Is Your Shoulder, Elbow or Hand Pain Really Coming From Your Neck?

This sounds like a heart attack. Maybe I should get this thing checked out, right? No one chases that pain down the arm, and rightfully so. And in the case where we have elbow pain, and this guy was the right side, so we're not really looking at a heart attack anyways, is that when he sits up, there's a possibility that we've unloaded light pressure that's been on to a nerve, which will go down that far. 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 Dr. Sebastian Gonzales, your host for the brand new, rebranded Restoring Human Movement podcast. This one today, actually if you heard that little snippet in the beginning, we're going to be going over some topics related to neck and neck correlated conditions. And the reason why I'm recording this one, actually, this time is because I found that, I mean, I get emails about stuff, and people say, like, well, I have this numbness into my fingers, what do I do about the hand? Do you have any hand stretches? Do you have any elbow exercises, or whatever the heck it might be? And then I keep reading their stories, and I think, this is probably a neck thing.

Like, we, like, they don't know. Rightfully so, they don't know, but at the same time, I have not put out any prevalent information about neck conditions, neck pain, headaches, and so on, as well as correlated conditions such as trauma, as well as stabbing pain in the shoulder blade, or periscapular region, we call it, loss or change of sensation into the arms, hands, elbows, shoulders. So we're going to go into some of that today. I will have a, or I had a podcast, actually. I didn't realize I just did it. 91 is Michael Shacklock, which is an amazing conversation, and he does something called clinical neurodynamics, which is a, it's a really, really useful part of diagnostics that we use.

If you've been treated by me, you're going to know it's some of those weird testing where I ask you, better, worse, or same, and we do sometimes other arm movements. So we're going to find if there is a, there's a lot of times a, there could be a musculoskeletal condition of the neck, or it can be a neurological, or it could be both. And there's multiple different types of musculoskeletal and neurological conditions, so I want to make sure I'm clear with that. Now, the reason you should stay for this podcast, by the way, in case you're wondering, am I in the right place? He's talking kind of technically.

I don't know if I have a neck condition or so on. If you have changes of sensation into the shoulder blade, arm, stabbing pain, burning, numbness, tingling, ants crawling, so on, you're still in the right place. If you have headaches or deep neck aches or even migraines, things like that, you're probably in the right place, too. Listen to the entire podcast. There was an intended mainly for lay public in this one, and if you're a healthcare provider, I wouldn't necessarily turn it off because I'm going to go over some cases that, or some conditions that, understand the terminology with it, because the way we explain our things to patients really dictates whether they understand and retain and complete care with us, really, because when I get these emails again, I start thinking like people, there's a misunderstanding of the public of what is neck related, what's not, and when should we have correlated treatments to the region versus when should we just rub out a shoulder blade region and never get it to go away?

You know, so there's definitely a lot of great topics in here. Before we start, I want to make sure that you guys do go on to the iTunes or Google Play and give me a review if you can. Five stars. Always amazing, but if you had some complaints, I'd love to hear those as well. The show notes are going to be on to p2sportscare.com. We have a pretty comprehensive search function now, so if you just go onto the search and you put neck pain podcast, you're going to probably find this, but also, too, on the show notes with your correlated player, you're going to find a link directly to the show notes as well and transcript.

Now, before the section I'm going to probably start doing to substitute some of those intros, and the last one is I'm going to tell you a little bit about myself within, I guess, the personal corner. So just something about me is that I have a past history of wearing metal shoes, and if you've seen me walk, and actually, I never see this. So I'll walk upstairs, and people behind me, they're like, hey, did you know you walk pigeon-toed? And I'll say, yeah, like I actually had little metal shoes when I was growing up, and they look like little metal tap shoes, and you can almost hear me coming with a tap, tap, tap, right?

Just like that, but high-ringing, obviously, because they're metal on concrete. But I had these little metal, almost like horseshoe-plated shoes that were leather. So we tried to correct this for a long time. I honestly have never seen anyone else in little metal shoes, but so yeah. So if you see me, just tell me about my little metal shoes, and you can always point out the pigeon-toedness. But I used to actually tell a friend that, he's like, how do you run so fast? I'm like, well, I'm pigeon-toed. Let's do it. So I taught him how to become pigeon-toed, actually. I think I was in probably fifth grade with this.

Anyways, here we go. We're going to go into the podcast. And before I start, I want to make sure that you guys understand that I'm very thankful for you listening to this podcast. I know you could be doing a ton of other things throughout your day, and hopefully you're listening to this while you're doing something productive as well. If you have a friend with net conditions or stuff that you hear about and it triggers your memory on this, send this to them. That's the whole point of the podcast is to share good, relevant information to make sure we stop getting bad stuff pushed to us, because there is bad stuff out there.

I hope mine's always going to be relevant. But here we go into the podcast. So going into the first type of net conditions, and one of the reasons why I want to do this is because I get a lot of emails over the weeks. And I can't help but cringe when I think that when people email me and they say, like, so there's a person that emailed me and said, hey, I've been dealing with this rotator cuff condition for two years. I've tried to rehab the shoulder. I've tried X, Y, and Z. I'm very frustrated. I can't do what I want to do. How do I get this to go away? And they mentioned mid-back tightness as well, some of the neck stuff.

But they still chase this diagnosis down, which is the rotator cuff one. I've seen it with elbows. I've seen it with hands. You hear it all the time with carpal tunnel syndrome or what's another one? The cubital tunnel syndrome, which granted, these conditions can exist. Those ones are numbness and tingling in the hand. They can exist. Rotator cuff conditions can exist. But when you have all these correlations of symptoms together and there's not resolution of the condition of the person's pain, then I think we need to explore the possibility of looking even further up. Now, this person in particular that I'm thinking about, I wanted them deeply to listen to a podcast just like this, but I didn't know of another one, or at least speak to me.

But here's the reality of it is that people like me or people who are, there's other great healthcare practitioners out there that they just don't have the time. And I've thought about before, like, if I, you know, had a sports hernia and I wanted to know the opinion of the best person out there, I would just call them and I'd set up a time and I would pay them for it, honestly, because it really comes down to you don't have time to answer the entire public's questions unless you're being reimbursed for it or you screen them out somehow. But so, again, that rotator cuff person was not really a rotator cuff person, I think.

Granted, I did not examine them, but at least from what I know, it's almost like if there's, you know, if there's a smoke, there's a fire. Like, you just kind of think, well, like, this isn't going well. You tried that, you tried that, and assuming they did everything right, you still have to investigate other conditions of the neck. Now, some of the conditions of the neck that I will be going to a little bit today is disc injuries of the cervical spine. There will also be pinched or I like to call pressurized nerves of the neck. There will be muscle spasms of the neck. I know I've heard people mention before and have a high concern of straightening of the cervical spine.

And tightness into the shoulders, or I guess a lot of people say they hold their tension up there. So these are all things that I commonly hear about. Obviously, there's a lot of other conditions of the neck that there could be. I am not going to go into them extremely deeply, but I might read an article correlated to them. So make sure to go on the site, and we're going to start setting up a search function. So you can just type up your condition, or if you don't find it, then there's going to be a sidebar which has the regions of the body on it, probably. Again, don't quote me on that. So back on the possibility of other conditions that, or other regions of the arm, even the lower body that could be affected, or the torso that could be affected by a actual neck condition, is elbow pain.

How many of you have had elbow tendinitis, or golfer's elbow, or what's the other one here? Tennis elbow, if I didn't say that. Golfer's elbow, tennis elbow. So both of those could be correlated to actually the nerve bundle up higher. And there's a nerve bundle which exits the neck region called the brachial plexus that could have some compression on it. Maybe it is also localized higher. We don't know. It would take a good exam to see. But what I usually like how I have people do is at least to troubleshoot themselves. Because a lot of times people come in very convinced that they have a certain type of condition, and they're not always open to the possibility that it could be a different area.

So usually what I say is, like, people with elbow conditions, and I have one recently. So he actually walked in, sat down, and it was his right elbow, and he just kind of always tilted his head when he's sitting there talking to me. Like, I said, can you straighten your head up? And he's like, yeah. So he did it. And his posture was really poor, at least sitting there, and so on. And I tested the elbow. To me, it didn't really respond from orthopedic testing like a lateral bachyndelitis or a tennis elbow. So I looked higher. And some people tend to look higher first, which is great. You've got to screen these areas out.

If you don't, then you might just go down the wrong rabbit hole. So this guy, I asked him, what bothers it? And so he did a gripping movement. I said, okay, so why don't we, why don't you sit up taller for me? And he did. And I said, how does that feel? He's like, oh, it's easier. It's better. It's less painful. I said, okay, well, keep that then. Keep that same gripping that you have. And now slots down again for me where you were. And he's like, oh, it came back. So this was like a switch effect. And you've seen some of my videos on different types of conditions. If you can find a switch, then I think it's a high probability of looking there.

Now, for all the patients out there that, or general population or public who is wondering like how the heck can posture like relate to that, it really comes down with, it really comes down to is the, where is, is that referred pain coming from? Now, if you're not familiar with the idea of referred pain, think about heart attacks. Most people will not argue the fact that if they are sweating, they have pain on the side of their face or lost a sensation there, their chest feels like an elephant's on top of it and they have arm pain, no one really says, well, that's carpal tunnel syndrome. They think, well, this sounds like a heart attack.

Maybe I should get this thing checked out, right? No one chases that pain down the arm. And rightfully so. They should be checking a more convincing or more probable source. And in the case where we have elbow pain, and this was, and this guy was the right side, so we're not really looking at a heart attack anyways, is that when he sits up, there's a possibility that we've unloaded light pressure that's been on to a nerve, which will go down that far. Now, this goes for lower extremity or lumbar spine or low back conditions as well, is that, and when people think about sciatica as another one where they, actually, I should back up a little bit.

When people say sciatica, by the way, it is not hip pain, okay? So they say my sciatic or my sciatica. They oftentimes point to like their gluteal area. It's lower, okay? It goes past the knee. So sciatica is an exact type of symptom pattern. So when you think about sciatica, a lot of people think, well, it's probably from my hip or my back. So like, at least they're in agreement there. Like, they won't chase it further. No one thinks, hey, let's address the knee. So when we're looking at higher conditions up into the neck area or that referring to the elbow, we're going to create loss of sensation or changes of sensation of the hand, the forearm.

Those are ones where it's the same grounds. The nerve is really the only thing that goes that far. Granted, there could be referred pain from other muscular areas. But even so, I think we're all in agreement that there's not one muscle which goes that far. Now, the fascia people out there say, well, there's a fascial tract there. Yes, there's fascia that goes down there as well. But either way, let's all agree upon this, is that there's a possibility there's a higher source. Okay, and I'm not one, I'm not one of those chiropractors who will tell you everything that starts the neck at all, like at all.

And there are some out there that a lot of the time their diagnosis will reside in the neck and mine doesn't. It's really based upon how the exam goes. And if it looks like there's a neck condition, I'm going to tell you. But I need you to be on board with realizing that there's a possibility that what you came in thinking was your issue is not your issue. Okay, elbow pain is not always from the elbow. Hand pain is not always from the hand. Hand numbness is not always from the carpal tunnel. By the way, if you don't know this trick already, the median nerve, which is the one affected through the carpal tunnel, only affects a certain amount of fingers.

It doesn't affect the pinky or the back of the hand. So if you are convinced that you have carpal tunnel, you should rethink that. Because I get these emails all the time, too. Hey, I got carpal tunnel on my pinkies now. And I'm like, well, you should really call me or you should really read an e-book or something that I've hopefully created that will address these things in regards to education for you guys. Because going down the wrong diagnostic track is terrible. It's terrible. It's just so painful, so uneventful, so frustrating for people that it makes me cringe inside. And I think about the lack of just basic knowledge that they could attain so quickly to go the right direction and have a more pain-free life.

I mean, I feel like it's so easy. So when I started creating all these articles and podcasts and video courses, which are coming into this year, I just want to hit that fundamental level of understanding for people. And I'm not telling them how to always address their pain because the fact of the matter is you can't treat someone if you haven't seen them. That is the truth of it. You can tell them about how a healthy joint functions. And you can tell them about how, like we're talking about right now, like these, like in a class setting, like generally speaking, elbow pain is not always an elbow condition.

You guys need to understand this stuff. And if you do, you're going to be that much closer to resolving your conditions. Now, a second thought with neck correlated conditions is not always the fact the neck has to hurt. All right. There could be tightness. There could be no sensation change at all. You might think it's normal for you. You might think that, hey, I'm just getting older. Hey, you might be thinking, hey, I can't turn left the entire way, but I can turn right. But that's normal. It's been there for years. But it doesn't mean it's not correlated to your condition down the arm, into the shoulder and so on.

So one of the things that I like to check, which in just the hierarchy of things for, for quote unquote, rotator cuff conditions or shoulder pain with athletes, with general public, with everything. By the way, there are certain ways to work with specific types of athletes. But if you're, if you're just a regular mom trying to pick up your kid, the function of you picking up your kid and throwing them into the air like you are, I don't know what that game is, but you kind of toss them up and you catch them, toss them up and catch them. It's not any different than, than throwing a wall ball up into a wall by someone, someone who's trying to get in shape.

All right. The mechanics aren't, shouldn't be different. The grip might be different, but the mechanics really shouldn't be different. So everything here just should flow into all parts of everybody's movement. Now with shoulder related conditions, we have to consider the possibility that there are muscles up there, which are fed, uh, electrical impulses to actually do their job. Let me say that again. Muscle conditions or muscle tightness, muscle tone, sorry, muscle tightness is not always because the muscle is overworked and it's not always a problem with the muscle being damaged. If you didn't hear podcast number 46, you should go back and listen to it because it's all about this exact concept, function versus structural, structural, structural muscle injuries.

So when we're considered the shoulder and all these muscles are supposed to be doing their job, can they do their job if they don't have the correct electrical impulse? Now, if we take this into the analogy of a house, um, say we have a dimmer switch and, because I actually do have one of these on my wall at my house, which, um, I, I had to change the dimmer switch out because like I was dimming it and the light didn't do anything different. Like I can flick it on and off, but I couldn't really dimmer it. And this is really how muscles, uh, they work. You had different contraction, uh, gradients.

So if your wiring system is not allowing the hardware of the shoulder, which in this case is the muscles, tendons, rotator cuffs, um, which affect the labrum and the glenohemeral joint. If they're not, if the electrical work is not working, then we have an extremely low chance of getting those muscles or joints or tendons to do what we want them to do. Now, in that same scenario there, when I get these emails on, Hey, I got this rotator cuff condition. It's not getting better by the way. My neck hurts. Where, where should we start there? You know, I tend to think, um, that we start number one with what supports the neck.

We know the rest of the spine does and especially into the sacrum or low back area that supports it too. Now what supports that when you're standing, it's the feet. We have ground contact. Okay. So all those, all those contributing factors in there contribute to, uh, neck health and the ability of the neck to have proper spacing so that the nerves can do their proper job without getting quote unquote pinched on that will allow the rotator cuff or the shoulder blade to do their work, which will decrease the possibility also of having a laxed shoulder, which can affect the labrum, which will also decrease the possibility of nerve roots or sorry, nerve bundles hitting the humoral head as you actually rotate to throw a baseball.

I've had the, I've had people come in with exactly this, by the way. So they come in, they say my pinky fingers, my pinky is numb on my throwing arm. I said, great. Can we find that position? We put them into external rotation, what we call late cocking. And I say, how does that feel? He's like, well, the tingling's coming back. I said, great. So I'm going to have you contract X, Y, and Z on it. And just to cue them, engage them to try to get their shoulder to stabilize itself. And they say, oh, in a way I say, okay, relax. Okay, it came back. Okay, so let's do that. Let's do that same cue again.

By the way, cues are different for different people or the condition too. Is that, does that go away? Yes, it went away. So these conditions that people tend to believe are surgical or pinched nerves or only neck base, they could be more so based upon what stabilizes and allows the neck to do its thing. Do you see where I'm going here with this? Neck conditions are not 100% neck conditions. Shoulder conditions are not 100% shoulder conditions. And same thing with all the way down into all the other joints of the body and muscles of the body, by the way. And if you have not read my article into the runner's tip section, I don't tend to think overuse injuries are really overuse.

I think that there are some people who will develop enough wear and tear on a muscle because they actually went too much. But realistically, when you take age, gender into consideration, say with running injuries, like actually the people who do, I think it was with men under 30 miles a week at the novice level actually have a higher potential of injury. So those people who are doing 50 miles a week, aren't they doing more quote unquote use, right? So overuse is not really overuse. Overuse is not a lot. Your body is not stabilizing or doing its correct mechanics to allow those muscles to do their normal job, not to do their extra work from other muscles doing their not doing their job.

So I don't want you to misconstrue that at all. So overuse injuries, sure, the tendon or muscle can have to do more work. But from the public's view, typically you'll think that, hey, I just did too much. It's not that you did too much. It's you made that one section do too much. I know I'm getting tangenting right here. So let's come back. Let's come back a little bit to the neck. Now, some of the conditions you probably heard about with neck pain is cervical disc injury, cervical disc herniation, cervical stenosis is something you might see on an x-ray. On an x-ray also, you might see straightening of the cervical spine.

You might see nerve root impingement, foraminal stenosis. You might see a lot of this stuff. But realistically, I know when I get people and have had imaging into the neck, like I had a gentleman, actually, I was looking for actually a malignancy. I was looking to make sure he was cleared and he didn't have any cancer or anything odd that we needed to check because sometimes when neck pain comes from nowhere, it's a little bit concerning. So we did an x-ray on him and just checked it and it was clean, but it came back. Or sorry, it was clean of malignancy or tumor. And so when he came back to me, we had the report in hand and he was really concerned.

And I said, look, this is great news, right? And he's like, well, what's all this other stuff? So he went through his MRI and he's like, what does this word stenosis mean? It says severe. It says moderate to severe. What does that mean? You know? And he's like, this one says mild to moderate. What does that mean? Right? He's like, this sounds really bad. What do I do? And I'm like, well, let's just consider this. I think we were talking about stenosis at the time. I said, let's just consider this. When did your neck pain start? And he's like, well, about a week ago. I'm like, did it hurt at all before that?

Like for years? He said, no. I said, okay. So this stenosis is a buildup condition. Cervical stenosis happens from over, it's over time. And in my opinion, arthritis is not related to genetics. By the way, I'm talking about osteoarthritis or the old age arthritis. I'm not talking about rheumatoid or all those other odd ones. There's a lot of different types. This stenosis and this buildup of bone around there is a response to the body, just like every other part, that has a response to load. If you're requiring the area to do too much work, the body says, holy crap, I'm going to stabilize the heck out of this thing.

Let's build some bone around this. Yeah, let's do it. Right? So I guess my conversation with him, which we spoke about it for about 15 minutes, which at the end he felt much better, and I felt good speaking with him about it because he was very calm too, is that this stenosis has been building up for a long time. So it didn't happen last week. And by the way, he felt better after about two weeks of care or so. And I said at the end, I said, did your stenosis go away? And he said, no, right? It's still there. So the things he should be doing to prevent increase of stenosis or bony growth is the stuff he should have been doing years ago to prevent it.

All right? Get the body to not have to deposit more bones so that you have all of its components doing its work. Now, bringing us back to that overuse condition that we, that I was refuting earlier, overuse of the bone in the neck, wouldn't that build stenosis there? That would build arthritis, right? It would. So that's just one of those things too, that just make sure that all your parts are doing their job. So stenosis of the neck is an extremely common thing that you're going to see. Now, granted, it is something that can be a big deal, but I heard from one doc, and I thought it was a great quote.

He says, stenosis is not a big deal until it's a big deal. All right? So there's a lot of you walking around with stenosis of the neck, foraminal stenosis, central canal stenosis. I won't even go into what those are. It's not important at this time. But just know that you're not really different than a lot of the other people that don't have neck pain, if you have neck pain. Same thing goes with disc herniations in the neck or annular tears in the neck. The area that developed the tear oftentimes is not trauma-based. Sure, maybe you were in a car accident and something happened to create that, maybe, but maybe you fell.

Maybe you're like a million-dollar baby and you fell on a stool. We don't know. Or it could just be that it developed over time. And that's how most lumbar spine or low back disc injuries occur. They happen over repetitive cycles, almost like if you're going to the beach and you're making s'mores, you have a fire pit, and you're making s'mores, and you just bend this coat hanger all around, right? At some point, it's going to break. So don't bend it a ton. You can bend it some, but make sure you bend it in a responsible way. That's probably a whole other side conversation, too. But when we're talking about cervical disc injuries or cervical disc diagnosis, just consider it like it should be very mechanical, in my opinion.

And neck conditions are typically very mechanical. Bending forward, if it makes it worse, then we know that that's a probability that's going to... I don't want to say don't do that, but take care when you do it. Bending backwards, if it makes it better, then we know we found a direction of preference. Bending forward would be a direction of pain or flexion intolerant. If you read some of Stuart McGill's work with the lumbar spine, it's very similar in that manner. So we got to let this disc gristle up and scar over if it is a true pain generator. Now, there's a laterality aspect. If you tilt to one side versus another side, does it relieve pain?

Yeah, it could, right? Now, I know that I had an issue with my neck recently. It's a funny thing. I woke up with it, just like everybody else. I'm sure I was doing something prior to that to develop it. I don't know what it was. But I can tell you one thing, though, that it improved when I stabilized, and I'll explain that for a second. So when I went downstairs, and I typically sit at the dinner table, and I start typing in the morning because that is about two hours of uninterrupted time, which is amazing that I can get some of this work done, some podcasting done, and we just get it done. And so I was sitting down there, and the left side of my neck really was kind of bothersome.

And I was turning left because that's the direction I was having to look, and it was painful. It was painful into my shoulder blade area, and I was like, gosh, that really hurts, so I started rubbing on it. When I started rubbing on it, it was not getting any better. And then I stopped and sat there and thought, why am I rubbing on this thing? Like, is rubbing working? Is rubbing the right correction to it? So I took a chapter out of Stuart McGill's book, and I went with the anti-shrug. So it's shrugging, but the opposite. Drilled that thing, drilled the shoulders away from my ears, turned left.

It was significantly decreased. It wasn't gone. It was like 90% better. And that stabbing pain was gone. It just felt restricted. So I found that my pain responded well to stabilization. That's that WD-40 or duct tape. What are you trying to fix? What do you need to fix it? Is it too loose or too tight? What does it respond to? And this is all what we find through proper examination of a neck injury. Now, the story, as it goes, is actually kind of better, as I realized throughout the day, how I can modify the things that triggered my pain. So as I said before, turning left triggered my pain. Bending forward really wasn't that bad, but turning left really, really was.

So luckily, on my car, I have blind spot mirrors. So I didn't have to turn a ton for that. If I didn't have blind spot mirrors, then I think that would have stirred me to go straight over to the store and get some $1 or $2 blind spot mirrors. It takes a couple days to trust them, honestly. I've bought blind spot mirrors for a lot of people. And they're like, well, I don't use them because I don't know. I don't trust them. Well, I'll say you got to trust them. You got to confirm that you can trust them and you use them. And that'll help you out a ton. But so what we did next is we went over to a friend's house.

We were watching football. So there's a lot of us there. And there was two of my friends. They were kind of standing in a diagonal, probably about like two to three feet away from each other because dudes don't always want to stand too close, you know? You don't know what the other dude ate for lunch. And so I was kind of more towards the guy on the right or to my right. So I was looking at him and he was when he was talking and then I turned left and I was looking at the other guy when he was talking. And every time I turned left, I thought, oh, this hurts. Why don't I anti-strug? Why don't I just drill that, drill that thing down?

So I was doing that for about five minutes. And then I thought, this is stupid. Why don't I change the environment? So I went and stood next to the guy on the left and I was looking at either one of them straight on and one of them to the right. So I wasn't actually turning left. And it wasn't that I was actually never going to turn left ever again in my life, which, by the way, my neck pain has resolved. I'm confident to say that. It's been months and months and months. Not to say I won't come back, but I believe we can change our environment with it. If you're having neck pain, if you're having disc-related injuries, or if there's a certain direction you can't move, it doesn't mean that you're stuck in it.

With a car, you're a little bit stuck in it. But when you're standing around, you're sitting around, you can move your stuff. You can move your chair. You can walk to a different position. You can move your computer. You can change your ergonomics. There's a lot of things you can do to make it better. And if you're not doing it, you're really not giving yourself a great chance to heal. Does that make sense to everybody? That's an important one. I have people all the time come into my office if we're talking about certain types of injuries. I actually, there's a little obstacle course I do sometimes.

And I put, you know, easy things, light things, heavy things, and so on around the office. And, you know, like they might be playing with a kettlebell. And I say, okay, put that down right over there on that bench, can you? And, hey, can you pick up my phone real quick for me? You know, and I see how they do it. Are they using proper footwork? Are they using proper positioning? Did they turn left in this case to do it? Or did they turn their body and let their head be neutral? So those are all, I think, important points. And actually, that brings up another point here. Is that since we have our athletic population out there, a lot of times people don't tend to realize that actually rotating.

So baseball and golf are sports that require a lot of rotation. And I had someone recently come in who had neck pain while turning, not just with baseball, but also other sports, too. But it was turning. And it wasn't turning the head. It was turning the body. But here's the thing with sports, especially let's think baseball, is that when you're turning the body to hit the ball or throw the ball, your head doesn't really move. It keeps tracking the ball. So that rotation or that movement that is painful, it doesn't always have to come from the head movement. It can come from the other section turning in relationship to the head.

Does that make sense to everybody? So if it hurts for me to turn, let's say, turn right, and I'm a right-handed batter, it's going to be non-painful when I'm looking at the pitcher, when he's throwing. And as the ball comes into the zone and I'm trying to hit the ball, if I let my body go into a follow-through, my head is almost on my right shoulder then. So I'm relatively turning right with my head, which then might trigger the pain. Does that make sense again? Golf is the same way. That quick whipping of the body or the spine around a stable head is what can create pain on people. So it's not that your head is moving during your sport, it's that your body is moving in relationship to your head.

That's an important part. Because when we do rehab people, it's not always about can we get them to resume their head rotation to the right. Sometimes it's can we resume their body's left rotation with a stable head to the right or a stable head, rather. So rehab, I think, is a big part of it if you're working with athletes on transitional movements. Now, as promised, I'm going to go into some of my favorite treatments with this. I don't know if I'm going to have a—I'll probably have some YouTube videos on this. I know I did some on one case that I had where we couldn't disassociate the shoulder from the neck.

Every time he turned, he shrugged his shoulder, which was hard on mechanics of what we were trying to address. I can do some on neck stuff, but one thing I want you guys to realize, too, is that, like, neck conditions are a little bit different beast than spine conditions or lower spine conditions. Lower spine ones are just extremely uncomfortable, but I believe that they're not very—they're not surgical very often, or it takes a long time to get there. Neck ones, on the other hand, is that if you've followed some of the professional sports, like football, for instance, there's sometimes you'll see people get hit, and then they become momentarily paralyzed, and then they pop back up, and they're like, oh, I feel fine, right?

So those are cases where, like, neck pain is not really even in the mix, but that's a probable surgical case. Like, that person can become paralyzed, right? So those are important things to consider, that if you have neck pain, you need to get examined realistically. I mean, this podcast is intended to help you, but realistically, you need to get examined because the possibility of having some other type of odd thing is much higher than other parts of the body, so get looked at. If you have a question about where to go, actually, I don't have a provider list on my website, but there are a couple places I typically like to look, so I'm going to see if I can provide some in the show notes, by the way, for you guys, or I can just—at some point, I'll make a reference page.

I mean, I have a lot of providers I like around the country, but it's a lot of work. I'm not going to lie. It's just one other project I don't know if I'm willing to do. The—it's funny. Actually, you know what I didn't do, actually? I did not talk about my metal shoes. I think this is the only podcast that I've ever done where I actually did not do the intro properly. And because of my belief that I think this is a real thing, this is a real-life thing that you guys see that I have—nothing's perfect. I tend to not edit these things, so I'm not going to edit this time, too, but I will tell you about my shoes.

Okay. This would be good for a brain break since the neck stuff is kind of—it's intensive, right? So, when I was younger, actually, I actually just found this. I found a document of it. So, I—actually, my mom tends to take very good medical history. She's very outlined and documented and Excel sheets and dates and what the doctor said and all this stuff. So, there's one, actually, that—it was really early on. It was about my pigeon-toedness. And I don't even notice this anymore, but apparently, like, friends have told me, they're like, did you know that—they walk behind me, and they're like, did you know that you have—your toes are in your pigeon toe?

And I'm like, yeah, I heard that. But I don't really notice. I think they're straight. So, when I was younger, I actually had these—I think they were leather shoes. But on the bottoms, there was metal on the front and the back. And I actually don't know the point of them, but I do remember they sounded like little tap shoes. So, you can hear me coming with these shoes on that I don't even know if we have anymore. If I do find a picture, I will post it with this podcast. But, yeah, they were—it was kind of embarrassing. You know what I mean? I think I was in—all the way up until first grade, I was wearing these metal shoes.

And, I mean, I don't remember much about, you know, those years of kindergarten, first grade, and so on. But I do remember metal shoes. And I do remember looking at the bottom, thinking those things wore out. And it was almost like you had—it was like horse hooves or the horse shoes that you just, like, nail new ones on. And I think I remember there being, like, four nails per, you know, thing. And I wore these things for a while, but I don't know what became of them. And I feel fine right now, but who knows? Maybe I'll be wearing some metal shoes in the future. So, if you've had an experience with some metal shoes or you have other childhood memories of this same type of thing, not necessarily metal shoes, but other odd things that you had when you were younger, please share them with me.

Email me, seb at p2sportscare.com. Okay. So, we're going to go in some treatments now with this. So, treatments. I tend to shy towards, number one, I look to see if there's any structure versus function resolutions I can make on the area. And this is going to go back to that idea of the stabilization work. Is there certain cues I can give that person to make their neck feel better at that point in time? Or is there anything, any cues that I can do to increase nerve, quote unquote, flow or function to the shoulder or to the elbow or to the hand? Because remember, neck stuff, we're not just talking about neck stuff.

We're talking about stuff into the arm. Or we call cervical radiculopathies or we can call cervical brachial plexopathies. Yeah. So, I tend to see if there's any cues that will work. Some of the ones I try first is, number one, actually, positions and cues I try. Number one is, do they have neck pain when they're standing? Yes or no. If they do, I sit them down. I said, how does that feel? And they say, well, better or worse or the same. And I lay them down and I say, how's that? And they say, oh, it got better. So, I try to keep their neck and spine positions relatively about the same, excuse me, relatively about the same through the testing.

And I say, well, okay, so what's the difference? And they say, I don't know. I'm like, well, gravity has a different effect on you here. All right. So, you were vertical before and now you're horizontal. So, there's a possibility that their spine or their disc or their stenosis or whatever it is does not respond to axial compression or there's a possibility that the, let's just say alignment or the bony structure of the area is not allowing the area to be loaded properly when standing or sitting. So, to me, what this means is that we're not really looking at something extremely torn, frayed, surgical.

It just means that we need to get the person to improve their ability to bear load better. Does that make sense? Next is if we still have pain when standing, sitting, and laying down, then I want to see if we can stimulate the shoulder blade or the torso to see if it creates any differences. So, one I like to really try, which is an easy one, is that I have them bring their knees towards the ceiling or bring their feet up off the table. So, they're kind of almost tucking their knees towards their chest, but they're really not way that high. So, what this does is, is it changes the position of the lumbar spine.

It might go from an extended position to a neutral or a slightly rounded. And also, too, it activates the torso if I make them do it for me, not that I do it for them. Sometimes I'll do it for them just to see, does this change anything? Sometimes, yes. I've had shoulder conditions that improve with this, too. And there's a couple different mechanics that shoulder conditions can improve with this. But either way, we know that we're not just looking at a shoulder or just a neck. We're looking at more. Next is I like to see if the shoulder girdle or even the torso from an upper body challenge can affect it.

And I've had people in the past where, like, they lay on their back and they turn, let's just say, left. And they say, yeah, that hurts turning left. They say, great, cool. So, put your hand in the air for me. All right. So, my hand, I'm going to put my hand in your hand. I want you to drive my hand to the ceiling. I want you to force me through the ceiling. And what happens is their torso activates, their belly. They get stiff around the midline or the abdominal area. And their shoulder blade, if they're driving properly, they're driving the shoulder blade against the ribcage more firmly. They're sticking it on there harder.

So, at this point, I ask them to do their movement, which hurts. Does it hurt more, less, or same? And they'll say, well, sometimes it went away. Sometimes it stays. Either way, we know the direction we're going. So, if it stayed, then I might assess what's the quality of the shoulder drive they did. Is the shoulder up into their ear? Have they shrugged? Right? So, then I'll say, hey, can you bring your shoulder out of your ear? Keep driving me. Does that make it better? Yes, no, or same? If they say no, then there's a possibility that I need to still see that they're activating the serratus well, which drives the area on.

There's also a lot of other things to drive it on, too. But sometimes you cue different areas, then they will stabilize better. So, sometimes I'll put my finger into the bottom part of their armpit, kind of like where the shoulder blade starts attaching to the body. And so, I say right there. And I'm like, you see how it's like I can push in and there's like no tensing effect? I want you to push my hand out, pop my hand out of there, pop the skin up. Sometimes they get this, sometimes they don't. But when they do, I've had a lot of shoulder conditions improve with this. I've had neck conditions improve with this.

I've had numbness into the arm improve with this. So, you'd be surprised. And again, what these all tell me is that is there a strong functional stabilization correction that's needed or not? If none of these work, then we need to look at the possibility of the structure. Is it predominantly a structural correction that we're going to do? Now, explaining this to people has actually been really challenging over my career so far. And I keep thinking I do a good job of it, but I don't know. So, I guess I'm trying to improve on this now, but I say this is a sliding scale. There is some injuries that are 100% you do the work, I don't touch you, I don't do...

Any adjustments, any tissue work, any stretching, any injection, any of that stuff. And it'll get better. There's other ones that are the other side of the coin. They got to do 100% that way. But a strong majority of them will never be at the 100% either way. They'll need other parts. They'll need a minor or fraction part of stabilization or vice versa. Okay? There's other parts in there, too. I guess we can think of this like an X rather than just a sliding scale. There's other things that it could possibly need. Maybe there's a nutritional effect. Maybe there is a brain-based therapy or a central nervous system effect.

So, either way, though, I need people to understand which direction... Ooh, I had an idea. I should just make this a picture. I'm going to try that this week at work. And I might have to report back and see how it does. I might just make this for you guys, actually, because I think that would be a cool thing. Because people need to be able to comply and do their rehab or understand their responsibilities. And if they're supposed to lay there and be treated, by all means, if that's what's needed, that's what's needed. But if it's not on that side of the scale, then I think we should... They need to understand.

So, what I need them to understand is that there is a possibility that there is stabilization or other types of corrections that are needed. Some of the corrections that I like or treatments that I like for actually passive care are the following. I tend to use joint manipulation. I tend to use it more into the thoracic spine or mid-back, honestly. I don't adjust the neck a lot. Sometimes I do, but it's in rarer instances. Because I tend to see that people respond better with some of the other approaches I'll use. Now, it's not to say it's wrong to do that. But if it's needed, it's needed. The other things I like is soft tissue work.

I've been doing active release for a long time. Active release is a specific type of soft tissue work where you improve relative slide of muscles and other soft tissues around the area. I might use this into the shoulder blade. I might use it into the mid-back. I might use it into the neck. I might use it actually into the low back. We don't know. We don't know until we look. So each person has a different call to action. Now, I might have them... What's other soft tissue? I've done taping before. I've done taping for the shoulder blade. More so just for kinesthetic awareness. Just to make sure their brain is realizing where I want their blade to kind of be.

And it's just a gentle tugging on it. But those are a strong majority of the tissue work or the manual therapies that I'll do. I will do some assisted movement. The assisted movement, though, I would probably categorize more of a movement correction or a stabilization correction. Because if you're not moving well, it's hard to say that you're stable in the areas where you need to be stable. Or the areas that need to be stiff. Right? Because I like to go down the stiff route. So movement correction a lot of times will help. You'll even see, too, that I saw this with a doc that I shadowed. The seated, sometimes you have people turn, let's just say, left, and they have localized neck pain.

And if you assist them into that... I said left, right? If you assist them into that left rotation by pushing not on the area of pain, but an area below it. Perhaps it's in the mid-back. Perhaps it's into the junction of the mid-back and neck. And you push them into it without actually pushing on the joint that is painful. And that'll help them. Surprisingly, right? So the squeaky wheel should not always get the oil. You should check around it. And that goes for your manual therapies. It goes for your corrective exercise. It goes for a lot of things. Now, before I actually close this podcast, I want to make sure that everyone understands that if nothing is working in your care with your neck, there is a possibility there's something serious in there, extremely serious, okay?

Some people have neck malignancies. Sometimes they have tumors. Sometimes they have... There's a condition called Arnold's Jari formation that I've actually had a patient with that if I adjusted her, I could have just lit her up. I mean, like, there's certain things that there's contraindications to certain types of care with. So if you have rheumatoid arthritis, you should really consider finding someone who has worked with a lot of that type of condition because rheumatoid arthritis in the neck, it just whittles away some of your bony areas, and it makes you relatively unstable. So I tend to not judge...

I don't adjust people in the cervical spine with rheumatoid arthritis ever. That's me. I believe that was... If I go back and look at my college notes or my grad school notes, I'm pretty sure that is one of them that if they just... It's along the lines of fracture. If you have a fracture in the neck, you should not be adjusting it. If you have rheumatoid arthritis in the neck, I'm pretty sure it's up there, too. Malignancy. You don't adjust malignancy. You don't adjust cancer. Those are just the contraindications according to standard of care that you're going to find throughout many different types of professions that work with this type of condition.

So I think that was good for the next stuff. I can't believe that I did not do the shoe thing earlier. I was just too hyped on getting into the neck stuff. But I'm excited to finally have some neck correlated topics onto my site. I will transcribe this because I cannot tell you how many people that I've had email and call and just... They start telling me their story. And aside from being able... I can't tell them exactly what's going on, but it is a smoke. If there's smoke, there's a fire. And I just see it and I think, I think this person is a neck person and they don't know it. And the sad thing is they are going to keep chasing that elbow problem.

They're going to keep chasing medial leprechaunolitis. You're going to keep chasing tennis elbow. You're going to keep chasing rotator cuff conditions. So it's sad. And I hope this podcast is a service to the public where... I mean, even if like one person realizes that, holy shit, I should get looked at because I don't know what this is. And it's not getting better and it's affecting my life or it's getting worse. If you get one person, I'd be happy to get one person to understand that. And I know I'm going to be making a big difference when I finally get emails from people who say, I heard this podcast or I read your article and I realized one thing is that I know that my shoulder condition might not be a shoulder condition.

Because that is something that is so prevalent out there that you guys need to understand that the neck and spine and stabilizing parts of the spine could be a large contributing factor. And they could be the reason, the secret, the secret to your treatment. They could be the reason you're not getting better. Okay, so if you guys have not gone on already, please do review me. Go on to iTunes. We are on Google Play now, by the way. I don't know much about Android devices or how to review on there, but it can't really be that hard. So I really want to, hopefully by the end of the year, get, I would love to have 500 reviews on iTunes.

That would be amazing. Like I would read them nightly, honestly. Because I learn something every time I speak to someone about their experience of my material. I hope it's entertaining enough, and I know some of these ones people really love that are very tactical-based or more or less joking. Because I like going through interviews and like joking with people. It's fun. Like, I mean, some of the people that I've had on, like, I thought, God, that was a good conversation. Like, I'm glad we recorded it. But when I do it with myself, actually, they're very hard. Like, podcasts are very, very hard to do as solo podcasts.

And, I mean, I can't joke around myself. I already know what I'm going to say. So, anyways, if you guys have not already, please review me. That would be amazing. And I will speak to you guys next week. Talk to you later. Treat someone really good today. And maybe walk on a different side of the street. Talk to you later. Bye.