[00:00:03] Nick: I do feel that it is often misdiagnosed. It's an easy target. Everybody already knows about it. How many people do you think that we've seen that, like they were diagnosed with a rotator cuff tear, they come in like, I gotta get surgery, I had a rotator cuff tear, and they just start flailing their arms all over the place. That's pretty good rotator cuff.
[00:00:29] PODCAST INTRO: Welcome to “In The RACK” podcast, where we provide you with the practical framework for breaking PRs in all facets of health and wellness. We are just a couple of bros giving you the simple house in a world of complex wants. No filters, no scripts, no rules, just straight talk, talk tune. Now, let's get into the rack with your hosts, Dr. Chad and Dr. Nick.
[00:00:55] Chad: Alright, everyone. Welcome to another episode of “In The RACK” podcast. I'm your host, Chad. And with me is my co-host and fellow physical therapist, Nick. One of these days, I'm gonna change that intro it's gonna get boring.
[00:01:08] Nick: Isn't it boring?
[00:01:09] Chad: I know.
[00:01:10] Nick: I do much more than physical therapy.
[00:01:11] Chad: That's true. I know. We'll have to change our names, titles, everything. It's going to happen. But anyways, I'm hoping some cool names that would be figured out. Next time, we'll get you. The last couple of weeks, we had some actually great guests on the show. We had Dr. Jeff Newman. And we had Erin Murray, both of which were great podcasts. Erin stuck around did a workshop, which was enlightening. And so many people love that we got a lot of good feedback on that. So looking forward to her coming back and doing some more talks with us. Because that was pretty cool.
[00:01:46] Nick: It just scratched the surface.
[00:01:48] Chad: This is true. But stay tuned, we got some good guests coming up. I will mention that at the end. But we're all lined up for like the next two months. So it's going to be pretty sweet. We don't have a guest today. But we do have a topic that we know a lot of people can relate to. And like, Nick, said in the last episode, we really haven't talked about the upper extremity. And we do treat shoulders, elbows, necks, a lot of them wrist. You touch a hand every now and then. But we treat upper extremities, we do that too. So today we're going to talk about shoulder, specifically, the “Rotator Cuff”, or as some people call it, the Rotary Club, the old famous Rotary Club, but it's Rotator Cuff for all of you guys that were not sure on the fence. So let me just start by saying the word rotary cuff or a rotator cuff is probably use way too much. And I think it's one of those words too, that people just automatically associate with shoulder pain, like somebody has shoulder pain that like rotator cuff due to rotator cuff I have one of those it's gotten I know somebody that had one of those. So I think it's just one of those things that we were we want to kind of like debunk today. And I do feel that it is often misdiagnosed. It's an easy target, it's there, everybody already knows about it. They're already expecting somebody to say rotator cuff. And then when they say it, they're like, “Oh, I knew it”. So we've seen a lot of this over the years. How many people do you think that we've seen that they were diagnosed with the rotator cuff tear, they come in, I gotta get surgery, I had a rotator cuff tear, and they just start flailing their arms all over the place and like, Well, that's pretty good rotator cuff tear that is compensates really well, not to say that there couldn't be a tear in there but that's also not unusual. But to have a full thickness tear and be flailing your arms up and down. It's very unlikely. But anyways, we're gonna talk a little bit about that today. We're also going to talk about some resources back behind the next big into that. So you'll get a little bit of that as well. But rotator cuff injuries are common. They are, in fact, they're probably the most common thing that we see in terms of shoulder pain, I would say. And probably the most common thing that doctors see as well, which probably is the reason why there's so many surgeries on it as well. So but we want to clear some things up with the rotator cuff. We want to educate you a little bit about what that is. And what makes that up because I don't think people actually really understand what the rotator cuff is?
[00:04:22] Nick: They think it's a cuff. I know it's that's the problem. It's a cuff.
[00:04:27] Chad: Because it's a ball and socket. Maybe they just think the ball goes in the cuff.
[00:04:29] Nick: That's really solid. That could be very misleading. Because the shoulder, not like a ball in the cup.
[00:04:39] Chad: Nick, what's the rotator cuff?
[00:04:41] Nick: So we think you guys should, like Chad said have an understanding of what the rotator cuff is. So the rotator cuff is actually a group of four muscles in the shoulder. So when you are told, “Oh, you just have a rotator cuff tear”. Well, that doesn't tell us where the tear is what muscle it's in. There's four of them and sometimes you can have multiple affected but the four muscles, the name, I'll give you the names, but you don't necessarily have to know them. It's the supraspinatus, and infraspinatus, teres minor and the subscapularis, all fancy terms. But basically, these muscles sit to have them sit really on the back of the shoulder blade, and wrap around to the, to the arm bone, humerus, and then one kind of sits on the top. And then once it's on the front, front side of the shoulder blade, and that one is the subscapularis that rests in between the shoulder blade in your ribcage. So it's a kind of in a funky area, you can't really get to it with fingers too much, you can kind of touch a little bit of it, but it's hard to get to. But these muscles all work together. Now, if we're talking tears, the most common they tone is the supraspinatus. That's the one on the top. And we'll talk more about that as we go. But these muscles have to function as a group, and most people because it's called the rotator cuff, they think it's rotation and they do a rotation. They assist with the movement of rotation and help the arm move in that direction. But really, we want you to think about these muscles as maintaining the joint, the shoulder joints centered. And what we mean by that is think about it. Like I said, it's a ball in a socket. But really, because there's so much freedom of movement in that shoulder, think of it more like a golf ball on a tee. And whenever you're moving that arm that golf ball has to say step centered on the tee, and that's really what the rotator cuff muscles as a group do, whenever you move your arm flailing around through space, that rotator cuff is firing and contracting to make sure that the ball stays roughly centered in the socket. Now, there is fluidity to this. Like, it doesn't have to stay perfect the whole time. And everybody's different, but it has to roughly stay in that golf ball on a tee position as you move about space. So that is the way that you want to think about that. Now, when you think about a golf ball on a tee, a golf ball can be knocked off the tee pretty easily. Don't think that your shoulders that fragile. So that's just a picture for you to imagine the bony surfaces. But then around that golf on that's it, you have all these muscles, and tissues, ligaments, labrum, all this kind of stuff to help keep it there. So don't think of it as being so easily knocked out of the socket as a golf ball on a tee. But think that rotator cuff wraps around to keep that centered there. And then the other thing I want everybody to think about when it comes to the rotator cuff is these muscles are super, super dense. They're small, but they're very, very dense, they're tissues dense. So think about tightly packed dirt. And water trying to seep through that dirt, if you were to have plants growing in this really, really firmly packed soil and then you try to water them, it takes a while for that water to seep through that tightly packed dirt. Same thing because your rotator cuff muscles are so dense, same thing with blood flow. So that's why a lot of people will go to exercise, and I like my shoulder. So stored, so stiff, doesn't feel very good. And then within 5, 10 minutes, it feels much better. Because it took a while for all that tissue to get the adequate oxygen and blood flow that it requires for that activity. So think about it that way. That's why warming up for shoulder exercise or really activity that involves a lot of shoulder movement is super, super beneficial. And really should be done to some extent it doesn't have to be anything crazy, but just warming those tissues up to get them ready for the activity is crucial. Chad, anything to touch upon with anatomy there?
[00:08:38] Chad: No, I think you hit it.
[00:08:40] Nick: Alright, solid. So let's get into this whole concept or diagnosis of the rotator cuff tear. Now, Chad mentioned that, that it's one of the most common injuries, it accounts for, I think 70% of doctor's visits for shoulder pain. And it's growing. The there's increased rates of rotator cuff repair done annually. And more and more people are reporting shoulder pain. So it is a concern, there's no doubt about that. But the reality of it isn't that these injuries are really multifactorial. Like, all injuries are but the rotator cuff tear is an interesting one because we see a lot of chronic tears. And what I mean by that is tears that, you've had some shoulder pain here and there, it started to get worse. And then you go see a doctor, you get an image. It's like, “Our rotator cuff is torn. I don't know when I did it, but I guess it tore at some point”. So that could be okay, just kind of gradual tearing over time. Could be just some frame. It could be you did injured at some point then it didn't fully heal well. So there's a lot of stuff that could be going on here. So when we think about it, it's a little different from other injuries. You think about someone tearing something in their knee. A lot of times that's an acute people know when they did it. They know that happens not always, but more often. So it is something that, this is a little bit more chronic, it tends to be more chronic in nature, there are some people that will have their acute tears of the rotator cuff. A lot of times from a fall on an outstretched arm. But the chronic ones don't tend to do as well, in our clinical experience with surgery, versus the person who falls on their arm had immediate shoulder pain went to a doctor, within a few days, imaging showed rotator cuff tear, it was likely that fall that did it, or at least that worse than that. And then they're in surgery and another couple of weeks. So those people tend to do really, really well, the chronic ones, they're kind of across the board, they're all over the place. And that's kind of what we want to talk today. We're not saying don't ever do surgery to repair a rotator cuff, but give it some time, try conservative treatment. And we will appeal to any physical therapist listening to because we can do better, we can absolutely do better. So that's the reality with rotator cuff tears, a lot of times they're present a lot longer than you think. So the more that the longer something is present, the more variables can play a role. And we're learning a lot more about rotator cuff tears and what can be involved. We're learning that diabetes and metabolic health are intertwined to some extent. So now we're like, “What role is that playing with an individual?” So there's a lot of factors that can be present. But nonetheless, rotator cuff tears are much more common than people would think. . And there's some research that it's all over the board, it's anywhere from 20s, 30s of people without symptoms up to three quarters of people. So three out of every four people have some kind of tear in their rotator cuff without knowing it, they don't have symptoms with the hem mild symptoms, not significant enough to send them to the doctor.
[00:11:58] Chad: And that's across the board to that's not even just like rotator cuff tears. That could be labrum tear that could be muscle strength, whatever.
[00:12:05] Nick: Absolutely. There's a ton of research on labrum is do and that's why we get weary about shoulder labrum 's and hip labrum when people are like, oh, , I've had this hip pain. , doctor said, it's, it's a torn labrum, and he needs to be fixed. It's like, whoa, hold on. Al, let's, let's see what's going on here. Well, number one, why is this torn in the first place? Is there an underlying root cause mechanics? How I move that kind of stuff? Is it my sport, my particular activity? So again, a lot of factors that we need to weigh in and consider. But nonetheless, there is higher rates than you would imagine of rotator that most people would imagine. So don't just say, “Oh, it's torn, I gotta go get that repaired.” So remember, your body is much more complex than just that. . And there was an interesting, systematic review in 2014. And the conclusion of this, I will read verbatim, the prevalence of rotator cuff abnormalities in asymptomatic people is high enough for degeneration of the rotator cuff to be considered a common aspect of normal human aging. And to make it difficult to determine when an abnormality is new, or the cause of symptoms. So that is the conclusion of a big systematic review. That basically compiles data from a bunch of studies. And they just said that it's pretty normal for people to endure this at some point living on Earth with gravity. , so that is a big, big factor. Does that mean that? No, you shouldn't get surgery because it's normal now? Not necessarily, but we have to weigh the options. You can't just jump right to it and say, “I need this right away”. So that's a big, big, big picture. Anything to add to that Chad? So let's get into a little bit more of the research. I was kind of overarching research, but let's go into surgery because I think it's worthwhile. I know, we both experienced this. People are like, I am going for rotator cuff repair. And you're like, “Were you educated on this particular surgery where you prefer this” and people that don't know, no doctor said, I'm going to be back to Golf in six months. It's like “Okay”. You know what happens and zero to six months? It's a lot, it's pretty significant surgery, and the small muscles most of the time. It's either fully scope or partial scope, depending on the surgeon, so you're not having these big, big incisions. And so that that kind of gives people the impression that, hey, this is going to be easy, but this is one of the more grueling rehab processes.
[00:14:45] Chad: I also want to say to that most people that get this surgery, they're prepared for the worst because everybody that I've talked to has had the worst “Experience” with PT after surgery and that's not always the case. But like Nick said, it can be grueling at times. But I will say this, you have to prepare yourself to push yourself. Because if you don't, then we face adhesive capsulitis, which is frozen shoulder, which is probably one of the worst things, we see that I think it's actually worse than rotator cuff surgery only because there's only a few ways to make that better and they all suck. So it's true. I would say that before you have that surgery, you need to mentally prep yourself to get your range of motion, you need to just be good with it. Be good with the process, because there's no other way to do this.
[00:15:45] Nick: Absolutely. And again, this isn't as scary for people from going in for surgery, like we want you to have all the knowledge. So there's a some amazing surgeons out there that we see these patients post up and we're like, “Wow, this is incredible how this person can move this already, like the surgeon clearly did a fantastic job”. So the surgery can be super, super effective. And people can get back to a point without the pain, they had preoperatively, all that kind of stuff and it's great. But you have to understand what the process ahead involves in typical rehab for a rotator cuff repair is typically okay, the first roughly six weeks could be a little sooner would just be passive range. So you're stuck in this sling, unless you're doing exercises or being stretched by the PT. And you're sleeping in a recliner, it’s very little that you can actually do day to day with that shoulder other than your exercises. And then in the next six weeks would be more focused on active range of motion regain the ability to have you move your arm versus someone else or an object moving it. And then around that 12 weeks or three months is where we get back into some form of resistance. So it's a long time. And there's like Chad said, you're pushing yourself quite a bit. So that is an important thing to understand. But nonetheless, there are pretty high retail rates for this orthopedic surgery compared to other orthopedic surgeries. Actually, the research indicates that from first small to intermediate tears, this reinjure retail rate can be anywhere from seven to 41%. And for large tears aren't full thickness tears, it can range from 20 to 94, which is kind of crazy that any research shows that it's 94 but that's something to take into consideration too. When it comes to all your variables present, the retail rates a little higher, you need to be smart with your rehab. And really listen to what the physical therapist and the doctor are telling you, because it's important, there's things that you probably shouldn't be doing shortly after surgery. And the research also tells us that that people don't comply with their mobility restrictions very well, for example, reaching behind your back, probably not great, just because it puts some decent pressure on the repair itself. And I personally have seen only a handful of people, but they just instinctively reach back to like put a belt in or something like that, and they pop the thing, they just pop the work that the surgeon did, right out of place and they have to go get it redone. So it happens. Again, it's not to scare you, but it's just to say, “You have to be smart with this, you have to understand what you're going through”. And be aware that this is part of all part of the process, all part of the healing process.
[00:18:43] Chad: We also want you to understand that this process can take time, too. So you have to be patient. But we also want you to understand what you're getting. So if you feel that you are in a place after rotator cuff, or maybe you're trying to avoid surgery, and you need to know the care that you're getting, and it's the care that you need. So if you're not getting the care that you feel like you need to go somewhere else or have a conversation with whoever is working with you. And it's We only say that because we see this all the time, people come to us three to four months later, they're still in the first phase, maybe in the second phase of their recovery, but they're two months behind. So they're still in the first phase, even though they should be in like the third phase and we're working on a frozen shoulder instead of working on a rotator cuff repair. So just know that if you're not pushing yourself in the beginning or you're not getting pushed, you need to find somebody that's going to do that for you.
[00:19:40] Nick: And it also speaks to so the higher retail rates again, we don't want to scare you but that part of that tells me and this is where my mind goes is that the return rate is that high clearly there was something going on with the way the individual moves, their mechanics, all that kind of stuff that is part of the route cause for this tear in the first place that we didn't address. So that's why pre-op PT can be super, super helpful. Because we may even be able to say, “If you have someone come in six weeks prior to surgery, you may be able to get them in a place that they feel great that they don't have to go for surgery”. That's ideal. You get them in a place where now they're moving better. So postoperatively, they're less likely to retire. And that's where you want to be thinking too, it's like, “I tore, what I did?” Like, kind of go through your individual variables? How am I moving? How am I sleeping, sitting standing? How am I doing everything really all my activities? And am I noticing any kind of shoulder discomfort when I do those? Are there things that can change, or her things that can manipulate Are there ways that I can move better throughout the day, or even just move more, so I'm not stagnant, putting pressure on certain areas of the shoulder all day. So treating those underlying causes is huge when it comes to not returning afterwards. So you want to do that due diligence prior to surgery. So you give yourself the best chance for a positive outcome?
[00:21:08] Chad: That's a good point. And I think finding the underlying issue to a shoulder issue is super important. Because if they go back to doing the same thing they were doing before, that was kind of all for nothing. And I will have said this on many podcasts, I'll say it again. But is it the shoulder? That's really at fault, I don't know. Is it the shoulder for that a little bit? 9 times out of 10, it's not. And if it's not, why are we spending so much time strengthening up the shoulder? We don't need to.
[00:21:39] Nick: We're big on that. So we've said it numerous times, if you're looking only at the area of pain, you are looking way too narrow, because it's not usually the fault of that area. It's somewhere else. So we're looking to the thoracic spine, the ribcage, obviously, with that comes the scapula, the shoulder blade, because that rests on the ribcage. Super, super important. So we're looking at all those areas trying to drive some mobility in the thoracic spine, all that kind of stuff.
[00:22:10] Chad: If you're an active, if you're an athlete, or you're an active individual, you could make your way down to the hips, you could make it down to the way. Or you can have a great, great discussion about the foot and how that can make its way all the way up the shoulder. Especially in those athletes that are really generate some serious torque.
[00:22:28] Nick: And that's part of our appeal to the physical therapists out there. We can do better. If we're just okay, obviously, early on after a rotator cuff repair, we want to regain some mobility in the shoulder, that's not phase one. Of course, you'd be surprised how much mobility you can regain faster if you work on some trunk rotation.
[00:22:45] Chad: But think about all the stuff that you could be doing in the beginning. That could prepare them for phase three, four, that you could just get without a doubt, a little advantage there without a doubt.
[00:22:58] Nick: Let's talk about some of the results. Because this is always a topic of discussion when it comes to orthopedic surgeries. It's like, oh, what's better long term, this getting the surgery or conservative management with PT? And for some surgeries, it's interesting, the long term results. With rotator cuff, it's actually tends to be in the favor of the surgery. So there was numerous studies, I believe there, they were all 5 and 10 year follow ups. And the results comparing operative to non-operative. They tend to be in favor of surgery long term. However, there was an interesting study that was done in 2018. That showed retire was predicted but early predicted by the extent of muscle atrophy of the super, and so they were looking primarily at that top muscle, and then also the amount of fatty infiltration of the muscle. So fatty infiltration, just there's increased fat tissue in the muscle when we should have muscle. So this is an interesting indication that muscle mass, and really obesity, amount of fatty tissue in your body are crucial when it comes to the health of your rotator cuff. So this data could very well be skewed by just the decreased health in our population. So say that about most research, like that's kind of crazy that it actually they could predict within 5 to 10 years if they were going to retire based on this. And the numbers were like if the extent of muscle atrophy was determined by the cross sectional area, so how much area the muscle took up in the space that was supposed to be in so if it decreased by more than 43% those people were going to retire like it was predicted that. And then they use like a grading system for the amount of fat tissue within the muscle but good indication that. If not gaining muscle mass maintaining muscle mass throughout the lifespan to make sure that your rotator cuff stays healthy, even after repair, and don't have excessive fatty tissue, because that's going to infiltrate your muscles if you do, and it's going to make the muscles not function as well, which is more likely to retire. So that's some interesting data for the long term. So, again, not trying to just say that the data is skewed. Surgery can be very, very effective. Again, we're trying to just drive this home because we don't want people that listen to this be like, “Oh, my gosh, they say don't concern”.
[00:25:40] Chad: Definitely know what to say.
[00:25:42] Nick: Because that people can do that sometimes. So we're not saying that. But think about all these other factors that are at play here. Gain some muscle mass, get rid of some of this is prevented were to see that.
[00:25:53] Chad: If you're listening to this now, and you're like, “Well, I could probably prevent this from happening in the future if I do X, Y, Z.”
[00:25:58] Nick: So just get strong, stay strong, try to lose a little bit of fat and you're good. Your rotator cuffs gonna be alright. So that was an interesting one. That was a really cool study, it still kind of blows my mind that it was predictive. So like I had mentioned before, there's some other research that's now linking diabetes, and dyslipidemia to retail rates. So this factor of insulin resistance, so not handling your sugar very well in the bloodstream. And then also having excessive fats in the blood, which is linked to clots, strokes, things like that. So again, going back to metabolic health, so we're trying to preach this whole get stronger, improve your metabolic health. And that's naturally going to help your rotator cuff, whether you don't have any pain, and you're just trying to stay avoid surgery, or you've had pain and you're considering surgery, you might get surgery, if you do get surgery, this is going to help whether you get surgery or not. Again, not saying don't do surgery, we just have to drive that home. So people don't take it out of context. I have some other studies, but is there anything else you want to you want to talk about? Because the other studies I have are about depression, anxiety is on that. But nonetheless, it is related. Like, they've been able to link it. And it's interesting, what they found with. So if someone is diagnosed with anxiety and or depression preoperatively they have worse functional outcomes postoperatively. So the way you are feeling before whether it's depressed, anxious, whatever, that could affect postoperative and that kind of makes sense. But we need better screening for it in our healthcare system. So the way our healthcare system works, unfortunately, is we've normalized surgery. So if someone goes in, “Doc, I'm having this pain’. Let's take an image. And the image shows tearing, we already said that, three out of four people, for the most part will have some degenerations that rotator cuff. So now the doctor is gonna see that and be like, “Oh, I can operate on this”. But now we haven't screen the person. Do you have depression? Do you have anxiety? Are you do you have diabetes? Do you have early like insulin any form of insulin resistance? What's your fasting insulin, all this kind of stuff? So now we get to this point where they just look at it based on the image like, “Oh, this is torn, I can fix this”, that's great. But at the same time, let's screen this person and say, do they have these other factors that might make their outcomes not too great. And they might end up back on my table a couple of times?
[00:28:40] Chad: Do you think that's gonna change?
[00:28:41] Nick: No, unfortunately.
[00:28:42] Chad: I don't think so either.
[00:28:44] Nick: But if you guys listening, if this is you, you've been dealing with shoulder pain, doctor tells you you've had come see us, because we'll try to sue you for that. We're not going to necessarily treat your depression or anxiety. But if you were open to talking about it, if you have it, we might say hey, look, maybe surgery is not for you right now. Let's go see someone else that can help you through this. And we treat you as a whole person, not just your shoulder, and your rotator cuff. And we say you know what, let's attack these other variables first, these root causes that are playing a role. And let's address them and then you go for surgery. The surgery is always going to be on the table. The surgeon will still do the surgery later on. Because the rotator cuff, it's got some capacity, like your whole body has capacity to heal itself. But if we're not changing what's causing that rotator cuff tear, or that that rotator cuff to be traumatized then it's not going to heal, it's not going to be in a good position to heal itself. So we have to change those root causes, those underlying factors, whether it's a mechanic's thing, the tissue is just weak. There's not enough muscle mass in there. There's too much fatty tissue that's infiltrated it, whatever the case is, if we don't change this, it's not going to heal very well. So surgery will still be on the table.
[00:29:55] Chad: And I always tell people it's like, “What's the worst that can happen?” You get better. That'd be kind of cool. And if you don't get better, then you have surgery. But once you have surgeries, you can't come back from that. That is what it is. And you're you have to play the cards that you were dealt with. So a lot of times you can be successful without the surgery, it really all depends on what level of activity you're in, and what you want to get back to. Those are all things that play into your decision making. But I think just knowing all the facts before you just take somebody's word for it is worth it. Just take our word for it. We are going to be talking about this one kid that we just had that had an ACL read tear, supposedly. And we found some stuff that leads us to believe that it might not be and we're going to wait until that one comes out on the next “Reckless In The RACK” episode, which I believe is in a couple more weeks.
[00:30:50] Nick: We're only going to tell you about and if we're right.
[00:30:53] Chad: I'm going to presume say it on I'll say it right now we're right. But we want to how about that will still tell you about it if we're wrong. We're gonna tell you guys no matter what that's true. Trying to go transparent. So right now we're kind of going through the process with this kid is actually going to get a couple more opinions. And I'm kind of curious to see where this goes. But this is a perfect situation in which the imaging was not clear. And based on our differential diagnosis in the clinic, looking at the individual as an individual and not as pitch what he could do and what he said he was feeling, all that kind of which you can totally relate to these rotator cuff tears is really going to be it's going to be good for you all to hear. And you can make a better decision as to what you guys need to do next.
[00:31:36] Nick: We don't need to deal with how many shoulders Chad brings in. It just happened to happen. Now, there's plenty of people I actually have someone right now that schedule rotator cuff surgery came to me for a training. I just looked at your shoulder. And then I said, “Man, this shoulder looks really good”. I was like, “Tell me what happened with this whole surgery thing?” And she's actually been feeling a lot better overall. And she was just like, “Oh no, I just I put it on the schedule for this time, because I didn't want to do it during this time”. And I was like, “Well, what if you give me six weeks and see what we can do?” Maybe put this off. And I'm not saying you never need this. But maybe you don't need it right now and she tried to be great.
[00:32:19] Chad: She had one or two visits with a PT as well. And she I think she gave up on it. She wasn't really given a chance. So I don't think she was provided the right information so that she can make the best decision as to where to go. And that's natural language.
[00:32:32] Nick: The language is crucial, because what I asked her what she had done in the previous PT and they were doing some good stuff, they were actually targeting a lot of thoracic spine. So mid back, scapular mobility, shoulder blade mobility, and all this other stuff. So they weren't necessarily just given her rotations like just strengthen this up. They were given her a lot of good stuff, but they didn't explain what’s right, and that's crucial. Because they have to understand that they could go to you and be like, “Oh man, this stuff seems great. But my shoulder still hurts”. But if you don't understand why they're doing that, your shoulder could still hurt, pain is very complex. We've talked about that on numerous podcasts. But if you understand why you're doing something, and it still doesn't feel great, but you understand like, this could help me in the long run. That's a much better situation. They told us doing it just because someone told you to do it.
[00:33:19] Chad: And somebody understands a plan of care. So if you say, “Oh, this is definitely gonna happen a couple weeks, this might even happen in a few weeks”. If it happens to be like, are you said this was going to happen? I'm ready. I was expecting this, not to say this started happening. That's normal to be, but you never told me that. You don't even now they start questioning what they're doing. So the language is huge. So I think that has a lot of weight as to the decision making process for a lot of people out there, for sure. I think we get it.
[00:33:52] Nick: We gotta fly to get to know.
[00:33:55] Chad: We're on our way to Orlando. Today, we're going to a coaching conference. It's called “Raise the Bar”. We just want to get to the cold weather. We just want to get the hell out of here, because we're supposed to get some more snow tomorrow. So we're like, let's do this. We just got a foot of snow the other day. So we're over it. It's almost time. So I think that's good. We got our new guests actually get guests coming in next week. And we actually have the crew from renegade movement and performance coming in. And if you haven't heard of them, they are. They're basically the New Hampshire version of us. They're crushing. They're crushing life. They don't have as much space as us. That's true. But they crush it. They do awesome. They do awesome work. It's owned and operated by Dr. Alexis and Kyle Brunel, and we've known them over the last probably close to the year, close the year. I actually met them I met Alexis through actually Shante Cofield shout out to you movement maestro, some of you guys might know her and I actually took a course with her Last year, and Alexis does a lot of that stuff for Shante. So she's like, “Hey, Chad, you're like, right down the road for me, why haven't we met? And I'm like, “I don't know, we should do that, though”. So they came to one of our workshops, we've been talking back and forth. So they're gonna come in. They're minded individuals like us. So we're super excited about this episode, it'd be fun. It's gonna be a lot of knowledge bombs dropped, I'm sure. And I can promise you, it's probably going to be a lot of real talk, because they're just like us. They don't care. It'll tell you like it is. And we're going to be excited for this one. So look out for that. I'm excited for it. So moral of story. It's not one of my best ones, but I'm still excited about it. “Instead of saying what the cup, let's start with what the cuff, that's first. We've said this a million times on the podcast, but be your own health scientist. Greg Cook, there's not a lot of things I love about the stuff that he does. But this one thing I can get with, he made the quote, “Moving isn't important until you can't”. And that's what we see a lot of. That's what we see a lot of. This will really affect most people's decision when they first have pain, especially if it's limiting their function. Our society today has created this feeling of having just immediate results. They want to be done. Let's get the surgery, let's just be done with it and move on. This can probably work pretty well for a Google search or an IG post, but not on your body. Your body is a different animal. And the body is amazing. As Erin Murray once said, it's pretty, pretty amazing. “So be patient. Don't rush into surgery. Good things take time”. And remember, sometimes you have to go through the worst to get to the best.
[00:36:50] PODCAST OUTRO: Thank you for joining us “In The RACK” this week. Make sure to subscribe so you don't miss out on any future episodes. You can also find us online at proformptma.com, or on social media at ProForm PTMA. And remember;
“If you train inside the rack, you better be thinking outside the rack”.
