Latest / The Driven Athlete / Rotator Cuff & Shoulder Issues with Dr. Kyle | Ep 28

Transcript

Rotator Cuff & Shoulder Issues with Dr. Kyle | Ep 28 · The Driven Athlete

• 0:00
  Speaker 1: If you're a driven, active person who wants to reach and pursue a higher quality life with some ambition, then guess what this podcast is for you.
• 0:07
  Speaker 1: This is the Driven Athlete Podcast.
• 0:10
  Speaker 1: What's up?
• 0:12
  Speaker 1: Y'all?
• 0:12
  Speaker 1: It's your man, dr Kyle.
• 0:13
  Speaker 1: Welcome back to the Driven Athlete Podcast.
• 0:16
  Speaker 1: Today we're going to talk a very finite conversation about the rotator cuff.
• 0:21
  Speaker 1: I wanted to shed some light and bring a little bit of education to some people.
• 0:25
  Speaker 1: I'm a little bit confused but exactly what the rotator cuff is, some of the common diagnoses we see with rotator cuff issues, and then what we do as clinicians, as sports physical therapists, to actually treat it.
• 0:35
  Speaker 1: Just bring some insights to you guys of like, all right, what should I keep in mind?
• 0:39
  Speaker 1: What should I look for?
• 0:40
  Speaker 1: And hopefully maybe bring some clarity and some hope, as in like, this isn't a doomsday thing, it doesn't have to be at least all right for the people that we work with.
• 0:47
  Speaker 1: So anyway, the rotator cuff actually, four muscles collectively make up the rotator cuff.
• 0:55
  Speaker 1: All right, so when we say rotator cuff, what they mean is these four muscles collectively make up this group called the rotator cuff the supraspinatus, which sits on top of your shoulder up here, your infraspinatus, which is in the back, your teres minor, also in the back.
• 1:08
  Speaker 1: And then the last one is called your subscapularis and that's on the front side of your shoulder blade, between your shoulder blade, your scapula and your rib cage.
• 1:16
  Speaker 1: All right, so we call it like the ventral side or the anterior side of your scapula, sitting between your scapula and a rib cage.
• 1:22
  Speaker 1: So those four muscles work collectively together in symphony to help compress your shoulder joint.
• 1:28
  Speaker 1: When we say shoulder joint, what I mean is your glenohumeral joint.
• 1:31
  Speaker 1: The arm bone is called your humerus, your shoulder blade is called your scapula.
• 1:36
  Speaker 1: The humerus attaches or has an articulation contact point with the scapula at something called the glenoid and that's the fossa called the glenoid, and that's the fossa or the indention component, it's the concave component of that joint.
• 1:50
  Speaker 1: So it's a ball and socket joint.
• 1:52
  Speaker 1: This is your humeral head and this is called your glenoid surface of your scapula and your glenohumeral joint.
• 1:58
  Speaker 1: Your humerus rotates around your glenoid and your scapula moves too.
• 2:02
  Speaker 1: All right, and we'll talk about that in a minute, about the influence of the scapular mobility as it relates to glenohumeral hypermobility, but anyway.
• 2:09
  Speaker 1: So the four rotator cuff muscles connect from your scapula to your humerus and they're small, they're not major large muscles, they're small stability guys but they all work together in concert to help suck in your humerus and keep it in place as it moves and grooves and rotates and moves overhead and stuff when a lack of rotator cuff activation or a lack of help elsewhere from scapular things, scapular muscles, it's not as stable as it could be and it allows for more translation of the humeral head excessively in the glenoid, which makes other things have to compensate and maybe affect neighboring structures, like the labrum an example.
• 2:45
  Speaker 1: All right, and it causes fraying over time.
• 2:47
  Speaker 1: We'll talk about the labrum soon too, but anyway.
• 2:50
  Speaker 1: So your glenohumeral joint has a lot of mobility, all right, and the rotator cuff just keeps it locked in and sucked in so they move it.
• 2:57
  Speaker 1: It keeps it all stable in one center point of rotation and the excessive translation is where problems come in and we would call that maybe instability, right, if there's a shoulder, instability is from that, the most commonly involved structures that get painful, right?
• 3:15
  Speaker 1: People usually come in and like man, my arm hurts right here, it hurts on the top of my shoulder, it hurts down, my arm hurts in the back of my shoulder, my trap, whatever.
• 3:21
  Speaker 1: People usually want to know what's the angry tissue right?
• 3:29
  Speaker 1: What's the problem Like, what's hurting and usually the structures that are contributing to the pain experience when you're having shoulder pain is the supraspinatus, the infraspinatus or the biceps tendon.
• 3:36
  Speaker 1: The long head of your biceps tendon is another smaller structure, all right, and usually at the origination point as it passes across the anterior part of your shoulder joint and your humerus right.
• 3:46
  Speaker 1: Here is your long head of your biceps tendon and it attaches to the superior part of your glenoid.
• 3:51
  Speaker 1: All right, and that's when that gets involved and frayed and displaced or separated off its attachment site.
• 3:58
  Speaker 1: It has a strong attachment to the superior part of your labrum and that's called a slap tear, all right, the superior labrum, anterior to posterior.
• 4:06
  Speaker 1: That's called a slap tear.
• 4:07
  Speaker 1: And it's when the biceps, anchor of the origination point of your glenoid, becomes detached or frayed and are involved and vulnerable and that's called a slap tear.
• 4:15
  Speaker 1: But anyway, so your long head of your biceps tendon gets lit up and it gets very sensitive and that can cause anterior shoulder pain or lateral front and anterior lateral front side shoulder pain with reaching overhead and doing bench press or push-ups or burpees or dips, stuff like that in the front.
• 4:32
  Speaker 1: But so the three most common things that we find that are that are broken down, lit up and contributing to the pain in your shoulder are the supraspinatus, infraspinatus and long head of the biceps tendon.
• 4:44
  Speaker 1: So, considering that, all right, let's consider this the mechanics of the shoulder joint.
• 4:47
  Speaker 1: It's very, very mobile For the way evolution has developed us as humans.
• 4:52
  Speaker 1: There's a lot of mobility and a lack of inherent stability of the glenohumeral joint, the shoulder joint, to allow for freedom of movement, right, overhead motion, reaching behind the car, all that stuff.
• 5:02
  Speaker 1: Right, full range of motion.
• 5:09
  Speaker 1: It's very excessive uh necessary for the shoulder, whereas the hip is a very similar uh joint structure.
• 5:12
  Speaker 1: It's a ball and socket joint but it's very deep and for a lot more stability because it's a heavy weight bearing and uh, it needs a lot of stability in your hip joint, um being being required for a lot of uh weight bearing activity.
• 5:23
  Speaker 1: So the shoulder is a little bit different a lot of instability and um set up for failure for stability, which makes the structures around it a lot more vulnerable to get affected and then painful.
• 5:34
  Speaker 1: All right, I've had some mentors describe the ball and socket joint of your shoulder is as unstable as like a tennis ball sitting on a golf tee.
• 5:42
  Speaker 1: Right, one little touch, I think it's off right, like that's where the rotator cuff and keeping everything sucked in and nice and stable in your joint to keep it center of rotation is really important.
• 5:52
  Speaker 1: Okay, so let's say rotator cuff is getting overwhelmed, it's trying its hardest to keep that center rotation doing doing its job right.
• 6:01
  Speaker 1: Um, for bench overhead, shoulder raises or shoulder press burpees, throwing a football, throwing a baseball, swimming, which is an aggressive overhead mobility position, volleyball right, hitting overhead, overhead throwing motions.
• 6:15
  Speaker 1: The rotator cuff is working overtime all the time to keep your shoulder joint in its place, okay, and they get lit up.
• 6:22
  Speaker 1: Usually the structures that are trying to overcompensate and they're overworking and working overtime, those are the victims and those are the ones that usually get lit up, all right.
• 6:32
  Speaker 1: So, considering that, as re from a rehab standpoint, for as sports physical therapists and treatment interventions, how are we going to fix this Right?
• 6:39
  Speaker 1: How are we going to get things better?
• 6:40
  Speaker 1: Are we going to help treat and work and focus on the structures that are overwhelmed, overcompensating, working overtime, victims that are lit up?
• 6:51
  Speaker 1: Are they the problem?
• 6:52
  Speaker 1: No, they're the victims.
• 6:55
  Speaker 1: Why are they the victims?
• 6:57
  Speaker 1: It's because other things aren't helping to contribute to the range of motion required for overhead or the stability requirements for sports and exercise and lifting weights and stuff like that.
• 7:07
  Speaker 1: Right, the dynamic activities.
• 7:09
  Speaker 1: The rotator cuff is doing too much.
• 7:10
  Speaker 1: That means that something else isn't doing enough.
• 7:12
  Speaker 1: Right?
• 7:13
  Speaker 1: There's a con, there's a pro and con.
• 7:15
  Speaker 1: There's like the inverse ratio here we got too much going on here and working and not enough working right.
• 7:20
  Speaker 1: So we have to even that out a little bit and have these guys contribute to help the overwhelmed guys.
• 7:25
  Speaker 1: The analogy we like to give is like imagine there's a fire alarm going off, right, the smoke detector going off and it's blaring.
• 7:32
  Speaker 1: Treating the rotator cuff from a rehab standpoint would be like us putting a pillow and duct taping it against the smoke detector to muffle the sound.
• 7:40
  Speaker 1: Was that actually solving the problem of why the fire is there in the first place?
• 7:44
  Speaker 1: Let's just put out the fire right.
• 7:49
  Speaker 1: The fire is.
• 7:49
  Speaker 1: What's the problem?
• 7:49
  Speaker 1: That's causing the smoke detector to go off, versus just trying to treat the smoke detector and muffle it with a pillow.
• 7:52
  Speaker 1: Let's put out the fire right and then that will follow suit and help solve the smoke detector from stop blaring, right.
• 7:59
  Speaker 1: That's kind of like how we like to approach solving rotator cuff issues.
• 8:02
  Speaker 1: All right, so, with that being said, since they're the victims the rotator cuff and the biceps tendon they're overwhelmed.
• 8:09
  Speaker 1: All right, so then, what's the problem then?
• 8:12
  Speaker 1: Usually, it seems like everything comes down to the scapula.
• 8:15
  Speaker 1: The scapula seems to be the problem as in it's not doing enough.
• 8:19
  Speaker 1: We need to help, have it contribute to reaching overhead and the overhead mobility requirements, the overhead range of motion requirements, or the stability component to help contribute to keeping things stable.
• 8:29
  Speaker 1: As it relates to a golf swing, a tennis overhand serve, a baseball throw, football, shoulder press, burpees, all those sports activities, it seems like the scapula is the biggest culprit.
• 8:43
  Speaker 1: That's not helping enough Just because it's been learned.
• 8:45
  Speaker 1: It's the learned movement pattern over many, many episodes of training, of months and years and years and years, and those learned movement patterns just reinforce the same patterns that cause more of a disparity in either range of motion and mobility or more of a disparity in either range of motion and mobility or more of a disparity in strength, stability and activation requirements for all the muscle tissue.
• 9:03
  Speaker 1: That's where we come in.
• 9:05
  Speaker 1: All right, that's what we do to fix the problem, versus just putting a mask on the issue, taking Advil or just icing it.
• 9:12
  Speaker 1: It's not going to do anything.
• 9:13
  Speaker 1: That's not going to solve the scapular problem.
• 9:15
  Speaker 1: Does that make sense?
• 9:16
  Speaker 1: It's not going to solve the scapular compensation problem and the rotator cuff being overwhelmed and getting lit up constantly.
• 9:23
  Speaker 1: Does that make sense?
• 9:24
  Speaker 1: So, with that being said, we're going to intervene then and focus our treatment at the problem site.
• 9:30
  Speaker 1: That's not helping and that's usually the scapula.
• 9:32
  Speaker 1: Hardly ever do we actually treat the rotator cuff right.
• 9:35
  Speaker 1: The thing's beat up, it's overwhelmed and it's a victim and it's getting broken down over time.
• 9:40
  Speaker 1: All right, are we going to do a ton of rotator cuff strengthening exercises and strengthen something that's already super lit up and beat up and a victim?
• 9:48
  Speaker 1: Of course not right.
• 9:49
  Speaker 1: That thing's just trying to do too much.
• 9:50
  Speaker 1: We need to get other things to help contribute and that's where our exercise prescription and choices come from and also our manual therapy intervention choices come from.
• 9:59
  Speaker 1: We're going to manually intervene to get the things that aren't moving well to move better.
• 10:02
  Speaker 1: Soft tissue restrictions that are limiting motion to getting overhead are the positions you need to.
• 10:06
  Speaker 1: We have to fix those soft tissue restriction problems and then activate and stimulate the things that aren't active enough to get contributing to the movements that are required for your sport.
• 10:16
  Speaker 1: Overhead movement seems to be the number one thing, followed by, I mean, agmr is another one, so just glenohumeral stability stuff, but it seems like the scapula is the root focus of our treatment, because that's like the problem.
• 10:29
  Speaker 1: That's not really helping.
• 10:30
  Speaker 1: Does that make sense?
• 10:31
  Speaker 1: So, and with that being in mind, the clinicians that we mentor and help coach with fellowship, training and residence for sports physical therapy, the clinicians that we mentor, we ask them all right, you're treating this patient right, you went this direction right, which means that your diagnosis was this since you chose this, this and this, and that's the direction you went for treatment, and they feel better, okay, and they're back to doing their thing.
• 10:59
  Speaker 1: When they get back to 100%, go unrestricted full activities, sports, exercise, lifting, baseball, swimming, whatever.
• 11:08
  Speaker 1: When they get back to 100%, how well is the problem not coming back?
• 11:11
  Speaker 1: If the problem comes back, then that means we didn't solve the problem, which means it was a directional choice of treatment that wasn't as accurate as it could have been or purposeful and effective as it could have been, which also means that you did that because the diagnosis wasn't as accurate as it could have been, with the wrong, maybe clinical rationale or not the best clinical rationale you could have had.
• 11:31
  Speaker 1: So we have to backtrack all the way back to the diagnosis and our clinical rationale.
• 11:37
  Speaker 1: What's the problem?
• 11:37
  Speaker 1: What is the cause of the problem?
• 11:39
  Speaker 1: What is the cause of the cause?
• 11:41
  Speaker 1: That's what we need to fix and intervene.
• 11:43
  Speaker 1: And that can't happen in one day, unfortunately, because there's compensation patterns that we have to unlearn, that have been reinforced for a long time.
• 11:50
  Speaker 1: We have to unlearn those compensation patterns.
• 11:52
  Speaker 1: We have to fix the mobility disparities.
• 11:55
  Speaker 1: If something's moving a ton the hyper mobile area and then something's not moving enough hypo mobile we have to fix and intervene that.
• 12:03
  Speaker 1: And we also have to intervene at the muscle recruitment and strength disparities.
• 12:08
  Speaker 1: If some things are very, very active and working overtime and other things are dormant and not helping contribute, we have to fix those muscle recruitment disparities.
• 12:15
  Speaker 1: So it seems to always come down to like the combination of mobility disparities and muscle strength activation disparities with their activity in sports and movement, their movement.
• 12:26
  Speaker 1: We would call that a movement system impairment, right?
• 12:30
  Speaker 1: So, like, what's the diagnosis?
• 12:31
  Speaker 1: It comes down to that movement system impairment as the cause of the cause that's causing the rotator cuff pain, right, pain doesn't happen for no reason, right?
• 12:39
  Speaker 1: That's another thing we always talk about with our patients For musculoskeletal stuff we've mentioned this over the podcast for neuromusculoskeletal problems, neuromusculoskeletal being like a tendon problem, joint pain.
• 12:51
  Speaker 1: Referred nerve pain right Like sciatica, is a trash can term that we'll talk another time.
• 12:55
  Speaker 1: Sciatica is just a blanket trash can term that's not as accurate as it could be.
• 12:59
  Speaker 1: It's just referred nerve pain because of a problem in the low back right or in the neck right Cervical radiculopathy.
• 13:05
  Speaker 1: But those things don't just hurt for no reason.
• 13:08
  Speaker 1: If we rule out systemic problems and red flags think musculoskeletal, neuromusculoskeletal problems they don't just hurt for no reason.
• 13:16
  Speaker 1: They hurt because of something, something's going on right.
• 13:20
  Speaker 1: It's usually for athletes or active people when things hurt for no reason.
• 13:24
  Speaker 1: It's the way that they're moving and grooving and just the compensation patterns with those disparities and range of motion and strength disparities that's causing things to get continually lit up right.
• 13:41
  Speaker 1: So it's either repetitive movements or prolonged postures that are the problem, that just reinforce things to get lit up continually over and over again, which means we can intervene.
• 13:46
  Speaker 1: We can control both of those.
• 13:47
  Speaker 1: We can control our postures and positioning and we can also control what movement things we're doing right now.
• 13:52
  Speaker 1: We have to modify some stuff at the beginning, of course, right.
• 13:54
  Speaker 1: So we have to modify some things totally, then we can intervene appropriately Manual therapy to correct the range of motion problem and joint mobility disparities, and then exercise prescription and choices for correcting those strength and movement disparities, and that seems to be the best way to help solve musculoskeletal problems.
• 14:14
  Speaker 1: So anyway, with that being said, we hardly ever treat the rotator cuff for rotator cuff and shoulder pain because they're already beat up Like we don't want to, we want to cause, we want to intervene and overwhelm them even more.
• 14:26
  Speaker 1: Right?
• 14:27
  Speaker 1: We're not going to have the overtime worker be like hey, can you come back and work extra?
• 14:30
  Speaker 1: They're already doing enough, right?
• 14:31
  Speaker 1: So we need to, we need to intervene.
• 14:32
  Speaker 1: The guys aren't helping enough.
• 14:33
  Speaker 1: So that's where our choices come from.
• 14:36
  Speaker 1: What we would do, though, for the rotator cuff specifically, we'll just mobilize the tissue, give it some love, right?
• 14:43
  Speaker 1: It stimulates hyaluronic acid to help with tendon gliding and fiber gliding maybe realign fibers to be a little bit more parallel, and it's knotted up for tendon and muscle fiber pliability, and then dry needling to help stimulate a healing response.
• 14:57
  Speaker 1: Dry needling definitely has to be very helpful, right, we'll dry needle the supraspinatus.
• 15:00
  Speaker 1: We'll dry needle the infraspinatus.
• 15:02
  Speaker 1: We'll dry needle the teres minor.
• 15:03
  Speaker 1: We can also dry needle, the subscapularis, for the purpose of stimulating a healing response and pain modulation and recruit endogenous opioids for pain to help things feel better, right, and then mobilize the tissue to give us some love for sure, biceps tendon included.
• 15:19
  Speaker 1: But we're not going to strengthen those things or have our treatment focus be on those, because we know that's not the problem.
• 15:27
  Speaker 1: The problem is the scapula.
• 15:28
  Speaker 1: So when we talk about the scapula, when reaching overhead, full overhead, range of motion for the shoulder was 180 degrees right, full, straight line overhead.
• 15:39
  Speaker 1: And if somebody can't get there, naturally, but they're able to do jerk press, snatches, military press overhead, throwing swimming, volleyball, all that stuff, that means that if they can't get it just in pure range of motion, then they're compensating somewhere and it's usually because the scapula isn't helping enough to upwardly rotate and finish the job to get the shoulder fully overhead.
• 16:04
  Speaker 1: A third of the total motion overhead comes from the scapula by itself.
• 16:09
  Speaker 1: So if 180 degrees is full, a third of that 60 degrees has to come from the scapula alone.
• 16:15
  Speaker 1: So if it's limited a little bit from the scapula, there's not much room for error and that means that something else has to compensate to finish the job, because athletes are the best compensators.
• 16:25
  Speaker 1: We know that Athletes just get the job done.
• 16:27
  Speaker 1: They'll do whatever it takes to get the job done.
• 16:31
  Speaker 1: So they're going to compensate, it's normal just to finish the job.
• 16:35
  Speaker 1: But if their scapula is not contributing and they're not able to get full range of motion overhead, then where are they going to compensate?
• 16:42
  Speaker 1: Two most common compensation places we see are the two most painful sites that we usually see.
• 16:48
  Speaker 1: It's the shoulder right up in here.
• 16:50
  Speaker 1: The shoulder is going to hyperflex because the scapula can't continue.
• 16:53
  Speaker 1: So what structures are going to get lit up to hyperflex and constantly help to overwork?
• 16:57
  Speaker 1: Supraspinatus and biceps tendon or infraspinatus, followed by another really common compensation area is their lumbar spine.
• 17:05
  Speaker 1: Their low back is going to hyperextend.
• 17:07
  Speaker 1: So what are the two most common places we see all the time with pain and people we treat, especially athletes, is shoulder pain and back pain.
• 17:14
  Speaker 1: The scapula plays a huge role with that and that's what we have to intervene.
• 17:17
  Speaker 1: So the lumbar hyperextension to finish the job, to get overhead, to hyperextend and bend backwards just to get fully overhead lumbar spine is going to get lit up chronically.
• 17:27
  Speaker 1: So imagine doing that repetitively, many, many, many reps of throwing right.
• 17:31
  Speaker 1: The lumbar spine is going to hyperextend and rotate or snatches and jerk press for barbell lifting and Olympic lift, shoulder press, standing shoulder press, whatever.
• 17:40
  Speaker 1: I mean that's a lot of reps in a row of a lot of beat up activity going on in the lumbar spine to hyperextend chronically.
• 17:47
  Speaker 1: So it's something to consider and think about.
• 17:49
  Speaker 1: So when people come in with back pain and they say you know what my back hurts when I do snatches or when I jerk press, we have to check the scapula.
• 17:56
  Speaker 1: And that's where that link comes in, because if the scapula is not moving well enough, then the to let go.
• 18:10
  Speaker 1: We had to do a full body eval, a way to exam everything and see how everything's moving.
• 18:14
  Speaker 1: Show me the motion that hurts and we can check that out and we'll see like, oh, your scapula is not really moving as well as it could move, making your lumbar spine overcompensate and hyperextend.
• 18:24
  Speaker 1: The most common thing we see for lumbar pain is pain with extension, pain with lumbar hyperextension.
• 18:29
  Speaker 1: So anyway, that's stuff we have to check out, okay?
• 18:33
  Speaker 1: So the most common diagnoses that we see when we see people with shoulder pain is shoulder tell me if you've heard of these before.
• 18:41
  Speaker 1: I'm sure you have Shoulder impingement, rotator cuff impingement, biceps, tendonitis, biceps, impingement labrum, tears, slap tear.
• 18:51
  Speaker 1: Those are all probably the most common things, that posterior impingement, those are probably the most common thing.
• 18:58
  Speaker 1: Oh, a subacromial bursitis, shoulder bursitis, the bursitis is a passive structure.
• 19:02
  Speaker 1: That thing is just that just helps with gliding of the tendons underneath the bone surface so it doesn't just rub against each other.
• 19:08
  Speaker 1: It's like a pillow that rub that helps prevent um fraying and rubbing against a hard surface like a bone.
• 19:14
  Speaker 1: That's all.
• 19:15
  Speaker 1: The bursa is all right.
• 19:16
  Speaker 1: So the bursa gets lit up, which you can.
• 19:17
  Speaker 1: Is the bursa the problem?
• 19:19
  Speaker 1: But we're going to help solve like bursas don't hurt for no reason, right, it's because it's getting um inflamed, lit up.
• 19:24
  Speaker 1: It's getting.
• 19:25
  Speaker 1: It's getting inflamed, lit up.
• 19:26
  Speaker 1: It's getting jacked up because it's something else neighboring it.
• 19:30
  Speaker 1: It's overcompensating because of a disparity somewhere else.
• 19:33
  Speaker 1: That's what we have to treat.
• 19:33
  Speaker 1: So bursa, that's the passive structure, but it's kind of meaningless in our treatment approach.
• 19:41
  Speaker 1: So bursitis, subacromial bursitis, impingement, rotator cuff impingement, biceps, tendonitis, biceps impingement, posterior impingement and labrum issues.
• 19:53
  Speaker 1: So those are the most common diagnoses we see of coming from other providers and stuff like yep, he's got a bursitis problem.
• 20:01
  Speaker 1: It's like, okay, I'm sure the bursa's lit up, but why?
• 20:04
  Speaker 1: What in the first place caused the bursa to?
• 20:07
  Speaker 1: I get let up.
• 20:07
  Speaker 1: That's what we have to investigate, but that's where we have the best results for active athletic people to solve the underlying problem so it doesn't come back again, so they can get back to exercising and jerk press and lifting weights and baseball and all that stuff.
• 20:20
  Speaker 1: Versus you know what, just rest, take some advil and ice it and then or maybe you know not getting better, just stop.
• 20:27
  Speaker 1: Just don't work out anymore.
• 20:28
  Speaker 1: Shoulder press, it's not good for you.
• 20:30
  Speaker 1: There's no reason why it can't be.
• 20:32
  Speaker 1: It's actually a benefit, right?
• 20:33
  Speaker 1: You just have to fix the underlying compensation patterns first and then we can intervene and wean back into that exercise for enjoyment of your life, right, and also for athletes that are wanting to train.
• 20:45
  Speaker 1: So, man, it's a bummer when we hear like you know what, I just haven't done it.
• 20:51
  Speaker 1: My doc told me it's not good for me.
• 20:52
  Speaker 1: Same thing with running, right, that's another one too.
• 20:55
  Speaker 1: Like we'll just don't run.
• 20:56
  Speaker 1: It's like well, how many?
• 20:57
  Speaker 1: There's thousands, of millions of people that run into their late decades of life that are fine.
• 21:05
  Speaker 1: So why are they fine?
• 21:07
  Speaker 1: But then all their colleagues and friends that are younger, in their forties and thirties, having pain.
• 21:11
  Speaker 1: If it was like running is detrimental for everybody, then wouldn't everybody that tries to run have pain?
• 21:16
  Speaker 1: What are they doing differently?
• 21:18
  Speaker 1: That's what we have to intervene.
• 21:21
  Speaker 1: That's what we have to investigate and figure something out.
• 21:23
  Speaker 1: There is a solution.
• 21:24
  Speaker 1: Things don't hurt for no reason and there's plenty of people that run and have no problems.
• 21:28
  Speaker 1: There's plenty of people that throw a baseball and have no problems.
• 21:30
  Speaker 1: There's plenty of people that do shoulder press and jerk press and they have no shoulder pain.
• 21:33
  Speaker 1: So what are they doing different versus the people that have pain with it?
• 21:36
  Speaker 1: What are they doing different?
• 21:37
  Speaker 1: That's what we need to investigate and that's where we need to intervene.
• 21:40
  Speaker 1: So, anyway, if you have any questions, man, I'm always open to answer questions and help shed some light on some stuff, clarify some things.
• 21:47
  Speaker 1: Don't hesitate to reach out to us if you have shoulder pain, back pain, any pain.
• 21:54
  Speaker 1: If you're an athlete, we treat athletes.
• 21:55
  Speaker 1: We work with athletic active people to get them back to doing the things they love in sports they love to do.
• 21:59
  Speaker 1: Oftentimes, people that come see us after they've seen a bunch of other providers not saying they're bad people.
• 22:05
  Speaker 1: They're not set up for success with the current healthcare system model, unfortunately, but the things that haven't worked in the past or they've been told you know what.
• 22:12
  Speaker 1: You probably just shouldn't do that anymore.
• 22:13
  Speaker 1: It's like what there's no reason why you can't do that.
• 22:15
  Speaker 1: There's plenty of people that do that stuff.
• 22:17
  Speaker 1: We just got to fix why.
• 22:30
  Speaker 1: Things don't hurt to reach out.
• 22:31
  Speaker 1: You can call us at 561-899-8725 or email us at team T-E-A-M at athleteRCcom AthleteRC short for Athlete Restoration Company.
• 22:43
  Speaker 1: So, team at athleteRCcom, or give us a call.
• 22:46
  Speaker 1: We would definitely love to chat with you and, um, start the process of investigating maybe why you have some issues and then bring some concrete answers and some solutions.
• 22:53
  Speaker 1: So, uh, don't hesitate to reach out.
• 22:55
  Speaker 1: Um, we're always open to suggestions and, uh, other topics too.
• 22:58
  Speaker 1: We'll catch y'all next time.
• 23:00
  Speaker 1: Hey, hold up.
• 23:01
  Speaker 1: As you know, we're a small local practice and we don't run any ads or something on this podcast, but it would mean the world if you could share, write a post or word of mouth recommendation for somebody just like you that's athletic and active, that wants to live their dynamic lifestyle and pay some good karma and pay it forward to somebody else just like you.
• 23:21
  Speaker 1: And, who knows, you could change their world and a 10 second review could be that avenue.