The Berman Method
The Berman Method
Throwback Episode #111: Berman MythBusters: Neck Pain, Tennis Elbow, and Carpal Tunnel
Is your approach to neck pain and carpal tunnel syndrome stuck in the past? We challenge long-held myths about these conditions, suggesting that soft tissue issues rather than pinched nerves might be the real culprits behind neck pain. Forget the quick fixes—carpal tunnel release surgery and elbow braces often miss the mark when it comes to treating the root causes. We promise an enlightening journey to understanding why comprehensive solutions, not temporary ones, are key to true healing. Our conversation revolves around creating awareness and encouraging you to look beyond the symptoms.
Posture and muscular imbalances could be the hidden nemeses in your battle against conditions like tennis elbow and golfer's elbow. We reveal how forward head positions and rounded shoulders contribute to nerve compression and muscle weakness, exacerbating these issues. While elbow braces and PRP injections might offer short-term relief, they don’t address the underlying problems. We discuss the critical importance of tackling these fundamental causes to prevent further discomfort and enhance your well-being. Tune in for insights that could shift your perspective and lead you to more sustainable pain management strategies.
Check Us Out On Social Media -
Facebook: @bermanwellness , @physicaltherapynaples, @Berman Golf
Instagram: @berman_wellness, @bermanphysicaltherapy , @Berman Golf
Youtube: Berman Golf, Berman Physical Therapy
TikTok: Bermangolf, Bermanwellness
Email us -
drberman@bermanpt.com
jenni@bermanwellness.com
Check out our website -
www.bermanpt.com
www.bermanpt.com/wellness
www.bermangolf.com
This is the Berman Method podcast, featuring Dr Jake Berman and physician assistant Jenny Berman. We are here to treat problems and not symptoms. Disclaimer this podcast is for entertainment purposes only and not to treat anyone or to give medical advice. If you are interested in any information that we are giving and would like to use this for yourself, we recommend that you contact your primary care physician or reach out to us and ask us questions about yourself specifically. Enjoy.
Speaker 2:Can I get a mic check? We're checking mics for the Berman Method podcast, where we're focused on treating problems and not symptoms. David against Goliath, where Goliath is the corporate medical system and big pharma and joint replacements and cookie cutter physical therapy and what else.
Speaker 1:Hi Good morning. We're not. Hi Good morning.
Speaker 2:We're not checking mics. Good morning, we're recording. I know we are. This is live. You didn't tell me, you pressed play oh.
Speaker 1:Everybody knows that I'm not in charge of the play button and that you were just trying to get me, but you didn't. You didn't win that time. I'm Jenny Berman, physician assistant.
Speaker 2:Dr Jake Berman here for another entertaining or infotainment episode of Berman Mythbusters. This is going to be the last episode that we're going to do on the physical body. This time physical body this time and then next week will be the last episode of myth busters on the nutritional systemic side of it. Maybe, I don't know, we might throw in another one. As of right now, the schedule is saying that today is going to be the last one for physical and next week will be the last one for nutritional awesome.
Speaker 1:You like it, I like it, I like it.
Speaker 2:All right, so a lot of good things going on. Real quick, make sure that you let us know if you want us to present to your country club, present to your group, present to your golf buddies or your bridge group, whatever it is. We're trying to get out in the community as much as possible. So if you have a group of people that you think we should talk to, make sure you reach out now so that we can get things booked up for this coming fall 2023 and spring 2024.
Speaker 1:That is right. We love just reaching one more person in the community, so telling one more about what we do, about nutrition topics, about insulin resistance, blood sugar instability, improving sleep, improving energy. You do some on back pain, shoulder pain, golf, so just getting our information out to one more person.
Speaker 2:And it's a lot more fun in person because there's demo dues.
Speaker 1:Right Interactions, yeah, yeah.
Speaker 2:Good. So make sure you reach out to us for those and also let us know if you know of any physical therapists, physical therapy assistants, athletic trainers or personal trainers that you think would be a good fit for our team, because we are actively hiring in preparation for this coming season, this coming snowbird season. We've got the Bonita location that we need to try to get filled up, so we're going to be juggling some people around. So if you know somebody that's really great and you think would be a great fit for our team physical therapist, pta, athletic trainer, personal trainer let us know. Now we are actively hiring and actively interviewing.
Speaker 1:Yes.
Speaker 2:Cool. So today, the last thing that I want to talk about, as far as Mythbusters goes, is neck pain, tennis elbow and carpal tunnel, and the reason why I wanted to wrap all three of these things together, because they all three are related.
Speaker 1:So my elbow pain and my wrist pain is related to my neck pain? Yeah, or maybe I don't have neck pain.
Speaker 2:Well, let's start with carpal tunnel, because that's the easiest one. Okay, the biggest myth about carpal tunnel is that a carpal tunnel release will solve your carpal tunnel syndromes.
Speaker 1:Carpal tunnel release is surgery. Yep that is surgery.
Speaker 2:Yep, that is surgery. And the surgeon says oh, it's one of the easiest, simplest, quickest surgeries that you can ever have. You don't even have to go under anesthesia. We just do a local little tiny baby incision. We cut this little ligament and it's going to release the tension on the nerve and fix your symptoms.
Speaker 1:Easy enough.
Speaker 2:That's what you would think.
Speaker 1:Mm-hmm.
Speaker 2:Eh.
Speaker 1:Meh.
Speaker 2:Meh.
Speaker 1:Wrong.
Speaker 2:So before I describe it, I'm going to go through all three of them and then describe them all at once, because they all are related. Mythbuster number two Tennis elbow, or golfer's elbow.
Speaker 1:Can't Just wear a brace and it will be better?
Speaker 2:Yes, Go to CVS or the pharmacy and get one of those tennis elbow braces or, even better, get the Copper Fit or Copper, whatever it is, what is it called?
Speaker 1:I have no idea.
Speaker 2:The copper brand that's got the copper fit for the knee braces. Now they got a plantar fascia. Brace back. Brace copper tone or no copper tones.
Speaker 1:Sunblock Copper tone is sunblock.
Speaker 2:Yes, you guys know what I'm talking about the infomercial, the copper, whatever it is that's taken over every single pain point in the whole entire body because they've got copper infused braces.
Speaker 1:anyways, putting a brace on your elbow or your forearm will solve tennis elbow or golfer's elbow me myth buster, but we're not gonna bust it yet because we're going to go the neck first.
Speaker 2:Yeah, and then neck pain. Neck pain there's a big myth that says that when you have neck pain that you have a pinched nerve. So a lot of people wake up with a crank in their neck and they'll say, oh, I slept wrong, I got a pinched nerve. Or I turned my head real fast, looking in my blind spot while driving, and I pinched my nerve, and it's a real sharp pain that you'll get when you turn a certain direction. And that's absolutely not true. 9.9 times out of 10, it's not a pinched nerve at all. It's just an actual piece of soft tissue, muscle, whatever it is, that's just getting pinched between two bones, essentially a joint, and that's what will cause that extreme pain response. It's not a pinched nerve at all. So let's go into more detail on exactly why I wanted to talk about carpal tunnel, tennis elbow, golfer's elbow and neck pain, because all four of those things are related to the same thing posture, posture I think we've talked about that before we have talked about it before and the problem with neck pain specific.
Speaker 2:Well, I guess they're all severe, but most importantly, neck pain is so many people get so fearful and emotionally involved with their neck pain that they can't objectively think through what's going on here, because they start thinking immediately oh I got a pinched nerve, is this going to require surgery? Am I going to have to get an injection? Am I going to have to live on pain pills the rest of my life? Am I going to have to have a fusion or a decompression? Whatever it is?
Speaker 2:And I can honestly tell you this that in all the years that I've been treating patients, I have never, ever, come across one person over the age of 40 who had neck pain, tennis elbow, golfer's elbow or carpal tunnel that didn't have some type of posture imbalance. I'll just say it that way. I'm not going to say bad posture, because a lot of people think of bad posture as that 90-year-old man with the hunched back and looking down at the ground the whole time. They think that's bad posture. I'm going to say a posture imbalance, so a not ideal posture. Something on the front of the chest area is tighter than something on the back area where it's overstretched and weaker. Something is not equal, so I can say that in all the years that I've been treating anybody over the age of 40 who's had neck pain, tennis elbow, golfer's elbow, carpal tunnel syndrome, has had some type of posture imbalance.
Speaker 1:I could definitely see that and most of the time chin related or chest related. Yeah, some type of combination of that, most of the time chin related or chest related.
Speaker 2:Yeah, some type of combination of that.
Speaker 1:Just a backstory. I have had the worst neck for a long time. It's mud doing much, much better now, since I have a husband that fixed my neck at one point. But I had horrible neck pain, control flexibility I don't even know what to call it for the longest time, so young.
Speaker 2:I know what to call it.
Speaker 1:But it was all posture related.
Speaker 2:It wasn't necessarily posture related as much as posture imbalances, muscle imbalances. So when we first started dating you, were very, very. You're still very, very strong. You were just disproportionately strong, meaning that your shoulders were one of the strongest things that you had in your upper body. Do you agree with that? Yeah, yes, there was a ton of ladies who look at you and go man, I'd love to have your shoulders Right. You actually won a handstand competition with your gymnastic coach. Where you went for how long?
Speaker 1:Too long, too long, too long.
Speaker 2:How long was it?
Speaker 1:More than 15 minutes.
Speaker 2:That's all we need to say. So you actually 19 minutes. How many? 19 19 minutes. So you did a handstand for 19 minutes to beat your gymnastics coach. So shoulder strength was one of your strengths. Right, right, yeah the thing that was not one of your strengths was scapular strengths. Right, right, yeah. The thing that was not one of your strengths was scapular stability.
Speaker 1:Right, which is the back.
Speaker 2:That's your back, that's the middle, middle back muscle. So the middle of the middle of your back, the scapular stability, let's call it that area. So you are super strong in your shoulders, but not super strong in your shoulders, but not super strong in your scapular stability. So the thing that took the blunt of the force was your neck, because your shoulders were so strong they were constantly pulling on your neck, versus when your scapulas the muscles that support your scapulas when those muscles are strong, then your shoulders can is when those muscles are strong, then your shoulders can pull on those muscles and not have to rely on pulling on your neck muscles.
Speaker 1:Right. So it just shows that oftentimes where your pain is is not what's causing the issue. Right, so you constantly, that just comes back to that.
Speaker 2:Yeah, you would regularly complain of neck pain. Yes, and every time.
Speaker 1:I went to that.
Speaker 2:Yeah, you would regularly complain of neck pain. Yes, and every time I went to work on it, do some manual and some massage around your neck. I'm just going oh my goodness, there's no muscles here. It felt like a 12-year-old's neck where there just were no muscles. And then you go down just a couple more inches and we talk about shoulder muscles and it's like, oh my gosh, she's jacked. Look at all these muscles. So it just. It was an imbalance.
Speaker 1:Right, right. So coming back to the topic, is it doesn't necessarily have to mean that you're not in a good postural position, as much as a total muscular imbalance somewhere surrounding the neck.
Speaker 2:Correct so to say those same words differently. If you were to look at you 10 years ago, you wouldn't say, oh, jenny has bad posture. But when she was in the gym lifting heavy weights, she had a muscle imbalance, so her shoulders were doing most of the work. She didn't have the scapulas to support it, so that was tugging on her neck and therefore flaring up her neck.
Speaker 1:Right, right. So for someone who is struggling with tennis elbow or golfer's elbow, oftentimes it's coming from rounded shoulders, it's coming from their head protruding forward. It's coming. What do you think?
Speaker 2:Oh boy. So let me go out on a limb here and let me say this 9.9999% of the people that I've ever worked with with tennis elbow have had contributing to the symptoms coming from the neck. Let me say that differently, more clearly when you have a bad posture position, which means that your chin is jutting forward, your shoulders are rounded and your chin's jutting forward, it puts a little bit of compression on one of the nerves that comes out of your neck and goes down and gives your muscles in your forearm strength. So the way I like to explain this is you turn a water hose on and the water comes out just fine. You go, step on the water hose and the water still comes out, but not as good.
Speaker 2:So when you're in that forward chin position rounded shoulders, forward chin position you're stepping on the water hose where that nerve comes out of your neck, and that water hose is what gives you supply, gives your muscles strength in your forearm. Now they don't have enough fuel to give them adequate strength. So then when you go and you do a gripping activity like golfing or tennis and you're trying to hold on to that club, your muscles get overworked and underpaid and that's what causes the inflammation and the pain response in the tennis elbow. And then everybody thinks that by putting that elbow brace on that, that solves the problem. Because the elbow brace does a really good job of pushing on a tendon that decreases how much the muscle can activate and therefore you don't use it, you lose it as far as pain response goes and you get the task done by compensating and doing something else. I don't know if that was clear enough or not.
Speaker 1:Yes, yeah. So in order to fix the issue because the brace is not necessarily fixing any problem we need to come back up to the neck and look at posture, muscular imbalance or muscular balance. I should say not imbalance. Fix the imbalances to balance the muscles more and that will take the stress off of the nerve that's providing the strength to the arm.
Speaker 2:Correct, so it'll provide more strength to the forearm and decrease the inflammatory response.
Speaker 1:Right. And so how about with the carpal tunnel on the neck same situation?
Speaker 2:It's the same exact thing just further down the chain. It's the same exact thing just further down the chain. 9.99999% of people who have carpal tunnel are sitting at a desk all day. When you sit at a desk all day, your shoulders naturally round forward and your chin naturally juts forward towards the computer screen, so you're putting compression on that nerve. It's no different from when you sleep weird on your shoulder and you wake up and your arm's asleep.
Speaker 1:Right.
Speaker 2:Because you're in an awkward position and you put too much tension on that nerve so it goes to sleep. It's just less intense over a much longer period of time in carpal tunnel. So the surgeon's answer is well, let's just go and cut the little tendon to give you more room for the carpal tunnel.
Speaker 1:It's like wait a second More room for your nerve to stay inflamed.
Speaker 2:More room for it to inflame more.
Speaker 1:Yeah.
Speaker 2:So now your nerve can get even bigger.
Speaker 1:Right as opposed to fixing the problem.
Speaker 2:Now I know there's a lot of people listening to this that are saying I had carpal tunnel and I had my carpal tunnel released and it cured my problem. Okay, well, good for you. What I can guarantee you, that is if you come into my office, I guarantee you that I will find a problem somewhere else along the chain. That will present itself sooner or later, meaning that your carpal tunnel symptoms might have gone away or later you're going to have elbow pain, you're going to have a shoulder problem or you're going to have a neck problem or some combination of all three, because you didn't address the root cause of what was causing the carpal tunnel to begin with.
Speaker 1:Right, right, it's always. When you don't fix the problem, something else is going to take the brunt of it.
Speaker 2:Yeah, so good. Those are the big three things that I wanted to cover today. Hopefully they're controversial. Hopefully there's some people out there listening to this. I guess, before we wrap it up completely, we should talk about PRP injections, because it's really popular now for tennis elbow. There's a lot of people with chronic tennis elbow that are opting in to get PRP injections plasma rich protein and it's completely cash. No insurance pays for it and there's a lot of times that they won't even do it here in America. People will go to different countries to get the PRP injections and it's never guaranteed that, and the thing that I want to say is it's no different from spraying WD-40 on a bad wheel bearing. It may take the squeak away temporarily. However, it will come back, because you did not address the reason why it happened in the first place and I know that I'm going to some people are listening to this going oh, I had PRP injections 73 years ago and I have not had pain ever since. Good for you.
Speaker 1:Right.
Speaker 2:Something somewhere else is going to come up sooner or later, whether you like it or not. I've been doing this a very long time and something is going to happen, and if it doesn't, it's because you compensated what you were doing to flare it up in the first place.
Speaker 1:Agreed yes.
Speaker 2:Good.
Speaker 1:Mm-hmm.
Speaker 2:So, in summary, the three myths, four myths that we're busting today is carpal tunnel is solved by a carpal tunnel release.
Speaker 1:Meh, fix your neck.
Speaker 2:Tennis elbow not necessarily fix your neck, fix your posture fix your posture tennis elbow and golfer's elbow is cured with tennis elbow braces and wrist and forearm strengthening and stretching me fix your posture, fix, fix your posture. Fix your posture and then neck pain. Neck pain is because you have a bad neck. Your mom had a bad neck. It's not my fault, it's genetics. Herniated disc. Herniated disc, bulging disc. Pinched nerve.
Speaker 1:Me.
Speaker 2:Me.
Speaker 1:Fix your posture.
Speaker 2:Fix your posture or fix your muscle imbalances. You may have good posture, but you've got severe imbalances with your scapular muscles and your shoulder muscles and posture muscles good, perfect.
Speaker 2:I like it all right, remember, let us know if you want us to come to your country club. We're taking reservations now for this fall and spring and let me know as soon as possible if you know of any physical therapists, physical therapy assistants, athletic trainers or personal trainers that are looking for a change and you think would be a good fit for our company. We got a lot of growth planned over the next six to 18 months. We got a lot of growth planned over the next six to 18 months, so we're looking for rock stars right now.
Speaker 1:I like it and to go off on the seminars or letting us know if you want us to come speak doesn't just have to be at a country club. It could be at a fitness center, it could be at a women's group, a rotary club. So we're not looking just to come over to your country club, but any of the groups that you may be in that you think are interested.
Speaker 2:Cool, that's awesome. Thank you, guys.
Speaker 1:Ciao for now. Thank you for subscribing on your social media and podcast platforms to the Berman Method. Dr Jake Berman with Berman Physical Therapy, and Jenny Berman, Physician Assistant with Berman Health and Wellness. Berman with Berman Physical Therapy and Jenny Berman, Physician Assistant with Berman Health and Wellness. You can find more information on our website wwwbermanptcom for physical therapy, wwwbermanptcom forward slash wellness for the health and wellness. You can also find us on social media, Facebook, Instagram and on your podcast platform, so be sure to follow us, like us, subscribe to us and if you would like any further information, definitely visit our website and reach out to us. You may also find our free reports on the websites as well, where you can download this free information for yourself. Have a great day.