What causes shoulder pain and what actually helps it

I had the conversation with him. I'm just like, I don't necessarily think that you need surgery right now because, you know, a lot of times like, is this preventing you from being able to do anything that you want to do? And he's like, no, not really. It's just painful when I do this, this, and this. I'm like, okay, so let's just try these things first before we go cutting you open and seeing if that's going to fix anything. Cause after that still going to require rehab afterwards as well. If you want to be able to move your shoulder again after doing surgery. So it's important to consider is this stopping you from being able to do any like high functioning type things like with professional athletes and whatnot. That's, that's a conversation to be had. But if you just want to be able to pick up your kid again and things like that, then I think that's not, you don't necessarily need surgery for that. Yeah. You're listening to the restoring human movement podcast where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now your host, Dr. Sebastian Gonzales.

Hey everyone. It's Sebastian, your host for the restoring human movement podcast. Thanks for joining the movement movement. This is your first time the show. Welcome. We are going to dissect down some good old stuff for the shoulder today, which a lot of you might say, Oh, my shoulder hurts. It hurts right in the front. And so we're going to cover all things shoulder today. That maybe that's the topic of the podcast today. We have a guest co-host who has the earmuffs on. And so she's kind of the host right now. It's Dawne Costantino. Hello. Hello. So we're going to do co-host style. So Dawne Costantino, you can feel free to jump in at any point too. Cool.

Just a little housekeeping. Again, if you guys are looking for help, we are in Costa Mesa, California. We'd love to help you out with stuff. And we have podcasts that come out weekly on topics such as this. We've covered foot and knee and hip and back and head and neck and numbness of the fingers and all that kind of stuff. So feel free to just look in the archives and just listen to all the cool stuff. Let's get right into it then. Shoulders. What do you want to talk about first with shoulders done? How complicated they are. Why are they complicated? I feel like it's one of those subjects that like you as a provider, most people are just like really scared of having somebody come in with a specific shoulder issue because the shoulder is just so complex with all the different structures that run through it and things that could be causing pain. It's kind of scary. I know a lot of the people that I know and colleagues of mine and stuff, they're just like, oh, I hate shoulder cases. These are complicated. So then, so then I'm a, I'm a patient right now.

And I just heard that and I thought, shit, I, there's no hope for me to get better because if Dawne Costantino can't figure it out, then what, what, uh, what are we going to do? I'm not saying that I can't figure it out. Did I say that? No, you seem like you're scared of them though. Those scary shoulder cases. I think at first I was scared just going through learning about the shoulder in school. And then when you have certain people come in with shoulder issues, it's just, it's, it is a scary joint to have to try to figure out what's going on. But now that I've kind of worked with them a little bit, I think a lot of times I notice some common denominators in most shoulders. And then a lot of times I've learned how to just kind of stress certain structures and figure out what's going on. But most of the time it's, it's one specific thing that can always cause pain in the shoulder. And then I think the shoulder itself, we should talk about like where exactly in the shoulder are we talking? Cause people say they have shoulder pain all the time and then point to their upper trap. So that's a good point.

So I think, um, yeah. And so I guess we'll categorize this down to what we're probably going to cover today is make sure that you guys know that you should not leave is we'll cover a little bit of what Dawne Costantino just talked about. We'll cover all of the, um, or majority of the, the types of conditions you probably told that you've had, you've had, and we'll, we'll tell you what are the common treatments or at least treatments that we found that work for these things. Um, if treatments have not worked for you, um, I think it's fair to say most people that we've seen have gotten better with shoulders, right? Um, so they're really not that, they're not that complicated. It's just challenging.

If you, if you pick the wrong solution to the problem that you really have, you're not going to have any results. And I know it's frustrating to do that. So we'll try to boil things down a little bit for you here as we get going with things. But, um, yeah, what's the shoulder joint? Uh, what's that all about? So exactly where we're talking here is, um, most of the time people, when they think shoulder issues, they'll, they'll point to like their upper trap area, that area where there's always super tight, there's tensions and sharp shooting pain. Um, but I think when we're, we're talking shoulder today, we want to talk about if you just kind of follow your upper trap down until you actually get to the shoulder joint itself, the part of your arm that moves around. Um, it's a ball and socket joint at the very top of the arm there. Um, and there's a lot of structures that go through there and things that can get stressed and injured.

So you're fighting that microphone core when you're doing that, huh? Um, yeah, yeah. And there's, um, the, the shoulder itself is really composed of a ball and socket. Like we're actually talking, actually talking shoulder joint itself to ball and socket, or some people call the ball and saucer because it's really not a big socket. It's a loose joint by nature. Um, it has a lot of range of motion. That's the beauty of it, but also too, it has to become fairly stable. Um, so there's a good balance in there, but the saucer is attached to the shoulder blade and the shoulder blade is an interesting structure because other than, other than one spot, it's not actually attached to the body with anything bony. There's no other bony attachment spots other than just the clavicle or the, uh, what do people call this? Uh, uh, what's the generic term for the clavicle?

Uh, collarbone, collarbone, the collarbone. So it's attached to the collarbone. And so really, the function of it is dependent upon how well you can get the, uh, soft tissues that help as we call, I call it a dynamic strut. Like you imagine a car, it's like there's the wheels kind of stuck on, but it's, it's able to turn. So it has these little bars that go out and stuff. So, um, you have the one bony spot, which moves, but not a lot, but then you have the soft tissue ones in the shoulder girdle, the shoulder blade, which really dictate how well the area functions. Um, and so missing that patient is a huge lose. Absolutely. Yeah. Um, one of the conversations I tend to have a lot with, uh, my patients with shoulder issues is I think a lot of times where they struggle with finding people who can actually help them is, Hey, have you had anybody look above your shoulder yet? Has anybody looked at your neck and see how well, um, that area is supplying the shoulder girdle. So the shoulder girdle has tons of muscles in it that make it work, but what makes muscles work it's nerves. And so we have to look at the neck every single time. Um, there's something going on in the shoulder to make sure things in that area are working properly and allowing a proper function. And so if you guys are listening to this, you have shoulder issues and nobody's looked above your shoulder yet, then that's something to consider. So I just hear another chiropractor talking about how the next source is all I'm hearing. Well, it's true. Yeah. And so in case you guys are wondering about like, yeah, she's kind of full of it there, there, there was actually a, um, a study that was put out in I think 2019 by, uh, Roswell that I've referenced a couple of times in the podcast that, so it mentions that it kind of takes people who are, um, they have basically shoulder pain in the absence of spinal pain. And so basically the people who were in the study, if I read it correctly, it was the patient's like, I don't have neck pain. It's not related to the neck. And the doc's like, it's not related to your neck. And then they went in and treated them like a neck and it got better. And so the people, the percentages that got better as a spinal source was 40%. So if you don't have upper trap or neck pain associated with it, um, there's still a 40% chance this is coming from your spine. So what if you have neck and upper trap, there's probably a higher probability that is probably from your neck.

So you're right. If someone hasn't really looked at your neck, they're not really, they're not really getting all the information they need to help you. Yeah, absolutely. A lot of times too, where we stress certain structures in the shoulder girdle itself. And we find that, yeah, maybe there is some sort of injury in there either to the rotator cuff muscles or, um, the labrum or things of that sort. But like, where did that originally come from? Did it come from improper function of that area where that improper function come from? And I always try to trace it back up to, Hey, if this is coming from your neck and we don't rule this out, no matter what we do to the shoulder, it's not going to work and it's not going to respond the way that it needs to, because the nerves itself are not supplying those specific structures. You know what I mean? So I always try to get people to understand that a little bit. Well, remember when we did, we just did all those YouTube videos on, uh, how to fix your shoulder blade. Was it a fix your, your shoulder blade? Uh, what was it? Imbalances popping out all the stuff. And, uh, I know those ones won't release for a little while, by the way, visit the YouTube channel. Um, but when it comes to like those types of presentations, it's like, well, my shoulder hurts because my shoulder blade is not working well. And you just mentioned that if those nerves supplying the area, aren't doing their thing either, then the shoulder blade really doesn't have a chance.

And then you have all this weird things that happen with the shoulder blade, even visually that you can see where they're just like, one's popping out and one's winging out. And if you start from the central part, at least rule it out, at least rule it out, then, then you might be making some easy wins in there. Yeah. I love to tell, I think you started off with loving to tell this story. And then I love to tell the story now too, of a patient that you had that couldn't even lift his shoulder off the side of his body. Oh, I had another one the other day. Did you? Yeah. Well, let's share both of them.

They'll love to hear it. Okay. Oh, do you want that one first? I'll tell, I'll tell the first one. Okay. Um, so Seb had a patient come in who couldn't lift his, um, arm off of the side of his body. It was like tremendous shoulder pain. Um, he did the examination on him, started with the neck, um, and didn't really find anything to really worry about in the neck that could be supplying this pain to the shoulder. Um, so then he did a full shoulder exam on him and started to, you were thinking like a little bit of labrum, right? It looked kind of like, like, I usually won't talk about the diagnosis until I'm fairly sure. And, uh, but yeah, it was looking like a labrum and I'm like, I started describing labral like types and so on.

And anyways, yeah. And so always as a part of our exam, which can then turn into treatment if it responds well, um, is still rolling out the neck no matter what. And Seb will always yell at me for that. Like, make sure you're still always rolling out the neck. So he does, you know, his magical chin tucks, doctor assisted chin tucks on this guy. And he went from not being able to lift his arm off his body too. Was it almost completely overhead? Oh yeah. He was really happy, but he still couldn't throw a football. Right. So yeah. There's still a lot to do for sure. But that's, that's crazy. Just within how many, how many of you think you did chin tucks?

We probably did 20. It's insane. It's funny. People's like faces when they, when you do something silly like this, it's like, what are you doing? This is silly. And then they're like, holy, can I cuss on this? You had that, you had that guy who was, um, you, you had the guy that, that he had a, what he had, he had a bunch of physical therapy done. Was it something like that? Keep going. I'll just make sure I'll shut the door. I hear that phone rang. Keep talking. Okay. Um, so yeah, there was a, there was a guy, wait, I don't know which guy you're talking about. Actually. Uh, you had someone you're talking about a couple of weeks ago, which was, uh, um, they, they didn't have any positive findings on an MRI. Right. And you end up going down the route, I think, looking at the neck as well. And he, he responded favorably from what I recall. I think I'm trying to figure out which one you're talking about. There's two that pop into my head that responded fairly. It was also kind of the same thing where it was like, yeah, I don't know. I think one specifically his neck exam showed a lot of reproduction of his shoulder pain in the neck exam. So it was kind of clear for that. Um, but a different guy, um, he had like kind of unstable shoulders and that kind of thing. A lot of it was looking like instability when I was doing the examination. Oh yeah. That was the golfer. That was the, yes. And he was on his trip from Colorado and just wanted to come in while he was here. So we looked at him and, um, and I, I kind of told him the story of the first one I just shared. And I was like, let's just make sure, let's just see what chin tucks does. And we did 20, just retractions. And he was like, just looked at me like, oh, well, that's actually a lot better. And I was like, okay, well, let's do some more. And we did some more. And I think just chin tucks itself gave him 50% improvement. And then we just loaded the shoulder a little bit more. And I think he walked out of here 70% improved in one visit. So that was really cool to see. So, well, let me, let me follow up through that. Then when you say load the shoulder, it sounds going to scare me as a patient. What are you talking about? Um, like, do you guys, like you can make them push hard weights overhead type of thing? No, not necessarily. So I started like for him, it was a shoulder hinge. So basically it's just like body weight. Um, and it's kind of exploring different movement patterns in the shoulder and kind of loading what we call like the posterior capsule. So it'd be just like the ligaments and the muscles behind the shoulder itself around the shoulder blade, um, and kind of loading those and creating, getting them to turn on a little bit more, what we say, like a tone change itself and see if that, if that helps with any sort of pain that he's having. So when we load specific structures, um, and then just see how well it responds, we make sure that when loading, there is no pain, it's just effortful.

Um, so as long as he's just feeling effort and then we see if the pain improves a little bit more with that, then we just kind of go down that route. Like, cool. Looks like we just need to stress these specific structures in the shoulder a little bit better. Yeah. I think that is important. You mentioned that, um, the corrective exercise or the exercise that you've been suggested shouldn't hurt. It should just be effortful. And there's many ways to tweak this. I know that we've, uh, discussed with a lot of people on the phone about like, you know, is it, can I do that stuff? Is it safe for me? Well, you scale it. Like you have to, you have to say something, if it hurts, then tell us and we'll scale it back. But we want you to get to the, to do the hardest thing you can still do well. And cause your body needs a challenge to be able to, um, adapt. Uh, and a thing that you mentioned earlier, or I thought a good tangent conversation would be there. Cause there was that one guy, I think, cause we mentioned the MRI, uh, some people won't do anything for their shoulder unless they have an MRI. Cause they're like, like, look, I don't want to make anything worse. I want to see the MRI. I want to visually see what's wrong. Uh, and in those cases where the neck was the, is the problem, you won't really see anything wrong in the shoulder. Or if you do, it's going to look like normal, like gray hair of the shoulder type of thing. Like, you know, tendonitis, like, like small types of impingement, bursitis is normal crap, you know? Um, but it's not going to look like, like your shoulder's falling off your body, or there's a complete retraction of a tendon. Cause those would change the game that would change what we're going to do, or even if we can work with you. But most people, a strong majority of people don't require an MRI or an X-ray or an ultrasound to start care for the shoulder anyways.

And most of them make better progress in just a couple of sessions. Like what you just mentioned, um, with the money they'll spend doing that versus burning their money on an MRI. Someone's going to say, you hate MRI. No, I don't hate MRIs. I think there's a time and a place for them. Yeah. You just don't need them in all, in most cases. So, um, so that, that other story that, um, I think I told you, but there was a guy that came in that he was, um, a lot of times when people will have, um, neck referred from, or to the shoulder, it's, it's, it's not uncommon for their shoulder and their bicep and their tricep or whatever they're presenting as to be more painful than the neck. And so sometimes you start fussing with your neck, just examining it. And they're like, I'm not here for any neck stuff. I know I get it. I understand, but let's just see, you know, because a lot of times you'll find in the exam, by the way, you might wonder, well, what is a good exam with the, with the neck look like in the shoulder?

Well, it should take more than two minutes for sure. Uh, it should take about 10 minutes and your, your doctor can stress test it. It's all manual testing. Uh, um, they'll use their hands on you. You can do some virtual, um, but you, you'll have to direct the patient a little bit more, uh, diligently to make sure they're doing the right things. Um, but you don't need any special equipment or anything. Uh, anyway, so, um, things like there, a lot of times they're not very, uh, they're not very, um, they don't see it until you prove that it works, but he wasn't able to reach behind his back. He couldn't get his arm overhead. Um, just couldn't sleep, couldn't sleep on that side.

You know, the typical thing that you hear with like rotator cuff tears is like I, or impingement, I roll on the side, it hurts. I roll off the side, it gets better. I know it's a sign of impingement. Yeah. But sign of other things too. So, uh, he wasn't really able to sleep well. And so we did, um, we didn't do the chin tucks. We just did, uh, uh, intervertebral frame and opener, which is basically just letting the nerve at the spine as it comes out. Just, just breathe a little bit. Um, kind of following some of Michael Shacklock's work, work, just letting give him, give him the nerve of chances. He says, um, I had to do some doctor assisted ones because he did, uh, he, it was not working well when he was doing it on his own, but, um, you kind of put a little dosage in there.

And, uh, lo and behold, you can see on his face so much more calm. Cause he was at, it's like a seven out of 10, just really worried about things. He wanted an x-ray prior. Cause you're like, something's definitely in there. I can know, I know it. And I'm like, I don't think so, but, uh, let's just try this first. And so he was down to a, a one out of 10 before he left. Uh, and he just has homework to do. And so it's, uh, we didn't do any tissue work on the shoulder. We didn't do any exercise on the shoulder. All we did was have him simply lean away with his neck and let, let the body do its job. Um, there were probably going to be no positive image, uh, imaging findings on the neck or the shoulder in his case, but we didn't need to look again, posing that situation where I'm glad he just came in and didn't like wait forever for imaging requests and so on. Cause he, he feels better already just after, um, his complete time with, with me was about an hour.

So anything in a shoulder exam come up as like, oh, all of it was positive because he couldn't move. So it's almost like, like actually my notes with that one, it was like, um, I, I was like, I started to do shoulder exam. I'm like, what's the point? Everything's positive. So you're going to have positive bursitis signs and impingement and rotator cuff and probably not labrum, but he wouldn't even get, be able to get into the labral position. Like, so what's the point? You know, it doesn't provide any more information. We've got to cool everything down before we actually see if there's anything really going on the shoulder. In this case, I don't think he is going to have anything in the shoulder. It's just referred in this case. I think one thing I want to want to kind of clarify for people is, although we're saying it's coming from the neck, there's a lot of times you hear us say like, it might be coming from your spine. This does not mean that we are, that we think that adjusting a specific area in the spine is what's going to resolve these issues that are referring. Um, so we're talking about finding specific positions that allow either whatever's causing the issue, like a nerve or a disc to calm down for a little bit. It's not doing a high velocity thrust through the spine and saying, all right, that one adjustment or an adjustment twice a week for the rest of your life is what's going to fix this.

Um, there might be a time and a place for an adjustment, but that's not what we're saying is actually going to fix this referral pain that we're talking about when we're saying, looking at the spine as a chiropractor. Yeah. There's nothing, there's nothing scary at all or quick going on with any of the stuff that we had people do. We actually, in most cases, we just have them do it to themselves. You don't even have to touch them, um, in most cases, but, uh, and so we covered basically the spinal referred. So we should go down the route of talking about the actual shoulder joint when it is a shoulder joint, because everyone's probably thinking, dude, we don't have this podcast. We're just talking about necks and stuff. So, um, keep in mind though, that most of these diagnosis that you're going, that we're going to read through a little bit and talk about, most of them are not really your problem. In most cases, they're just labels. And, um, I'm not going to say they don't happen with people, but they don't happen with most people. And there's certainly signs and symptoms and things we'd find in a physical exam. Just again, not machinery, no, no, no magic, like, you know, pictures that will necessarily see it, but someone really skillfully going through and being able to stress test your shoulder and your neck and the areas around it to make sure that everything's intact.

Um, and so, uh, we covered basically neck covers roughly 40%. It's going to be population specific activity specific and so on. Um, but I'm going to read down Dr. Google here and see what the most common cause of the shoulder pain are. You just stopped me. And when you, or you pick one, when you want to talk about the first one, whatever it is you want, uh, arthritis. Okay. That's the number one arthritis. They're saying that's the number one cause of shoulder pain. Yeah. That's the number one causes shoulder pain. They say, I've, I have a comment to make on this later, but I'll let you start. Say it now. So there were, there was a, there was a, there was a, there was this, um, study that was done a while back. I will not be able to find the reference to this. So any chiropractors or PTs or doctors listening to this, you're going to have to go search it for yourself.

I don't recall. I don't write this crap down. I just, I just read it and say, Oh, it's interesting. I'll store it in the data bank. Um, but it was interesting that they took people through, um, they, they did imaging x-ray studies on people who had, um, that they, that they found had arthritis. It was a severe, more severe form of arthritis in the shoulder. Uh, and they just, they took the image and said, do you hurt? And half of them said, no, that's pretty shitty odds in my opinion. So just cause you have arthritis in shoulder, it has, I don't think it has a large merit that you actually have pain. Cause there's many of the reasons, um, or things that can become pissed off because you have arthritis or just because arthritis is there. There's other things that it could be an incidental, incidental finding as we call it, you know, um, just cause it's raining doesn't mean you got wet, you know, they don't, they don't always link up. What do you think on that?

Um, I mean, so a lot of times too, my mind went two different directions. I'll start with one. Um, a lot of times people are told like arthritis, you have arthritis in your shoulder. You need to be, you need to take it easy or you need to stop, you know, loading this joint or stressing this joint or whatever it may be. And then that's when we noticed that pain starts to increase a little bit more. So just because you have arthritis in your shoulder, um, does not necessarily mean that you still can't stress that specific area. It's just important to find a certain ranges of motion that are pain-free that we can then load that shoulder in. Cause it's still important for that, that shoulder to take on a load.

Mm-hmm. Yeah. And I think if, even if you look at some of the Dr. Google references on what you do for shoulder arthritis, it says move it. I mean, stretching and move it, you know, basic stuff. Movement is medicine with it. Um, and yeah, and you'll definitely deload the shoulder if you don't move it at all. And I'm pretty sure most range of motions are going to be painful if you don't use that shoulder ever again. You sound like you're far away for some reason. Oh, Oh, you picked up. See, that's why those, that's why those are valuable. Um, but yeah, I, uh, I think with arthritis, I don't want to throw anyone on the bus, but if they, if, if they don't find definitive skipping, skipping, like you can't move the shoulder joint at all. And they're saying like, if you have almost full shoulder range of motion and the reason for your pain is the arthritis, I would say that's probably not, I would not say that. Um, I think there's probably another reason, but there's, there's certainly when you do an exam on someone with a shoulder and you, there's like this definitive skip, skip, you know, that you feel when you examine them, even hips too. And it's like, Oh, there's, there's something going on. Like, there's not a round structure in there anymore. Uh, Oh, you, am I still, um, yeah, it just sounds weird for some reason. So I forgot part of, part of this, I'm going to get rid of the setup. Part of the setup will, it will become muffled.

Oh yeah. That's what I'm hearing halfway through the podcast. Okay. Um, I'll level it later on the audio leveler, but the other one will probably better. Okay. I'll stay here. Uh, but yeah, you'll be able to feel that. Um, so it's, it's, it's, it's pretty severe if it's going to be a part of your problem. Yeah. Um, I think another direction my mind was going is like when you're looking at imaging certain ways that they'll say that you're the shoulder joint is degenerating or it's arthritis or things of that sort, as they'll find things called like osteophytes in that specific area. Um, and that could be like one criteria to saying that you have arthritis in that area.

Um, one of the reasons for osteophytes is because it's your body's way of trying to, um, immobilize the joint itself. So there must be, there must be too much movement in this joint and osteophytes are forming to kind of decrease that. And what are osteophytes? They look like, I don't know, how would you describe them? Like little claws coming off of the joint. Yeah. Yeah. It's basically like bone growth off of the joint itself to try to just immobilize it. Um, and so one of the things that we can think about too, is if that's occurring, then maybe we just need to learn how to use the shoulder better. There's too many times where people are in say improper, um, what do you call it? Posture or yeah. So say like if you guys are at home and you're sitting in a really rounded posture, like say a really poopy posture, um, sub loves that I say poopy posture, but you're sitting in a really rounded posture and you try to put your arms above your head. Um, and your, your shoulders don't go very high. Right. They should try this right now.

Yeah. So like you're sitting there and you're rounded and you try to put your arms above your head. You're going to stop at a certain point. Like you probably won't even be able to get your hands like to the side of your head, but you sit up a little bit straighter and then you try to do that again. And now my, my shoulder can go a little bit further. So my point of saying that is just finding optimal ways and better ways to use your shoulder joint can help. I don't know if it's right to say decrease this from happening, but that's one of the reasons why that's happening is because your shoulder joint isn't working properly and you've been asking too much of it.

And we just need to show, um, teach you better movement patterns in that area. Yeah. Well, another thing too, that they can, they can use, um, and we do this with different joints of the body too, is it's not necessarily bad to remove a provocative movement, a movement that bothers the joint or the knee or the ankle or whatever, um, for like a week and then reprogram it in, uh, essentially, uh, creating a situation where that, that or that movement no longer pisses off whatever structure you're pissing off. And the body's pretty good at this. It'll, you know, sunburned heel cuts heel, you know, your hair grows back. I mean, it'll regenerate, you know, to, for the most part in, in most circumstances. Um, and if we just stop pissing it off for a week and then bring it back in again, then you, then you start to, then things, magic things will happen.

An example with this will be, cause I, I see this a lot with people when they have shoulder, uh, like impingement. Um, they'll take their hand, go palm down. If you guys want to try it now, um, they go palm down and they'll reach off to the side. Like they're trying to make a big old rainbow and they'll say, yeah, they'll get just around kind of like parallel to the floor and they'll say, yep, yep. It hurts right there in that spot. And I was like, flip your hand over and they go up and like, Oh, it's better, you know? And so they're really focused on that range. They can't do, I'm like, focus on things you can do right now and stop testing that.

Cause apparently whatever you're doing right there is pissing off that structure. That's pissed. Um, let it just find another movement option for a little bit. We'll plug that in later. At the same time, usually I'll do it with them. I say, look, you're not much lower than I am. You know, I'm younger than you. And so I only got another 10 degrees. If I go further, yeah, it pinches me too. So stop, stop doing that for a week or so. And then, and then we'll bring it back in. Yeah. All in all your shoulder is usually safe to load. If you notice the common trend here is movement is medicine here. You know, I was thinking about this and we didn't talk about it yet, but you ever, you ever noticed that let's say with people with like back issues or sciatica and things like that. Um, sometimes when they have a knee that is not like has been repaired or something, they just don't squat anymore. And when you get them to squat, all of a sudden they feel better.

You ever, someone told them at some point, don't squat down probably. And so people with shoulder pain, they've been told don't ever, ever lift 10 pounds over your head ever again. I kind of think that creates a positive feedback loop in these people. Cause when we take them and load them overhead, either with or without weight, um, or on the ground into a non like kind of like flipping gravity is opportunity to load the shoulder into like a downward dog position. They tend to do a, they tend to do okay with it. And actually that, that range of motion is usually not painful on a lot of people. So I kind of think they, if we reverse engineer that and say, stop, stop avoiding stuff forever. I did mention, uh, avoid it for a week maybe and then bring it back. But I did say, bring it back. So you shouldn't disuse as Dawne Costantino said earlier.

Definitely. I love our treatment approach. I think it's great. I think most people are happy about it too. When you tell them, no, I am going to put some weights in your hand today and we'll see how you respond. They look at you like, what I get to lift weights today. Cause most people, you know, that's something that they were doing and then they were told not to do anymore. So I think it's awesome. But I, I, how is your clinic different than I just, why would I pay cash to come to you again? I'm just sorry. Are we bringing that right now? No. Yeah. Yeah. I think, uh, yeah, I just bring it. People, it's, it's interesting. People have a preconceived notion of, of what to expect when it comes to shoulder treatment. I think they're thinking an ultrasound or like, you know, tissue work and adjustments and, you know, bands and stuff like that. And so I, I know we, you know, we try to set ourselves apart, but I really don't think people have any idea of what will happen to them day one, day two, if they just come in and give us a chance with it. Um, this is mad magic happens. Uh, okay. Number two is cartilage torn. You have a torn cartilage. Don't move ever again. That's sad. Uh, so torn, do you have any thoughts on torn cartilage or you want me to start? Um, no, you can start. So with cartilages, usually they're talking about the labrum. There's multiple types of labral tears. If you look at any picture, they're probably gonna have a labral tear. They will or will not have pain associated with it. Uh, and most people, I think, I think there's, I, you might correct me if I'm wrong. I think there's seven types of labral tears. Um, most people will not have an intervention surgically unless it's a two and two and above, uh, ones. I'm pretty sure I have one. I know shoulder pain whatsoever. Um, now if somebody wanted to go back and pitch again, then maybe this is a conversation where you have to intervene a little bit more if they have something more than a grade two, but most people are not pitchers. They're perfectly fine throwing underhand footballs to their kids. They don't really care that much. Um, and so if you're asking to do something extreme with your shoulder again, you have above a grade two tear of the cartilage, then maybe we need to have that conversation, but most people do not require surgery for torn cartilages. Yeah, absolutely. I think that's a really important thing to go over is people are told just because we find a torn cartilage on imaging that meet that is a surgical candidate. And that's well, one let's, I mean, even if we know, or if we're suspecting labrum, we're certain, we're going to load these people. We're going to rehab them and see if that we can decrease pain, um, just with finding proper movements. But one of the conversations I had with a person who, um, I wasn't, I mean, it could have been from torn college, but it was, it was an unstable shoulder that I was finding was that, um, I had the conversation with him. I'm just like, I don't necessarily think that you need surgery right now because you know, a lot of times, like, is this preventing you from being able to do anything that you want to do? And he's like, no, not really. It's just painful when I do this, this, and this. I'm like, okay, so let's just try these things first before we go cutting you open and seeing if that's going to fix anything. Cause after that still going to require rehab afterwards as well, if you want to be able to move your shoulder again after doing surgery. So it's important to consider is this stopping you from being able to do any like high functioning type things like with professional athletes and whatnot. That's, that's a conversation to be had. But, um, if you just want to be able to pick up your kid again and things like that, then I think that's not, you don't necessarily need surgery for that. Yeah. Yeah. And surgery is not, I know we're like saying don't have surgery, but obviously it's merited in some circumstances. But, um, I know, uh, uh, one of the interns had a, they had a good story of one of their longtime clients or people they knew that had a knee replacement and they had the knee replacement because the pain in the knee was pretty persistent. And then afterwards they still had the exact same pain and they were kind of thrown off because their husband had had the knee repair or the total knee replacement and he felt good. And so, um, her pain did eventually go away, but it wasn't like it was, it was because it was a spine, it was spinal related in her case apparently. Um, but it was, uh, just because, just cause you see something on an image or you see arthritis or you see a torn, whatever, it doesn't necessarily mean that fixing anything is going to help it. Um, because again, wrong solution for the problem that you have is not going to have a result no matter how extreme, like, um, the surgery might be. So it might actually just set you back. Like Dawne Costantino said, you got to do a little bit more rehab to get back to your, um, ground zero. Um, rotator cuff, torn rotator cuff. You want it or me? Torn rotator cuff. Okay. So we are talking about, um, the muscles in the backside of the shoulder that attach to the shoulder blade itself. Um, and they are responsible for external rotation of your shoulder or like, say you're about to throw a ball overhead, that kind of motion. Um, and a lot of times we see this in athletic populations, overhead athletes. Um, and sometimes we see this in general population with a, I would say more with the muscle, like the supraspinatus muscle, which is the most common. Yeah. Cause that one's like at the top of the shoulder, um, kind of like right underneath the upper trap and it goes underneath your AC joint or like the joint on the outer part of your shoulder. Um, and it gets impinged a lot is what happens. So if your shoulder is elevated, like you're shrugging your shoulder towards your ear and then you try to do overhead movement. A lot of times it will cause impingement on that specific muscle. Um, and over time there's just little micro tears that can cause more and more injury to the, cause it is part of the rotator cuff. So you could be labeled as a rotator cuff tear in that instance.

You mentioned that boobie posture too. That'll also create like an impingement. Like that'll, what that obstruction is what will limit your overhead movement. Um, This is usually like an overuse type of thing you would say, right? Not a lot of times you'd you see like one traumatic event that would cause this. I've seen falls. I've seen falls, um, to have ruptures and so on. But, um, yeah, I, I don't want to sound like a, like a broken record here, but most of the time they're not, they're not big. Like I don't, I, in the population that we see, I don't see a lot of true rotator cuff problems. Um, and I wouldn't call it an overuse situation.

We call it under use or under utilization of the other things. We talked about the dynamics, dynamic strut earlier. Um, the other parts of the cuff that are a lot of times inhibited just from making the shoulder joint, the ball, the ball saucer happy. Um, and I think the rotator cuff function is totally dependent upon how well that dynamic strut can work. So I wouldn't blame the super spinaeus, although it's the most common, um, from a history standpoint, I think, I think if you look it up, they'll call it the steering wheel muscle or something like that. And cause all of a sudden people, yeah, all of a sudden people are like, I know what I have. And you're like, what super spinaeus tear. How do you know? Cause it hurts when I turn my steering wheel. Well, that's not indicative of anything, but I kind of liked it. They're like, they're like, Oh, it's me. You know, Google. Yeah. Right. Cause I can hurt on anything. Even those cases we've mentioned earlier, that could be positive on that. So, um, but there's multiple different types of, of tears too. Just like, just like labrums or carlids, there's lots of different types of, um, uh, muscle tears. Um, probably the one that's most confusing to people is the, they call it a complete tear. And so people will come in and they'll say, I have a complete tear in my super spinaeus. And, uh, complete tear is actually, it's a, it's a, there's so imagine a piece of paper, a complete tear is side to side, a pinhole. Essentially that can be a complete tear.

Um, you know, a partial is, is a part, like a dugout section of it. Um, and then there's a rupture contraction, um, uh, or retraction rather, which that is the one that people think of when they hear complete, they say, Oh shit, it just ripped off. Well, that's a complete tear retraction. Um, and funny, I did have a patient come in one time that they did not have any shoulder pain whatsoever. This is a good, like you probably couldn't make this story up or I didn't even know what was going to happen. It was so cool. Um, she come in, she came in no shoulder pain whatsoever. Um, we were learning to use diagnostic ultrasound and I said, I knew she had a past partial tear of the cuff. And so I said, Hey, I'm, I'm learning how to use ultrasound. Can I look at your shoulder? Sure. Looked at it completely blown off. Um, super spinaeus retracted from the bone. Uh, I don't remember how far retraction, but, but me and the other guy are looked at each other like, Holy shit. Can you raise your arm, raise your arm overhead? Absolutely no problem, no pain whatsoever. Um, and, um, when you, we eventually talked to her about it, uh, I think it was months prior she had slipped and fell and, um, she, it was after she had the initial partial, which also came from a slip and fall too. Um, don't fall. It was a, it was a foosh. She was a fallen astuce hand type of thing. And, uh, and that's, and that's what it was assumed created the terror or the complete rupture.

But then in that situation, it's like, Hmm, there's a complete rupture here. No pain. Do you do surgery? We, she opted to, she kept asking what do I do? I'm like, shit, I don't know. It doesn't hurt. Clearly you function fine without anything. Well, why'd she come in though? She said, you said she had shoulder pain. Yeah. It's just hanging out. No, no, no. Oh, no, no. It was a shooting coming for shoulder pain. Oh, I thought, Oh, gotcha. Gotcha. Gotcha. She's hanging out. Okay. Just visiting. Oh, gotcha. I thought you said this was a patient and came in for shoulder pain. I was like, what do you mean she had no pain? I don't know. Yeah. No, it's just visiting. So I can rebuild the details of who it is later. Um, that's interesting though. But yeah, no problem. Uh, she, she eventually had the surgery done and, uh, it went well, but it was, it was kind of like, why, you know? So I guess the point of me telling the story is, uh, you can have absolutely zero pain with a complete, like worst of worst torn off bone rotator cuff chair, the super spend is, which is the most common one. Or, or you, uh, you could have no pain. You could have pain. You could have not had pain.

And so the little pinhole one that you're probably thinking of, or that you might have is really not a big deal. You can probably return to full function like that. Either way, we're just going to rehab again. Yeah. So when, uh, in what circumstances would you refer out then maybe, uh, cause people are wondering, they're just trying to, they're just saying they could fix everything with these people. What circumstances would I refer out and just specifically rotator cuff or shoulder issues itself? Just shoulder pain. Like why would you refer somebody for another consult from somebody else or imaging or whatever? Um, so I would, I think the first one that I would think of is if they've been in my care, um, for four to six weeks and they have had no improvement, then I would say, I don't think that I'm the right person for you. I can't figure this out and you need to go see somebody else. Um, so that, yeah, I'm not one that would hold onto somebody if I can't figure out how to help them too, if there is loss of function. So maybe some like myetomal deficit, which is like a decrease in your strength that we're noticing, um, progressive weakness like that is a reason I would, would, um, refer out. Um, as well as if it's like super unstable, I think that's something I would refer out for as well. Like a, like a traumatic. Um, so the, yeah, there's a, there's one called the tubs, which is a traumatic unilateral bank heart surgery, the acronym, um, someone who dislocates your shoulder, like traumatically, uh, usually would be more of a surgical consult. Those are the first few things that come to my head for shoulders specifically that I would refer out for. Yeah. Yeah. I, um, I would agree with you. So I just was curious cause I'm just playing devil's advocate with everybody. Um, uh, I'll go down this list a couple, there's probably a couple of things we'll just kind of talk, talk about briefly. Cause there's where we hit all the biggies. Um, so swollen bursal sacks and tendons.

No, I haven't seen one of those, but, um, actually I had somebody come in and said that that was the reason for his shoulder pain. His PT told him that he had bursitis. Yeah. So I took my finger and poked it and it didn't cause any pain. Yeah. Yeah. I don't, I mean, I, I know that there's probably better ways to try to rule in or rule out that, but I know that that's one of the ones that we learned in school. You can just push right on the bursa and see if it, if it increases the pain at all. And for him, it didn't specifically, but, um, bursitis is the point of bursas is just like a fluid filled sack. Um, usually underneath like a tendon or a muscle that helps with just like gliding motions of, um, the muscle in your shoulder. And there's one underneath your, your AC joint in your shoulder that can get inflamed usually from just improper use of the shoulder, improper muscle activation, um, or the impingement. It's one of those things that can be a part of impingement.

Yeah. I kind of classify the supraspinatus, tendonitis, tendinosis, degeneration, all those things, all the, all the supraspinatus things, aside from the traumatic ones, I'll, I'll usually classify that, uh, and the bursitis as, uh, re they're just subsequent problems that come from, uh, like impingement. So to me, they're just the same thing. Um, I know we didn't talk about impingement yet, uh, really directly, but you kind of alluded to it with, um, the poopy posture reached overhead, um, and so on. So, uh, there's also something in that category we should probably just discuss with the hooky necromions. Um, there is, um, uh, Cody D-Mac had a good, he had an interesting, uh, theory with this stuff based upon just, uh, what do they call like study of ancient people's bones? Um, archeology, not archeology. Anyways, so he was kind of based on this theory based upon, uh, the hip orientation of like, you cock it your, like your Caucasian male versus somebody from Asian American, Asian descent, um, just different general anatomy. And so, um, people who are, um, I think you're, you're Caucasian people and I'm sure there's, you know, scattered information everywhere, but, uh, basically the idea is that we don't really have, like, we, we have a little, we have less space because our acromions are a little bit longer, um, not allowing overhead shoulder movement really that well. And so we're a little bit more prone to something like that, not to say it's genetic or anything, um, versus other people who have a lot more range of motion laxity in those joints.

Um, but, uh, a type three hooking acromion is sometimes found on an MR and that might have to be addressed maybe. Um, but other, other types I wouldn't worry too much about. Yeah. I forget about that one, to be honest, the hooking, the hooking part of it. Yeah. Yeah. It's, I haven't, uh, I haven't had to refer out for a shoulder image in a long time. So I haven't found anything that made me concerned anyways. People just got better, you know, probably, you know, they got up to grade three because if you think about it, like they had a grade three, they're probably their whole life. Why shoulder pain now? So there's other, there's other things which will create that shoulder problem. Yeah. Not messing with people's normal anatomy. Right. Yeah. Just change the environmental stuff. Uh, so on the list also, Dr. Google says bone spurs. We already addressed that pinch nerve in neck and shoulder. Dr. Google, you should have put this at the top is all, um, cause it's common broken shoulder or arm bone, frozen shoulder, dislocated shoulder, uh, injury due to overuse, repetitive, yeah. You are repetitive use spinal cord injury and heart attack. They're comprehensive in here. So yeah, the heart attack one is a thing that's a left arm side of face, sweating, nausea, vomiting, sometimes the inner part of the hands. Uh, yeah, it feels like an elephant sitting on your chest. Possibly you should go to the ER for that. I think you should go to the ER definitely should go to the ER for that. Uh, yeah. Anything that creates like a systemic type of response, like you're nauseous and you probably should go. Um, uh, how about frozen shoulder? What do you think on that one? So my, I think this might be kind of fun to bring up actually, cause frozen shoulder, a lot of times when I have conversations with people about frozen shoulder. Um, it's the idea of like the psychosocial component of it, to be honest. Yeah. Um, so psychosocial component of frozen shoulder, the reason that's brought up and I've heard some people talk about is so frozen shoulder basically is you, you can't really move your shoulder at all in any direction, um, no matter how much you try. And, um, I've heard that like, you know, passive or active range of motion is limited. You put them under anesthesia and all of a sudden you can move their shoulder. So that that was like something that people had brought up for the psychosocial component of it. If you just kind of take their, their awareness of the shoulder out of it, then you think you're able to move it. So that's kind of interesting and a pretty cool conversation we can get into about it. Yeah. I think, uh, you know, I had a lady with a knee issue. Uh, she had a knee replacement similar. Um, she wanted to come in and, uh, remove scar tissue from her knee area. Should have told her knee replacement. She didn't have full, um, flexion. She didn't have full bend, but interesting when she went under anesthesia to make sure that she, there was nothing wrong with the prosthesis. She had full range, you know, similar things. Like, so what are we really working with here? You know? Um, the only thing I have to say really on the frozen shoulder is that, um, there's, there's some, and I might be wrong with this. So someone might have to correct me, but I'm going to give you just the basic parameters while I bring it up. If your shoulder pain started yesterday, you don't have frozen shoulder. If it started a week ago, you don't have frozen shoulder. If it started a month ago, you don't have frozen shoulder. You can't even, you can't even make the real diagnosis until I think three months. It has to, like, that's part of the criteria for the diagnosis. It's three months. Uh, so the part where I might be wrong is it might be six. I don't recall it, but I think it's three. Um, either way, um, the point of me bringing it up is if you have new shoulder pain, this is not frozen shoulder. So do not worry about that and stop reading all the stuff that freaks you out online about it could last three years and it just de-thaws on its own. Um, but if it really is frozen shoulder, they say classically, they'll say it just, uh, it's frozen and then it thaws. It's a natural thing that goes away and they say it's idiopathic.

Nothing creates it. Um, which, which is why you're, that's what you, you brought up your possible other reason, right? Yeah. Well, yeah. Cause it's like idiopathic. I mean, that's just a way of saying that we just don't know yet what causes it to be honest. But, um, what's the other criteria of diagnosing frozen shoulder besides the three months and I think it's pretty restricted, active and passive range of motion in, in nearly all directions. Is it usually painful? Um, you know, I don't recall that. Yeah, I don't either. I don't recall. I, it is can't, they, they can't get there. You know, it's like when you move them, it's like you're moving a brick wall, you know, type of thing. And, um, yeah, I don't see a lot of frozen shoulders. So, but the reason I thought we should talk about it is that it's such a garbage can diagnosis. Cause it's, it's most of you who think you have frozen shoulder do not have frozen shoulder. Um, and they also correlate with things like diabetes. And so there's other, there's other factors that could be involved with frozen shoulder, but, um, make sure you get a good eval. Um, if you're going to really stick yourself in that hole, cause frozen shoulder is one of those things where it's like, okay, just got to wait. And so you could be waiting for three years of your life when you could have just waited. It could have been like a month and it resolved. So it can dramatically affect your life if you let it and you just assume that's what you have. Um, probably the last thing, uh, I want to address, uh, unless, is there anything you want to bring up before you? Okay. Um, yeah, I'm recalling what one of the guys said.

We had the shoulder recently. He was really wanting to talk for a while about how he did nothing to create this. And I was, I was kind of thinking in my head, I'm like, so you're thinking you don't deserve it? Or, you know, like people get really fixated on the idea of I didn't do anything. I just woke up. And so they're really confused about why, and they want to unravel the reasons why of this, why this is happening to them. Um, any thoughts? Um, so I think what I was just talking to somebody the other day on the phone, he was telling me it wasn't about the shoulder. It was actually about the fingers. And so my thoughts go towards like, you just went back when it first started happening, like seven, eight years ago and went over every possible thing that could have caused this specific issue. And he's like, I don't know. And it's almost like he was asking me like, based off of all of these things I'm telling you, which one do you think is the one that did this? And it's like, I can't tell you, I have no idea what one of these things, was it one thing? Was it a couple of those things that did it? Or was it all of these things that contributed to it? Um, so sometimes when you just wake up one day with it and you, you can't recall what you did the day before that could have caused it, keep in mind that a lot of these issues are just repetitive and overuse. It is over time.

Um, and your body responds to stress in certain ways. And at a certain point, it just has a breaking point. And so if you reach that breaking point is when you then start to feel pain and you have, um, injury that needs to be improved. So, um, the more we work with you, the more we figure out, okay, well, looking at your movement patterns and things of this sort, the more we talk to you, the more we learn a little bit more about your life, we can probably tell you a little more about, Hey, it's probably this that could be contributing to it. Probably this that could be contributing to it. But either way, the most important thing is we're going to figure out how to fix it.

Yeah. Yeah. I think it's a good point. It's, it's really, I know it's, it's nice to figure out what created it, but who really cares? Like it's, it's like, what does it need right now? Like we can fixate and be detective and figure out, you know, what happened with the dinosaurs or you can just figure out, you know, what do we do need to do right now to save the planet? You know, type of thing. Um, so yeah, I don't know. I think when there, I do, I do think that people tend to forget that the situation that they're in is not an accident most of the time. It's not, uh, I don't think a lot of them are circumstances of like life just happened to you. You did nothing to deserve it.

And it's just, uh, hereditary. Uh, I think we're a, some of our past habits. And so if you're overweight, your habits probably got you there, you know? Um, and if you have shoulder pain, your habits probably got you there or your movements or whatever. Um, there's something that got you there. And so, um, just start at, you know, ground zero start now. And we reverse engineer this whole thing. We just set better habits. And so, although your pain can go away with like we had mentioned a couple of weeks, you know, and I'm sure that, you know, some people a day, some people, um, a month, you know, it's ever different for everybody. Uh, I think it, I think it comes down to get rid of the pain, make, um, in any way that you can, uh, we found some nice movement ways, non-medicated, non-certical ways that can get you out of pain. Uh, and then reverse engineer the thing and it shouldn't take months to feel good. It'll just take months to get your body to continually adapt to whatever, uh, stimulus want to put on it. Like Dawne Costantino said, we load the shoulder, you load it because you want to use it again, right? You can easily put it in a, in a, probably in a sling. It won't hurt at all, but is that really how you want to live? So, um, change your habits. And if you need help with that, just, you need, you need a professional, probably a lot of people suffer through getting, trying to get through this crap on their own.

You certainly can. And some people do it. Um, but it's, it's really hard to do your own taxes. I don't want to, it's too complicated for me. I just want someone to say, pay here, pay this amount. That's it. You know? Uh, and I succeed at my taxes, you know, I want to succeed in my shoulder too. So if you guys are struggling with that, stop trying to deal with it on your own. Just, just hire somebody. I think one thing though, cause, cause I want to make sure that people don't get the wrong idea when we say like, who cares what caused it? Like, I'm, I think the importance of people knowing what caused it so they didn't know not to do that again is what they're searching for. Um, so just understand that we will educate you once we find what is causing your issue on what usually caused that type of pain. We can educate you on how to prevent that in the future. Um, and then we'll strengthen you around that area so that you know how to work it better and how to, how to find optimal function out of that specific area. So it's not that we're going to say we don't care what caused it. Um, and don't worry about it. Who cares? But it's just that we don't know exactly what, um, we can tell you what's causing your pain, what specific structure, um, and how to fix that and then how to prevent injuring that structure going forward. Um, but there's just no frigging way that we can figure out exactly what it is that did it. Yeah. Thanks for polishing roughness. Everyone likes Dawne Costantino better than me, Paul. Um, yeah, I just think it's like we can fuss forever about what it was, or we can just do something about what it wants right now. And it's, there's nothing wrong with spending a little bit of time like discussing it, but at the same time, it's, it's like, just, just do the work. You'll get better. Hire the guide. That person will dissect down all the relevant information. So you don't have to overthink things. Don't overthink things. Um, just do your homework and you'll feel better and it will, it'll take less time than you, than you thought possible. If you find the right solution. Um, yep. More polish that time. Uh, is there anything you want to cover before we start closing? I think we covered most of the structures in the shoulder, how to deal with it. Surgery, no surgery. I don't really know what else there is to talk about. Um, why don't we just cover, um, briefly then? Cause people might be wondering, that's all, that's all cool. Uh, now what do I do? Um, just cover briefly, briefly, some of the exercises they might think are helpful things, common ones maybe. Um, and, and maybe discuss why maybe those things aren't working or if they are working, they're probably not listening to this podcast. So, um, let's see, what are the common, like Codman shoulder, Codman shoulder exercise? They might've seen about those.

They might've seen external rotator shoulder exercises or rotator cuff exercises. Uh, and they might've seen, uh, uh, stretching, stretching of the pec minor, stretching of the upper trap, which one you want. I'll take the one you don't want. Um, we'll go over Codman's. Codman's. Remind me what that is again. Codman's is the exercise that a lot of people get when, um, they're, um, when they have a really acute shoulder or they're like post-op. Codman's is a, uh, it's an exercise. It's kind of like you're, you're standing like over a bench with like a three, five pound weight in your hand and you're making little circles. And so it's like a, like a decompressive type of effect on the, on the glenohumeral joint or the ball socket joint of the shoulder. Not a bad thing, but it's, um, I kind of classify it as like, like if you come in and you're 20 and you can show me that you can throw a baseball, but there's, there's pain with throwing the baseball. You don't need Codman's. You need something better fit for you. And so, um, as we mentioned earlier, the exercises are given based upon what you can do. The hardest thing you can do. Well, Codman's is not hard for most people, but it's appropriate for some people.

Um, I don't remember the last time I gave Codman's, um, like a little swingy exercise, but we give a different one, which is, uh, which is kind of similar. It's called a farmer's carry. It's big old heavyweights hanging out, hanging down from your arm and you have to walk with them. And so that helps with a lot of people with shoulder pain, but these weights can be 30, 40, 50, 60 pounds, you know, versus a three pound weight. So it's dependent upon if you can do it without pain. And a lot of times we'll test you after, uh, or so we'll go before and say, Hey, show me your shoulder pain and you'll show it to us. And we'll do the, we'll do the exercise and we'll test again. And they say, Oh, that's better. We, if you pick the right corrective exercise, that's right for you and your body, it will probably feel better immediately after.

Um, if not fully, um, it'll probably be partly better. Yeah. That's one thing to consider too, is that we're, we're not going to just like throw a bunch of exercises at you and say, try these. And hopefully it works. It's usually where we're testing most of these exercises while you're in here. As long as you're having the pain while you're in here. Um, then it's easier for us to pick something that causes your pain, show it to us. We'll trial this and then retest your pain afterwards so that we can make sure it's not making you worse and that it is actually making you better. Yeah. So you want to, you take the stretching then stretching. We'll finish off this because a lot of people probably stretching their pack doorway, stretch, upper trap stretch, you know, they're doing a lot for their shoulder. That's probably where most people are starting point. Yeah. I think that, um, I never give stretching myself.

Um, I wonder if there will be a time or a patient where I think that stretching would be beneficial for them. And to be honest, I don't think that it's bad. Um, I think that if it feels good and it makes you feel better than do it. Um, just be one thing that we always talk about and it kind of goes back to the nerve related neck thing. Um, if it's a nerve related issue that could be causing your pain and you haven't had that checked yet and you're stretching it, you could be making it worse. That's one thing to consider with stretching. Um, but if stretching makes you feel better, um, and you like to do it, then I'm okay with it. I never really prescribe it though.

Yeah. I don't much either, but there was, I mean, there was a guy that came in the day. He had a hip problem and we had released him. We didn't get very far on him. Um, we didn't have to make a lot of progress. And then he comes back a month later and, uh, he can, he can, he can sit across his legs and it's like, Holy shit. How'd you do that? He's like, I just stretched it. Yeah. Perfect. Shit. Should have suggested stretching to you, but that's not what I would gamble on anyways, but it's not bad. Yeah, absolutely. Just has to stick. Okay. So, uh, we will close up on this podcast and, uh, yeah, everybody, uh, thanks for listening to the podcast.

Feel free to share and share it with a colleague or a friend who has shoulder pain. Uh, it's not very often that we get to spend about an hour talking about this kind of stuff with people. And I think the problem is a lot of people go through and they, they dig into Dr. Google when they have, you know, five minutes break at work and then they just get little bits and pieces of information, which are just, uh, not right for their situation. And to be fair, Dr. Google is covering a lot of basis, you know, but they're not covering the 20 year old or the 80 year old. They're covering everybody, you know, it's, but it's not specific. So hopefully we can break it down a little bit more for you. Uh, would you like to close us? Sure. Is there a way that you always close these things? Uh, I eventually end with thanks for being part of the movement movement. Um, but how can everyone reach us? Ah, gotcha. You're better with that. Um, all right guys. So if you are curious about your shoulder, you've had people who have looked at it and you haven't gotten better at this point, maybe some of the things that we went over kind of lit up a light bulb in your head and you're thinking, Oh, that sounds like me. Um, you can always reach out to us. We would love to chat with you a little bit more about your symptoms. You could do that by calling us. Um, you can do that by emailing us. You can set up an appointment with us. Even if you're not near us, we are doing virtual. Um, and a lot of times we've had actually most people that we have worked with virtually, um, have responded really well because we don't need to put our hands on you to make you feel better.

So, um, email, make an appointment call, and, uh, let's just make sure that you guys are getting the correct treatment. Um, and people are looking at it the way that they should be and picking the right, um, treatments for you. And, uh, yeah, that's it. Oh, I thought you're going to close. Thanks for being a part of the movement movement. Yeah. See you next week. Okay.