Shoulder Anatomy, Rotator Cuff Tears and Why Shoulders Start Hurting

This is the Performance Place Sports Care Podcast, session number 41. Yeah, I don't believe in like age and numbers, but if I had to put an age on me, I'd say 35. Welcome to the Performance Place Sports Care Podcast, where you can learn about sports injury theory, rehab, diagnosis, and how to understand the doctor lingo you didn't understand at your appointment. And now, your host, Dr. Sebastian Gonzales. Hey, everybody. It's Dr. Sebastian Gonzales again with Performance Place Sports Care. Thank you for tuning in and willing to learn something about your body today. This one, if you look at the title of this podcast, it's actually probably going to be more of a boring one, and I'll tell you the reasons why.

It's because we are going to go into some anatomy as well as some light mechanics on how the shoulder works, and we're going to talk a little bit about how it applies to throwing sports as well. The reason why I actually wanted to do this boring topic all by myself and not have an expert or anybody else in was because that when I was talking to a friend who is going to be the expert on shoulder, like he actually gave really, really good research at one of the seminars that I went to about shoulder mechanics and what's right and what's wrong and how to rehab it and so on, but I realized that without a basic understanding of how the shoulder is put together, you know, from a muscle, from a ligament, a bone standpoint, then you guys might not be getting everything you could.

So, I was thinking that as we go through some of these injuries in joints, let's just say even knees to come, I should really probably spend some time talking about the bony anatomy, the ligaments, the cartilage, the muscles, and just some light teaser stuff that I think you guys should know because this is honestly a lot of the stuff that I start talking about some of my patients with when we come into the office, when they come into the office, and it's a lot of the same questions, and I'm starting to realize that everyone needs to have a better understanding of how stuff's put together. Now, you might not need to know all of the technical, technical terms, and like we're even going to go into some of the rotator cuff muscles today, what their actual names are.

Now, if you wanted to have, if you wanted to be a super nerd and remember all these terms, by all means, go ahead and listen to this podcast like five times. But it's not super, super important to realize what all the muscles are. Just kind of know roughly where they go, be familiar that you've heard them before, understand why a shoulder hurts and when, and blah, blah, blah, and so on. So I want to start out with letting you know that, so there's a few types of shoulder diagnosis typically, and this goes along a lot of, actually, I did a great article, I think, a really long article on pitching shoulder pain on my website.

If you want to read along a little bit, I'm taking some of the information off there. It's p2sportscare.com slash shoulder pain, and you can probably Google that and you'll find it. And it's a really, really long article. There's lots of pictures and so on, but in there, I actually was, I was astounded about when I was looking at all this research, because I think I had about 30 different research articles to validate this article I was writing. And one of the facts that stuck out to me, because I didn't realize the need for this type of article until I actually researched. And the estimate was that around 66% of rotator cuffs do not actually have pain.

And I think it's amazing to see that, because there are a lot of rotator cuff tears out there. And by the way, tears can be of varying different degrees. But there's a lot of them out there with pain, or sorry, without pain. More have less, or there's more out there without pain than with pain. And so of that 33% that still, or that one third who still remains that actually has pain, they say only 20% of these people actually report for medical attention. And that's a startling number as well. I mean, obviously, there's lots of rotator cuffs out there. And like, if they're not painful, cool, that's great and everything.

By the way, I'll talk about expansion in a second, which I think is an interesting part of why you should know if you have a tear in the first place, or realize that even if you have a non-symptomatic or non-painful tear, you should probably still know a little bit about the shoulder anyways, because at some point, it can become painful. Now, the reason, so one of the reasons here that I went so gung-ho on this article was because that 20% that seeks medical attention must really get it, or they get some, or they have some type of drive or need to make the shoulder feel better. Now, the other 80%, again, of that one-third of all the rotator cuffs walking around on the street, didn't care enough to seek attention or thought it would go away on its own, or if it does go away on its own, like, really, is it any better?

You know, they didn't completely understand. And as we go into the topic of expansion, I think you'll start to really understand why I'm so passionate about this. Now, expansion is really, it's where a previously sustained tear becomes larger. Now, I know I've said the word tear a lot, but consider the fact that impingement, which is, or impingement, impingement, or bursitis, a lot of these go hand in hand with tears. And tears are, can also go synonymously with tendinitis or tendinosis, usually the different types of tears of varying different grades that we kind of categorize and get all these different types of terminology surrounding them. But I can tell you this from personal experience with working with a lot of tendinitis, tendinosis, tears, or whatever you want to call them, that majority of the time when someone comes in with a shoulder condition, if they have impingement, a tendinitis, or some type of bursitis, we're looking for some type of small, even partial tear. Now, if they can't raise their arm or there's a large amount of disability involved, then we're looking for a large, basically torn off muscle, which a lot of times you'll find on imaging. But again, knowing that there's different types, different grades of tears really leads us into this idea of expansion. And that 66% of people that have tears walking around the street who might, I guess they could be, they could be rehabbing it on their own. They could be doing some type of preventative program, and they could be using their shoulder and the rest of their body really well, which would be awesome. But I really doubt it. And that's why I'm talking about this today, is that expansion is when tears get larger over time. So a tendonitis, quote unquote, would turn into a partial tear. A partial tear will turn into a full tear. And a full tear can turn into a basically a ripped off and torn one. I know those sound like a similar or the same thing. I have a whole infographic to describe different types of tears.

And since it's a three-dimensional structure, it's a little bit harder to explain. But for the most part, just in this section, just understand that tears will expand. And what you have to understand is that rehab is an ongoing process a lot of times. The overall long-term goal is to not allow these tears to expand further. Because one of the studies they did, actually, it showed that these tears, when they became painful, when the shoulder finally became painful, it was because of the expansion. So let me say that again. They actually had a whole series of people, and they imaged them prior to them actually developing pain. And they asked them, hey, when this area develops pain, when the shoulder develops pain, I want you to come back. And when they came back, they imaged them, and they already had a prior standing image. So they wanted to see if it got any bigger, if it changed, and so on. So the overall consensus with the study was that when someone reported back for pain, pretty much a lot of the time, it was because the tear expanded. That was the thing that happened.

So it's a freshly developed injury, basically. So understand that first off. And when you, sure, you can have a rotator cuff surgery. But if we're talking about baseball players, just know that there's very low probability if you have a rotator cuff tear, especially of a complete tear, I believe the estimate is around 8% ever get to pitch again if we're talking about pitchers. It's really, really dismal. I even interviewed a strength coach from Major League Baseball, and they said that it's actually very, very, very low as well. So the best thing to do is really just prevent these things from happening in the first place. Now, I know there's probably some surgeons listening to this at some point. So just to let you know, obviously, I'm not a surgeon.

This is just from what I read in research to make sure some of the complications that could be with surgery of a rotator cuff tear. And I'm mainly talking about this from a standpoint of pitching because the return to play is a little lower, obviously. But first, the thing we have to consider is that the ligaments in the area or even the pliability of the muscles and tendons around the rotator cuff, it's a very dynamic structure. And if you see the large amount of range of motion and whipping effect that goes into a baseball pitch or a throwing sport, these muscles and tendons have to be really, really dynamic and resistant and pliable to tearing. Or sorry, I guess I said that backwards. So pliable and resistant to tearing and the rigidity or firmness that comes along with it.

And even like the other point is that the loss of range of motion is very detrimental. And I've actually heard stories that I haven't personally had this experience, but sometimes when you work with pitchers to increase range of motion, you actually mess up their pitching too. Because with pitching or throwing, and by the way, I know I'm diverting a little bit down the throwing or pitching path, but I will come back. I promise. Hang in there. I'll go into the anatomy and that will cater to everybody. But with pitching or pitchers, which are the poster boys of laxity of the shoulder, you have what we call a, so you have greater external rotation than internal. And we call this phenomenon GERD, which is a glenohemeral internal rotation deficit. So that greater range of motion is actually, if you look at a pitcher pitching, when they're all the way back and their arms behind their head or their hands behind their head, this cocked back position is the great external rotation that they have that is an accommodation that the body makes over time to make the velocity higher.

It's not always a bad thing. A lot of times it is a good thing and actually they've shown that when you have greater external rotation in combination with a few other things that you actually throw with higher velocity. So through a surgery on a pitcher who throws hard, you're going to lose some of that and it's almost like you have to learn to pitch all over again. Now going into anatomy, there's a few different types of structures or anatomical structures in the shoulder and I'll break down the basics of them first. So we have bones, cartilage, ligament, and muscles. Okay, I'll say that again. Bones, cartilage, ligaments, and muscles. And the bones is kind of like just the rough architecture and if you see anyone like they're building like an office building, like all that rough framework of iron and whatnot is kind of similar to the bones in the area. And there's not too many bones in the shoulder. Granted, it's not like the ankle or the wrist, but the bones do provide some structure. Now, ligaments, ligaments are, imagine that same analogy, and then we have, now we're bolting or welding those iron, what are they, eye beams, I guess? Eye beams across to the other one and we're making it so this thing's not falling over or falling apart. Ligaments basically do that. They hold bones together and they're very rigid structures. Some, they do have a little bit of pliability. Within the shoulder, there's ones which go around the ball and socket and there's also other ones that hold kind of the clavicle together with the shoulder blade and whatnot. I'll go into that in a second. Colleges are a, they're interesting structures and when damaged, they're very, very hard to deal with just from a rehab standpoint because they don't repair extremely well and some of the cartilage on the shoulders are, it's like the labrum, the articular cartilage, which is on top of the ball of the humerus, which is the, I guess, arm bone. I'm trying to break these down really easily, but the labrum is, it's on the part of the socket of the shoulder blade, which the socket is on the shoulder blade, which deepens it and provides some stabilization there. Then there's muscles and muscles can be broken down into a couple different categories in the shoulder. To make it simple, we'll start with rotator cuff and non-rotator cuff. And even getting further than that, muscles of the trunk, the legs, the hips, and so on are very important in decreasing the possibility of shoulder conditions. The reason for that is actually with throwing, they estimate that only about 13% of force or velocity comes from the shoulder. So the remainder comes from somewhere and it's pretty much going to be the torso and below. So a lot of it is hip related. So in the case of pitchers, if you're not using your hips well, I mean, technically in shoulder prevention, we need to make sure that you're using your hips well and you're strong down there if you're going to throw a high velocity. So if we're not doing that and we're just patching together the shoulder and rehab, we're preventing things up there with, you know, shoulder blade exercises, etc., then we're not doing you any favors either. Okay, so now going to bones, we have a few different bones of the shoulder. So the shoulder blade is also known as the scapula. That is the technical term of it.

The shoulder blade is located on the backside of the body. It's like the wing that you have back there. And actually, what most people don't realize is that if you put your arm, actually, if you put your hand on top of your shoulder and kind of inch your fingers back, you'll actually find this bony area right there that feels like a ridge. That is still part of the shoulder blade. And when you follow that thing all the way out to the shoulder, just the tip, there's a spot right there called the acromion process. That too is still part of the shoulder blade. And there's also on the front part of the shoulder, like you know where you like grab someone on your shoulder and you kind of like from behind and you kind of sink your fingertips in there just because it hurts. There's it's called the coracoid process. And that is also part of the shoulder. Now, the the actual shoulder or the actual arm itself is called the humerus. The humerus and shoulder and shoulder blade come together to make a ball and socket. Now, something that some people don't they don't recall either is that the shoulder actually, if you're taking apart a chicken, you'll kind of see this like it kind of just like the the wing and like the shoulder girdle just kind of falls off of the breast, the body. And with shoulders, with humans, there's only really one bony attachment of the shoulder to the remainder of the body. And that is where the clavicle comes in and attaches to the sternum, it's kind of right up by your throat. Now, this area right here, it does develop some conditions on people like arthritis and whatnot. But the overall thought with it is that since that's the only bony spot that's holding the whole shoulder, hand, elbow, wrist on the rest of the body, we have to consider what the other parts are, right? And if we're considering how unstable this whole region is, if we're going to keep it on there well and keep it functioning well, we have to make it so that the rest of those stabilizing structures that attach the rest of the body, the shoulder, are working. And those structures are muscles which attach the spine or trunk to the shoulder blade. I'll say that again, because I know that I rambled a little bit. So the muscles which hold the shoulder blade on come from the spine.

And the shoulder and the shoulder blade together would be known as the shoulder complex. So from this point forward, everyone stop thinking of the shoulder as the ball and socket. Start thinking of the shoulder as accumulation of the shoulder blade, the torso, and the shoulder or the ball and socket itself. They cannot work independently well of each other. There was a seminar that I watched. It was awesome. It was put on by a biomechanics professor. He was a smart dude, real, real smart dude. And he was going over shoulder mechanics and whatnot. And he put up this shoulder blade picture and he says, I'm in a love relationship with the shoulder blade or with the scapulae, he said. And it's because he was saying that how important it is to decrease the possibility of shoulder actual injuries. And he explained all this away. And you got to believe me from here on out that the shoulder blade is a large part of the key to making it so your actual shoulder doesn't hurt, whether it be from, so from a non-traumatic standpoint. By the way, before I go any further, the shoulder can be hurt from trauma. Trauma is falling on it. Gosh, falling on it is a major thing. I remember that there was a friend that I snowboarded with. Actually, he broke his clavicle because he fell snowboarding.

But non-traumatic or cumulative trauma is basically doing poor motions over and over and over again. And it's not always that you're doing the repetitive motion itself because the body is amazing. It has the ability to change its structures and to strengthen things and reinforce things to make it so we're not going to overuse the structure. But sometimes, I mean, if you took like a knife and just scraped it across a table, let's see if you can hear my pen, then at some point you're going to get through the table. And the mechanics, my analogy to this, the normal mechanics of the shoulder would be, let's make it so this pen, or sorry, this knife doesn't scrape through this table. You know, that's not normal mechanics. But doing the motion back and forth across the table is. Okay. So we went over the bones of the shoulder. We have the humerus, the scapula, the clavicle. Okay. Those are the major ones. Arguably, again, we can say that the body works as a whole unit and we can go down into the rib cage and the torso and blah, blah, blah. But for the sake of this podcast, we're going to keep this a little bit more tight. Now, ligaments of the shoulder, again, the point of the ligaments are to hold bones together. Now, I'm not even going to go into the names, the names of these ligaments of the shoulder because I even wrote them down here just to make sure that I was going to say them well for you guys because they're a little bit complex in name. I can honestly say going through school, I thought, dear God, why did they name these things this way? Why couldn't they make it really simple like the Achilles tendon of the ankle? But they didn't. They made it really, really complex for people to understand. But for the most part, understand that there's ligaments forming roofs in there for things to pass through. There's ones attaching the clavicle to the shoulder blade.

There's ones attaching the shoulder blade to the humerus. There's ones that form the joint capsule around the shoulder so it doesn't fall off because it is a very loose joint period. So sometimes these ligaments are damaged through trauma. And sometimes, I guess we won't go too deep into it right now, but they theorize that abnormal motions, especially with pitching, tighten certain ligaments up, which create ambient or compensatory motion to the shoulder, leading to some type of tear, impingement, labral tears, and so on. Now, cartilages, again, I alluded to the fact that cartilages are a mystery.

They're not a complete mystery to us, but they're very frustrating. They're frustrating for the patients. They're frustrating to the provider. I don't know about the surgeons. I've never talked to one about this, but I really would love to, actually. If anybody knows one who'd love to be on the podcast, feel free to refer them over to me, p2sportscare.com. So the cartilage of the shoulder, there's the labrum, there's the glenoid fossa, and there's the articular cartilage. I'll recap on those right here. The labrum is made of what we call a fibrocarlage, and there's a few different types of cartilages in the body. The fibrocarlage is, gosh, think of this like a gasket, like an o-ring. And the o-ring, at least in the way I'm thinking of using it, it kind of deepens the contact of one thing on another. Let's think of it like you're screwing a bolt onto a nut, and you need some type of, say, black gasket, which will allow for, let's just say we're in a watertight environment. We don't want water to leak out of whatever we're tightening together. Now, that gasket, as you put them together, it'll start to like mash and gum up, but it'll form a seal is the point. And the labrum in the shoulder, it kind of deepens and secures the ball within the socket and so on. Now, the articular carlids and the glenoid fossa, those are a different type of carlids.

They go together, and it's the bottom of the socket and the head of the humerus. And these carlids, mainly, they just kind of make it so things like move around smoothly. But the interesting thing about carlidges is that they are avascular, or they don't have blood vessel supply. That's just the nature of the beast. They are unique in that fashion. But because of that, they're really hard to repair. And I know that with knees over the years, they've considered perforation or regeneration of the carlidge and so on. Because if it's a carlidge injury, then we have to try to repair the carlidge. I mean, that would be the best thing to do. But it's really, really hard to repair. And obviously, if anyone has any groundbreaking stuff on carlidge that's listening, feel free to contact me. I'd love to hear about that as well. I don't spend a lot of my time figuring out those types of realms yet. I will spend some time in the future. Now, rotator cuffs. Now we're getting into stuff that you guys probably have a little bit higher interest in because you've heard of it. The rotator cuff is really only four muscles. And it's the supraspinatus, the infraspinatus, the teres minor, gosh, sorry, I think about that every time, and the subscapularis. Now, the reason I stuttered on the teres minor is because there's a teres major as well. The teres major is technically not part of the rotator cuff.

There's only four muscles, but that doesn't mean the teres major is not important. There's other muscles around the shoulder as well. And they also function to do, or they help the shoulder with function, but they're not technically the rotator cuff. Now, you might be wondering why is the rotator cuff such a special little group? It's because they are the ones which drive the head or the ball in the socket together. They're the ones which keep it centralized, and they're the ones which often get damaged as well, especially the supraspinatus. It's one probably, I don't know a stat on this, but I would say of rotator cuff tears, I'd say it's 80, 90%. I mean, it's a majority of the time you see the supraspinatus injured. Sometimes you see the subscap or subscapularis. Other times you see the infraspinatus. I don't think I've seen the teres minor, but I have seen people point to pain there, so possibly. But you'd really have to investigate on ultrasound or MRI to see which one is really being damaged. But again, that's the infatuation with the rotator cuff. But the muscles which move the shoulder are really, they're really not the rotator cuff. They're the ones which surrounding it. And if you listened to my podcast on the three Ps of the shoulder, I'll be recapping a little bit of that. But for the most part, the rotator cuff is the protectors. It's the protector group of the shoulder. They're responsible for keeping the ball and socket from coming apart, as well as with those passive structures such as the cartilage and ligaments and so on.

But also the protector is also, so it's the rotator cuff as well as the biceps long head tendon. The bicep, obviously, it's that muscle which the big one Popeye has. Actually, if you, I know that if you've been working with sports injuries, you might have heard of the term Popeye arm. Popeye arm is actually where they've had a rupture of the biceps long head tendon and actually you end up looking like Popeye because the muscle kind of slides down. But the biceps long head tendon is a stabilizer of the actual ball and socket. Now, again, just to recap, I'll come back again. So the rotator cuff holds stuff together in that small joint. The non-cuff ones are which I'm going to go into right now. So the next group of the three Ps is the pivoters. So they're responsible for putting the shoulder blade into the correct position to decrease shoulder impingement and then further on with rotator cuff tears. And these encompass the trapezius, the rhomboids, the levator scapula, serratus interior. I know these are probably not, you're not going to remember these right now, which is totally okay. I do have a whole infographic on the three Ps of the shoulder on that same page, p2sportscare.com slash shoulder pain pitching. So those are the ones which move the shoulder blade. Now, the reason why, again, the shoulder blade is important is because it holds the entire shoulder girdle on the body besides that one bony contact point. Now, I know that when you look at someone, if there's someone in front of you, hopefully they're raising their arm and asking a question. And when they raise their arm, you're going to see that when their arm hits about parallel to the ground, it's mainly the shoulder, the bond socket, which moves. And after that, you'll start to see this big wing come out and they'll start looking like Bruce Lee if they're really muscular, but you'll see the actual blade start to come out like flare from the midline of the body. And this is how the shoulder blade works. It clears the space where the rotator cuff goes through this small tunnel called the subacromial space. So the subacromial space is below. So there's sub or below the acromion.

Again, the acromion, if you go back and listen to the portion on the bones of the shoulder, the acromion is a bony prominence or almost like an outward projection of the shoulder blade. So it sits over the top of the bond socket. And I strongly encourage if you're listening to this, if you're driving a car, you don't have a choice. But if you're at home or you have access to a computer, you should be looking up, googling pictures of the subacromial space because that will start to make this real to you, make it more interesting. So it raises that space. And also the rotator cuff produces what we call a roll and slide maneuver, where when the shoulder comes up to a certain point or the ball and socket comes up to a certain point, it starts to depress or push down the ball in the socket to also clear space too. So there's a few ways we can clear space. And the reason why I'm bringing this up, the subacromial space is the magic to if you have pain in regards to impingement or bursitis. And I'll tell you why. It's because the space is really small. And there's not a lot of room for error. So let's just imagine that the ball rises or the ball of the shoulder rises as you raise your arm rather than depressing. It narrows the space even more. I honestly don't remember what the what the space is supposed to be. But let's just make an arbitrary number. Let's just say five millimeters. So there's the say you have five millimeters, and I want you to actually take your fingers, your index and your thumb, and want you to put them out in front of you and like form like just let's form an inch, make it easy. Now I want you to take your other hand, and I want you to slide two fingers in there. Well, let's go three, three fingers in there. And you're going to see that it barely fits through this space, but it still does. Now, here's the problem is that let's just say these fingers within between that the left hand spreads. So spread them out a little bit, put some space between your fingers. Now you're going to see that you're putting pressure on your actual tunnel, or the other, or the finger, which was making the inch. So this is an analogy of expansion in within expansion of a structure. Now, what can expand in there? It can be the bursa. It could be one of the tendons. It could be a bony prominence, which could be like arthritic findings. So now that's one way you can pinch things. Second is, I want you to, instead of making an inch, make it half an inch.

Now we have a narrow space. And obviously, you can't fit three fingers in there, maybe two. So everything's going to be absolutely crushed in there. And you're going to eventually tear something up. And that is how these injuries present themselves. But it doesn't mean you actually have to clear the space. It means that you have to improve the mechanics that are creating it in the first place. Maybe we can get that half inch to a full inch, right? Maybe we can decrease the size of those things that have inflated in there, such as the tendon and the bursa. For this reason, actually, there's, I had to pull up the research that I have here. Let's see if I can find it. So actually, this is one of the facts which I pulled, the fun facts I had in that article. So 12 weeks is the number of, number of weeks of physiotherapy found a rival, rival subacromial decompression surgery success rate. Now, if I know if, if I were, if I had this, I would rather rehab it than surgically change the structures first. Now, don't get me wrong. I'm not, I'm not opposed to surgery.

And I have sent people to surgery when they have nothing else working for them, or they have the conditions which dictate it. And I know there's been a push so much over the last, I feel like, five years where I've heard people absolutely not wanting surgery on X, Y, and Z. But sometimes you need it. Sometimes you do, but it really depends on the case. Now, in, in my opinion, on a lot of the shoulder cases that I see, they don't need it yet. And I would rather them put the hard work in, learn the education, and start to make their body move better so they don't have to take that space and shave it up. Now, again, if we're talking about tears again, if there's a large tear, then you might have to put it back on. And that's just the name of the game. And I know that some people don't want to.

My mom was actually one of them. She had a completely full through and through tear, detached, just hanging. And there was a gap between the tendon or where the tendon was, and we're supposed to attach and she didn't really have she didn't have any pain, which was really surprising. And it made me really reevaluate how I look at shoulder conditions in cases that come in now, because she didn't have any pain. I'm telling you, I'm just I'm not even joking. She had no pain, full range of motion. And you really had to isolate it down to be able to see that she had a lack of functionality. But the question she asked me was, should I have this repaired? And I'm like, gosh, like, I mean, you don't hurt, you know, like if it if you go in and it comes out worse. I mean, I know from my standpoint, like I like if it was a normal patient, I'd say, yeah, here's pros and cons and so on. But it's not like it's a little different when it's your family. So you have to make sure because you're going to see them all the time, you know, and at some point, if you make the wrong call, I don't want to put anyone in the position where they would blame my judgment call because I made the call for them. It's really, it's the patient's call. It's not life, life or death. So it's the patient's call. Now, I think this went through majority of what we needed to for understanding the shoulder. I want to reiterate that with shoulder conditions, it's not always trauma, it's, you might sleep on that side and all of a sudden it starts hurting. You might start, you might throw a baseball with your son for a couple of times and then that irritates it as well.

Remember, it's not that it's a new thing typically. It's just that it's been happening a lot over time and it expands. Okay. It's the expansion. So I consider that anytime that if someone knows they have a condition and they're not doing anything about it, they're being negligent on themselves. You know, I hate to say it, you know, but being realistic, like if you know you have it and you're doing nothing about it, it's not top on your priority list. That's just how it goes. And I tell people all the time, like, I know you're busy. I know you have a busy life, like it happens, but it's not my shoulder.

It's not my back. It's not my knee. And I'll give you as much information as you want, but I can't do the work for you. Okay, it's simple as that. There is no easy way out of this stuff. And if you want to take the less invasive route on these things, then you have to put the work in. Now, I hope this was helpful. I think I went through everything. The only other thing there is, which I might go into in the next podcast, is some of the movements of the shoulder. I don't want to bore you too much in there, but make sure to go on to my website, p2sportscare.com slash shoulder pain pitching, or you can just go through with p2sportscare.com, and you'll see when you start scrolling down, you'll see some pictures of a runner, a golfer, a baseball player. Just go into the baseball player's shoulder and click on it, and you'll see this entire article pop up, and it's going to be longer than you're going to want to read at the time. So, I'd suggest if there's a, I think there's a pop-up that comes in that says you can download it through PDF. So, just save it, put it on your phone, and just read it at your leisure.

This is, this is where you should go to learn about how to rehab it and other stuff I didn't hit on today. I will bring in an expert to talk about it, but for all I know, like, I mean, he's a friend of mine. We might, him and Han, kind of go like back and forth on different topics and joke around and miss something. Typically, on the podcast, I like to, I hope it's entertaining, but also educational, too. So, sometimes we don't get to everything, so we might have to do it again. So, thank you for listening. And again, my name is Dr. Sebastian Gonzales. Please go to my website and share it. I made it really easy to share with the links on the bottom, with Facebook, Pinterest, Google+, Twitter. I want, the reason I spent so much time on this is so that people can share it.

But, I don't write for my health. I proofread and have grammar like I've never been to school at all, into English. Actually, English was one of my worst grades in high school and college. It was terrible. So, I have to send these things out to get proofread, honestly, because I'm terrible at writing, I think. But, I mean, I know the ideas I want to put out there. So, please do share. I have great pictures, great infographics. And if you go through there, and you want to see what we do for rehab in our office, we are putting together a course. There is a course link on the website, and you can see what we have there. We're trying to build one for patients in office because we do have a lot of people who have questions on the rehab that we suggest, as well as to repeat stuff like this, you know, understanding their pathology or their injury. But also, too, a couple different injuries that I really want to home in on are, so, rotator cuff health for pitchers and knees for runners. I have a huge passion for both of these.

I played baseball. I've run recreationally, not in college or in high school. I actually tracked it was during baseball season, so our coach wouldn't really let us go over there. But I see it's so common, and it's such an easy thing to understand with runner's knee or injuries of the knee to runners that I don't see any reason why I couldn't put a course on for it. So, again, if you guys have a personal question that you want answered on the air, then go to the site again. There should be a voicemail button right there. It's super easy to do, and I think that's all I have for you. Take care and listen in to the expert next time.