All right, everybody, welcome back from another episode of the barbell therapy podcast. Iâm your host, Dr. Brett Scott. And with me today is my colleague mentor. And thereâs something we can add to the end of that pretty soon
Unknown Speaker  0:16 Â
is remez Antoon. So Ramirez is the owner of neuro PDX. And heâs been on the podcast before. So weâre coming back. Iâve had a couple of people reach out that wanted to dis have us discuss a little more in depth of how we differentiate shoulder pain versus neck pain. And how do you know what to go after. So we see a lot of people in the clinic every day, which come in and have kind of failed treatment a little bit or just didnât work for them where something was missing from either the history they gave, or the questions that were asked, and just maybe the treatment that happens. And, you know, if you have shoulder pain, and youâre continually doing everything under the sun, and itâs not getting better, we should think about taking a look at your neck and how youâre moving and what youâre feeling. And thereâs a ton of stuff we have just from asking the right questions to lead us in the right path of this doesnât smell like a shoulder. This smells like a neck thatâs contributing to most of the pain. So me and Mazur gonna go through some of that. So, mez, welcome back to the show, here it, it just, thereâs 14, well, you have even more training than me. But thereâs about what 17 years of education in this room, and it just took us 45 minutes to figure out the microphones.
Unknown Speaker  1:39 Â
Yeah, thatâs about it sounds about right. So and Ramirez is such a nerd that he thought audio input was just like the motor sensory system, which he forgot that the computer is the central nervous system for this. So he had settings backwards for a bit. But anyways, weâre here now we figured it out after 45 minutes.
Unknown Speaker  2:00 Â
And weâre going to talk a little bit about shoulder versus neck pain, and what could be coming from where and why. And a couple things you could do to kind of see for yourself if your shoulder pain might be neck pain, or vice versa, and some things you might be able to do about it. So remez take it away. What do you got for us?
Unknown Speaker  2:22 Â
Thanks for the intro, Brett. So I mean, yeah, what you touched on, you know, a lot of people who go to physical therapy or chiropractic for short, quote unquote, shoulder pain, a lot of times failed treatment, in the subjective or in the history, a lot of times you can start to glean whether the shoulder was the primary issue. And weâll get into a lot of that later on. But I think my mentor Martin helped me really
Unknown Speaker  2:52 Â
screen that out from the subjective history. And then thereâs some very simple things we can do in the objective testing that can actually confirm our hypothesis coming in to the objective exam from the subjective interview process, which unfortunately, I think a lot of times, we as clinicians coming out of school, we kind of glaze over the subjective history. But the more training that I had postgraduate, I realized that the subjective interviewer and actually listening to the patient and listening to their story is probably one of the most important starting points to actually help them get better. So yeah, I think from from there, we can kind of break down what to listen for or from a to really bring value to the audience what they should pay attention to, so that when they go to see a clinician or a provider, they can be a better detective and reporter as to what theyâre feeling and whatâs going on. I think thatâs kind of probably one of the biggest things we can bring to the audience from from todayâs podcast. Yeah, and even being able to tell your story. And if these things add up for you in lineup, like these are things, even if the clinician isnât asking these questions, because a lot of times in the traditional medical model right now, thereâs a lot of questions providers have to ask just to write down for insurance, and theyâre not maybe relevant to actually, you know, getting you better. So thinking about these things, and being able to add these in to your subjective report are huge because, as Matt said, the investor is the one that taught me all about the subjective examine how important it is. Itâs like now my, my clinical testing of putting you through all kinds of different movements just solidifies the evidence you already told us for the most part, and sometimes it brings us down different rabbit holes. But anyways, thereâs plenty of times we see this and how would you like to to lead them into this from here as well? Well, I think a really good place to start would probably be teaching our listeners how to start to journal and write down some of the
Unknown Speaker  5:00 Â
things that theyâre experiencing, and maybe give them some categories to filter out whatâs relevant and maybe irrelevant. So
Unknown Speaker  5:11 Â
if we set this up with, Okay, someone is experiencing shoulder pain,
Unknown Speaker  5:16 Â
what can they do to start writing down some of their triggers? And start to notice when their pain gets worse when their pain gets better? And is like, youâre saying, Is this even a shoulder situation? Or is this potentially referred pain from the neck?
Unknown Speaker  5:35 Â
I think that would be a good place for us to start, discuss just some common classifications of of triggers and what
Unknown Speaker  5:44 Â
what may what may feel like shoulder pain may not always be shoulder pain. So I think that would be a good place for us to start, how can how can they write in journals and things down so when they go into your provider, the their report is a little bit more organized, and less all over the place. Because sometimes shoulder pain can feel like itâs all over the place and feel like it doesnât really make sense. And so having some organization to their report can can really help I think, yeah, so the big, the big three things we have that we need to look at with the cervical spine. In most times, if you have shoulder pain, there might be something upstream to with the neck or the thoracic spine, that arenât working as optimally as we want. So the big things we need to keep in mind with the shoulder are load. So that could be gravity. That could be when you press a barbell overhead, youâre adding load to the cervical spine, so itâs even lifting your arms up in front of you is adding cervical load, because youâre compressing the muscles, which can,
Unknown Speaker  6:52 Â
you know, mechanically is putting pressure through the spine or decreasing the amount of space between discs, which, if thereâs some type of issue with the nerve or the disk, this can create some type of sensitivity. So that is one, the other is tension. So
Unknown Speaker  7:10 Â
if you thought about your nervous system, and your nerves as cables, essentially your nerves run from your fingertip all the way up your arm into your brain, and your brainstem. And so we can have tension on these nerves to or pulling in certain areas or a lack of mobility in the way the nerve can behave for various reasons. And that can become a trigger, and is something that will contribute to shoulder pain, although itâs coming from the neck as well. The last is position. So as many of you know, our neck moves in all different directions. So we have flexion. So bring your head down. By extension, bring your head back rotation, side bending, all these play into
Unknown Speaker  7:58 Â
essentially, especially looking at our day to day life. So if you sit at a computer all day, and maybe we donât have the the best ergonomic setup where our computers too low, our keyboard is too far away. We donât have armrests, or head support, we end up with this kind of forward head posture, which isnât bad if weâre just there for a little bit. But if we spend eight to 12 hours a day here for a years, sometimes we end up in extension, and that can become sensitive, because
Unknown Speaker  8:27 Â
thereâs a host of reasons it becomes sensitive. But basically, the body could just be sick of that position, or there could be something else pathologically going on or structurally going on. So those are things weâre going to talk about here of those are basically our three pillars of what can happen at the neck that can create shoulder pain, anything else you want to add there mess. Now I think just summarizing, it would be helpful for our listeners. So load, position, nerve tension, and then sustained postures or position. So those are the four categories that we listen for in the in the subjective history. So when Iâm listening to someone complaining of shoulder pain, and they tell me things like okay, well yeah, just sitting at my desk is painful or watching TV at night in my recliner, I start to get pain in my shoulder. And when I hear that, and I hear that their shoulder isnât moving and theyâre having aching, throbbing pain in their shoulder. One of the first things I think of is the neck, I just asked myself, could this be referred pain? Right? And as a practitioner, when Iâm asking someone to lift their arm up and they say, Oh, I have pain, one of the first things that I do just to screen that is to just give the cervical spine a little bit of traction or decompression and see if the shoulder pain goes away and or they can move the shoulder a little bit better. Alright, so pain at rest is one of the first things that makes me think neck and
Unknown Speaker  10:01 Â
Looking at shoulder movements in a loaded, aka sitting or standing versus an unloaded position could help me figure out okay, is this truly a neck situation? Or is this a shoulder situation? So when we take this back to journaling, for the people listening, if youâre experiencing pain at rest in your shoulder, at night, in a recliner sitting at your desk? The question, we canât just assume that itâs the neck. But the question we need to ask is, is this truly a shoulder problem? And thatâs the first thing we ask ourselves as clinicians. Right? So looking at low looking at position, so you mentioned I donât know if you mentioned this earlier, or if you mentioned this in a previous conversation together. But you know, if the weâre looking at the position of the shoulder, is the shoulder painful when theyâre going through shoulder movements, that is potentially shoulder pain. I know that sounds like common sense. But when thereâs that differentiating factor, like, oh, I move my shoulder, Iâm okay. But at rest, I feel shoulder pain. Thatâs another thing that makes us think, Hmm, could this be a neck, right. And then another thing that is interesting is, if the person is doing a few movements overhead, and theyâre fine, but when they report doing sustained movements overhead, and then they start to experience a shoulder pain that could be a shoulder could be a neck, but a lot of times in my experience, sustained overhead movements.
Unknown Speaker  11:37 Â
You mentioned earlier, some of that scapular thoracic or the shoulder, the muscles that travel from the neck to the shoulder, when theyâre active quite a bit, they add a lot of compressive load to the spine, just because they crossed the segments of the spine. So looking at talking about like the upper traps, for example, if Iâm doing a lot of overhead movements in a sustained position. So like electricians, for example, or painters, for example, theyâre doing a lot of hours on end, their arms are overhead, right? Iâm in my mind when theyâre saying that to me, Iâm thinking shoulder, but then Iâm also thinking back in my mind, could this be an irritable neck? Could this be some nerve tension, irritability from that sustained, repetitive movement? Right? So some things to take note of, if you are a patient with this experience, what do you write down, these are some really good bullet points to write down when you report to the clinician or to the provider that youâre seeing.
Unknown Speaker  12:36 Â
And then
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sustained positions was one of the other categories. So if pain is irritating at night, if pain is waking you up at night, if pain is worse, first thing in the morning, we are in our system, weâre very
Unknown Speaker  12:51 Â
keen on looking at how the neck is positioned at night, and the pillows and the mattress situation and sleep position. Right. So looking at those things are critical, and can outweigh a lot of manual therapy or quote unquote, corrective exercise fixes,
Unknown Speaker  13:09 Â
in the in those situations.
Unknown Speaker  13:12 Â
So yeah, I would really, really look at the categories of load position, nerve tension and sustained positions, in that, in that sense. Yeah, so I think next, we should just kind of go through this list.
Unknown Speaker  13:27 Â
We have that is more related to cervical spine and more, which could be related to shoulder.
Unknown Speaker  13:35 Â
And weâll keep summarizing for our audience so that we give them the bullet points to take home. So you take it away, but Alright, so for for anything that comes from the cervical spine, as Mina said, and for a lot of you guys out there that are active.
Unknown Speaker  13:53 Â
Could we have a a bag that has both, you know, cervical and shoulder findings? Yes, absolutely. Again, depending on how mobile you are through different segments, the demands of what youâre doing or your sport youâre partaking in. So we canât ever rule one out and just say itâs the other but for the most part is miss that. So what we see is, you know, if you can work out for a two hour period and you donât feel pain and you feel better, but then you sit at your computer for eight hours and then by the end of your workday, youâre feeling shoulder pain that lasts you know up until you go to bed. That is something thatâs load is a load sensitivity that could be irritating your symptoms. Another thing we see more with the neck pain, besides like you mentioned as being someone thatâs been overhead all day, so weâll see that sometimes have I got this really bad shoulder pain, the day after painting, you know, I was fine all day painting and then I woke up and my arm was dead. I couldnât move my arm red, tingling and numbness down my arm. Thatâs another one where
Unknown Speaker  15:00 Â
Are we just, you know, we did too much, and we get this bout of an inflammatory process. And
Unknown Speaker  15:08 Â
that can cause some issues to the nerve of the nerve root and causes some some pain down our arm. And that could cause lack of strength too. And sometimes itâs very temporary, and it could last a couple of days and get better, sometimes it could be longer.
Unknown Speaker  15:20 Â
The other thing we see a lot, or I see a lot is
Unknown Speaker  15:24 Â
this, these people you guys will come in, itâs like, the pain doesnât make sense. It doesnât correlate with anything Iâm doing, I could do all these different workouts and nothing really seems to bother it. You canât locate the pain, youâre like, youâll be in my office, like, itâs almost like you guys have fleas. And youâre like chasing yourself around trying to scratch your back and point out that pain is very vague. Itâs very vague. And the thing with that too, is those symptoms might change, the pain might be moving around one day, it might be you know, in your upper trap, the other you know, in the next day, it might be in the front of your shoulder or the back of your shoulder. And itâs just really hard to locate.
Unknown Speaker  16:05 Â
One point right there, but when when itâs not clear in those situations, thatâs another time where I really urge people to take notes, and journal. What it is that theyâre doing day to day, at a very basic basic level, like what exercises did you do if youâre not following a strict program? You know, what activities were you doing? And so that you can start to actually, when you look back at the last three or four days, rather than just being like, I have no idea, you can start to gather and see a pattern potentially, like, Oh, when I go to yoga on Wednesdays, I usually Iâm in pain on Thursday and Fridays. Okay, what positions are you doing in this yoga class? On Wednesdays, letâs break that down. Letâs look at what youâre doing. Letâs look at the yoga flow. For example, letâs see what positions are putting because it might not be the position it may might it might be the position and the sustained
Unknown Speaker  17:04 Â
position itself, right. So itâs like if youâre in and out of that position for a second fine, but some yoga instructors make people hold positions for long periods of time. And that could be the issue there. So like, knowing those categories, and knowing how they interplay together can really help us become better detectives. So yeah, good point. Yeah.
Unknown Speaker  17:25 Â
And I find a lot of times to with that is the people that have shoulder pain, that is really neck pain. A lot of times theyâll feel better working out if theyâre not doing anything like crazy overhead. Theyâre doing like a nice backward or whatever, theyâll move around. Itâs the days theyâre not working out where theyâre sitting at their computer and working a long day, that they might find their pain is worse. Yeah, they say, Well, I didnât do anything, quote unquote, right. Yeah, that that could be the problem. Yeah, thatâs the same. Itâs the sustained posture. And so thatâs the other thing is looking at, and this is where people donât take enough notes. And every time I ask them, this question that Iâll get back to you on that is, is, when is it best, and when is it worse? What is the pattern of it, so a lot of times, with, with something thatâs an irritant of the spine,
Unknown Speaker  18:15 Â
we could notice that, you know, maybe you wake up stiff, and maybe we donât have our pillow in the best position. And we have been irritated all night. And typically, that might loosen up a little bit. But then three, four oâclock, youâve been sitting in your chair all day. And then from three oâclock to when you go to bed, you have this nagging pain that that doesnât go away, and you donât know what you did
Unknown Speaker  18:40 Â
have and having a sedentary job in itself can be something thatâs weâll have this onset of,
Unknown Speaker  18:47 Â
you know, we donât see any increase in activity, you know, your workout hasnât changed. None of this makes sense. And so a lot of times, and we saw this a lot with COVID, too, is nothing changed about anyoneâs workout schedule for some people did, but for many, you know, nothing changed about their activity outside of work. But then we all went home and went to this horrible, you know, everyoneâs sitting at the kitchen table or the kitchen counter or on the couch. And all of a sudden thatâs you I saw a huge spike in cervical cases there because
Unknown Speaker  19:22 Â
no one had the right ergonomic setup and they were spending
Unknown Speaker  19:27 Â
so much time in front of electronics and at their computer that it just that is the thing that people didnât see or didnât put together.
Unknown Speaker  19:39 Â
Let me just double let me just double click on that term you used, right ergonomic setup for our for our listeners.
Unknown Speaker  19:47 Â
We are now classifying right, ergonomic setup as you have variable ergonomic positions, because thereâs a lot of people out there these days that are kind of trapped in this dichotomy.
Unknown Speaker  20:00 Â
To me of right versus wrong ergonomics. And the evidence is very clear at this point that itâs more about the variability than it is about the correct posture. So thatâs another piece which kind of falls back to the fourth category of the categories we gave, which is sustained posture, if you can try to really break up and find as many productive postures as possible, that can really help take a lot of the issues that weâre seeing off the table. So I just wanted to add that piece in terms of right ergonomics because a lot of people get really a lot of anxiety about those my ergonomics, right or not. And itâs like, if you have variable productive postures, youâre right. Yeah. Right. Yeah, itâs the right, the right ergonomic setup for you. And a lot of times, Iâve seen people that are hyperactive about having the right ergonomic setup, the right ergonomic setup. And itâs almost like theyâre trying too hard to be in a certain posture. And maybe that posture isnât for them. And thatâs actually what sensitizing them, a lot of people will think they need to sit upright with their, you know, shoulders back in their head up tall. And sometimes, sometimes we need to get out of that posture, because weâve just spent too much time and the body needs to do something else. And just mix it up. Absolutely.
Unknown Speaker  21:19 Â
The next one we have here is not specific to any movement. So again, just working out, you know, no specific movement seems to irritate it, you know, if you can work out, and you donât feel pain,
Unknown Speaker  21:34 Â
Iâve been told and what one of my other mentors says is, you know, if youâre not feeling pain within two hours after your workout, itâs likely not your workout thatâs causing your pain, itâs probably something else. Is it the way youâre recovering? You know, are you going home and I had one patient a while ago that had some neck pain going on. And then we found out that he worked every night on his computer monitor, after he worked out with his head turned 45 degrees to the left.
Unknown Speaker  21:59 Â
And we put it back to the center, and magically, his pain started to get better.
Unknown Speaker  22:04 Â
Another one here is some things weâll find too. And you can try to do this yourself as well. But does your pain or mobility get better when you go from a seated position or standing position to lying on your back that takes some load off of the spine? So do you feel like you know, you get a pinching sensation when youâre trying to bring your arm overhead versus if you lay flat on your back, thereâs no tension on there, does your shoulder pain improve? Thatâs an indicator that maybe there is something to do with the cervical spine.
Unknown Speaker  22:36 Â
And
Unknown Speaker  22:39 Â
if weâre testing a shoulder, and people can do this themselves, too, is if you put your shoulder in a certain position, whether it be out in front of you, you turn it whatever. And
Unknown Speaker  22:52 Â
even if you hold your arm out in front of you, where you sometimes notice some pain, like if youâre doing front shoulder raises or something. And if you can recreate or provoke that pain even worse by typically bending your head backwards and looking towards the ceiling, or flexing your head down or to the side. There might be some type of cervical involvement there too. So itâs just another way for you to self kind of diagnose and see. Is there something going on there.
Unknown Speaker  23:18 Â
And as we said, with ergonomics, the biggest things I tend to see in people that have some type of cervical pain is theyâre working at a desk setup where they donât have an option to rest their head back on their chair at all. And they likely donât have armrests. And if they do have armrests the armrests donât fit them. So theyâre constantly using their traps and their cervical erectors to hold their head and their arms up all day. When wouldnât it be nice if we just let those things relax a little bit so that the body knows that it can go into a state of relaxation?
Unknown Speaker  23:56 Â
Yeah, that goes back to our point of variability Right? Like, can you relax back on a supportive backrest neck rest armrests? Can you recline back and be productive? Can you come forward and be productive? Can you can you alleviate your shoulder pain when sitting at your desk when you rest your arms on the armrest or when you completely scooch all the way back will have your whole back contacting the backrest and recline. If you say that if you stay there for a couple of minutes and then you feel like your shoulder pain is getting a little bit better. Now weâre starting to smell the neck coming into play a little bit. Right. So yeah, those are all very, very, very valid points and I think really helpful things to make note if people are sitting there journaling, what is their triggers? What makes it better what makes it worse? Yeah, anything else you have to add there for the spine?
Unknown Speaker  24:52 Â
Yeah, the comment that you made earlier about if you donât feel pain two hours after your workout
Unknown Speaker  25:00 Â
I donât know that I completely agree with that, because Iâve had some, some interesting like cervical radiculopathy, these that presented with that very thing. And at first, the first few years out of school, that was my my logic, but when do it when getting better at screening and assessing this stuff.
Unknown Speaker  25:23 Â
And I had people journal what they did for workouts, we actually started to pick out a few things within their workouts. And when we remove those things, or created variations of those things, they, they improved, so I wouldnât take that comment for face value. I would maybe, in general, it makes sense. But thereâs like, I would say 25 to 30% of people where they might have more delayed onset of irritability later in the day, if itâs a, Iâm not talking about like a really acute, irritated neck, Iâm talking about more of those very vague sub acute
Unknown Speaker  26:05 Â
issues, right. So itâs just something to keep in the back of your mind, if youâre getting pain towards the end of the day, itâs, I would, I would audit the entire rest of your day, the the dire previous part of the day and the day before, which really comes back down to journaling and making sure youâre making note of these things rather than just taking that as face value. Because I have seen some cases where that wasnât the case. And when we really double clicked into that, we were able to close the case, if you will, what, what types of things were they doing that were irritating them, remember?
Unknown Speaker  26:44 Â
Um, so Iâm talking about the, Iâm talking about some martial artists, and Iâm talking about some people who are really into weightlifting. So a lot of a lot of bag work, a lot of, you know, punching, striking, blocking, a lot of overhead lifts, a lot of pull ups, push ups, any repetitive
Unknown Speaker  27:06 Â
upper body, whether itâs horizontal push pull, or vertical push pull movements,
Unknown Speaker  27:11 Â
and really looking into the the loads and volumes that theyâre doing. And just like kind of stepping into my strength coach shoes and look and asking him about the set rep schemes, and then kind of following that pattern through along with the orthopedic screens and testing and the subjective and then really starting to think figured out, they werenât red flags, there were yellow flags. And when we kept following those yellow flags, we started seeing, like,
Unknown Speaker  27:33 Â
the days that youâre actually having pain, like later in the day, and even into the next day, we go back and we look at the previous workout and we audit the program, we find some we found some of these exercises that were it wasnât necessarily the exercise itself, it was more the volumes and loads that we had to adjust. That really helped us kind of take their case to the to the next level in terms of just
Unknown Speaker  27:57 Â
recovery, if you will. Yeah, you have done a very good job of explaining this to me.
Unknown Speaker  28:05 Â
Can you just explain for people? Why some of the why behind? Why would that occur? Like, why can I do these things during a workout? And Iâm, Iâm fine. But why is it the next day? What is happening there? Hmm, thatâs a really good question.
Unknown Speaker  28:23 Â
Itâs
Unknown Speaker  28:27 Â
I was gonna
Unknown Speaker  28:29 Â
go ahead, are you gonna go through like action potential thresholds here, Iâm not going to use those terms, Iâm going to try to use analogies to maybe help people understand it a little bit better.
Unknown Speaker  28:39 Â
Thinking of it as a bucket of water, right? You can keep filling the bucket of water and it doesnât overflow. But eventually it reaches a point where it water starts overflowing the bucket, right? So these exercises that I was just talking about that seem to be the triggers.
Unknown Speaker  29:00 Â
The amount of volume and low that they were using, were just weâre just starting to overflow the bucket. And they were they were so sensitive that eventually those
Unknown Speaker  29:16 Â
those like non provoking inputs, they built on each other to the point where now they are a input thatâs very sensitive and causing pain. Right. So itâs, and thatâs thatâs the tricky part about these cases where you itâs not a clear cut picture, right? Itâs like thereâs such a delayed onset, and itâs the inputs build on one another and in the technical term is called summation. There, there are these sub threshold inputs, they build on each other, and then you add that to a ergonomic setup that doesnât have enough variability. You add that to a person who is doesnât really know how to unload
Unknown Speaker  30:00 Â
their spine throughout their day, or just is very stressed out all the time, right. And all of these stress inputs build on one another. And then by the end of the day, they have this overflowing effect that they canât control. Right. And so thatâs the way I like to look at it. Itâs like a bucket overflowing. And if you donât know how to empty the bucket throughout the day, and you just keep adding water, adding water, adding water, eventually youâre gonna have a mess to clean up.
Unknown Speaker  30:26 Â
Itâs
Unknown Speaker  30:28 Â
so we could go, we could we could go down the action potential threshold thing, but I donât know if our listeners would appreciate that. No, weâll save that for your podcast.
Unknown Speaker  30:37 Â
The other thing, and you kind of said this up, too, itâs almost like, when mama ainât happy, ainât nobody happy if momâs been at work all day, and her boss is yelling at her and her co worker says something that annoys her. And then she gets a text from someone. And then you know, you remember being a kid and you like, ask whatâs for dinner, and she just unloads on you. She didnât unload enough during the day.
Unknown Speaker  31:00 Â
I havenât read this book. But this, the person who described this book, to me explains this really well. Itâs called the body keeps score.
Unknown Speaker  31:10 Â
And, you know, when you just keep adding stress on top of stress on top of stress, and you donât add recovery of some sort, eventually, the body or the nervous system flips you the bird and says enough is enough, right? And so itâs all the inputs previously, were no big deal. But after they accumulate, eventually the nervous system is going to talk to you. And sometimes itâs just going to give you a nudge, and sometimes itâs going to scream.
Unknown Speaker  31:37 Â
Yeah.
Unknown Speaker  31:39 Â
Alright, so I think that about sums up what we have for cervical and neck related pain and meds, letâs have you talk a little bit about what shoulder pain truly would be that we can use to solidify our evidence that maybe we donât have anything going on with the neck.
Unknown Speaker  32:01 Â
Yeah, so this is where things make a little bit more sense. I would say, you know, the person comes in like, man, every time I take my shirt off, it hurts. Every time Iâm in the shower, Iâm washing my hair, it hurts, I canât reach behind my back, it hurts. Iâm sitting in my car, trying to put on a seatbelt, trying to take my arm across my body, it hurts, I canât reach in the back seat, it hurts, right? These activities that either make us cross midline, go behind my back, reach overhead. And itâs very,
Unknown Speaker  32:30 Â
itâs very classic, right is every time I do this, it hurts versus that vague pattern that we described earlier. So I think shoulder pain is a lot more true shoulder pains a lot more of like what we learned in school and a lot more of like, what people will experience every time they go to do something like I just described, theyâll cringe a little bit, you know, theyâll feel a pinch, theyâll feel theyâll feel a stab sometimes itâll itâll kind of shoot down into their bicep into their, into their upper arm. Right?
Unknown Speaker  33:01 Â
Yeah, itâs just a,
Unknown Speaker  33:03 Â
itâs just a classic. When I move my shoulder, it hurts. And when I just when I and when Iâm not moving my shoulder, itâs fine.
Unknown Speaker  33:10 Â
You know, itâs, itâs pretty, itâs pretty straightforward in that regard. And so when you hear that in the subjective history, itâs just like, Okay, Iâm thinking, Iâm thinking shoulder, but most of the time, weâre still weâre still screening the neck, weâre still looking at neck movements, right. But the subjective history will sometimes really tell a very clear picture. And itâs important for our listeners to understand that if youâre dealing with a good clinician, theyâre not jumping to conclusions too soon, right. Itâs like, I have my suspicions when Iâm listening to the patientâs story. And I have my hypotheses going into my objective examination and my physical examination.
Unknown Speaker  33:51 Â
But Iâm never jumping too soon into off, itâs definitely this right as one of the biggest things that Iâve learned from my residencies and my mentor ships is like, itâs your, you have a hypothesis. Okay, now, letâs test. Letâs see if the testing in the in the history makes sense. Okay, letâs intervene, Letâs retest. And then letâs continue to refine our thought process versus getting too down in the weeds of like, oh, this is it and letâs, letâs just keep going with this route.
Unknown Speaker  34:23 Â
Yeah, absolutely. And I think the other piece too, is just a lot of times if it is truly a shoulder at least with the population I see typically,
Unknown Speaker  34:36 Â
it could be I was doing a snatch or I was bench pressing and I felt a pop or I felt like something was gonna rip. Itâs more acute, like youâll, itâll be more in the moment of knowing something happened.
Unknown Speaker  34:54 Â
That you will feel some type of local pain, you know, and it will be local. Youâll be
Unknown Speaker  35:00 Â
be able to point it out. Itâs not going to travel down your arm typically or radiate or give us zinging. numbness, tingling, anything like that. And typically, if itâs really bad, it might this Yeah. Like, then like in some serious situations, but again, if youâre feeling someone, when something like really goes when youâre bench pressing or something like that, and weâre dealing with something thatâs a potential structural issue, sometimes sometimes that can happen. But people, people will know if thatâs the case, because they wonât be able to lift their arm and pain shooting down the arm. Yes, thatâs different situation. Yeah, like if you truly tear a muscle and you have bruising, and the muscle belly rolls up, and you have a bunch of swelling. Yeah, you could feel nerve pain.
Unknown Speaker  35:44 Â
But thatâs the maybe 20 to 30% of injuries that at least I see. This isnât even medical advice, because it took us 45 minutes to set up a microphone. So we donât know what weâre talking about. Well, luckily, luckily, mics are not medicine. Thank God. Yeah.
Unknown Speaker  36:03 Â
So again, these are just things to keep in mind. This doesnât mean exactly what weâre saying is exactly what youâre going to be dealing with. And you shouldnât use this to self diagnose yourself, either. But it can give yourself a better idea of, maybe itâs not your shoulder, you should keep going after maybe itâs some thoracic mobility, maybe thereâs some stabilization exercises, or just changing your posture. Looking at your pillow, looking at your workstation. Seeing starting to note like Mitch said, the differences of another one I am thinking of now to is, do you feel better on the weekends, a lot of people you know, walking to can typically help any type of cervical or lumbar pain. So if youâre up and moving in, you know, youâre not stuck at your desk all weekends, or youâre not just looking at your electronics all weekend, and youâre doing errands, driving around whatever, and you donât have as much pain on the weekends. Thatâs another insight that maybe thereâs a pattern to this that has to do with the spine or doesnât have to do with the spine. So really getting into, like we said, taking a look at your desk setup. Have you tried working somewhere else? Does it feel better when youâre working in a certain place than another place? Have you tried a different pillow or a different pillow setup? Have you slept on a different bed?
Unknown Speaker  37:24 Â
Other things people should could could or should consider
Unknown Speaker  37:29 Â
all things to write down in a journal to really help
Unknown Speaker  37:34 Â
with pattern recognition for for when you go see a provider? For sure. Kind of just kind of going all the way back to what we said in the beginning? How do you start making sense of these things? How do you know what to write down? How do you know what, what to even say when you go see a provider? Because sometimes it can be so overwhelming when you go see someone in a healthcare setting. Right?
Unknown Speaker  37:57 Â
Yeah, and it will definitely help them and and typically, even though it might not make sense to you, as someone that just straining and maybe youâve done some research online, thereâs typically some pattern or trend of something thatâs going to aggravate it. And unless and itâs a severe case, typically thereâll be some type of position or posture, or maybe even exercise or movement that might feel at least, maybe not better, but less bad.
Unknown Speaker  38:27 Â
Right? Yes. Yes. So.
Unknown Speaker  38:31 Â
So thatâs really that. If you guys have any more questions, feel free to reach out. You can find me at barbell dot therapy on Instagram, barbell therapy performance.com, or at ARCHITEC fitness.
Unknown Speaker  38:46 Â
Our Instagram is at a RKIT eect fitness and meze where can people find you?
Unknown Speaker  38:55 Â
So our Instagram handle is neuro PDX. Thatâs neuro any you are Oh PDX PE D ICs. And you can email me at remez at neuro pdx pt.com. And I respond to all my email. So very responsive there. So any questions or concerns about anything? Shoot me shoot me an email. Yeah. And for those of you that are still listening here, mez as a brilliant teacher, and heâs taught me most of what I know to this point now and has made me this really good detective at figuring out the subjective and how to assess people. And he has a really cool mentorship program as well where he teaches clinicians how to be better at what they do, how to better assess how to ask better questions, communicate, and he really helped me become, you know, way better at really finding what I need to ask him the right questions and just itâs made my practice so much more successful. So thank you for that meze. And appreciate that. Any PTS out there looking to get better and put all these systems together.
Unknown Speaker  40:00 Â
and make sense of everything, especially these complex cases, please reach out to us because heâs your man for that. So thank you, Brett. Appreciate that. Welcome. So,
Unknown Speaker  40:11 Â
yeah, again, weâll have a couple more episodes. And is there anything youâd want to talk about next time?
Unknown Speaker  40:18 Â
Anything weâd like to talk about next time? Why donât we open it up to our listeners and see what what they want to learn more about in terms of maybe doing another thing like this for another part of the body?
Unknown Speaker  40:30 Â
help them become
Unknown Speaker  40:33 Â
detectives, you know how to how to be investigators have their own triggers and alleviating factors, I think that that can be really helpful because the better informed they are coming into a subjective history, the better off a provider can help them. Figure out the root cause. So yeah, letâs open up to the listeners. And letâs see what they what they want to hear from us. Yeah, so Iâll put out a poll and you guys can let me know. And for any clinicians listening, me and Matt will probably do a clinical version of this on his podcast. And we can nerd out a little bit more because thatâs what weâd like to do. Give us just give us an hour to set up the microphone. For real.
Unknown Speaker  41:13 Â
Well, thank you all for listening, and stay tuned for our next episodes coming up shortly. Thanks.
