The below is an auto-generated transcription from the podcast. Please excuse typos and grammatical errors.
Charlie McDermott 00:00
This is the Bridging the Gap Physical Therapy podcast keeping you active and pain free. Hey there, Charlie McDermott, co-host of the podcast and good, good news as always, I have Dr. David Lee with me today. Dr. Lee, how you doing?
Dr. David Lee 00:15
I’m doing well. Thank you for having me, Charlie.
Charlie McDermott 00:18
Well, thank you for being a part of your show. But more importantly, thank you for helping and I know I’ve shared this before in a previous episode, but you know what you’ve done and off camera, you just saw Barb, here a few minutes ago, and she was showing you her range of motion, and she is back to normal and she had a major, major shoulder issue that you fix, man. I, again, because we’ve talked about this, I just want to share in case anyone missed a prior episode, but I kind of shook my head when we decided to head in your direction. It was kind of like, you know what the heck, but because I had rotator cuff surgery, and she seemed to have the same symptoms. I said, hey, you know, absolutely, let’s David have a crack at it. If anybody can, can help you. It’s him. But I was also going yet, but I know, in a few months, you’re going to be on the surgeon’s table, because there’s just no way. Man, you work miracles. So, I’m going to turn the stage over to you and let’s get into shoulders because I know obviously, Barb and I are not the only ones experiencing those types of troubles.
Dr. David Lee 01:31
Right! No, I was actually that was awesome to see Barb and her showing off her shoulder to me. Like perfect timing too.
Charlie McDermott 01:43
You really talk about today. Well, we hope the universe cooperates again.
Dr. David Lee 01:51
I mean, shoulder pain is definitely something that, you know, probably most of us go through at least once in our lives. You know, it’s a very, it’s quite a second most prevalent diagnosis that we see in our clinic, first being low back pain and the reason why shoulder pain is so prevalent is because it’s a very sloppy joint. I call it sloppy joint. Yeah, it’s like a golf ball on a golf tee. So, I know you guys can picture a golf ball on a golf tee, it’s not very stable. If you just move it a little bit this way or a little bit that way, you know it can fall. Same thing with the shoulder is that it we call it a ball and socket joint. Basically, there’s some what we call inherent stability that’s from the labrum, I’m sure you’ve heard of that. Some ligaments, and tendons, which are actually the end of the muscles. So, those are kind of things that hold it in place without the muscle actions holding it together. So, that’s one of the reasons why it’s a very common diagnosis and if you don’t know how to use your shoulder correctly, meaning having balanced in the shoulder, so front, back side to side, all those muscles have to kick in, then what happens is that you can have an issue. You can have an overuse injury. You can have tendinitis. You can have arthritis. You can have label tears. You can have bursitis. You can have frozen shoulder. See, these are all different diagnosis of the shoulder that kind of get wrapped up into, oh, I have a rotator cuff injury or oh, I have impingement, which it kind of gets a little bit deeper than that a lot of times so,
Charlie McDermott 03:38
So, much that can go wrong. I mean, how do you even begin to figure out what the issue is or is it more you mentioned, you know, the, what was it alignment? Or how you engage the joint? I mean, how all do you kind of figure it out?
Dr. David Lee 03:54
Yeah, it’s a great question and what we do here is we just evaluate everything. So, it’s a combination of what the patient tells me and then me listening to them and then going in and doing motion testing, strength testing, functional movement testing to see exactly where this is coming from, because it can come from a lot of different areas, it can come from the shoulder itself and or it can also come from the neck, the thoracic spine, which is the upper back and then it can also come from like the low back the hips as well too due to compensatory, you know, issues that we have as well. So, you know, with posture and things like that, that’s why it’s important because if we can get into a better called biomechanical position, not just like being upright, because when people get upright, they just kind of like fling their body back and arched their low back, which isn’t the right position, right? So, it’s a biomechanical position, meaning learning how to actually move through certain parts of your body correctly and actually what I go into is actually firing the muscle to keep you in that position. So, you have inherent stability so that you’re protecting your joints, as opposed to putting damage on them.
Charlie McDermott 05:17
Love it. So, you’re like, an investigator, right? I mean, it’s not like, you know, putting everyone in a box and going out with this is what we do for shoulder pain, and everybody gets the same treatment me you spend, and again, just going off of what Barb shared with me, because I wasn’t there for the treatments. But, you know, every time she came back, you know, it was like fascinating to hear some of the things you did to help figure out what was going on and more importantly, how to get her out of pain, because she was in a lot of pain, I mean, was infecting her sleep. She couldn’t even buckle your seatbelt. You know, she’s very active and teaches a group X class on a regular basis. I mean, it was really impinging upon her quality of life, and you were able to, again, dial it into, okay, here’s the issue, and here’s how we fix it.
Dr. David Lee 06:09
Right! And that’s the thing is, to get someone I always say, to get someone out of pain immediately is it’s not that hard. Because you can do some soft tissue techniques. You can do some joint mobilization techniques. You can do, like some basic strengthening, and a lot of times people feel better. It’s basically preventing the pain from coming back. That’s the hardest part that we have to take into account here because what I’ll do is, a lot of times, if I know what the issue is, I’ll treat it and then the patients will immediately respond to it, they Oh, yeah, I feel a lot better and then what happens is that you resume daily life, and you’re not aware of what’s going on with your body and a lot of times you can damage it again. So, what I try to do is I try to install knowledge and people and awareness so that we can prevent re aggravation, so that we can keep getting better because I know it’s like anybody if you feel okay, one day, and then if you have pain, the next day, you feel like, oh, I’m not getting any better at all, when that far from the truth is just the process that you have to go through, there always are going to be flare ups. You just need to know what to do when there is a flare up. So, that’s what I try to install in my patients is a higher level of knowledge, so that you know what to do so that you don’t freak out and be like, oh, wow, my shoulder is not getting better. I need surgery. I need to have a steroid shot. I need to have some kind of more invasive procedure, that a lot of times it doesn’t require.
Charlie McDermott 08:03
And which is also again, and I’m going back and our mindset why Barb went to you because I know, I’m trying to be politically correct here. But you know, back in Pennsylvania, if we had gone to a medical doctor, typically, and I know everyone’s different, and I love docs and all that. But I think cortisone would have been a very quick, you know, air quotes solution for Barb that wouldn’t have really addressed any of the really the core issue of what’s going on and it would have been temporary and maybe gotten her, like you said, gotten her out of pain. But then what happens when it comes back, you know, it’s just like that, right, that cycle thing over and over again until yeah, you know, she probably would have ended up on the surgeon’s table at some point, because you probably get fed up with it after a while and is just like, just got me open doc, you know, or put the scope in.
Dr. David Lee 08:56
Right! It’s crazy, because you know, I’ve treated and I’ve treated people with chronic shoulder pain, you know, more than, oh, chronic is actually classified as more than a month of pain. So, if the pain doesn’t go away for months, its chronic, but what happens is that, you know, some of these people have been treating, and they’ve been having pain for about 20, 30, 40, 50 years, it’s crazy. Like they just deal with it because they don’t know what to do, or they’ve gone to surgical intervention, and that hasn’t helped them. It’s actually made them worse in certain some circumstances because now you’re adding more damage and scar tissue to the area and if you’re not strengthening correctly, if you’re not moving the shoulder correctly, you know, that can actually make it worse over time. So, you know, I always say the body has an incredible ability to heal itself as long as you let it. So, there’s been, you know, research articles done and experiments done with. There’s one in particular that I want to mention to you is a person with hip degeneration, okay, something that you would probably go and get a total hip replacement with. Basically, they had degeneration on one part of the joint so that if you can picture a ball and socket joint, just like the shoulder, basically, the femur is the ball, it goes into the hip socket. So, the part that it’s basically going into that joint and the bones are touching, or bones are meeting together, that cartilage wears down.
So, that’s what we call it degeneration when the cartilage wears down and then you start getting like called bone on bone, basically, that’s arthritis, right? That can cause inflammation that can cause pain. So, what happens is that there’s evidence of degeneration in disguise hip, but what they did is they just surgically rotated the hips so that there wasn’t any degeneration, touching on those joint surfaces, right? So, they did that for I believe it was two months, don’t quote me on that timeframe, but I believe it was about two months and what happens that they did another imaging test and basically, they saw that part that was degenerative, they saw that coming back. So, basically, the cartilage regroups. So, what does that say? That saying that your body can actually heal if you take the stress off of it. So, that’s the biggest thing is like, you have to be able to take the stress off of it. So, if I have shoulder pain, and lifting my arm up overhead keeps on hurting my shoulder, right? Well, what do you got to do? You got to stop lifting your arm up, so that it can actually you know, rest, and recover, right? If push-ups hurt my shoulder, I can’t keep doing push-ups, or I’m not gonna give my body a chance to recover, you know? So that’s what I deal with too, because a lot of people love to do what they want to do.
Like, they love their working out, they love their golf, they love their activities but what happens is that sometimes we have to modify a little bit and you know, I’m not saying don’t be active, because I’m a huge proponent of being active. I am always active and if I have an issue, I’ll modify myself too. But we need to make sure that we’re taking some of the stress off of that area, either modify, you know, go lighter, go slower, do less volume, you know, something like that, where we can actually work different body parts, and different motions, and then we can take the stress off there and let it heal and then amazingly enough, the patients come in for the next visit. They’re like, oh, wow, I actually feel a lot better. Okay, well, I didn’t really do much to you, it’s just, you just took the stress off the area, now we can actually get into things because you’re not so flared up and you don’t feel like you need pain meds, you don’t feel like you need a shot. So, now let’s just go ahead and do what we need to do now and you know, create a lot of awareness, build strength, build that motion up, build all the stability in the body, improve your posture, you know, all these things, we need to incorporate all these things into the program, so that we can maximize and optimize how you get better, and how fast you get better.
Charlie McDermott 13:27
Wow. So, yeah, the body is an incredible healing machine and what you really do in your modest way is, is open that door, to allow the body to heal and help educate your patients. So, they understand how the body works. Yeah, wow.
Dr. David Lee 13:47
That’s a huge component because, you know, a lot of people we’re not we’re not born with awareness. We’re not born with, you know, how you should position your arm overhead. We’re not born with that kind of stuff. You know, this is kind of this is higher level stuff. This is like things that you have to actually study, go to school experiment, know how it feels, all those things to actually teach somebody. So, you know, I tried to instill all that knowledge in people because I want you to be able to take that home with you and you be you to problem solve and figure things out. So, that when a situation arises, and you’re like, oh, I have pain. Well, don’t just get into the pain be like, okay, well, make sure Okay, I gotta make sure I’m good position. I got to make sure I’m using some muscles. Let me get some of these other muscles working. So, it helps me out. You know, all those things because we’re not born with awareness and once we do one exercise in a position, if we do another position, a lot of times you’re like, well, what the heck’s going on? I don’t know how to do in this position. So, you know, you have to know how to how it feels you have to know you know, you have to get that what I call brain to muscle awareness, that’s huge. Like, when you’re doing a bicep curl, actually firing the bicep, and not just moving your arm, that’s huge because then again, if we get the muscle firing, it’s like, wow, I actually feel like I had a workout opposed to, oh, my elbow hurts, or oh, my shoulder hurts, you know? So, I see that all the time, I go over every single thing and that’s why I try to get to know the patient, because I need to know exactly what you’re doing. We need to know exactly how to activate everything in those positions and then we need to be able to load and build that awareness basically.
Charlie McDermott 15:43
And, you know, you raise a good point, I mean, sometimes, that’s something I’m gonna say all the time. You know, it’s very hard to self-diagnose ourselves even a simple thing, you know, using bicep curls, as an example, you know, you get fixated on, on strength and more weight and before you know, it, you’re using 0% of your biceps, and, you know, mostly your back and causes damage because you’re using way too much weight for the tendons and all that to support it. But, you know, having that outside individual, see those movements and understand and have that education to know exactly, again, back to what you did for Barb know exactly what we need to do here. Plus, she wasn’t the only one with this shoulder pain issue that you’ve seen through all your years of working with patients and helping them get back to their active lifestyle. So, you know, that experience is monitored as you are, I mean, you’ve got a ton of experience, and you just help your patients, your clients get there a heck of a lot faster, because, you know, I’m sure you’re learning every time you work with someone as well, right?
Dr. David Lee 16:52
Oh, yeah. When I see somebody, it’s 100% focused on them. I am constantly experimenting, diagnosing, making sure that we’re getting to the bottom of the issue, like making sure that we are on the right track and I’m in constant communication. I’m always making sure that the exercises are performed correctly, I’m always, you know, I’m always monitoring observing every single little detail. So, I mean, that’s what it takes, you know, if you don’t have that detailed eye, then if you miss something that can be the deciding factor. So, I always try to really, you know, pay attention the whole time and you know, it takes a lot of focus and effort on my end. But you know, I’m willing to do it just because that I know, that’s gonna get the person better.
Charlie McDermott 17:44
Well, Dr. Lee, this has been great getting this story out there and this information out there. I mean, you are a treasure and your team there to Southwest Florida in particular Bonita Springs, where you’re located and looking forward to the next episode. Hopefully, Barb doesn’t have to get injured again, for us to talk about and other areas [Inaudible] for our family, but, you know, whatever we need to do to help you out here.
Dr. David Lee 18:13
I mean, those kinds of things always hit home. So, it’s like, if you can live through it, then it makes it so much more applicable to you. But you know, there’s, like you said, all these people, there’s so many people, you talk to anybody. They’ve probably had shoulder pain once in their life.
Charlie McDermott 18:29
Until the next episode, keep doing what you’re doing there, and we’ll talk soon.
Dr. David Lee 18:35
Okay, sounds great. Thank you, sir. Appreciate it.