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- Welcome, my friends, to "the Bob & Brad Podcast,"
produced by Bob and Brad,
the two most famous physical therapists on Internet.
I am Bob.
I am exactly one half of the Bob and Brad team,
and today my guest host is...
- Mike Keenan's physical therapist assistant.
- And Mike is gonna help me interview Rick Olderman,
and we're gonna talk about
back pain, knee and hip pain, shoulder pain,
and foot and ankle pain,
so stick around.
- Because you're gonna realize everything's connected.
- Right?
- So now we're gonna switch subjects and talk about
fixing your shoulder and elbow pain.
So, to fix many shoulder and elbow problems,
you often begin with the shoulder blade.
Can you discuss this,
and explain how posture can affect this?
- Yes, so let's first talk about the shoulder blade,
and I'll use my trustee skeleton again.
All right, again, going back
to the architecture of our bodies,
look at the architecture of this shoulder blade.
There's only one other bone in the body that
has a similar architecture, our pelvic bone.
It's a broad flat bone.
It has a socket on it, just like the hip bone.
The pelvis is the center of function
for our lower body mechanics.
The shoulder blade is
the center of function for our upper body system,
and this is why we have to look at
the shoulder blade to understand more chronic problems.
So, fortunately, Dr. Saraman has worked out the rules
to how the shoulder blade should be working,
and there are some landmarks that we look at.
One is that this part of the acromion should
be resting at thoracic level two.
This border here should
be resting three inches from the spine.
I don't care if you're five feet tall or seven feet tall.
Those are the resting landmarks.
If we find a problem with either of those,
and we often do, it means for sure that...
Because the whole purpose of the shoulder blade is
to assist the arm in movement.
So if we find a problem with it just resting,
well, we know then for sure we're
gonna find problems with how it's being used.
So when the arm is raising up overhead
with the shoulder blade, now this guy goes into action.
So the landmarks that should be happening here are
the acromion should be moving up
to cervical level seven.
The inferior angle, the bottom triangle point
of that shoulder blade should be coming
out to the midpoint of the thorax,
and this angle should be reaching 60 degrees,
because 180 degrees is normal overhead motion.
60 degrees of that comes from the shoulder blade,
120 of that comes from the shoulder joint itself.
So, once we measure this, we see, "Oh gosh,
"most people that I have who have
"chronic neck, headaches, shoulder issues, elbow issues,
"will find that not only are the resting landmarks off,
"but the movement landmarks are off too."
So then we start to solve those things.
We're laying the groundwork for success elsewhere,
because it is the foundation, just like the pelvis.
- Makes sense.
- So in the book, you talk about, with women in general,
there are two things that can depress their shoulders.
Would you mind elaborating on that?
- Yeah, shoulder depression means that
these shoulder blades are typically resting too low,
and the reason this is really important is
not only for shoulder mechanics,
because it will screw up the movement mechanics,
but there are really important muscles that
attach from the shoulder blade
into the neck bones and the base of the skull.
The big one is the trapezius.
Again, it's like the gluteus.
It's like this big hand muscle that
has all sorts of function.
It starts at the base of the skull,
comes all the way down here,
and inserts into the shoulder blade.
It's massive, and we divided it
to an upper, mid, and lower trapezius portions,
because it's so big and has so many jobs,
but deep to that big guy is
this little levator scapula muscle that starts at
the very corner of the shoulder blade here.
It inserts into C1 through four, sometimes five.
So again, just like everywhere else in the body,
if the big guy isn't doing its job,
the little guy has to take up the slack and do more,
and that's when we have shoulder, neck pain,
headaches, all that kind stuff,
and you'll see everyone say,
"Oh, it hurts right here."
"Oh gosh, I have a knot right here."
They're not pointing at the trapezius,
they're pointing at the levator scapula deep to it.
So that is...
So when we talk about
women having typically depressed shoulder blades,
what's happening is that they are sitting too low,
which is then causing the levator scapula
to work even harder to try,
because it's levator means to elevate.
So its job is to elevate.
Well, the scapula is sitting too low,
so now it's being turned on excessively.
Not only is it carrying the load
doing the job with the trapezius,
but now you stretched it out while it's under load,
and it's saying, "No mas, I can't do this anymore."
So that's...
You know, scapula depression, in a nutshell,
why it's affecting neck pain,
headaches, and shoulder issues,
and women in particular have this
because one of the things that
drags the shoulder blades down is
the chest and breast size.
So, if a lot of women wear their bras,
and their bra strap is
on the outside of the shoulder blade.
Well, depending on how large the breast is,
that's like holding a five pound weight
in your hand all day long,
and gradually your shoulder's gonna get tired.
Well, when you have a bra strap that's resting out here,
and I see so many, you guys have probably seen this
in the clinic too.
When you move a bra strap,
you see this big divot in the shoulder.
- Right, absolutely. - That tells you how much that
thing is dragging down the whole system.
So instead of having it out here,
where it's a long lever arm,
wouldn't it make sense to put it here instead,
where now it's off of the shoulder blade,
and now the connections from the shoulder blade
to the neck are unloaded.
- If someone has tight internal rotator muscles,
you know, it brings their posture forward.
How does this affect negatively in your rotator cuff?
- Yeah, so again, it depends on how the scapula is resting,
and how the function of the scapula is.
- Sure. - Again, that is
the foundation of shoulder movement,
then when we get into the shoulder internal rotators,
that's gonna exacerbate, because, if you look,
one of the big ones is the chest.
So if you look at the fibers of the chest,
a lot of them are moving downward,
some are moving across.
A lot of 'em are like this.
So they are contributing to scapular depression.
So, not only are they attaching to the arm bone,
and contributing to the arm being internally rotated,
and internal rotation in almost any joint in the body
increases compression and pain,
but they are also contributing,
by virtue of the fact of their orientation,
they are pulling everything down too.
So yes, stretching the chest muscles
will help release that internal rotation of the arm bone,
and thereby the internal rotation and the compression,
but what it's also gonna do is
relieve some of that scapular depression as well.
Did then answer your question, Mike?
- Yeah. - Absolutely.
- So, to correct, say, shoulder blade issues,
what are some of your favorite exercises you give people?
- Well, we have to understand
the problem with the shoulder blade.
So if we're just looking at scapular depression,
we need to stretch the scapula depressors.
One of those are the chest muscles that
we just talked about,
so you stretch those guys out.
The latissimus dorsi is another one.
It starts down here at the pelvis,
and it hooks onto that scapula just a little bit,
and then into the arm.
So that's another scapular depressor.
So, but really, and then, you know,
one of the exercises that we do,
and this is a common yoga one,
what's it called when you're on your hands and knees,
and then you sit back on your heels,
and just let your hands stay there?
It's like a prayer--
- Yeah, a prayer stretch. - Kind of motion.
- I don't know. - Yeah, a prayer stretch.
Is that called a prayer stretch?
- Yeah. - Okay, so prayer stretch.
What you'll notice, if you're doing that prayer stretch,
if you keep your hands where they are,
and then you sit back,
that's gonna pull the arms up overhead,
and most people with tight scapular depressors
will feel a stretch here.
So that's stretching a lot of the muscles that
are pulling the scapula down,
and causing it not to move the way it should.
Now, Bob, you, you and Brad did
a really, really interesting...
I saw you did a clip on a doctor who wrote a book about
hanging to solve shoulder problems.
- Dr. Hirsch.
- Do you remember that one?
- Dr. Hirsch. - Yeah.
Yeah, so what that's doing,
it's just like what I just showed you,
if you hang...
- Yeah, that makes sense. - If I get that arm off.
If you hang, what you're doing is,
you're stretching all of the muscles that
are pulling the scapula down.
- Sure. - And what it's doing is,
it's restoring the upward rotation of the shoulder blade.
That's why it's contributing.
That's why it's helping shoulders,
and I do have some hanging exercises I give my patients.
However, people with chronic pain,
hanging is way too aggressive for them.
So this all-fours rocking stretch is
a nicer, gentler way of starting,
as opposed to just hanging on the thing,
because if you've got chronic pain,
all of those tissues are irritated,
but that's what the hanging is doing,
is it's solving one or two of the scapular landmarks,
allowing the scapula to...
Because if it upwardly rotates,
what we're doing is
moving the roof of the shoulder blade out of the way,
so the arm bone can come up better.
So that's what that is doing.
Okay. - That makes sense.
Hopefully that makes sense. - Yeah.
- All right, and so that's what I'm hoping,
you know, all of this information,
and this is what all my therapists say,
and my patients say too,
it's just like, "Gosh, this makes so much sense.
"Why isn't anyone else doing this?"
And that's the thing is,
it's because of how we've
been trained as medical professionals,
because the gold standard is,
"Oh, everything has to be evidence based."
So in order to generate evidence about a shoulder,
we have to look at ever smaller things.
We can't have 20 different things that
we're measuring in a shoulder study,
we can only measure one thing,
and so you can't research systems,
and that's why it's taking me so long
to put all this together,
is because there's not research,
there's bits and pieces all over the place,
but you have to integrate this,
and so when people understand,
patients and therapists alike,
when they understand how things work together,
the significance of the architecture,
and everyone's just like,
"Oh, that makes so much intuitive sense."
That's my greatest compliment, is that, yes, it does,
because that's how the body works.
- Right. - So, anyway,
my little soapbox there.
- Rick, when you have people do these exercises,
how long before they might get some relief?
- My standard in the clinic is I expect immediate relief.
- Really, same day? - Right then and there.
- Really? - Yeah.
Not only the same day, within minutes,
because-- - Really?
- Yeah, the way I do everything is I do a test-retest.
"Oh, you've got back pain?
"Show me the situation that you're doing your back pain in."
"Okay, I think this is causing your back pain,
"Let's fix this thing.
"Now do that test again."
"Oh, that feels a lot better."
- Awesome. - Okay, this is
what you're gonna do at home.
It's so immediate, I typically expect...
Typically, I expect at least a 50% reduction in pain
after our first visit,
because we've tested it in the evaluation.
We know what's gonna solve their issues,
and also, because I've seen so much volume of patients,
I can identify the pattern of problems almost immediately,
just by watching them walk to my table.
So once you get good at this stuff,
you don't have to do 1,000 orthopedic tests.
It's so simple, it's so simple.
Anyway, I expect immediate results.
- So, you better name your clinic, Rick,
because people are gonna want to come to it.
- Oh, well this is the thing, Bob,
I sold my clinic
back in April. - Oh, you did? (laughs)
No! - Well, here's the deal,
I just couldn't deal with the insurance.
- Yeah, I understand.
- I just couldn't deal with the insurance anymore.
It was just-- - I'm right there with you.
- Hurdle after hurdle.
- It's getting worse and worse.
- And I mean, yeah, our contracts were 15 years old.
I called up Blue Cross, I called up Cigna,
I called up United Health, all the biggies.
"Hey, can we renegotiate our contracts?
"We haven't had a pay increase in 15 years."
"Absolutely not, we don't even want to talk to you."
Okay, well, therapist salaries are going up,
all expenses are going up,
and what am am I supposed to do?
- Right. - Yeah.
Yeah, so I finally just got out.
- Good, good. - So, my focus...
Yeah, my focus is,
now, instead of a little brick and mortar clinic,
and this is why I developed all these home programs,
is because you don't need to go
into a clinic to solve these things.
If you just have the right information,
you can solve it yourself.
It's what the whole point of my books were about,
and it's the whole point
of my downloadable programs is that...
And the downloadable programs are so much more succinct.
I mean, I've really just given you,
like the minimum to solve everything,
and my goal is to make the world my clinic,
as opposed to just my little brick and mortar business.
- Could you name your website again?
- Yeah, it's fixingyoumethod.com,
is where you'll find all of my down loadable home programs,
and then if you type in "fixingyou," all one word,
you'll get a 20% discount on your purchase.
- Oh, great.
- Yeah, and then if you're a practitioner out there,
who wants to learn this approach to solving pain,
I have another website called healpatientsfaster.com,
and there I've created an online web training program,
and it gives 30 CEU credits.
I couldn't believe they gave me 30 CEUs.
- Oh, wow!
- Yeah, it's huge!
So 30 CEU credits for just about all states in the country,
and that's where you'll learn all of these mechanics,
and how to look, and solve pain using a system standpoint.
If you wanna look at my blog and other things,
if you go to rickolderman.com,
that also has all of these links, and my blog,
and I've got a book that I'm gonna be publishing next year,
and I have some excerpts from that book,
some chapters there, if you wanna read those.
- Yeah, awesome! - And some other free stuff
that you can get if you want.
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