Achy Shoulder Blade Pain: Five Myths That Keep You Stuck

And when I have people who are stressed, sometimes I say, look, what happens when you go on vacation? And they say, look, I went to Hawaii, I was laying in the sand, I was playing in the waves, and I didn't have any shoulder blade pain whatsoever. Really? Cool. What happened when you got back? Oh, it came right back. My life is so stressful. Now, in this case, I like to talk to them a little bit more about what is a way to de-stress for them, right? Do they need a Mindspace app? Do they need to go walk in the park? Do they need to go to the beach every day, you know, for a little bit? 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, everybody, it's Dr. Sebastian Gonzales, your host for the Restoring Human Movement podcast. Thanks for joining the Movement Movement. If this is your first time on the show, welcome. You're going to spend about a 45-minute to hour-long format of me really helping out, hopefully improve the clinical experience for patients to understand what's going on, but also get better quicker. I believe that, I mean, I know that there's a lot of people, there's a lot of patients that don't understand what the heck their doctor is talking about. And because we have another language, we have another language we learned in school, and we never got broken of stop speaking that language sometimes.

So, we're all hanging at a bar, and we're having a beer, and you know what, screw it. Today, you're having a Mai Tai. You're an audio technician who has decided to pick up Mai Tais this month. I decided to go keto, and I decided to get tequila, which is, I'm going to go with the Añejo today. And the other doctor went with the Reposado. He decided he didn't want to be keto unfriendly and teasing with a beer, so he decided to get that. So, we're all hanging out, chatting about problems, about clinical problems, and how to rehab people, all right, and how to feel better. So, it's kind of what this podcast intention is.

Today, I'm going to cover one of the audio tools that I use with, as I've come to find, is that sometimes people aren't always ready to actually make the jump and come in and see me, or see us as the healthcare provider. And so, there's a lot of beliefs that they have that might or might not be true, that they have not been able to debunk, and they keep going down the same route of having the same treatment done. And sometimes they'll even call in and say, hey, look, I want X, Y, and Z done. And you're like, hmm, I think I could help you, but I might not do those. And so, this is an audio that I've actually offered people who have called me, as well as people who reach out on Instagram, social media, and say, hey, do you have one exercise for this?

What do I do for this? I'm like, well, I don't know what you do for that, because I haven't examined you, but you should probably listen to this audio. It's probably a good way to start you on the right track. And so, you'll hear the shoulder blade version today. I also have one for other types of conditions that I've targeted a little bit more, and I feel comfortable talking about, that are very, I don't want to say unknown, but they're trouble points for a lot of people. And so, I'll cover that today. Usually, in the past, they've been about 20 minutes, but I've expanded them to about 40 minutes because I've found out there was other parts that needed to be done for people to actually take an actionable step in and seek care.

So, if this is also your first time in the podcast, I tend to share a little short story about myself to help you understand a little bit more of who your host is. So, hopefully, you, like me, and hang out a little bit and learn more. Before we get into that story, I should actually say that last month in December, since this is the first one of the year, Happy New Year, everybody. This is the first one of the year, and last month, I did a month of giving back to all the listeners. A lot of the listeners are student clinicians, as well as young doctors, PTs, DCs, ATCs, strength coaches, and so I thought I'd give back on the only way I can, and that's probably with knowledge.

And so, I, for every week last year, I gave away videos of the related topics, examination, clinical pearls, tension, weightlifting cues, and so on. There's a lot of great clinical gems in there, and so it was really challenging to me to put all my thoughts together on paper and then present them on video. So, you'll see everything on video if you go through there. There is a little bit of an email opt-in with it because I'm not going to email these directly to people. I need to automate it a little bit. So, please go through there, and you'll get all of the things for last month. Probably start with the one that's hip, all right?

That's the first one of December. That's where you'll start to get the related information first. If you think you're going to get the deadlifting one first, you're not. You can listen to it first, but you won't get that information first on the email correspondence. Got to make my life a little easier. Let's get to that story. We'll get right into the show, okay? So, over the last month or so, actually, this was in the month of, not November. What's before November? October. October, I decided to challenge myself and only restrict certain activities for certain days, for the certain amount of days of the year, or of the month, anyways.

And so, during the month of October, I decided to only do four days of any alcohol touching my lips of any type. However, during those four days, I can have as much as I really wanted to. I mean, I could get blackout if I really wanted to. However, it was interesting because I found that I actually did only three days of any type of drink. And on the days where I had any types of drinks, I actually had, I opted for beers because I like beers. And I actually took ones that were actually lower in alcohol. I wasn't going to rush it, you know, and try to, like, jump in there and get trash or anything because it was, quote, unquote, the day.

But it was interesting because I think, in my opinion, I think as we start to, if you want to improve yourself, you have to challenge yourself and put yourself in a little bit of an uncomfortable situation. And so, I've always had the thought that, you know, after I got to about 25 or so, I realized, you know what, I'm an adult. I can go home and have a beer if I want to, you know. I can do a, quote, unquote, nightcap. I can do whatever I want. And so, I decided to actually challenge that a little bit and say, you know what, you could do it, but you can only do it four days this month. And so, I found that on the first day, I used it.

I used one. And I said, oh, shit, I got about 30 days left of only doing three now. And actually, again, I only did three of them total, so I was still under my quota. But it was an experience. And so, the month after I actually expanded it, I went to four days of anything I wanted to, and then four days of a single go-home-and-have-a-beer type of thing because I like to taste the beer. And I actually found over the course of the first month, I slept better. I didn't feel, I mean, I didn't feel dehydrated or cottonmouth or anything like that because you have the ADH stuff and, you know, you're not peeing all the time if you're drinking.

And I found myself much more productive as well. And so, I'm not going to say I'm an alcoholic or anything, but it's normal practice sometimes to just, like, imagine if you had coffee every day. Stop doing coffee about five days a week and just see how challenging that ritual is. So, as it becomes a ritual, I think it's nice to challenge it. So, if you guys are interested in taking that challenge with me, it's challenging, all right? And it doesn't have to be the thing that I did. You just pick whichever one that you want to get better at. And so, if you decided that you wanted to add something or take something away, it's totally your call.

So, anyways, that's how I like to challenge myself sometimes. And, yeah, check that out. Here we get to the show. Hey, thanks for joining me. I'm Sebastian Gonzales. I'm a doctor at chiropractic. I've been there for about 10 years or so now. I thought I would share a little bit about my experience with achy shoulder blades. And I've had personal experiences with it. I've been in practice for about 10 plus years now. And I found a lot of things which seem like they didn't work as well as things that did work. And surprise, surprise, I'm not going to tell you that actually adjusting is going to help everything.

It'll help some things in this if you want it done. But I have a lot of people who come in who are not open to doing something like that, which is perfectly fine. I thought I would address that head on here because usually the stereotype we get as chiropractors is people tend to call and they think that's the one thing that we do. That is the public's perception a lot of times of what our profession only does. And I just want to let you know that's only a small part of what we do. Now, when we're talking about achy shoulder blades, I think there's a lot of beliefs that people come into the office with.

And a lot of times people will tell you what they've tried, what they believe it is, what they read on the internet, and so on. And not all these things are necessarily wrong. They're just a very small part of the story. And as I like to tell people is if you have not figured out the actual problem, you can't apply a solution. Or sometimes the solution you're applying is to the wrong problem. And so a lot of people who have come in are just unknowingly doing solutions to the wrong problem. And I don't blame them with this. I know that I've had personal experience with one achy shoulder blade, and I'll share that story in a few moments here.

It's a natural progression of just people kind of feeling what their body's feeling. And a lot of times they'll need a guide to help them through that. And I thought this audio would be helpful for everybody to understand if they have not been through this before, maybe get them a leg up on the situation and understand the things which might or might not work and in what situations. So I like to call this podcast audio the five myths of the achy shoulder blade. And I'll cover the five myths here first just in more of a bullet point fashion. And I'll cover each one individually in their own right to come.

The first thing is a lot of people come in saying that the tight muscles of their shoulder blade or between their shoulder blades are actually the cause of the problem. Number two is that the knots are normal for them, and that's what's causing the problem. Number three is it's stress-related. Number four is that adjustments, massage, stretching, and other forms of passive care, meaning things that people do to you, are actually needed for you to get better. Number five is that I need an image because I'm worried about what's in there, and we need to really figure out what the root cause is. So all those things, all these myths, notice that I said always on a lot of them or is always the cause is because just like when I'm talking about the other possibilities of things today, it's not that everybody truly has one fix or one solution because, again, everybody has different problems.

Now, we can generalize and say that some of these things are like if you put a gun to my head and I said, hey, and you said, hey, what's the cause of achy shoulder blades? So I would tell you my best percentage guess, but I'm probably wrong about 20%, 30% of the time because you didn't allow me to have a second guess. So there are things that are the higher percentage reasons for it, and in my experience, tight muscles and knots are actually not it. It's actually more of a low percentage reason if we were going to take a gamble. Now, my personal story with an achy shoulder blade is actually probably about less than a year or so ago now.

I've never really had major neck pain or headaches or numbness in the hand or anything like that, which, by the way, if you guys are experiencing some of those types of things, numbness in the hand especially is a good indicator that this is not a muscle problem. It's more of a – we have to consider the nerve-based consideration. And so a lot of times the nerves will actually trigger a muscle to become tight and feel tight and become knotty and so on. So those are, I guess, some kind of jumping into the part one and part two myths. Either way, though, so I was at my gym working out, and so I decided to do pull-ups.

And so I did about six, seven pull-ups per round, did about three rounds of this or so, mixed in with other things. Sorry, clearing my throat today. So after the last – it was the last round of pull-ups. I went about three, four pull-ups, and I felt this twinge in the right side of my shoulder blade area. It was kind of between the shoulder blades, but more so to the right, and it felt almost like it popped kind of. It was just a little click that happened. And I thought, oh, man. Okay, so I'm going to take a little break. And so I decided to not continue my workout. And over the next couple days, laying on my back was painful.

You know, it was very uncomfortable. It was probably about a 4 out of 10 pain. It was just kind of like – it wasn't like I couldn't sleep, but it would wake me up. You know, it was like rolling around in the area. It felt like it was irritating. I felt like I needed to stretch my shoulder out. It was an area that I thought, you know what? I think I'm going to get my girlfriend to maybe rub it, massage it. We actually have some silicone cups at home, which are kind of the press, and it kind of grabs your skin variety. And it feels really good on some things. But so we went to that, and it just wasn't really making any change.

Probably for about a week there or so, it was really uncomfortable, and I was just kind of thinking, well, I'll let this thing settle. I'll let it go away on its own. So it really didn't that much, you know. I continued to ask my girlfriend to do some massage. I ended up getting some adjustments from some of the interns at the office and even some soft tissue work in the neck. And so a lot of it helped a little bit. Like in the moment, it felt really good to actually get my shoulder blades and levator scapula and upper traps rubbed. It felt really good. And I remember one time one of the interns, he did some work on me, and I felt good for a couple days.

But it eventually did come back. And so this is the experience a lot of people have. It's not that it's a bad thing. It's just, in my opinion, for myself, it was just incomplete. And so this was going on for like two, three weeks here or so. And finally, I mean, it had settled a little bit. It was getting better. But to live with this type of thing, I was probably going to drive myself insane, you know. I'd probably feel like I wanted that relief that I was looking for that I had gotten after that one intern's work. I would want to go back probably on a biweekly basis. I'd probably go twice a week if I knew that after you were about, that it would last a couple days.

Because four to five days a week of relief is better than nothing, you know. And in the past, I've never really had, again, any headaches and shoulder blade pain and so on. And I've spent a lot of time using my shoulders. I've been a baseball player for years. I'm 38 now. And so I've been playing baseball for years, and I never really have any shoulder problems. So it was kind of foreign to me. Like, I've beaten up my shoulder, and it has not been a big deal. I've lifted weights. I've gone overhead. They've been fine. So it was just kind of foreign to me to really have that type of pain in that location.

So finally, I took it upon myself to just sit there and think. I'm like, I'm just going to keep ignoring this thing, or am I going to do something about it, you know. Like, because a lot of times at my office, we'll get people in who have tried these same interventions and have seen very much the same story that I've had. It feels good for a little bit, and then it comes back, and it kind of feels like at some point that's just the norm. And for me, it's not the norm. And that was, again, about, it was less than a year ago. So it's been six plus months now where I've not had any shoulder blade ache whatsoever.

It's been great. I've been able to return to pull-ups. I've been able to do overhead pressing. I can deadlift. I can throw. I can run. All that stuff's fine. No problem sleeping. I sleep like a rock now. So what I decided to eventually do was treat myself like a patient, you know, and give myself an opportunity to decrease the symptoms with something other than stretching and something other than massage because a lot of times it tends to work. And so it really comes down to figuring out what is driving this bus. Like, I imagine there was a movie Speed. It was Keanu Reeves and Sandra Bullock. And so they were driving, right?

And so if Sandra Bullock was, she was the driver. But imagine if the driver was, I don't recall, say it's on a remote control. Like, it doesn't matter if Sandra Bullock passes out at all. The bus is still moving. And so whatever's driving this bus to continue, whatever's driving this pain and this discomfort to continue needs to be slowed down. And then so I was addressing it like knots and tight muscles. And I didn't necessarily think it was stress-related because I'm usually pretty chill. But I didn't really look at the other stuff because I just wasn't of the mind of it. I've always told people it's very challenging to be a patient.

It's challenging to have something because sometimes you're way too close to the problem to really understand the bird's eye view and just look at everything kind of in an objective way. So finally, I did. And I would not suggest for anybody to really manage it all on their own. But I decided I'm going to try this myself. And so we call it doing a trial of care. So what I did was I treated as a cervical spine disc irritation, which a lot of times refers down into that area. If you Google C5 disc irritation or let's just say C5 nerve referred pain pattern. If you Google that, you'll find a couple nice pictures which show the shoulder blade becomes really irritated when one of the nerves is irritated in the neck.

Now, what's driving the irritation is, again, who's driving the bus. It could be a disc or it could be just stenotic change or narrowing of holes or just something else pressing on the area. It could be a couple things. However, based upon my gun against my head guess, I took the disc because it would make sense with everything else I was experiencing. So the intervention was do a handful of exercises that are easy exercises. You just have to remember to do them. About 10 reps every hour that I was awake. I wasn't able to do them all, but I did a lot of them. I remember I pulled up to a friend's house in the afternoon.

I'm like, I didn't do them all. I'm just going to stand by my car and do them. And so you look like, you look kind of weird doing them. And so I just stood by the car and did them. People were getting out of their car around me, probably thinking I was a weirdo. And I did them. And so surprisingly, after that day of doing about 150 reps or so, I was probably about 50% better the next day. And I can tell you with all honesty, I didn't wake up at all that night with sleeping. It was great. And I thought at that moment, I was like, dude, why didn't you just do what you do with people? You know, just don't go with the muscle tightness or the knots.

Don't go with the trigger point and the stress-related types of interventions because they're not a high percentage win. So you might be wondering what that exercise is. It's a little bit hard to describe here. But however, a lot of times people's chin jutting will increase it. And I probably, if I had to guess, my chin jutted forward a little bit when I was doing a pull-up. And so I just had to, I'd probably irritated the disc. Now, the five days that I experienced after, it's a normal thing. Like, it's a thing like a cut. There's a normal inflammatory period that has to happen, you know. It's just irritated.

It's hard to speed up. It's uncomfortable. But it doesn't mean I have to pick the scab anymore. And I was typing a lot during that time. I was writing articles for the website and, you know, writing scripts for, little scripts for things like this or outlines anyways. By the way, it's in scripted. This is off the cuff. But I do have the five points now. So I was creating a lot of content for you guys. And sitting tends to drive this type of thing. So I decided at that point that I wanted to create a guide. I wanted to create all these little guides for people who are suffering from these problems and really not understanding why.

And I thought addressing the myths here is probably going to be the easiest thing. And I do suggest that everybody go to someone who knows what they're doing. I believe that every clinician who is competent in the area of your concern is going to know beyond a reasonable doubt what to do with you. And I can tell you, with all honesty, I'm really bad with gastrointestinal problems. I'm not going to be good with talking about diet with you. I'm actually really not good with working with ankles and feet. But I'm really good with hips and shoulders and low backs and necks and some of the stuff down into the extremity.

I like working with knees because I feel confident in recommending for them. And also I feel very confident and competent in examining them. And so when someone examines you for this type of thing, it's probably going to take more than 15, 20 minutes, especially including taking your story and everything. Even if they're very quick, it's going to take more than 15 minutes or so because we have to screen out all the things that it could and couldn't be. Like I said earlier, it's about percentages. All right. So we're figuring out where all the data lies in your exam and then we can recommend accordingly.

However, similar, kind of on the thread of doing this myth audio, I believe everybody needs to have a little bit of a meet them where they're at type of thing. And I think that you guys should be educated about what things could and couldn't be. And when you find the right solution to your problem, you're going to be off to the races. It's going to be fine. Or in most people's cases, I guess I can't promise it will be fine. But in most people's cases, it goes very well. And by going very well, I mean that you feel much better within a week or two. Remember how my situation went. I felt way better.

All right. So if you guys are looking for a guide in this type of thing, I am available if you need me. I'm in Huntington Beach, California. I'll mention where I'm at later in the audio. But just know that I'm around. I can help. All right. Although you're listening to this and you're thinking dude's like, you know, three hours away. You can totally come in. All right. If you're suffering through this thing and you can't find anyone local, just come in. All right. Now, on to those myths, we have number one, tight muscles are the cause. So tight muscles are the cause is number one is they're not always the cause.

And I think the percentage of time is I'd say I'm going to make up percentages here because I'm going to have to go off the cuff. 25% of the time, I'd say maybe. But definitely not a majority of the time. Now, tight muscles are oftentimes a guarding effect. And I like to use the analogy of people playing chess. And so the nervous system, so the disc, the spinal cord, the nerves that go out into the arm, they are, they're kind of like playing, when they play chess, I forget who the, is it the king? The king is the one you got to knock down or is it the queen? For some reason, I thought it was the queen.

Either way, king or queen, whatever. You don't want to get those taken. So you'll easily throw a pawn in the way. So the pawns are the body's way of protecting against further damage. And tight muscles are a way to actually, although it's painful, the tight muscles will sometimes guard against further damage of other areas. In this case, let's just say with a, with a nerve being affected out into the arm, sometimes that numbness and tingling that people have, it actually increases when they bring their shoulders down. And I know a lot of people will say, well, I'm always stressed and my shoulders are up in my ears.

You know, sure, your muscles might feel tight there, but your hand might not be numb. You know, if you push your shoulders down, your shoulder, your hand might become numb. Now, considering the hierarchy of protection there, the nervous system is a little bit more important than that muscle is because if the muscle tears or a bone breaks, those things will heal up pretty good. But if you tear a, tear a nerve, you're going to be in trouble, right? I know that I've met a couple of kids who have played high school football and developed stingers. And so they, they hit their shoulder on someone, hit their shoulder pad on someone's body and their arm literally becomes dead for a little bit of time.

And so they're, they, that's a neuropraxia. It's a, it's a stretching of the nerves in the brachial plexus area. And so it, it, it shuts down the arm. And so the job of the body is to protect the nervous system first. Now, intervention of these, uh, to improve how these nerves are feeling is not, it's not, it's not very challenging, but it's not the, it's not the same solution as, as tight muscles. Remember, the shoulder shrugging in the, in the tightness you feel in the shoulder, shoulder muscles, like the upper trap and the levator scapula and the, all that area up there, a lot of times they're working really hard to help keep the shoulder elevated.

If the shoulder is not elevated, it'll compromise the nerves maybe because they'll be stretched a little bit beyond their tolerance point. Now, taking that protection away, taking that pawn away, exposes your king or queen to being taken, right? And so sometimes massaging the areas, yeah, it feels momentarily good, but you know, the body's not dumb. It says, you know what? I'm going to throw a different pawn in the way. And so it just tightens that area back up, which brings out the whole, like, I keep getting things done, but things keep coming back. If that is the case, then maybe we have to consider the possibility there's something else which is driving the bus.

If the tight muscles were driving the bus, which they can be sometimes, um, uh, stretching it and massaging it are going to work. As I tend to tell people is, if it's going to work, it would have worked already, all right? If you spent three months doing that, even like a month or two doing that, and it's not working, it's not working, all right? The, what do they say? The definition of insanity is doing things over and over again and expecting different results, all right? Switch gears a little bit and, uh, have your healthcare provider examine other things, um, if they haven't already, or just, uh, communicate with them and say, look, this isn't working for me.

Sometimes people tend to drop off a care, and actually this is probably more common than we think, is they say, well, I went to Joe, uh, Joe massaged it three times, or, uh, you know, but, but it's not working, so I just left, I didn't call back. Now, I'm not going to say, um, I say Joe in this case is that Dr. Joe, he, he was probably trialing care, all right? We trial care to see what the effect is. Now, I'm looking to see, when I intervene with somebody and I give them a suggestion to do at home, I want to see, does it improve it or not? And so that helps gather information from me to guide you further.

This is a relationship. This is a team. And so, we are working on improving what you're feeling and feeling, uh, improving comfort and getting relief. However, you have to communicate back, and so if you just ditch out on Dr. Joe there, Dr. Joe does not have the information needed to actually help you further. Now, if Dr. Joe keeps doing the same thing over and over again, then I think we're running into maybe a little bit of a problem here, uh, and in that case, maybe he isn't getting the communication he needs to actually switch gears, or maybe that's the only tool that he knows. Either way, I don't know the situation maybe that you're in.

However, um, when people are able to get better, they tend to get better over the course of, in my observation, in about a couple weeks, you should have significant improvements with leaps and bounds. Now, people have, um, uh, other confounding factors with it or comorbidities. So, when, so let's just say someone with a nerve-based problem, if they're diabetic, it slows it down. If someone has endocrine-based problems or, um, thyroid issues, it slows it down. If somebody was, uh, overweight and overweight was a aspect to their problem, it slows it down. So, those are things that, that your healthcare providers should be talking to you about if they're related.

If they're not related, just like posture, they're not always related, they're not related. All right? Sometimes they're related, other times they're not. Hey, everybody. This is a pause from the show. All the information, everyone needs a brain break at some point. So, let's brain break this with a little story. So, last year, I put on a couple workshops. Workshops were chill, super chill. I wanted to, actually, in the CEU one, I wanted to just have some beer and just everybody just drink while we're doing it. Not sloshy, but just, you know, chill. You know, just chill. But you couldn't do it because it was CEUs, or at least I don't think we could have.

But anyways, we didn't do that. So, I wanted everybody to get together again for a couple workshops this year. Just a really good bro-down sesh. I'll do all the curriculum, and the workshop is called Putting It All Together. A lot of times, students will resonate well with this. They're like, we learned so many tools in school, but we don't know how to use them. And we go to these workshops, but we don't know how to use them for certain cases. I get it. I've had many interns over the last couple years, and I hear the same story over and over again. And if you guys are going to start your own practice, you need to figure out your own way.

If you're in someone else's practice, you're probably going to practice like them because they're hiring you. But either way, though, allow me to put some pieces together for you, and we're going to do a case-by-case basis. This is going to be hips and knees and shoulders and backs and spines and referrals and blah, blah, blah, all that stuff, okay? Now, for docs, there is a doc version. By the way, student version, there is one day. It's May 30th. It will be capped at 20. The doctor version is going to be two days because we got to do this CEU thing, okay? So we're going to do 12 hours CEUs, California, April 25th and 26th, both times, students and docs.

We will have a badass barbecue after, okay? Everyone had a chill all the time. Everyone is out there kicking it in my garage until about, I want to say, like 7, 8 a night last time. Good times. So, and we ended at like 4 or 5, I think. But for docs, I'm not going to force my way of practicing down your throat. We're going to see how we can patch this into what you're already doing, okay? And that's the biggest takeaway I can say with this. And so I want to make your treatments more efficient and give you some good framework of where you can patch in certain tools and corrective exercises and then loaded exercises within the people you already have to get them better outcomes.

So reach out to me on Instagram. That is performancehb. Or email me, which is better, seb at p2sportscare.com. Look forward to seeing you guys. Now back to the show. Knots are always the cause. It's myth number two. Knots are, I remember speaking with a lady that she was convinced that the knots were normal for her. I think the knots are a more of an adaptive change, you say. And so if you remember the era of Arnold going into Arnold Schwarzenegger, going lifting weights, getting big old muscles, right? Like probably every high school boy goes in and like lifts weights for about a month and says, oh man, I didn't get bigger.

The kid who lifts for about two years gets bigger, all right? So muscles will adapt and the body will adapt. Bones will adapt. Just like with osteoporosis, weightlifting is a assisting thing. It helped build bone density. The muscles and body will adapt. And they don't always adapt in a favorable way because if you've been using those upper trap muscles for a long time, then those muscles have also been worked out extra for a year. You've been doing the Arnold pump for about a year or so. And so sometimes that adaptive change will happen and it'll feel like those muscles are quote unquote bigger.

And it might feel like there's little areas in there that have knots. Now, knots, number one, I guess to address this head on is knots are not always painful. All right? I got a big bicep. It doesn't hurt. Knots are not always painful. Trigger points are actually people who have areas that are knotted up and feel like they have trigger points. Again, the trigger points are not always painful until you touch it sometimes. And it's just touching an area or pressing on an area is not always a reflection of a main cause. Yes, pressing on an area can hurt. All right? I can probably press really hard on your thigh, but it doesn't create your headache.

And so it's not necessarily a root cause of the problem. Sometimes pain is just pain. Pain is the body's natural alarm system telling you to stop doing what you're doing or at least change things a little bit. If I was stepping on your leg and you had no pain response, you'd let me keep doing it. And at some point, I'd crush everything under my leg, under my foot. So understand that pain is normal. It's not—prolonged pain is not necessarily a good thing. But pain as a communication tool is actually not a bad thing. However, don't miscommunicate pain in one area as being the cause of your problem.

In my opinion, or in my experience, knots are—they are more of a issue when it comes to chronic cases. If you've had something over six months or so, then yeah, knots might be an aspect to it. But usually, in the case of, say, my shoulder blade, when I was doing those pull-ups, if I felt knots in there, those are probably not related to my problem because it's fresher. Most people, I think, fare much better when you—when they do an intervention which is quicker, all right? We don't want to get to the point where the muscles have adapted in that fashion because it's a little bit harder to dig yourself out of that well.

So what we're looking for is mainly to address these things head-on very quickly. It's very normal for people to kind of stall things out a little bit for a couple weeks to see if it goes away. I get it. I did the same thing. However, after a month or so, it's a nice idea just to get in with it, all right? Just get on with it. Let's get it done. And let's get you to feel normal again. The third myth is the stress myth. And I don't want to say stress doesn't have a part of it. It definitely can. The analogy that some people use is that your body has like a red solo cup, and once your solo cup overflows, then we have problems, all right?

Whatever you fill a cup with, with stress or muscle tension or knots or poor movement, poor posture, whatever you fill it with, can be associated. However, it's not always. And when I have people who are stressed, sometimes I say, look, what happens when you go on vacation? And they say, look, I went to Hawaii. I was laying in the sand. I was playing in the waves. And I didn't have any shoulder blade pain whatsoever. Really? Cool. What happened when you got back? Oh, it came right back. My life is so stressful. Now, in this case, I like to talk to them a little bit more about what is a way to de-stress for them, right?

Do they need a mind space app? Do they need to go walk in the park? Do they need to go to the beach every day, you know, for a little bit? Go play in the sand at home. Do you live by the beach? Do you have a lake there? Can you swim? Sometimes it's the getting away from stress. Sometimes it's just that you're moving, you know, because a lot of times people do have sedentary jobs. I'm not saying that's the, it's not the devil or anything. It's just, it's just a way of life for them. They're doing too much of one thing. Now, all of a sudden, when they get up and walk around and play in the waves and use their arms, they feel better.

And so it's not always the stressful aspect. That's not the only variable that changes in that situation. There's other parts too. Now, let's just say if we are really looking at stress again, what is a way to de-stress? Well, exercise is one. Getting outside is another. Hanging out with people you enjoy. Laughing is, laughing is, it's very hard to be stressed when you're smiling and laughing. Now, what is a sustainable way to you to feel de-stressed? With the vacation analogy, most people aren't going to be able to go on permanent vacation. And rather than just kind of lean on the next vacation, maybe a better thing is just figure out what is a way to integrate parts of that vacation or ways to de-stress or move when you're in your actual life, right?

A lot of times people will try diets that are not sustainable and they drop off and they get frustrated. Some people try exercise programs that are just not sustainable, meaning that they do like one to two hours a day, five days a week. And it's just like, I couldn't do it. I couldn't keep it. I believe in sustainable habits, personally. Just find something that's sustainable. I know for me, I do some challenging workouts that take about 20 minutes, two days a week, sometimes three. And I go out and I go for walks and I take breaks in the middle of the day, right? That's just something that's sustainable for me.

If it's not sustainable for you, then find out what's sustainable for you. Number four is adjustments, massage, stretching, and other forms of passive care are always needed. Now, as I mentioned before in my personal story, these things didn't work long-term for me. They felt better. There are good ways to modulate pain or decrease pain and manage pain. But I do mean manage pain. Like, they helped manage pain. They got me mentally feeling better for a couple days, or at least that one did. But it doesn't mean it's a good long-term strategy because it didn't stick around. Now, could I say, maybe I need to actually go and do more of it?

Sure. I think that every treatment planned or every trial of care should be given its due time to make the change. And I could have had that done for whatever amount of time my intern suggested. And at that point in time, I make a judgment call whether that's working or not. However, to do this thing for six months to a year and just assume that's what's needed is I believe it's bad form. And I think there's other things that we can do to actually double down and make it so this can feel better. And so, with my shoulder blade pain, I actually did none of these things during the time when I would actually feel better.

And so, or when I actually got to the point where I was feeling much better. So, I guess I should clean that up. I tried all those things at first and then what got me over the hump was not those things. And so, when I eventually did the appropriate first aid exercise for my problem, I did it for about three, four days. And after that, I started to slow down doing it. And I just started to do corrective exercise after that, which I did that for about a week or so. And then I actually started to lift weights again. I didn't stay away from the weights. I'm going to do pull-ups today. Hell, like those are movements that everybody should be, they should get back to if they want to.

Now, loaded exercise is not something that everybody necessarily needs to do. But if you think about it, loaded exercise or picking up stuff and putting stuff over your head and carrying things of various weights, these happen throughout everyone's life anyways. A probably perfect example is mothers. I know a lot of mothers will have shoulder blade pain, especially new mothers, because they're stressed out. Let's use that myth. They're holding their baby and they're sitting a lot and they have tight muscles because they feel like it's overworking because they're holding their baby. They're breastfeeding, right?

But at the same time with that, it's, they're also too, they've spent a lot of time over the, some people, I guess it's classified, some people have spent months of really not doing as much because they've been pregnant. They've been carrying their baby. Now, once you get out, all of a sudden you got car seats and strollers and babies to hold. And so that is, those are heavy. They're really heavy. And they're bulky. So a lot of times, like in my opinion, the, um, the, the stress and the load, the exercises should match what you're going to experience in, in life already. I'm not saying every pregnant lady should work out, but, uh, but I am saying that load is going to be experienced at some point by everybody.

You're going to pick up your bags of groceries and you're going to bring them into the house. You're going to be picking up your dog food from the floor. It's unavoidable. All right. Gravity is, is the load that you experience every single day and it's not going to go away anytime soon. Gravity always wins. All right. And so in my experience, in my personal experience, as well as working with people, the passive cares that we do, uh, adjustments, massage, stretching, foam rolling, icing, heating, these are, these things are all cool for modulation of pain and getting things to chill down, but it's not a good long-term strategy.

It's not the only thing that needs to be done. It's definitely helpful, but getting people to, um, build up their tolerance again for some of those loaded movements that they're going to experience throughout their life is, I think it's a lot better long-term strategy. Uh, I think as people tend to get, uh, older and I do mean older by over, over about 25 or so, um, they just need to have some strength and mobility and a lot of times active care or really good strength training program under some direction and knowing what you're doing. I'm not talking about going on machines and doing Arnold presses.

I'm talking about a well-coordinated type of, uh, exercise program is usually, um, or weight lifting program is usually a lot more attainable. Um, now does, do you need to get massive muscles? No. Do you need to look like Arnold? No. Do you have to spend an hour in the gym every day? No. All right. This is just the assumptions that some people make when I talk about resistance training. But again, I probably spend no more than, um, no more than an hour a week doing stuff like that. And it's very sustainable. I don't feel like I'm crushed every time. Then the last, uh, myth is, do you need to, do you need an image to be treated?

Um, a lot of times people have concerns when they have ongoing problems. So they're like, what is in there? What is the problem? I need an MRI. I need an X-ray. I need an ultrasound, um, and all this kind of stuff. And I understand it. However, uh, treating people, um, we definitely, we don't need it on everybody. Most people don't need images, honestly. And, uh, unless we're looking for fractures, um, bony alignment, or if we're looking for, let's say with MRIs, we're looking for, uh, big, bad, and scary things. We're looking at the quality of a disc, uh, if the, if someone's not responding, but a lot of times, um, disc, nerve root pressure, um, or, um, muscle strains, knots, and so on.

They, they don't need an image to be treated. We need to see if the trial of care works. If the trial of care works, then we know beyond reason without what's going on. However, and also too, we, we have to do the examination to see if we're collecting all the information where, uh, where we're applying the, the, I don't want to say correct solution because we're still trialing it, the probable correct solution for that problem. Now, if things don't work and the homework's being done, the provider feels very good about the, the, the course of, of care and you're not getting better, then yeah, images might be needed at that point to see if there's anything else going on.

But as, at first go, a lot of times people don't need, don't need images, but they, I know a lot of times they're concerned about, they're scared about what's going to go on there. Um, I get it. Uh, I understand, but everything on an image is, is not an indication of the reason why you're in pain. Just because you see a disc herniation in your image does not mean you're in pain. I've had a disc herniation for 20 years now, and I've spent a good 19 of those years without any pain, so it's not a reflection. Arthritis is not always painful. Um, there's a lot of things that, stenosis is not always painful.

Uh, they're not a problem until they're a problem, and sometimes when we look at those images, it's when you have a problem and then we see them and sometimes we, we think they're related. They're not always related. So, that's probably an important part there. Now, you're probably wondering what you can do next. Um, I think that everybody should not go through these things on their own. I think they need to find somebody who's, um, well-educated about how to direct you into the right direction of care. Um, and I know a lot of people say, well, I, I don't know what to do. There's no one around.

I've tried everything, and I get it. I've been there before. However, um, I think you need to get a little uncomfortable and maybe travel an hour to see somebody. Uh, I know that I've, I've spoken to a couple people that live no more than 30 minutes away from me, and they're like, hmm, too far. Um, I know they, they have no reason to really trust me because they don't know me, but at the same time, they're not willing to try something. And, uh, I try to give them all the information of things like this, of the myths and things they've tried, and I try to, um, at least build some trust with them.

When we talk to them on the phone, we try to talk to people on the phone for about five to 10 minutes to build some trust in, in understanding about what's going on. And I've told people on the phone that I can't help them. Um, but I, it, it's challenging to get someone to, um, help themselves if they're not willing to do anything. So if you're, if you're willing to get uncomfortable, find somebody who, who can help you. And if you're wondering who can help you, uh, I, I did put together a little guide, which you guys can get, um, you'll get an email about it, that it actually, there's a directory of, of places where there's clinicians who practice like myself.

I'm not saying I can help everybody, but, um, I, I believe that they're, they're honest. They have the information and knowledge that it takes to guide you in the right direction. And if, if, if they can't help you, they'll, they'll tell you where to go. And so I put some directory in there as well to, so you guys can, um, find somebody close to you. There's also a list of people that, that I, I believe that are very helpful, um, because I personally met them. I know their skillset. And so there's, there's various people around the country and I've, I put some, some lists in there. Now I know a lot of people will get videos and, um, they'll, they'll read books.

Those are very helpful in regards to understanding what's going on. Uh, however, it's, to be honest with you, like I have some of these online too, and I have one for the shoulder blade, which it gives you a glimpse into what's, what we do to help people. However, it's, if I was to say that's the best type of care, I'd be lying. All right. And you're not really under my care. You're just reading something I wrote and you see some videos that, that I think are useful of the exercises that we do or the ones that I've done to help myself. But to say that it's the best type of care, it's not. There's different types of, um, interventions that people can do.

But, uh, I know that a lot of people get frustrated with their, um, medical team and, or they don't feel like they have a medical team and they just feel like I, uh, they're like, I feel like they're not listening to me. Uh, I feel like I'm not getting any better. They don't want to see me back for a month or so. It takes forever to, to get, um, an appointment. This doesn't have to be, it doesn't have to be. Um, I know for a fact that if someone were to want to come in to see me, uh, I can see them next week and, or maybe even today if I have a, if I have a, um, if I have a gap. If you want the help that you're looking for, I know that when I was looking to actually improve, um, my, my back, I hired a strength coach and I paid him.

He came in twice a week for three months. All right. I didn't need to wait for that. He's just willing to come because I was willing to pay him. And so if you're looking for help, sometimes you got to pay for someone to, to help you. So I know when someone were to come in and they say, look, I got cash. Let's do it right now. Hey, can I see you twice this week? I'm only in town for a couple of days. Yeah, you can. Let's do it. Right. There's no big barrier to it anymore. And sometimes that barrier is something which gets people very frustrated and they feel like they can't, um, like they can't get better because they feel like they're being like they're helpless and not in control.

I get it. Okay. Um, like I won't manage anybody's satellite. I, I will only see them in person and then I can manage some satellite. But if, if we're talking online consults and manage you from like Kentucky to, you know, and never really come in, I, I don't do that, you know, because I believe it's inefficient. Now, um, the only ways that if you're looking for me to help you is number one, come in. Number two is just, um, you can listen to this audio. I guess I think is, it's nice, but it's really doesn't tell you what to do. Hope this was helpful to everybody. Um, if you have any friends in Southern California, I'm in Huntington Beach.

Um, LA is about 45 minutes away. San Diego is about an hour away or so. Um, and let's see what's another city that people tend to know. Laguna Beach. Laguna Beach is about 30 minutes down the road. So if you're looking for some help, if you're, if they're looking for some help, please suggest them to come in. Um, I do my very best to help people in a very timely fashion to guide them to the, um, to the, uh, interventions they can do on their own. And I don't, I don't, I don't tend to force people to come in for long treatment, uh, long treatment durations. I believe that they might need some strength training and if they want help with strength training, that's my form of quote unquote wellness care.

Um, but to actually feel better and to feel normal again, it doesn't necessarily take that long and it doesn't take a lot of sessions in my experience. So, um, please, um, suggest people, uh, if you know anyone close and I hope this was helpful. Look for those emails. Thanks everybody for joining in. Uh, again, that was the audio of the, um, the things that people get when they actually, if they're not ready to actually come in yet. I've created, uh, other ones throughout the course of the last year or so and I've had some really good responses from them. I found out that nearly everybody who goes through to opt in through it, downloads it.

I'd say a good 80, 90% of them do. And I'm hoping that wherever they're at, even if they don't come see me, people get the care they're looking for. Uh, I don't think that there's any reason why people are need, we need to have people go through this life feeling like they can't have control over their own bodies or it's uncomfortable there being their body or they feel like there's nothing they can do to get out of their problem. So, um, if you guys make something like that, um, enjoy. But if you are, um, if you're not going to make something like that, you should talk to someone who does and figure out how down hard it is.

Cause it's hard to actually do those, um, the talking points. So I didn't realize until I started podcasting, but, um, it helps you organize your thoughts. Even if you're not going to do an audio one, I'd suggest do a written one and suggest it to people who are not ready to come in to see you and hopefully, or they're far away and hopefully they come, they come see somebody, um, or they get the information they're looking for and they feel better. So, um, since this is the, uh, we're still in January here, I want to remind everybody that there is still, um, there's still something going on that you should know about.

And so on January 18th at Sandy's in Huntington Beach from five to seven, look up Sandy's Huntington Beach restaurant and I will be there sitting there. So don't come kill me. Um, but it is a meeting of the minds and then there's not going to be any pricing that anybody has to do. No one has to pay for anything except for the own stuff that you're going to buy. I'm going to be there regardless. So I'm sitting there having a beer and I probably won't be on that challenge this month, but, um, I'm probably having a beer and eating some food. Even if no one shows up, we're going to be hanging out.

And so I'm going to invite some like-minded healthcare providers. I know a lot of students at SU are already opting to come in and just hang out. And, um, for all the questions that you might've wanted to ask somebody, uh, someone like me, it's, I'm an open book about it. Um, there might be a podiatrist coming. There might be a doc that does PRP local to me coming. Uh, I'm going to see if I can get a neurologist to come. Uh, I'm going to see if we can, um, get a strength coach to come. Jesse Macedo said he would come. Uh, Brennan Gassamia said at this point he would come. And so I'm trying to get people to come who, um, might be able to, um, resonate well and bro down.

It's a bro down sesh. So if you guys are open to that, you don't have to RSVP. If you do, that'd be nice, but it doesn't really matter. Um, we're just going to hang out there. So look for me. Uh, maybe I'll be wearing a hat. I'll, maybe I'll go with a fountain Valley, blue fountain Valley FV hat in case you don't know what I look like. Uh, and just approach me and I'll be having a red rose and just hang out. And, um, I'm not looking for anything in return. I'm just hoping that we as a community can get together as part of the movement to, um, learn from each other. I'm going to learn stuff from you guys and you guys are going to hopefully learn stuff from me.

And that's, that's it. That's it. So, um, thank you everybody for joining in and share this with a fellow clinician or healthcare provider who you think would, might benefit from this. Talk to you guys next week.