Latest / The Driven Athlete / The Scapula Secret: Your Shoulder's Hidden Pain Generator | Ep 94

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The Scapula Secret: Your Shoulder's Hidden Pain Generator | Ep 94 · 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, y'all?
• 0:13
  Speaker 1: Welcome back to the Driven Athlete Podcast.
• 0:15
  Speaker 1: I'm your man, dr Kyle.
• 0:19
  Speaker 1: A common thing we see a lot is shoulder pain.
• 0:21
  Speaker 1: All right, probably the most common things that we see is shoulder pain, back pain and then a hit or miss, but those are the two most common things, followed by, like, neck pain, knee pain, hip impingement, ankle, elbow, wrist, but the shoulder and the back are the two most common things we see.
• 0:47
  Speaker 1: So here's the recipe that we investigate and hypothesize, the typical recipe to fix shoulder pain.
• 0:54
  Speaker 1: The first question we ask, we have to figure out, is like what's the problem?
• 0:58
  Speaker 1: What's causing the pain?
• 1:00
  Speaker 1: Why did that start?
• 1:02
  Speaker 1: What can we do to fix it?
• 1:05
  Speaker 1: And then how do we prevent it for coming back again?
• 1:08
  Speaker 1: Right, those are the main questions that we need to figure out and ask.
• 1:10
  Speaker 1: All right, so with our evaluations, we're investigating, like what is the actual what's causing the pain?
• 1:16
  Speaker 1: Like what's the angry tissue, what's the what's the thing that's causing pain?
• 1:20
  Speaker 1: But that's not enough to answer, that's not enough to fix the problem we have to figure out.
• 1:25
  Speaker 1: Okay, let's say, your rotator cuff is the problem.
• 1:27
  Speaker 1: If it's your supraspinatus tendon, okay, maybe some contributions of the biceps tendon, long head of the bicep, we understand that.
• 1:34
  Speaker 1: It's not that hard to figure out.
• 1:35
  Speaker 1: Actually, here's what sets us apart.
• 1:38
  Speaker 1: I think that is really.
• 1:44
  Speaker 1: This is the way you fix it.
• 1:46
  Speaker 1: Why did it get irritated in the first place?
• 1:48
  Speaker 1: The cause of the pain is the rotator cuff.
• 1:49
  Speaker 1: If it's, the supraspinatus and the bicep tendon, that's an example.
• 1:51
  Speaker 1: What is the cause of that cause of pain?
• 1:54
  Speaker 1: That's what we have to figure out and that's what we have to fix.
• 1:57
  Speaker 1: Otherwise it comes back.
• 1:58
  Speaker 1: So the people that we mentor in our clinic physical therapists, doctors of physical therapy that come to mentor with me, that are in the fellowship, training or fellowship courses and stuff we ask them what is the cause of the cause?
• 2:10
  Speaker 1: And then if you are intervening, you're rehabbing this person and you say, hey, you know what person?
• 2:17
  Speaker 1: Hey, patient, go out and exercise or do your sport, throw and play the crop, run, whatever, full go.
• 2:23
  Speaker 1: If the pain comes back, that means you didn't solve the problem.
• 2:27
  Speaker 1: If it doesn't come back, it means you solved the problem right.
• 2:31
  Speaker 1: And then solving the problem first comes with the right diagnosis.
• 2:34
  Speaker 1: We have to have the right lens in which to perceive the problem, to diagnose it accurately, which is going to totally change the trajectory of treatment of how to fix the problem.
• 2:44
  Speaker 1: All right, totally change the trajectory of treatment of how to fix the problem?
• 2:46
  Speaker 1: All right, with manual therapy intervening at the right joints.
• 2:48
  Speaker 1: Soft tissue work If it's dry needling can be included too.
• 2:51
  Speaker 1: That helps facilitate the healing process and then corrective exercise prescription.
• 2:57
  Speaker 1: That's going to solve the problem.
• 2:58
  Speaker 1: And my question would be like why choose that exercise versus something else?
• 2:59
  Speaker 1: What's the biomechanical rationale linked with your diagnosis of why you chose that exercise to fix the problem, the biomechanical rationale linked with your diagnosis of why you chose that exercise to fix the problem?
• 3:07
  Speaker 1: And if it's, if a clinician is not able to answer that concisely, then that means they're just throwing stuff against the wall, blind.
• 3:12
  Speaker 1: All right, just like dark, dark room trying to hit a dark board, like maybe this will work, right.
• 3:17
  Speaker 1: So purposeful, right, we got to be purposeful with our manual interventions and also our corrective exercises.
• 3:23
  Speaker 1: So, with the shoulder specifically, the things that we check out usually that we have to investigate, number one is the shoulder blade, the scapula.
• 3:31
  Speaker 1: All right, that is the keystone for the shoulder joint and the shoulder girdle.
• 3:36
  Speaker 1: All right, the scapula has to move enough.
• 3:40
  Speaker 1: It has to start in the right position in order for things to move enough and accurately and then it will F up.
• 3:48
  Speaker 1: All the muscles that originate because there's all four rotator cuff muscles originate from the scapula and then insert to the humerus, the arm bone at the head of the humerus.
• 3:59
  Speaker 1: So if the scapula is dysfunctional, it starts in the wrong position.
• 4:01
  Speaker 1: It's not the rhythm of the scapular activation isn't there, it's not moving enough.
• 4:07
  Speaker 1: What do you think the muscles that start from there are going to do?
• 4:10
  Speaker 1: They're going to be dysfunctional.
• 4:11
  Speaker 1: They're not going to activate right, they're going to be overly.
• 4:13
  Speaker 1: Usually those rotator cuff muscles are over-performing, they're overcompensating to make up for a lack of scapular mobility.
• 4:23
  Speaker 1: All right.
• 4:24
  Speaker 1: So if the supraspinatus is the main rotator cuff muscle on the top of the shoulder that gets painful the most, followed by the infraspinatus, followed by the teres minor, followed by the subscapularis, that the supraspinatus is getting involved, and so is the infraspinatus a little bit.
• 4:36
  Speaker 1: Why?
• 4:38
  Speaker 1: Right?
• 4:39
  Speaker 1: And there's a huge commonality that the scapula is not starting in the right position and there's other muscles that help to activate the scapula that aren't contributing enough.
• 4:48
  Speaker 1: That's making the supraspinatus have to overcompensate to make up for that lack of movement in the poor starting position, and we would call that scapular rhythm, all right.
• 4:57
  Speaker 1: So the scapular rhythm needs to be working well, all right, otherwise the rotator cuff is going to be overcompensating.
• 5:05
  Speaker 1: So here's just in.
• 5:05
  Speaker 1: The rotator cuff is going to be overcompensating.
• 5:06
  Speaker 1: So here's this.
• 5:06
  Speaker 1: And the rotator cuff is a group of four muscles that are very small, they're not massive and they work in concert together to suck in the arm bone and keep it in place while you move and groove and do stuff with exercise and pushups and shoulder press and throwing a football and baseball, whatever.
• 5:19
  Speaker 1: So they work in concert together and they're not big and they don't massive muscles.
• 5:24
  Speaker 1: If they have to overwork and compete against the scapula, that's not moving well.
• 5:31
  Speaker 1: And other major muscles like your latissimus dorsi, your lat and your pectoralis major, your pec, and Terry's major is another big player too for creating internal rotation.
• 5:41
  Speaker 1: That's a big, strong muscle.
• 5:44
  Speaker 1: If that little muscle and those two small muscles are competing against big muscles that are really strong and dominant and tight, who's going to win?
• 5:53
  Speaker 1: What's going to happen to the rotator cuff?
• 5:54
  Speaker 1: It's going to get broken down over time.
• 5:55
  Speaker 1: It's going to get frayed, it's going to get overwhelmed, it's going to get broken down.
• 5:59
  Speaker 1: And what does that look?
• 6:00
  Speaker 1: What does that feel like?
• 6:01
  Speaker 1: It hurts, it causes impingement, right.
• 6:03
  Speaker 1: So shoulder impingement, rotator cuff-based pain and classic signs and symptoms for referred rotator cuff-based pain is pain down the lateral shoulder down to the arm and like it feels like down my arm, my arm hurts.
• 6:16
  Speaker 1: That's classic referred pain from the rotator cuff, or front pain where the biceps tendon is getting irritated and sensitive and overwhelmed.
• 6:24
  Speaker 1: Because the biceps tendon is getting irritated and sensitive and overwhelmed Because the biceps tendon also is going to contribute to help prevent the shoulder from dysfunctioning too much.
• 6:30
  Speaker 1: But that's not really the job of the long head of the biceps tendon.
• 6:33
  Speaker 1: It's going to get overwhelmed and it's going to get overly stressed and strained and that's going to cause it to get painful and irritated as well.
• 6:39
  Speaker 1: All right, on top of that, the joint capsule of the glenohumeral joint, the shoulder joint, there's a small membrane that unsheathes the shoulder joint itself up in here and that is also.
• 6:50
  Speaker 1: This has tons of nerve endings on the undersurface membrane called the synovium and that's going to get irritated and lit up too.
• 6:56
  Speaker 1: So the rotator cuff is lit up, the supraspinatus and infraspinatus, particularly the long head of the biceps tendon, gets lit up, very sensitive, and then the capsule itself gets overwhelmed, stressed and then sensitive and painful too and that creates like shoulder pain.
• 7:10
  Speaker 1: All right, so that's a classic thing.
• 7:12
  Speaker 1: So, key considerations we have to investigate the scapula.
• 7:15
  Speaker 1: All right, that's the first thing we're looking at.
• 7:16
  Speaker 1: That's what I educate my clinicians that come in, the doctors of physical therapy that come mentor with me in the clinic.
• 7:22
  Speaker 1: That's one of the first things we check out and investigate.
• 7:24
  Speaker 1: All right, we have to look at the scapula first.
• 7:27
  Speaker 1: Like I said, all those muscles originate from the scapula, and then the next thing is just the glenohumeral joint itself and the humeral positioning.
• 7:38
  Speaker 1: So if the humerus starts more anterior, more forwardly tilted or more forwardly shifted, that's a great recipe for an anterior shift or a forward shift of the shoulder ball and socket joint.
• 7:50
  Speaker 1: What do you think the front structures that span over the anterior part of the shoulder joint are going to be like?
• 7:56
  Speaker 1: They're going to be overstressed and strained and painful.
• 7:57
  Speaker 1: Right, so that looks like with throwers as an example, if they have pain when they reach back at layback or late cocking of the throw and they have pain in their shoulder with early acceleration.
• 8:09
  Speaker 1: That's a classic sign for anterior hypermobility.
• 8:14
  Speaker 1: All right, where the bicep tendon and the anterior capsule are getting lit up and the rotator cuff is way overcompensating to hang on for dear life and we got to fix that stuff, all right.
• 8:26
  Speaker 1: So, and then also the scapular rhythm, like I mentioned, compared with the ratio of range of motion contributed from the ball and socket joint, the glenohumeral joint and the scapula itself, to get fully overhead in the shoulder joint, you need 180, the consideration would be you need 180 degrees of full range of motion overhead.
• 8:47
  Speaker 1: That'd be a straight line when you reach your arm straight overhead.
• 8:49
  Speaker 1: Is that a straight line straight down your rib cage, like the mid rib cage line?
• 8:55
  Speaker 1: We call that the mid axillary line.
• 8:56
  Speaker 1: Okay, the axilla is like your armpit region.
• 8:58
  Speaker 1: So in the mid axillary line, is it a straight line from your arm bone straight down?
• 9:02
  Speaker 1: Very uncommon, that's.
• 9:05
  Speaker 1: A lot of people actually not many people have full range of motion, okay, and if they do, it's usually because they're overcompensating.
• 9:12
  Speaker 1: So if you need 180 degrees of overhead range of motion, 120 degrees of that should come from pure glenohumeral roll and glide and the remaining 60 degrees should come from your scapula by itself.
• 9:27
  Speaker 1: So usually it's the scapula that's athletic.
• 9:32
  Speaker 1: The scapula is usually limited, partly because it's starting too far stuck in the mud down and it's not starting in the right position.
• 9:43
  Speaker 1: And then the muscles that activate and move the scapula upward rotation, to rotate it upwardly aren't activating and functioning strongly, they're not recruited enough.
• 9:50
  Speaker 1: And then there's also soft tissue restrictions that are limiting the motion on top of that and therefore the rotator cuff has to compete against those things.
• 10:00
  Speaker 1: To move your arm overhead enough.
• 10:02
  Speaker 1: And imagine doing that repetitively with like shoulder press and jerk press and snatches and hand cleans, power cleans to jerk press stuff like that Military press, right, inclined push-ups, inclined bench, repetitively, over and over again right push-ups, inclined bench, repetitively over and over again right.
• 10:21
  Speaker 1: And then if the glenohumeral joint isn't rotating enough too because of soft tissue restrictions, that's also going to be limited and the rotator cuff has to compete against that also All right.
• 10:28
  Speaker 1: So get full overhead range of motion.
• 10:29
  Speaker 1: A person needs 180 degrees straight up and down with their arm, okay.
• 10:34
  Speaker 1: They also need to get enough full external rotation of their arm, all right, their arm has to rotate externally, feeling like longitudinally overhead, and then their elbows need to get fully straight.
• 10:45
  Speaker 1: So here's a quiz question Try right now Can you reach your arm straight overhead and get 180 degrees with your elbow straight and your hand rotated outwards?
• 10:54
  Speaker 1: If the answer is no, then you're not getting full range of motion.
• 10:57
  Speaker 1: I haven't really met one person yet.
• 10:58
  Speaker 1: I haven't met many people.
• 11:01
  Speaker 1: I probably have, but I haven't met many people that can do that, so it's kind of uncommon.
• 11:07
  Speaker 1: So imagine, then, an athlete who needs to get overhead with shoulder press, jerk press or snatches, push press, incline bench, whatever.
• 11:15
  Speaker 1: They need to get fully overhead, but they're limited in range of motion in their shoulder.
• 11:19
  Speaker 1: Where's the rest of the range of motion going to be made up for?
• 11:22
  Speaker 1: What they do is they're usually hypermobile in their shoulder joint, they hyperflex in their glenohumeral joint because the scapula can't continue, and then, in addition to that, they hyperextend their lumbar spine, their low back, so they extend their low back and then their shoulder joint itself will hyperflex.
• 11:41
  Speaker 1: Okay, because of lack of mobility elsewhere.
• 11:43
  Speaker 1: That's going to create a lot of a cascade of things that are going to overcompensate and get irritated in your low back and in the shoulder joint itself.
• 11:50
  Speaker 1: Okay, and what are the two most common things that we see, the most cases that we see consistently is low back pain and shoulder pain.
• 12:00
  Speaker 1: Anyway, there's a link between the two.
• 12:02
  Speaker 1: One other thing we can't neglect is that we had to investigate the thoracic spine.
• 12:05
  Speaker 1: The thoracic spine region is 12 vertebrae in the middle of your back, the upper back, and there has to be enough of extension, for sure, and rib mobility.
• 12:18
  Speaker 1: Add the relationship between the scapula and the thoracic spine, and then some of the muscles connect from the rib cage in the thoracic region to the scapula and also to the shoulder joint.
• 12:28
  Speaker 1: So the thoracic spine needs to be pliable and mobile as well.
• 12:33
  Speaker 1: Okay, so that's something we investigate also.
• 12:35
  Speaker 1: So, anyway, that's like, that's like the recipe that we investigate.
• 12:38
  Speaker 1: And one more thing on top of that Okay, so what's the usual step when somebody has shoulder pain?
• 12:46
  Speaker 1: What do they do?
• 12:47
  Speaker 1: They go to the doc.
• 12:47
  Speaker 1: What's the doc say?
• 12:48
  Speaker 1: We need to get an x-ray.
• 12:49
  Speaker 1: Okay, if it's soft tissue, they're not going to find anything.
• 12:52
  Speaker 1: Anyway, they just had to do that.
• 12:53
  Speaker 1: They had to do an x-ray first to satisfy insurance requirements to then have an MRI.
• 12:59
  Speaker 1: Okay, so now it's like x-ray came back negative, schedule an MRI, come back and schedule a follow up with the doc later.
• 13:05
  Speaker 1: All right, that's at least a three week process and in the meantime of those three weeks they're not having any benefit.
• 13:10
  Speaker 1: They're not doing anything about their shoulder pain, they're just waiting for the MRI results.
• 13:14
  Speaker 1: They're waiting for the appointment to have a consult and then usually in the consult the doc's like you're not a surgical candidate, go get PT.
• 13:20
  Speaker 1: So I'm like, bro, just come in right away, we can fix the problem earlier.
• 13:23
  Speaker 1: And that's a three week.
• 13:24
  Speaker 1: And then the schedule of PT is another week to wait.
• 13:26
  Speaker 1: That's a four week timeframe where, like that, four weeks could have had some interventions and feel better already, some answers and then actually feel better and back to some of the functional activity you like to do, without that delay.
• 13:37
  Speaker 1: You know what I mean, because you can't get your time back, but anyway.
• 13:41
  Speaker 1: So what do they usually find in MRI?
• 13:42
  Speaker 1: All right, so there's internal derangement that can be totally present, where the labrum can get involved, the biceps tendon and the biceps anchor can get involved, that rotator cuff can get involved and frayed those are the most common ones.
• 13:56
  Speaker 1: And the joint capsule.
• 13:57
  Speaker 1: There can be edema and increased signaling and swelling present in the joint capsule itself.
• 14:02
  Speaker 1: Synovitis all right, tenosynovitis and then capsular synovitis as well.
• 14:08
  Speaker 1: That represents, like synovium, the synovial soft tissues that allow for fiber gliding, that ensheath the tendinous and joint capsule structures.
• 14:22
  Speaker 1: So imagine, with these flawed shoulder mechanics and biomechanical compensation patterns, with thousands and thousands of reps over many, many weeks and months and years, with those flawed mechanics and undue stress being placed on certain structures and instability or hypermobility in certain directions in compensation patterns, what do you think is going to happen?
• 14:43
  Speaker 1: The labrum is repetitively going to have stress placed on it and undue stress in certain positions, certain areas of the labrum.
• 14:52
  Speaker 1: That's going to cause fraying of the labrum and that repetitive fraying over time can become enough to a point where it causes pain.
• 15:00
  Speaker 1: But there's plenty of people that have a lot of fraying evident in their labrum, or tears, if you want to call it that, and they have no pain.
• 15:09
  Speaker 1: So it's not always the structural abnormality that causing the pain problem.
• 15:14
  Speaker 1: Okay, it just represents underlying shoulder instability over many, many chronic episodes.
• 15:19
  Speaker 1: Okay.
• 15:20
  Speaker 1: And then same thing with the biceps anchor.
• 15:21
  Speaker 1: So the biceps, the long head of the biceps tendon, you have two tendons in your bicep by meaning two and the long head goes up in the shoulder joint and it connects to the, to the super glenoid tubercle Okay, of the scapula, all right, it attaches to the inside of your shoulder joint and it anchors with the top part of your labrum.
• 15:40
  Speaker 1: Okay, issues with that, or detachment, or fraying, or stress and tears, that can happen.
• 15:47
  Speaker 1: There would be a slap tear, okay, that's where the word slap tear comes from, slap meaning S-L-A-P, superior labrum, anterior to posterior, and that has to do with the biceps anchor as it attaches to your shoulder joint and that would be a slap.
• 16:01
  Speaker 1: Involvement is what we would call that.
• 16:02
  Speaker 1: Okay.
• 16:03
  Speaker 1: But that again represents flawed mechanics with a lot of chronic high volume activity with underlying shoulder hypermobility.
• 16:16
  Speaker 1: In certain directions it's usually in the anterior forward direction of the humeral head is more hypermobile, okay.
• 16:23
  Speaker 1: And then also the rotator cuff.
• 16:25
  Speaker 1: The tendons of the rotator cuff can get, with all the repetitive stress and compensation patterns and flawed mechanics.
• 16:32
  Speaker 1: It can get frayed over many, many episodes and that fraying is termed a tear as well.
• 16:37
  Speaker 1: And enough of a tear is graded in certain ways in certain vocabulary descriptions, and that fraying leading to a tear can seem scary.
• 16:49
  Speaker 1: But that's also what can be found as well is the tendons can get frayed over time Like a rope gets frayed enough to the point where it causes symptoms, and enough symptoms that then go to the doc to get the image in the first place and they're like oh, you have a rotator cuff tear and a labrum tear.
• 17:02
  Speaker 1: It's like, oh my God, I had no idea.
• 17:03
  Speaker 1: Well, that tear might have been there for years.
• 17:06
  Speaker 1: Okay, from all the repetitive microtrauma, micro injuries and repetitive stress placed on them, from all the compensation patterns for many, many years, where the image of that MRI currently looks like you have a labrum tear, slap tear and a rotator cuff tear.
• 17:24
  Speaker 1: Whatever that image.
• 17:26
  Speaker 1: Imagine if you would have got an image three years ago of your shoulder.
• 17:29
  Speaker 1: It very confidently and very commonly the image would be identical.
• 17:34
  Speaker 1: But you didn't have pain three years ago, but now you have pain for the past six months.
• 17:38
  Speaker 1: All right, three years ago, but now you have pain for the past six months, all right.
• 17:44
  Speaker 1: So is the structure actually causing the pain enough to have a structural intervention like a surgery?
• 17:48
  Speaker 1: I'm just saying like I don't hate surgery.
• 17:50
  Speaker 1: Surgery is necessary, sometimes totally, but we don't have to jump the gun and it sounds scary.
• 17:54
  Speaker 1: We don't want to be fear mongered into getting surgery, though sometimes, all right, we don't have to do that.
• 17:58
  Speaker 1: It's important to get an opinion.
• 18:00
  Speaker 1: Sometimes, all right, you can get a second opinion.
• 18:05
  Speaker 1: Of course we're a little biased because we're conservative therapists that work with athletes and active people.
• 18:08
  Speaker 1: We're naturally optimistic individuals Because we've had really good results of people that have had imaging that doesn't look great.
• 18:17
  Speaker 1: But if we look at the cause of the cause, why did this happen in the first place?
• 18:20
  Speaker 1: If we fix the cause of the cause and keep the structure as is, we've had plenty of people that feel totally fine and back to no functional restrictions.
• 18:27
  Speaker 1: And the question would be like after surgery, would your functional capacity be better than what we were to do now, if we were to work together for six weeks, would the functional capacity be higher and better than what it would be if we did this, if we fixed those compensation patterns?
• 18:44
  Speaker 1: Cause after surgery, like all everything's off the table, like everything changes as in, like the compensation patterns haven't changed, the neural recruitment patterns haven't changed, but now there's like we're just starting over and starting from scratch.
• 18:56
  Speaker 1: But um, the things it's not uncommon for stuff to just like proliferate in the same direction Again if you don't fix the underlying compensation, compensation patterns that led to the derangement in the first place.
• 19:07
  Speaker 1: But anyway, would your funk?
• 19:09
  Speaker 1: Here's the question, here's the filter yes or no, to have surgery or not surgery?
• 19:13
  Speaker 1: Would your functional capacity be better than what it would be if we were to work together for a month?
• 19:19
  Speaker 1: If the answer is like maybe not, or the same, then why not just do the conservative and spare the risk and the time and the pain.
• 19:26
  Speaker 1: It's like it's painful after surgery, but I'm not sure if you know, but like you need.
• 19:29
  Speaker 1: That's why you have pain meds after rotator cuff repair.
• 19:31
  Speaker 1: Oh my gosh, you're.
• 19:33
  Speaker 1: It's just, it's as appropriately necessary happens and expectedly, as expected, someone's going to be very sensitive and painful and sleep is the number one thing.
• 19:44
  Speaker 1: That's very challenging for the first six to eight weeks of surgery.
• 19:47
  Speaker 1: I've seen a ton of them.
• 19:49
  Speaker 1: All right, but anyway.
• 19:51
  Speaker 1: So that's just something to consider, right?
• 19:53
  Speaker 1: I don't hate surgery.
• 19:54
  Speaker 1: Sometimes you got to have surgery, but it's never a bad idea to get multiple opinions, all right, and then just look at it from a different, reframed angle of like, what's the decision here?
• 20:04
  Speaker 1: What's the best decision?
• 20:05
  Speaker 1: But anyway, if you have any questions, that's a little bit of breakdown of the recipe of shoulder pain Usually.
• 20:09
  Speaker 1: If you have any questions, comments, concerns or conflicting opinions, please reach out.
• 20:13
  Speaker 1: Come, step into my office.
• 20:14
  Speaker 1: Let's have a conversation, discussion, I'm all about it.
• 20:16
  Speaker 1: I love to hear different opinions and have a arousing conversation about some stuff.
• 20:21
  Speaker 1: And if you have any pain or issues and you want to work with a specialist, please reach out.
• 20:26
  Speaker 1: We'd love to at least talk.
• 20:27
  Speaker 1: We can at least talk on the phone and figure out if you have an issue that we can help or maybe point you in the right direction.
• 20:31
  Speaker 1: And the best way to reach us is 561-899-8725 or our email, which is team at athleteRCcom.
• 20:38
  Speaker 1: That's the best way to reach out to us.
• 20:42
  Speaker 1: Um, but yeah, if you have any pain, you want to work with a specialist, you need some answers.
• 20:45
  Speaker 1: You're not sure what to do.
• 20:46
  Speaker 1: You've been told by multiple providers that you need like you're screwed.
• 20:50
  Speaker 1: You'll never be back to doing this.
• 20:51
  Speaker 1: You're in pain forever.
• 20:52
  Speaker 1: You need to take pain meds, surgery.
• 20:55
  Speaker 1: This isn't working whatever.
• 20:56
  Speaker 1: We hear that very often.
• 20:57
  Speaker 1: We can at least have a conversation right and then point you in the right direction.
• 21:01
  Speaker 1: If you don't feel like we're the right fit, or you don't feel like if we don't feel like you're right fit for us, you don't feel like we're right for you, totally understandable we at least point in the right direction.
• 21:09
  Speaker 1: But if it's something you want to investigate with a specialist, please reach out.
• 21:12
  Speaker 1: All right, I look forward to hearing from you and we'll catch y'all next time.