Interview Details: Dr. Jared Vagy on Hip Injuries

Dr. Jared Vagy is a physical therapist, and he’s a climber who’s incredibly motivated to help other climbers heal their bodies. In this interview, we talk about common hip injuries in climbers and what to do about them. It’s super in-depth and he describes exact protocols to use on hip injuries, so I hope it helps you out.

More Details

• Why healthy hips are important for climbing
• What the most common hip injuries are
• How shoulder pain and hip pain can be related
• How to tell if hip pain is originating from back
• Specific stretches for high-stepping
• What to do about hip injuries

Other Interviews with Dr. Vagy

1. Interview #1: We talked in general about how to heal injuries, but since that time he has gotten way more specific about the steps we need to take to address them.
2. Interview #2: He talked about how to heal shoulder impingement.
3. Interview #3: We talked about rotator cuff injuries and neck strain.
4. Interview #4: We discussed finger pulley sprains.
5. Interview #5: We discussed elbow injuries.

Jared Vagy Professional Credentials

Dr. Vagy is an authority on climbing related injuries. He has published numerous articles on injury prevention and delivers lectures and seminars on the topic. He received his Doctorate in Physical Therapy (DPT) from the University of Southern California, ranked the number one DPT Program in the nation for the last decade by US News and World Report.

He is now a professor at the University in the DPT Program. As a Doctor of Physical Therapy in clinical practice, he went on to complete a one year residency program in orthopedics and a one year fellowship program in movement science. He is a Board Certified Orthopedic Clinical Specialist and a Certified Strength and Conditioning Specialist.

Supporting Videos from Episode

Hip Mobility Part 1

 

Hip Mobility Part 2

Rock Rehab Protocol Links

Dr. Vagy has created 6 injury protocols using his Rock Rehab Pyramid method that are available on TrainingBeta. You can find out more about his methods by clicking on any of the links below. You can see a description of all of the protocols (which we’ve made available for $15 each) at www.trainingbeta.com/rock-rehab.

• Inside Elbow Pain
• Outside Elbow Pain
• Finger Pulley Sprain
• Shoulder Impingement
• Rotator Cuff Strain
• Neck Strain

Dr. Jared Vagy Links

• Jared’s book, Climb Injury Free
• Website: www.theclimbingdoctor.com
• Instagram: @theclimbingdoctor

Training Programs for You

Do you want a well-laid-out, easy-to-follow training program that will get you stronger quickly? Here’s what we have to offer on TrainingBeta. Something for everyone…

• Personal Training Online:  www.trainingbeta.com/mercedes
• For Boulderers: Bouldering Training Program for boulderers of all abilities
• For Route Climbers: Route Climbing Training Program for route climbers of all abilities
• Finger Strength : www.trainingbeta.com/fingers
• All of our training programs: Training Programs Page

 

Please Review The Podcast on iTunes

Please give the podcast an honest review on iTunes here to help the show reach more curious climbers around the world.

Transcript

Neely Quinn 

Welcome to the Training Beta podcast where I talk with climbers and trainers about how we can get a little better at our favorite sport. I’m your host, Neely Quinn. And I want to remind you that the Training Beta podcast is actually an offshoot of a website I created all about training for climbing. And it is Trainingbeta.com. And over there, you will find tons of training programs for boulderers for route climbers for people who just want to train finger strength or power endurance. So every time you purchase one of our training programs, you’re helping to support this podcast. So you can find those at Trainingbeta.com/programs.

 

So today, on the podcast, I have an interview with Dr. Jared Vagy, who has been on the podcasts, I think, five other times, he’s also written protocols for Training Beta, all about how to heal elbow injuries, shoulder injuries, finger pulley injuries, and neck injuries. And we’ve talked about all those things on the podcast before. He is a Doctor of Physical Therapy. He’s a professor, he’s a climber. So he’s really familiar with these injuries. And he wrote a book called Climb Injury Free, it’s a really pretty, thorough book all about climbing injuries, and what to do about them. And so you can find that on Amazon. But also his protocols on TrainingBeta are located at Training beta.com/rock-rehab. So hopefully, all of these things combined can help you if you have an injury.

 

But today, we’re going to focus on hips. And we’re going to talk about the common hip injuries that climbers get, why they get them, and things that we can do to prevent injuries and what to do when we have them. So I’m gonna, I’m gonna let him take it from here. And you may be a tiny bit confused when we first start this interview, but just bear with me, and I think you’ll enjoy it. So I’ll talk to you on the other side. Enjoy.

 

 

Okay, thanks very much for talking to me again, Jared.

 

Jared Vagy 

Absolutely, Neely. It’s always a pleasure to be on the show.

 

Neely Quinn 

Yeah. So, do .. are we going to do these exercises?

 

Jared Vagy 

All right, let’s do it. Yeah, so Neely. Neely and I were talking before and I want climbers to think about how these vocal exercises will improve their climbing performance and prevent injuries. So we’re gonna start with: Neely repeat after me. Topeka, bodega.

 

Neely Quinn

Topeka, bodega.

 

Jared Vagy 

Unique New York

 

Neely Quinn 

Unique New York.

 

Jared Vagy 

Red leather, yellow leather.

 

Neely Quinn 

Red leather, yellow leather.

 

Jared Vagy 

Irish wristwatch.

 

Neely Quinn 

Irish wristwatch.

 

Jared Vagy 

I’m a mother pheasant plucker I pluck mother pheasants

 

Neely Quinn 

I’m a mother pheasant plucker I pluck mother pheasants

 

Jared Vagy 

Neely. You nailed it.

 

Neely Quinn 

That one is pretty hard.

 

Jared Vagy 

It is tough. It is tough. But I bet people listening are probably wondering what the heck we’re doing.

 

Neely Quinn 

Yeah. So when I first got on the phone with Jared, I had him do a sound check. And that is what he said. So I was like what —

 

Jared Vagy 

So essentially, I’ve been filming all these physical therapy videos for University of Southern California and we’re around this like tech stage and audio vocal exercises are important to get your you know, your your vocal cords warmed up. And so now both of our vocal cords are warmed up for this intense interview that we’re going to have talking about the hip.

 

Neely Quinn

Very intense. But seriously, most of the time I lose my voice by the end of the podcast. It’s not just that I’m not interested in what my guests are saying is that my voice is not there anymore. So just FYI. But anyway —

 

Jared Vagy 

We’re gonna take a — we’re gonna take an intermission Neely and do those vocal exercises to get you warmed up and psyched to talk about the interventions for the hip.

 

Neely Quinn 

Yeah, very exciting stuff. But, but let’s back up for a second. You’ve been on the show a ton of times, but just remind people who you are and and maybe just touch a little bit on why you’re doing those videos like you were talking about.

 

Jared Vagy 

Okay, yeah, so my name is Jared Vagy am a doctor physical therapy and I’m a professor at the University of Southern California, which is a top physical therapy program in the country. So fight on Trojans. But uh, I’m a rock climber and I got into rock climbing through my own injuries. And I sprained a play ligament, my finger I tore my rotator cuff and I just started to try and figure out how these injuries happened in myself and started working with these to start to prevent injuries and different athletes. About eight years ago, I started writing articles on preventing climbing injuries for a bunch of different climbing magazines. I started writing books, I’ve written two books on the topic, the second one, our most recent one, Climb Injury Free. And then I started working with tons of climbers, so from novice athletes to the top rock climbers in the world. And my passion is movement in climbing, and additionally, physical therapy, and I’ve been really lucky to be able to combine all those together.

 

Neely Quinn 

Cool. So what are we talking about today?

 

Jared Vagy 

Neely, we’re talking about the hips. And today is gonna be all about the hips in every direction, every position every way to test them, train them, get them stronger, get them better at moving, so you can climb. And then I also want to talk about the injuries, certain injuries that climbers can have in the hips. And don’t worry, Neely, I’ll be quizzing you all along the way to keep you on your toes.

 

Neely Quinn 

Yeah, I’m like really tired today because I was at a bachelorette party all weekend long. And I was like, Oh my God, he’s gonna be quizzing me, I need to wake up.

 

Jared Vagy 

Study up study up.

 

Neely Quinn 

Be easy on me.

 

Jared Vagy 

I’ll be gentle.

 

Neely Quinn

This one’s good, though. Because I have hip issues myself. I’m always such a nice guinea pig for people to like, I have some of those issues, too. Let’s, yes…

 

Jared Vagy 

Neely, Neely, let’s make sure to talk about your hip at some point. And feel free to interject your questions. That’s what I love is some of you know, if you’re wondering or thinking about different things we’re talking about, but let’s make absolutely sure to get into your hip a little bit with this podcast to cool,

 

Neely Quinn 

Yeah, gladly. Alright, um, where shall we begin?

 

Jared Vagy 

All right, well, I’m going to start with a question. So Neely, why are our hips important when we climb?

 

Neely Quinn 

Well, it’s funny, because I never really thought about that. But I realized after I stopped climbing for a couple months, like a couple– like a month ago, like four, whatever, doesn’t matter, and my hips stopped hurting. And then as soon as I started climbing, and started hurting again, I was like, What am I doing? And it’s like, pulling in and arching my back all the time, I think. But I mean, obviously, our hips are important for stepping up on things. And yeah, like high stepping and keeping our bodies close to the wall and steep stuff and everything.

 

Jared Vagy 

Yeah, I mean, you basically nailed it is how we move up the wall most efficiently is by positioning our center mass over our toes, because our toes are on the foothold. And the best way to do that is to move our hips. And whether that involves, you know, arching your back a little bit to bring your hips into the wall. So your center masters over your toes, whether it means dropping a knee and swinging your hips into the wall. So almost using the outside edge of your foot, or whether it means going frogger style, and rotating your hips outwards, and bring your hips flush into the wall. Those are all ways to improve our efficiency.

 

And then specific movements like you mentioned, well, first of all, the high step, that’s one of the best ways to progress or center mass upwards. And so we have to have that flexibility to step high. We also need to be able to heel hook sometimes, and you need to be able to have that hip mobility to get your leg up into certain positions. And so oftentimes, what I notice is when a climber comes in with shoulder pain, elbow pain, wrist pain, finger pain, and it’s on both sides. And it’s consistent, and they keep getting these upper body injuries, the first thing I do is look at their technique. And I wonder, Is there something that they’re not doing in their lower body, that’s making them overuse their upper body, and usually it comes down to either footwork, or the hips themselves.

 

Neely Quinn 

So you treat the hips for the shoulders.

 

Jared Vagy 

So you can you can, and you can’t do that blindly. You have to actually watch the move and see if there’s a deficit. And if there’s a deficit, then you can start to go in specifically, and I’ll actually give a almost put that thought in the back of your head for a while, is there is a direct relationship between how much someone can flex their hip, and how much they may or may not have shoulder pain, and all talk about that in a moment. But if we can kind of file that away, because it’s a pretty interesting concept, how everything’s connected.

 

Neely Quinn 

Okay? Yeah, I’ll file it away in my notes here.

 

Jared Vagy 

All right. So let’s go by movement first. And I want to start just general and talk about the different techniques in climbing that revolve around hip motion or that need hip motion. And then what is needed, why the techniques important, how to assess it. So anyone listening can assess or self assess, and then how to treat it to make either your hip more mobile or to take pressure off of, for example, your shoulder.

 

Neely Quinn 

Okay.

 

Jared Vagy 

All right. So number one, let’s start with high step. So Neely, let’s explain a high step. What’s the high step?

 

Neely Quinn 

You’re climbing and you put your foot high up to step onto something?

 

Jared Vagy 

Yeah, perfect. And then once you step onto it, what do you need to be able to do?

 

Neely Quinn 

A pistol squat.

 

Jared Vagy 

Yeah, you have to transfer your weight. And then use a pistol squat with some upper body assistance to then help you progress up the rock wall. Alright, and then do shorter climbers or taller climbers who has more difficulty with getting into high step positions up on the wall?

 

Neely Quinn 

I think taller climbers?

 

Jared Vagy 

Almost. 50% correct.

 

Neely Quinn 

50%? It’s shorter climbers?

 

Jared Vagy 

So it’s a little bit of a trick question. So shorter climbers. Imagine that you have two climbers, and you have a bow standing on the ground. And you have a foothold. At about, let’s say about like 100 inches off the ground. Which climber is going to be more able to get their foot on that foothold?

 

Neely Quinn 

Oh, yeah. Taller climbers,

 

Jared Vagy 

The taller climbers. Except one thing, which one has longer leg bones? 

 

Neely Quinn 

The taller climber That’s why I thought —

 

Jared Vagy 

Correct. Yeah, it’s a trick question. So the taller climber is going to be more apt to get their foot higher to get on that foothold. But because they have a long leg bone, so the femur right, what happens to their body weight and their center mass, which direction is ago,

 

Neely Quinn 

Their body weight and center mass it? I guess it like, because their leg is so heavy, it’ll pull them over, when they try to do that?

 

Jared Vagy 

Almost. Imagine they’re facing a wall, they step up as high as they can never really long leg bone, their leg bone, if they keep their hips away from the wall, it’s gonna be pushing like they’re, they’re basically let’s imagine they’re stepping up their knees directly in the wall. And because their thigh bone is so long, their center mass is far away from the wall. Does that? Are you able to imagine that or visualize that?

 

Neely Quinn 

Yeah, yeah, yeah.

 

Jared Vagy 

So essentially, if a tall climber high steps, they’re gonna have to work a little bit harder with their upper body because their body weight is further away from the wall, although they do have the ability to step higher than the shorter climber.

 

Neely Quinn 

Okay.

 

Jared Vagy

So essentially, when I hear climbers that are really tall, complain, or talk, climbers are really short complain about their body dimensions. There’s always pluses or minuses, and you just work with your body. So for example, if a tall climber high steps, my recommendation is for them to high step and use their inside edge of their foot, rather than the front of their toe-box. And what do you think that does?

 

Neely Quinn

It keeps their hip, it keeps their leg closer to the wall?

 

Jared Vagy

Yeah, it brings our center mass closer to the wall. And that’s a movement strategy for that for that taller climber. So when I look at someone’s ability to high step, I look at their limb length, which is one thing and versus their overall height. And if they have longer femur bones as well, compared to their height, they’re at a little bit of a disadvantage. And so there may be some movements that they can utilize to be more efficient on the wall.

 

So let’s say we watch a climber and they do a high step. And they just can’t get very high. Then what’s limiting them? Like, what do you think the, the part of their body that stiff? Which which part of the body would be keeping them from doing that high step?

 

Neely Quinn 

Their hip?

 

Jared Vagy 

Their hip. Yep. And so which part of the hip cuz this is a tricky one. So if you were to stretch, Neely, to try and improve your high step, what would you do?

 

Neely Quinn 

Maybe like a half pigeon or something.

 

Jared Vagy 

Okay. Yeah. So you’re almost flexing the knee up your, your knees rotate outwards a little bit. You’re lying on the ground. Yeah, that’s an excellent one. And then when you do that stretch, where do you feel it?

 

Neely Quinn 

In, like, my well in my hip, lower back, and butt.

 

Jared Vagy 

Yeah, you feel it in the back of your hip, kind of the buttock region, as well as a little bit sometimes in the low back. And so the buttock muscles, as well as the joint capsule in the hip, are the muscles that if they’re stiff, they make it so you can’t step very high. So if someone’s complaining about not being able to or I shouldn’t use the word complaining, maybe if a climber is reporting not being able to do a high step then stretching out the buttock muscles may allow them to get that foot in that hip a little bit higher into that position.

 

Neely Quinn 

You think so, like regular stretching would do that?

 

Jared Vagy 

Oh, that’s — now we’re getting into a little bit more of how you dose it and what exercise you’re gonna — we’re going ahead of ourselves, we’ll get there in one moment.

 

Neely Quinn 

Okay.

 

Jared Vagy 

We’ll get there in one moment. So there are two things on that right side of the hip, that are limiting it. One is just muscles. So that’s the buttock muscles, or the deep six rotators in the hip, and the muscles basically in the back of your hip, that are limiting that high step. And the second thing is what’s called the joint capsule in the hip. It’s essentially this fibrous shrink wrap that wraps around really deeply within the hip joint that keeps it tight and nice and stable. And those are the two main things that limit your hip from flexing up high into a high step.

 

Neely Quinn 

Okay.

 

Jared Vagy 

And so the question you raised was, well, how do you stretch it? And how do you dose it? Well, first of all, if it’s soft tissue, such as muscular, what would you do to a muscle? Almost like say you’re cooking chicken, Neely? What would you do to the chicken, to make it nice and supple before you cook it?

 

Neely Quinn 

Pound it?

 

Jared Vagy 

Yeah, you’d pound it right? You tenderize it. And so how would you tenderize the glutes like what would you do to tenderize the the muscles in the buttock?

 

[Laughter] 

 

Jared Vagy 

But maybe not that terminology, this needs to be a kids friendly program. So, so yeah, so you would use –How would you…

 

Neely Quinn 

You could like massage it — self massage?

 

Jared Vagy 

Exactly, exactly. So you would use — good save there. So you would use a lacrosse ball, you would use a foam roller, you would roll on those muscles, the bottocks and you would tenderize those muscles. And then you follow that up with a soft tissue stretch, you could do a pigeon stretch, you can lie on your back and grab your knee. And you could do a couple different things to help you get passive motion into that high step position. And that’s that soft tissue that we’re talking about.

 

Okay, now, what if it’s the capsule, what if it’s this shrink wrap that wraps around the joint, you actually have to treat a little bit differently. And with the joint, you actually have to glide or move the joint. And a simple stretch doesn’t do the trick. And oftentimes, if it’s a joint, you’ll feel it really deep, and sometimes really feel it on the front of the hip, like you’re gonna, you’re supposed to fill in the back in that buttock region and the muscles. But when you do that stretch, by on your back, grabbing your knee, and it’s the joint, you may actually feel it in the front are quite deep. And so how do you think you treat that it’s way different than how you treat muscle. It’s it’s thicker, more fibrous tissue, and it takes longer for it to adapt.

 

Neely Quinn 

I don’t know do you have to strengthen it somehow? I don’t know. 

 

Jared Vagy 

You could strengthen it, but you need to stretch it. But the duration of stretch is much, much longer. And so for soft tissue deformation, they’ve done tons of research studies, especially in the lower body, three sets of 30 seconds, you know, routinely is adequate enough to improve short term mobility or motion. But and that’s for a soft tissue such as the buttock muscles. But for the joint capsule, what’s deeper down, you need to stretch at least two minutes, three minutes, this long, sustained position. And you can even add something that will move or glide the joints. So if you imagine that you lie down on your back, and you’re pulling your knee into your chest, if you take a really stiff resistance band, and you loop it around the front of your hip, and then you attach that to a squat rack or climbing wall or something like that, so that the resistance band pulls your hip downward creates space within that joint capsule and opens it up, then that’s a really nice way to stretch what’s called the joint capsule on the hip.

 

And so some people, you know, they don’t know whether they have a tight muscle or a tight joint in the hip. And if they don’t go into see someone specific a medical practitioner to differentiate those, well, you could just do both. But if you go in and see someone they can tell you, they can say you know what your hip joint capsule is what stiff do this stretcher or maybe it’s just your bottocks, do this or you can do a combination. But those are the two structures that when stiff would limit someone from a high step on that same side.

 

Neely Quinn 

Okay. Yeah, that’s, that’s good. I wonder if there’s a resource for people to see that stretch you were just talking about with the band.

 

Jared Vagy 

Yeah. If you remind me I could put that up on your page so they can see exactly what that looks like. And then, likely, after this podcast comes out around this time, actually, I filmed a video series with Adidas and John Cardwell. And I have John actually going through that exact exercise that I just described, and showing how to perform it and how to differentiate between the two. So that’s another resource that’s gonna be on Epic TV. So people listening as well can type in Epic TV. And there either will be soon or or it’s already up there. A series that involves that specific stretch.

 

Neely Quinn 

Oh, cool. And what’s it called?

 

Jared Vagy 

The stretch or the series?

 

Neely Quinn 

The stretch.

 

Jared Vagy

The stretch is a hip flexion joint capsule stretch.

 

Neely Quinn 

Okay. Great. That’s very handy.

 

Jared Vagy 

So and most people don’t do that most people do the general soft tissue stretching those maybes, people that aren’t getting very good gains, were trying to get their high step a little higher. And that may be something that they can work on.

 

Neely Quinn 

Yeah. Yeah, I think that there are a lot of people who complain about having well, who report — 

 

Jared Vagy 

Nice!

 

Neely Quinn

Having really, really stiff hips. Like, I’ve heard a lot of people say that. So I think if that can actually help. We’re going to get into — are we getting into dosing now?

 

Jared Vagy 

Yeah, we can get into dosing now for sure. And I also will piggyback on if climbers listening now are trying to determine which stiffness do I have? Is it the capsule? Or is it the muscles? If you stretch your hip, and you feel it in your butt? It’s the muscles. If you stretch your hip, and you feel it deep, and in the front of your hip, it’s likely the joint capsule.

 

Neely Quinn 

What if you feel it in both? 

 

Jared Vagy 

Both of them. Was that a personal question?

 

Neely Quinn

Yes.

 

Jared Vagy 

I could read into that one. Alright, so dosing?

 

Neely Quinn 

Yep dosing. Okay. Yeah. How often do people need to put this into their routines?

 

Jared Vagy 

Alright, so the important thing of importance about stretching is frequency. And most important is what time of day, do you think? Or before what activity? Do you think that it’s essential to do these stretches?

 

Neely Quinn 

Well, it’s interesting, because, you know, we’ve been told for a long time to not stretch before we climb, so I don’t know.

 

Jared Vagy 

All right, yeah. It’s tough. Now, it’s conflicting evidence, right? And conflicting opinion. And I’ve gone on and mentioned static stretching before you climb the five minutes before you climb is bad, you know. And that’s true, the five minutes before you go on the wall, static stretching may decrease your your strength and affect your performance. But 10 minutes before, or 15 minutes before you go on the wall, totally fine. And it actually can improve your ability to climb, especially stretching the lower body. And a little bit more mindful of people over stretching their finger flexors, you know, before they climb, but absolutely in the hips, is you need to stretch them. But there’s a recipe and you need to follow the recipe. And the first part of the recipe is what we talked about, is target the joint capsule or target the soft tissue.

 

Neely Quinn 

That’s so interesting. So it’s like the, the joint needs time to recover something from the stretching. And that’s why it’s not good five minutes, but it’s okay 10-15 minutes before?

 

Jared Vagy 

Well, typically, actually, the research they’re doing on injuries, they actually look at muscles and tendons. And the joints are fine. When you when you stretch them, it’s just muscle and tendon injuries may, you know five to six minutes before vigorous activity may decrease performance. And so that’s more our fingers or shoulders when we climb, it doesn’t really matter how much performance gains we lose in our lower body. Because we’re not maximizing our hips when we climb at 100% of their maximal voluntary contraction, every move. They’re operating at a very low threshold, so super safe to statically stretch those prior.

 

But there’s something that comes after statically stretching, which in this recipe that we’re putting together is the important part. So imagine this Neely, you have — which hip is stiff for you?

 

Neely Quinn

The left.

 

Jared Vagy 

Right, your left hip is stiff. You just realized you said you know what, it’s probably my joint capsule. You do that joint capsule stretch feels a little bit more loose than you do your stretch for the buttock muscles and you don’t feel that pinch and it feels a lot better. And now your hip is a little bit more mobile. Now before you progress to getting on the wall, there is one step that you need to do in between getting on the wall. And if you don’t do that step, you’re kind of wasting your time with stretching. And what do you think that step is?

 

Neely Quinn 

I don’t know.

 

Jared Vagy 

So stretching improves the passive flexibility of the hip. So your ability just to improve just the the flexibility of like almost grabbing your hip and bring it up. That’s called flexibility. What it doesn’t do is improve your mobility, meaning your ability to use that motion.

 

Neely Quinn 

So to activate it.

 

Jared Vagy 

You got to activate it right after.

 

Neely Quinn 

I was gonna say that.

 

Jared Vagy 

I know you’re right. So you went, you defaulted. You said, I don’t know. Neely, I know that you know, this. So, okay, so you you activate it. Right. And so Neely, should we do some vocal exercises to get back on track?

 

Neely Quinn 

Wake up.

 

Jared Vagy 

I mean, mother pheasant plucker.

 

Neely Quinn 

No, let’s not right now.

 

Jared Vagy 

All right. So you know, but you got it. You nailed it. So essentially, you have to activate it. And so this is a really cool exercise I have climbers do after they stretch their hips. You balance on your right leg. You grab your left hip, and you pull it into your chest as much as possible.

 

Neely Quinn 

Rour hip or your knee?

 

Jared Vagy 

I’m sorry, your knee.

 

Neely Quinn 

Okay. All right.

 

Jared Vagy 

Good call. Good call, you’re on your toes. So you grab your your left knee and you pull your knee into your chest as much as possible. And then you slowly remove your arms and raise them in the air without letting your knee drop a centimeter. And it is so hard for climbers to do if it’s not trained.

 

Neely Quinn 

Yeah.

 

Jared Vagy 

And some climbers will cheat, and they’ll lean backwards to try and make that hip go a little higher. And if you lean backwards, well, that sucks when you climb because now your center mass is going away from the wall. Right?

 

Neely Quinn 

Yeah.

 

Jared Vagy

And so that’s a compensation. So for those climbers, I say go against the wall, lean your back against the wall, grab your knee as high as you can pull it, pull it into your chest, and then slowly bring your arms up into the air without the knee dropping a centimeter and that is your mobility.

 

Neely Quinn 

Okay, yeah, that makes sense. In that it would be really hard. That’s like, dancer stuff.

 

Jared Vagy 

Dancer style. Yeah. Or, you know, 5.14, high step style, right?

 

Neely Quinn 

Yeah.

 

Jared Vagy 

So no, but either way, it’s, it’s really important to be able to do that. And the recipe is you stretch it first, then you improve the flexibility. And then you stand in you perform this technique and improves the mobility or your ability to lift it. And, Neely, I have super stiff hips, like that’s one of my the two things I can say with my technique I could improve on one is hip mobility and the others, well, we can all have stronger fingers. But that’s a little bit of weakness that I have in mind. And so I used to be in these scenarios where, you know, my climbing partners tell you all the time, where I’m trying, I’m on a sport route. I’m trying to get that high step and I literally can’t do it. But I have a solid jug for my right hand. And I grabbed my left knee, and I pull it up with my hands. Have you ever had to do that? 

 

Neely Quinn 

No.

 

Jared Vagy

You know, climbers are —

 

Neely Quinn 

Yeah, I’ve definitely seen that, yes.

 

Jared Vagy 

Yes, no, but that’s exactly that’s flex, I don’t have I have that passive flexibility. At that point, I, I could lift it with my arm, I was just burning out on my opposite arm trying to you know, hold that jug. But I don’t have the mobility to lift it myself. And so I know for my warmup, I’m stretching my hips before I climb. And I’m spending 10 to 15 minutes just on my hips, and I am static stretching before I climb. And you’ll see me in the gym and I am doing these stretches. And then I go in and I use the mobility I start doing active stretches afterwards.

 

Neely Quinn

Okay. 

 

Jared Vagy

All right.

 

Neely Quinn 

So the, the passive stretches sort of prepare you for these active mobility stretches and sort of activating.

 

Jared Vagy 

Exactly, they make it so it’s easier for you to perform these active stretches, they give you that flexibility or that tissue a little bit of extra play within your tissue to make it so it’s easier to actively use it.

 

Neely Quinn 

Okay. So is that what you recommend for people is doing it for that long, 10-15 minutes before climbing?

 

Jared Vagy 

Well, I mean, that’s if you have a deficit such as mine, and I’ve pinpointed that my hips are stiff, and I want to make them more mobile before you climb. Really, if you do a minute and a half of if it’s your soft tissue, a minute and a half of stretching, or if it’s your joint capsule, two to three minutes of that passive stretching, so min and a half would be three sets of 30 seconds. That’s your joint capsule, two to three minutes, three to four minutes just sustained, and then followed by three sets of 30 seconds actively. That’s no more than six minutes. Maybe if you have a capsular issues a little bit longer, but yeah, under 10 minutes, if you really identify that you have stiff hips and you want to improve them.

 

Neely Quinn 

Yeah. Okay. I mean, that’s doable.

 

Jared Vagy 

It’s doable.

 

Neely Quinn

I’m terrible at doing it and like taking the time to do it. But for me, it’s mostly, I don’t know what to do. So if you said Neely do this stretch for this long for, you know, and then do this one, I can imagine doing that before climbing.

 

Jared Vagy 

Yeah, and that’s where I give the analogy a lot, you have a machine gun, and you have a sniper rifle. And if you know exactly what’s going on with your body, you’re being much more efficient with your time because you’re using a sniper rifle. So for example, for me mine soft tissue flexibility. So I don’t need to do that capsular stretch, I’m going straight to the stretch that I know that I need. versus if I didn’t know that about my body. While that may be difficult, I’d have to spend a little bit extra time doing a stretch that may not be as effective.

 

Neely Quinn

Yeah.

 

Jared Vagy

And so what that breaks down to as well is, are there assessments that are standardized, that we have research that supports them that climbers can do to determine whether it’s important to stretch their hips or not? Would that be cool? Yeah, I set that up a little bit, right. But wouldn’t that be super cool if there was a research based assessment that even linked your ability to flex your hip high with how hard you climb?

 

Neely Quinn 

Yes, that would be very cool.

 

Jared Vagy 

Wouldn’t that be cool if that was a study by Nick Draper and colleagues that went through all these climbing specific assessments?

 

Neely Quinn

Whoa.

 

Jared Vagy 

So there’s a really cool study that Nick Draper and colleagues did, and part of that study was what’s called this adapted grant foot raise. And essentially what they did is imagine there’s a wall in front of you, Neely, and you take tape, and you place your hands at the shoulder distance apart on the wall. Can you imagine that?

 

Neely Quinn

Yeah.

 

Jared Vagy

Now you take tape, and you take two strips of tape directly down from your hands to the bottom of the wall.

 

Neely Quinn

Okay.

 

Jared Vagy

And then you take one more piece of tape, and you mark it 23 centimeters from the wall itself.

 

Neely Quinn

Okay.

 

Jared Vagy

So now you’re standing 23 centimeters away from the wall, your hands are on the wall, and you have two pieces of tape running down underneath your hands. Okay. So this is what’s called the adaptive grant foot raise. And essentially, what you do is you slide your foot up that piece of tape, and you have to keep your hands pressed against the wall. And you lift it as high as you possibly can. And you have someone mark a pin, your height, how high you can flex that hip. And you do that three times on each side. And it’s really fascinating to watch. Because, you know, I work with novice climbers to some of the top climbers in the world. And regardless of climbers skill and ability, we can always find asymmetry side to side. And can you imagine, let’s say on your left side, if you can only lift that, you know, lift that hip lift that foot, let’s say it lifted, let’s say 10 centimeters lower than your right side. Well, how do you think that may affect your climbing?

 

Neely Quinn 

Well, then your climbing is going to be asymmetrical.

 

Jared Vagy 

Exactly. So every time there’s that left high step is maybe you’re not able to step as high or maybe you have to pull a little bit more with your arm and with your shoulder.

 

Neely Quinn 

Oh, okay.

 

Jared Vagy 

Oh, we’re coming, we’re coming back to it. And so when your arms are on the wall, and you’re trying to lift that foot up, and it’s not getting that high, your shoulders actually start to round forward, your spine flexes to try and create a little bit more room for that high step. And that —

 

Neely Quinn 

Moving your shoulders forward is going to affect your shoulders’ health.

 

Jared Vagy 

Exactly. And so that’s why when we look at climbing technique, and I look at, I look at climbing footage all day, I’m like at night before I go to bed scrolling through climbing footage, and if — I enjoy it, I love it right. But I have to look at the footage of my patients before I see them. And if I notice that there’s an inadequate high step, and someone’s having pain on that side or on their shoulder as well. And I noticed as well, their shoulder blades rounded forward every time they do that high step. I’m absolutely going to line them up on a damn adaptive grant foot raise and see how high they can lift their hip or lift their foot.

 

And it’s so cool because it’s so measurable. Like you’ll see you’re sliding your foot up and down a line. Like you can just As hard as you want, but your partner your therapist is marking how high your foots going, there’s no way to fake that deficit, you can definitely see side to side asymmetries, and then you can track it and improve it over time.

 

Neely Quinn 

So then how does the lay person use this? Like, how does somebody listening to this, use that information?

 

Jared Vagy 

Alright, so here’s what I would do. Let’s say we’re a lay person that’s listening, we have left hip pain, or right hip pain, or left shoulder pain, whatever it is, all you do, take a piece of tape, measure 23 centimeters from the wall, measure two pieces of tape, shoulder width apart, have a buddy, give them a pen, then slide your foot up on your right side three times as high as you can have them mark that distance, do your left foot three times have them mark that distance. And if there’s a difference, and right, they haven’t objectified, how much a difference actually is. But let’s say if there’s a difference greater than two to three inches, then that’s a immobile hip. And maybe you should perform some of the stretches that we talked about earlier, such as lying on your back, and grabbing your hip and having a resistance being pulled down if you feel a pinch in the front of your hip, or maybe lying on your stomach doing almost like a pigeon stretch, if you are feeling in your buttock. And then for fun, do your stretches, stand up, flex your knee up to your chest, do the active mobility exercises, and then go back and do the same exact test. And if you do the same exact test, and your foot is now higher on that left side, well, that’s your warmup. And you should probably do that every time before you climb, until you can normalize your side to side positions.

 

Neely Quinn 

How scientific of you and us lay people.

 

Jared Vagy 

But really easy to implement, right? You don’t have to be an expert in movement, or be a medical practitioner, these are assessments that anybody can do. And then you do the intervention. And you can test — it’s — this test was tested with reliability of inter and intra rater. Basically, it’s a test that every time you perform it, whoever is doing the measurement in whoever’s doing the hip flexion that is accurately as long as they have their hands on the wall. So you just reassess it. And you can see if your intervention actually worked.

 

Neely Quinn 

Yeah, that’s really that’s super cool. I like that.

 

Jared Vagy 

Yeah, so that’s for high step and hip flexion. And we can pretty much do this for every single movement in climbing. But I just want to point out, you know, we don’t have a seven hour podcast going going here. But I just want to point out in depth, an example of how you can apply this for the high step position.

 

Neely Quinn 

Yeah, that’s great. Super useful.

 

Jared Vagy 

All right, so and that tied in as well, to the shoulder too which I see all the time. And especially if someone has a long femur bone, they need to start using either the inside or outside edge of their foot during during high steps. And inside edge is the go to position for high steps unless you’re spinning your center mass around and doing something maybe like a hip swivel or drop knee.

 

Neely Quinn 

Okay. All right. Good to know.

 

Jared Vagy 

All right, so should we should we move on to the next position?

 

Neely Quinn 

Yes.

 

Jared Vagy 

All right. So let’s — Alright, so Neely, you’re climbing as steep, challenging sport route? Do you consider yourself someone that toes in and uses the outside edge of your foot more often? Or you flare your hip outwards and use the inside edge of the foot?

 

Neely Quinn 

I would say the latter.

 

Jared Vagy 

Okay, so your inside edge?

 

Neely Quinn 

Yeah.

 

Jared Vagy 

Okay. And what do you think I do when I’m climbing a challenging route? Or rather challenging for me? Do you think I use the inside or outside? 

 

Neely Quinn 

Well, since you said you have bad hip — or flexibility, I’m guessing the outside.

 

Jared Vagy 

100%. So my hips are stiff. And I know that and I train them, my flexors, I work on those exercises. And part of it is also genetic. I can’t blame it all on genetics, but I have what’s called a retroverted hip, which means I have decreased motion in a certain position. And we’re not going to get in depth into that. But I’m diligent about my hip exercises. But there are some positions I just can’t get into and that toed out position, especially — err sorry, with the the frogger position or that knee out position is one that’s quite a challenge for me. And so what I do is I rotate my center mass into the wall and I use the outside edge of my foot very frequently and you’ll notice that I use a lot of hip swiveling when I climb.

 

But you have sounds like — I haven’t I haven’t seen you climb very much with sounds like you favor the opposite position. And maybe it’s because you have that flexibility or maybe because you favor that opposite position, that’s why your hip is starting to hurt. We don’t know, we don’t we don’t know, chicken or the egg. But let’s go to that same thought process for what you described as this toe out position, or sorry, this knee out position, or this almost frogger position. Am I describing this for people that are listening appropriately?

 

Neely Quinn 

I’m getting it. Yeah, I can. I can. Yeah, picture it.

 

Jared Vagy 

So basically, there’s two ways that climbers do this one, they’re directly in this frogger position, both legs are fully rotate outwards, and their knees, you know, is rotated away from the wall. But the more common position, which you likely do, Neely, is just a single limb is rotated outwards.

 

Alright, so how do we assess this Frogger position with one leg? So Neely, you’re climbing, you kind of step out, you flare your knee outwards? How do we assess just like we did that adaptive grant foot raise? How do we assess if a climber is stiff in this position? Any, like, make something up? Think about what you would do?

 

Neely Quinn 

How quantify how strong they are?

 

Jared Vagy 

Yeah, and let’s just start them lying on the ground. What would you do?

 

Neely Quinn 

Um, well, I know that. What can I use a wall?

 

Jared Vagy 

Yeah.

 

Neely Quinn

So one of the things that a trainer had me do for my hip was like, you put your — you lie on the ground on your back, and you put your butt up against the wall? And then I think you can assess how flexible one is, like, with how close they can get their legs to the wall? And in certain positions? I’m not sure.

 

Jared Vagy 

Yeah, and is your is one of your knees bent, or is is your butt fully against the wall?

 

Neely Quinn 

Well, with this one, it was just like sitting there with their view that different things you would have to do. But one thing would be to have my knees like drawn into my chest, basically, and my feet up on the wall. And it was mostly just a stretch, but so my foot was flat, my feet were flat up against the wall.

 

Jared Vagy 

So that’s one way, that’s one method. And then I’m trying to imagine that’s a good way to also test hip flexion. Another really interesting way. And this is called a modified Faber’s test. So this is an actual orthopedic test that is used for surgeon’s physical therapists to assess the hip is the climber just lies on their back, and you take their ankle, and you cross it over the basically right above their opposite knee. So can you imagine that? Yeah. So you’re lying down on your back, you take your ankle, and you cross it right above that opposite knee. And what’s gonna typically happen is the pelvis is going to start to kind of rock or shift over. So what the therapist or the assessor does is they stabilize the pelvis, they do not let the pelvis move. And they push that knee down to the ground, as far as it comfortably can go. And they take a measurement of how far that knee is from the ground.

 

Neely Quinn 

Okay, that’s easy.

 

Jared Vagy 

So essentially, yeah, and you do on the other side, so the climber lies on their back, you cross one leg over the other, almost like you’re sitting cross legged, but you’re lying down, and that ankle is right above the knee, the therapist stabilizes the pelvis, and they push their knee down towards the ground, and they assess a different side to side.

 

And this one isn’t as easy to do on your own, right, it’s a little bit easier if someone does for you. But it tests your hips ability to rotate into that outward position. And there’s oftentimes, like the other one, there’s an asymmetry side to side. And this is another one. And then, John is cool with me saying this because we actually filmed a video, as I mentioned earlier for some of these techniques that I’m going to put out there, and on the video, we tested a limb for him, John Cardwell, that was he had a little bit of a previous knee injury. And on that limb, it was several inches difference for him is his ability to press down on the ground, and that was related to a previous injury. And so this is just something another thing for climbers to check, is maybe you’re not towing out as much on the wall. And maybe for this particular assessment, you can compare one side versus the other.

 

Neely Quinn 

Yeah. But but like you’re saying, you need help to do that.

 

Jared Vagy 

Yeah, this one is a lot harder because you need someone to stabilize your pelvis and to measure and the hip flexion one’s a no brainer. You can you can do that yourself, really. But, but this one, you do need someone to stabilize your hip and then press it down towards the ground.

 

Neely Quinn 

And it’s just how — which one can go closer to the ground?

 

Jared Vagy 

Yeah. Really, which which one passively can go closer down towards the ground.

 

Neely Quinn 

Okay. I mean, I can imagine having like my husband do that or something.

 

Jared Vagy 

Yeah. And so for this one, let’s say that left side, Neely, so your left side, let’s say that’s not going down as much as the other side. And then let’s also say that that left side is the side, you usually favor in that towed out position, you know that you’re — sorry, that kneed out position when you’re when you’re climbing. So what can you do to stretch that out? And you mentioned some earlier, you know, some different ways to stretch it. And a really nice way, actually, in that toe out position, is there’s a progression you could start with, I don’t know if you’ve tried this, but have you tried hands and knees, and then you rotate or flare your knees outwards? And then you rock back and forth?

 

 

Neely Quinn 

No.

 

Jared Vagy 

So you essentially go on the hands and knees position, you rotate both knees outwards, and then you start rocking backwards. And climbers will do this. And as they start rocking backwards, they’ll start to cheat. Any thoughts on how they cheat?

 

Neely Quinn 

Well, when you say rotate outwards, you just mean like, you put your knees more at an angle and not quite — 

 

Jared Vagy 

Yea.

 

Neely Quinn

Okay.

 

Jared Vagy 

Yeah, so your knees are kind of out in this like frogger position, instead of your knees pointing towards your hands, your knees are pointing, like away from both of your hands out to the side.

 

 

Neely Quinn 

Okay. 

 

Jared Vagy

And you almost feel like a groin stretch when you do this.

 

Neely Quinn 

Yeah. So the only way I can imagine cheating would be like arching or rounding your back or something

 

Jared Vagy 

100%. So climbers, when they do this, and they rock back, and they’re stiff in their hips, they’ll start to round their back as they go lower. And as you round your back, take a snapshot of that, imagine that’s on the rock wall, rounding your back flexes your spine, that brings your center mass away from the wall when you’re climbing.

 

Neely Quinn 

Yeah.

 

Jared Vagy

And so this is one where I tell climbers, arch your back, you know, keep your core engaged, but keep your back arched, and then rock back and forth into this position.

 

Neely Quinn 

Well, that’s interesting that you say that, because what I’ve noticed, gives me pain is when I am climbing, how often I arch my back, I think, because that’s what’s giving me the pain in my hip.

 

Jared Vagy 

Okay, so you may fit into a different category. So one thing that may happen, so arching the back, and where do you feel it in your hip, when you arch your back?

 

Neely Quinn 

Just like down the back of my hip.

 

Jared Vagy 

Describe for a moment.

 

Neely Quinn 

So it’ll start in my lower back, and then I can feel it. I mean, I’m doing right now. And I can feel it all the way down the left side of my back into my, the middle of my hip.

 

Jared Vagy

Okay. So and you were just arching your back. And you could feel that right. So I’m going to tell you a research study that they did. And I’m going to see what your thoughts on this. So this is back in the 80s, where they didn’t have internal review boards that were as you know, as big on patient care and safety. And they essentially took a sailing solution, so an irritant, and they injected it in people spine. And this is a research study, and they said, Can you come back in two days? And tell me where you have pain? So can you imagine signing up for that study?

 

Neely Quinn 

No.

 

 

Jared Vagy

We’ll give you $3 if you sign up for blindly for this one study. And so these were injections studies, and these are pretty landmark. And so they went in and they injected different levels, your lower back — your lumbar spine is five levels. So they injected different levels of all these participants. And they came in and they injected for all the patients that they injected the level L1 and L2.

 

So the first two levels, they mapped out where all their pain was. And they had a pattern. They had low back pain, but also wrapped around the front of their hip. And they didn’t even have hip pain, or sorry, they didn’t even have hip dysfunction. They had an injection their low back, but their pain wrapped around the front of their hip. They then looked at all the participants that had injections in the middle of the spine L1, L2, L3, L4, and that pain radiate down the side of their hip, and then they looked at all the participants that had L4 or 5. And they had this buttock pain that radiated down the back of their hip. So what does that tell you potentially about some people that may have hip pain?

 

Neely Quinn

Um, I’m not sure you tell me.

 

Jared Vagy

It may potentially be referred from the low back. And because we have pain in a certain area of our body and I’m not saying this is the case for you, Neely, because I haven’t you know asssessed or taken a look. But it’s something to keep in mind because we have pain in one area of our body doesn’t necessarily mean that the tissues in that area are the ones that are generating the pain, it could be referred from another area. So essentially what those studies is it showing that they injected the spine, but people had pain in their hip, as well as their low back. So essentially what they have in their low back in their hip, that could be referred pain. And so I’m not saying this is the case for your Neely, but it could be that if someone has pain in an area, it’s not always that the tissues in the area affected, it may be referred from somewhere else. So when I hear that someone has hip pain when they arch their back, my first thought is are the facet joints in the back, especially since they have back pain as well, are the facet joints in the back actually referring pains to hip and hip may actually be okay.

 

Neely Quinn 

Oh, so then what would, how would you even figure that out.

 

Jared Vagy 

So how a physical therapist would figure this out, or how I would, is I would have the patient stand into a back bend. And if they get their hip pain, when they do a back bend, I’d have them do a back bend, and then I would traction or lift their spine as a back bend. If that decreases their pain in their hip, I would then have them back bend and engage their core. If that decreases the pain in their hip as well. I’ll add them on their stomach, I will strap down their pelvis, their pelvis doesn’t move, and I’ll move their hips back, almost lift their hip back independently. And if that does not cause pain in their hip, then I could say, oh, potentially, this is related more to their back. And then I’ll press on their back on each joint that is stiff, or sorry, each joint that is affected. And if I press specifically on their back, and it generates a pain in their hip, I mean, that’s pretty much a slam dunk that what they feel in their hip is related more so to the back.

 

Neely Quinn 

Yeah.

 

Jared Vagy 

And that’s your — and sometimes you do this, and it’s a little bit nebulous, and it’s difficult to tell. But sometimes if it’s clear cut mechanical pain, you can confidently say that this is low back pain that’s radiating into the hip. And we can do as much as we want for your hip to help. But it’s likely we’re going to have to address the spine to help this condition.

 

Neely Quinn 

Okay. So then you would go see a PT for that.

 

Jared Vagy 

Or you can do it yourself, right? Basically backbend see if it causes pain, backbend, take a deep breath and lift your torso, see if it changes your pain, back bend, engage your abdominals, see if it changes your pain, lie on your stomach, pelvic tilt, so your pubic bones pressing into the ground and lift your leg. And if that does not cause pain, then the last thing you just need is someone presses on your spine and causes pain, then you’ve got that slam dunk, or you have that send, you know, I’m using basketball terms, especially probably, you know, you just sent your project of physical therapy, differential diagnosis.

 

Neely Quinn 

Yeah. But then if you do figure it out, figure out that it is radiating from your back then it seems like that’s the kind of thing that you would need the help of somebody to fix.

 

Jared Vagy 

Not everything, the way they see it, it’s really helpful to go in for a single session to figure everything out and get set up on a plan. And whatever medical practitioner you trust in that you, you know, your LinkedIn with go to, and if they’re a climber, that is awesome, that’s a huge bonus, you know, for what you’re doing. But if you don’t have the money, the resources the time to do that, well, you can self manage, and you could find ways to kind of put yourself in those different positions to see what’s causing your symptoms, and then you could do interventions to help them and I mean, that was one of the big things, Neely, on your site with these assessment programs that we put up or sorry, these protocols that we put up is have people tried to self manage and that they’re not effective see a medical practitioner and or the other way around. So I think there’s room for both to self manage and to see someone but my biases to see someone that knows what they’re doing. And it doesn’t, you know, it’s really helpful if they’re a climber, they don’t have to be a physical therapist, they can be a chiropractor can be acupuncturist, whatever profession it is, but just someone that you trust, and that can do these mechanical diagnosis. And as long as they test and retest meaning, they do something, they do an intervention. And they do that same thing again, to show that there is a change, then you’re with the practitioner who’s in the right ballpark.

 

Neely Quinn 

Okay. Okay. Yeah, that’s super helpful.

 

Jared Vagy 

Yeah, but I might might pitch this. Yes, I’m a doctor physical therapy. So I do think that the physical therapists are for movement dysfunction. That’s our wheelhouse and that’s the big thing that we assess and treat and so that’s my that’s my my bias and my push but I truly believe in that,

 

Neely Quinn 

Okay. Where were we. We were talking about… 

 

Jared Vagy 

Alright, so we were talking about it was really interesting because we, you know, we were talking about the hip, right, we talked first about the high step. And then we talked about doing this, like frogger position or assessing this kind of towed out position, or this knee out position when you climb. And then we got into your pain, which may or may not be hip related, it may be referred from the lumbar, lumbar spine or low back and may go into the hip. And we talked about potentially some, you know, a bad diagnosis and what climbers would do to assess and treat and intervene with that.

 

So I think this is probably a good segue to then get into, well, what could go on in the hip? Like, what are the hip diagnoses that are most common? And we could we could talk about those?

 

Neely Quinn 

Yes, let’s do that.

 

Jared Vagy 

All right. So for climbers, the — a common diagnosis, there’s probably three common ones that I’ll typically see. But one is a labral tear. And you’re quite familiar with that terminology. Right, Neely?

 

Neely Quinn

Yeah. 

 

Jared Vagy

So tell tell us about the labral in general.

 

Neely Quinn  

Well, I actually got an MRI on my hip a long time ago, that said that my labrum was fraying, which is better than it being torn, but labrum is like cartilage, right?

 

Jared Vagy 

Yeah, it’s cartilage. And it’s essentially it what keeps in suctions, the hip joint together and it almost imagine that it’s it goes around the rim of the joint, and it keeps everything suctioning and absorbing shock quite nicely. It’s kind of a simple way to put it.

 

Neely Quinn 

Right. But it’s kind of like a precarious little thing, because it’s not a muscle. It’s not a tendon. It’s not nothing’s actually really attached to it. Right. It’s just like sitting in there. Your your bone, right?

 

Jared Vagy 

Yeah, it’s a think of it as it’s a suction. Really.

 

Neely Quinn 

Yeah.

 

Jared Vagy 

So alright, so we have the labrum, it’s the suction that keeps our, our hip absorbing shock nicely, and it fits the socket around the bone. And then on top of it, we have all these types of ligaments. So commonly, with climbers, the labrum could be frayed or torn. And so if climbers are really mobile is oftentimes the case that there’s an extra little bit of play in the hip, there’s a little bit of extra motion. And so by stepping in, like awkward back steps, you know, really tough stemming moves, where you’re kind of stemming with both legs, even some drop knees itself, or even torsions, or rotations, step throughs. Can all put a little bit of stress into the labrum in the hip. And it’s a really difficult diagnosis, one to assess. And then the second to treat. And why it’s so hard to assess, is because we have all these clinical tests for you know, a special test, Neely, that you like an orthopedic surgeon will do or a medical practitioner, they’ll put the limb in a position, they’ll generate pain, and then they’ll cluster these tests together and say, you likely have this diagnosis. Did you have something like that for your shoulder? Maybe your hip?

 

Neely Quinn 

Yeah, yeah, definitely for my shoulder.

 

Jared Vagy 

Yeah, so for the shoulder, those are well researched. They’re fairly well defined. For the hip. They’re not very good. And even the clusters of test together, you do four or five, six of them put together, they don’t necessarily line up or match up well to the MRI or the image. And so this is where the diagnosis is oftentimes a little bit tricky in the hip, is if we assume there’s a labral tear, then we start thinking, Okay, in addition to some of these positive tests that medical practitioner would do, is there some clicking some locking or some catching, or something that would lead to this hip being a little bit unstable? That would make us further think that this labrum is is a diagnosis? Because it’s something that adds stability to the hip joint?

 

Neely Quinn 

Yeah. And yes, the answer is yes.

 

Jared Vagy 

Okay, so you have some clicking some lashing, locking, some caching, you have an MRI, that shows that you have a little bit of fraying in that area, and you potentially have also a low back component, right, that’s referring pain to that area. We don’t know we haven’t assessed, but let’s dive into the hip itself and say, for now that let’s say the labrum is affected, in you Neely, let’s say that’s our one of our diagnoses. So what do we do? Like fundamentally what do you do your labrum and your hip is affected? What’s your — what’s your problem solving? What’s what do you need to do to hip itself?

 

Neely Quinn 

Well, you need to strengthen everything around it to help stabilize right?

 

Jared Vagy 

Yes, that you’re 100% correct. So if the labrum is affected, you need to stabilize the hip because the labrum additionally provides a shock absorption, the stability. And this is where things get really tricky for the hip itself. So tell me like what you would do to stabilize the hip Neely. So some exercises?

 

Neely Quinn 

Well, I mean, if I’m comparing it to the shoulder, you’re like strengthening your rotator cuff by doing band exercises, or —

 

Jared Vagy 

Yep

 

Neely Quinn 

— preferably like even heavier exercises, like overhead presses. And so it’s just weird or with your hip to do that kind of stuff.

 

Jared Vagy 

Yeah, and here’s the thing. So we have a rotator cuff right, and that’s in the back back and front of our shoulder, and it stabilizes our shoulder. We also have a butt rotator cuff. And it is deep within our hip.

 

Neely Quinn 

Oh.

 

Jared Vagy 

So are they’re called the deep six lateral rotators. So they’re these muscles called gym L I internus and externus. You have this operator internus and externus is, yeah, there’s six different muscles in that region. And then we have our glute medius, we have our glute maximus. And those are the larger muscles that surround our hip. And if you wanted to stabilize your hip, here’s the biggest thing that I noticed people go wrong, let’s say your shoulder, let’s say you want to strengthen your rotator cuff, you’re not going to do pull ups, because that’s gonna straighten your lat muscle, right, which is that big, giant muscle that fans across our back? Well, if you want to strengthen the deep stabilizers in your hip, your you’re not going to do these kind of large gross motions, you have to have these really fine tuned rotations, almost like those rotations that you would do with your arm with the resistance band.

 

Neely Quinn 

Hmm. Okay.

 

Jared Vagy 

So, and if you’re doing an exercise, and I’ll give it really interesting, I’m going to start with one that’s non-functional. And then we can build this into something that’s a little bit more functional. Okay. So imagine that you’re sitting down on a table, right? And your hip is flexed. And then you take a resistance band, and you put it around your ankle, and you pull that resistance band away from your body, you attach it to a wall. So essentially, you’re just sitting, your legs are dangling from a high table, so your feet are off the ground. And you have a resistance band around your ankle pulling away from your body. Almost, let’s say it’s attached around your left ankle, and it’s pulling all the way, far off against the wall to the left. Does that —

 

Neely Quinn 

Pulling your ankle?

 

Jared Vagy 

Yes, it’s pulling your ankle. So your lower leg bone wants to almost like rotate up, okay. And then all you do is you let your lower bit leg bone rotate up, almost like a windshield wiper. And then you bring it back down to that position where it’s perpendicular to the ground, and you let it go up like a windshield wiper, and you bring it back down. So it’s parallel to the ground. And you flip it around, you pull the opposite direction, you do the same thing. So you’re almost imagining your hip is rotating like a chicken on a rotisserie, and your lower leg bone is moving back and forth. Is that tough to imagine, or —

 

Neely Quinn 

No I can, I think I can imagine it.

 

Jared Vagy 

Okay. And so that’s one exercise that people may do and the trick is to feel that deep, deep within your hip. And oftentimes when people do this, they’ll feel it in their butt muscle, or they’ll feel it in that gluteus maximus or large hip muscle. And for this one, you have to actually relax your butt. And feel this even deeper, kind of like right around the joint in the back or right in the back of your hip quite deeply. 

 

Neely Quinn 

Hmm. Okay. And why — why is that? And I asked because I went to a physical therapist for my hip recently. And he made me do these exercises where my butt was absolutely flexed every all the time during the exercise it had to be. So what is the purpose of this? 

 

Jared Vagy 

So the purpose of this is to isolate and I’m not saying that it’s, you know, it’s probably good to strengthen the gluteal muscles, those large muscles, but they’re not going to stabilize your hip as the deep six rotators that are closer to the joint line. Just like if you were to go to you know, physical therapists and they were to give you pull ups to strengthen your rotator cuff. Well, maybe it strengthens your rotator cuff a little bit but it’s gonna strengthen those large muscles such as the lat muscles that you know, that span across your back. So and it’s good. Adding lat strength and stability may help stabilize the shoulder but maybe not as much so as those deeper muscles.

 

Neely Quinn

Okay.

 

Jared Vagy

So, not to say that it’s wrong to do exercises that you feel about burning, but it’s this really fine tuned micro motion that you can start feeling deeper within the hip.

 

Neely Quinn

Yeah, that makes sense.

 

Jared Vagy½

So then what we start doing with that is that is not climbing specific at all right, you’re sitting on a table, moving your limb back and forth, you can pretty much be watching TV that doesn’t relate to climbing, right?

 

Neely Quinn 

Perfect. Just my kind of —

 

Jared Vagy 

I love it. So maybe a good starter exercise. But then we have to think about how do we utilize these muscles when we climb. And this is where you can start using those same muscles. But performing standing drop knees. And essentially what you would do is you would start standing with your feet really wide, almost wider than your your shoulder distance, and you go up on your toes. And so your heels are lifted, you’re on your tiptoes nice and wide. And then you start to drop one knee to the ground almost into a lunge, you’re going to rotate your hip inwards, drop the knee to the ground as you reach your opposite arm. Or sorry, same side arm up into the air. And can you imagine that Neely?

 

Neely Quinn 

Yeah.

 

Jared Vagy 

So you’re essentially feet wider than your shoulders. Coming up on your tiptoes, you’re going to drop your knee towards the ground into a drop me almost in the lunge while staying on your tiptoes and then reach your arm up overhead. And that fine tune motion of that femur bone, or that leg bone rotating in that socket. And those deeper hip muscles controlling it is now taking a very simple exercise where you’re seated and making a little bit more climbing specific is related to a drop knee.

 

Neely Quinn 

Hmm, that sounds hard.

 

Jared Vagy 

It’s hard, but it’s actually really cool to do and climbers start shaking when they do this. And part of it too, is also now your base of support is on your tiptoes, which is the equivalent to just very small platforms on the rock wall.

 

Neely Quinn 

Yes, true.

 

Jared Vagy 

And then as you reach your arm up in the air, for example, Neely, if you do this on your left side, you’re dropping your left knee down into a drop knee, you’re raising your right arm overhead, and you feel your hip pain. For you, what do you think an interesting cue would be to see if it gets rid of your hip pain. And it has to do with the low back, we’re talking about the different assessments of bending backwards.

 

Neely Quinn 

Yeah, like arching it or rounding it.

 

Jared Vagy

Yeah, so if you tighten your stomach while you’re doing that, and your hip pain goes away, or if you inhale, when you do a drop knee like that in your hip pain goes away. Well, now we’re thinking that we’re adding stability to the spine. And maybe the spine was what’s causing hip pain in the first place. And when you get on the rock wall, and you do a drop knee, maybe you just inhale or you engage your core, and the hip pain can start to go down, which potentially may have been pain referred from the low back.

 

Neely Quinn 

Okay, so then you just have to watch that while you’re climbing.

 

Jared Vagy 

Exactly. So any, like when I see patients, I try and replicate their movements on the wall on the ground. And then I build backwards from there. So for example, I’d watch someone do a drop nee, let’s say in climbing footage, and watch and do it on the ground. And then I’d move their hip about and try and decide why they’re going a certain way or move their low back. And anything that you do as an exercise, the closer it relates to rock climbing, the more effective it’s going to be. So typically, we need some type of primer exercise to get the right muscles moving or get the right movement. But then after that, we need some exercise that looks and feels just like climbing. So earlier in this podcast, an example of that high step, pulling that knee up towards your chest, using your muscles, keeping that knee up high, and then raise your hands in the air. That’s climbing, right that looks like climbing.

 

Well, can we just do that same exact thing with a drop knee? Can we on the ground perform this fine micro movement have a drop me have that look and feel like climbing and then do that before we go on the wall. So our movement patterns are starting to be a little bit more efficient.

 

Neely Quinn 

Right. Okay. Do you want to talk about dosing with this kind of thing?

 

Jared Vagy 

Yeah, so here’s the interesting thing. So if you — we talked about stretching soft tissue, and maybe three sets of 30 seconds, we talked about stretching a joint capsule, and maybe a joint capsule that’s stiffer, it’s harder to move. And you would stretch something like a joint capsule for three to four or five minutes, something like that. And when you’re talking about strength exercises, which we’re now getting into, it’s not as much flexibility or motor control exercises, the dosing changes.

 

And here’s an interesting — so they did studies on motor tasks. And they’ve done tons of motor studies where they like throw beanbags; throw darts, and they see how long it takes to acquire a motor skill or movement skill. And Neely, do you have any guess like how many repetitions that takes over a six, six week period, when you’re dosing each week to acquire a movement skill.

 

Neely Quinn 

Like darts like anything?

 

Jared Vagy 

Let’s just say I mean, they did darts and beanbag, but climbing is essentially motor patterning and motor skills. So how many times do you think you’d have to do a drop knee on the ground to have that translate to when you’re in a stressful position on the rock wall to a more efficient movement?

 

Neely Quinn 

I don’t know. Probably hundreds.

 

Jared Vagy 

Yeah, exactly. And we don’t actually know the answer for these like high level motor tasks. But for throwing darts and beanbags and things like that. It’s about 100-150 repetitions. And so when we talk about dosing, for motor learning, frequency, the type of practice whether it’s a blocked practice, or whether it’s randomized practice, the position the climbing gym that you do it in, if you do it in the same spot, every time the climbing gym, there’s less likely carryover if you do it by the restroom one day, and then you do it out front the other day. Yeah, you change the positions, right? So there’s so many factors that go into motor learning in the best way that I could say is do the movement patterns, often as much as you can, with a high level of motivation. And in all different areas, you’re at a dinner party, you go to the bathroom, you have a couple minutes, alright, do some drop knees, you know, you’re, you’re at work, you know, you need to step out, do some drop knees, that type of thing, versus always going to the same exact spot in your bedroom before you go to bed and doing that motor pattern.

 

Neely Quinn 

I mean, it makes sense. Because like, if you do it in the same spot at the same time, your brain is like this is when we do this.

 

Jared Vagy

Yeah.

 

Neely Quinn 

And then when you’re climbing, this doesn’t come to you, I can see that.

 

Jared Vagy 

Yeah, but for stretches, oh, doing the same exact spot, all you want, because we’re just working on tissue adaptability. But for motor patterns, you better be changing that in different positions, you better be climbing on all different kinds of rock and starting to feel how that drop knee feels in different situations for that motor task. The carryover.

 

Neely Quinn 

Okay. Okay, cool.

 

Jared Vagy 

For dosing for strength, because the seated exercise we’re talking about, where you’re just sitting your windshield, wiping your leg against resistance, that’s a little bit more strength as well, or maybe, Neely, the exercise you’re doing where you’re making that bump muscle just burn, right? That’s a strength exercise. So how long were you doing those exercises for? Like, what were your reps and sets?

 

Neely Quinn 

It was like, for a minute. And then I would have to do it three times with a rest in between. 

 

Jared Vagy 

Excellent, so you’re in you’re fatiguing, right, you were going to —

 

Neely Quinn 

Yes.

 

Jared Vagy 

So a lot of the strength training research and there — it’s conflicting, but but a good amount of strength training research has shown you go to fatigue, that’s all you have to make sure to do. Have correct form, go to fatigue, do three sets, wait 24 hours to 48 hours in between. And you’re going to improve the adaptability of the strength in, you know, six weeks or so. And so I think a key was strength exercises that I noticed with climbers or with any patients is when they’re doing rehab exercises, a lot of climbers aren’t going to fatigue, they’re you know, just going to a level where they can feel the muscle a little bit and then stopping. But if you’re truly trying to build strength, you have to be able to fatigue out that muscle.

 

Neely Quinn 

Yeah, we don’t like go into fatigue. It sucks.

 

Jared Vagy 

Yeah, but I would say one caveat. And I don’t want to kind of throw a wrench in things, if we’re doing an exercise, right before we get on the rock wall. So some climbers will do activation exercises. So like a resistance band exercise before they start climbing. Those are ones you do not want to do for to fatigue, do you have any idea why?

 

Neely Quinn 

Well, it seems like it would kind of pump you out for the rest of your time.

 

Jared Vagy 

Yeah, it’s gonna kill your performance. And you just want those to be a sub threshold where you’re just turning the muscle on just enough, and then you get off the rock wall.

 

Neely Quinn 

Okay. So if I’m doing my hip exercises to fatigue, I might not want to do them before climbing.

 

Jared Vagy 

Exactly. And what you may want to do before climbing is maybe similar hip exercises, or maybe one that focuses on the deeper six muscles. But do that at a very low threshold. So you just feel them turn on. And then now they’re stabilized enough they’re woken up, and there’ll be a greater likelihood you’ll use on the rock wall in a much greater likelihood that you’ll use them the rock wall if you follow those exercises by what?

 

Neely Quinn 

If I follow them by I don’t know…

 

Jared Vagy 

Some type of movement that simulates you —

 

Neely Quinn 

Oh, follow them with yeah, yeah, the activation movement exercises.

 

Jared Vagy 

Exactly. So maybe you then follow the exercises by some type of Drop Knee or something that utilizes those hip muscles while turning your your thigh bone inwards.

 

Neely Quinn 

Yeah. Okay.

 

Jared Vagy 

So, a lot, right.

 

Neely Quinn 

Yeah, it is.

 

Jared Vagy 

So should we do one more? Or?

 

Neely Quinn 

Sure, yeah, let’s — 

 

Jared Vagy 

Let’s do a quick one. Let’s do a quick one. So we addressed flexing the hip. We addressed rotating the knee outward the muscle frogger position. And then we addressed almost this you know, the hip rotation through a drop me in associate that with the labrum on itself, so labral injury in the hip itself. There’s another common injury that climbers get in their hip. And another thing is a hip flexor strain. So they just strain either hip flexor, so muscle in front of the hip or abductor, which is a groin muscle on the side.

 

Neely Quinn 

It seems like groin was growing injuries are pretty common with us.

 

Jared Vagy 

Yeah, and when would you normally strain a groin because I’ve actually done it climbing several times?

 

Neely Quinn 

I don’t know. Maybe — I mean, I would assume high stepping. I’m not really sure.

 

Jared Vagy 

So high stepping you can strain the opposite side groin, typically, the stemming, like stemming really far. That’s very common way to overstretch or to strain a groin muscle. And sometimes you won’t even strain it. You’ll just be stemming and your limb isn’t used to be in that position and the muscle just cramp temporarily.

 

Neely Quinn

Yeah, I’ve had that.

 

Jared Vagy 

You’ll, you know, and you’ll just kind of have to shake it out. You’re like, oh, man, lower me down. Let me do a couple stretches. And then I’ll get back up on here. So, groin strain, or even groin muscle cramping is pretty common with climbers, and especially if you’re going to be stemming a lot. So, so Neely, what do you do with like, let’s say you, let’s say you were on a problem. That’s like a lot of stemming, and your groin tightens up, feels uncomfortable. And you can’t send the problem you lower down, like, what do you do?

 

Neely Quinn 

I mean, I think I would just try to shake it out until the cramps stopped, and then maybe walk around and try to get things back in balance. I’m not really sure.

 

Jared Vagy 

Yeah, so yeah, you can shake it out. That’s common, right? So you’re trying to just increase a little bit blood flow, relax, oscillate through the muscle. Some people will drink some water because maybe they’re dehydrated, and they’re cramping. Some people eat a banana, maybe there’s a difference between their sodium and potassium balance. And but what if it doesn’t go away? I feel like I feel that groin cramp that muscles now shortened, and it’s uncomfortable and you walked around, you had a banana? You drink some water? You shook it out, you know, how are you relaxed, but still there? Now I do…

 

Neely Quinn

Stretch.

 

Jared Vagy 

 Stretch. Alright, so how do you how would you stretch that out?

 

Neely Quinn 

That one’s hard. I mean, I guess I would maybe sit in like an I don’t know what it’s called, like a prayer. prayers position.

 

Jared Vagy 

Right where your feed are at the bottom touching.

 

Neely Quinn

Touching. Yeah.

 

Jared Vagy 

Yeah, that’s, that’s a great way. So that’s a nice way to stretch out the groin opens up the hip. What else would you do? Think about other stretches?

 

Neely Quinn 

Maybe that one where? I can’t remember what it’s called in yoga, but you get on your hands. And it’s like a frog where you put your knees? Yeah.

 

Jared Vagy 

Yeah, you’re in a Frogger. So you’re basically on your toes. Right. And you squat down. And then press your knees out with your elbows.

 

Neely Quinn 

Yeah. Yeah.

 

Jared Vagy 

And then sometimes you you know, the people that are really good at sustain the position, they’ll rock actually onto their hands and hold that position.

 

Neely Quinn

Yeah. 

 

Jared Vagy

But yeah, so you could do a stretch where you’re on your toes, you squat down, you press the knees outwards. Excellent. So now here’s the trick. Let’s say you were stemming, so when your stemming, your knees aren’t flexed, their extended or straight. So how can you stretch your hip now, without bending your knee as much by just keeping it straight.

 

Neely Quinn 

I guess you could also put like how ballerinas put their feet up on the bar. And stretch that way.

 

Jared Vagy 

Yeah, you could put up put a foot up on a bar and maybe have your toes rotated forward and you can feel the growing in a similar position. Easy Way. Also, if there’s a bench, you could take your opposite leg and put it up on a bench and then shift your bodyweight over towards that opposite leg so that you can feel a lengthening or a stretch in that groin as well.

 

Neely Quinn

Okay.

 

Jared Vagy 

And let’s say then, you go in you fix that, you know stiffness in your groin, it feels a lot better. And you realize your hips are — don’t have very good motion into spreading out into the splits per se. And you really want to send this problem and you want to in the long term, improve your ability to do the splits to go into this stemming position. This is where I want to introduce one concept that’s a little bit different than what people think. How can you make sure to gain more flexibility in your hip? But without stretching? So what could you do? And you don’t have to answer this, Neely, I’m just saying it rhetorically, for people that are listening in, they’ll say what what to do. But how can you make your hip more flexible, without stretching it?

 

Neely Quinn 

Not sit down all day?

 

Jared Vagy 

Okay, so not going not be in the positions that make it tight. 100%. But there’s been emerging research that actually shows that by eccentrically training a muscle, you can improve its muscle length. So a lot of people, if you’re listening, and you’ve gotten stuck with trying to stretch and stretch and stretch, and you’re not seeing any gains with it, there is some emerging research that showing if you actually eccentrically, strengthen. So what that would look like is, you know, let’s just say you lie on your back, and you put your legs up in the air, and you put an ankle weight on one of your legs, and you slowly let it lower down into a splits or stem position. And then you bring it back, and you slowly let it down and control that eccentric position that lengthening, there’s been some research that shows that that can actually improve muscle length.

 

Neely Quinn

Okay.

 

Jared Vagy 

So a little tip for anyone that’s kind of stuck with doing the same stretches, you can strengthen and potentially gain that length as well.

 

Neely Quinn 

Yeah, that’s good to know. I mean, in all aspects of training and recovery, right?

 

Jared Vagy 

Yeah. And it doesn’t just go for the hips, it’s for, for any muscles throughout the body. It’s really interesting. There’s not a breadth of that research, yet. There’s only a couple of studies, but I’ve been playing with it with my patients. And I’ve been having really good results with just focusing on that eccentric component, rather than either statically or dynamically stretching.

 

Neely Quinn 

Oh, interesting. Cool. Did we cover what the last topic completely? Or is there something else you wanted to say about that?

 

Jared Vagy 

No, I mean, I think that covers at all it’s the hip is a really tricky area. And I think it’s also tricky, because other areas in the body, such as the low back can refer pain into it. And so sometimes you can have a hip disorder, that’s also confounded with something coming from the back. And so there’s maybe two things that people have to address when it comes to that location or region. And there’s some really simple ways that climbers can perform assessments, whether it’s the high step one that I talked about, or if you have a buddy, and they put you in that favorite position, where you’re rotating your hip outwards. Or if you just measure how far you can do the splits and market and then track that over time, there’s really nice ways to start to assess or quantify. And the more specific climbers can get about their deficits, the easier they are to start fixing them and maybe decreasing hips symptoms, or improving their hip mobility and movement, so it’s easier to climb.

 

Neely Quinn 

Nice. Well, hopefully this is helpful for people to at least have a starting point and possibly even fix some of their issues. I really appreciate this. Thank you.

 

Jared Vagy 

Yeah, absolutely, Neely.

 

Neely Quinn 

So I’ll, I’ll try to put some resources. Like if I find that link to that video you were talking about, I’ll put that up on the page for this episode. And if you and I think of anything else about hip stuff, we’ll put it up there. But yeah, thanks so much. And I’ll talk to you soon.

 

Jared Vagy 

All right. Sounds great.

 

Neely Quinn 

All right. I hope you enjoyed that interview with Dr. Jared Vagy. I put some videos up. Some hip mobility videos up that Jared created for this podcast, and those are on the show notes, you can go to Trainingbeta.com. And just search Jared Vagy – are one of those names and you’ll find it in there. He’s really into making videos because they are so helpful and he’s really good at them and they’re really professionally done. So hopefully that will help you a little bit. And there’s a ton of other information in the show notes too like lots of links to all of his protocols and all of his other information. So hopefully all of this will help you if you have a hip injury.

 

Coming up on the podcast. Next week I will be putting out the John Brosler episode about speed climbing finally and and then after that, I will have Diana Rodgers on that nutritionist I was telling you about who studies sustainable meat production. And I’m just gonna keep churning these out because I feel really behind on podcast episodes. So you’re gonna be hearing a lot from me coming up.

 

And stay tuned soon for our new programs to be coming out. Matt Pincus and I are going to start working on those, and they should be out by the beginning of next year. And that means something that means that our current subscription programs are going away, and the people who are currently on them, they will continue to be on them, that’s totally fine. But we won’t be offering them anymore. And so if you want to get on those programs, now is the time. And it’s also the last time that they’re going to be this inexpensive. They’ve been $15 a month for — since 2013. And times have changed a little bit. So we’re going to increase the price. On our next programs, we’re also going to offer you more with those programs. So just a fair warning, they’re going away. And so if you want the bouldering program, you can go to Training beta.com/bouldering. And if you want the route program, you can go to Trainingbeta.com/routes, and those are the only ones that are changing, like our ebooks are gonna stay the same, everything’s gonna stay the same. It’s just the subscription programs and that will change in January and I will definitely let you know when that is happening.

 

So I think that’s it. I’ll talk to you next week. Thank you so much for listening all the way to the end.