The Show Up Fitness Podcast

Shoulder Surgery or not? How Personal Trainers can properly assess shoulder pain

• Chris Hitchko, CEO Show Up Fitness • Season 3 • Episode 318

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A client came to me after being told she needed shoulder surgery.

MRI showed a slight supraspinatus tear. No physical therapy was recommended. No movement assessment was performed. Just “you’ll need surgery.”

Instead of jumping to conclusions, we performed a full movement screen looking at the GH joint, scapula, thoracic spine and LPHC. No red flags were present. Several exercises were completely pain free. Others were only uncomfortable based on fear and guarding after being told she was “fragile.”

This is where the biopsychosocial model of pain becomes critical for personal trainers.

Pain is not always tissue damage. Language matters. Assessments matter. Understanding anatomy and movement matters.

After helping her better understand what the MRI actually meant, how her shoulder moves, and which patterns felt safe to load, she avoided surgery and returned to training without pain.

Knowing your scope as a personal trainer is important. But so is knowing when to assess, when to refer, and how to confidently work with clients who are in pain without making them feel broken.

Textbook certifications like NASM ACE ISSA don’t prepare you for real world scenarios like this.

That’s why we created the SUF-CPT and SUF-STM certifications.

If you want to:
 • Assess clients in pain
 • Program on the fly
 • Partner with DPTs
 • Charge $150+ per session
 • Build confidence with real people

You have to SHOW UP.

Learn more about our seminars and certifications here:
 [Insert Website]

#PersonalTraining #Biopsychosocial #ShoulderPain #NASM #CPT #MovementAssessment #PainScience #ShowUpFitness

Become a personal trainer, SUF CPT the fastest growing personal training certification for personal trainers

Want to become a SUCCESSFUL personal trainer? SUF-CPT is the FASTEST growing personal training certification in the world!

Want to ask us a question?  Email info@showupfitness.com with the subject line PODCAST QUESTION to get your question answered live on the show!

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Live Shoulder Assessment Setup

SPEAKER_01

Addio, welcome back to the show fitness podcast. Today is a live video from an in-person screening and assessment of a client with shoulder pain. Doc told her she needs surgery. Belt buckle trainer disagrees. Watch the screens. The audio is a little off. We're working on that, so be patient. Mine is okay, but the clients, it's a little hard to hear, so we're working on adjusting that. Let us know what you think while you're walking on your treadmill, or if you're driving, be careful, but watch the video. It's pretty cool to see how we can help people because we're qualified personal trainers. Get into the mentorship, leave that five-star review, and remember big biceps are better than small ones, and keep showing up. Welcome to the Show Up Fitness Podcast, where great personal trainers are made. We are changing the fitness industry one qualified trainer at a time with our in-person and online personal training certification. If you want to become an elite personal trainer, head on over to showupfitness.com. Also make sure to check out my book, How to Become a Successful Personal Trainer. Don't forget to subscribe, rate, and review. Have a great day and keep showing up. We're gonna be going over a little shoulder assessment here with Miss Jess, and we have some issues, and you got an MRI. And so why don't you kind of take us through when it started? MRI, how you're doing mentally and everything, and then let's go from there. Oh, large size.

SPEAKER_03

Let's just talk about the facts. Okay, so um I think it was December. I was so this shoulder has always been a little bit weaker than my right. I'm left-handed, I don't know if it's overuse or what it is, but I've always kind of like done things with both hands. But this shoulder has always been just slightly weaker. So like I'll experience every so often just a little bit of like it's like worn out. If I'm doing the same like workouts arm arm day or whatever, I'll notice that this one's a little more worn out than my right, right? So one day I was doing bent over barbell rose, and I definitely added I think too much weight that I was ready for. And it wasn't an immediate thing, like I didn't hear a noise like a lot of people describe. It was like this slow burn over the next couple of days, like 48 to 72 hours. I was like, oh my god, like I did something. And I and I felt it while I was doing it because I was going through the motion.

SPEAKER_01

So you got your bar, how much was on the weight?

SPEAKER_03

20 on each side.

SPEAKER_01

Okay, so then it was it was two, it was 85?

SPEAKER_03

Yeah. Okay. Yeah, with the bar and everything. Yeah.

SPEAKER_01

And so if you were set up and I was I was be doing that, you were coming here and to take me through like how you were doing it.

SPEAKER_03

Yeah, so I was don't don't judge me too much. I was like, well, I don't know, I just had my knees slightly bent. I was like bent. I was I don't remember the exact form, but I was gripping like this and just pulling.

SPEAKER_01

That's fine. I'm just kind of going through the there's no right or wrong answer. There's no right or wrong answer.

SPEAKER_03

I was doing it with like fives. And I was doing like fives on each side, and then I think we had a conversation and she was like, You I think you can go a little bit heavier next time. And but I went 20 on each side, which was too heavy. And then I think it just like was it the last rep or was it in the middle? Where did you feel that rep or is like uh oh something feels like the that's a good question. I think once I felt like it was just I think it was the last one.

SPEAKER_01

So then we have January, February, roughly two months. Yeah, and when was the point where you're like, yeah, I'm gonna go get this checked out by the doc?

Interpreting Imaging And Pain

SPEAKER_03

It was about um, well, I mean, I'll share, like it was like a month in, and I was like, okay, this isn't going away. So I went and saw my doctor, and they're like, we're probably gonna need to go to get an MRI on that thing. But like, I'm also trying to get pregnant, so that's another thing y'all will encounter. Um, so I it was like, I can't do it right now, so I have to wait because I I didn't know where I was in my cycle and I was so confused, you know. So I was like, all right, I'm gonna schedule it for like three weeks out, and then I knew everything was good, but even though MRI doesn't really have a lot of radiation, but something they were doing, it was like the injection, the dye, or whatever. So, anyways, scheduled it out. I think it was like I finally got it January, like mid-January. But yeah, I think you have you saw the results. I didn't fully understand them. So I got the results back. It says something about like partial tear, but nothing significant, no thick tear or whatever. But then the doctor was like, I don't fully agree with the radiologist. I think you do have a more substantial tear.

SPEAKER_01

That's the thing about MRIs, is that prior to the MRI, you could have had a slight tear and move fine. And then they go in there and they will find something. That's the goal of the MRI is to find something wrong. Most people who have low back pain, if you, you know, 10 people in here, if we go get an MRI and he doesn't have pain and he gets an MRI, the MRI can show dysfunction and he has calcification, steniosis, and those labels can kind of mess with the mind. And so it's really about what you're capable of of doing movement-wise. Like right now, sitting here, scale one to ten, what's your pain like?

SPEAKER_03

Um, it's right now it's not bad. I would say it's like a one or a two. Okay because I'm not because I'm purposely babying it, not using it. So that's why if I if I use it, like let's say I carry groceries, and I I live like three blocks from the grocery store. If I carry groceries from the grocery store to my house, I'm in a lot of pain.

SPEAKER_01

And what would that a lot of pain be like?

SPEAKER_03

Like on a scale of one to two.

SPEAKER_01

Five, seven, ten.

SPEAKER_03

Um, like you gotta take time off and like maybe like a six, and then I have to be like, okay, and only use this hand, which now I have um tennis elbow and this arm because I'm favoring this.

SPEAKER_01

Frustration. I I I guess.

SPEAKER_03

And I actually, funny enough, have a shoot tomorrow that lasts four days, 10 hours a day, and I'm gonna be with my camera. So um, so yeah, so now this is happening, and it's just like now it's left and right. Now I can't even like lift weights or do it's just feels have you tried lifting weights? I tried, so I tried to do like light ones, like the the reverse curls, but like it's just it's a mess. And I'm scared, I'm gonna like further injure myself.

Daily Triggers And Fear Of Movement

SPEAKER_01

That's a huge thing right there, is that the psychology where it's like you're going in there, don't feel good, and then you're thinking, I don't want to make this worse. And you have then the noise in the back where it's like a doc saying, Oh, you do have a tear, and then you're thinking, oh, surgery thing, I'm gonna pregnancy, what about all my stuff? It's like a lot going on.

SPEAKER_03

Yeah, and then Sonisha helped me because you put me on like just a lower body split like two days a week. And even that, I'm just like, I'm just scared to do anything. So I'm just doing like leg press and like squats, and I'm like scared to use my arms for anything, even bands. I'm like, am I pulling too hard? You know, it's like I feel like I can't win. So yeah, that's where I'm at right now.

SPEAKER_01

Okay, so the first thing we should want to look at is just like your capabilities with movement. So if you were just uh put your hands above your head.

SPEAKER_03

Yeah, like I can definitely do that.

SPEAKER_01

So that's a great sign. And what about if you put your other so your bad arm, put that across and hold?

SPEAKER_03

Yeah, I definitely it it doesn't feel great, but I can do it. Okay, I can do it, but I feel that it's like and this is why it's so great to do.

SPEAKER_01

Like if you're watching this, you can just see the hesitation with the movement. There's fear there. Yeah, and so and that's just like you're moving through to see, okay, it's not terrible, but like, and then they'll kind of but yeah, something doesn't like it. Yeah, yeah. So let's try doing your hand behind your back.

SPEAKER_03

And that one, oh, and then like scratching my back. I'm like, oh am I 75? I can't like I can that fear. So it keeps this doesn't this actually feels the worst of all the things you said.

SPEAKER_01

Okay, and then can you lift your hand off your back? Yeah, yeah, that feels the worst. And so you you're putting it into the most precarious situation here, and it's just gonna get a little stretch in there. So, and then if you were to on your good hand, so this one, so face me. So come down and tip your yep, and I want you just to hurt this hurts because I have tennis elbow now. So I will take a look at the tennis elbow too. So just drive into my hand, just whatever you're comfortable with.

SPEAKER_03

That's actually not bad, but I can definitely feel it start to in your elbow.

Movement Screens And Red Flags

SPEAKER_01

Yep. So I want you to do the same thing with this one. You're not gonna go at any point like push through it. You're not trying to set any records, you just want to see look at that force in there. Yeah, so it's like you have nope, you have force, you have the range of motion. Yeah, it's more of the guard behind the fear of I don't want to make this worse. And so, you know, nothing that you presented the MRI, perfectly fine. You know, I sent that to our DPT, yeah, and they weren't worried about that. They just say that's a normal a lot of the time. I mean, I'm not to um talk bad about our Western medicine, but a lot of docs may want to just go in there and just they want to get their quotas and they want to just go in there because they think it's gonna help you. And if have you met with a therapist at all? No, I physical therapist.

SPEAKER_03

So physical therapist, and I was like, well, not okay. I so I couldn't get into physical therapy until March 3rd with my first appointment. So I'm like, I have to wait this whole month and just do what's going on. And in the meantime, I have to get another, I have to get an MRI on this arm now.

SPEAKER_01

Okay, so I wouldn't do that. Um that's just my opinion. Don't do that? No, really, because it's gonna be the same thing. They're just gonna say that with any type of it's just called lateral epochonylosis, which is discomfort there. And everything that you just said is because of what happened. Like if you would have said, like, it's numb and I can't feel these fingers, it's radiating, it's shooting. So what you're gonna find is it's on the lateral side. This side right here. Yeah, so yep, it's right there. That's just so that's just like if I shake your arm really, really hard and I do it a bunch, this is gonna hurt. So, but this is the issue. So, this bony protuberance is where it hurts, but it's these muscles. So, these muscles are gonna be really sensitive and yeah, yeah, yeah. So, she's like moving back. Don't touch me. But we would just want to work on getting some.

SPEAKER_03

Oh my god.

SPEAKER_01

So you want to just breathe through it, breathe through it, okay, and just work on this. Can you do this?

SPEAKER_03

Oh, this? Oh god.

SPEAKER_01

Up and down.

SPEAKER_03

I mean, that that's painful, but luckily I I always say life's painful. And yeah, that's true.

SPEAKER_01

But you'll notice with these types of movements, we're not massaging, we're just taking it through a range of motion, and then you take it away. A lot of times it'll feel better, and but it's never worse. It's not like, oh my god, uh it's throbbing and it's not worse. So then what you want to do is just strengthen it with some some light. If you have any uh dumbbells at home, if you have like two and a half five-pound ones, at home, okay. So get some five-pound ones, and you just want to start by doing holding there, and then as you feel comfortable, just come down eccentrically nice and slow, come up nice and slow to see how that feels.

Tennis Elbow Assessment And Education

SPEAKER_03

Okay, I can barely hold this. That's just that. No, it's not. Put it right here.

SPEAKER_01

Yep, put it over here and see if you can just hold it isometrically.

SPEAKER_03

Oh my god. So here, go like this, like this.

SPEAKER_01

Like this?

SPEAKER_03

Sorry.

SPEAKER_01

Try that.

SPEAKER_03

Okay.

SPEAKER_01

Yeah, and that's everything that you're so get on the on the your knees. Everything that you're reporting is very, very normal. Okay. So that's just it's a lot of that overload, the camera, what 50 pounds, maybe a hundred pounds, and we're not strengthening that tissue. And so that tissue gets really, really irritated. And it's it's usually, you know, we're not physical therapists, we're not doctors, but when you're when they point to a specific spot, that's exactly what this is gonna help with. So you're that bad.

SPEAKER_03

Yep. But when it's like back.

Isometrics, Eccentrics, And Home Work

SPEAKER_01

So then you just leverage it just so right now we're strengthening these muscles, which are gonna help there, and so then you do a set of eight to ten, hold isometrically just like this. See if you can hold there for 15-30 seconds. And I can tell she's you know, I'm talking in my mind, so if you weren't here, this is what I would be. But I can tell there's like there's a little bit of um hesitation where it's just like everything is very like uh, so you have to respect that. And you know, if you don't want to start getting in and doing things, you know, making your people feel uncomfortable, you have to go off of how they feel, and it goes into your confidence as well, and just observing the movement and nothing that we're doing. So that was a good 30 to 45 seconds, and just by doing a couple of those sets, like the next couple days, you'll feel like, oh wow, it's a little better. So then what do most people do when it feels better? They stop, then it gets worse. Yeah, yeah, yeah. So it's just like you have a bad chest cold, you're given a Z pack, taking it for three days, now it's just we gotta take the whole thing. So this is your new homework. It's like we don't like this discomfort that we're living in right now, and the aftermath from this is over here. So let's get this feeling better. I'm gonna start doing those exercises. If you want to, you know, do those soft tissues on her, you can get in there. You can also do it yourself by getting something a little harder, and you can put your to get into that tissue, just gonna make it feel better. Yeah, but that movement and what that does is because this is a very vascular spot, there's a lot of blood flow. So when you get into this tissue, you're just letting the brain know it's like you know, that's I'm not pressing hard at all, but you feel that. And it's these muscles that are causing that irritation. So we want to just move through it, and by moving through, you're you're calming the brain down. It's like, oh, I'm not nearly as broken as I feel I am, and then it afterwards, right? And then afterwards, it feels better afterwards.

SPEAKER_03

Yeah, it does it, it definitely feels more mobile and less frozen, but yeah, it's definitely like there's a lot of inflammation in here. Like this is bad news.

SPEAKER_01

It's just irritation. Oh, it's not inflammation, yeah, and it's perfectly normal.

SPEAKER_03

So you think I I can take 100% away without getting surgery 100%.

Building Confidence With Push-Ups And Rows

SPEAKER_01

This really and you don't think I should because of the you want to eliminate those red flags, and the red flags being irritation, that she uh shooting numbness, that you have that, so there's no nerve entrapment. So you how's your mobility if you go like this? Can you go like that? She has great mobility, nothing to be worried about. When it's like think of it like oh shit, that's what your mind's gonna go. So if she was just like, Yeah, my arm really hurts, I'd be like, oh shit, like that's not good. That's extreme. And it's right here, it doesn't feel well, it's it's here, and then she moves it, and then you put a little, oh okay, that's exactly what you expect with that discomfort because it's picking up all that slack. So pretend like we're on a rowing team, it's us four right here, and all of a sudden I'm like, you know what? I don't like you girls, I'm not gonna row anymore. You have to pick up the slack for me. Even though you're conditioned, picking up my slack, you're gonna wear out faster, and you're not gonna be able to complete the race. So that area is picking up the slack for stuff over here because you're super, super guarded of it. So it's really just, I mean, and that's the unfortunate thing about a lot of doctors, they're not the most engaging, they're not very friendly. It's just like, um, what's your last thing? Uh uh, okay, well, just kind of diagnose you and they think at you as just like a cog in the system. There's no, there's not that human element, and so then you feel broken, you feel disabled, and they don't really give you a solution. They give you that next step. Get this MRI. Oh, probably if you surgery there, it's like, oh man, this sucks. No hope. So your brain does exactly what it amplifies that situation, central amplification. It makes it like, oh, you have to move a lot more carefully, which you don't, but you have to respect that. So I'm not gonna have her do okay, there's so many push-ups, you can do max. That's too aggressive. You have to go off of what the organism, the individual, how their comfort levels are. And for that, that's perfectly fine. I'm not worried about that at all. Now we just want to tell you, she's like, oh my god. But that's important to say as well, because that gives confidence. Where if she were to say numbness, it's shooting.

SPEAKER_03

Um, question there there no, I was I was going, I was flexing. Oh, yeah. Yeah, but but I but I I want I want to give you a little bit of background. So there are times that I wake up with numbness. I think I might have a little bit of carpal tunnel in both hands just from like serving, shooting, typing, whatever, um editing for hours, you know. So I have that, but to give you a little bit of context on the tennis elbow, so this kind of started, I want to say it was like a little bit over a year ago, I got an a steroid injection because I was like leaving for a shooting trip internationally, and I was like gonna be holding all my gear, and I was like, I I need a quick solution. And there he's like, Well, I would put you in PT for nine months, but since you're going on this trip and you're gonna have your camera in your hand like 10 hours a day, then yeah, I'll just give you an injection. Gave me an injection. And then I went back after I had like a boating incident. It's funny that you said rowing. I had a rowing incident, we don't have to get into it.

SPEAKER_01

How much were you drinking?

SPEAKER_03

Not nothing. I was it was like a storm, I was in a canoe, we got we capsized, it was just very dramatic, and we were rowing with all our might, and I think it reactivated the tennis all, but it was so over, it was crazy. So then I went back and he gave me another ejection because I was like, I need to shoot. And he's like, Okay, didn't do anything, did nothing. Yep.

SPEAKER_01

But the first time it helped.

SPEAKER_03

But the first time it helped.

SPEAKER_01

So what happens with cortisone shots is cortisone is an anti-inflammatory, but it also can deteriorate soft tissue. So it can go in there long term and it can make it even worse. So it can give you that, think of it like, okay, so I I have a crazy headache this morning and I take an aspirin, I feel better. But if I still drink a bottle of whiskey every single night, I'm not fixing the issue. So it's like I'll need more of that medicine. So a lot of times when they go in there, it will give you that immediate reprieve, but long term it can waste away some of that connective tissue in there, which it's not like end all be all, but it's like have you had you strengthen that area like this?

SPEAKER_03

No, no, not at all.

SPEAKER_01

So definitely have you implemented a plan for a good 30 days where you're doing three to four exercises per week. No, so like that's your hope right there. I know. There you go.

Band Work And Scapular Control

SPEAKER_03

Yeah, but you but but Tanisha did give me exercise. Yeah, but when it's not like this, I'm just like, oh, I forget about it and you go about life, but it still has to be a ritual.

SPEAKER_01

Look at the amount of load that you're carrying on one side. That's a lot of work here. That numbness would be pretty. I would point to that, not worried about it. Also, she noticed when she wakes up. So sleeping, you know, we sleep like maniacs. You're over here one day, yeah. Uh-huh.

SPEAKER_02

So cut off our circulation.

SPEAKER_01

Nothing, nothing there's concerning. So the the arm 100% that that's gonna get back to normal. Absolutely.

SPEAKER_03

I do believe you're saying this because yesterday the doctor was like, Yeah, you're screwed, wear and tear, you gotta get surgery. I'm just like, it's such a different approach. And by the way, he was rushing out of the room, and I had to like almost like pull him back in.

SPEAKER_01

Well, I'm a doctor too, but uh, I'm just different. No, but that's but that's really important, is to give that hope. And it right there, it's like imagine you're you if you've seen a scary movie and you come out of the scary movie, it's gone, it's in the past, but shit will scare you. Walk into, oh god, that's oh, it's like you're still living in what you just experienced. So imagine going to a doctor who's not giving you the attention, he's not giving you, okay, talk to me. How's it going? Oh, how's your family going? Like getting to know you. It's just like, here's a report. You have this cortisone one didn't work, a two didn't work. Okay, let's do a three, let's do surgery, blah blah blah. You're just like, Yeah, you don't feel yeah, yeah. So you feel depleted. So that psychology is so important, and that's why it's called the biopsychosocial model of pain. You got to look at all aspects. Nothing was, and if you ever have like because you're new at working with someone or a new injury, it's perfect. So you know what? That's a great question. I don't know. Would you mind if I hop on a call with my therapist and maybe you give me like a little minute voice call of like what's going on, then send it to them, and then they'll give you that report back. And so it's like you're when in doubt, refer out, but when you've been doing it for a while, injuries like that, very, very common because of what she said. Waitress, is it typing a lot?

SPEAKER_03

Uh yeah, typing a lot, talk to a waitress thing earlier in my 20s, and then just the camera.

Progressions, Dose, And Recovery

SPEAKER_01

Yeah, well, yeah, that sucker's just that's nasty all there 10-hour day. Imagine that. It's like if you if if I were to have you hold this cup, you'd be like, that's that's it, really? That's not heavy. Do it for 12 hours. Yeah, you won't be able to hour eight, you'd like, this is the heaviest thing in the world. You did you strengthen? Are we going through a program that's going to get those muscles stronger? So when you do get those muscles stronger, which you have, right? There you go, this will absolutely go away. Not worried about that one whatsoever. So the main issue was the shoulder. That one's fine, don't worry about that. So now I just kind of want to see what she was talking about. No radiating, no shooting, no numbness. Again, good range of motion, but there's more fear behind that. Do you feel like your shoulder is unstable?

SPEAKER_03

Um, so I'll tell you the other day I did I did it, I did like a nine-hour shoot, and then I had a a two-hour shoot following that nine-hour shoot. So during the two-hour shoot, I was like, it was like on Sunset Boulevard and I was like running around with this person, and every like two minutes I was like, sorry, and I had to set my camera on the ground because my shoulder started giving out, so I couldn't even hold it anymore. I mean, also I was holding it all day. So there's that. But I was just like, hold on, like every two or three minutes. I mean, we got ended up getting great shots and stuff, but like I kept having to put it down, and he's like, What are you doing? And I was like, My shoulders eating out, sorry, and I would pick it back up.

SPEAKER_01

Could you do push-ups before?

SPEAKER_03

Yes.

SPEAKER_01

And how do you feel about push-ups now if I were to say push-ups like all my own?

SPEAKER_03

Oh my god, there's no I don't I doubt I could do one.

SPEAKER_01

Okay, so we're obviously you wouldn't go down there, but you get that feedback first to see.

SPEAKER_03

Yeah. So I mean I would try it.

SPEAKER_01

Well, we can get there. So if you were to come to the wall right here, yeah, and just go like that. Nothing crazy.

SPEAKER_03

Okay.

SPEAKER_01

You're not trying to set any records here. We're just we're we're testing your movement to see how it feels. Now that's why it's important to kind of look how she moves. I saw a little squint in her eyes, you couldn't see that. It's just maybe something you haven't done in a while.

SPEAKER_03

I have not done this in months.

SPEAKER_01

And how does that feel?

SPEAKER_03

It feels really good to do it. Okay, great.

SPEAKER_01

So, do you think you'd feel comfortable doing it here? Maybe with your own comfort? So like my whole body?

SPEAKER_03

Yeah.

SPEAKER_01

And worst case, something feels off, you just put your leg forward so nothing can happen.

Soft Tissue, Traps, And Nervous System

SPEAKER_03

Okay. These are I upper body's my favorite thing to work out, but obviously it's too scary lately, so yeah, I can do that.

SPEAKER_01

No discomfort.

SPEAKER_03

I mean, I I can definitely feel it.

SPEAKER_01

Do you feel it because you think you feel it from your past and what they're saying, or does it actually have some type of discomfort?

SPEAKER_02

Um, there's a slight dull pain like in my tennis level arm, but my shoulder feels okay. My shoulder feels okay.

PT Coordination And Team Approach

SPEAKER_01

Your shoulder's fine too. I'm not worried about that. You don't you don't need to get shoulder surgery either. And you you a lot of it's just a fear from what we have. So let's just start with you're you're finding the lowest hanging fruit. It's like if you were to train someone who's mobile obese, someone was texting me that about a 600 pound life. How would you train someone like that? You're not gonna do really advanced stuff. You start with what you're capable of, and then you repeat and you lose weight over time. Same thing with injury, you have to start with the lowest hanging fruit. I could give her a 25 pound weight and make do. This now. She'd be like, ah, he's making me do it and she doesn't feel safe. And then oh, it really hurts. Of course, because that wasn't appropriate. So you start with what the individual feels comfortable with. It's all about their comfort level. So if someone had an injury on a specific lift, I typically don't go right to that lift right away. I just kind of see how they move. And I'm I was watching her very closely with her eyes. And I noticed when she did that, she was like, there was nothing that told me, like, um, I'm scared of this. That's really good data. It's like you're seeing, okay, you're not afraid of movement on that. Your shoulder didn't hurt. It's more like the almost like PTSD from your elbows and other things, and being told time and time again that you need surgery, you need surgery, you need surgery. It's like you know, from a psychology perspective, it's like imagine getting diagnosed with um uh I'm I'm thinking PTSD, but I'm thinking uh um ADHD. All right, so you you have this, you have this, you have this. You've been told that over and over and over time, you start to tell yourself that. So people have told you you're broken, you're broken, you need surgery. You start adapting that. And so everything is very fragile in the way you move. And yet, even when I touch you, oh, I'm gonna start crying. It's like your brain is very scared of moving right now. So you have to respect that. But you want to find some things that you know, so let's just see like a very, very light row, nothing can happen here. Do grab this one. So this is your good one, but you might fill out your arm a little bit and your elbow. That's fine. Just see if you can roll it back.

unknown

Okay.

SPEAKER_01

That's usually how it works. The first one, you see her eyes, they moved. It's like she's registering and she's playing around. Like, is this gonna hurt me? Yeah, and it didn't. And then you get more comfortable, and that's gonna help lower the guard long term.

SPEAKER_03

Let's keep doing it.

SPEAKER_01

Nothing, it's okay.

SPEAKER_03

Definitely okay. Yeah, I'll show that out. Oh, okay.

SPEAKER_01

Like it's like just go right to the side of your chest. That's it, back.

SPEAKER_03

See, I don't even remember how to do it.

unknown

It's so sad.

SPEAKER_01

Sometimes we'll take it to that extreme range because we're trying to find that discomfort. And I don't want you to do that. I want you and that's it's very common when people like they'll they'll have an injury and they'll be like, yeah, this hurts, and they'll push and aggravate it. Yeah, it hurts, and they keep on doing it. Stop fucking doing it. Don't keep on re-irritating it. And so it's like, oh, oh yeah, that hurts up there. Yeah, that and they keep on doing it. And so it's like, you know, just get into a pain-free range and see how it feels. So that's gonna be sagittal based. That's very low-hanging fruit, appropriate. Now I want to see how she'd feel with going really wide and pulling it to your chest.

unknown

Yep.

Psychology Of Pain And Hope

SPEAKER_01

Really, really wide, really, really wide. Okay. And if anything feels off, you just don't pull. Come back nice and slow.

SPEAKER_03

I can definitely feel it in the tennis arm, but it's not like I would keep doing it.

SPEAKER_01

But when you do the exercises with the tennis level, that's gonna be gone. So the shoulder's fine.

SPEAKER_03

Yeah, the shoulder's good. The shoulder's good. And what what's crazy is so I I do yoga. Like yoga's like my happy plate. Can I cut you off for a second?

SPEAKER_01

Can you stand up and face this way?

SPEAKER_03

Yes.

SPEAKER_01

Now I want to push the traps down. I want to come to your chest. Bring the band to your chest. Yep. Why? There you go. And then bring it up. Back front. I want you to bring your scapulas off the back, off the back, off the back. Good, good, good. Get that arch. Now come back and do it again. And then roll. Good. Going forward. Good breathing. How's that feel?

SPEAKER_03

Actually. It feels like it's been really stiff back there, and I'm like releasing it.

Programming Next Steps And Follow-Up

SPEAKER_01

If you had a serious rotator cuff injury, that would hurt like holy hell, and you probably wouldn't even be able to pull it to your chest. So the fact that you can do those, nothing's wrong here. I'm more than confident that no, it's like there's like we we've had people, we had another case example like this, Sam's friend. And he came in and he and I told him, I'm like, yeah, you're fucked. Like you'll know, like, yeah, that's yeah, I'm not dealing with that because you don't have that range of motion. She presented the range of motion a little, but I'm not worried about that. It was more of the psychology of it hurts, it hurts, it hurts, it hurts. And then when it comes to the movement, this is this would irritate you if you had a torn rotator cuff. And if you spend time strengthening this, the rotator cuff, whichever one it was, it's I think it said super spinaeus, it's gonna get stronger. And over the course of a year, they've even looked at rotator cuff repairs via surgery. And those that didn't have surgery a year later, they had the same capacity. So time will help it get stronger. You just have to kind of you're competitive, and so I could see you potentially getting better and then just going ham. We don't want that, so it's like you have to respect the process. So you do it every other day and just start moving more. And I mean that that was very simple. This is just band pull apart, rowing here, pushing there. I would start there as your your homework. I could give her 10 other things, but because of the fear and you haven't been doing the stuff regularly, I don't want to give her too much to may almost give make her too ambitious, and then she just starts pushing through it, and then it makes it worse. So it's like you you have an injury, you got to respect the injury, let it do its course, just slowly but surely. Those exercises you can do two, three times next day, see how you feel. Wouldn't be uncommon for the next day to feel a little off. You know, it's that's normal, especially you're gonna go on a shoot for that period of time. I would try to bring a band with you and like in the morning, just like that's your little warm-up and and do this. Have you ever done any type of exercising like before or after long shoots?

SPEAKER_03

Um, I usually stretch.

SPEAKER_01

Yeah, stretching's fine. You said you're a yogi.

SPEAKER_03

Yeah, so it's great. I can't I haven't done for months either.

Ethical Sales And Last Takeaways

SPEAKER_01

But we're not really overloading the tissue to get stronger. So if we did bands for the rest of our life, you're not gonna continue to grow. It's just like this is the starting point. Yeah, so then we can get to more advanced stuff where you're doing rows here and pulling. That would be like your next progressions. But the fact that she can do that one, now I'll give her just another little test just to see. Let's see if we can go here and see how that would feel. Yeah, that's probably gonna hurt, but I'm not gonna at your own comfort level. Yeah, straight out and make sure you're scattered off the back. You can even go a little wider to make it easier. Yep.

SPEAKER_03

Oh wow, that yeah, nope, good.

SPEAKER_01

So you see, yeah. So that's a that would be a progression we're gonna get. And you can see like that was great because she was like, Oh no, no, and I like that. Well, I think okay, we'll be able to get there, not worried about that one, but for now, because that really puts the the cuff into a vulnerable position. Let's just get stronger here and then work on some of these movements, progress, check in every week, and as you get stronger, we can add in more. And like, what about if you were to do we'll go this one first? So you'll start. I'm gonna give you the band, and I want you just to come out. Let's see how that feels. So here. And then you're gonna come out. So that's gonna be one. Two would be doing the same thing. Pull on in. So no, no, with this one. Oh, I'm showing the good hand first, what she's gonna be doing on the other side. I didn't just give it to her. So that's what we're gonna try to replicate with this side. I want to do that this one first. Internal is gonna be easier. That's what we're gonna start with. So tuck it down like there's a pillow. There you go. Pull it into your tummy.

SPEAKER_03

Pull it in. Yep.

SPEAKER_01

So as in pull it in. How's that feel?

SPEAKER_03

It feels okay.

SPEAKER_01

What was that goodness for?

SPEAKER_03

Well, uh no, I don't know. I mean, I can feel I can feel it in my shoulder. The this motion, I can feel it in there. Yeah, in like the front.

SPEAKER_01

Come back. Nice and control. Control it on the way back.

SPEAKER_03

Okay. Yeah, I can definitely that's intense in my shoulder.

SPEAKER_01

Okay, and so talk to me about what that feels like.

SPEAKER_03

So it just feels like it's I don't know, it feels like it's pulling on something. Okay, and then not in a normal way. It feels like it's the more I go, the more uncomfortable.

unknown

Okay.

SPEAKER_01

It is. So then we would work up to that. What about if you just hold here and maintain this isometrically and just hold that.

SPEAKER_03

That's definitely easier than pulling.

SPEAKER_01

So you see that that intensity prescription there. Where it's like, oh, just push through it. No, there was there was some hesitation. So then you regress it back. Let's find something, okay. So then let's work on holding this for a minute. So you can get uh something like a pull, do this at home, hold for a good minute, and then we just it's always just like with nutrition. The poison is always in the dose. It's the same thing with exercise. I could get her the best exercise in the world, but if she's doing thousands of reps, it can make it worse. So it's like finding that Goldilocks right in the middle. That's what we're trying to find. Feels okay?

SPEAKER_03

Yeah, it feels good.

SPEAKER_01

For now, I'm not gonna try the external, you can try it maybe in a week or two, but just because you know it's so how does that feel?

SPEAKER_03

It feels honestly, it just feels like I'm waking everything up. It feels good. Like I can feel it, I can feel the effect, but it's like it's nice.

SPEAKER_01

So the soft tissue that I would start with would actually be your upper trapezius because it's not gonna have nearly as much of an impact. And then just because of camera bands, her upper traps are gonna be extremely sensitive. So if you feel comfortable, I will put a little pressure in your upper traps to see how that feels. So face the this way. So you're gonna, it's gonna it's gonna hurt. It's not gonna feel great. Yep. So it's like you're gonna feel like this is yeah, that hurts. Yeah, yeah, it hurts. So this isn't have any impact on the tissue whatsoever with uh the it's irritating her. This is upper traps, and she's just hypersensitive, and I can just tell from what she's experienced that this is squeezing on the trap. Nope, I'm just pressing down, just pressing straight down. And worst case with this, if something feels off, take your hand off, nothing can happen. So it's but it's like I call it the like the zit effect where you're playing with the nervous system. So I'm telling her nervous system, calm down, lady, calm down, you're okay. And like, how's it feel right now? Good, yeah.

SPEAKER_03

Um, kind of it feels good, it doesn't feel like I did anything to worsen it.

SPEAKER_01

Okay, so that that's what we're going for. We're going for progressions here. So you can see where if you just keep on going, okay, now we're gonna go do bench press, we're gonna do pull-ups, we're gonna do it. It's way too much. So just start with some good. And that's the scary thing is a lot of people wouldn't. They would just listen to the person, your your trainer tells you that you have to do it, and so you do it, and then it really makes it worse. And so, you know, I'm everything that you've presented, especially the fact that you do have a therapy session set up in two weeks.

SPEAKER_03

Yeah, March 3rd, whatever today is.

SPEAKER_01

So then I would go through and implement these regularly, three to four times, and then when you get to that session, it'd be great for you to go with her as well. You can meet the therapists and it's insurance-based.

SPEAKER_00

Yeah.

SPEAKER_01

So then it'll be interesting. It'll be interesting to see what they give you in their diagnosis. And you could have uh contradicting ideas, and that's all right. You respect it, and that's where you have a team yourself. You say, Hey, you know, doc, she went to this doc over here, kind of gave her some, you know, not maybe not the most optimal stuff. Would you mind taking a look at it? And so since she already has that appointment, I'm not gonna say, like, oh, ours is better, you gotta go through us. It's like, go see how it feels. There, the experts with movement appreciate that. Network with them, see how they're doing, you know, and then a good therapist would agree with what we're saying here, and then say, Oh, yeah, you don't need surgery, everything you presented. They'll do some more specialized tests as well. But you know, movement is is great. You have force, and that's that's brake test that we did here. If she would have pushed and stopped and came back, that's a bad sign. You saw that with the the band pull apart with this, it's kind of similar to that, but that would just be a lot more aggressive. Now we're loading it, so she didn't report of anything uh with the brake test, but this one it's just uh it's a little stuck stuck uh stuck. So let's just move and get a little stronger, do some mobility stuff. Everything is is very hopeful for you. Okay, nothing that I've would like. I've worked with tons of people, and nothing that you anything like any questions that you have or anything.

SPEAKER_03

I mean, that's just so different than like yesterday. I left the doctor, just like I'm doomed, like I way too young for this. I was so sad. I was like crying. I was like, what I'm done for. My arm's ruined, and you're like, oh no, you're fine. So it's like nice. I mean, I would I would ask, like, maybe when can I do yoga again? Or maybe it's I don't know if it's in my head or what, but yeah, it's it's day by day.

SPEAKER_01

You take it day by day. And uh the the exercises that we gave to you today, you can do at your own leisure and comfort at home. The wall push-ups, even push-ups like here. If you feel like I want to try a push-up, you would just do a negative. So at home, if you're like, you know what, I'm feeling pretty good. I want to see if you know, just standing in this position, how does this feel? Okay, do I think I can come down to the ground? And oh, it feels bad. You go to your knees, nothing can happen. But I would like to see if potentially you can work up to just coming down and then coming to your knees and coming up. That would be a progression. But as long as you know, so imagine doing this kind of trial and error by yourself after the doc tells you this, it could be very, very scary. Versus do these exercises. You did push-ups perfectly fine. You just it's gonna be a more progressed version. See how you feel. I'd be pretty confident that you'd be able to do these centrics, but you just have to, at your own comfort level, try them and just touch base with her regularly, and then she can always bring back stuff into class. And but that's just it's a really important thing to understand is how important the the psychology is around everything. When you tell people they're doomed, or if you do fear-based stuff, there's there's a point for certain things. That's why we have those tests. You pass those tests, pretty helpful. I'm not too worried about anything that you presented today. Again, I would be it's gonna do way much better to provide hope. Even if there's a couple like, uh let's check out the movement. So maybe if she had like this one, it wasn't like the best, like it wasn't like I feel it. Well, let's just see how some movement feels. Start out with sagittal, simple stuff, see how she presents. And if there's more fails and more fails, that's when you're just like maybe your doc was right. But she was able to do push-ups and she was able to come over here and do push-ups, she was able to do rows, she's able to do these. There's a lot of stuff that you can do there, a lot within your wheelhouse, and week to week as you progress, it's just gonna get stronger. And I would say the biggest thing is just the psychology component behind how it was presented to you.

SPEAKER_03

Yeah, for sure. That makes a big difference. I I didn't expect you to say any of that based on yesterday.

SPEAKER_01

So it's like right now, does there how does it your elbow and your your shoulder feel?

SPEAKER_03

It feels I mean, obviously I can still feel the pain, but what we just did, those small movements just feels like good to move. It just feels like you're alive after people are like you're dying. You know? Yeah, so it's just nice to feel that way that I can move, that my body can do something and not be like impaired.

SPEAKER_01

It's nice. So if this was the potential client, I'd say, okay, so I want to see you today's Wednesday. I want to see you Friday and come back in, and then we'll just progress a little bit. I'll check in with her tomorrow, send her a message. And this is where like the salesy stuff can come off very inappropriate, where it's like, okay, so you got to sign up with me a hundred sessions, it's gonna cost you$25,000. It's a little too aggressive. And it's like there's no need for me to say you have to sign up today. I'm perfectly all right and confident knowing that this was beneficial for her. Let's schedule you in, and when you come back in on Friday, then we can take care of how many times you want to train with us. So it's like that there, there's that fine line of where trainers can get in trouble. It's like, okay, great, she's feeling better. Now buy from me. Bye, bye, bye, bye.

SPEAKER_03

And it can get a little like, oh it's like you're already, I'm already in like a compromise and vulnerable place, and that's just like taking advantage of me. So I like that approach of like, let's check on you in a couple days. Nope. It's very slow.

SPEAKER_01

That's just the people game, that's the soft skills. And you know, there's gonna be times when you have a you know a girl or guy comes in, they want a big ass or a big chest, and you take them through a great workout and you smoke them, and you're like, How many times do you want to train? Always, every day. It's like, what can I get? 100 sessions. Okay, let's do it. That's fine for that moment, but you have to respect what you know what happened essentially. It's like you have some trauma from that, and there's no there's no benefit from trying to get a big commitment from now because we're trying to help people, and that's what you know. You you even admitted that you felt better.

SPEAKER_03

I admit it. Yeah, yeah, I do because I haven't done, I've just been so scared to do anything. And holding my camera, it's like I'll hold my camera all day and I'll put it down. I'll just be like collapse.

SPEAKER_01

And when is this next shoot?

SPEAKER_03

This is tomorrow, 10 hours for four days straight.

SPEAKER_01

Okay, and so then touch base, text if you want to send a little uh FaceTime, hey, you got this, you know, grab a band, give them a band. It's like that's that going that extra mile because we didn't get much into we know about her profession, but imagine if she's able to not get surgery and then she's around all these people at work and they've seen her in agony, like, oh, she's always bitching and complaining about her shoulder. But then they see her like, oh, now she's super positive and she's doing great. It's like, what happened? Oh, I got this great training, Santa Monica, you gotta go work with them. Poor to mouth, they just start pouring in. It just takes one person to change what their environment is, and so that's where it's not sales. At any point, did you fit see it salesy in here?

SPEAKER_03

It's like, no, no, no, and that's rare because I always sniff it out wisely.

SPEAKER_01

And I think it's really it's really good to understand that we're in LA, and it's like it's it's all over the place. And if you're a trainer at Equinox or Lifetime, you're like, oh, you know, you got to do this, or you you know, but you scare people. Inside, they're gonna be like, I can sniff it out, and so I would be willing to bet if someone were to present a package to you, be like, oh, you know, that's a little too expensive. They're just gonna use an excuse to get out of that situation because it sucked. They're not gonna tell you, actually, you're kind of creepy, and your breath smells, and everything you did was inappropriate. They're not gonna say that. They're gonna say, My husband won't let me work with you, or it's too expensive. They're gonna come up with an excuse. But if you truly provide that value and tomorrow, imagine if you wake up tomorrow and your everything is 50% better. How are you gonna feel?

SPEAKER_03

I'm gonna call my trainer and be like, wow, let's keep doing this.

SPEAKER_01

Yeah, and so then that that's that value add. Yeah, and you're like, I gotta get in again, I gotta get in again. And that's exactly what you're able to be able to do. Did you have any questions about the screens or why we chose different exercises? You know, look at the movement patterns, it was all upper body. We essentially saw if she could pull, and pulling is gonna be usually a lot safer in the beginning versus pushing. I don't put that seed into their mind, like this is really gonna hurt you, be careful. No, it's just gave it to her and said, How does this feel? It may irritate your elbow a little bit, which that's what she said, but you're just you're working with in her constraints now. If she were to have one of those issues, I wouldn't have done those tests. So if she would have been like, I can't lift it above, oh, I can't even get my arm back there, and like, oh no, I wouldn't, I wouldn't keep on going down. Oh, let's try some exercises now. That's why you do those screens, they're called red flags for a reason. And I'm not trying to, you know, sell her or give her false hope. I tell people straight up, like, oh, you're fucked. That's how you say to people, it's like that's not my scope. But everything you're presenting today, it's exciting because it's really cool to see the progressions and you will be able to 100% with the elbow, very confident with the shoulder as well. Just gotta do the exercises now.

SPEAKER_03

Thank you. I yeah, I'm I I mean, now that I've seen how immobile I can be and like in pain I can be, I'm definitely gonna do the yeah.

SPEAKER_01

You'd be good, promise. Thank you so much. You're welcome. Appreciate it.

SPEAKER_03

Yep.

SPEAKER_00

Thanks, guys.