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002 Shoulder Issues Part 1

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002 Shoulder Issues Part 1

By Jurmaine Health

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When Shoulder Issues really isn’t a shoulder issues. Case studies of Client has had a year of shoulder pain and couldn’t do muscle ups Client shoulder pain, referred from ribs Client shoulder pain from bronchitis Client shoulder pain from mild pneumonia Client shoulder pain, severe episode, turns out to be cancer. and more

SHERMAIN [17:22]
Yes. So when she came in, it was it turned out to be a hip issue again, but this time in the hip flexor, so not being able to stabilize from bottom up, her shoulder has to cop in terms of being able to provide a range or stability. In that sense, the shoulder was the symptom yet of the original issue, which was happening in the hip and pelvis.

SHERMAIN [18:02]
Yes. So if you guys want to say you don’t know where your hip flexors are, it comes from anywhere from T12 to T LL2, all the way down into your lace into there. So it’s a very long muscle, and you have that on both sides. So if you guys happen to be sitting for a very long time, even if you go young and youthful and fairly fit, or flexible, and you stand up and feeling like an old person, most likely you’ve got to give us a call. Okay. Yes, you’ve just given us a call. Don’t worry about stretching it up. Yeah, you can overstretch it.

CERA [02:02]
So my assessment and train of thought follows closely to what Jackie used to do go along with how the pain initially come on aggravating easing factors. Do your typical strength tests help patient around the joints, the neck. Yes. From as a physio I find that a lot of shoulder pain stems from the neck and thoracic immobility to come, especially in the spots that people usually come in with is from CrossFit heavy lifting overhead. If you think about it, we spend we don’t spend a lot of time with our arms over head and suddenly, you know, in that one-hour class, you’re like thrusting weight overhead and trying to claim that position which you’ve never worked on or earned. So that’s mostly the type of things I’ve seen in the past.

CERA [16:13]
So this patient is incredibly strong, participates in CrossFit and weightlifting, still manages to get through all her training, despite, regardless of pain and discomfort, main issue is chest trouble getting inverted upside down walking on her hands. And in her snatches, she actually cannot sit her shoulder back comfortably. So she’s actually supporting the weight muscularly actively, which is not ideal in terms of building to heavier loads. So she decided to come and have, you know, have another opinion, good thing to note that she has previous frack job to her first rib, and she just thinks that everything in her showed up or stems from that.

Dr Shermain Wong is a seasoned chiropractor with particular expertise in Sports Medicine and a passion for the benefits of in ‘Active Release Technique™ (an advanced Soft Tissue Technique developed by Chiropractors). She is professionally trained in ART and has a Masters in Clinical Chiropractic from RMIT University. Dr Wong has provided chiropractic and movement rehabilitation services at international sporting competitions, and provided rehabilitation and training for professional dancers, professional football players and professional athletes.

She can be found at https://www.jurmainehealth.com.au/dr-shermain-wong/

Episode 002: Shoulder Issues Part 1

Podcast brought to you by Jurmaine Health

JACKIE [00:00]

This is Jurmaine Health, the center to help you achieve wellness in both your brain and body. We endeavor to encourage cross communication between health professionals for your health and well being. We bring you topics on neuro psychology, neuro behavior, neuro musculoskeletal, neuro gastro, movement is well being, metabolism and microbiome, which are also some of the services that we provide.

Today we will speak to you about how common shoulder issues that may or may not be so common after all, and this will also be part one of our shoulder series. So historically, when a patient comes specifically to say 'Mam' there is' shoulder issue, or a dysfunction, I predominantly looked at them from a biomechanical background. So I've looked at how the shoulders moving, how they're moving, where their pain tends to be, how long they've had the issue, what set it off, all these things. Predominantly, I've looked at the case from an anatomical perspective, looking at the muscles, joints, tendons, ligaments, anything that could be contributing to the patient's problem. However, during my time here at Jurmaine Health, I've come to learn that not all shoulder issues, in fact stemming from the shoulder and its surrounding tissues, and these are the cases which we'll be talking to you about today. So I've got both Shermain and Cera with me today, and we will be talking to you about what we've seen recently.

SHERMAIN [01:24]

And thank you, Jackie, for that introduction. That is Dr. Jacqueline Swiatlowski. I am Shermain, Dr. Shermain Wong, a chiropractor. We are both chiropractors. We don't hit physios. And that is Miss Cera Lai.

CERA [1:39]

Just Cera Lai

SHERMAIN [01:41]

Miss Cera Lai, physiotherapist.

SHERMAIN [01:44]

I'm not good at introducing people. Sorry, guys.

SHERMAIN [01:47]

That's all right.Okay, let's get started with the episode. We'll go with Cera first, and what would be some of the common shoulder issues that you've seen as a physiotherapist.

CERA [02:02]

So my assessment and train of thought follows closely to what Jackie used to do go along with how the pain initially come on aggravating factors. Do your typical strength tests help patient around the joints, the neck. Yes. From as a physio I find that a lot of shoulder pain stems from the neck and thoracic immobility, especially in the sports that people usually come in with is from CrossFit heavy lifting overhead. If you think about it, we spend, we don't spend a lot of time with our arms overhead and suddenly, you know, in that one-hour class, you're like thrusting weight overhead and trying to claim that position which you've never worked on or earned. So that's mostly the type of things I've seen in the past.

SHERMAIN [02:59]

Yeah. That's true. That's quite common amongst crossfitters. Strength type work. And what about yourself?

JACKIE [03:08]

Well, as I said, I've predominantly gone looking for the anatomical part, as most people are also looking at, or most people actually expect that they think that the original cause of their shoulder is, say a shoulder.

SHERMAIN [03:23]

Yes.

JACKIE [03:24]

So that's what they expect them. To be precise. We had exactly the same sort of, I have exactly the same sort of person presenting today. We're sure mainstreaming. Shermain came into with me today for this one.

SHERMAIN [03:37]

No, I said like, I really had someone who thought they had shoulder, shoulder issue.

JACKIE [03:45]

This one here pretty much presented with neck and shoulder thinking that yeah, it's coming from their shoulder blade. Then with more or less chasing the pain in the shoulder blade. When we did our testing came out to being more coming from or more stemming from their lung itself, so irritation around the lung lining, and as well as their intercostal muscles are working through that, and which tend, which seemed to really, well not maybe, not relieve their pain per se, they were still chasing the pain afterwards. But Cera also sat in with me for this particular patient, so she was a witness to it when it came to their range of motion in their neck. Every time I treated, I moved from one segment to another so move from one area of the lung then to the area of the intercostal, or 1 intercostal level down again, and then retest the neck movements. Every single time we retested it, she managed to have more range of motion, despite the fact that she was saying she's still got pain in her shoulder. Only thing that seemed to relieve her shoulder pain or tended to settle her with regards to them. Continuing on with the pain, following the pain which I should say, was when I actually poked it, actually looking for anything specific in the shoulder itself.

SHERMAIN [05:09]

So there was nothing in the shoulder

JACKIE [05:11]

Nothing in the shoulder that I was actually going forward, to go alright. Tis specific trigger point guarantee this is going to be the be all end, all wasn't doing anything specific. I was just taking her through motions. And then as soon as I did that, oh sweet, this feels a lot better. This is what I needed, which then I had to explain to her saying that know what you actually doing is you've got the preconception in your head that unless you touch the shoulder itself or any of the musculature or any of the areas surrounding it, it's not going to relieve it needs to be the shoulder itself. If I'm saying it's the shoulder, it has to be the shoulder that has to be touched to get a result for you. We had a nice hold and I explained to her that you had your range of motion back in your neck before we even touched the shoulder itself. You saw it, we had the witnesses to it. But it wasn't working for her until I actually just physically touched the shoulder. And then she went, okay, this is what I like, this is what I need. And this is what I came in for yeah. And I had to tell him, we have to decondition your thought pattern from going, okay. Just because I feel it in the shoulder. It has to be the shoulder. Well, that was my thing for today that I saw anyone else.

SHERMAIN [06:32]

So that means then she's chasing fish. She's chasing a particular pattern that is�

JACKIE [06:39]

Maybe not so much a pattern. She's chasing this particular thought process. Yeah, it's a thought process. So she's got it in her mind that because it's a pain she's feeling in the shoulder. The shoulder must be the cause of it.

SHERMAIN [06:51]

That's right.

JACKIE [06:52]

We see that often don't we?

SHERMAIN [06:54]

Yes we do. Don't you see that often? Or not really. I sometimes feel like that. Yeah, yeah. So even in our own bodies, that's what we are conditioned to think about. Yeah, so that is something that we try to highlight to many of our �

JACKIE [07:13]

Educated patients.

SHERMAIN [07:14]

Yeah, highlight to our clients, patients, educate our people that we train that whatever that they are feeling, not all the time about 80 I would say about 80 to 90% of the time, it's symptomatic and or a inverted commas, close inverted commas have an existing and maybe more distal issue from what they are experiencing itself. I think that Cera, I have seen quite an interesting case of a crossfitter coming in recently for a short bilateral shoulder issue I have seen that case before and what are your thoughts on it?

CERA [07:58]

Well before I jump in

SHERMAIN [08:00]

Yes

CERA [08:01]

this is the second time we met this particular patient.

SHERMAIN [08:04]

That's right.

SHERMAIN [08:05]

What did you do for the patient the first time?

SHERMAIN [08:08]

So this patient came in with bilateral shoulder pain. And he said that he has gone to see a physio or someone else and got his shoulder treated, and they thought that it was. So what happened was that he came in to see us after some time, it was for a year I think he had it for. Is that correct?

CERA [08:33]

Yeah.

SHERMAIN [08:34]

I think you'requite aware of this as well. I'll find and what happened was that I well, I assessed him. And I said that he was posterior, posterior chain dominant. So I treated the posterior chain so that means it's from the Achilles tendon all the way up into the neck, leaving the shoulders alone. So that's what I did and his coach said that he started to move a lot better. I mean of course it is not a miracle work right. So we have also given him some other exercises to do to really come back and what did you do, see? Or do you see a difference the way he moved? well given that,Cera and, he trains in the same gym so you have a background of that. It's not like she has a big brother thing on everyone that comes in, but she knows him.

CERA [09:36]

He's a lot more comfortable going overhead. A lot more stable in his jerks, which was one of his biggest problems, not problems, but things.He's working on with in terms of his weightlifting. Also, another thing he did his first muscle ups in a year. Wow. So yeah.

He said, I felt really good doing it. So here, that's why he's more than happy to come in ...

SHERMAIN [10:08]

And the time lapse between the last time he came in and now it's about two weeks to three weeks, so we haven't really seen in that time. And the result was quite good, I think. But till today, his issue was, he still feels a bit tight and in his both shoulders really. So what we did was instead of looking at his shoulders, after the assessment we were looking at his contralateral hip. So instead of looking at working on his shoulders again, it was, the hips that was really locked down so to speak. So we spend a lot of time just working on that left hip, and his right shoulder is ready to go. Better. Oh yay, party time, you know. So we were really happy about that. Subsequently, we worked intercostals of his ribs, that made another major difference. So make sure that his right shoulder looksmuch better. It's much further, he has got less pain in that. And he is happy. I am looking forward to hear what Cera will be seeing further down the next couple of weeks, how he's going on, that'll be quite exciting to watch. Yeah, so watch this space for that patient. The next space oh, listen to this space for that patient. So any other exciting case in?

SHERMAIN [12:10]

Oh, yeah. So he wasn't chasing that kind of pain that we were talking about. Yeah. So that was quite good. So we don't have to spend cognitive effort saying do you say?

JACKIE [12:35]

We promise that we know that this is really notthe issue.

SHERMAIN [12:39]

Speaking of some promises made, right. So some problems we have, we really don't know what it is. When that happens. We tend to send these patients out to at least go GP, but if they sometimes have a good relationship with a specialist.For example, there's one case there are two cases of pneumonia that we picked up. So it both came in with shoulder pains. One of them. One of the case involves a fairly young girl, not well, lady, and shewas doing CrossFit. Nothing to do with CrossFit. The injury was not really a CrossFit type injury, but initially, that's what it looked like because she said there was shoulder pain. So what happened was, so I was asking her when does she feel it, she said she doesn't feel it, lifting overhead, she doesn't feel it when she's putting it down on her shoulders. But she felt it the most when she was racking the bar. So placing the bar back on the stance, so and when that happened I had, two choices. One was to test it out and what I knew what to work on and gave that a go for at least two sessions. So I said to her after the second session, I said, look, this is really not working. I really don't think this is a shoulder issue. So, do you have any form of respiratory issues going on like asthma bronchitis, broncho-type inflammation, infection, one of those things. She says no, no, I'm fine. I'm all good. All right, well, how about this?

Go to your GP. And she was like, I am okay, she's like, no, go to your GP like really seriously. And she said that, yes, she has quite a bit of bronchitis thing happening. Yeah of course. Yes. So that's why we kind of test things out a lot. The next lady was, nice lady also came in with a shoulder issue. She's much older. So she came in saying that she has a neck pain and shoulder pain. And I was wondering if it was really the case. So what happened was that after the assessment and treatment, I said to her look, I think it's a little bit more than that. Could you go to your GP? And she asked why she said, why do I have got to go to my GP. So I responded to her look, I think it's got something to do with your lungs. And then she revealed to me, Shermain, I've got a history of pneumonia. I was like okay. Good for you to go to yourGP right now.

Get it checked out, regardless of what it is and sure enough she's got a relapse. But the next shoulder case is quite interesting before I give you guys a more sinister story. And so another lifter that had trouble working in her handstands. I think or doing a push press. And this patient is known to serve too. So I think that it's good for Cera to share that piece with you guys.

CERA [16:13]

So this patient is incredibly strong, participates in CrossFit and weightlifting, still manages to get through all her training, despite, regardless of pain and discomfort, main issue is chest trouble getting inverted upside down walking on her hands. And in her snatches, she actually cannot sit her shoulder back comfortably. So she's actually supporting the weight muscularly actively, which is not ideal in terms of building to heavier loads. So she decided to come and have, you know, have another opinion, good thing to note that she has previous fracture to her first rib, and she just thinks that everything in her showed up or stems from that. She says

SHERMAIN [17:07]

on their first, the first route, the old injury,that her thought process was, it hasn't healed. Well, she hasn't done enough rehab around the, around that problem.

CERA [17:19]

So was she over rehabbing that?

SHERMAIN [17:22]

Yes. So when she came in, it was it turned out to be a hip issue again, but this time in the hip flexor, so not being able to stabilize from bottom up, her shoulder has to cop in terms of being able to provide a range or stability. In that sense, the shoulder was the symptom yet of the original issue, which was happening in the hip and pelvis.

CERA [17:52]

So the original issue of the hip flexor was happening a long time ago anyway, was it irritation of the hip flexors.

SHERMAIN [18:02]

Yes. So if you guys want to say you don't know where your hip flexors are, it comes from anywhere from T12 to T LL2, all the way down into your legs into there. So it's a very long muscle, and you have that on both sides. So if you guys happen to be sitting for a very long time, even if you are young and youthful and fairly fit, or flexible, and you stand up and feeling like an old person, most likely you've got to give us a call. Okay. Yes, you've just given us a call. Don't worry about stretching it up. Yeah, you can overstretch it. Anyway. I'd love to share with you the most sinister case that we have come across. It was not by us.

It's seen by a good friend of ours who is a chiropractor. It's because this case was sent to her because the patient couldn't come to where we are due to time constraints and scheduling and location as well. So we sent him to the other person with no interest on the other side of town. And what happened was that he had chronic shoulder pain, he had seen and spent a lot of money on rehab. It was his son who asked me whether if he could come to see me or but realized that because of the shadowing and location, his father couldn't make it to see it.

What happened was that after making the referral to our colleague, our colleague managed to investigate and investigate further into his shoulder issue. She thought that shoulder issue did not like look like a shoulder issue. Usually shoulder issues, it's quite easy to recommend, I mean, easier for us to recognize is quite simple. And it's not complicated. But when it becomes a little bit more than looking like a shoulder issue, we start having to look further should give his GP a call and ask him when he, what had,lost his blood tests and health check. And his GP was like, oh, it's done quite early on. I mean, within a year, and he had no issues. This colleague of ours sent him to have a test extract. And the result that came in, came out was not very good.

It was metastasis of lung cancer that has reflected your shoulder and it looks like shoulder issue. It looks like shoulder issues. It looks like the entire area was well the entire shoulder and was an issue. So that said, unfortunately, the person has already passed since. And this is something to share with you guys about because we would like you to know that not all shoulder issues look like shoulder issues are shoulder issues. If it doesn't walk like a duck, smell like a duck, quacks like a duck, it probably isn't a duck. You can certainly substitute that with whatever animal that you like. But this sets a pain pattern.

JACKIE [21:37]

Just put in there just because that one was presenting similar too for, any layman's person thinking it was a shoulder issue and ended up being a cancer issue does not mean that if you have a shoulder issue you have gotten that, you're pretty much.Do not fly into that conclusion straightaway. That's just this is not where we are flying. This is not the way, what you to go straightaway,

SHERMAIN [22:02]

Unless you have an oncologist for a patient, then everything is like cancer. Yeah, that's true. We have had oncologist coming in here and then they go I've got neck cancer. I was like no, you don't have backpain. So you probably have tight hamstrings or something like that. And that's common too. So that is one. One version of it,

JACKIE [22:22]

Dr Google always seems to have cancer as a culprit as well

SHERMAIN [22:26]

Does it. Okay, that's not good

JACKIE [22:28]

There's always this, there's always some form of cancer that can fit all your symptoms.

SHERMAIN [22:32]

Okay.Well, that's all. So in the next part two, we'll be talking about shoulder stability, mobility and assessments that makes sense and how some don't, and why some treatment type makes sense and others do not

JACKIE [22:50]

If you like what we're presenting, please give us a thumbs up a like or share it with one other person who you think we may be ahelp. For those of you who are coaches, dancers or athletes, and may find difficulty with expressing or executing movement patterns. Please do connect with us on our website, www.jurmainehealth.com.au and JurmaineHealth is spelled j u r m a i n e h e a l t h. Or please socialize with us on Facebook, which is JurmaineHealth or Instagram which is JurmaineHealth body. And last but not least, since this podcast is made for you, our clients, patients and fans, please do let us know what else you might like to hear about.Signing out now Jackie, Shermain, Cera.

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2020-07-28T15:03:22+00:00