind of a new squat form thing that you could try. It's called a dumbbell drop squat, although I use a kettlebell. You take the dumbbell or the kettlebell, and you put both hands on it, and hold it between your legs. So you're standing up straight. I guess you kind of hold it straight in front of you. You're standing up straight, and you hold it next to your body right in front of you, so it's right in front of your hips, I guess. And then you just squat straight down so it goes down in a straight line.

And what I like about that is . . . I've done traditional barbell squats, that sort of thing. This squat kind of forces you to be in a little bit better form, so you can kind of learn your form. So if you've struggled with your squat form before, this is a good way to kind of do this exercise to get what it should feel like. It's kind of tough, because you end up staying in a little bit more of an upright position.

But anyway, I thought that was cool. You could Google it if you want to, a dumbbell drop squat. But perhaps something new to add to your exercise regimen, especially if you don't feel a lot of confidence about doing back barbell squats and eventually you want to get to the point where you can.

Troy: That's a kettlebell squat then.

Scot: Well, the way I saw it, it used a dumbbell, but I used a kettlebell because that's what I have.

Troy: So either way, it works.

Scot: Yeah, you could do it either way. Exactly.

Troy: Okay, nice. I have not done that. I'll have to check it out.

Scot: All right. Time to say the things that you say at the end of podcasts because we are at the end of ours. First of all, if you want to get in touch with us, you can do it in a lot of different ways. The way that would be kind of cool is if you called 601-55SCOPE. That's 601-55SCOPE. Leave us a voicemail with your message, your question, your feedback, whatever. But there are other methods as well.

Troy: You can contact us, hello@thescoperadio.com. We're on Facebook, facebook.com/WhoCaresMensHealth. Our website is whocaresmenshealth.com. Also, subscribe anywhere you get your podcasts. We're on Apple, Google Play, Spotify, Stitcher, Pocket Casts, whatever works for you.

Scot: Thank you for listening. Thank you for caring about men's health.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Scot: "Who Cares About Men's Health," providing information, inspiration, and motivation to better understand and engage in your health so you feel better today and in the future.

All right. Time to do a little roll call here. I need to know who cares about men's health. My name is Scot. I am the senior producer at thescoperadio.com, and I care about men's health. Who wants to join me?

Troy: I'll join you, Scot, because I think it's my turn next. I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah, and I care about men's health.

Dr. Gee: And I'm Dr. Chris Gee. I'm a sports medicine physician here at the University of Utah, and I care about men's health.

Scot: All right, Dr. Gee. Welcome back to the show. Next time, I need a little bit more enthusiasm, though. Say like you mean it, okay?

Dr. Gee: All right.

Troy: Say it like your life depends on it.

Scot: That's right. Today, we're going to do a listener question episode. Some listeners have sent us some questions for Dr. Gee, who is a sports medicine physician. Why do I get cramps in a muscle, and can I fix that? We're going to talk about rotator cuff rehabilitation without surgery and is KT tape for real?

But before we get to the main topic, I have a question for you, Dr. Gee, or Chris, or whatever you want me to call you. Do you do time-restricted eating? Do you even know what that is? Like, fasting?

Dr. Gee: I've done some fasting, but I'm not very good at it. I hate fasting, let's put it that way.

Scot: So what does fasting look like? Because it means a lot of different things to a lot of different people.

Dr. Gee: The basic premise behind this is that it's probably not great for our bodies to get huge boluses of food and to eat just kind of grazing all through the day. And so the idea is to have a time for your body to kind of process things. Some religious groups do it routinely with monthly fasts and ceremonial fasts. But obviously, the time-related eating is more that you eat certain times through the day, and then at night, you stop eating overnight, or whatever it is that you decide to do.

Scot: Yeah, that's exactly right. It's that time-restricted eating. We've had another guest on who's a nutritionist. He's a big proponent of it, like 12 hours of eating, 12 hours of not eating. Or if you want to try to lose a little bit more fat, you can make that 10 hours of eating, the remainder not eating, or 8 hours. So you have done that time-restricted eating and just don't like it?

Dr. Gee: Yeah. I am probably the worst nutritional person out there as far as my diet is just not great. I've done a little bit of it and tried it and I have a hard time. Let's put it that way.

Scot: Yeah. What's your challenge to that? Because I just started doing it again. I did it for a couple weeks before COVID and then COVID came along, and every routine I had went out the window. But I felt better even after two weeks, and I feel good now after just a few days of doing it. So how did it impact you?

Dr. Gee: For me, whatever the problem is, I tend to be really great with a diet or with some time restriction or something like that for a couple of days. And then it just goes out the window for whatever reason. I'm just like, "Oh, I'll just have this snack. I'll just break it this one time." And so I don't know. I've kind of done that. I know I need to kind of adjust that, but for me getting through the first day or two is just hard.

Scot: Yeah, it is a little tough. Troy, have you been sticking with it? I know you had talked about doing it.

Troy: I have been sticking with it, yeah. I do 12 hours, Scot. That seems to work for me. And I just tell myself I'm not going to eat after 8:00 p.m. and I'm not going to eat before 8:00 a.m. Just restricting it to 10 hours of eating, I think, would be really tough because then I'd be looking at stopping eating at 6:00 p.m. So I find 12 seems to work and it seems to be working okay. But I agree, it's tough.

Dr. Gee: Can I ask Troy a question?

Troy: Yeah.

Dr. Gee: How do you do that with your shifts? Do you still do a number of shifts in the ER?

Troy: I do, yeah.

Dr. Gee: I always have a hard time with that.

Troy: You're right. Yeah, that's what really throws me off, is if I work . . . As you know, Chris, we'll do these shifts that are evening shift. We call it an evening shift, but you get out of there at like 1:00 or 2:00 in the morning and get to bed at 3:00. So those days, I'm probably not eating after 11:00 p.m. and I'm not eating before 11:00 a.m. So it's probably still working out to 12 hours because I'm trying to do better at eating at work. That's what I found. If I don't eat consistently at work, I get home and it's like 2:00 a.m. and I'm so hungry that I eat a ton, and then my stomach just hurts when I go to sleep and I can't sleep well. So that's how I've tried to adjust it, just by bringing plenty of food for work and trying to be consistent about eating so I don't come home hungry. But it's hard. With shift work, it's really hard.

Scot: And have you noticed a benefit, Troy? What does it do for you?

Troy: I have, Scot. When I first started doing it, I did feel like it did reduce my body fat somewhat. The other thing I like about it, I feel like I don't have to pay as much attention to what I eat. I know that's bad, but I kind of feel like it kind of gives me a little wiggle room there where I'm like, "I can eat more stuff that I was a little more concerned about eating before."

And then just going to bed, sometimes I would eat at 9:30 and then maybe I'm asleep at 10:30. And it wouldn't be until about 1:00 or 2:00 in the morning that my stomach would really feel okay, because that food just kind of sat there. So I felt like it's helped my sleep as well.

I feel like it's made a difference, and I feel like I've done okay with it. I've tried to do this since we first talked to Thunder about this. It must have been a year ago or so. And it's one of those things I've kind of taken from these talks we've had with Thunder that I feel has definitely been beneficial.

Scot: Well, I just was curious because I was curious to know, Chris, if you did anything like that as well and what your challenges were. I guess now we know. I feel like I wake up a little bit more clear-headed for sure and a little bit more alert.

By the way, I did see a documentary that talked about fasting. And there's some research out there that says even if you do it five days out of the week and two days you're not as religious, you still get the same benefits. So for somebody who works Monday through Friday, and then the weekends maybe they let themselves go a little bit. Maybe that would help. Chris, you think we can get you onboard or just no way?

Dr. Gee: You're tempting me for sure. I'll have to try it.

Troy: Maybe just three days.

Dr. Gee: I need to have a new plan. And so that'll be good. If I can only do a few days a week, maybe I'll start with that.

Troy: Scot, if there's benefit to five days, there's got to be benefits just to even three days, you know.

Scot: You would think.

Troy: You'd think so. Maybe you could say, "Hey, this is going to be my Monday, Wednesday, Friday thing," and start there. Don't eat after 8:00 p.m. Don't eat before 8:00 a.m., or whatever works, 7:00 p.m. and 7:00 a.m. Because I feel like 12 hours for me is doable. I feel like beyond that like, to consistently do it is . . . there are definitely days where I'm maybe restricted to 10 hours, but it's hard to do that consistently.

Scot: All right. Let's get to the topics here. So our listener questions, lots of ways you can get in touch with us. There's email, there's our listener line, and that's how we got a hold of these questions right here.

Dr. Gee, let's go ahead and start out with listener question number one. This individual says they get cramps, and they're wondering why they get cramps. What does a cramp mean, and is there something you can do to fix it if you have a muscle that's kind of consistently cramping? I've had this with my legs, my calves, for example.

Dr. Gee: There are a number of different reasons why a person may have cramps. First of all, and the most common, are related to maybe dietary things, or you're dehydrated, or you've been working out a lot and at a certain point during your workout or your run or whatever, you're getting cramps. So those are more nutrition-based recommendations where make sure that you're well hydrated, that you're not getting dehydrated through the course of your day or your workout.

Also looking at making sure that you're getting electrolytes with that, so some kind of Gatorade or something like that, that you're using to replenish those electrolytes as you are sweating.

But then the second group of cramping, the way I look at it at least, is that there are times where your muscle maybe isn't as strong as it should be. And so, if you imagine maybe you've got a calf cramp or something like that, and as you start to run and work out, maybe you're well-hydrated and you have good electrolytes, but the muscle is a little bit fatigued, it can't quite keep up with the demand that you're putting onto it, and it basically has to go into a bit of a spasm to hold the demand that you're putting onto it.

And that will often happen during workouts and things or even kind of after the fact as people are walking around. Those cramps, depending on where they are and what's going on with them, they can benefit from doing some more dedicated directed exercise at those areas.

There are different types of strength within muscles. A lot of times, the way we think of strength, we think of, "Oh, I can pick up this really heavy weight," and that is a type of strength, but there's also dynamic strength, which is basically where your muscles are holding your joints and your body through the course of motion. And if they are fatigued, if they are not up to where they need to be, they will basically have to go into spasm to try to hold that dynamic control, and that's oftentimes when people will start getting cramps.

Troy: Chris, imagine that you're mountain biking somewhere or you're running or competing in some kind of event, and your leg just cramps up. It's kind of like related to what Scot said. Do you recommend just stopping at that point and trying to massage it, or stretching, or just slowing down a bit, or just pushing through it? What's your typical advice when that happens?

Scot: What I love about that is Troy never, ever said, "Or just quit?" He never even offered that as an option.

Troy: I'm imagining, Scot, you're somewhere where you probably have to get home. You're on a trail. You can't just call Uber. You've got to get home somehow. So, yeah, how do you get through that?

Dr. Gee: Yeah, that's the next version of Uber, the mountain bike Uber.

Troy: The mountain bike Uber, just a little trailer on back.

Dr. Gee: That's a really good question. And I think all too often as weekend warriors and just recreational athletes, we tend to push through those things. And what I find is that that tends to make it worse. You really tend to have more problems as you continue to work out. And so I do suggest that you stop, you rest, try to stretch out that muscle, do a little massage. Think back on what you've been doing with your hydration. Have you been hydrating well enough? Have you urinated recently?

That's always a good sign to see where you're at with your hydration. If you've been pounding a ton of fluids and you're urinating really clear, you might be going a little too hard hydrating. But if you haven't peed for a while, and when you do try to go it's really dark, then you need to really try to push some fluids and recover and then kind of build your way back into your exercise. Try to maybe go just below that threshold at which you were cramping before, which can definitely be difficult if you're pretty far out and you're trying to work through a cramp as you're trying to finish.

Scot: So, in that situation, just want to make sure I understand correctly, and it's cramping, you should stop. Did you say you should rub it, try to massage? No, stretch it. You should stretch it.

Troy: And massage it sounds like, yeah.

Dr. Gee: Both. Yeah. Oftentimes, I find that when it's acutely in spasm . . . so we'll have an athlete come off the court or the field and they're acutely in spasm, really the only thing that's going to help or the thing that helps the fastest is to stretch that muscle. So really just try to stretch it back out, and then some gentle massage to try to work fluids around through that muscle to kind of break down some of the more tight areas that might be more likely to spasm.

Troy: That's good to know, though. Yeah, start with the stretch, though.

Dr. Gee: I've had people try, both personally and professionally, to just massage that cramp, and it takes a while to get it to release. And so I find stretching it first and then working into a massage is probably a better route.

Scot: If hydration was the issue and you started drinking some water, then would that clear itself up pretty quickly, the cramp, or not very quickly?

Dr. Gee: It can definitely help, but it's really hard, I find, once you start cramping to kind of turn that around, or at least within that exercise or that particular workout window. Usually, it's going to take some time for your body to try and correct the electrolytes and the fluid balance as such that it's going to ease it up.

So even as a recreational athlete, really listen to your body and know at what point you're going to start feeling that cramp come on. And if you can get to that point and say, "Okay, now I'm pushing it a little too hard," and start correcting those either fluid issues or technique issues, making sure that you're not pushing beyond that, it usually helps to prevent you from having cramps throughout the workout.

Scot: All right. Question number two. Boy, this is probably going to be a tough one. Rotator cuff rehabilitation without surgery. So do you see a lot of rotator cuff injuries? I find it fascinating that the rotator cuff is called one thing, but it's actually four different muscles.

Dr. Gee: Exactly.

Troy: This really hits home for me, because in high school I injured my rotator cuff. I never saw anyone for it, but I'm certain that's what it is. And I've convinced myself over the years, "I can do this without actually seeing someone for it." So I'm curious what you have to say, Chris.

Scot: You can hurt your rotator cuff like doing sports, but even if you fall, you could hurt it, right?

Dr. Gee: Exactly. Yeah, it's a very interesting joint. And it's one of those things that I see a lot of. We all hit the new year and we say, "Hey, I want to lift and get some definition in my body." So we go and we overdo it with shoulders and start getting some pain in the shoulder, or even getting out and biking and things like that we'll have people crash and have a trauma to the shoulder.

So, in general, just as kind of an educational piece with the rotator cuff, basically, when you look at the shoulder, you have the ball and socket joint. Now, the socket is really very shallow. I make the analogy it's more like a golf ball and a tee. So you have a big humeral head, or a big ball, that's trying to fit into this small little depression of the shoulder blade. And so there's a group of four muscles that come off the shoulder blade, and they surround the humeral head, and they move it around.

Now, because there's not a lot of bony restriction, it gives us great motion of the shoulder, but it's at the compromise of stability. And so that's always the problem, is that if those rotator cuff muscles aren't working together, and they don't have that dynamic strength and control I was talking about earlier, they will allow that ball to slide off the socket and cause things to get stretched and cause pain and impingement and other problems.

And so, when we're younger, when you're in high school and you injure your shoulder, usually that rotator cuff will just stretch. It'll stretch out. It'll cause some instability problems. But unfortunately, as we get older, ages . . . the rough estimate is 35 to 40, which that throws me in the old category. I don't like that. But as we get older, the rotator cuff doesn't tend to stretch as well, and it tends to tear.

And so those little things that maybe you can recover in a day or two as a teenager are going to do more damage as an adult and you can tear part of the cuff, and that may require more treatment than what you had as a youngster.

Troy: So when you say treatment, are you saying you definitely need surgery, or is it something where physical therapy or strengthening or those kind of things are going to help you recover?

Scot: Yeah, this listener is hoping without surgery.

Troy: Hoping you're going to say no surgery.

Dr. Gee: Honestly, I find the vast majority of these do not have to have surgery, which is great.

There are a few different buckets that these fall into with these rotator cuff injuries. If you're young and otherwise healthy and you haven't . . . like I said, it takes a lot of force to tear the rotator cuff when you're young. So most of the time, we'll put those people through some physical therapy working on rebuilding the rotator cuff. Working on shoulder blade positioning and posture helps with that rotator cuff, and that allows them to progressively get back to normal.

Even when you have an older patient that maybe . . . I've had patients that are in their 70s that are just pulling up something, maybe the sheet on the covers of their bed, and they've torn part of the rotator cuff. So, at that point, as everybody's rotator cuff gets weaker, believe it or not, you can do therapy with that group too. So getting out and getting some physical therapy, strengthening that rotator cuff, what's left of it, or the muscles around it, will actually calm their symptoms down and they do pretty well.

It's really the ones that have an acute traumatic injury. You fall really hard when you're skiing or you dislocate the shoulder and you acutely tear the rotator cuff. Those are the ones that more often need surgery. And the rest we're pretty successful with being able to rehabilitate the muscles and maybe doing an injection to calm down inflammation, but they do fairly well.

Scot: And I also think it's just always good if you have hurt yourself to go see somebody just because you start making those accommodations and then who knows 20 years down the road where that's going to get you. I think it's kind of gotten me into a bad place, and I'm trying to undo some of those things. It's not going to get better if I don't do some actively with it.

Dr. Gee: Exactly. Yeah.

Scot: All right. Question number three is KT tape for real? So this KT tape, this is the tape that sometimes you see athletes . . . I went to a chiropractor once and they put some KT tape on me. They cut it up and made it into some tribal looking design on my shoulder and my bicep. Is that the real deal? Is that legit or not?

Dr. Gee: KT tape has kind of been the rage over the last number of years and you see a lot of athletes doing it and Olympians doing it. When you look at really what it's doing, it's not going hold the joint into place because it's not connected to any muscle. It's not connected to any bone or anything like that. What it is doing, though, is giving a little bit of feedback through the skin, through the nerves that are in the skin, just to kind of remind you a little bit about that position.

So, for example, in the shoulder again, it's probably not going to keep your shoulder from sliding out. It's not going to prevent you from using your shoulder wrong. But what it can do is remind you as you start to slip into maybe a bad position, you start to feel a tug on your skin, and you go, "Oh, okay, I've got to bring my shoulder back, and I have to kind of get that better position."

The way I try to use it is maybe using it early on just to remind people of positioning. We'll use it sometimes around the knee and the shoulder just to kind of help people to think about positioning and activation of muscles. But over the long term, I definitely want people to get dynamic control and strength of their joints so that they don't have to use those things.

Troy: And do you find, Chris, it's more helpful than just wearing an Ace wrap or some sort of thin brace on your knee or something? I mean, does it seem like it does better than that kind of thing to provide that reminder that maybe you need to do things differently as you're going through those motions?

Dr. Gee: It can help in certain scenarios. So, for example, if somebody has an unstable knee, meaning their kneecap is kind of wanting to drift off to the side, sometimes taping it a certain way can help to encourage that to stay back and it can remind people. But you can get the same effect with even a sleeve over the knee that has a hole in the front that kind of encourages that kneecap.

So, as far as when you look at studies, they really say that any kind of proprioceptive feedback with an Ace bandage or a sleeve or a brace can help just to remind you of positioning of that joint, and it doesn't necessarily have to be the tape.

Troy: Duct tape?

Dr. Gee: Yeah, there you go.

Scot: I think it doesn't stretch as well as KT tape, right?

Troy: Maybe not as good, but . . .

Scot: In a pinch? All right. Dr. Gee, again, awesome job answering our listener questions. Sure do appreciate having you on the show. And thank you for caring about men's health.

Dr. Gee: Yeah, it's always a pleasure to be here. I love getting the questions and hopefully got some things answered.

Scot: All right. Welcome Producer Mitch to the show. I guess Producer Mitch has a question for Dr. Troy Madsen. Mitch, what was your question?

Mitch: I've been going to doctors and I've been reading the after notes in my chart. Is "generally pleasant" code for anything? I've been described by two doctors now as a "generally pleasant 32-year-old male."

Troy: That is great. It's not code for anything.

Mitch: All right.

Troy: It just cracks me up when people use that.

Scot: Hold on. This is in your chart? What medical purpose does this description serve, Troy?

Mitch: It's at the top, right?

Troy: It's so funny. Yeah. I never use adjectives like that to describe anyone because it's just . . .

Scot: In the ER, do you have to describe people?

Troy: I never use that. No, some people just do that. It's just habit, I think, just because the average person who is nice, who comes in, who they enjoy talking to, they will describe as, "This is a pleasant 30-year-old male who comes in with a chief complaint of," whatever. It's just habit for them.

It is not code for anything. It doesn't mean they think you're weird or something. Yeah, it's funny when it's in there because when I see that, I always think, "What are they going to say about the person who's not pleasant? Are they going to say, 'This very unpleasant, 40-year-old man'?"

Mitch: And that means something.

Troy: Yeah. Exactly.

Scot: I love how they use the word "generally." Mitch, does that concern you that in that short interaction that there was possibly a moment where you were not pleasant?

Troy: That is the one piece that jumped out to me. Typically, they'll say, "This is a very pleasant 30-year-old man." The fact that they said generally, yeah, that's a little bit of a red flag, Mitch.

Mitch: Oh my god. It was an ENT too. I'm like, "What did I do?"

Troy: Yeah. "What did I do wrong? What do I have to do to get very pleasant?" Ask them that the next visit, like, "What does it take to get a very pleasant description?"

Mitch: "What do I have to do?"

Scot: Yeah, "What can I do to just have you drop generally, just so it says a pleasant?"

Troy: Yeah, just need "a pleasant." "This is a pleasant."

Scot: Oh my gosh, that's fantastic.

Troy: Oh, yeah. It just cracks me up when I see that. It's kind of like this old-school thing. Yeah, like I said, I never use adjectives like that, but it's just funny.

Scot: But some doctors do and there's no purpose to it, Troy?

Troy: Yeah, there's really no purpose to it. It's not like I look at that and say, "Oh, good. I'm so glad I'm going to see him now, because if he hadn't said pleasant, I would not want to see this patient in my clinic." So it's not some code between doctors. Don't worry.

Mitch: Well, it's almost embarrassing, because I'm trying to read all their instructions, but I can't. In that first line, I'm like, "What did they mean? What did they mean by generally pleasant?"

Troy: You're trying to decode it.

Scot: You don't actually make it to the important stuff about your health.

"Just Going To Leave This Here." It could be a random thought, it could be something to do with health, or it might just be something that really couldn't find its place elsewhere on the show that we wanted to share.

So, on Instagram, I follow some health accounts. They're not your typical health accounts. This one is @letstalk.mentalhealth, and they have this little graphic that I love because I think it sums up the things that we're never taught that we should have learned at some point in our life that are so crucial.

This says, "What I learned in school: How to multiply eight times seven, and what H2O stands for. What I wish I learned in school: The importance of mental health, mindfulness, self-esteem, reframing negative thoughts, self-care, emotional regulation, personal finance, and the importance of sleep." And that's why we talk about some of those things on this podcast and some of those other things that we don't talk about. It's never too late to learn something new about any of those areas. They will pay dividends.

Troy: I'm going to add two more to that list: home maintenance and car maintenance. I wish they taught those things.

Scot, I'm just going leave this here. I'm just going to let you guess. What is the top-ranked diet of 2021?

Scot: Well, if you're bringing it up, I know you're a fan of the Mediterranean diet, and you probably want to give it some props. So that's my guess, Mediterranean diet.

Troy: No, it's the see-food diet. I see it and I eat it. Just kidding. It is the Mediterranean diet. We always come back to the Mediterranean diet. It's come up many times as we've talked about different diets. It is the number one ranked diet of 2021 by "US News and World Report."

The thing I love about the Mediterranean diet is it's such a straightforward diet. It makes sense. And then there's good research to back it up looking at heart benefits, weight loss, general health, all those sorts of things. Really good research to back it up.

So, if you're looking for a diet for 2021, and trying to switch things up a little bit, look into the Mediterranean diet. Again, we've talked a lot about it. But it's a very straightforward, great diet.

Scot: All right. Time to say the things that you say at the end of podcasts because we are at the end of ours. First of all, if you want to get in touch with us, you can do it in a lot of different ways. The way that would be kind of cool is if you called 601-55SCOPE. That's 601-55SCOPE, and leave us a voicemail with your message, your question, your feedback, whatever. But there are other methods as well.

Troy: You can contact us, hello@thescoperadio.com. We're on Facebook, facebook.com/WhoCaresMensHealth. Our website is whocaresmenshealth.com. Also, subscribe anywhere you get your podcasts. We're on Apple, Google Play, Spotify, Stitcher, Pocket Casts, whatever works for you.

Scot: Thank you for listening. Thank you for caring about men's health.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Troy: I told Laura I'm just like the Ed McMahon to Johnny Carson, and she's like . . .

Scot: No, you're not.

Troy: She said, "Don't give yourself that much credit." I said, "I'm just here just for the da-da-dum."

Scot: No, you're not. I mean, you are funny, but you bring information. Most of the time you're funnier than I am.

Troy: I'm just here to . . .

Scot: Which really bugs me. We're going to talk about that some time.

"Who Cares About Men's Health," providing information, inspiration, and motivation to better understand and engage in your health so you feel better today and in the future. My name is Scot Singpiel. I'm the manager of thescoperadio.com, and I care about men's health.

Troy: And I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah, and I care about men's health.

Dr. Gee: And I'm Dr. Chris Gee, and I'm a sports medicine physician at the University of Utah, and I care about men's health.

Scot: Dr. Gee, it's great to have you back on the show. We had Dr. Gee on last season, when Mitch rolled his ankle, to talk about what it's like to deal with a sprained ankle. So if you've ever had that happen, we've already had that conversation with Dr. Gee, so you can go back to our last season and find that out.

But today, we wanted to do kind of like a sports medicine doctor Q&A. Before I get started, though, I wanted to know, Dr. Madsen, what'd you think when I said we're going to have a sports medicine doc on? What was the first thing that went through your mind?

Troy: Sports. Thinking about sports. Well, I think that's what a lot of people think. Chris, I'm sure you hear this a lot, but I think a lot of people hear sports medicine . . . I'll see an 80-year-old in the ER who has an injury and everything, maybe X-rays show a fracture or maybe they don't, but I'll refer them to sports medicine, and it's like, "Sports medicine? I'm not playing sports." So I think maybe that's people's first impression, that your primary target here is athletes, like college or high school athletes. I think that's often what goes through people's minds. Dr. Gee: For sure, yeah. It's one of those things you end up . . . I get a lot of patients that come in and say, "Why are you seeing me?" or don't understand really what the specialty is. It's really kind of more activity medicine and being active, but I guess that is where we're at.

Scot: So activity medicine, do you deal with stuff like back pain, that sort of thing?

Dr. Gee: Yeah, we do. We'll see some pain . . . basically kind of any joint in your body, anything that's non-surgical orthopedics is kind of the way I put it.

Scot: All right. So you're on an expert on the bones and the ligaments and the muscles and how they all work? Is that what a sports medicine doc kind of really knows?

Dr. Gee: Yeah, that's basically it. And we work on all ages, so anybody kind of from a weekend warrior, professional athlete, or even just somebody trying to get that knee to not act up as they're walking around the block.

Scot: All right. Sounds good.

Troy: And we know you're a great doctor, Chris, because you got Mitch through his 5k. He had his sprained ankle, you saw him, you cared for him, he did his rehab, and he got through the 5k. He did it.

Scot: Let's go ahead and hit the questions here. So we've got three questions we're going to try to get through for Dr. Gee, our sports medicine doctor on "Who Cares About Men's Health."

There are a lot of different ways that people could have gotten these questions to us. They could have emailed hello@thescoperadio.com, they could have gone to our Facebook page, facebook.com/whocaresmenshealth, and direct messaged us, and then we also have a listener line nowadays, where you can call and leave a message, and that phone number is 601-55SCOPE. That's 601-55SCOPE.

So here's the very first question from our listener line. Here's a listener that had a question.

Man: Hey, guys. Love the show. Hey, I have a question. I have a pain that I experience kind of in between the shoulder blades. It's been kind of off and on for the past, I don't know, I'd say maybe five years. I don't really remember injuring it. I work in an office. It's not so bad that I need to . . . I don't know. I don't know what to do about it. Thanks for letting me know.

Scot: All right. Dr. Gee, do you have any advice for that individual? Do you see a lot of back pain? Is that something that you do see? I did bring that up earlier, but I didn't quite catch what your answer was.

Dr. Gee: Yeah, we do. You tend to see a fair bit of back pain in a lot of different patients, a lot of different environments. In this case, what it gets me thinking, particularly if it's sitting in an office and having to kind of sit forward, that's a tough position on the shoulders and on the upper back. And over time, spending all that time in that position does tend to weaken the muscles around the upper back and particularly around the shoulder blades.

And so as those muscles kind of get a little weaker, they put the shoulder in a bad position, and then those muscles are trying to kind of hold it back and it can definitely cause some discomfort.

It's something I'll see pretty regularly that people will have some pain or problems with their muscles that stabilize the shoulder, and so putting them through some therapy and some exercises to kind of work on those muscles as well as just working on position, looking at your desk and making sure you're trying to sit in a good posture as much as you can, or even getting up and walking around a few times an hour can help just to kind of break up that monotony.

Scot: Hey, if I wanted to do a little bit of research for some exercises, what are the muscles that we're talking about back there?

Dr. Gee: So particularly the scapular stabilizers are the ones I'm thinking of, the rhomboid major and minor, some trapezius, and even some of the rotator cuff muscles through there. And then there are some very important muscles in the upper spine, the erector spinae muscles, that kind of help to keep us upright.

Scot: And those muscles that you mentioned, with the exception of the erector spine . . . the erector what muscles? Spinae?

Dr. Gee: Yeah, erector spinae.

Scot: The erector set muscles?

Troy: This guy, haven't you been working out your erector spinae muscles lately?

Scot: No. I've neglected it.

Troy: Isn't it part of your routine?

Scot: That was actually my question. Those other muscles you mentioned, the rhomboids and the trapezius, in our kind of day-to-day life, if we're not doing any sort of activity, those are kind of ignored muscles in general. We're not really exercising those, are we?

Dr. Gee: You look at just what we do through the course of the day, and so much of it is just right in front of us. You're holding your phone right in front and your shoulders are sloping forward, and your upper back is sloping down, and you basically put those muscles kind of into a stretch and they're never having to really engage. And so doing some exercises to increase the activity of those muscles and really bring them back into position just helps to open that up and decrease pain.

Scot: Is there such a thing as a muscle falling asleep? Like, because you don't use it enough, it kind of forgets to fire and you've got to kind of reawaken it, so to speak?

Dr. Gee: Sort of. Basically, muscles are worked by activity and exercise, and when they are used, they hypertrophy and those neural pathways get a little more prominent. And if they're not used a lot, they get weaker as well as if they are having pain, they'll get inhibited, and so they're not used as appropriately as they should be.

Troy: Now, Chris, I don't know if you know, but Scot is really into kettlebells now.

Scot: I'm not really into it. I just got started.

Troy: I'm guessing some good kettlebell swings is going to work a lot of those muscles. I don't know if you're familiar with the kettlebell swings, but . . .

Dr. Gee: Yeah, they can work some things out, but you have a high risk of injury, so maybe you'll end up seeing Troy. I don't know.

Troy: Drop it on your foot.

Scot: There can be. I've been exercising with strength training for a long time, and I'm really a stickler for form, so I'm being very careful with the kettlebells.

Dr. Gee: That's perfect.

Troy: So what about an MRI? Would you tell this person, "Hey, it's been five years. Let's get an MRI and see what's going on in your back"?

Dr. Gee: It all depends on the symptoms that they're developing. It does tend to be less common to get thoracic vertebrae problems or disk problems just because it's a more stable area. Oftentimes, we'll put people through some therapy first and see how it will do, but eventually, if it's not improving, they may need other imaging, something like an MRI, to see if there is something else causing the symptoms and the pain.

Troy: And what about surgery? Are you ever recommending surgery in these patients, like if he's just like, "Hey, this has been going on long enough. I want to get this fixed"? Or any kind of injections?

Dr. Gee: Yeah, injections are usually the next step. Let me step back. There's a bursa or a little sac that sits underneath your shoulder blade, and sometimes that can get inflamed and be a source of pain. So sometimes doing injections there or even surgically debriding it can be helpful. But a lot of those muscles get tired. They can get trigger points, they can have a lot of irritation, and so doing injections into those muscles can be helpful.

Scot: And when you say therapy, is that just short for physical therapy? Is that what you mean?

Dr. Gee: Yeah. And physical therapy involves a lot of things, anything from manual therapy where they're doing actually massage and stretch or dry needling all the way up through and including exercises to kind of strengthen areas.

Scot: I've had the exercises for a couple of issues, and I've got to say it's amazing how well they work after a couple of weeks. It really is.

Dr. Gee: For sure, yeah. I've always found that pretty interesting too. I'll get very skeptical looks from people when I tell them, "Hey, this is what you need to work out." But once you do it, you realize, "Wow, it's stabilizing that joint, increasing the control of the muscles over it. Really helps a lot."

Troy: And you mentioned massage, Chris. Is that something you're telling people, "Hey, go to a massage therapist. Try this out and that'll make a difference," or is it more of the PT, the exercises, that kind of thing?

Dr. Gee: I do like massage as far as a modality to treat some of the pain. The hard part is that a lot of insurances don't cover it, and so it's a little tough. But yeah, different kinds of massage can help, particularly if you're having muscles that are having to go into spasm to try to hold position in your back or neck or shoulders. They get really tired, and so kind of working them out can alleviate a fair bit of the pain.

Scot: All right. Our second question here, this is actually a sports question. Boy, this could be a really involved answer, so we'll go ahead and just give this a listen here. Question number two for Dr. Gee, our sports medicine expert on "Who Cares About Men's Health."

Man: Hi. I've got a question for your sports medicine doc. I'm just wondering what's your opinion on arm care for baseball players? What should be the limit for how much kids throw, and do you ice, do you heat? What's your opinion on best way to stay healthy?

Scot: All right. So I wanted to tease out there. It sounded like he said arm care, baseball players, and then he said something about kids, so . . .

Troy: Yeah. He's probably got some kid he's trying to get into the Major Leagues.

Scot: It's his retirement policy is what it is.

Troy: Exactly. He's like, "I've got to make money off this kid."

Dr. Gee: What's happened with youth sports over the past 10, 15, 20 years is that when I was kid, we used to just play a season and then you were done and you'd go out and mess around. Now, kids are getting to the point where you play with your high school team, and then you have a competition team, and you have another competition season, and they'll go away to tournaments, and they end up playing throughout the entire year and giving no chance to really rest the arm.

Particularly in pitchers it becomes an issue. In younger pitchers, there are growth plates. So the bones basically expand at these growth plates, and those growth plates have muscular attachments to them. And so when they're throwing really hard, oftentimes that muscle is pulling off of that growth plate and it can cause stress injury to the bone. They can even tear ligaments and cause a lot of problems.

And so there are some great recommendations out there looking at limiting number of innings pitched for pitchers, limiting the number or types of pitches that are thrown. Curveballs tend to be a little more of a dynamic stress on the elbow and on the shoulder, and so they have them hold off of that for a period of time until they hit a certain age, and gradually over time looking at building that up.

So it's something we'll see a fair bit of, and most of the time, you've got a coach that may be good about limiting what his athlete is doing from game to game, but they don't know about all the other games these guys are playing in. And so, as parents, you have to be really careful about how much your kid is pitching, how much your kid is involved in the sport.

Troy: Chris, it sounds like parents looking at regulating pitch counts and the types of pitches thrown, it sounds like that could be pretty involved. Are there any sorts of guidelines, particularly for different age groups and numbers for those groups?

Dr. Gee: Yeah. There are some really good guidelines out there that have been looked at and published and reviewed routinely. You can find those under USA Baseball online and also Major League Baseball. MLB.com has some of those published guidelines, depending on your age and what kind of position that kids are playing.

Scot: Does this arm care just . . . is that mainly for people that are in a pitching position?

Dr. Gee: Yeah, it is. That's the biggest concern is that as they pitch that many hard throws, it just puts stress on their arm. But the other thing you definitely have to think about with these kids is that if they're going from . . . maybe, say, they're playing as pitcher and then they're going to play first base, the rest as first base, they're still going to be throwing quite a bit. And so you've got to really look at how much volume you're putting on this kid's arm.

Troy: I think one of the parts of the listener's question was about icing, and maybe that's a bigger question in general I think probably all of us wonder about. Do you recommend people routinely ice their joints if you're working out a lot? Some people like ice baths, things like that. Is that something you routinely recommend?

Dr. Gee: For sure. Yeah, it's one of those things that what we believe is happening is that as you're working out, you're getting small little tears and little bits of inflammation within the joint and within the muscles. And so placing a little ice on the joint after working out is a good idea. It just decreases the inflammation that's there, allows that to recover.

I'll usually tell people if you're doing a hard workout, ice down for 10, 15 minutes afterwards. And then maybe if you're feeling stiff or tight as you're starting to work out, doing a little heat before a workout just to kind of warm it up should be helpful.

Troy: Okay. So heat before, ice after. You don't recommend if you've got a hot tub necessarily jumping in the hot tub right after your workout?

Dr. Gee: No, not necessarily. There's not a lot of hard science behind it. Most of the research says that icing is most helpful after an acute injury for about a week period, but what most people will do is end up using ice after kind of a workout to try to decrease the inflammation they've developed.

Scot: Is that the secret weapon, if you will, of all of these professional athletes you work with? I see those ice bathtubs that they hop into, which look wonderful.

Troy: Yeah. How did they get in those things, though? I mean, it's . . .

Dr. Gee: Torturous, right?

Troy: I can't imagine.

Scot: You just grit your teeth and do it man, right?

Troy: Seriously.

Dr. Gee: Right. Have you seen Kevin Hart's podcast where he puts athletes into cold tubs and then interviews them as they're sitting there?

Troy: I haven't. That sounds great.

Dr. Gee: That's a new idea for The Scope Radio. You guys should get in the ice tubs.

Troy: There we go. We've got to put every one of our guests . . . just put them in an ice bath and see how they do.

Scot: I have a hard enough time getting guests anyway because of schedules and whatnot. If we're putting them in an ice bath, that's going to making it even harder.

Troy: Yeah, nothing like ice baths. I'm sure that'll go well.

Scot: All right. Our last question here is an email from hello@thescoperadio.com. This is from Val it looks like, so a woman listening to the podcast, which is cool. It's "Who Cares About Men's Health," but we . . .

Troy: Well, it could be a man's name too. It could be a man's name.

Scot: Oh, it is? Oh, maybe it is.

Dr. Gee: True.

Troy: Yeah.

Scot: I guess I don't know. Can a torn meniscus heal on its own? If it's not surgically fixed, will it cause a lot of future problems? So, first of all, what's a meniscus? Is that in my nose?

Dr. Gee: Not quite.

Troy: That's mucus, Scot.

Scot: Oh, okay.

Troy: Meniscus is different.

Dr. Gee: "Menucus." So a meniscus is a piece of cartilage that sits in your knee, and it kind of acts as a shock absorber between the bones. As they hit together, instead of hitting the articular cartilage or the lining of the joint against itself, it hits against this meniscus and that absorbs some of the shock.

The meniscus, however, doesn't have great blood supply to it, and so it tends to not heal very well. Some of that depends on where in the cartilage it is. If it's in more of a peripheral zone, where the blood is transmitting a little closer, it can heal, but most oftentimes I'd say they don't heal over time.

The treatment, though, doesn't always have to be surgery because what we want to do is basically allow that meniscus to be in there and act as a shock absorber without having to remove it as long as that meniscus lays down and doesn't get caught in the joint. So every time you flex the knee, it's popping, or it even bends over and kind of gets locked in the knee, then that's something that has to be fixed. Otherwise, oftentimes, I'll recommend we trial injections and some therapy and see how much we can get it to calm down without having to go in surgically on it.

Troy: And it seems like that's a common thing with skiing and that sort of thing. It seems like you hear a lot about meniscus tears here.

Dr. Gee: Oh, for sure. It's a really common injury. They are at a lot of risk. Whenever you're squatting down, bending, twisting, you're just kind of pushing against that meniscus, and so that's why it gets injured so often.

Scot: When my knee pops, is that my meniscus popping always?

Dr. Gee: Not necessarily. It can be the kneecap kind of shifting along as it's moving through the trochlear groove. The meniscus does shift a little bit as you're moving your knee, and so sometimes it is just kind of getting a little catch and it'll just pop. As long as it's not painful and doesn't swell up after it, you can kind of just leave it alone.

Troy: And is this one of those things where physical therapy can make a difference, or are you really looking at injections at that point?

Dr. Gee: Yeah, you can start with some physical therapy with those. The idea with that is, obviously, it's not going to necessarily make that meniscus heal, but it's going to stabilize the musculature around the knee, help it to move more easily and unload the pressure on that meniscus. And as long as it's calming down on its own, you don't have to do anything more. I usually use an injection as sort of getting pain under control so that they can do some exercises and therapy.

Scot: All right. Troy, do you have anything else? I think that was our three questions.

Troy: No. I think it's great information. We covered the back, we covered the arm, we covered the knee, so I think it's a pretty thorough review.

Scot: Yeah. We did all right there. Dr. Gee, are you feeling pretty good about this?

Dr. Gee: Yeah, I feel good about it. It's been good.

Scot: All right. Well, thank you very much for answering our listener questions. We sure do appreciate it, and thank you, Dr. Gee, for caring about men's health.

Dr. Gee: You're welcome. Glad to be on.

Scot: Time for "Odds & Ends" on "Who Cares About Men's Health." Got a couple of items here, Troy, that I'd like to throw out there for "Odds & Ends."

The first item is really excited about next week's show. We're going to be talking to a gentleman named Lorne and also psychologist Andrew Smith. Lorne, we're going to find out what his story was in hopes that maybe if you're struggling with alcohol dependence that it will help you.

One thing we learned during the episode, because we've already recorded it -- like many podcasts, we pre-record a lot of our things -- is that it's not necessarily about the drinking. That's just a symptom of a lot of other problems, and that was very eye-opening for me in that episode.

Troy: Yeah, me too. That was the point I think we're going to see really come out in this is that there's a whole lot more to this. And interestingly, that's what the therapy focuses on. It doesn't focus on the alcohol. It focuses on the underlying issues that the alcohol is used to try and cope with. Yeah, really interesting perspective.

I think regardless of where you're coming from, whether you think, "Maybe I do have an alcohol use disorder," or if you're saying, "Hey, I don't even drink alcohol. Why would I care about this episode?" I think it has a lot to it in terms of other things we might do in our lives and maybe other habits we have and how those . . . It's not about that habit. It's about what that is trying to deal with, and then finding that and addressing that. So I think that was the larger point of the . . . that's the big thing I think we're going to hear.

Scot: Item number two, we had Nick Galli on last week. He was our sports . . . he's a mental performance coach. He works with the U.S. Speedskating team, and I've already been able to use some of his advice from his last episode about performing like a pro.

Troy: Nice. You've got people's names right now? I know that was your concern. We had this come up.

Scot: I've had other things that I would like to perform well at, and normally I would get in my own head over. I just try to keep his advice in mind. And a couple pieces of advice that he had in his episode is this thing that you're doing that you're going to gonk yourself at, reframe it. Don't think of it in terms of "This is the most important thing in the world." Think of it as "I'm really lucky to have this opportunity to share this information with somebody" or to share this story.

And then also, just realize you're human, and if you screw up, it's fine. You're in a room with other humans. Just experience that moment together. And it made all the difference in the world. I didn't gonk myself and I didn't have any major problems, but I knew if I did, I'd be able to handle them.

Troy: Nice.

Scot: Check out that episode from last week with Nick Galli and how to perform like a pro.

Troy: And I would sing it, but I . . .

Scot: Na-na-na-na-na-na-na, Thunder! Troy, do the honors of singing, "You've been Thunder Debunked."

Troy: I can't do that, Scot. Come on.

Scot: Thunder Debunked.

Troy: I have to maintain some sense of dignity.

Scot: Thunder Debunked.

Troy: I'm sorry, I can't . . . I think you already did it.

Scot: All right. This segment is called "Nutrition Myths: Thunder Debunked with Thunder Jalili" on "Who Cares About Men's Health." Thunder Jalili is our nutrition expert, and we've got him back for another question. We're going to give him some kind of fitness advice or something you might read somewhere, and we're going to find out if it's truth or if it's going to become Thunder Debunked.

Today's question: How many meals should I be eating throughout the day to boost my metabolism? Is there a magic number? I've heard lots of small meals throughout the day boosts your metabolism when you're pursuing weight loss versus only two or three meals.

Thunder: So let me just clarify because people always talk about metabolism and boosting metabolism, but I guess I'm a little ignorant. I'm never quite sure what people mean by that. So do you mean as a way to help you lose weight? Is that the idea?

Scot: I believe that that's what . . . when I hear people say this, that's what I would think as well. So metabolism meaning "Is there something I can do to my body that makes it burn more calories or more calories more efficiently?"

Thunder: Yeah, that would be exercise. So the idea of having six small meals a day, or one meal a day, or three meals a day, or whatever, if you're trying to lose weight, the more important concept there is to eat in a finite period of time, to make sure you have a fasting period in each 24-hour cycle. Sixteen hours is an amount that has been identified that has been a good tool for weight loss. Doesn't have to be 16 hours. Just for caloric maintenance, 12 hours, I think, actually works too. But to have six meals a day, if you have it in that time period, that's fine. It could be three meals a day. It doesn't really matter.

Where I think six meals a day becomes more helpful is not to lose weight but to gain weight. If someone wants to lift weights, wants to build muscle mass, and wants to gain weight, easier to do that if you have more meals because each time you eat, you have protein in that meal, and that protein stimulates muscle protein synthesis. You release insulin, which is an anabolic hormone that leads to synthesis of tissues, including muscle protein synthesis.

So to have increased hits of food and protein and insulin is better to help you gain weight, but I don't really see how that would help you lose weight. So, for losing weight, I go back to the time-restricted feeding and not really care how many meals I'm eating during my allowed eating time.

Scot: So eating six meals throughout the day to boost the metabolism, that has just been Thunder Debunked.

Thunder: Or at least Thunder Modified.

Scot: Thunder Modified. You need to come up with a catchier name, Thunder Modified.

Thunder: Yeah. That's so boring.

Scot: "Just Going to Leave This Here," it could have something to do with health, or it could just be something that's on our mind, or something we want to share. Troy, why don't you start off "Just Going to Leave This Here"?

Troy: Well, Scot, I'm just going to leave this here. I got something that I've got to tell you about it because I don't know if you've ever used this kind of thing. I got a percussion massager. It's one of these things, you hold it and it looks like a speed gun like some police officers hold.

Scot: Oh, yeah.

Troy: Yeah, like holding a radar or speed gun or something.

Scot: Yeah, my chiropractor has one of those. A lot of people will experience those in their chiropractors, and it kind of goes "do-do-do-do-do."

Troy: Exactly. Yeah. And you can buy it online. They're fairly expensive, but you can find some less expensive options. Mine wasn't super expensive by any means, but it's great. I've never used one of these things before. I've had some massagers, but not like this. This really works the deep tissues. I've just got these sore spots I continually deal with. We've talked about IT bands and rolling and all of that. Using it on my IT band, using it on these sore areas on my hip and all of that, and it's great.

So if you've got some sore spots, consider it. I've enjoyed it, and it's working well for me after about a month, and that's what I'm going to leave here.

Scot: Just going to leave this here. Of course, last week, the Vice President of the United States was in Salt Lake City for the vice presidential debate, and I got stuck because of the motorcade. So I'm trying to go through this intersection, and all of a sudden, two motorcycle police cops pull up, and each one of them gets off their bike, and one goes to one side of the intersection, one goes the to other side of the intersection, and then they stop us. So I know immediately, "Oh, the motorcade is going to be coming down the road." Have you ever seen a presidential or vice presidential motorcade?

Troy: I have never had that experience.

Scot: It was crazy. So you've got these cops that did that, that blocked this road. And as soon as they blocked it, two other motorcycle cops, or actually a bunch of them, go zooming by. I don't know how fast they were going on this 35-mile-an-hour road. Presumably doing the same thing, right? I'm sure they're just kind of leapfrogging each other going from intersection to intersection. And then 30 highway patrol motorcycles came rolling down.

I'm going to tell you now that I actually looked this up because I was curious how many vehicles are in a motorcade and how they get all those SUVs and stuff here. So I looked this up and I just want to share it because I'm just nerding out about this. The president could visit three places in a day, which means they might have to have three separate motorcades in three different locations, which blew my mind, first of all. So they transport these vehicles by military planes, like big C-17 military planes.

Troy: Oh, wow. They're not renting from the local Enterprise?

Scot: No, they're not. I don't think the Hertz has exactly what they're looking for.

Troy: Hertz's dollar rental does not carry these SUVs? Okay.

Scot: So, as I'm watching this, you see the police motorcycles, the highway patrol motorcycles, you see police cars, and then you get to the real deal part of the vice presidential motorcade. And they've got all these black SUVs, and they've got one that's for electronic countermeasures, so it jams communications and remote-detonating devices. I saw that one.

Troy: So did your cell phone stop working?

Scot: No, I didn't know at the time. This was in retrospect. I looked it up and I went, "Whoa, that's what that was." And then they've got a truck kind of thing, and that's for hazardous materials mitigation. And it's got sensors to detect nuclear, biological, or chemical attacks, so I saw that.

Troy: So it's actively sensing as it's going past?

Scot: I guess. So I saw that one. And then another SUV comes by and it's a communications vehicle because it has all these antennas on it, and that's exactly what this one was.

Troy: Wow.

Scot: And then you get some of the cars that come by. You don't know which one is carrying the vice president. That's part of the smoke and mirrors, right?

Troy: Are they just a bunch of limos or . . .

Scot: Yeah, there are identical limos and you don't know which one the president is in, and apparently they will switch positions periodically to just keep . . . like a shell game.

Troy: To be clear, this was a motorcade for the vice president?

Scot: Yeah, which I'd imagine is probably very similar.

Troy: It's the same process.

Scot: Yeah, I would imagine. I mean, I don't know for sure. And then towards the back, two ambulances are following this thing. And then you've got a whole . . .

Troy: Were they local ambulances or were they brought in?

Scot: I'm not sure about that.

Troy: Were they Salt Lake Fire or who they were?

Scot: Yeah, I couldn't tell that.

Troy: Couldn't tell? Okay.

Scot: Yeah. And then you've got a whole bunch in the back, a whole bunch more cops and stuff. I mean, this was just an incredible sight. It was just crazy. So I will put a link to the article that I read about it because I thought it was just fascinating, I guess, in a guy geeky sort of way, what it takes to transport this one individual from Point A to Point B.

Troy: That's pretty remarkable.

Scot: It was just crazy. So, yeah, check that out on the show description page. I'll put that up there if you want to check that out.

Troy: The only thing I can compare to that is . . . some of the greatest satisfaction I get from running is running a race, and you've had this too, Scot, running through a city and having the police officers stopping all the traffic and seeing cars lined up like 20-long just waiting for you to run past them. It's not exactly a presidential motorcade, but it is a certain amount of satisfaction. "You guys can wait on me. I may not be going fast, it's Mile 23, but you can wait."

Scot: All right. It's time to say the things that we say at the end of podcasts because we are at the end of our podcast. Troy, go ahead.

Troy: Thanks for listening. Please be sure and subscribe wherever you get your podcasts, whether that's iTunes, Stitcher, Spotify. We're on all the podcasting platforms.

You can contact us at hello@thescoperadio.com. Reach out to us on Facebook, facebook.com/WhoCaresMensHealth, and our website is whocaresmenshealth.com.

Scot: And then we also have a listener line. You can leave a message at 601-55SCOPE. That's 601-55SCOPE. Thanks for listening, and thanks for caring about men's health.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Producer Mitch has been training for his very first 5k. After several months of improvement and finally reaching his goal of running a full five kilometers, he hit a major set back. He caught his toe on a bad patch of sidewalk and badly rolled his ankle. As if the loud crunch wasn't bad enough, It immediately became quite swollen and turned black and blue overnight.

According to sports medicine specialist, Dr. Christopher Gee, sprained ankles are quite common in sports like running. They can take a while to heal and can be a major setback to any athlete at any level.

One way to prevent a rolled ankle is to improve a person's proprioception. Proprioception is the body's ability to sense where it is in space. It's the sense that allows you to put your hand behind your head and still know how many fingers you're holding up.

When running, your foot gives the same type of feedback. The nerves in your foot send signals about the angle of the terrain, how far the foot is turning, where your leg is in space. In the best-case scenario, as your ankle starts to twist too far, your brain should sense what's happening and quickly use your leg muscles to straighten out the joint before the injury.

There are exercises available that can help improve a person's proprioception by retraining the nerves and neural pathways in your feet. These exercises can include standing on one foot or doing activities while on a wobble board. Diagnosing an Ankle Injury

When a patient comes to Dr. Gee with a sprained ankle he diagnoses the severity and treatment through a three-part process.

First, Dr. Gee will get a history of the patient as well as a description of the event that caused the injury. It's important for the physician to know what kind of athlete the patient is. An injury in a new runner may have a different cause, treatment, or outcome than a seasoned runner. Additionally, the physician will ask a series of questions about what they heard and felt during the injury, which could clue them into the severity of the sprain

Next comes a series of x-rays of the injured joint. Fractures in any joint can be serious. They can require casting or surgery if severe enough. As such, it's important to rule out any breaks early in the treatment of a sprain.

Finally, the orthopedic physician will conduct an exam on the joint itself. An x-ray doesn't tell the whole story of an ankle sprain. There can be significant swelling and tearing of ligaments that won't show up on imaging. The doctor will assess how severe the bruising and swelling of the ankle is. Then they will press on joint lines to test for tearing and rotate the joint to check for functionality. This part of the process can be uncomfortable for the patient, but it's a crucial step to diagnosis Treatment and Recovery after Rolling Your Ankle

After a sprained ankle, it can take weeks to get back to even walking around normally. It can take longer to get back to full activity, like running.

"The biggest thing to do is to get the fluid out and the swelling down," says Dr. Gee.

Inflammation in the joint is the first thing to treat. There is likely a lot of swelling and bruising with a sprained ankle, and the inflammatory response causes a majority of the pain and irritation. The swelling can be brought down by staying off of it, icing it, elevating it, and compressing the area with an ace bandage. This should be done for the first week or two after the injury.

Once the inflammation starts to come down, the second phase of recovery is working on motion exercises with the affected joint. Try moving your toes back and forth or "drawing the alphabet" by moving your toes around at the ankle. Short walks and spending time standing can also be helpful.

The final step of recovery is to gradually return to full activity. For runners, this may mean short jogging sessions at a slower speed. It's important to listen to your body and not push yourself too hard too early. Exerting beyond what your body can handle could lead to further injury and a longer recovery. Keep in mind, it can take 6-8 weeks after a sprain to get back to normal.

"It will get better," says Dr. Gee, "it just takes time."

The first 3-4 weeks of healing will be the hardest. Listen to your body and only do what feels comfortable. If the joint begins swelling, clicking, or causing pain, slow down. Odds and Ends

The Who Cares About Men's Health 5K is on June 20. We encourage anyone who wants to join this virtual race and show support for Mitch as he gets closer to his goal of going from couch to 5K. The virtual race can be completed any way you'd like, whether it be running, biking, walking, skipping, whatever you can do to get in your physical activity that day.

We have received a handful of messages from listeners about testosterone therapy in response to Episode 22: "Will Testosterone Cure Everything?" The questions asked were quite specific and would require a professional's opinion. We will be bringing in a urologist in to help answer these questions in a future episode. Just Going to Leave This Here

On this episode's Just Going to Leave This Here, Troy is overcoming his serious sports withdrawals by getting into space science and rocket launches. Scot urges listeners to stay vigilant on their efforts to stop the spread of COVID-19. Talk to Us

If you have any questions, comments, or thoughts, email us at hello@thescoperadio.com.