Episode Eighty-Two.mp4: Audio automatically transcribed by Sonix
Episode Eighty-Two.mp4: this mp4 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Kevin:
It’s going to be a little bit of a weird podcast today. Originally, we were going to have him on with a special guest, but it looks like the special guest couldn’t quite make it. Then our plan was to have Carol join us at the end of the seminar that she’s currently doing at the moment. She was going to try and be done by the time we started this podcast, but we are absolutely running on McMakin time this afternoon. So.
Kim Pittis:
All good. We know better. We are what we call adaptable and resilient. These are all things we try to teach our young athletes. So we’re going to not just talk the talk, but walk the walk today.
Kevin:
That’s right. That’s right. We’re just going to keep it interesting.
Kim Pittis:
I always have so much to say. So I’m never concerned about me being on the spot for lack of information. So I think what I’d like to do is go through some of the questions that we’ve been getting pummeled. I can talk a little bit about clearing up some frozen shoulder things because I seem to talk about frozen shoulder all the time. I’m happy to go through a couple slides and give some updated information on that until Carol is ready for me.
Kevin:
That’s perfect.
Kim Pittis:
Does that work?
Kevin:
Yeah. No, I think because like you had mentioned before, we we keep having the questions come in, but we don’t always get to them all. So yeah, we don’t.
Kim Pittis:
And my and I have a list of things that I’d like to talk about. We never get through my list. So the list grows, the questions grow, and then we get tons of questions and answers live. We’ll be just fine. Derek says you guys will fit right in here in Hawaii. Yes. Because, like, island time is a thing. Just.
Kevin:
We’re just. Oh, wait, Is it this one? This one?
Kim Pittis:
I think it’s that. This is like I love you, which also totally works.
Kevin:
Hang loose. Love you. Right?
Kim Pittis:
You could do hang loose. And I love you all at the same time because you could do that, right?
Kevin:
This is. So you said you were going to share your screen, right?
Kim Pittis:
Yeah, I do have a couple. I do have a couple things that I would like to share my screen with Frozen shoulder because it helps and I’ll try to verbally be as clear as I can for everybody who listens on YouTube and not or listens on like the podcast versus watches on YouTube. But it just helps me stick to some sort of structure and flow. Yeah.
Kevin:
So you should be able to just hit the share screen. I think it should work.
Kim Pittis:
Okay. Let me let’s just try this. Oh yeah, there’s the share screen right there. And there’s my PowerPoint. Perfect. Okay. I’m going to just stop, though, for a second and I’ll be able to start and then you just chime in when you’re ready and I’ll just pause my chit chat. Okay. Does that sound good?
Kevin:
That sounds perfect. Okay.
Kim Pittis:
Great. Hi everybody. I’m get a ton of questions with frozen shoulder and I seem to do the same sort of talk every year or use it because frozen shoulder seems to be one of the things aside from low back pain and headaches that we see a ton of and whether or not it’s true, frozen shoulder is something I want to clarify. I do stand behind what I say on my slides and what I say publicly. I do believe frozen shoulder is a garbage can diagnosis. There. I’ve said it. I’m recorded saying it live. I just think we’re really quick to say, oh, it’s frozen shoulder. When people come in with restricted mobility in their glenohumeral joint or their scapula. And what I really want to tie in on today is that the two have to be addressed simultaneously. They both work together. They can’t function apart. So I want to drive that point across and then give you a little bit of update on some frequencies that I’ve been using and why since I started the frozen shoulder talk. That being said, I’m going to share my screen. And just so we have a little bit of structure with what I want to talk about, and I will be as clear as I can for people who don’t watch and just listen. So like I said, hopefully, you can see these slides. Let me know if you can’t and throw it in the question and answer or the chat.
Kim Pittis:
If you’re not able to see this, I’m going to try to do this here properly. Slideshow from current slide. And let’s just see if that works. Somebody let me know on the Q and A or chat if you can see my slides. Okay. Just for structure. And I’m going to go through this really quick. So somebody some people are saying on the chat looks good. Thanks, everybody. Appreciate it. Thanks, everybody. Great. Everybody can see it. Wonderful. So I’m not going to give a straight up presentation. But what I do want to do is, like I said, go through some of the things that you will be seeing, some things that maybe I’ve changed a little bit since I started doing this talk. The main thing is that we have to remember the rule of two. There are two joints, your glenohumeral joint and the Scapulothoracic joint. Okay, so that’s the first thing you need to remember here. There’s two joints that are at play and there’s two types of frozen shoulder. So in the general world, before we had FSM, I don’t think it really mattered that we were thinking about frozen shoulder as having two different types because we were treating it the same way, right? We were just trying to rip apart tissue and free up range of motion. And now that we have frequencies that we can be specific with, we want to make sure we are treating the cause of the frozen shoulder first. And then that really makes us try to remember and investigate why we have two different types.
Kim Pittis:
So the first type is what we call the primary frozen shoulder, which I think is a little bit opposite because most people don’t know about these types of frozen shoulders that they have this type of onset. So I do think that is a little controversial because there’s so many causes that are thrown at it. So things two things that could trigger primary or type one frozen shoulder are changes in the immune system, biochemical and hormonal imbalances. Diseases like diabetes, people who have diabetes actually have a three times higher risk of developing frozen shoulder syndrome. We also see cardiovascular and neurological disorders contributing to frozen shoulder. And we have to remember that sometimes we have both shoulders being quote unquote frozen at the same time, or the left will start and then very soon after, the right will start. Our secondary or type two frozen shoulder. That is what we typically think of as frozen shoulder. This is an acquired restriction of range of motion that happens from stiffness due to an injury or surgery or any type of other prolonged period of immobilization or and I want to add inactivity. People who are sedentary tend to develop frozen shoulder a little bit faster than our athletes who have their arms up and outstretched or are active people that are just using their arms in wider ranges of motion as opposed to people who are typing, playing musical instruments, cleaning, cooking, let’s just call it as it is.
Kim Pittis:
We’re all stuck on our phones, right? Everything is anterior chain shortened because we’re all flexed forward with our elbows and shoulder blades glued together. So that’s our secondary type two. Of course, we have three stages freezing, frozen and thawing. I’m not going to get into all of this. You need to know that in that freezing stage, that’s when we have pain. And fortunately, people don’t tend to seek out treatment in that freezing stage when it’s really easy or a lot easier to treat. This freezing stage can take anywhere from six weeks to nine months. So as we all know, if something is restricted for nine months, there’s definitely more and more scar tissue and adhesions building up during that time frame. The frozen stage 4 to 12 months. That’s typically when we start seeing more people, they’re getting more frustrated. We’re not seeing a real big increase in pain during this time. But what we are seeing is that restricted range of motion. So that’s what people are going to notice when they try to do those ADLs, those activities of daily living or their sports, because that’s when they are becoming more and more limited. It’s not the pain that’s driving them to treatment, it’s the restriction they can’t get the seat belt, they can’t pull their arm behind them to fasten their bra if they’re a women. So there are these restricted ranges that they’re going to start noticing are more and more frustrating.
Kim Pittis:
And then the thawing stage is when movement can actually become easier. So we do see it just starts to loosen up on its own. And when that happens, and I’ll talk about why that happens in a little bit, but that could take anywhere from 12 months to three years. So some people will come to say, Oh, I had frozen shoulder a few years ago. I had it for a year and I’ll say, What did you do to help it? And they’ll say, nothing. It just got better. And it doesn’t just leave without leaving behind some sort of footprint that it was there just so everybody is clear on that. I love researching terms and especially things that have been around for a long time, and it came across as a very cool book ages ago by Dr. Codman in 1934. And I, as far as what I could find, that was one of the first frozen shoulder type terms that we were hearing. So it’s called the shoulder rupture of the supraspinatus tendon and other lesser lesions in or about the subacromial bursa, if anybody wants to pick up a copy of that. But as far as what I could find, he Dr. CoQ10 was one of the first doctors that was starting to talk about this classic diagnostic criteria. Or maybe that was when the garbage can first started coming onto the scene because we were just looking at these idiopathic etiologies global restriction in a range or in the range of movement in the shoulder, which is so generic severe restriction of external rotation.
Kim Pittis:
Thank you for being more specific. Painful at the outset, which is meaning when there externally rotating the glenohumeral joint. There is pain typically on the anterior part of the glenohumeral joint and the X-ray findings seem to be normal. So my sticking point is that a few years later, in 1945, another doctor Navazio, comes on the scene saying there’s a term called adhesive Capsulitis and thought this had more to do with the integrity of an inflamed capsule that he thought was like sticky plaster. And then we get another doctor that comes on the scene, the guy who argued that frozen shoulder is not associated with the capsule, but more related to a synovitis and progressive contracture of the capsule. So again, if you would have given me all these little books to read and studies to read, 20 years ago, I would have been like, Yeah, it’s all the same thing. Something is stuck in the shoulder. And for the most part, as clinicians, that’s pretty much all we care about, right? Something is stuck. Something is restricting range of motion. But now that we have frequencies that are more specific, I really saw those words jump off the page and I thought, okay, there might be a different way of looking at things now. So I have these two pictures. For those of you who are listening.
Kim Pittis:
One is like a pallet with boxes that is shrink wrapped with tight plastic. And that is what I think of when I think of synovitis or capsular contracture. That is when the capsule is globally getting thick and tight and is putting pressure on the joint as opposed to the camp that was saying more adhesive adherence with layers. So we think about that as that loose plaster that is in sheets that’s easier to chip away with and dissolve. So I hope you’re getting visuals. For those of you who are listening, those of you are watching on YouTube. You can see my two slides here and hopefully the hamsters running in your brain a little bit because there’s different approaches here. So we didn’t typically care about these labels in these words, like I said. But we have frequencies depending on what camp and I’m not saying you have to choose. Are you a contractor capsule camp? Are your layers of adhesion camp because you have frequencies to try both and it works pretty quick when it is resonating with the right idea. Dr. Bunker in 2010 is another one who clearly signs on the contractor Leif. I’m not saying like I said, you have to pick a camp. These are just different ideas that you can throw out there. So really quickly, contractures are that shortening of the muscle connective tissue, tendons, ligaments and skin. I have a problem with that diagnosis, that definition as well, because as only muscle can truly shorten on its own, because it’s the only structure that has the sliding filament mechanism of actin and myosin right? Tendons and ligaments and skin can’t contract, although they can get adaptively shorter due to things.
Kim Pittis:
So I love words. I just want to be careful with what I’m saying. Fractures typically develop when normal elastic connective tissue becomes replaced with inelastic fibrotic tissue and fibrosis or fibrous is in red for a reason. To start thinking of frequencies and then are adhesion is typically what we see are those dense layers of scar tissue that are laid down in those same structures muscle connective tissue, ligaments, tendons and skin. And that will result from a self-healing mechanism. Typically when we work out, when we have exercise, we have microtrauma, right? The actin and myosin in the muscle fibers are stretched with an eccentric contraction. They’re pulling apart. And that’s what makes those little micro tears is what helps hypertrophy or for those muscle fibers to tear apart and the body goes in and rebuilds them thicker and stronger and better. And that’s how we get bigger muscles. So when our muscles and other tissues are under stress, our body fixes them by laying down scar tissue, which is strong and supportive but can have like a nasty organization sometimes with those cross-links adhesions will typically develop that way. You need to know clinically. For those of you who are listening as clinicians, that sometimes you’re going to be sent a referral and they’re going to say, I’m sending you one of my frozen shoulder patients, and I just put a big smile on my face and I say, Thank you.
Kim Pittis:
I can’t wait to see the patient that has restricted shoulder mobility. And they’re like, Yeah, it’s frozen shoulder. I’m like restricted shoulder mobility because I don’t like saying frozen shoulder. Patients come in with these labels and frozen shoulder can be very defeating to hear that slapped on a patient. So when I do get a patient that says I have frozen shoulder and I said, Well, let’s just see how restricted your shoulder mobility is. And that just seems a little bit more digestible than frozen shoulder, because when a patient gets diagnosed with frozen shoulder, the first thing they’re going to do is Google how long frozen shoulder can last, and then they’re going to see up to four years and surgery might be needed. And that’s really hard. And I don’t think we should freak anybody out unnecessarily. And for the patients that are listening, if you have been diagnosed with frozen shoulder, I do believe that some people are physicians and doctors and PTs and massage therapists. I think people are throwing that term around and I don’t want you to get defeated if you hear that, because you have restricted shoulder mobility. And I think there’s a lot of tools out there that can help. So there’s my public service announcement on that again.
Kim Pittis:
A lot of times I’m seeing an old labral tear being frozen shoulder or supraspinatus impingement being frozen shoulder. Sometimes it’s just pec, minor splinting, pec minor is this really tiny, small chest muscle that when it shortens, it causes this anterior tilt off the shoulder blade, and that can cause restricted shoulder mobility. Sometimes we have neural weaknesses due to a host of other causes that poor rhythm to happen in the shoulder. So let’s just not get caught up on labels and words. Those of you who are clinicians listening to the podcast are watching, sometimes you won’t get the diagnosis that or the label that’s coming in, but what you will hear is I can’t sleep on my side, I can’t reach and put my coat back on or fasten my bra or reach the seatbelt or wipe my bum. That was one that was not external rotation, but more internal rotation, but still downward rotation of the scapula. So I added that one on because it definitely was restricted shoulder mobility. We need to really like with anything else that we do with FSM, we need to go back, way back in that history and not just ask about their pain today and how long the onset is like really go back because that will help decipher where you’re going to start with your frequencies and your treatment strategy. So like I said back 20 years ago, I didn’t care about what the onset was because I was just treating the tight shoulder that was in front of me.
Kim Pittis:
And yes, we do have to address that. But to really dial in no pun intended, where we need to start, we need to ask those questions. I say disease versus musculoskeletal, but that’s that type one onset versus type two onset. That primary type one or the disease component. Like I said, we’re going to check the history for immune system problems, biomechanical imbalances, hormonal imbalances, diabetes, cardiovascular neurological disorders. And then my big thing is somebody seeing infection, stress and trauma. Why do we need to ask these questions, even if that’s really not in your scope of practice to treat biomechanical or biochemical or hormonal imbalances? We have frequencies for the Vagus, right? And that’s what’s happening when we have any of these infections, any of these stresses or any of these traumas. Like I said, you will now have a little bit of a clearer path as to where do you want to start? Viral onset. Okay. Maybe there was shingles. Maybe there was something else at play. The emotional factors, the autoimmune frequencies that we can use, diabetes. Diabetics will have a history. The emotional factors to just go back to that really quick, I have concussion on here, PTSD, some of the 9 70s. I can’t tell you how interesting it was 15 years ago when I was seeing a whole bunch of frozen shoulder patients when I was not using FSM or just getting into it.
Kim Pittis:
And there was this group of women who were like empty nesters with or with frozen shoulder. And I wish I could go back in time like we all talk about and say, okay, I have these frequencies, I know what’s going on, the stress of everybody being gone and all your kids being out and now you’re left and who knows what other kind of stresses were involved. So you might see like a chunk of a demographic that kind of fits this bubble. And Dr. McMakin always talks about pattern recognition. So sometimes I’ll go back in that way and say, What else was going on in your life? Even if I’m pretty sure it had to do with a injury like what we’re talking about here. There could also be another component at play. And that’s especially true when you think you have a type one or type two frozen shoulder and then the lines are blurred. So maybe your the patient is pretty sure. Yes, I stopped moving my shoulder when I had this car accident or I fell off a mountain or I ran into a tree skiing. And then you start talking about them and say, Oh, yeah, but I was also going through a divorce and my child just got diagnosed with ADHD, and we don’t know what’s going on, blah, blah, blah. So ask those questions. Like I said, we want to confirm if it’s frozen shoulder or just the silly little muscle imbalance that might be really easy to fix.
Kim Pittis:
We rely on the intake and the history, but we also have to rely on our own assessment. So I hope everybody is still doing their assessment, even though patients are coming in with, Oh, I’m restricted in this and this, you need to make sure you’re seeing it for your own eyes and charting it, because that’s how we know the frequencies are working is when a patient comes in and they can only abduct 20 degrees. And when they leave their 180 degrees or 90 degrees or whatever degrees. So make sure we’re charting range of motion as much as possible. Like I said, we have two different joints when we’re talking about anything to do with the shoulder, that is the glenohumeral joint, which is how the humerus articulates in the fossa, right? That is what people will typically think of as the shoulder. They will point to their shoulder bone and say, My frozen shoulder hurts and it hurts right here. And they’ll point to the deltoid attachment or the bicipital groove. They’ll point to the supraspinatus or the anterior delt. They’ll point to the anterolateral part of the shoulder typically, But I will always stand behind them and see what’s going on at the scapula first. So the more important joint, in my opinion, is the scapulothoracic articulation. That is how the scapula or your shoulder blade articulates on your rib cage. And when you move your shoulders up and down like I’m doing right now, those of you listening, I’m just looking like a chicken.
Kim Pittis:
I’m just abducting my elbows, lifting my elbows up towards the ceiling for every 2 to 3 degrees that my shoulder bone, my arm bone can move up. My shoulder blade has to move up one degree. This is what’s called scapulothoracic rhythm. Okay. So if the shoulder blade, if the scapula is stuck, is if that is adhered down to the rib cage, there is no biomechanical chance that your humerus, your arm bone is going to be able to lift up or lift up freely without so much strain and work with the shoulder muscles, with the rotator cuff. If there’s anything that you remember me saying today, it’s the scapula thoracic rhythm. And I say 3 to 1. I’ve seen it written as a 2 to 1 ratio. I’ve also seen it written as a 4 to 1 ratio. I don’t get caught up on that so much. What you need to get caught up on is for every few degrees that humerus can move, the shoulder blade has to move and that is where the restrictions will start. The supraspinatus doesn’t get impinged from outer space. The mechanics of the way the humerus articulates and the glenoid fossa has to do with the way that shoulder blade is allowing that arm to move. And if those of you who are watching on YouTube have this really great split screen slide by or side by side slide that shows that the upward rotation that needs to happen with the scapula for that shoulder to abduct.
Kim Pittis:
So hopefully that gives you a bit of a visual. And those of you who are listening, take my word for it. Maybe go back and watch it just so you can see the slide. So like I said, hopefully you’re doing your own range of motion assessment to just document what you are seeing and feeling with the humerus going and with the scapula the way it’s articulating on the rib cage. We want to make sure we’re noticing crepitus grinding crunches, pain. What is the end feel look like? Is it a bony block or do you think that if you passively did it, you could get a bit more range because that shoulder blade could float a bit more? I like to stand behind the patient because I can monitor what’s happening with the arm, with the joint, and I can monitor what’s happening with the scapula. So a lot of times I’ll just stand with my hands really close to their scapulas just so I can see are their scapulas upwardly rotating nice and sometimes they’ll get the end part looks the same. Their arms will get to the same point up overhead. But it’s the quality of movement. How do they get there? Sometimes the right will float up really freely and the left, they have to do all these. Compensatory movements to get their arm up overhead, or sometimes they’re sticking their head out.
Kim Pittis:
So do a 360 when you’re evaluating these patients, because from the front might be a little bit different than what the back. Again, going into these three stages, if you are a patient that’s in pain and you are seeking help during this freezing stage, I’m hoping that your therapist is saying, I have to get your pain down and if you are the therapist, I hope you’re thinking I have to get their pain down. Yes, they’re going to be restricted and you’re going to want to dig in there, but the pain has to come down first. The pain doesn’t come down. If I’m a patient and I’m paying somebody money and I’m taking time out of my day, I want to leave with a reduction in pain. And if you’re a therapist, you want to have that patient’s pain level down because you’re a wonderful person that cares so much about your patients. But B, when a patient isn’t in pain, the tissue just relaxes, right? Like you’re able to get in so much more freely when there’s not splinting or guarding and the patient is relaxed and you can just sink into the tissue. So public enemy number one during freezing stage is getting the pain down. So usually in my world that means treating the nerve for inflammation or scarring. Right? 40 or 13 on 3 96 for the nerve. And then you’re also thinking about what the nervous system is doing. Could that mean running concussion or the emotional frequencies? Maybe you need something big like PTSD, maybe 40 and 80 9 needs to be running, so something on the background to help the pain.
Kim Pittis:
And during that freezing stage, frozen stage, same thing. We need to work on keeping the pain down. But now we can really have fun with mobility. Focus on freeing up the range of motion a bit more. Removing that pathology. Is it scarring? Is it 13? Is it fibrosis? Is it 51? We can get in a little bit more aggressively that way and then thawing. Hopefully the pain is still staying down. The range of motion is freeing up. But one of the big components during that thawing stage is the repatterning that has to happen. I don’t know about you, but if I haven’t moved my arm in a year or two or longer, I’m probably not bouncing back with strength and good function the way I was before it was frozen. So I think we need to really focus on making sure that the range of motion stays strong and that there hasn’t been a lot of compensation that took place that you may need to go back in and figure out how abduction needs to work. Sometimes that means learning how to throw a ball differently or doing overhead work differently. So there’s a lot you can do by increasing the range of motion, by using 81 and 49, increasing the secretions and the vitality to the area and using that with appropriate exercise.
Kim Pittis:
So these are just all your channels. We’ll have all this stuff for you guys to look at. I’m not going to ramble them on and on, but removing the pathology, right? So thinking about virus infection, parasite, I like to use the basics. There’s also malignant virus, general toxins, organic toxins, Lyme mold. Dr. Sosnovske could be so proud of me for throwing those two in there. And so that would be my starting point if I knew I had a patient whose onset talked about all of these areas as I was treating the tissue. I’m very hands-on all the time. So even when I’m doing all my manual therapy treatments, I’m still not letting them sit in with these frequencies. I’m seeing what the tissue is doing underneath my hands. And then in that second type, again, thinking about the basics, trauma, paralysis and allergy, the frozen shoulder came from somewhere. There is something that triggered this. So I do start with the basics all the time. And then if we’re thinking it’s that fibrotic area. So that capsule is like tightening and getting short and I’m thinking about 51in the capsule. If I’m thinking it’s more adhesions, I’m going to start with 13. After a certain amount of time, it’s probably getting hard. So I’m going to use 91 mineral deposits. How long has it been there? So you have lots of options. Torn and broken has a star there because that is time-dependent.
Kim Pittis:
If I know it’s from an injury where the shoulder was maybe dislocated, separated, there’s some sort of big trauma there. I know those fibers were initially torn before everything got clumped together again, hypoxia. This is where I started falling in love with the frequency because. As a manual therapist. One of my favorite techniques that I learned was ischemic compression. What is ischemic compression? You are. I’m going to just use my thumb on my forearm here for a visual, but I’m going to press down on the muscle with my thumb. What am I doing? I’m occluding blood flow to the area while putting pressure maybe on a trigger point. Right. So mechanically I’m occluding blood. And what happens when I remove my thumb after this compression? When we get this reflexive hyperemia, we get all this blood flow that goes through the area and oh, it feels so good. So I think of the hypoxia frequency like a giant ischemic compression after you’ve removed the pressure because we when something is restricted, it’s not getting proper blood flow right? So we can promote that with that frequency regardless of age or type one versus type two, We’re treating the shoulder. So your big heavy hitters for where your b-channels are going to want to go, nerve joint capsule, connective tissue, fascia sheath or fascia one 40 two muscle I use 62 and 46 sarco something ligaments, tendons, adipose periosteum. Those are the big ones that I typically hone in on.
Kim Pittis:
If we’re thinking.
Kim Pittis:
Of another type of onset where it’s like disease or autoimmune modulated, maybe we’re thinking thyroid immune system. If there was a cardiovascular component, neurological component, concussion component, so many options on that side. So this was just about hyperemia. I do love I love it so much. It gets a superhero caption to it because it changed a lot as far as set up. Again, a ton of options treating supine. We typically have something around the neck, a towel. I will have things in through the axilla and up onto the anterior chest because I want to treat pec minor typically. Those of you who are watching on YouTube, I typically like more of that top picture where you can see things around the neck, along the thoracic cage and in through the axilla. That’s typically my go to.
Kim Pittis:
You can also treat somebody prone. That’s fine too. Or lateral recumbent. My patients are going to get all three scenarios. As far as adhesions go, I do love 13 and 77 that is like that religious experience. So if you are believing that you are dealing with adhesions in the connective tissue, we’re probably going to start 13 and 77. We love 13 and 77 together, just like we love 3 and 97 sclerosis in the Adipose. So those two seem to work really well when it’s just straight up adhesions. 51 on a 480 on B fibrosis in the capsule. So if you’re thinking the capsule is more of that shrink wrapped scenario, I really love 51 and 480 in that case. Subscap. Of course, that is our public enemy number one. When we want to go and release, everything immediately rotates the humerus. It abducts the humerus. So when we are hurt, we are bringing that arm in and keeping it close. So it is a huge component, is a huge contributing factor to restricted range of motion in the shoulder. The other thing that mimics frozen shoulder said are labral tears. So when there is a tear in the labrum, we’re going to shut down the range of motion to the shoulder. So we want to talk about how old is it? Were there pain restrictions, limits, fear of movement? Because when you tear your labrum, it hurts. So when we have an onset of frozen shoulder coming from something they can’t remember and they’re like, Oh yeah, I had that labral tear.
Kim Pittis:
I’m like, Huh? So I’m going to start with 124 because it was torn and broken first before it was restricted. So old Teres like I said, like the active, passive and resistant range of motion in the Scapulothoracic and the Glenohumeral are going to dictate where to start. So compromised glenohumeral range of motion will translate into that adhered restricted scapulothoracic range of motion which further impedes glenohumeral range of motion. So we start this like loop of who’s on first, who’s on second, and they’re both feeding each other. So we really want to get in and treat the Subscap, the serratus, all of those muscles deep within the axilla. On that new sort of side. Bankart lesions affect the glenoid fossa on the scapular side. Hill-sachs lesions result in damage to the head of the humerus. Those of you who have treated folks that have had shoulder dislocations, you might see both of these in a single injury. And when you have an acute dislocation, you’re going to get immediate shutdown to the scapulothoracic function. Right? They are going to want to keep that arm tight and close. And it doesn’t take long for restricted ranges and adhesions to develop in that scapulothoracic junction. So in this case, you want to go back and think about, okay, I have a frequency for periosteum and if there’s damage to the head of the humerus that we see in a hill-sachs lesion, that can be very helpful.
Kim Pittis:
So don’t forget the periosteum in that case. So obviously new Teres 124 124 124 And then stop the bleeding. Stop the trauma, stop the paralysis, stop the allergy reaction. So going back and doing the basics in that scenario. 9 970 has a question mark. It actually should have an exclamation point because there is always going to be a emotional component to an acute injury, especially such as a shoulder dislocation. Location of the pathology obviously dictates where you’re going to think about those B-channels So 77 is connective tissue, which is like the gold standard, like where to start, Like super easy in that case. 214 is a frequency I didn’t love and I use it because I can’t not use it because it does work in a lot of cases. So I’ll use it for labrum and meniscus, but I’ll never start with 214. Personally, I’ll always start with 783 sort of frequencies. In my opinion, that one is like my plan B 480 for capsule 783 periosteum 157 Joint surface cartilage 191 tendon 100 ligament 195 bursa. Lots of options for you to use again. 124 in the acute phase non-stop if possible, have it on loop. That just means having it on loop in my opinion is I would prefer to make shorter programs the patient can put, start and stop as opposed to building a three-hour program because when somebody sees a program is three hours, they get this kind of look of panic.
Kim Pittis:
I can’t sit still for three hours. I’m like, okay, I’ll make it for half an hour and you can run it as much as possible. Oh, that’s great. And then the next day I’ll say, How often did you run the program? Oh, I had it on for 4 or 5 hours. I’m like, Oh, that’s fantastic. So in my opinion, building smaller programs is a little bit more beneficial for patient compliance and adherence. Yes. Incorporate METH. You read that right? We’re not telling people to do methamphetamines. This is an acronym for Movement Elevation Traction and Heat. This is the acronym that we’re seeing a lot with professional sports, a lot of new great data. You can Google METH and see some really neat studies on it right now. And METH is it’s written as movement elevation traction and heat. But I’m going to explain it in a second because you’re going to move those acronyms around. Movement Move, Move is good. Elevation Elevate. That’s old school. Keep it above the level of the heart. Right. To help slow. Traction. Traction can be funny, so this can be therapists applied traction, but you can also traction joints yourself just by the way you are positioned, right. Keeping a joint open.
Kim Pittis:
Keeping a joint like hanging as long as it’s pain free and heat. We want to be starting to apply deep moist heat proximal to the muscle belly, promoting an increase in circulation 10 delivering much needed macrophages, which are our body’s cleanup crew. And that helps prevent action of the surrounding muscles. When something is cold, they’re going to contract and splint. That’s the last thing we want. We want to bring good blood flow to the area. So after the patient has applied heat, we want to move it again to help use that skeletal muscle pump to bring that inflammation back into circulation and help vacate the debris. I hope that makes sense. So movement, elevation traction and heat could probably be. Some elevate traction, heat and then move, right? So we want to keep people moving as much as possible. This is not rocket science. This is not new. We’re seeing much fewer people getting immobilized than ever before. We know the benefits in keeping a joint moving as much as possible. Just think about all the changes. Post-surgical. We’re not putting people in casts and laying them in bed for days upon end. We’re getting people up, moving. We want to promote that as much as possible. When it comes to the shoulder, proprioception is key for recovery. There is so much proprioceptive feedback that needs to happen in both the scapulothoracic and glenohumeral articulations to help develop strength and stability.
Kim Pittis:
We need our shoulder blades retracted and depressed. We’re never retracted and depressed. We are retracted, upwardly rotated and elevated at all times because we’re on the computer. We’re cooking, we’re driving, we’re holding babies. We’re everything is in front of us. Proprioception exercises are really important in any stage of healing to help stabilize get muscles firing that have been shut down or impeded because of restriction. And it’s going to help improve the overall coordination. These slides are like my starting point, these pictures. So I love using balls, squishy balls for any stage of healing. Just having a patient walk their hand up the wall with a ball as opposed to just walking their fingers, Just thinking about manipulating something that’s round and is unstable gives a lot more feedback than just walking their fingers up the wall, having kids. Maybe kids aren’t having frozen shoulder, but restricted range of motion having their arms up overhead. A ball is fun to play with. Okay, so instead of just hands on hands or a bar, I’m going to try to use a ball as much as possible. And then there’s so many progressions that you can make. And because you are amazing patients, you’re listening to your therapist and because you’re amazing therapist, you’re listening to your patients. So everybody’s improving really fast. So there’s a lot of ideas you can get on the internet. I’m happy to share all the stuff that I do together.
Kim Pittis:
Hands up, instability, wobble boards, push ups are great to do because you have to develop co-contraction. But why not do a push up with a ball? You don’t need to be using full body weight even at any stage. We want to develop instability and co-contraction and good proprioceptive feedback. So unstable surfaces, right? Our world is an unstable surface. So all the athletes that I work with, I’m always trying to incorporate single leg unstable work and they’re like, Kim, why are we doing this? I’m like, Because when in your sport, are you ever standing completely still on both legs? I don’t know one sport that you’re statically just standing there watching somebody. I’m always trying to incorporate activities of daily living or sport into all the stages of rehab and especially with the shoulder. My slides are stuck. All right. So here are some other pictures of just some of the athletes that I work with using unstable surfaces. So whether it’s a shoulder separation, an AC fracture, clavicle fracture, even lower body stuff. But since this is a shoulder talk. Oh, Carol is back. Hello. You’re muted. I’m going to stop sharing because I was almost at the end anyways, so I’m just talking about all the fun that we do with movement and using FSM with movement and all the stuff. And look at that. I was just done. It’s like we planned it like this.
Dr. McMakin:
I know. We almost did. I’m going to stop sharing.
Kim Pittis:
Are you having fun over there?
Dr. McMakin:
Oh, we did. We’ve I believe it or not, Kevin woke me up at 9:00 this morning. I overslept. I set my for 715. I slept through two alarms. The hotel calling me twice. Kevin calling me twice. And then he came and knocked on the door at 9:00. So we just finished the practicum, and everybody’s having a good time. And we have an Ehlers-Danlos patient that is adorable and didn’t know that she had Ehlers-Danlos until like today she did because her mom said, We have Ehlers-Danlos in the family and mom’s finger goes to 90 and the girl’s finger goes to 90 and her thumb goes to her elbow and this goes to five inches and our elbows go ten degrees backwards and she’s got 9 out of 9 Beighton points. So I’m going to do treating her in real time with four machines. But and she’s dressed and ready to go so I can dry lab it and do the setup and talk through it. If you have time. Do you have a hard stop at 4:00?
Kim Pittis:
Lois But you’re connected so I can jump out.
Dr. McMakin:
Okay. I can keep going, I guess. I’m sorry. I got to see part of you. I came out and I saw you doing. I love that 880 and 7.4 with the Superman and the spinning words. It’s I. I’m so jealous. You’re so good at that.
Kim Pittis:
I just have a little bit more time for slides. It’s less content, more fun When I speak so good.
Dr. McMakin:
I have to be all content because people have to go back and look over them 27 times. Yes. At least that’s what I think. I might be wrong.
Kim Pittis:
No. Good for you. Another fire hose of info cam. Thanks, Leif. I appreciate that. Oh, thanks, Jane. I appreciate it, guys. It was funny.
Dr. McMakin:
A couple of slides and it was fabulous.
Kim Pittis:
I love if I could be a professional power pointer. I’m going to try to do that because I do love making especially this fun stuff. But I do have before I leave and before you do the practicum, if we can really quickly hit two questions that have been flooding me, if that’s okay while you’re here, because I didn’t want to tackle this by myself. Okay, Let me pull it up. We have a and the person might be listening to practitioner slash patient who is getting an ACDF. So an anterior cervical discectomy plus fusion and has a CustomCare or has devices and is able to use their device in PACU. So has it all organized?
Dr. McMakin:
Oh, so that’s what we did when we did. My surgery was set up the pads in pacu anterior posterior. So there is a post-op C-spine. And great. Yeah. Already in the mood bank. That’s fine. And the thing I underestimated when I wrote it was. The shape of the cervical spine is created by the fact that the discs are wedge shaped. They’re wider in the front than they are in the back. So the curve in the spine is set up by the discs. Shape of the discs. By the time you need an anterior fusion, your discs are rectangular and your neck is straight. So when they put in a wedge shaped insert. It restores the curve and it jams your facets so you have some soft tissue annoyance. The scarring in the Vagus is not going to show up for 5 or 6 weeks. And it’s a combination of the soft tissue, the esophagus, because you’re intubated and have to move it aside. So you have trauma and torn and broken in the esophagus. The facets are more than annoyed. So it’s acute facets, acute esophagus. And if you look at the other anterior tissues, you’ve got the they avoid the jugular and the carotid. If they’re and they’re good at entering. Fusions are easy. Like they’re just not a big drama usually and. That’s it. So you treat the bone because. And the bone marrow because the spinal segments have marrow in them. So the marrow is going to bleed. It’s going to get inflamed. Most of the implants now are titanium. If she negotiated with her surgeon, I’m going to guess she negotiated titanium with him.
Kim Pittis:
Yes.
Dr. McMakin:
Yes. So there’s 3% chance of allergy reaction with titanium. So that should be okay.
Kim Pittis:
And I want to say the patient has an issue with adhesive, but I think the sticky pads are okay with them.
Dr. McMakin:
Yeah though we have hypoallergenic. Our two by two sticky pads are hypoallergenic. That’s what I thought. Okay. They’re carbon based, not fabric based, so they tend to do better. Yeah. Yeah.
Kim Pittis:
Perfect. And then the next question is you got this one also from Kevin. I thought since we’re doing a little bit of neck work, we would throw it in today. There’s a next I’m going to quote the question. There’s a next specialist who promotes proloed therapy for tightening C1 C2 ligament laxity, the kind exacerbated by looking down at devices.
Dr. McMakin:
Just wondering the time that’s exacerbated by what?
Kim Pittis:
Looking down at devices.
Dr. McMakin:
What he wants to do. Prolotherapy at the occiput C1 and C2.
Kim Pittis:
I’m just reading the question. Yes, it just says okay. It’s not my diagnosis.
Kevin:
Emailed in so I don’t think.
Dr. McMakin:
Emailed in.
Kim Pittis:
Yeah, Kevin sent it. I thought this would be good for the next segment. Question is wondering about your thoughts on this versus FSM versus physical therapy slash changing habits. Like I was just saying, with frozen shoulder and how everybody just says frozen shoulder, frozen shoulder. We all have this posture right now because everything is anterior chain dominant. So if we just start shooting everything up, that’s LOX because it’s lengthened. I don’t know. I think we’re shooting everything up on the posterior chain then, because, yeah.
Dr. McMakin:
There’s a problem with the upper cervical spine that is not a problem with the shoulder and that is the Medulla. And the brainstem does not exist in the shoulder. No. And the occiput C1 and the occiput and C1 were the problematic ligaments are. At the brain stem. They’re like, where does he propose you’re going to put the needle? I would ask him that. That’s that would be a reasonable clarification. So getting anybody to even consider surgery or any you can’t proloed C1 C2. You just can’t because the goo you put in there. To create scar tissue. You haven’t got any place except maybe the dura, if you’re lucky. To keep it where you want it. It’s like the brain stem is literally a millimeter or two millimeters away. From the alar and posterior C-spine ligaments. That’s the thing, right? Yeah. So I wouldn’t be a fan. I wouldn’t let anybody do it to me. So there’s that. Yeah.
Kim Pittis:
That’s. I know nothing about this. So I always love to exhaust therapy and exercise rehabilitation first. And then when that doesn’t work, then maybe. But if somebody’s positionally has ligature laxity from just, you know, work being like in front of a screen or being down on a device, how about we try exercises first? Is that the.
Dr. McMakin:
First? And I’d be willing to bet that it didn’t start with the screens that someplace in the woodpile there’s an auto accident or some sort of. Sure. Yeah. Because there is creep. You can creep the Ligamentous. But most people don’t look down at their phone 18 hours in a day. That’s true. They’re up and they’re down and they’re around. And at this point, the cell phones make everybody so they hardly do anything for more than two minutes at a time. This is true. So maybe so I’d be interested to see if anybody is doing that, because it doesn’t make a lot of sense to me.
Speaker5:
Yeah.
Kim Pittis:
I haven’t seen anybody with Proloed in their neck. Okay.
Dr. McMakin:
If you haven’t seen it, then you’re more likely to see it than I am.
Kim Pittis:
My question. So anyways, thank you. You know, I’m glad we made it work for a little bit. Although I do love talking about the shoulder. I can do that every day.
Dr. McMakin:
I can see that. That was good. You only thought you couldn’t fill a whole hour by yourself.
Kim Pittis:
I know. I kept looking at the time and I’m like, I’m just going to keep I’m going to keep going down this train. There you go. There’s nobody derailing me today.
Dr. McMakin:
No.
Kim Pittis:
But let’s see your practicum and I’ll jump out when I can.
Dr. McMakin:
I’m going to let Kevin. Matt, which one do I pick up?
Kevin:
You don’t have to do anything. I’m going to follow you with the iPad. It’s like.
Kim Pittis:
Live cam.
Speaker5:
So.
Kim Pittis:
I’m before I forget. Thanks, everybody, for sitting with me for all that time listening to my shoulder talk. I’m always happy to share the new stuff with you guys. So thanks for listening.
Kevin:
The Frequency Specific Microcurrent podcast has been produced by Frequency Specific Seminars for entertainment, educational and information purposes only. The information and opinion provided in the podcast are not medical advice. Do not create any type of doctor patient relationship and unless expressly stated, do not reflect the opinions of its affiliates, subsidiaries or sponsors or the host or any of the podcast guests or affiliated professional organizations. No person should act or refrain from acting on the basis of the content provided in any podcast without first seeking appropriate medical advice and counseling. No information provided in any podcast should be used as a substitute for personalized medical advice and counseling. Fss expressly disclaims any and all liability relating to any actions taken or not taken based on or any contents of this podcast.
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