The #1 Thing Everyone Misses About Shoulder Pain- Dr. Josh Satterlee

Fix This and Radically Reduce Your Shoulder Pain | Dr. Josh Satterlee

If shoulder pain were truly a shoulder problem, we would’ve solved it by now.
Yet millions of people—and even athletes—are stuck chasing rotator cuff diagnoses, endless rehab exercises, and generic advice that never fully works.

In this episode of the Crackin Backs Podcast, we sit down with Dr. Josh Satterlee, a nationally recognized sports chiropractor, educator, and performance clinician known for challenging outdated thinking around shoulder pain, movement assessment, and rehab.

Dr. Satterlee has worked with high-level athletes and trained clinicians around the world, and his message is simple—but uncomfortable: most shoulder rehab fails because we’re asking the wrong questions.

What you’ll learn in this episode:

• Why most shoulder pain isn’t actually a shoulder issue
• The critical first fork in the road when someone presents with shoulder pain: stiff, unstable, irritated, or referred
• 2–3 simple daily-life “tells” you can notice right now (sleeping, reaching, putting on a jacket)
• Why chasing the rotator cuff often misses the real problem
• The upstream drivers Dr. Satterlee evaluates first: rib cage, thoracic spine, scapular control, and neck function
• The truth about frozen shoulder—and a simple decision tree to determine if it’s truly frozen
• The gym debate answered honestly: Is overhead pressing bad for your shoulders?
• How to bulletproof shoulders for rotational athletes (golf, tennis, baseball) by building the right capacities in the right order

This is not a conversation about chasing symptoms or labels. It’s about movement patterns, capacity, and asking better questions—whether you’re an athlete, an active adult, or a clinician trying to get better results.

If you’ve tried everything for shoulder pain…
If you’ve been told, “It’s just your rotator cuff”…
Or if you want to train, lift, and perform without fear—

This episode will change how you think about shoulders.

 Subscribe, listen, and learn why fixing this can radically reduce your shoulder pain.

We are two sports chiropractors, seeking knowledge from some of the best resources in the world of health. From our perspective, health is more than just “Crackin Backs” but a deep dive into physical, mental, and nutritional well-being philosophies.

Join us as we talk to some of the greatest minds and discover some of the most incredible gems you can use to maintain a higher level of health. Crackin Backs Podcast

Transcript

Dr. Terry Weyman: 0:00

Hey everybody, you know, I met this man just a few months ago, and he just took me by storm. I actually love this guy, and we're going to talk shoulders today. And if shoulder pain were actually a shoulder problem, you know, we'd probably have it solved by now. But today's guest is treating high, high level athletes. He trains conditions around the clinicians around the world, and he's built a performance model around one uncomfortable idea, most shoulder rehabs fail because we're asking the wrong questions. And so today we were talking to Josh Saturday. He's here to challenge how we think about shoulders from assessment to performance, and why movement parents matter more than diagnosis is welcome to the show, buddy.

Dr. Josh Satterlee: 0:44

Hey. Thank you. I appreciate it.

Dr. Terry Weyman: 0:46

So you know, just, let's just start off when somebody says they have shoulder pain, what's the first fork in the road you choose stiffness, unstable, irritated or referred?

Dr. Josh Satterlee: 0:56

Well, I want to give you the most scientific answer to any question, which is, it depends. It depends on what they're doing, yeah. But I would just say, if you're just saying, like, where do you treat? You have one minute, you're on a sideline or something, and you got to treat something, I would say, I'm going to default to thoracic stiffness. I'm not saying thoracic spine. I'm just saying the thorax is stiff somewhere. Mobilize it and you'll get some traction, you know. I mean, you look at like, junior high and high school athletes, right? They're like, hunched over looking at their phones and typing all day, and that's that T spine, and those ribs are just just getting stiffed up. If you look at people working in an office, you know, we're all in that kind of front quadrant praying mantis position, banging on computers. And then it's like, I'm going to go out and I'm going to lift weight overhead and and completely take my pecs to end range and whatnot. And I'm like, so I would, I would default to thoracic stiffness. Now, if you want to expand on that, you know that that's look at the T spine. The segments. Are they, you know, extension or rotation or couple motions. I mean, if I keep going down this path, like, the number of women that are going to call in and say, let me get that guy's contact information is just like overwhelming, because when you're talking coupled motions early in a podcast, like, it's pure gold, it's pure gold, you know. But all right, so couple of motions, extension and rotation. And then you think, okay, slow move outside of the T spine, right? Then you got the the rib heads, they have to elevate and depress. They have to they do a little bit of, like, upward and downward rotation with breathing, right? And then you think, hey, the ribs themselves, as you go out, they gotta, they gotta kind of get wider and get narrower, like you have the muscles in between the ribs have to allow for movement, and then wrap that all the way around. The ribs end up at the SC joints on the front, with the sternum, clavicles, and then what's the only place where the shoulder actually attaches to the skeleton? Yeah, take those old first year of Cairo school files and blow them up the dust off of them. The SC the sternoclavicular joint, is the only place where the shoulder skeletally attaches to the rest of the skeleton. It's the only bony attachment of the shoulder. So you got to look at that, and that would also include like how the clavicle moves up and down to allow for shoulder motion, and then we can go out to the shoulder. But I'll just tell you this, the reason I don't go out to the shoulder and look at like, you know, external rotation, internal rotation. All that first is, how many people do you know, friends, relatives, patients, that have had shoulder pain for way more than four years and told you, oh yeah, I went to this guy, and he treated I went to this woman, then I went to this massage therapist. They they they worked, and they point to, like, their shoulder area. They're dealt it's like everybody's had shoulder pain, everybody's had it worked on, and nobody's better. So whatever the hell approach we're using is the wrong one. So let's just flip it around, go Central and look distal, instead of starting distal and looking Central. Besides that, guys, it's been a pleasure being on here. Being on here, and we'll talk to you later.

Dr. Spencer Baron: 4:07

I gotta tell you, man, Terry, I'm so glad this guy is on the show, because it was only a couple months ago that I started realizing that so many tight thoracic spines are leading to other conditions, and may not be coming from for a neck problem or a low back problem, but a mid thoracic problem. And then I started venturing out into the shoulders. And you know, pitchers, tennis players, all those you know, lopsided sports, golfers fix the thoracic spine. It's tighter than tight.

Dr. Josh Satterlee: 4:40

You want to hear something crazy that I learned along the way Spencer is, there's a guy named Greg Rose, Dr Greg Rose, he's amazing chiropractor. He he's at the Titleist Performance Institute, right, yeah. And because Titleist is paying their bills, they can afford, you know,$250,000 camera systems to monitor guys. They can afford, you know, $100,000.04 Splits and all this stuff. And he said, when you look at PGA golfers, now, remember the one thing that's interesting about PGA and pitchers as well as it's it's an asymmetrical motion, right? Like you're only hitting to one side, right? Now you're doing a backswing, but then you're hitting to one side. So we know it's not symmetrical, right? Like running would be symmetrical, so it's asymmetrical motion. But he said, when they put all the fancy sensors on them, and they they measure all this and stuff, and you look at the thoracic spine, guess how many degrees of asymmetry will appear before there's complaints of pain. So what I'm saying is, if you measure the rotation and extension, let's just look at rotation, because that's easy to compare side to side, right left rotation of the thoracic spine and right rotation of the thoracic spine. How many degrees of asymmetry is allowable before you start getting pain complaints? Does that make sense? Does that make sense? Is my question. Makes sense. It's kind of a confusing thing, but, like, how much less to One Direction Can you turn before people golfers start

Dr. Terry Weyman: 6:08

complaining of pain? No idea. I would say one, two degrees

Dr. Josh Satterlee: 6:12

point 4.4 degrees. So by the time you and I can see it, it's an asymmetry. Treat it right and and here's my other question is, how many chiropractors in the world, and I'm talking to all our our Cairo homies here, how many chiros treat the thoracic spine every single day of their career, as close to 100% as we can get? Right? There's probably some weirdo who only adjusts feet or something, but like, his sandwiches smell bad and when he eats lunch and stuff. So we're not talking to him, but, but we treat all time. How many of them measure the motion of the thoracic spine or the thorax daily? Yeah, none. Like you're shaking your head, and that's so common, Terry, you were at my presentation at pro sport. When I ask everybody who treats the thoracic spine, every hand goes up, right? I mean, it's like the point of pride. It's the easiest thing in the world to do. World to do, and it's a great treatment. I'm not, I'm not saying that. But then, like, what's normal range of motion for the thorax? And everybody's like, yeah, yeah, well, it's, it's really important. I know that. I'm like, Yeah, I agree. It's important. What's the degree it's super? We need to measure it. I'm like, I agree. What's the number, you know, it's really, it's super like, that's the most important thing. And it's like, right? So anyways, it's 50 degrees, by the way, 50 degrees of rotation to each side. Rotation and extension are coupled motions. So I just, you know, only thoracic, yeah.

Dr. Terry Weyman: 7:39

So hey, Josh, I want to get before Spencer jumps in. If you're talking what point, four degrees right to left, even a going on under a, you know, any type of measurement tool. How can you get that specific for the average person? Whether you

Dr. Josh Satterlee: 7:55

can, we can't, we can't. That's why I'm saying like, it only works because they have the, you know, kajillion dollar motion capture systems with, like, you know, they're putting reflective dots all over the athlete. They're putting little electromagnetic sensors, you and I can't do it in our office, but no, when they're saying point four, basically, if you can see a difference, treat a problem. Yeah. I mean, you don't need to go anywhere to be like, is this 1.3 or is this point nine? Like, dude, if there's a difference, treat it, you know, yeah, I'm

Dr. Spencer Baron: 8:25

thinking about all the patients that have come in over the years. I go, you know, we can help a little bit, but that mid, that mid back, that mid back is

Dr. Josh Satterlee: 8:36

like, well, here. Okay, so let's go back. Let's go back to, like, remember when we learned anatomy, right? I mean, you know Terry for you. Like, what was it Carter was in office at this point, but we're going way back,

Dr. Terry Weyman: 8:47

yeah, okay, Lincoln was impressive when Spencer learned it. So, yeah,

Dr. Josh Satterlee: 8:53

by the way, that guy had a great cervical spine. I'll give you that Spencer. Like, thank you for treating him. You know,

Dr. Spencer Baron: 9:00

he had marvelous too. That's another story.

Dr. Josh Satterlee: 9:05

Go back, then, what's the primary curve of the spine? When every baby is born, what's their primary curve? It's that forward kyphosis, right? I mean, we could say it's that single kidney bean shape, yeah, all the other ones, like our neck lordosis and our lumbar lordosis. Why do we get those? Those are secondary curves. When do we get those? So just think about your own kids. They have a curve. When do they stop getting rid of the singular curve? And when do they go for secondary curves? When they become weight bearing? They're not they don't have that when they're crawling around on all fours, because they don't need it. But as soon as they have to bear the weight of their head and their upper body, we develop those secondary curves, because now you have this nice s shock absorber, right, right? It's just a subtle shock absorber. I think about that like it. It doesn't give but it absorbs shock. So that's why we get them. But in the whole time, from the second you're born, one. What's the most important motor pattern you do cross crawl before that? And I'll tell you. I'll give you a hint. If you don't do it, someone in the room in your first minute is going to smack you on your ass, farting, breathing, breathing, right? That? I would say that's secondary, and that's a colicky baby?

Dr. Spencer Baron: 10:20

Yeah, I don't know. I just babysat my seven month old granddaughter,

Dr. Josh Satterlee: 10:24

so I don't know, but think about it like breathing is the most important thing we start doing right, and breathing involves what muscles, what joints, what area that's right. We don't care if you move your legs. We don't care if you move your eyeballs, like if you're not breathing, we're going to attack that before anything else in the medical system. And then, how many people do you know come into your office and they're so bound up Spencer, their breathing looks like a labored excursion. It's like, how far did you walk to get here? Oh, no, I just parked out 10 feet outside your office, you know? Yeah, yeah. So breathing is so important that, you know, it's one of those things, we should probably assess it more and address it. And I'll tell you that if you have somebody with like, long, persistent shoulder pain, assess their breathing. Assess, are they compensating for something? And if you can find the source of the breathing problem, you often find the source of the shoulder problem.

Dr. Terry Weyman: 11:21

Hey, Josh. We started doing some of the office a couple of months ago. And we started doing blood ox on everybody, on their hands. And we would see one side completely different than the other side. And we start working on their mid back and their thoracic and we work on until they equaled out. And so, you know, that was kind of an interesting thought. And I got some of that actually from you when you when you were talking about this, that I'm like, Well, if, if we can assess breathing, we have to look at blood ox too, because if it's not getting to our extremity on that one side, why? Yeah, so, yeah. So that makes a lot of sense.

Dr. Josh Satterlee: 11:53

Yeah, yeah. That's an interesting one, because there are the mechanical issues of breathing, right? Like, do your bones and joints move enough to inhale. Then, like, Can the muscles move those bones and joints to provide enough? And you have to, like, fill up your if you think of your lungs as a bucket, you have to fill up your bucket enough to sustain life. And then as you do more and more activity, like, you have to fill up more. But as you do that, compensations have to be made surrounding that, right? So that's primary. Is the mechanical then you go to, if you're going to blood ox, you have another, other layers, like the chemical layer. How many red blood cells do they have or not have? You know, you think about guys who are on testosterone, for example, which is pretty common. They often have, what is it? Hemochromatosis, where you have too many red blood cells, right? And so that would increase oxygenation. Terry, and then you look at women like during their period, are going to almost be anemic, so they're having less red blood cells. And so all these factors come in. But all that is to say whether you're anemic or you have an overabundance of red blood cells, you still need to mechanically move your bones, joints and muscles to breathe. Right?

Dr. Spencer Baron: 13:10

Stomach breathing versus chest breathing. I hear different things. Would you look at that? Yeah? Stomach breather, yeah.

Dr. Josh Satterlee: 13:20

I would like you to convince the world that I'm a stomach breather, and that's the only reason I have a gut. But, you know, otherwise, I would have a six pack. So if we can, just like, put that out on this episode, you know, and you're not scientifically, obviously, I'm a picture of hell, not pregnant, right?

Dr. Terry Weyman: 13:39

He has AB, not abs, that's right.

Dr. Josh Satterlee: 13:45

So that reminds me of a joke. I live in Las Vegas, and there's a town over called Pahrump, and it just has a name of like a small town, and prompts famous, because in Nevada still as if you can believe this, if you have a population less than 100,000 you can have a cat house, and I'm not talking about a veterinary clinic. Yeah, Pahrump is known for that, right? Anyways, there was a joke that, did you know the toothbrush was invented in Pahrump, because it was invented anywhere else would be called the teeth brush. So anyways,

Unknown: 14:27

I was afraid of where this is going.

Dr. Josh Satterlee: 14:30

I can't wait for the AI summary of this episode. We're going places here, boys. Anyways, let me go back to abdominal breathing, or chest breathing, or however you want to think about that. And and Spencer, I'll say this. You remember back in the day, like in the 80s, when there was, like, a lot of, like, occupational medicine, there was this thought of, like, spine preserving exercise or spine preserving and it was like, basically, like, Whatever you do in work and life, don't flex your spine. So they would teach people to stay in, like, this neutral. Spine to bend over and pick up a box, and then they're like, use this lumbar support so you never flex. And I think what we've realized in the last, I hope in the last 10 years, is you need to flex your spine. You need to extend your spine. You need to rotate your spine. Now there are dangerous positions, like when you're bearing weight or doing a back squat in the gym, you probably then that's not a good time to go into flexion and back out into extension, right? But if you're reaching to bend over and pick up your keys off the ground, you need to flex like, you don't want to look like some weirdo idiot. Like, don't flex, go down, pick up keys and then come back up B row, like, dude, what's with this guy? And so I think if we go to like, breathing, there are times where you need to do chest breathing. There are times where you need to do abdominal breathing. And there was a study came out in, like, I think, the Journal of Strength and Conditioning, maybe three or four years ago. You know, when you run really hard, like, if you ever did wind sprints or something in football, or if you played sports, and when you're tired, do you lean forward, put your hands on your knees, right? And your coach would be like, Oh, don't do that. Admits weakness or whatever. Well, they decided, somebody decided to test it, and they found out when you are at a high excursion activity, meaning you're breathing hard, you're breathing deep, you're you know that actually is one of the greatest ways to recover. And the thought is, when you put your hands on your knees, hold, let me tell you the mechanics of it. When you bend over, put your hands on your knees, and you lean forward, it's going to basically provide these stilts that lift your shoulders up and gently expand your thoracic cavity now, allowing your lungs to inhale and exhale easier than if they had to bear the extra weight of your arms, right? And Spencer, we know you're super buff, so each arm weighs like 50 pounds. But just think, if they're hanging off in space, you have to lift those extra 50 pounds up with every breath and set them down. If instead, I prop them up on something. And for those I'm talking about kind of that, like a position that an umpire in baseball is in, right, that kind of like neat hands on knees, kind of situation that it goes you know what? That's a really good way to recover from the activity. Now, it's not a good way to breathe while you're running. You don't want to keep your hands on your knees and but to recover, that seems to actually be better than putting your hands on your head with your fingers interlaced. But again, even if I put my hands on my head, what am I doing? I'm like, de weighting my thorax, right? And so the muscles can catch up. And it'd be like, telling the dog not to pant or something. It's like, Dude, that's just how we're designed, right? But if you want to go back in time and try and convince your coach you were right the whole time, then best of luck.

Dr. Spencer Baron: 17:37

You know, right? The same coach told you not to drink water during practice.

Dr. Josh Satterlee: 17:41

Well, every nose that gives you cramps. Man, you don't want to be a sissy. Come on.

Dr. Spencer Baron: 17:45

Yeah, there are so many revelations in the first 15 minutes of this, right? I don't even know what to say. All right, Fess up. I need to find out. When did you realize that the thoracic spine was so mechanically involved and integrated into shoulder pain. I I

Dr. Josh Satterlee: 18:06

was about four years into practice, maybe five. I was in four or five years in practice, and I started to notice that I had three groups of patients. I would say I had the big 50 to 60% of my patients that are like, Hey, man, this is awesome. I love what you do, right? I had the 10 to 20% that, well, I'll say 10% that are just like, Oh my God, you're a god. Like, every time you touch me, I feel significantly better. Like the middle group is just like, hey, I'm feel good. It's gonna take us a few visits. And then you have those people where you're just hitting home runs with and they go from I couldn't walk in here, and now I feel like I can run a marathon. I'm like, Oh, I love that. But then the thing that bothered me is I had this, like, 20% maybe 30% some weeks that I'm like, these people are saying they're better, and I'm doing the same stuff, but I know I'm not really making them that much better. Like, what's going on here? Like, what? Like, they're being nice, and they're like, Oh, I appreciate it, Doc and stuff. But I'm like, come on, like, you're not that much better. And, you know, like, as a professional, I think you want to constantly get improve. And you can kind of see it when, you know, when you make lasagna for your family, and you're like, What's it taste like? Oh yeah, it's, it's, it's good, you know, but I got to run to my friend's house, and you're like, Okay, so, but I rather know at that moment, like, what's wrong with the lasagna? Was it the I didn't cook the meat enough? Like, do we need different cheese? Like, I just want to know it's not offensive to me. I just want to be great, right? So that was happening, and it probably went on for a year, and I was really like, what is it that I'm missing? And so I would go back, and I was an art professional practitioner, so I look at my air T manuals, like, between patients, right? And I would really be like, well, Terry kind of had this pain pattern. I look at, you know, travail charts and like, where the like am I getting any insight into? Like, where it extends or where, you know, and those things sometimes are, what would you say people don't present as a textbook? I'll just say that, you know. So then I'm like, thinking about my adjustments, and like, okay, my is my line of drive different, or could I gap that a little bit? Or, like, are there ways to polish that up? And so I would try that, but it would still it would not make a significant dent in the people I couldn't help now, again, you have these two other groups that are, like, pretty good and amazing, right? And I'm like, Okay, that's great, but what is it about these people? So anyways, as an art instructor at the time, I was invited to this art instructors meeting, and they had these two guys there present, one of whom was Greg Rose, the chiropractor, and the other was a guy named Mike Voigt, who's a physical therapist. And I thought it was great, because Mike had been involved in a lot of different high end research and stuff. But he said, like, you can do all this high end stuff with force plates and MRIs. And he actually was part of a lab where they had a MRI you could, you could run in, imagine that an MRI machine, they could record like, movement within it. It's massive. It's only for research, but it's, you know, think about what they can look at. And he basically said, Hey, all, that's great, but I'll just tell you this, for 99% of people, you just need to evaluate each side of, you know, the body, like, just compare right to left, and look for massive asymmetries. And if you do that, you're going to find most of the problems, not all the problems, but most of them, right? And you think, who's walking into a chiropractic office in your local neighborhood? It's not the person with, you know, it's not the striped, hyperpigmatized Zebra, pygmy zebra, that's walking around, right? It's horses like, you know, they say you're here the beating of hose. You turn and think you'll see horses. Well, that's who it is. So anyways, they just gave a really fast way of evaluating and comparing side to side and for symmetry, and that's called the SFMA, the selective functional movement assessment right SFMA. And I went through that class and I realized, okay, I I'm never going to remember anything they said, except for I just need to start comparing right to left, right? And that could be as simple as, like, you know, raise your right arm, raise your left arm, and is there a difference? Right? And so, like, I started going back to my office, and I'm like, Man, I I gotta just compare. So I'd start comparing. And I remembered a little bit of the class. Well, as soon as I did that, I found a couple things that were, like, massive asymmetries I'd I'd missed in patients that were I'm already treated. So I'm like, at their they've come in for 10 visits, and now at the 11th one, I'm finally comparing right to left, or, like, simple stuff, like measuring right SLR to left SLR, right. I mean, basic stuff. And I'm going, Oh, that's weird. That's really good. So I'll tell you. Spencer two that stuck out. I had a patient I was treating for low back pain, and they had everything that looked like, like, essentially, disc based low back pain, no radiculopathy, but just, you know, flexion. They didn't like flexion, you know, all their emotions, they said, matched up with this. And I'm like, Okay, well, I'll do the SLR side to side. And I would guess it should be limited here, right? And all my treatment up to that point was treating the posterior chain like, you know, using my thumb to work on the muscles and and putting them into adjustments and everything, betting on the fact that their posterior chain is super tight. And this is like a 42 year old guy who worked in construction, right? What do you think his SLRs look like? Normal dude? They were excellent. It went up to 90 degrees. He went past 90 degrees. Now, when's the last time you saw a 42 year old construction worker in jeans do a 90 degree SLR in your office with no knee then, and I realized, holy crap, I'm treating this guy to get him more mobile. He's already mobile, right? What the hell's going on? What am I doing? And I'm wasting all this treatment. Then I had a lady come in and she was complaining of shoulder pain, and so she raises her left arm up just into full flexion and abduction, and her left, her right arm up right. You were perfect. You're perfectly symmetrical. But her shoulder pain on her right side, she said, Oh, when I move my right shoulder, man, my neck really hurts right. Her issue was cervicogenic, but because I never compared, I was treating the shoulder pain was referred from the cervical spine, right? I was treating the shoulder to improve the cervical spine, which just, unfortunately, doesn't flow upstream like that, right? Yeah, yeah. Good for business, because she's going to need 2000 appointments before she gets better. Bad for the patient. And so those two stuck out with me. And I'm like, Man, I really need to do this. And I'm, you know, kind of hit me. Like, my approach up to this point has been pretty dumb, like just admitting that to yourself, like, it's okay, I mean, I'll get better. But I was dumb. So then I was like, well, I need to take that class again. So I'm kind of hard headed. And so I took that class five times in the next two. 12 months, and I think I was okay at it by the time of the fifth but, you know, just want to refine it. Refine it, refine it. Was that was a breakthrough. That year was the biggest breakthrough of my career. I would say, like, if you look at my inflection points, that was the major inflection point in my career. I don't know if you guys have had those, but like, that was, I can tell you, that was the moment I was like, this is going to change my life. Oh, I unbelievable.

Dr. Spencer Baron: 25:25

I feel like, while you're talking, I'm thinking, oh, all the patients that we're just going to focus on the thoracic spine tomorrow and the rest of the it's again, fascinating and true. Yeah, thank you for sharing that. Um, yeah, when a rotator cuff injury comes in, what do you

Dr. Josh Satterlee: 25:42

do? Uh, I do the same thing I do with every patient. I ask them to go through the same motions, which the to just make sure I'm not missing anything major, which is, if they're standing, take your chin down to your chest, lean your head back, turn your head right and left. I just look for those Cardinal cervical motions. Are they present and are they symmetrical, right? And then I'll say, All right, let's take your good side, the non painful side, right? I want you to move your arm like this, and then so like, kind of, for those who are listening and not watching, imagine you're brushing your hair and reaching for your opposite scapula. Okay, so that's external rotation, flexion, abduction, and some elbow bend, along with some thoracic motion has to happen, right? You have to go into subtle extension and rotation. Your scapula has to elevate. Like there's all sorts of shoulder motions going on, but we're just going to wrap it up into brush your hair, touch your opposite shoulder, and then I'm going to do the opposite, which is kind of go behind your back, like you're getting handcuffed. Terry, you know this one, but and reach for your opposite SCAP, right? So I'm just going into internal rotation, extension of the shoulder, a little bit of extension of the thoracic spine, or thorax, I should say, and then some elbow bend. I'm gonna look at that on the good side, right? Now, then I'm going to go for the bad side or the complaint side, right? And what should I see? What should they not be able to do? Spencer, if it truly is a rotator cuff tear, right? Or people say it's my rotator cup, you know, I like that one, you know. Now, one of the things we know, if it's a full thickness tear, they should not be able to brush their hair, right? They're never going to get their arm above shoulder height. They're never getting their elbow above shoulder height. So if all of a sudden they can brush their hair, which has happened immediately, what are you thinking? It's either not a full thickness tear or something else is going on, right? So I'll do those two motions, and if it and I'm going to go through that before I go into any, like, pinpoint testing, empty can anything like that. I'm just going to go for these, like, big, huge ranges of motion that everybody should be able to do. And then I'm going to kind of dive in more. I'm going to go through some other tests. I'm asking them to do full flexion. Touch their toes, put your arms up as high as you can, lean back, just looking for like kind of extension of the entire body, the hips, the thorax, the neck, all that stuff. Turn your whole body right, turn your whole body left. Stand on one your right leg, stand on your left leg, and then squat down. I just do that as like a checklist, right? So in anything you know, you can improve it with a checklist. I don't know if you guys have ever read, uh, Freakonomics. You read that book. No great book. If you there's a there's a story in there where they say they want to see what's better world class cardiologists or nurses with a checklist, right? Because they said, like in cardiac care, so in MI, my cardio infarction, aka heart attack. There's just, like a checklist they should go down. So I think it was the Mayo Clinic they have in the ER department. They have a group of patients, and for like a six month period, if you came into the ER, one group gets sent to these world class Mayo trained cardiologists, best in the world, right? That's their initial intake at the and the other patients, so like odd patients. So evens go to the cardiologist, odds go to the nurse who has a checklist, and all she's doing is asking a series of questions, and no matter which path you went at the end, they run a EKG on you. They run a ultrasound in your heart. What's that called a telemetry? Yeah, they run all the tests, blood tests and all this stuff, and they say, Were was this group right? Was this group right? Here's the crazy thing, predictive success of the nurse with a checklist, 93% 93% of time they were accurate by just going down the same questions every time and and they would say, yes, this person has a heart attack. Or no, that's an anxiety attack that person is dealing with, you know, indigestion, right? They were 93% accurate. The world class cardiologists, world class, 63% of the time. One out of every three was being misdiagnosed because they as humans, do we jump to conclusion? Conclusions, right? We jump. We Oh, I know exactly what this is, and the better you get at medicine. Unfortunately, that approach is more and more common, right? I've seen this 1000 times, and so that stuck with me at the same time I'm reading that book the same time. So I decided, hey, I'm just going to checklist every single patient that comes in. And sometimes it challenges your assumptions, sometimes that person that says I've had a rotator cuff tear for years all of a sudden is like, full flexion abduction of their shoulder, and you're like, that's that doesn't make sense, that doesn't fit with what I thought, you know, and every time it happens, I realize the world, I don't know about your guy's life, but the world has had a pretty good track record of slapping Josh in the face and saying, Don't be dumb, right here, you assume the wrong thing here. So that's what I would do. Spencer, now, if it's confirmed that they can't move their arm, I'm going to go down that path and find out, does any change improve their motion? So for example, with a rotator cuff tear, why do people there's going to be a really long answer. So do you guys want to grab a glass? Of water or anything? Because I don't, you know, let me just ask you this. Well, good. Why do they have a rotator cuff tear? Like, think about, how did they end up there, right? Yeah, in my mind, I'm thinking, okay, the rotator cuff, those muscles fundamentally position the head of the humerus, in the in the SCAP, right? In the kind of cup of the SCAP. What do we call that? The labrum, glenoid labrum, glenoid fossa, and then the gleno labrum surrounding that, right? Yeah, so it's layers, that's cool. So why did it tear? Huh, it would. It's designed not to tear. Most healthy shoulders can handle all the motion in the world, right? You see baseball pitchers throwing 100 miles an hour. They don't have torn rotator cuffs. You see people working in factories moving heavy objects all the time. They don't have torn rotator cuffs. Why did this person, why did this person working at a frickin desk get a rotator cuff tear? That's weird. And so I think, what are the mechanics? Well, generally, and this is something I brought up at the talk I did met Terry at is in the shoulder. Generally, things that move too much are painful, and areas that are stiff go unnoticed. Let me say that again, generally, areas that move too much are painful. Areas that are stiff go unnoticed. So Spencer, when you're looking at these people that have stiff thoracic spines, how many of them come in and say, I'm here because it's stiff and uncomfortable. Very rarely, they say, my neck hurts when I turn and I think, yeah, because you're asking your neck to turn 150% of its normal in the rotator cuff, you're asking the rotator cuff to aggressively move that, that head of the humerus into the glenoid, because the glenoid itself, the scapula is not moving into position because the thoracic, the thorax is stiff and won't let the the scapula slide backwards, right? So the only way to compensate is do way too much motion for the Super spinatius, or the Terry's or whatever, those sits muscles, and you ask them to do too much, and they tear right? And so get that scat moving. And there's and by the way, for all those who doubt what I'm saying, think about this. How many people do you know that say, Oh, my rotator I had a rotator cuff tear. Blah blah. They get surgery. They're good for like, six months because they're immobilized, and yeah. And then six months later, what do they say? I retore it. It still hurts. It came back. Blah blah, okay. Well, if, if the problem was the rotator cuff, we addressed that. Why do they still have problems? And it's like, because nobody addressed the thorax, nobody addressed the lack of motion of the SCAP, right?

Unknown: 33:48

Yeah, right. I can't wait to treat patients tomorrow,

Dr. Josh Satterlee: 33:53

so great. I will tell you. The coolest thing about this is, as a car you know, the coolest part for me of being a chiropractor is is like, we don't have to play the stupid, I don't want to use a bad word here, the stupid game of, let's wait four to six weeks and see what happens. It's like, no right now, with your head and your hands, do it right now. And is it better? And we have the ability sometimes to get 4050, 100% relief of a condition. You know, I'm not saying that one adjustment fixes everybody every time. I'm just saying, like, you can know today, if you're making people better today, there's no other profession like that, right? Like, if you go to a PTS office and they're having you do the band stuff, and they're rubbing your this and that and stuff, it's like, Cool. I'll know in 12 weeks if you're any good I don't know today, but if you go to a good chiropractor, it's like, and they do, they find the joint that needs to move. They know that t4 needs to rotate to the right more for me to get rid of my shoulder pain, and they set you up, and they blast t4 and they help it move. You'll know right now. Holy crap, that's way different, right? Yeah, I'll tell you a cool Cairo story that I'm like, proud of. I did some miss. Missionary work, not missionary work, volunteer work, with a group called Liga. Liga, the Flying Doctors of mercy, super cool group. So they leave, they meet up in San Diego, and you fly small planes like Cessnas down to these little villages in Mexico that don't have any medical care. And there's a building on site that's the medical facility, right? A lot of what they're doing is like checking eyes, checking dentistry, and then sometimes they'll get ophthalmologists to do like, a special eye surgery for these kids that can't see, or they'll get the cleft palate repair right and and so it's this crazy group. Sometimes it's just like, hey, we don't have that. We don't have that. We're just doing internal medicine. Hey, sometimes we're doing OBGYN stuff or obstetrics or whatever, right? So anyways, this guy comes to talk to my rotary club, in this rotary club, and he's talking to me about Liga flying, Dr mercy. And I go, Hey, do you ever, you ever, I'm a chiropractor? Do you ever have chiropractors do it? Because he's talking about the cleft palate surgery and these eye surgeries. I'm like, Yeah, we can't do that. And he's like, Oh man, we love chiropractors. I'm like, really? He's like, Oh yeah. He's like, all the time, we'll get these bleeding heart orthopedic surgeons who, like, retired. He's like, they come down to Mexico. They're long line of people. He said, Oh yeah, this guy needs an MRI and this, I need to get this. And he said, I have to grab by the shoulder and get like, Brother, see that bright light in the sky. That's as good of an imaging as you're gonna get today. Okay, so whatever you can see is that just that's as close to an x ray MRI as we're gonna get the sun, he said, and they can't do anything. They're hamstrung. He's like, Oh, I want to give them this or treatment, and I want to get this gel. And he's like, we got nothing, do whatever you can right now. And he said, with you chiropractors. Man, I give you a park bench. You can treat 200 people today and they'll be better. He's like, all you need is, like your hands and a flat surface, and you're bringing care to the world. And I'm like, hell yeah, hell yeah, yeah. The other crazy thing I learned that trip, by the way, so when you get into these, like, Cessnas, they're weighing, like, your bags. They're weighing you everybody has to step on a scale, and you kind of and you kind of have to balance out, right? They know exactly, like, this plane can only carry 1000 pounds or whatever, and I'm a big guy, so they're like, I'm flying. There's no suitcases around me. There's no There's no cans of soda. They're like, Let's strip all the weight we can, you know. And they're like, telling me to spit and go pee before I get on the plane. Get rid of any weight you can. But anyway, so we're flying, and I'm helping unload a plane, and there's like, a stack of newspapers. And I'm like, the hell who brought newspapers? Like, think about the heaviest thing that you just like, track. I'm like, What the hell is this? And the one dude was like, Oh no, if you buy brand new newspapers and you keep them folded, they're sterile inside because of the pressure and the temperature they're printed at. So as soon as you open them up, you can use that as a sterile environment. And I was like, Huh? I'm like, when you're, when you have discovered that what you need is a stack of fresh newspapers, and that's what you're that's what you're guaranteeing a sterile environment. I'm like, this is, this is gangster care, you know. So, yeah, but I mean, I treated like lit. I can't even if I might have treated 150 people in a day. It was crazy, but you can do it. That's the greatest thing, being a car, dude. You can do it.

Dr. Spencer Baron: 38:14

So let me ask you a couple things about we get patients that come in with frozen shoulder. It's not often, but they do, man, that is the most miserable. I mean, you know, that's totally agree. Seriously, that's the only condition that you have to go past the pain and that patients are miserable. What do you do?

Dr. Terry Weyman: 38:34

Hey, I want to piggyback on that, because you said some a minute ago, where most professions, they say, just wait for it to go away. The number one thing in frozen shoulder, oh, has to go through its thawing phase, is all that phase, and give it eight months and you'll be fine, yeah. Why? I mean, ridiculous.

Dr. Josh Satterlee: 38:52

I'm like, Thank God you guys work at a hospital, or thank God people have medical insurance to come to this visit. Like, can you imagine as a Cairo being like, yes, then we're gonna do some really crappy treatment and not really do anything, but eight months from now you're gonna keep paying me money. Like, what other situation would anybody agree to that as a customer? Like, I know you came into my restaurant today because you're hungry, and eight months from now, we're gonna serve you the best ZD you've ever had. It's like, no call a frickin plumber, like, Hey, I know you called today, but eight months from now, we'll unclog your toilet. Don't you worry. It's like you're out of your mind, Dude, you are out of your mind. So yeah, I I'd go back to this Spencer frozen shoulder sucks. It's, it's a tough diagnosis, and one of the ways I always know like, is it actually frozen shoulders? If the person's willing to put up with that treatment, like you're saying pushing past, I go, Okay, it's good. If they're like, hesitant. I'm like, you don't really have frozen shoulder. Like you have a tender shoulder, you know? But like, frozen shoulder patients are like, I don't care what you do. Like, you can drip lemon juice in my eyes. As long as the pain will go away, I'll do it, you know. But I will go back to this. I will say this frozen shoulder number one, violates what I said about things that move too much are painful and things that are stiff. Frozen Shoulder usually is painful, and strangely lack of range of motion, right? It's one of the weird ones. Okay. The other thing is, in my experience of treating frozen shoulder patients, I find some other area other than the shoulder to treat, and we seem to get a lot of relief. I will tell you this, the next time you have a frozen shoulder patient come in, just ask them to touch their chin to their chest, lean their head back to see if through their full cervical extension, turn all the way right and all the way left. Just check the cardinal ranges of their cervical spine. And I think you will be surprised to see they have a massive asymmetry in their cervical spine. Now that's not 100% guaranteed. That's gonna that treating that is going to remove some of the issue of their cervicals or their frozen shoulder, but I'll ask you this, how uncomfortable is it for you to adjust my cervical spine? Like, if I have a stiff cervical spine, I'm the patient you see every day. I come in and lay down on your table. Spence. How uncomfortable is it not? It's not at all right? Like, maybe I'm a little sore afterwards. How uncomfortable is it to directly treat a frozen shoulder? Wicked, yeah, like, incredibly painful. So I would say, How long does it take you to treat a cervical spine if you find an asymmetry, like, let's just say that I can turn 80 degrees left, but when you see my right rotation, I'm stuck, like, 20 degrees How long does it take you to lay me down and adjust seconds, yeah, 30 seconds, okay, in those patients where you find the asymmetry, I would try those things because they might help. They might and let's assume the worst, they do nothing. What did it cost you? 30 seconds, right? And it's like 30 seconds less that they're going to be biting on the on the wooden stick, and, you know, water coming out their eyes. But what if it does reduce, what if it reduces 30% of the pain? What if it gives them back 25% range of motion in their shoulder because the cervical spine now moves better? Is that worth it? Yeah. And I think, yeah, absolutely. Manipulation is so effective, so fast, that I think it's why not try it? Why, like, look for an asymmetry somewhere else, treat that and then see, did that help us?

Dr. Terry Weyman: 42:34

Hey, Josh, how often do you find the opposite hip involved

Dr. Josh Satterlee: 42:38

in shoulder pain or in, specifically, frozen shoulder. Frozen Shoulder. That's a good question. I don't have the answer there, but I will say that a very common in athletes, a very and this might we might be saying the same thing Terry and just from different areas. It's very one of the most common causes of shoulder pain in athletes is opposite side lower extremity instability, meaning, if you think about a thrower, they're throwing right arm. Their left foot is going forward. Well, if they can't stabilize on that left foot, knee, ankle, hip complex, you will often see increase of shoulder pain or shoulder dysfunction. If you strengthen and stabilize their lower body, you'll be shocked at how much it improves their shoulder so this extra motion of trying to stabilize while moving violently fast causes all sorts of pain and tightness. And you know, the deep down root causes. Fix the fix the opposite hip. Usually it's a glute issue, but or glute, there's gonna be some nerds that attack me for what I just said. It's not just glute, it's lower extremity complex. How about that? You know?

Dr. Spencer Baron: 43:56

Yeah, actually, with pitchers and quarterbacks, we look at the the big toe on the throwing side. When they come in with a shoulder problem, it's actually fascinating. Like I'm an alien, I go just that big toe means a lot to them, you know.

Dr. Josh Satterlee: 44:17

So, yeah, Want to check it. I'll say this another suggestion I just make to listeners, if you have an athlete like you're saying pitchers and quarterbacks and everybody that's struggling, check their big toe, I'm looking for, you know, extension of the big toe, right? Well, if you extend your big toe, what are you almost always doing is what we call triple extension, your implanter flexion, right, which is extension of the ankle. You're a knee extension, as in it's locked out, and you're in hip extension, which means your glute should be fired, right? That's just like the toe off phase of gait or power All right? So check their big toe extension, and then. Ask them to do a glute bridge, and do it Single Leg Glute Bridge. So you have them go up on both feet and then straighten their left and that means you're testing the right glute. Just see how long they can go for. You'll be shocked at how many people go two seconds, and then they grab their low back and like, oh, because they're, they're, they're glute is not stabilizing, right? So they're overusing their low back or their hamstring, and then I have them go back up on both legs. Now straighten your right leg and check it on the left. It's pretty rare that they are symmetrical and that they can pass. What you're looking for is them to pass 10 seconds, 10 seconds of stability without sagging their hips. Is normal stability.

Dr. Spencer Baron: 45:42

I can't wait to do this. Actually, in retrospect, you were talking about the cervical spine, and I just realized I have a 40, a 57 year old male who has shoulder pain. He can't do this. He can do this all day long. And we'll go, you know, super spend is impingement and all that. If he, if he cracks his neck, this is his words. If he can crack his neck, he can bring his arm, I go. What the hell is that? And you are talking about?

Dr. Josh Satterlee: 46:12

Yeah, I bet he is getting like, c6, c7, maybe t1 to move a little bit. And if you just take that, that train of relief down to t1 2345, he's gonna be like my god. Spencer, you're a god. I feel so great.

Dr. Spencer Baron: 46:27

Yeah, let me ask you about night pain patients come in. Or, actually, I asked him about, do you are you sore in the morning? Or is the shoulder sore in the morning? Or what have you. So, what's your approach to their habits when they come in and talking about night pain,

Dr. Josh Satterlee: 46:46

yeah, number one, I've had a couple friends die in the last five years of cancer that they were 40 something years old. They and they, they reported night pain along with other symptoms, and their PT, their Chiro, their primary care just skipped over it because they're like, Hey, you're a healthy 43 year old. So I would say, night pain, it's one of the signs of cancer. So pursue that until you prove it wrong, which shouldn't be too long, but just prove that wrong. Along with that, if you're doing all this treatment of like asymmetries, and you're doing good treatment, and people are coming back a couple days later with exactly the same symptomatology. To me, I'm like, that's a red flag. I'm pretty freaking good at what I do. I know chiropractic works. I know hands on manual therapy works if I'm doing what I think and things are not improving. This ain't a joint muscle problem. Get imaging, ask red flag questions, do all that. So let me just put that to the side Spencer, because it I never, I never did that, until my friend started dying, and I'm like, What? What the f is happening here? Like, how did a friend of mine, 46 years old and died of stage four colon cancer, went to seven different providers. Went to a car he had back pain, went to a Chiro, then a PT went back to us, went to his primary care, who gave him some meds, went back to a second PT, went to a hip specialist, and then a nurse at Urgent Care was like, happened to us? Do you have any blood in your stool? And he's like, you know, I do, but I just assumed it was because I'm on so much ibuprofen. And she's like, we need a we need an MRI. And he had stage four colon cancer that probably would have been stage two if the first person had slowed down to ask him. So 46 years old, he had six weeks to live and bad times, but it started out as what looked like mechanical low back pain. I want everybody to hear that like, just don't get burned by that. It doesn't take long to ask red flag questions. We should do it more often than we we do it sucks. I've missed it. I'm sure we've all missed it. Let's Let's improve, right, all right. Going back to your thing about night pain,

Dr. Spencer Baron: 48:53

shoulder pain, because we can go crazy with all sorts of other pain.

Dr. Josh Satterlee: 48:57

But, yeah, but think master, yeah, lung cancer used to be the one of the more common cancers. Luckily, it's on the down downhill slope. But there are some lung cancers that can occur and create referred pain. But let's assume you've, you've cleared out the red flags, right? Assume that we're good night pain. Okay, I've treated some golfers. And one of the things about treating professional and like semi pro golfers, is golf is actually one of the more high output. So these guys that are playing professionally, you see them on on TV, playing Sunday at the Masters, right? But everybody who played Sunday had to play Saturday and to play Saturday, and to qualify for Saturday, you had to play Thursday and Friday. So that's four days, and then that started Thursday. Well, Wednesday is usually a Pro Am tournament for a charity or something where they're raising money, right? So they played Wednesday, and they usually were on site Tuesday to play the course before they saw that. So they've been playing Tuesday through Sunday, and. If they made it right, saying that you only get one day off, which is Monday, there's very few sports we play for six days in a row at a competitive level, right? They've also gone to the range of all done this. So the amount of volume is incredibly high, right? You're not going to have an NBA basketball player play six, six days of games in a row, right? You'd be like, Oh, the injury risk is too high. Golfers do it all the time. One of the problems you get into them is like, how do you reduce the volume when it's like you need your shoulder to work in the golf swing? I can't say, Well, this week, don't, don't use your shoulder in these in these rounds. But you know, score really well and make money. That doesn't, doesn't work. So one of the things you realize quickly is like, they're not recovering enough at night, and a common one is guys. And I don't know why it seems to be more guys than women, but guys who sleep on their side with their arm up right seem to have longer lasting issues and not resolve as quickly for shoulder problems. So a trick is encourage them to start the night with their hands shoved into the pocket of their pajamas or underneath the waistband of their sweatshirt. A lot of times, they'll come back and say, hey, my shoulder actually started feeling good. And I'll say, okay, that's because you had your arm down right. It's just not putting stress and blood flow and all this stuff on that shoulder, if they won't do that, and they have a girlfriend or wife, I have asked them, ask the girlfriend wife, tie their arm down. At night, their symptomatic arm, tie it down with something. I mean, I've gone like golfers often have the kind of cotton fabric belts, you know, and so they'll put on a belt, but they'll shove their arm, like, next to their body with a belt. I've said, just take an old, like, long sleeve t shirt, wrap that around, right? And guys will say, yeah. Like, I'm surprised how often I end up like this, but when I don't my shoulder, I wake up. My shoulder feels pretty good, right? Yeah. So that's one of the tricks I've used. And then you it's tough because, like, you got to balance those things. Guys who want to sleep on their side and put their arm up like, you can only adjust people's sleep so much. But like, sleep, the just the sheer volume is so important for most of my patients, I struggle for them to just get enough recovery during sleep, you know. So I don't want to adjust your sleep. If you're like, I'm only getting four hours a night and I'm going to screw up the way you sleep. I'm like, the first thing is, get enough hours in the night, and then I'll talk about how to make it better. But, you know,

Dr. Spencer Baron: 52:28

yeah, so let me ask you, because based on time, I want to know one of the most common things that you see in the in the gym, and now it's, you know, the new year, and everybody's got their resolutions going overhead pressing. Back in the day, it used to be behind the neck pressing. Nobody does Hell yeah, because it trashes the neck. So what Yeah? Say About overhead pressing?

Dr. Josh Satterlee: 52:55

I would say overhead pressing is awesome. I would say the human body is meant to, like, reach overhead, I would say that's all great. Asterisk next to that, as long as you have a full range of motion of your entire shoulder and cervical and thoracic spine area right now, if we go, which people working at a computer on zoom all day have a healthy cervical spine with full range of motion, which, have, you know, healthy full range of their their upper extremity and their thoracic spine and thorax and ribs and pecs and lats and posterior elements and anterior elements and sternum, clavicles and everything has full range of motion. You know, it's like, it's not, it's funny, as you get into this, it's not the exercise we do that kind of caused the issue. I think the root cause, I don't think that overhead press is the issue. What I think is it's your crappy posture for the other 1214, hours a day, sitting curled up, texting, tapping on your computer, and then you're like, Well, I'm gonna go from the most contracted, tight, horrible position. And I'm going to go do the complete opposite end of the motion spectrum, which would be both arms retracted, reaching overhead with weight and now. So now my my spine has to compensate and stabilize. And you're like, Well, the easiest way would be to stabilize by going flexion. No, no, I need to extend as far as I can. But oh, your extension sucks because you have this tightness and you're at and you've been sitting all day and blah, blah, blah. And I think, yeah, if great exercise, bad person doing it like, you know, the lead in of 1214, hours, but in front of a computer was a bad way to prep for this exercise, right? So that's my point, you know, but I will say this, if you're somebody that's like, Hey, I love because there you ever seen that? Um, there's a great TED Talk. And the woman says, talks about body language. And she says, if you run a race and you and you cross the finish line, what position do you go into? Naturally, you put your arms up overhead. You look up right? Your arms overhead is. Just like a celebration position, this researcher went and looked at like over 100 people that are congenitally blind. They have never in their life seen somebody finish a race. They've never seen it. Their eyes have never worked. Guess what position they go into if they win or they win a race, arms overhead, looking up like this, right? It's crazy. It's in our DNA. It's in our DNA and and if you do a really good adjustment, how many of you have, like, nailed the adjustment, you put your arms up, right? Like, it's just natural. I think Spencer, that's one of the reasons we love overhead press, is it feels like, Yes, I'm celebrating, right? Like your your DNA is saying, put weight overhead. You know, you know, you guys are probably dads, right? When you have your kid and they're safe enough to throw around, isn't it so fun to hold them over your head and, like, look up at them, and it's amazing. Anyway. So I think there's this, like, genetic drive, especially as males, to do that. But if it jacks up your neck or your shoulder, try this press one weight. Just do a dumbbell. Press it overhead, and look at the weight as you go up, because it's going to give you a little bit of cervical rotation. And we know that as your cervical spine rotates to the right, what happens your thoracic spine, it starts to on the right side, extend a little bit, and you'll get some relief. So try that. Brilliant. Cool. Yeah, I know, brilliant.

Dr. Terry Weyman: 56:22

All right, Josh, before we go to our favorite section, I do want to ask to leave the audience with a couple of things, since they're all pumped up now, what's some three exercise, or three movements that you would tell every rotational athlete or every person to do every morning and every night,

Dr. Josh Satterlee: 56:40

laterally flex and rotate their thoracic spine. The way I like to do it, drop down on your right knee. Okay, so you're on your right knee. Your left foot is in front of you. We call that a half kneeling, or split kneeling position right, and the leg that's in front turn towards that direction. Once you feel like you can't turn anymore lean left and right, and then you'll be able to turn more lean left and right. For all the nerds out there, what you're doing is you're just taking the facet joints and rub it on them, each other, right, and then going a little further, rubbing those facet joints on each other. Get that motion in there. I think that's one you wanted. Three. The next thing I would do is any motion that combines your thorax, your upper thoracic with your cervical rotation. So like, are you familiar with the term? Like open books, or like, you know, or John Travolta in Saturday Night Fever, you know, just like moving that way, you know, for the for the guys with gray hair, that one, that one connected, yeah. And then a third thing is, make sure these are athletes, right. You ask for athletes, I would say, make sure your lower body is is stabilizing equally. So do something, a lunge on both sides, a glute bridge, something to just make sure the the lower body's has awoken. And if you can do it like in the toe off position, it's even better, like what Spencer was talking about, the big toe. Get that big toe cranking. Get your tighten that booty, and we'll have a lot of success.

Dr. Terry Weyman: 58:03

All right, I got one more. You got a guy like a pitcher, a golfer, and the his one hip is super locked up compared the other one. What's a morning routine for him to loosen the hip up? So Andy's,

Dr. Josh Satterlee: 58:16

yeah, okay, so just think generally, where does all of our proprioceptive information come from when we're trying to do sports? What are the sensors in our body? I mean, this is again, year one, chiropractic college stuff, right? But where do our motion sensors in our body come from? They live. We call them mechanoreceptors, Golgi, tendon, organs, muscle spindles, right? Where are all those? Pretty much you can think they're concentrated around the joints. What's the biggest joint in the body with the most real estate of structure? It's the hip, right? So if I want to stimulate more of those around and make the brain go, oh yeah, this is the hip, and I can use it. I need to get all of those things, sending information up and I'm brain sending information down, right afferent and efferent. We're getting real nerdy here, but man, the reviews on Apple podcasters to me, off the charts here, boys. So how do I do that? Okay, Golgi tendon organs need what to trigger a sensation. They need tension, right? They need stretch. Muscle spindles. Need what stretch and or contraction, okay? Ruffinian corpuscles, pacinian corpuscles, right? The Italians in the job. They need pressure, right, right. Mechanoreceptors, what do they need they need joints to rub on each other, right? They need stimulation holding a long, slow stretch. Only does half that equation, meaning your GTOs and your muscle spindles will feel the tension. But if I want to rub the joint surfaces over each other, get those mechanoreceptors and I want pressure from the. The core puzzles, and I want all those things. I think a windshield wiper or a 9090 stretch, switching from right to left and aggressively twisting the joint capsule will give me the most stimulation. So let me say it differently. Imagine if movement was water inside a towel, and you had to get the movement out, getting the water out of that towel. Would you pull it tight? That would help. But what would you immediately start doing? You'd start twisting it right. Our joint capsules are no different. Twist them, get them tight, and pull as hard as you can get that water out. That water is movement that will help your hips move. I think too many people do these low level things where the brain's just like boring. I've sat on my ass all day. I've learned to turn that system off. No, no, you got to start twisting and moving and rubbing those surfaces

Dr. Spencer Baron: 1:00:53

on each other. Perfect. Josh is freaking me out here today because I just I run every Sunday about four miles, and I just recently started doing the windmill thing. And I go, why didn't I do this before? I feel so much more loose just doing a stupid windmill for a couple seconds.

Dr. Josh Satterlee: 1:01:10

Yeah, yeah. I along with that Spencer. I just got to say this. You know, a lot of back when I started, I've been in practice 18 years, it was really hard to find foam rollers, right? And now they're everywhere. You get them off Amazon, for God's sakes, and like, foam rollers saw their day, and then all these people were like, well, foam rollers don't actually lengthen the the the muscles, and, oh, it's not going to stretch this. And it's like, yeah, okay. But my current thinking on foam rollers is the reason, because I've had the old patient, I don't know if you've had these guys, like, the crowd that's over 6570 they're going on golf trips together, traveling. They swear by the foam roller. They're like, Oh my God, it helps me. I feel so much looser. What I think is actually happening is, I think you're rolling on the foam roller so you're you're stimulating those core puzzles, right? You're getting pressure. You're putting them in different positions that they haven't been in, those developmental positions. You guys ever taken a DNS course or, like, looked at early rehab. It's like, get on the floor. Lean on your right arm. McGill's big three, like, get on your side plank. You're kind of asking them to side plank transition, go front plank, but the foam roller is what they're focusing on. So their brain is getting all this stimulation. And then you start rolling areas you don't use every day, the rolling the inside of your thigh, rolling the outside of your leg, not stimulating those things in day to day life. So now we're sending all that information to your brain and going wake up your motor control system and start using all these areas we stimulated. Right? It wouldn't be any different than if you just took, like, the backside of a comb and just like rubbed every single surface of your body. I think that would probably work the same. The foam roller was just more

Dr. Spencer Baron: 1:02:45

convenient, agreed. So here, here we're at Terry. We got to make a decision here the rapid fire questions that we ask at the end of the show. You've answered most of them already. I'm going to switch the one that you the one that you didn't answer. Are you ready now? It's a rapid fire question, so keep in mind knowing that

Dr. Josh Satterlee: 1:03:09

I'm pretty bad at that. Yeah, I am. All right.

Dr. Spencer Baron: 1:03:12

All right. Okay, let me ask you question number five, when people you've helped are moving well, years from now, what do you hope they remember about you beyond those results,

Dr. Josh Satterlee: 1:03:30

wow, that I empowered them, that I empowered them, like, go out, do it, man, do it. Load it. Do it faster. Have fun with it. Pick up your grandkids as you do it.

Dr. Spencer Baron: 1:03:41

Nice, nice.

Dr. Terry Weyman: 1:03:44

Terry, we got one more. Give him one more. One more. This is fantastic.

Dr. Spencer Baron: 1:03:51

Josh, you now, you had mentioned some of the movements and that people should do on a daily basis, somewhat on a daily basis, but that is that what you consider movement capacity, because I know how you feel about, you know, exercises and so on, is movement capacity any of the activities that you've shared, if so, if not, what? When it comes to shoulders and extremities, what's one movement quality? You see clinicians think they're training, but are actually missing completely.

Dr. Josh Satterlee: 1:04:22

Um, and this is rapid fire, so this has to be a short answer. Jesus, man, don't ask a four part question. Then with uh, areas to go, I would say, when we're talking capacity, the reason we train in the gym is so that you don't wear down as fast. My kid plays football. The reason you strength train in the gym is so that you can deal with more hits. Rory McIlroy is a tiny golfer. He weighs like he walks around 140 pounds. He he's put on 30 pounds to put up with the rigors of competitive golf over and over and over again, right? Um. Them. So that's why we train I think that's a great reason do it. And I think the number one thing, like Gabrielle Lyon and these other people are talking about that's going to kill people long term is loss of muscle. Load your patients when they're moving well, load them more. And then when they can't, when they can't do something because it hurts, that's your job. Jump in. Fix them with the intent to load them more. Don't back off. I think there's all these people who are like, backing off, backing off, backing that's not serving people long term. Love it, yeah, I want my patients to die looking like sprinters, not Ultra distance marathon runners, you know, slash concentration camp escapees, you know.

Dr. Spencer Baron: 1:05:40

Yeah, perfect. We good. Terry, we're good man. Oh man, Josh, that was that was extraordinary, fantastic. Lots of Revelation. Thank you so much for your time.

Dr. Josh Satterlee: 1:05:51

My pleasure. You're

Dr. Terry Weyman: 1:05:53

great, Josh, as always, love love the laughs, love the humor. Thank you for all you do for our profession, and you'll be remembered as a man that really pushed people to be better. So I appreciate you.

Dr. Josh Satterlee: 1:06:04

Hey, man, I appreciate you guys getting the word out about it. You know, I've thought I've been pretty smart for a while, but my wife keeps arguing that fact. And you know, when I don't get on podcasts, I don't, I can't spread it around, you know. So I really do appreciate this opportunity, guys, and for all the Cairo's out there, man, we have so such amazing skills, we just need to get them out to the right people, and don't do dumb stuff that we shouldn't be doing. And if we do that, we're that's why we've made it this far. You know, a medical profession tried to crush us, except our results are too good, and they're like, damn it, these patients that are getting better just get in the way of all of our our ghastly attempts, you know, so

Dr. Terry Weyman: 1:06:43

you have the last day buddy. You too.

Dr. Spencer Baron: 1:06:48

Thank you for listening to today's episode of The Kraken backs podcast. We hope you enjoyed it. Make sure you follow us on Instagram at Kraken backs podcast. Catch new episodes every Monday. See you next time you.