Shoulder blade and neck pain: two cases, two opposite fixes

Hey clinicians, before we start, I'm going to draw your attention to the premium version of the podcast that we have that we released back in January. It's going very well. It releases once a week and it's all the stuff that you care more about than some of the general conversation you might get in some of these free version podcasts. So it's about 15 minutes long. We do case presentations, all of the stuff that we tried, things that work, things that didn't work, and a little bit more specific to you and the things that you wish might be in there too. It's very affordable. You can quit at any time. There's a link in the description below.

Go check it out. You'll love it. Now onto the podcast. 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, this is Sebastian, your host with the Restoring Human Movement podcast. Thank you for joining the Movement Movement. This is your first time in the show. Welcome. You've missed a lot of episodes. We've done about 240-ish different episodes. This podcast's pure intention is to improve our communication with doctor and patient and just generally understanding better of how to make yourself feel better. This podcast won't necessarily include all the tips and tricks that you might want to find out of things like Google and YouTube and so on. And people look for quick fixes of things. But for those who generally want to understand what's going on and just understand an easy way out of having pain, this is going to be an excellent episode today. In the past, we did have a lot of interviews with industry experts, with healthcare, mainly with musculoskeletal medicine. We don't really dive into things like nutrition and so on too much. But this one in particular today is going to be some fun case studies of people who have experienced shoulder blade and neck pain. Shoulder blade and neck pain is something that it's quite an enigma to a lot of people. Sadly, we've noticed from our YouTube channel that people leave comments and they suffer with this thing for years and years and years. And they've been through a lot of people. They've tried a lot of things. And sadly, this thing just continues. I should first probably preface things with, I want you all to understand that there's many reasons why you could have shoulder blade pain. Not just one, because a lot of times we'll get comments from people where they're like, well, I have this, what do I do? Or what one stretch do I do?

I don't know. It really depends on why you're having the problem you're having. And the two case presentations I'm going to show today are actually pretty much exactly opposite from each other, although very similar presentation. We have a lot of people also who tend to, they get a little confused when they say, well, you on this YouTube video or in this podcast, you said do this, but not do that. And I don't know. That didn't work for me. Again, the reason why you're having the problem is unique to you. So it is very useful to have someone on your team, such as a healthcare provider, a trainer, an MD, a chiropractor, a PT, whoever it might be. Even someone who teaches you how to stretch might be very helpful in this situation. So, um, on a preface, it just as that, but this is going to be some very useful information we're going to go through today. Um, can you apply to you? Maybe, but this is not included. Uh, this is not intended as medical information. Uh, by the way, if you haven't subscribed to the podcast already, you probably should. Um, we've done episodes in the past on hip pain, um, sports hernias, low back pain, low back pain, disc, neck pain, shoulder, rotator cuff, knee, ankle, you name it. We've done pretty much everything. We've done them in different formats, which is the one like we're going to do today, which is a kind of, uh, just me podcast. We've done interviews and we've also done a back and forth with me and Dawne Costantino. Uh, I think those ones are personally the most fun and we recently went through a bunch of those. So, uh, we'll have them come back on pretty quickly. So, um, the first probably thing you should probably understand about shoulder blade pain and neck pain, but is we should probably first understand basically where it is, what I'm talking about. A lot of times people will point between the shoulder blades, the area where I like to call, you can't put some block on that area, or at least the least flexible people can. I certainly can. I could barely put my index finger on if I was trying to scratch it.

So the shoulder blade area is the shoulder blades muscle on the backside of your body between your shoulders. And there sometimes can be pain in between them equally both sides or on one side. Sometimes it can go a little bit higher as if you're reaching over the top to put some sunblock on your back. And sometimes people say, no, no, I don't have that. And, and then I'll say, well, what do you, what do you have? They said, Oh, it's under the shoulder blade. I'm also talking about that today too. A lot of times people have very similar, but different presentations or variations of presentations, which could be a similar interventions, but maybe not. As I mentioned before, let's not, let's not make this too confusing just yet. Also too, a lot of people will complain of neck pain, neck stiffness, neck tightness, past neck issues. I have a bad neck or so on. They'll mention things about their neck or even headaches related. What this will typically give us information about is these are clues. We're almost playing Sherlock Holmes with this. We're trying to figure out where your problem starts at. But if you have neck pain, neck stiffness, morning neck pain, or headaches that go behind your eye, around your ear, around the top of your head, the base of your skull, like all of these are clues that can help us find out the right area for you. For me personally, I might be a little biased in this, and this is just generally guessing, is a lot of times when people have the neck and head complaints too, they all, this typically all starts from the neck somehow.

I have a friend who he asked, he's like, what do you mean by that? And I said, well, you know, that's, it's, I'm like, no, I can't really explain it that well. And I said, why don't we do this instead? Because he was really convinced the shoulder blade pain was his rhomboid muscle. People tend to think it's their rhomboid, their upper trap, their lower trap. And the easiest thing to do is to first eliminate the possibility of what it might or might not be. So I like to play devil's advocate with people and just kind of paint the picture of maybe it's not what you think it is. And so usually when people look down, if you looked all the way down and it increased their shoulder blade pain, then we have to rationally think the shoulder blade muscle that we have in question, such as the rhomboid or arguably the middle trap, but let's just say rhomboid for now, it's probably simpler, does not connect to the neck. So what's happening? Why does moving the neck increase the rhomboid pain? Well, probably cause it's not the rhomboid maybe, you know, uh, very rarely is it actually the rhomboid muscle. Um, there is not a lot of images that will actually reveal that there's anything physically wrong with the rhomboid muscle, even in the presence of rhomboid muscle pain. Okay. Shoulder blade pain, if you will. Uh, if looking up changes things too, again, if you don't move your shoulder blades, this doesn't move your rhomboid. Um, the rhomboid attaches to the mid back, um, uh, uh, vertebral segments or parts of the spine and the shoulder blade, it doesn't attach to the neck. Now the middle trap, I guess there's fibers in there, which can kind of extend upward at some point into the neck, but, uh, we can reasonably say the lower trap and middle trap don't also attach to the neck. So if we're thinking maybe it's these muscles and neck movement changes it somehow, some way, then it's probably not. It's probably something maybe that goes along with the neck movement. Maybe now there's the possibility that people tend to, uh, kind of consider, well, maybe my scapula is sick. Maybe my shoulder blade is sick. That's S I C K, which is an acronym, which basically means dysfunctional. Maybe possibly, uh, in my experience, a lot of times shoulder blade, uh, sick scapula, shoulder blade winging, uh, shoulder blade flaring is also possibly coming from the neck as well. Uh, one of the considerations we have to have is there's something called the, um, uh, um, long thoracic nerve that, uh, goes into the air with the, uh, they called the, uh, serratus interior muscles, which go onto the shoulder blade, but from the front side, it goes around and it wraps to, from the front side, almost like if you were to watch the movie, three hundred and P and you see these little slips of muscles up by someone's armpit on the front side, kind of by their ribs. It almost looks like ribs that are muscle ribs. These are the serratus interior, um, slips. And so this muscle is innervated by, uh, some of the nerves that come from the neck.

And if it gets generally lazy, it can make the scapula wing creating the quote unquote sick presentation. And so maybe the muscle itself is not working, but also there's a consideration it could be coming from someplace higher too. By the way, I know that that section is a little bit technical. We will move away from technical aspect here in a moment, but if you, if this is something that you're like, huh, that's interesting. He's saying some things that are making a little bit of sense, but you went too quickly. Just rewind it. Just, let's just rewind the podcast here. Uh, understanding that is half the battle what it might not be, because as long as you hold on to your beliefs that it might be that muscle and it doesn't respond to any muscular treatment, then you're going to miss out on a lot of easy, simple possibilities, which I'll go into these couple of cases today. So the cases are, uh, one of them is, uh, was, uh, both are mothers, but these are both, uh, ladies. One of them is about 40 years old. I'll start with her. Um, she, uh, obviously this is all, uh, protected for privacy. Uh, she was someone who came in to us before for something else. And I'm very, I'm very, I'm happy when people trust us enough to come back for something else, because sometimes I know that's a very common in our profession that you see someone for their ankle and then they'll go to someone else for their neck. It's just like, which, you know, you want to go to someone who has a good experience with those areas, but sometimes they just see us as the ankle people. And so the neck people maybe go somewhere else, but we're actually pretty fantastic at neck and shoulder blades. So I, I don't want to toot our own horn, but, uh, I think we're pretty good at them. So, uh, anyway, she comes in and, uh, she had just had a new baby, uh, over about six months ago. And she noticed that her shoulder blade started hurting. Her neck started hurting as well. Uh, this was the left shoulder blade and left neck area, no headaches involved, uh, nothing big, bad, and scary, by the way, for the clinicians out there, they're listening to the podcast. I know that this podcast has changed a little bit over time. We've gone super technical.

We've gone simple. We've gone even more simple. We've gone more specific to lay public as we are today. If you want to know the details of orthopedic testing of neurological testing of what we did, why we did it, theories of why, of how we did it and what methodology we're using to help these people. There's a premium show, which I probably mentioned in the beginning of the show. So we get more technical in there. Uh, this case is actually presented in there as well. So, uh, left shoulder blade and neck area. She couldn't turn left. Um, she couldn't look down. She couldn't look up. She can turn right or away from the area, but she was a little bit confused about what to do because she's never really had neck pain before. Um, she's never had this issue before. She's had other issues.

Uh, she's generally physically active. She runs a lot. She weight trains. Um, but obviously, you know, as we all know, when, when you have kids, sometimes you get robbed of that time and your activities change. Uh, her activities change dramatically, uh, mainly via nursing and holding a baby and looking down on the baby. And so we played a little bit of a teamwork on this. And so I believe everyone, uh, who gets looked at, by the way, um, whoever you're working with should be part of your team. All right. Your team members will help you find out what's going on and they'll help you find out how to deal with it. And so we played a little Sherlock Holmes. Uh, she is my Watson. Uh, I'm Dr.

Holmes, hopefully, and we're gathering information together. And so, uh, running bothered it looking down, bothered it. Uh, it was worse in the morning. It traveled down the hand sometimes, but not always. It was gone at the point where she had come in. Uh, she had a little bit into the fingers. If I recall correctly, no real elbow pain, nothing into the forearm. Um, no major headaches, no visual change, none of that stuff. Um, she didn't do anything to create it. The only thing really different in her life was, uh, her new motherly duties. And so we're gathered this information beam playing like Sherlock Holmes together or the team of Sherlock Holmes. We're going to figure out what to do next.

So obviously we go through a little bit of testing. We go through not only history taking just as we did, which reveals actually a large part of the puzzle. Um, at this point though, it seems like when I talked to her, when I watched her, I said, can you tell me, show me what hurts. And she looked down and she's like, that's the worst looking up was just kind of pinchy. It's like, like it wasn't really good. Like it didn't feel good. You can see it in her eyes a little bit. Um, but looking down was not helpful at all. Like it, it was, it was painful. It would make logical sense based upon her, um, new motherly duties. But, um, and I'll cover that bridge in a moment here, but usually the examination and physical examination, I mean, testing, we'll figure out what to do next and figure out if this information presented to us is all that we need or we need a little bit more.

Um, a lot of times people don't need x-rays or MRIs to actually diagnose what's going on with these things, nor to figure out what to do. It's that's just maybe a little bit further, more information than we might need. If we don't find enough information with the history and exam, which will take you, which will take care of most of what people need. Um, we'll fit with physical exam findings. The interesting part was that range of motion testing was obviously painful as I mentioned before, but when we raised her shoulder up, uh, when I, when we lifted her left shoulder and made it so her left shoulder theoretically didn't have to do any work, uh, you can look at it as, um, I believe I went next to her and put my knee on the table or my foot on the table and had her rest her arm, her forearm or elbow on my leg. And so at that point I had her look down and look up and actually her symptoms reduced dramatically. So what does that mean? Is this the rhomboid again? Is this the levator?

Is this the six copula? Probably not. Um, there's a, there's a chance that this is more something, uh, more of like a, a, a neural tensioning or a pinched nerve, if you will. The reason why the shoulder passive shoulder elevation works is because it slackens the nerve path as it goes down into her whole entire arm. As we mentioned before, she did have a past history, recent history of having some numbness in the fingers, which by the way, um, I don't know if you've heard our other podcasts on numbness of the fingers, but numbness, tingling of the fingers, loss of sensation, pins and needles. Those are pretty exclusive to nerve stuff. Um, obviously it can be vascular too, but nerve and vascular are kind of the things in there. Like it, it, it eliminates a lot of the things where we're thinking of, uh, maybe she has a rotator cuff tear. It's like, well, that wouldn't really create the nerve thing. And obviously we can maybe say that the rotator cuff tear or the six scapula or the rhomboid or whatever we call it could be the thing that drives the symptoms. It could be the main root cause. That's right. But if we don't address the neurological component first, we're not going to get anywhere. It's like playing chess. Like you can't, like, I don't think in chess, you're actually allowed to move your King out into the exposed area. Like the other person's going to be like, yo, you can't make that move. Um, I think it just won't let you, you have to sacrifice a pawn or something first. So the body's basically playing some chess a little bit here until we address the neurological component, the bigger threat, then we're not going to get anywhere. And so it's best practice to find what's going on with the neurological system first. In this case, letting the shoulder passively raise or putting her elbow onto my, my knee, or even if safe, she was like slumping kind of over the, over a desk, um, and kind of letting that left shoulder to sag and relax completely. I bet she'd be able to look down to her chest again. So what does this take us for treatment? Well, we have a saying here. It's, it's very simple, but do what feels good. And to refine that a little bit more, do what feels good now. And later, let me explain that for a moment here, because it'll give a better, uh, framework of why we did what we did and feeling good now and later means we can raise her shoulder. She feels a zero out of 10 pain. She does not feel any pain in that position when we raise the shoulder, not when she raises her own shoulder. And we just hang out in the position for about a minute. And then we have her look down and don't support her shoulder and her neck range of motion improves her turning left improves her looking up improves. And she doesn't have any problems, really significant problems. She has like maybe a one or two out of 10 when she originally came in with a six or seven. So that's what I mean by now and later. There's certain things that people will do such as stretching, rolling, um, deep tissue work, adjusting, whatever. It could be anything, medication, self-medicating, uh, drinking alcohol, taking pills, whatever it might be where you do feel better now, but you don't feel better later. And the stereotypical one I like to use with that is binge drinking. Like I've met people who have had neck pain or shoulder blade pain who like, you know, it really helps a bottle of wine, but then I feel horrible the next day. It just comes right back.

Well, okay. So now you, next day you have the shoulder blade and neck pain again, but then you also have a hangover too. So this would break the rule of feeling better now and later. Now, how do you know if you're doing something that feels better now and later? Simple, you have to pay attention. Just pay attention to what your body is saying. Uh, some people, uh, they don't really do mental check-ins sometimes, uh, you know, ask, just sit there and think, how do I feel this moment? Does my shoulder blade hurt? Well, no, it feels actually pretty good. Okay. Well, how does it feel like saying 10 minutes passed? How does it feel when you're doing this, when you're playing softball? Well, it's actually not too bad. Well, how does it feel when you swing the bat? Oh, that hurts. Okay. So maybe swinging the bat is something that is not within the confines of feeling better now and later. Cause it hurts now. Now we can also take this approach with something like running. Like she wanted to introduce running back in. Hey, can I run? Why does it feel with running? Well, it hurts a little bit.

Okay. So don't do that the moment. Let's do this one exercise or two exercises that we gave you. And then let's try running again later. And so there's a chance that it was maybe too sensitive to, to allow for the bouncing of running. A few days later, she was able to run with no pain. She didn't have any negative repercussions of it. She felt fine the next day. So she would be within that category of, yes, I can run. It feels better now and later. Sometimes general movement makes people feel better, but in the early stages of recovery, sometimes movements will provoke the problem. So in her situation, we gave her a really simple exercise to do. I had, we had her, um, we had her, uh, what do we ever do? We had her, I had her grab her shoulder or sorry, grab her elbow and, and just kind of bring it around her body as if she's attaching her elbow to her chest, almost like she's doing a left arm sling, like a shoulder sling. And then we just have her look down based upon the mechanics that we identified in the exam. This was going to be a very probable high payoff activity for her, uh, clinicians. We do cover this in the paid podcast, by the way, the premium, you can find it at the bottom of the podcast player. Um, so we had her do this for, uh, recommended dosage in the day, which wasn't that much. And things just generally got better as things get better. You can almost think of this, like you're, everyone's pretty familiar with quote unquote inflammation. It's like, Oh, it's too inflamed. I can't do that right now, but in a couple of days I can. So this could quote unquote, kill the inflammation or make it so she feels better. So we can start introducing activities that were too much at the moment, such as running. Um, we had a, uh, a kid come in the other day who he was, uh, a great case. I should probably present this in the premium podcast is he had some cat, he had a calf strain, uh, from playing soccer. And so he couldn't do anything soccer related, really running would bother it. And so when he came back after about three days or so, he, um, everything was much better, but he still couldn't jump high and land. And so he's like, well, what'd I do about that? Well, just, that just hasn't come back yet. Just don't just do what we're doing, do the plan, do the exercises.

By the way, in these, both of these cases, I should mention, I didn't adjust either of them. We didn't give medication to either of them in neither one of them required, uh, an X-ray or MRI, just noting that because that is a very big, uh, stereotype that people have about what they need to do to get better. And it's, it's most of the time false. Um, so anyways, uh, we're going to wait to see and let the body do its recovery job. If we allow it to, we have to give the body a chance. And that's what we did with the, uh, with this neck case here, we gave and get this case. In this case, she had something called a cervical radiculopathy. She had a nerve impinged in her neck. She had a pinched nerve. And so we have to let the nerve have a chance. We have to let the nerve be in a state of happiness, which is just don't pinch it. And then a lot of things will come back. Some of them won't come back very quickly. Sometimes things will take longer to come back. Sometimes there's activities that are avoided, but then we need to plug them back in. Um, let's just say if she wanted to go do a overhead pressing or snatching or Olympic lifting, maybe this is something we have to plug in a little bit more and patchwork together with something like a corrective exercise. But, uh, it's important to realize too, that, um, the activities that are given to you, the exercises and treatments are given to you should be based upon your goals. Her goal is not to be an Olympic lifter. Her goal is just to be a happy mom run and lift weights, uh, you know, just general strength conditioning. She didn't need to do, uh, power movements overhead or Olympic lifting.

Cause remember that's a sport. So the exercises or activities given to you to perform at home, to help yourself resolve, um, should be specific to what you want to do. If you don't want to be an Olympic lifter, you shouldn't be given Olympic lifting suggestions. Just throwing that out there because it does happen sometimes. Uh, so in this case, uh, what our expectations are for her is that number one, uh, we don't want her to change too much about her day other than just adding in that one, we call it a first aid. It chills everything down. It chills it all down. So we set a nice white canvas for building up some adaptation later. Uh, luckily she was already doing some, she's, she's not opposed to being active and doing some, putting some work in and, uh, kind of giving herself some time. I know it's hard when you're a mother, uh, when you're a parent. So she's able to get herself about 15 minutes of time, which is enough to actually do what we suggest that she do.

Uh, she, we did talk a little bit about what maybe caused this. And so I told her what the main reason why we see people a lot of times with these quote unquote, I didn't do anything injuries. I didn't hurt it. I didn't trip. I didn't fall. I didn't break anything injuries or pain, uh, pain, pain types of, uh, presentations is because they have exposure spikes of activity or inactivity or certain category categorizations of activity. In her case, she's looking down a lot right now. Uh, I know that you probably have, uh, there's probably, you look at children now or teenagers now, they're always looking down. I'm sure they have similar things as well. It's more about not that looking down is the devil. It's that the amount of volume of looking down versus straight and up and everything else that, that the neck and the body can do is not balanced. It just, you just need some balance with it. By no means do we want her to not look at her baby when she feeds. Uh, but we want to make sure that she spends a little bit of time doing something else. Um, perhaps if she's reading a book, if she gets time to read a book or say she's reading her phone, maybe she holds it up a little bit or she does it, uh, does it when she's, um, uh, laying her back and remove a pillow. Uh, I always like to, I know that I'm not a parent and so, but just food for thought is like, I do have a dog again. I look down a lot too for the dog, but, um, I noticed a lot of parents will look down at their baby when they're feeding them and we can use our other senses possibly to make sure the baby's not, you know, going to spit up or choke or anything like that. I would imagine, um, hearing feeling looking down. It's just another sense. Like it's helpful obviously to see what the baby's doing, but also at the same time, like maybe give yourself a break a little bit too, because it hurts and it hurts to be a parent. So we need to make sure that you're saying, you get to sacrifice a couple of things to make sure that you feel good too. Uh, the last thing I should probably, uh, add with, uh, that type of concept of being in the middle, having some balance is that, uh, rehabilitation and recovery from problem in most cases is nothing more than simple math. We're adding things that are positives, such as in this case, we gave her the, uh, the sling and look down type of maneuver, which helps out to give the nerve a chance that's adding positive ones to the equation of life or the equation of recovery. Negative numbers come in the form of doing things that piss it off. So it's just looking down and watching the baby feed, looking down to text message. Uh, maybe she stops reading her phone quite as much right now and just maybe she has Siri or somebody read it to her. Maybe she does a book on tape. Um, maybe in her free time, she starts to take, picking up birdwatching where she looks up. So we're removing the negatives. All we need at the end of the week is a net sum positive number in some form. It could be positive one. It could be positive 10, but we, what we can't have is a negative 10 and say that the treatment failed. The treatment failed because the math is all wrong. All right. It's not that the intervention was wrong. The intervention could have been right. The treatment could have been right.

The suggestion could have been right. The exercises could have been right. The stretch could have been right, but the volume is off. So either what you got to do is increase the volume of the positives or you have to reduce the number of negatives. A lot of times when we give people some suggestions in here, we just, uh, suggest an absurd amount of positives done throughout the week. That way, we don't have to tell them to be afraid of during doing certain movements, like looking down, but maybe then making them a little bit mindful of just reducing the time, mainly because we just want to make sure we get the math, right. If we get the math, right, this person will feel better.

They'll be more open to doing things that we suggest. Uh, we'll build the trust with them. And, um, we can suggest, uh, uh, more of the fun activities that they really want to do. Uh, I know it's the primary goal for most people in shoulder blade and neck pain is to reduce pain, but when it really comes down to it, if, if you were to do anything fun that you could choose to do today, if you didn't have the kid, if you had the time, if you had the time and you didn't, and your neck and shoulder didn't hurt, what would you do? You know, uh, I know one person that they really loved hiking and every time their backpack, uh, pulled down on their shoulder blade, when walking downhill, it would shoot pain into their neck and shoulder blade. Uh, they would probably hike a bunch.

Uh, I have, I have friends who play baseball and have stopped playing baseball because of some of the aches and pains that they experienced. So reintroducing reintroduction into that type of thing into, um, into the activity that you want to do, uh, is what the next step is beyond just pain management. The last thing I need to add in her case is the concept of getting other areas of the body to help. Uh, we call these non-painful dysfunctional regions. Um, that's based upon the, the basic idea of the functional, um, uh, functional movement screen, the FMS screen. You know, you can probably look up, uh, mobility stability model of the body and you'll see, find a bunch of articles on this, but the basic idea is that sometimes areas of the body are recovered are required to do too much.

So they hurt AKA squeaky wheel always gets the grease because of the area, other areas aren't doing the work. And so an area that wasn't doing the work on her also didn't hurt. So she didn't think it was part of the puzzle. And this is why having a team is so valuable because it's very hard to address a non squeaky wheel. It's also not moving either. It's hard to figure it out unless you have someone watching you and suggesting things to you based upon what they've seen. That's what we do here. We just guide people. And so in her case, um, I don't know if you've seen some mothers, um, some mothers have a really rounded upper back. Some fathers do too. And, uh, I don't know if there's something that comes later after because of pregnancy. I don't know if it's because the act of feeding or looking down or always being stooped over, but the outlier here is that the mid-back doesn't really have a lot of extension available at the moment. Now, will it come back? I don't know, but we can certainly expose it to extension, which in this case, we did this to her and all of a sudden all of her pain went away. Doing the, doing the last intervention I mentioned, such as the shoulder raised one took away a lot of her pain, but she still had some pain at the end ranges of movements, especially looking up. And then looking down was fairly clear and, uh, turning left had dramatically improved too. But the mid-back intervention, which was simple, it was just sitting on a standard chair with a high back, not too high, but around the shoulder blade height and just lean back over the chair as if you're stretching your shoulders and upper back. She did 20 reps of that and all of her pain went away and her range of motion came back. So that's going to be part of adding her exposure.

Uh, the rounded upper back and looking down is part of the having kids thing, part of the having puppies thing. Um, but you can combat some of that by doing the opposite. Now, let me make this more confusing for everybody. And I'm going to paint, paint the picture of, uh, we had another case who was kind of the opposite. Similar presentation. She had a little bit more neck pain, but similar presentation. And I only bring up the opposing because I want to make sure that you guys do understand that it's not as simple as just you do this and you do that. It all comes down to figuring out what your body likes and what it doesn't like. And then you can do the, then this and that, uh, we have a YouTube video right now that we're going to clean up probably pretty soon, but it's about sciatica or leg pain. And so we do the three most, um, the three exercises you should not be doing with sciatica. And we start off the video with, you should never, ever, ever, ever do these with sciatica, but maybe you should, because the problem is what helps one person does not help another. And so we have a lot of comments in the video where people are like, I don't quite understand. It's confusing. It is confusing. It's really confusing unless you narrow down exactly why you have the problem and what mechanics are the body likes and doesn't like. So let's paint the picture of this person. This one, by the way, we did via virtual. Uh, I only note that because, uh, it's, it's kind of fun to let me, uh, show people that you can actually get help very quickly by watching somebody, uh, watching one of your team members, uh, or sorry, allowing one of your team members to watch you move. So, uh, in this case, she was not able to come in. Uh, we do suggest that people do come in because we can do more, more testing. Uh, as I mentioned in the beginning with the last case is we did a history, we did movement exam and we did all of orthopedics testing, neurological testing, neurodynamic testing. We did a bunch of testing. We did a bunch of stress testing in the spine and the shoulder and we did all that stuff. But in the case of virtual, you can't do all of that, but it doesn't mean you can't try something either. Uh, we just let them know that, look, we'd suggest you come in. And by the way, if things don't go very well, um, or if it looks like we can't help you, then we'll tell you right away. But for a lot of people, virtual can work. Okay.

I'm sure by now, a lot of you have probably had, uh, virtual appointments of many different types. Um, but, uh, in the case of shoulder blade pain or musculoskeletal pain in general, leg pain, back pain, uh, sciatica, knee pain, foot pain, um, shoulder blade, shoulder, elbow, wrist, all, a lot of these can be managed very effectively by someone who can coach movement virtual and who knows what they're looking at. Okay. So, uh, and there's a lot of people out there. You just have to find one. Okay. By the way, we're always here to help if you need us. So this one, uh, she had neck pain, shoulder blade pain, nothing in the arm, nothing to the elbow, no headaches. Looking down was absolute murder. Looking up was perfectly fine. So this is in contrast to the last person, which looking down was painful, but looking up was also painful. Turning side to side was, uh, okay with this person turning left and right with the other person was not, uh, this person, I had them physically hold their shoulder against their body or their elbow against their body.

Just as in the last case, I had her look down and it did not change. So make sure to note that. So this is something different. So this is something where the shoulder blade does not have as much as an effect on her movement and her pain levels than in the last case. So, uh, in this case, uh, I usually take the approach of just doing something and seeing if it helps. Uh, I know it sounds like a very kind of like gunslinger way of going about it, but I guess you should first probably know that the things that we do, the things that we have people do, which I'll note with this person are not generally going to make like her neck explode. It's not something that will dramatically make things worse. If it's the wrong thing to do, it just won't help is all, or it'll slowly start to get worse, but it'll take over the course of about two minutes or so. Um, there's always stopping points. We always take, tell the person you can take a break, uh, let us know we're on the same team.

Just communicate with us is all, um, Dawne Costantino does these virtually as well. And so, uh, we've seen a lot of people virtually for a neck and shoulder blade. And so we just ask them to communicate with us of if it goes down your arm, let us know immediately. If it starts to kind of ping on your shoulder blade or ping on your neck or it feels stretchy, that's okay. Um, and so with her, we just tried something, um, knowing what to try, uh, just comes from seeing enough people with it. But, uh, there's generally a few things that work well when you just kind of try things is, uh, neck retractions, or we call double chins. Some of you might have seen them in our YouTube videos. We show those as well. Uh, there's also looking up and grabbing the shirt. Um, I'll explain that in a moment.

Uh, or there's the one that we tried on the last case, which was, uh, hold the shoulder and look down. So those are the major three that work well for us, but also to like, so me and Dawne Costantino were talking about this recently. I'm sure we'll do another podcast on this is that, um, low back and hip stuff is way easier to just, if you just blindly sent the person a video and they followed the instruction in the video, they might feel better. They'll probably feel better. Neck and shoulder blade sometimes is a little bit nuanced, uh, manual, uh, like a manual assisted manual approach to some of the same exact protocols, uh, that I'm going to talk about are more so needed because I actually, I don't know why, but it seems like more so people respond quicker and, uh, we have a better measurement tool on day one of what to do when we help them manually go through some of those movements. So, uh, the first one is we call them double chins or ugly faces. And so you just slide your chin back into your head. Like you're doing double and triple chins. The YouTube video we have covers this. If you're looking for the YouTube video, just type up a shoulder blade pain performance place. You'll probably see Dawne Costantino right there. It's like a three minute video. And so, uh, we've been, we usually have people sit on a chair and do this and they do it about 20 times or so. And we just kind of shut up. Um, sometimes they'll say, well, it feels tight on the back of my neck. Is that normal? And we say, yeah, it's completely normal. Uh, sometimes they'll start doing it weird, like to look down or look up. And so I'll usually say, imagine your chin is on a pane of thin glass.

Don't break the glass. Don't take it off the glass, slide it off of the glass. Meaning don't look down, don't look up, just slide it back. Okay. That usually works pretty well. Um, so we haven't do it about 20 times and we just haven't retest whatever movement was painful for them. In this case, uh, she did not respond or she didn't, she didn't, didn't feel really good to look down. So I just had told her to go and look down. And so she's like, oh, that's way better. Um, notice that she's telling me it's better. I'm not, I'm not committed either way. I don't, doesn't really, I'm not biased giving her this one versus another intervention or another first way or another way to, to modify pain. Um, I just need to know the information. We're playing Sherlock Holmes. We're Sherlock Holmes and Watson. She's Watson. I can't gather the information that she gave me unless she gives it to me because I don't know how she feels. Um, we can obviously measure ranges of motion, but she's going to know pretty quickly if she feels better. It's probably the easiest measurement tool. And this is how we conduct most of our, or pretty much all of our examinations and treatment approaches. Let's do what, what makes you feel worse. Go ahead and do it.

Let's try this and do that again. Hey, it's way better. Good. We're on the right track or it's not better. Okay. Let's try this instead. Now, if that didn't help, then we might have her do the lookups. The reason is because looking down is painful. And it was, we mentioned earlier, just finding some nice balance in life. Just looking up sometimes is very, very magical. It's just better. And so we have her look up 20 times. And I, a lot of times I'll have them hold their shirt or their jacket on the sides as if they're trying to pull down their, their collar and just have them look up and try to almost see the wall behind them. Uh, in her case, it was absolutely pain-free to do this, um, in the examination, but, uh, I didn't really have her do it for a treatment because the double chins worked so well. I want to, I want to re rephrase that one more time is she did one thing. A lot of times we have people buy, uh, sometimes our, uh, programs that we have online or they'll come in and see us in person and we'll try multiple of what we call first aids. First aids are helpful, but most people only need one. And so we've had a lot of people who try to, they, they try to do all of the first aids and then they have haphazard success. And then when they come back, it's like, well, what did you do? Well, I did this, this, and that. Well, I really, we only need you to do one. Yeah. But I thought doing more would be better. It's not doing the thing that makes you feel better now and later will make you feel better. We believe anyways, or at least it's the first thing we want to check.

So, um, she, the, the, the lady in this case, uh, she did that. I watched her virtually. It looked fine the way she was doing it, her looking down improved dramatically. And so we deemed that was going to be what she was going to try for the next week or so, by the way, I should probably know, I haven't seen her since we, um, did this session anyways, but I, I have no reason to think it will go negatively. My expectation for her would be that she probably improves her, her neck discomfort improves probably by about 50 to 75% in a week, but also she wants to work out and do other things. So we got to plug some exercises in. Uh, I took the liberty to actually give her some exercises, which in the other case I did not because, uh, it, it was, uh, I forget why actually now I think about it, but this, this person in particular did ask, what else can I do? And so rather than giving her more first aids to do, I gave her some corrective exercises, which might help out to support the area. And, um, I did give her the disclaimer though, that because her neck was so sensitive and so acute, uh, it might be best to just do the things that feel good now and later for a couple of days and then plug in the exercises that we might do. And so we did the exercises.

She looked fine doing them. And one of them was called a kettlebell halo. It's a half kneeling kettlebell halo. If you don't know what that is, we probably have YouTube videos on it. Uh, and it's certainly in the guides that we have. It's one of the videos we go to very commonly when people are dealing with, uh, in this case, a cervical disc herniation. The last person was a pinched nerve. This one was a cervical disc herniation. Uh, neither one of them tend to need medication, surgery, or, um, injections of any type. I should mention that again, because it's really common that people think that. So I just want to make sure to kind of shove this one down the throat a little bit. Right. And so, uh, she did kettlebell halos. And the reason why kettlebell halos work so well is because we're using the shoulders to move independently, greasing the shoulders up while we're letting the neck remain stable. In this situation with cervical disc herniations, a lot of times the neck is doing too much movement and it just likes a little bit of stability.

It likes a little bit, a little bit of support, a little bit of muscular support from the sides. And so holding the head straight while the arms move around it work well because the arms and the shoulders moving around it tend to try to drag the neck out of the centered position. And then the neck muscles have to fight it. And so it's a really simple way to add some neck support while they're, they're still in the chin tucked position, which in this case helped her. The other one we tried to is called a low bear. It's derived from, uh, the methodology called DNS. Uh, you can look up, uh, low bear. If you want to on YouTube, we probably have that as well.

And so low bear and halo are the ones that we typically go to, but going to too soon can create some problems. And so low bear worked really well with her. Uh, she had zero pain doing low bear as well until we went to too much, uh, uh, too much time. She went to about 15 seconds of holding the low bear, uh, which is, uh, which is usually most people can do that. Most of you can hold it for about 30 seconds or so, but for her, it was too much too soon. And so we did a little clusters of three seconds to two second break, three seconds, two second break, just finding the position and just getting into the effortful, uh, part of the exercise. Um, I, she asked, should, should I do this at home? Should I do this today or tomorrow? Uh, and again, reiterating, do the simple thing first. Uh, a lot of times I feel like people are a little bit afraid of getting behind in some of their activities or exercise, but taking a couple of days and just doing simple things and doing something else like walking and bird watching or whatever, getting outside, just general movement that doesn't hurt, but also not is very, is not very specific. In addition to doing the first, to doing the first aid exercise that we deem is useful is probably that this is the most useful thing possible. And you don't necessarily, uh, get a lot of, um, fallout. You don't get a lot of, uh, thing, negative repercussions. It might come from doing the exercise poorly. Uh, again, the exercise can be too soon. It can provide that negative math. So we're adding more variables in. There's some people we sent home simply that have shoulder blade and neck pain that we just give them one thing to do. And it's dramatically better. We have lots of reviews on our, on our Google, uh, on our Google page that, uh, there's one of them in particular I can think of that we give her one thing and she was like 80% better overnight. I got an email the next day about how good it was and she'd been dealing with it for like three months and she didn't, uh, she came in person, but we could have known virtually as well. Um, but she'd been dealing with it for like three months cause she wasn't able to go see anybody. And so finally, finally she reached out and, um, it was like 80% better overnight. Um, I actually, I was actually surprised it was that good. Um, but she wrote to me an email about it. I'm like, Hey, you know, it's a really good story. Can you post that? Can you post that? So, um, and cause she was so excited and I was excited to see that it works so well. I'm always very surprised that these simple things work. Um, and it's the simple things that work very well. I've found, um, it's really bad for business. It's bad for our business because we don't need to see people quite as often. We don't need to see people very long, uh, unless there have extravagant goals of doing more weight training and being professional athlete and, um, pushing their body to the limits. In that case, we have to do more reversing the adaptation that got people there. Um, and that's a little bit more strength and conditioning, a little bit more of corrective exercise and just the body doesn't adapt overnight. Pain can come and go overnight as you kind of seen with these cases, but the adaptation occurs over time. Uh, there was a mother that came in with her son recently and, uh, they said, what do you think I, what do you think he needs to add to make it? So this doesn't come back. And, uh, he was a soccer player too. And, uh, I said, I think he should see us trans conditioning coach twice a week, uh, especially probably off season, but maybe once a weekend season, but you know, multiple times a week for the remainder of his career. And it's not that it's going to, you're going to do stuff. That's just bad exercise or, you know, only doing simple things like he's going to get challenged. He's going to get strong. Uh, and a lot of times just doing good strength conditioning can help out with reducing re reoccurrence. At least that's my belief because we're reducing the adaptation that went the other way. They got them there and then we're pushing the adaptation of muscle bone ligaments, tendons, uh, neurological systems, software patterns, movement patterns. We're pushing everything back the other way.

And as you probably seen by, uh, Jacqueline looked really good until he died. Like he was still very muscular, you know? And so he adapted at least muscular wise, adapted to a very strong muscular individual. And that stayed for a long time. So he pushed the adaptation so far one way that it took him a long time to go back and become, he's got more to lose basically. And so, um, I guess I got a tangent off there, but if you're only looking for pain reduction, it shouldn't take too long. Most people, whoever you're, wherever you're going should be reasonably be able to help you in my opinion, or at least in my experience of working with people with it and Dawne Costantino's as well is about two to three weeks is enough time to, to see that things should be reducing by about 50% or so. If you're not hitting that mark, or if you're at least you're not going that right direction, you might have the wrong diagnosis, the wrong approach, the right, the wrong treatment plan, or just simply the math is wrong. Like there could be, there's something not happening. There's something not, that's not right. Uh, and you might have to find something that's just more productive. Once you get away from that, then you can go to the strength conditioning, the corrective exercise and generally the fun stuff.

Like the cool thing is at least if you're an active person, you like being physically active, the quote unquote, keeping the pain away approach is just fun stuff anyways. So it's really not a big problem. Uh, all right. I hope that was helpful to you guys. And I want you to subscribe to the show. Please do because we have more podcasts like this coming. Um, if you're a clinician, again, I'll remind you that if you want the clinical part, not just the, um, boiled down version that's all available, it releases every Monday on the premium version of the podcast. I share, um, with patient privacy. I share all the orthopedics tests. I share fun cases, cases I could have done better with, uh, cases that, uh, I, I, uh, I, we boil it down. We boil it all down to make it, make, uh, help you guys make better judgment calls. If you feel like you want to improve to some degree, uh, we're learning all the time as well. I should probably mention that I want to act like, uh, our office or normie is a know-it-all. We, we just very certain with some things, but we still learn stuff every week. And when our interns come in, they teach us stuff as well. Uh, so, uh, if you guys want help from us as clients, you can reach out to us at info at p2sportscare.com. We do have people to fly into. Uh, I know it sounds absurd, but people do fly in to see us. So you're totally welcome to do that. And that'd be the best case scenario. Uh, virtuals are possible too. Uh, just contact us and let us know what you're able to do, or if you need to maybe help, uh, uh, uh, have us help you find someone local, we're willing to do that as well. We're here to help subscribe to the podcast. I'll see you guys next time. Thanks for being part of the movement movement.