Acute Shoulder Pain w/ DPT Coleman

A sudden shoulder pop during a heavy lift can mess with your head fast. We sit down with Dr. Coleman to map out what a smart, trainer-friendly response actually looks like when you or your client has acute shoulder pain and still wants to train safely.

We talk about where a coach’s scope begins and ends, why “never train anyone with pain” is unrealistic in the real world, and how to separate DOMS from true tissue irritation. Dr. Coleman shares a simple decision-making framework built around time and trend lines: how symptoms should change from day 0 to day 7, what it means when progress stalls at 10 to 14 days, and why a three-week plateau is often your referral point. We also dig into practical red flags, and why the shoulder can feel more ambiguous than a clearly swollen ankle or Achilles.

On the training side, we get specific about movement selection. You’ll hear how to use “target tissue” to decide whether an exercise is helping or just poking the bruise, when isometrics can be a better move than more reps, and which pressing positions tend to flare anterior shoulder or biceps tendon irritation. We also tackle the stretching debate, breaking down mobilize versus stabilize so you can make better calls instead of following trends.

If you coach strength training, CrossFit, or general fitness, this is a clear, usable playbook. Subscribe, share this with a trainer friend, and leave a review with the shoulder issue you want us to cover next.

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Transcript

Welcome And Why Shoulder Pain Matters

SPEAKER_00 0:00

Haddy y'all, welcome back to the show for this podcast. If you have shoulder pain or any clients, today's podcast is for you. Dr. Coleman and I review acute shoulder injuries, addressing the best methodologies to help your clients get out of pain so you can continue to train them and when it's important to refer out. Have a great day and keep showing up. Well, uh, we got some folk on the call today. I was gonna lead it off with some questions on uh myself and then uh go from there. Um, where can people find you on social media if they're not following you?

SPEAKER_01 0:30

Uh TikTok and Instagram, um Coleman PT underscore performance. Um, and then uh my partner and I shared business coast to coast physical therapy is uh at coast to coast underscore pt.

SPEAKER_00 0:45

Yep, and I've been uh watching you grow. I think when we first met, I was just telling how we first connected. You were a shade below 10k. Now you're a big row. I'm surprised you're even talking to us. You're a big guy 31,000. It's like who is this? No, man, that's uh same me, you know what I mean?

SPEAKER_01 1:03

Just more just more people, just more people listening, maybe. I don't know.

SPEAKER_00 1:06

Yeah, that's good. And I was I was talking before about your relationship with CrossFit. Did you have to pay rent there? Did you get that?

SPEAKER_01 1:13

Yeah, I did. I I um they gave me an extremely fair um a fair rent that um yeah, I had my own space there as like uh a floor right above where the gym was. So I had my own space, small little room, but it was more than what we needed, and and it and it freed me up to um to create a fair pricing point for my for my patients. I didn't have to charge an arm and a leg because they weren't charging me an arm and a leg. So it's great. It's really good relationship.

SPEAKER_00 1:38

I know with pain, it's as

Trainers As First Line Support

SPEAKER_00 1:40

simple as you have knee pain, you just kind of walk backwards and do your knees over toe stuff. Of course, it's easy, it's not multifactorial at all, it's very simple. But I know with social media there are some people who are a little more aggressive. And I was looking at a post today from Doc Russ and and we don't we don't need to get into him, but he he said 93% of gym goers have pain. And I thought that was kind of interesting where that statistic came from. One, but I know that there's this navigation with trainers. I've seen on you know, Reddit and Facebook when I'm drinking my whiskey, going in the depths of hell, seeing what people are talking about. There's some people who say as a trainer, you should never work with anyone if they have pain. You got to refer out. And I think it's kind of like the whole pain model. It's it's multifactorial. And I think there's a lot that we can do, but there's a lot that we shouldn't be doing. And, you know, we have some great screens that we've implemented from Dr. Waterberry and the prehab guys to kind of at least know if this is in our scope. And a lot of it's more chronic because when it's central amplification, there's usually a lot more room to wiggle per se. Like if you've had shoulder issues for you know, seven years, it's probably not tissue trauma. It's something, you know, maybe something else going on there. But today I wanted to see if we could just kind of dive more into that line and recommendations when it does come to more acute stuff. I was in the spot on Saturday. I was hitting 265 and I didn't think wrong, or like my warm-up was fine, and I was coming up concentrically, and it was just a little bit of a pop. It wasn't like, oh shit, something screwed up. I'll still have to finish the lift and then finish my workout the next day. It was definitely, you know, one of these, where it's like, okay, well, you know, I can move fine. I'll probably, I'm getting older, I'm gonna, you know, it's not be as aggressive as I used to. I did some screens, I was fine here. Overhead, I was fine. But then, you know, going behind my back, definitely I was like, oh shit, like that's definitely hand off the back is uh, you know, I'm not diagnosing myself, but I'm still thinking that, yeah, that's I'm probably fine. Um I would never to a client say, oh, you tore your rotator cuff. No. But you know, I was just kind of hoping to dive a little bit deeper into how you would help coach up a trainer if that was the client. And you know, where's the line that you'd want to be like, okay, well, obviously numbness, radiating, that's something to go get checked out. But where would be that line where you would, you know, allow for trainers to maybe try some, whether if it's soft tissue or correctives, and when would you not suggest that?

SPEAKER_01 4:05

Yeah. Um, I would say, you know, I to go back to kind of like the you know, should you ever work with pain? I think it's I I agree. I think that like trainers are on the area first line of defense, right? Like everyone's in front of a trainer, you're more accessible. I think the notion of like should you not work with someone with pain, sure, if we as healthcare professionals were were better at our jobs in terms of getting people back to that level of fitness and two more accessible, which we aren't. So I think if you're gonna do the whole like, we're it's our job, give them to us. I mean, I have a three-week waiting list right now and I'm seeing 25 people a day. I can't help you today, right? So, like, um, so I think like you said, it's it to say out loud from someone else, yeah, like you guys are you have to. We need you to do that. We need you guys and us to be better at that first layer. So um, you know, kind of going beyond the gray of the numbness, the tingling, that sharp pain. Um, you know, Dr. Russin, 93% of people are in gym are in pain. Um, that's kind of you know, that's a little wishy-washy too. It's you know, I did a leg day yesterday and I can barely get up off my chair right now, you know, so I'm in pain. You know, now did I push it too hard? Yeah. So there's a there's that layer of like, is it DOMS? Is it pain? Is it injuries? Is it trauma, right? So even for you with your shoulder, you know, I always use like kind of like a time frame of like, you know, if it's less than 48 hours, it's your wheelhouse of like over, you know, you overdid it, but

Acute Shoulder Pops And Red Flags

SPEAKER_01 5:40

you're not in in tissue damage beyond 48 hours, 72 hours, you're in some, you're in some acute tissue trauma, right? So you need to take care of it. But the next step would be like you you just need to maybe regress slightly, modify, deload. And then time is your best friend from for me as a as a doctor, and for for you as our first layer of defense, these these acute, subacute things that are that are just kind of pain provokers, non-pathological, they should be they should resolve if you're doing what I just said, eliminate the noxious stimuli, start working around it, promote movement. They should go away in in six to ten days. So I think if you're not being silly and kind of just being like, all right, well, I heard you're sore from two days ago, but we're gonna run that program back again. It's like, well, you're gonna compound that and make that injury. So if you're doing the right things, you're modifying, you're regressing, you're working around, apply some soft tissue pre-post test. If I do, you know, like you kind of I've seen in your in your uh in your posts and stuff, if you got that backside of restriction, let's open up the bicep and peck, do a little soft tissue, a little attack and stretch. Let me get 10 of those pre-test, post-test. Oh, look at that. Now I can reach back and go for it. There's a soft tissue restriction, that's your wheelhouse, move on, right? But if you do the pre-post test and it's not quite resolving and you're and you're still finding that it's it's been it's been 16 days, it's still kind of as bad as it was at day 10 and 14. I'm no longer getting that relief with that backsided little release. That's all I got. Those are my tools. I think that's kind of the part of it too, is like you guys are doing a good job of putting more tools in. And I think just um I think using the time frame, using the tools you have, and then just being honest with yourself as far as like what's the next next clinical decision that needs to be made, if they're not getting better and it's been that three-week time frame, I think we need to refer out. So I think time is a big one too.

SPEAKER_00 7:36

And I think that's one of the kind of frustrating things with the body is it's it's beautiful, but like, you know, with the shoulder, you're not gonna necessarily see swelling, but if with an ankle, you can go, oh yeah, we got a little swallow in there, so maybe they'd be a little more careful. The shoulder's a little more ambiguous, or if it's you know, thoracic area, yeah, low back, yeah, right. That's a little tougher. So when swelling is in the equation, so I remember speaking with a therapist. Sometimes therapists will scare the shit out of you. And and one told me that, you know, I started to run and it was during COVID, so you know, everyone's locked up. So you go out there and you don't really apply the rules of you know progressive overload in 10 to 20 percent per week. So probably started doing 10 miles next week, probably hitting 20 and just too too aggressive. And my Achilles, as it is actually now a little bit too, but it started getting kind of swollen. And when it I mean, he told me, this therapist, that when it comes to the Achilles, if it gets swollen, back off immediately because that sucker could rupture. I don't know if there's any uh validity behind that, or you know, what is your thought process if it would come to lower body extremities and say doing a lot of volume with uh running in the Achilles?

SPEAKER_01 8:47

Um yeah, I would say maybe not fear of God in you. I would just say like if if it's swollen, if you can see visible swelling, there's there's trauma, right? And it's your it's your body's way of kind of

Deloading, Modifying, When To Refer

SPEAKER_01 9:00

bringing in the the system to kind of repair and and kind of you know see see what's going on, you know, it takes some out, put some in, type of thing. You're you're you're remodeling. So it's just more about respecting that process, right? Like the, you know, you're you're knocking walls down in here and you're trying to, you know, you're remodeling your apartment, it's gonna look a little nasty. It's got the the the skeleton of your of your walls are exposed. It's you know, you need to understand that that's what's happening inside too. So I wouldn't say you're more susceptible to rupture, especially with something like going out for a run. You know what I mean? If you're playing some hoops or something like that, that's a bit more, then I'd say, hey, now you're now you're up in that risk factor a little bit. But um, I would just say it's more about kind of like listening to your body, and and when you see the inflammation, you know, I I would just make that known, like you said, with the shoulder. It's like, I don't quite know. Well, if you see that Achilles is is thickened and it's acute and it ebbs and flows like that, I would just maybe I would I would kind of listen to it a bit more. So I'm I don't know if it's as easy as just being like, oh yeah, you're it's tearing, you're gonna tear if you go for a run. Um, it's more about just kind of giving it the respect it needs and let it resolve.

SPEAKER_00 10:10

And so when you get into that quote unquote corrective world, I know that's a flashy word on social media, but are there certain exercises that would be counterindicative when it comes to like my shoulder stuff? Would it just be based off of discomfort and pain that you experience? So if I do like some ER stuff, it's like, oh, it's exhibiting that discomfort, lay off that, or if it's acute, would you not want to push through that?

SPEAKER_01 10:33

I think um I think like uh working target tissue. So let's say I'm doing ER, right? I'm just doing some bandwork, totally fine. You know, what are my target tissues? I'm working the backside of the cuff. So if I'm doing this and I'm I'm like, all right, everything I do, whether it's push, pull, overhead, horizontal, I'm getting this kind of this anterior shoulder pain. You know, what if I do some rows? It's like, all right, yeah, I can row. It's the first thing. You go to PT, everyone's got the bandit row, the banded pull down, right? Well, it's like I yeah, I feel it. It's like, where do you feel it? I feel it in my back of my cuff, I feel like my rhomboids, mid-trap, it's like perfect target tissue, right? It's what we're working. If I'm hitting ER and I'm doing it, I'm like, yeah, I'm feeling it. I'm feeling it right here. Every time I go out, bang, ping, bang, ping. But we're not hitting target tissue anymore. The the inflamed tissue is is kind of heightened and it's it's clearly that motion is is not letting you access that feel and it's recreating the the the same symptom, like your symptom, um, that's when I might bounce off of it. And maybe I need to do something where I'm just doing isometrics. All right, well, maybe if I'm not, no, that biceps tendon is irritated, and I'm every time I do load and roll through, and it's rolling in and out of that bicipital groove, and it's just friction, friction, friction. Well, hey, maybe I just need to stay put. And now if I just, all right, I can do it. I can't give 100% effort, but I can give 50. I feel backside, right? So I just stay here and I do my ISOs. That's an you know, that's not breaking the mold, that's not diagnosing anything, it's just a simple modification regression and let you kind of feel that. So I think, you know, not to I don't want to be so so gray. I'll give you a good

Swelling, Inflammation, Achilles Worries

SPEAKER_01 12:10

example today. I had a um a young-ish, you know, 39 active guy in the gym, um, confirmed bicipital kind of injury. Um, and it's the horizontal work. So he came in, injured doing a doing a bench press, and now it's um all things pressing is bothersome. I can get him into certain positions and he's getting back into the gym. So for me, my my bugaboos are are things that that create length for that bicep across that tendon. We might have had this discussion before. So I I apologize if I'm repeating myself for anyone listening. We might have talked about this with our last guy that we we had this chat with, but um, the things where I'm I'm long, you know, I'm excessively horizontally abducting here, right? So I'm creating length across the humeral head, or if I'm doing a dip and now I'm excessively extending across that humoral head, those are things that the bicep starts to create pressure, compression, and tension. And those are things that we stay off of. So if you're if you're someone who's listening to this and you're experiencing this pressing type of pain, and yeah, Chris, if you're getting that kind of that that rotation back type of injury, and and now you're kind of in this, you know, everything I do kind of pressing past horizontal and I'm breaking that that position past neutral, um, those are positions that we stay away from while we're in this hot zone, right? So um that's kind of the only thing I'll say where I'm like, I'll be black and white with it, is this an example from today. Um, so that's that's kind of the thing that I would do is is can I hit target tissue? Can I work the backside and feel backside? Um, that's kind of where I go. I try not to stretch too far across into that area because I'm just lighting up a lot of different structures and through there. Um, so we try to work backside, we try to work anterior chain movements that are at neutral or in front of me. Um so you know, if we're doing resistance, we're doing up the wall with a band kind of above my arms and or below my armpits, and we're just maybe doing some tapping. Right? Where I'm still getting some some anterior delt, I'm still kind of getting some sagittal motions. I'm not just living in my posterior chain. Um, those are kind of specific things that I did today with that guy that was like, all right, hey, I feel I feel my front side today. We did some shoulder taps and a high plank. Um, so just things to keep the front side active, not pro not provoke that that symptom, right? Use the analogy of like not poking the bruise.

SPEAKER_00 14:31

Yeah.

SPEAKER_01 14:32

So if you're able to keep it moving, hit target tissue and avoid some of those pain-provoking positions like that excessive uh abduction and extension.

SPEAKER_00 14:41

So then what so for example, if it's me and I'm doing say floor pressing and that's all right for the time being, when would you want to go back and to quote unquote try to poke the bear to see if it is is okay? Like, is it something you want to kind of retest every every couple of days, is it a couple of weeks? Is it a block? Or you know, where would where would you want to start experimenting to see if you're okay to come back to action?

SPEAKER_01 15:02

I would I would want to see that the if the floor presses were load dependent. You know, I can do 25s on the floor, but I can't do 45s. It's like I I could do 60s, but I can't do 45s. Like, well, we're still hot.

SPEAKER_00 15:13

Okay.

SPEAKER_01 15:13

Right. So so it's kind of like if the floor press, and for anyone listening doesn't isn't aware, the floor press is just it's just Chris on the on his back here. And now he's doing a chest press, but the the the ground is stopping me from going into that hyper abducted position. So I love that as a as an intro into some pressing motions. But um, if you start to feel like you're progressing that and it's great, but if it's a load-dependent issue, like Chris, you could do 265 without the pain. I can do 185, no problem. But every time I get 225 on there, it's pain again. Well, we're not better yet, are we? Right. So sometimes that's the that's the issue too. If you're if you're just kind of doing you know modified and workarounds, and for a trainer who's

Pick Movements That Hit Target Tissue

SPEAKER_01 15:55

doing that and it's great, and you're not kind of seeing that linear gain, 135, great, 185, I'm doing well, 225. Hey, we're back. If you're stuck and it's load dependent, you still have an active irritated tissue. And and that might be time where it's like, hey, maybe it's a it's a bit out of my realm too, where the load dependence is is kind of that that last little bit that that's still there, and it's it's definitely still uh still inflamed, and you want to listen to it. Um so that's when I would say if it's if you're progressing well and you're at a percentage of that, hey, I I can do 65s and I can get to 50, I'm still doing fine. Um, my next step is is usually a unilateral chest press. Um and typically the couple reasons for that. One, I can't load like I would bilaterally, right? So um, if I can do 65s, if I try and throw 65 on one side, I can't quite control it, right? So it makes me underdose it a bit. Um, and the challenge becomes a bit less progressive overload for the target tissue and more of a core anti-rotation drill. And now I can really kind of integrate all those core stabilizers that are otherwise not active with the double arm. And now I can feel out is it load dependent? No, I can still do the 45s. I'm actually getting more recruitment from good scap and and and rib stabilizers. So it's almost like this this like one, I'm getting good underdose, but two, I'm I'm recruiting all these muscles that should be active and otherwise aren't. Um, so I love the unilateral chest press on an incline, flat bench, um, and let people feel that, and then they can get that good stretch and have all that integrated safety net from the anterior chain.

SPEAKER_00 17:40

And so then when would you or would you ever want to incorporate like a semi-heavy or eccentric in that regard? Both hands come up with the 65 and I can control it down eccentrically, but I don't want to test the concentric aspect.

SPEAKER_01 17:54

Yeah, I find that it's it's hard to prescribe that in in gym settings like that. Um I'm trying to think what I've used recently. It with me in the gym, with when I'm working with people individually, I'll spot it and we'll do like a progressive eccentric where I'm just kind of there helping with the concentric, or we'll use blocks, right? So we'll use a yoga block or a wooden block and we'll kind of just micromanage that the progression of their depth too. Um, but yeah, I mean that's that's a nice way I would say at a gym that has blocks, that's probably your next step, other than just having someone with you spotting you work in the um the eccentric and concentric. The um I just just uh realistically in the gym, I find it hard to do like the, you know, just I'm using heavyweight, I'm happy to kind of do this unilateral style with every rep. So um this just more from a an application um rationale for that. But it's not a bad, not a bad uh implementation either.

SPEAKER_00 18:55

And so where would you draw the line? I don't necessarily draw the line, I don't know what the word would be, but for stretching, because I know that sometimes people are, you know, old school therapists are huge stretching, and sometimes the therapy today, they're like anti-stretching. And so where do we, you know, where do we agree with on what to do and what not to when it comes to any type of static stretching?

SPEAKER_01 19:18

Um I think stretching is stressful, right? Like everything's not just like, oh, that hurts just go stretch it. Like that's you know, especially for tendinopathies. Like we're learning a lot about you know, Achilles, patellar, you know, all these tendinopathies that um that that stretching it aggressively is actually making it worse, right? You're you're yanking on that that tendon, um, that tendon bone attachment site that's already sensitive, right? So depending on the issue, stretching is contraindicated. But I think again, generally, um, if you've got like an obvious mobility restriction due to the pain, um, and mobilizing the restricted area doesn't recreate pain. You get good pre-post test, um, it's not a bad place to start. You don't want to strengthen into a restricted area, right? You don't want to make this the immobility stronger. Um, and then I think from a next layer, um maybe like uh SFMA style movement screen kind of thought process is is identifying tight versus weak areas and and and the saying that like I you know I learned from from titleist the the TPI uh um certification is you know you can't fix a mobility issue with stability, and you can't fix a stability issue with mobility. Right. So I think the evaluative evaluative process to determine what's tight, what's weak, and then providing interventions to that route is is is probably a bit more into our realm than yours. Um outside of just that simple like SFMA style, like, you know, can I modify? Can I move? Where's the exact restriction? Can I apply an intervention? I'm not hurting that person, let's move forward, you know, and and that's your tool, right? So I think everyone showing up to the dance and dancing with the girl you brought is kind of like the the saying, right? It's like if this is what you've got. And if if if you don't have that next tool or you don't have that next knowledge, it's okay. I do it all the time. An answer to a question is I don't know, and that's okay.

SPEAKER_00 21:27

Yeah.

SPEAKER_01 21:27

Um, so so I think this the stretching is um is we live at the end of the ends of the spectrum, right? We were overkilling the stretching and now we're underkilling it and we're demonizing it. So I think it's more about just being better about identifying a problem and providing an intervention that addresses that problem, um, versus just being like, nah, we don't stretch anymore. That this injury needs to be stretched. So um, so I I think mobilizing and stretching someone is a way to elicit stress to an area that's not overly. load, you can assess someone's tolerance to movement with stretching. Right. So um I think that's a that's a it's a fair thing to just kind of implement to keep them moving. Like for you, just like kind of a peck stretch. Right. I don't think it's a I don't think that's your end all be all, but it'll

Retesting Pressing And Load Dependence

SPEAKER_01 22:15

let me know like, no, I get like a ton of relief with a peck stretch. It's like, all right, great, let's let's dive into that then, right? Like is your pect tight? Let's dive in. Right. So um I think using I don't like to use exercise as your assessment um but you should at least have your wheel spinning constantly in that session when someone's got pain. Could you explicate it a little further on the difference between mobilize and stabilize yeah so I think um I think mobile mobilize would be taking a a joint or a tissue and creating length through it, whether it's a a flexibility with it with a muscle stretch or a a mobilization at a at a joint um stability is would be the opposite stability is you're you're creating tension at the area. So using the example before as far as like um your shoulder Chris we talked um you know stability interventions would be me utilizing that isometric hold for the back side of your shoulder and that high plank shoulder tap for the front side of your shoulder right like I'm I'm not mobilizing anything I'm not creating changes in length at the joint. I am however creating shortening and tension and co-contraction at that joint. I'm creating a sense of stability right um versus mobile mobilization creating length at the at the area the pec stretch getting you into a 9090 and creating length across the front of the joint um creating opening at that capsule into that capsular pattern um this the soft tissue mobilization with the lacrosse ball maybe a little ART where I'm I'm pinning and then I'm stretching through that soft tissue to create length so so lengthening versus versus shortening in the in the sense of it.

SPEAKER_00 24:04

So yeah I go to a lot of seminars and we'll teach trainers and a lot of them have this black and white thinking where it's like this is fact this is not fact. And I just like you were saying that it always depends but I try to come up with the the best response and not be dogmatic in my uh you know suggestions and you know people who have maybe a limited range of motion people will say oh you know you can't pass a certain you can't get your hands behind your back and you may not be in pain now but you will be in pain. Could you explain a little bit more about uh the thought process behind that and you know where maybe trainers are going wrong with that explanation I don't yeah I think it's like not we're still learning to be honest with you like like we don't know there's no normal you know like even what we're doing and it's like oh yeah like you should have 180 degrees of shoulder flexion you meildred who I just evaluated who's 79 years old you know with the bad back and you know it's like what is normal who's normal out there right like I think I think ideal I think symmetry isn't a realistic goal but can't we always be striving for it right like if I got one arm that reaches my C7 and one arm that can't get higher like is that like oh it's just asymmetry you're fine right or is that a problem like so I think I think being able to access your full ranges of motion I think bridging the gap between what you have passively and what you can access actively I think you should always be striving for that.

SPEAKER_01 25:36

So um those are things that I implement with my patients is like hey I don't they're like oh is that normal and I'm just like you know I don't I don't know not you know it's definitely it's tighter than I'd like it to be right like if if I get a girl that comes in and she's a dancer and her left hamstring has 120 degrees of a straight leg raise and both hips are at like 90 degrees of rotation both ways and then her right hamstring's at like 70 degrees I might be like that's normal right like hey 70 degrees not horrible but you're only you're almost half of the other side and you know given how mobile your hips are we might want to dive into what's happening with this this restriction here. Now is it a is it tight because it's weak or is it tight because it's restricted we got layers to that but at the very least like it's you know I think I think not chasing symmetry but at least kind of like um chasing more for ourselves right I think it's easy to be like you can bench press 265 ain't that enough Chris I can't bench press that much so like shouldn't you stop? And it's like well no I I want to get stronger I want to get more mobile I want to get more athletic I want to run faster. So um so I I think that there's not quite

Stretching Versus Stability Interventions

SPEAKER_01 26:50

normal I think that there's ideal and I think that that's kind of what we're trying to push for our patients to is like um you know what's your sport what do I need to do for this activity if I'm bench pressing 265 I better have adequate range of motion into this position. Otherwise every time you put that barbell on it's it's a loaded stretch for you and you're blasting through passive constraints right so my dancers that have all that mobility if I can move you 90 degrees in both directions and you can't do a bridge or you can't stand on one foot or you can't do an RDL without losing balance it's like that's the not normal thing not the range of motion stuff we're we're you're gapping about right so I I think that's it we that model the the normal is all based off of our system right it's all based off of like what insurance companies want to see as far as like what's the number that you're looking for what's what aren't they at what's the intervention you're doing to get to that point. So everything is built around that and I feel like we we're getting away from that because shit that didn't work for the last hundred years. So what else we got? So I think that's kind of where the the bones of that type type of conversation lays. And um I think people that do what I was doing kind of outside of network where it's like wow all of a sudden I stopped thinking that way and I still got people like way better. What's wrong with that? What's what's wrong with the system so um so yeah I I think that like trying to understand what what is ideal and where where you should be given what you want to be doing is probably a bit better question to ask.

SPEAKER_00 28:29

Yeah I like that a lot because the curiosity should always be evolving and not just you know okay this is fine let's just move on you know we had that conversation about uh via DM about some squatting a lot of weight but then you know frontal plane abductions they couldn't do anything and you know that's like okay let's let's maybe we can improve that and and to to kind of dig a little deeper for the last little thing before I answer any questions that people have you were mentioning about someone who didn't maybe have optimal range of motion and they were going into a stretch where is the the line for okay well there is going to be a little bit of discomfort so like say for example on like T Rex I can't barely do this I can only can't even hit C7. So where's that line for trying to you know maybe use a towel and assisted stretch and you know work into that a little bit and you're gonna experience a little bit discomfort and is that discomfort okay and and where do you kind of draw the line with that?

SPEAKER_01 29:23

Yeah it's like the the pain versus discomfort right like it's that's a hard that's like an individual type of thing. I think um I think pain from a perception standpoint as far as like what your brain is experiencing is like a warning shot, right? It's like, yo, what are you doing? Right. So those those golgy tendons that live inside those those parts of our our muscles and our joints are are the first things woken up to be like that's not what we usually do. What are you doing? Right. So and then if you feel like maybe I can like I can kind of just close my eyes I can breathe I can create some type of parasympathetic response to that that heightened issue and then it releases like everyone do it now. Everyone just stand up and touch your toes. There's gonna be a point where you go and you stop and then you go a little farther right that's everyone's body saying whoa okay right like so I think that that point where you do the you you reach back and like oh man I'm also very active right now right so if I just take this and now I can grab on and now I'm very passive well look I can actually go a lot farther very comfortable now right so I think that like I think you have to let yourself feel that first warning shot and then make a decision and it should be getting better and better right so I think that if you want better just like any other athlete 265 on the bench if you want better and you're chasing something extraordinary the line between helping and hurting is going to get thinner and thinner. Accept it every athlete does right that's why no one comes into the office that's an athlete and they're like can't believe I tore blank blank and blank. It's like no the only people that are doing that are the old people coming and being like I can't believe I hurt my back I was just picking up a pencil. You know what I mean like those the only people questioning why they got hurt. Every athlete's like yeah I was uh I was pushing it pretty good so here I am right so I I think athletes are aware of kind of that point and I think that flirting with it is your choice but knowing that that what's happening to you is happening for that reason that that pain response should let go. And if the first rep sucks second rep should get better if second rep is worse listen to it. Something's happening in there right so um I think that's kind of what we do with with my current patients now is like hey Sean that it hurts when I'm doing this let me see you do it. Where does it hurt?

SPEAKER_00 31:46

Have you tried it this way put your foot here try this cue put your knee out to my hand better worse or same worse let's stop right so most times it's like oh it's better all right keep going and I have to go treat my other nine people but that's that's kind of the way it it it goes right now is is it's not like whoa let's just modify everything it's like it hurts where why is it getting better or is it getting worse again something that you guys could utilize too and I think if it's getting worse I think that was your tool and I think it's time to kind of refer out right and so just the last question to bring us back to the original topic with the acute issues if uh so if I were to come in on your client and you're a trainer you know where and what are the some of the suggestions that would be within our wheelhouse to suggest but also maybe not to suggest I know old school thinking was just rest for a week no don't do anything.

Pain Versus Discomfort And Simple Recovery

SPEAKER_00 32:40

You know old school would say icing and icing isn't bad per se you know it can help you know numb the pain a little bit you know sometimes your clients we can't prescribe obviously but your clients oh I'm gonna go take some some Naperson or I'm gonna take an NSAT or something.

SPEAKER_01 32:53

As of today at least with our current understanding what are some things that would be okay to recommend and some things that are maybe that's a little outdated don't suggest that yeah I think um I think I always try to like not just give you like bullshit like cookie cutter answers you know what I mean um I think like you said I think the ice I ice people all the time I ice myself you know what I mean I think that when you look at the data for what what icing does and doesn't do um you know it's not as harmful as we think it is it's definitely not as good as we thought it was right so I I think like you said kind of using it for the for the numbing effect you know I I've got to calm this thing down I can't move get me out of pain if I could put an ice pack on myself and it goes it cuts the pain 50% use the ice you know um movements medicine so I I think keeping you keeping you the trainer keeping the client keeping everyone in the gym active moving I think does so much for you other than just the pathophysiology of of healing um so I think keeping people moving and keeping people moving in ways that like I said before like modify work around reduce um you know uh keep it going through the motions like we mentioned before as far as like you know for your shoulder I didn't mention the word rest at it once right but we did by prescription I thought about four to five different things that you can do today and and things you can progress to that's the mentality is like you can keep yourself moving and you can you can work around it and you can you can find ways to to hit the target tissue in ways that aren't provocative. Even what we just said here it's like chess day and I can't bring them here right like there you have to tap into your library and you get creative. Like if if you want to be better than AI this is your time to shine right like that's that's what it comes down to. So I I think keeping people moving keeping them feeling like they're still working even if they are just like letting it rest um is totally there. And then you live in that realm for that zero to seven range on day seven where am I compared to day zero better worse or same better great we're not done yet seven to 14 where are we at 14 to 21 like if it's not doing like a little bit of this but it's not a net gain in that seven days 14 days like you're losing them a little bit and you and you'll keep that client if you do good by them and send them somewhere that's that's gonna hold this kind of plateau. So I I think you use your tools you um you work around the pain which I I think is is kind of a buzzword but I think given specific examples is a bit easier to kind of talk about but um you got to keep them moving. I think that um like for for another good example for me I mentioned my leg day yesterday I'm writhing in pain right now I'm I all day today I was dying right so I can't unring that bell there isn't a foam roller there isn't a massage gun that's gonna fix me right now like I need to rest right like I need to not work these legs out until this pain goes away right and that's kind of what has to be done right so I think that I'll be better for it come Monday if I just hit legs again and then I'm like same rep same weight schemes and guess what it's now Wednesday and I can walk again I'm great that's progress even though there was a small micro of rest like that's what has to happen. Yeah I can I could do some stuff for my core I'm gonna do the gym day after this and work the upper body a bit hit the stairmaster and that's that's me working around my current pain. But if I keep banging through this if it's like Wednesday and guess what client we're gonna we're gonna keep you active we're gonna keep you moving and I do something silly that's gonna compound this pain I'm gonna start getting trauma into these legs. So I think just being smart about the workarounds.

SPEAKER_00 36:47

Well this is great doc appreciate your time today and we'll definitely have you back on here and I'll I'll put some questions out to students for for future opportunities to to get some of these answers from you. But again appreciate your time and look forward to you know seeing you again soon.

SPEAKER_01 37:01

Yeah for sure thanks for having me.

SPEAKER_00 37:03

All right everybody have a good one we'll see ya thank you