If you've ever had shoulder pain, then this is the video for you. Today I'm walking through a guide on how to rehabilitate shoulder pain, whether it's your teninitis or impingement or other words that people might say it is. What we're talking about today is something called a rotator cuff related shoulder pain. Kind of fits in this big bucket of all those things we used to have individual names for: suprochromibursitis, rotatic off strain, impingement, you name it, all that kind of falls in this bucket now. And today, we're going to walk through one approach that you can use to kind of rehabilitate that. So, this is my approach to it. Certainly, not the only approach to it. I'm walking you through my framework for how we kind of think about rehabilitating this and moving on. So, let's get started. So, in this show notes as well, there's going to be a link to where you can get this program. So, I'm going to walk you through what it looks like and how I kind of think about it. So. First of all, rotator cuff-related shoulder pain, probably the most common shoulder pain out there, right? So, this is the vast majority of the shoulder pain that I see in my clinic day in and day out. It's kind of that annoying one, right? So, and the goal this year is you have to make sure this is a right fit for someone, right? So, this rehab program or any rehab program, you have to understand what is our main goal, right? What's the goal? The goal here is to reduce pain, improve mobility. An enhanced understanding of how to modify activities, how to continue to work out, and just get you back to the things that you want to do. And so that's the main goal of any rehab: you should reverse engineer: like, hey, what's our end goal and start from there? And this specific program, I'm trying to think of: is this right for you? I look at things of where do you fall in the spectrum? You know, did you develop pain gradually over time after repetitive use? If you're pain kind of dull in one spot, it can be worse by overhead lifting, reaching up over, you know, getting something out of the counter, something like that, lying on a shoulder. Or you're not an elite athlete who had an acute injury, right? So, the things where you wouldn't be a good fit for this is if, hey, you had a significant amount of pain from a specific injury, saying, hey, I was doing some activity and I fell and I hurt myself. Well, that's probably not the right use case for this specific program. If you have numbness and tailing, that's consistent. If you have a History of dislocation, or you feel like unstable, like your shoulder is going to pop out, or you can't even lift your body weight. That's a big thing as well, or your arm can't lift it up at all. Big thing. And then, if you have constant severe pain. At night, that doesn't get any better, or if you have severely restricted range of motions in all directions. What I'm trying to say here is this rotator cuff-related pain is usually from overuse. So, it is a kind of insidious onset, comes on over time, not from trauma. If you fell on your shoulder and have acute pain, that's not what we're looking for here. You should get that evaluated. If you have. Horrible pain, and you can't move your shoulder in any direction. We're worried about something like a frozen shoulder. You should not be doing this program. You should probably get evaluated. So, what I'm saying here is When do you have to go to the doctor? Well, usually, if you kind of have this chronic achy stuff, hey, after I'm doing bench press, it kind of bothers me. Hey, after I do overhead press, or after I'm throwing, it kind of bothers me. It's not the end of the deal. Like, that's what we're looking for. That's the type of shoulder pain that's rotated or cuff-related pain that we can continue to try and rehab. But if we're having really bad numbness, tingling, lots of pain, really, really reduced mobility, or if you can't lift your arm up at all, we worry about a complete rotator cuff tear, which would require A further evaluation and probably surgical intervention. So, those are the things like we're trying to differentiate here that hey, we want to be very cautious and not go too crazy. If you fit that first category, then absolutely, do it. And when it comes to rehab, there are some expectations that you should talk about. I think it's very important to set expectations for anybody. So, when you are going on any sort of exercise journey, whether that's trying to get into strength conditioning or running or whatever it is, you should have expectations for what you're going to have, right? So, if you have never lifted a day in your life and then you start lifting, It'd be nice if someone tells you, Hey, you might be sore a little bit. Like, hey, that might happen. Just have some guide rails on where to go. So, that's what I'm trying to provide here as well. There are going to be good days and bad days. Like, that is completely normal. You will have days where, like, hey, I'm feeling good. And the next day, you're like, bad again. You're wondering, oh no. What's happening, please don't catastrophize. That is a normal part of things. It's also really important to celebrate small wins. I see this all the time where people are like, I can't even put on my jacket, it hurts so bad. And then I see them in a couple weeks and they say, like, oh, it's not any better. And you're, okay, let's tell me about your life. And they're like, oh, that's gone, but I just can't do this anymore. It's like, okay, well, We're clearly making progress, and maybe not the whole progress that we want to get. And maybe we can distill those goals a little earlier in the process or a little more clear. You're definitely making progress. So, celebrate the little wins. If you have pain all the time, and when you're sleeping, it's bad, and all of a sudden you get your first good night's sleep. Let's celebrate it. That's something to consider and do. So, and then also healing takes time. This is the biggest thing. I think the biggest thing. For any sort of rehab, whether it's shoulder or knee or whatever, it is expectation management. Understanding that, hey, this problem probably came on over time. I consider rotator cuff-related pain, and most injuries that I see that are chronic in nature are a mismatch. So, you're just doing too much, your body's not ready for it. So, kind of this load mismatch. And it happened over time and it's not gonna get better overnight. It's going to take time. So I tell people to think in terms of months, not days or even weeks. And when you get that, that's helpful, right? You say, hey, I'm expecting this to take probably eight to 12 weeks at least. Sometimes it might take even longer than that. And that's totally fine and normal. Everyone kind of covers differently. Also, it depends on your age and lots of different factors. But I tell people this is going to be a months-long process, not days or weeks. And I think that's a big thing. A lot of people go into rehab, they think, hey, I'm not better in four weeks. What's going on? Like, well, nothing's wrong. That's just going to take a while longer to kind of build you back up and build your tolerance. So, that's a big, big expectation that. Hey, may not happen right away. And on top of that, anytime we're doing any sort of rehab, it's always, always fine to continue to stay active. And I encourage, in fact, I encourage you, right? So I want you to do other training. I want you to stay active. I want you to stay cardiovascular fit. Hit our overall physical activity recommendations. Maybe for this, specifically for your upper body, you're not able to do the things you want to do in terms of big lifts or whatnot. So that might have to fall back a little bit. There's still activities you probably can do, though. I can guarantee you. You might feel really good with rows, like horizontal rows, and you could do that for days. Maybe you could do chest-supported rows. You feel fine. You can do one-arm stuff, you can do lots of things you can do, and that's totally fine. The general goal here is if you feel okay, if something feels okay and doesn't produce pain, we'll talk more about that. You're good to go. You can do that. So, I want you to stay active. It's just overall helpful for so many different things, not only for mental health, but for physical health and recovery. All those things are good. And as I mentioned before, you call the shots. If something you love, And it doesn't bother you, then go for it. However, if something you do love does bother you, we may have to scale it back, maybe alter how much we're doing. The weight, the you know, the way we're doing them, the exercise, something like that may have to change temporarily, but the goal is to get you back there as well. So that's the big thing. In this program, for any shoulder program, I usually put in optional mobility days, meaning, hey, stretching is totally fine, can do, and it's not a requirement that you have to do it all the time. I think some people are probably missing this. The big thing for me is, I just want to emphasize strengthening is like the number one most important thing because I think strengthening helps build tolerance to things and gives you more capacity and capability of doing things. That's the biggest thing for me, is building you back up. But, and that's not to say, hey, there's no place for stretching. I think there definitely is, but if I had to choose, I choose strength, and that's kind of my bias. But other programs, you know, really focus on flexibility. And I find that a lot of times. When we do a lot of stretching, that can be helpful for some people, but for a lot of people, it doesn't solve the underlying problem, once again, which is that load mismatch, right? So we need to build you up and get you ready to handle load, and stretching doesn't necessarily do that. But it can be very, very helpful for some people. Some people are lacking range of motion in certain areas and they're compensating and they're waste, and that can contribute to shoulder pain. So I'm not saying, hey, don't do that. I just say I don't prioritize them as much as the main stuff, but if you've got extra time, I would encourage you to do that. The ones I mentioned here could be any, I mean, there could be so many, right? So I mentioned a pec stretch. Uh, child's pose with side reach, which is a lat stretch. So, any lat stretch, wall slide is working on scapular motion, making sure that we're moving up there. And so, kind of talking about all our scapular mechanics. So, those are big ones. Other things you can talk about are thoracic rotation. That's a big one that I see with a lot of people. Is that the thoracic spine is not moving as well? And so you can really pick any stretches you want to do and consistently do them. You feel like they're good for you and they feel fine. I think really reaching overhead might be problematic for sometimes for people with shoulder pain. So, like doing lots of overhead stuff might not feel good. So, staying a little below the shoulder might be helpful. But once again, thoracic spine, lats, pexic, all these things are going to be probably helpful for you, just not the bread and butter of the program. But they're there, and you can do them and kind of incorporate on your off days, which I think can be helpful for people. And so, I do want to mention as well, understanding the shoulder pain, right? So, a lot of times this pain, rotator cuff-related pain, is felt on the front side, or the back side, or the side side. And there's just lots of different ways around it. We're not necessarily sure. Where it comes from, in terms of it doesn't really matter. So, we see this presentation in this pain where it can be kind of all over the shoulder. Typically, the top of the shoulder is not so much. I think of that more as A C joint, but around the shoulder can present really anywhere there. And the big things that people have here is. They have pain going overhead. When I'm reaching up for put the dishes away, or I'm doing an overhead press, or I'm lifting things away from my body, putting behind my back, when someone says, I'm grabbing my seatbelt, or I'm putting on my jacket, it can be really painful. Lying on it may be painful. That's a big one. When people say I have pain at night, a lot of times that's screaming me. This is rotator cuff-related pain. You know, sudden quick movements can be bothersome, and then repetitive arm activities like swimming, throwing. Work tasks, all those things are problematic. And that's like rotator cuff-related pain in a nutshell. We think the tendons are just irritated. That's kind of how I explain to people. Pain is really complex, and there's a lot of it's a whole different talk, but I typically tell people: hey, tendons are irritated. For some reason, we've had the capacity go up or the demand go up and the capacity is not there, and we have this mismatch, and the tendons are irritated. So we have to calm them down and then build them back up. That's how I generally explain it. But the good news is. This is not a dangerous condition, right? So, rotator cuff-related pain, a lot of times, MRI might show some tendonopathy. So, this tendons, once again, being angry, maybe a little bit of bursitis in there. Who knows? All those things are fine. You know, what this is, though, this is just a Chronic condition, not a big rotator cuff tear, right? So, even small rotator cuff tears fit into this box of rotator cuff-related pain, but large tears, which To me, I typically classify if you're getting over greater than 50% tear of the thickness there, then I say that might be a little bit bigger. But small tears, super common. Also, this would work for that as well. In terms of so, not a big injury, not an acute injury. Those are the things that will really irritate overhead. That's the big thing. And for any program, I like telling people to have golden rules or stoplights. And so I'm going to talk about that in a second here. So, some golden rules here is that, you know, I kind of made these up, and that each condition you have, there'll be different golden rules. But here, the big thing is, Try not to irritate it if at all possible when we're resting, right? That's the big thing. If we can have it where we're not having pain, then that's what we're going to do. And I tend to tell people: The golden rules are here to kind of steer you in the right direction. They're not like set and stones have to do these, but they're underlying principles to help you not continue to irritate it day after day all the time. And so, first one is modifying irritating positions and activities, right? So, sleeping, if you're. Sleeping on your right side and you have right shoulder pain, then maybe sleeping on your left side is going to have to happen. Some people may say, Oh, I can't do that. Well, we're going to have to make some adjustments, right? Or maybe you're on your back with a pillow on your elbow. Or something like that just to alleviate some of that pain because that can, once again, if we're triggering it constantly, I always tell them we're not really giving ourselves a chance to heal if we're constantly in pain. So we need to calm it down and teach our body that, hey, it's okay. There's no current threat, and we'll build it back up. Other daily activities, things like reaching overhead, can be helpful using the other arm, going up on stairs, stuff like that, whatever we need to do. Lifting, trying to keep the loads closer to your chest rather than further away, and extreme ranges of motions probably won't feel good as well. And so it's really just listening to your body. That's really the main thing. There's not, once again, nothing you can and can't do specifically, like you can't do this. It's just listening. If you're constantly irritating and reaching up overhead and saying, ow, ow, ow, we're probably not doing any good right there. Do I think we're doing harm? No, that's a very important thing. I don't think pain equals damage. That's a big thing I want you to take away from this: pain does not equal damage. But it's not helping us in the term road to recovery. The big thing for road recovery is to calm it down, let us like relax, let your body be able to relax. And once we're in a calm state, we can start. Slowly, gently challenging your shoulder so that it learns that, hey, okay, I'm actually safe here. There's no structural damage, we're okay. And slowly build upon that. So that's like, for me, pain is more of a marker of, hey, we're just not quite ready for it yet. Not, there's a problem going on. And that's a big thing I want to say: you are. Very, very capable and resilient. Your body is really resilient. And so that's a big thing I want to mention. To go with that, I talk about a stoplight analogy. So I kind of say this is the red, yellow, green. And this is a system to kind of help you understand what motions may or may not work for you. And so this is going to help you customize your own program. So, I always tell people on a scale of one to 10, how much pain are you having? That's like a date activity. I guess zero to 10, you could have no pain, which is wonderful. But 0 to 10, 10 being the worst pain you could ever imagine, and then zero being no pain. I tend to tell people, hey, I categorize things. Green is like around zero to three. The yellow is around four to five, maybe six. I typically put four or five just it's easier there. And then red is six to 10 out of 10 paint. So, green is kind of this zero to three, like you're pretty much good to go. If you're doing an activity that gives you green levels of pain, like, ah, just a little bit, I can feel it. Like, I'm okay with that. That's fine. Like, we're going to have some pain in this process, and I totally expect that. That is normal. And so, if you just waited till you had no pain whatsoever, you'd probably be waiting months and months or never doing this at all. So, a little bit of pain is okay, but I would say it's more discomfort. Like, this is like discomfort level. Whereas, yellow, we started getting a four and five. This is once again proceeding with caution. This is not a hey, stop, you're doing damage. This is awful. This is just, hey, we're probably doing a little too much. I say it's okay. To continue there for a little bit, but not push past it, not go further for a long time. Just think about: hey, maybe we need to scale back down so we can get back to the green. The goal here is: if we do peak there, pain should return back to the green level within a few hours. For sure by the next morning. That's a big thing. When we're looking at these pain symptoms, I always talk about the next 24 hours. So, if you're doing something, you're doing an exercise, you have pain. How does it feel? Are you feeling okay now? And the next day you're really sore? Well, then that might have been a little too much. And that's something to keep in mind. That's typically how I present with my shoulder pains when I have them. Feel good, everything's fine. The next day, I'm like, dang, what did I do? And that's how I present. And so looking at it 24 hours, saying, hey, if I have a bump up from green to yellow the next day. Then, whatever I did the day before is probably a little bit too much. And so you can kind of titrate saying, Hey, oh, I did four sets instead of three sets. Maybe I need to go back to three. I'm not quite ready for four. Or I did, you know, went from 10 reps to 15. Maybe I got to pull back down to 10 or go up to 11, just kind of slow. It just gives you an opportunity for auto-regulation, is what it's called, to kind of slowly guide how much your body specifically needs because nobody knows your body better than you do. So. And finally, the red is six to 10. To me, I just tell stop here. Like, not like that, it's necessarily damaging anything. You're just not helping anything. It's going to be painful. You're probably doing too much. Your tissues aren't ready for this, and it's just going to be a bad time if you continue to push through it. So, just kind of. Calm it down, back rest, rest it off a little bit, and then kind of try to ramp up from there. So, red is just for me, more for me. Hey, we're not doing any good here. Like, pushing through this is just gonna be a lot of pain for you, and not going to get what we want out of the exercise. So, let's just pull it back, try to get back into that green if possible. And go from there. So, stoplight is generally pretty, hopefully easy for everyone to understand. Everyone understands a stoplight. And so, we can hopefully just have some more information. You can kind of help guide yourself. And now I move into the meat and potatoes of this. So, overall, this, when I think about rehabbing it, we always think about different phases. You know, it's almost like puritization when we're doing strength and conditioning. But for me, Phase one, two, and three, it's just easy to have three, right? Everything works better in three. So I put this into three different phases. So phase one is like the calm down phase. Phase two is building strength and control. And phase three is more strength and getting you back to almost where we want to be, is where we're going. So. In that first phase, like the big thing is just calling things down. And how long do these phases take? Well, it's variable. Everyone's different. I can't say yes, it's going to take it. You know, if you look here. I'd say one to three-ish weeks. Some people take longer than that. Then, phase two, four to eight plus weeks. And once again, phase three, four to eight plus weeks. So if you look at that, look at eight weeks plus eight weeks plus three Weeks, you know, we're looking at a long time, multiple months, right? And so that's a they Mindset: I want you to have that. Hey, this is going to take a while. Phase one, though, is really where we start. This is when your shoulder is irritable and flared up and cranky. And the goal here is just to reduce pain, kind of learn some. Good habits, how to take care of it. Once we talked about the pain rules, understand that initiate, you know, getting range of motion back a little bit, but just really trying to move your shoulder in a gentle way to get your shoulder to understand: hey. It's okay to move a little bit. We have certain positions that are safe and just kind of calm things down. Things we'll do here are a lot of isometrics. So, isometric internal and external range of motion. Scap squeezes, all those things. And the goal here is to get your daily pain down. So, once you are your daily pain is low, you can complete these phase one exercises. You're feeling good without consistent flare-ups, you feel good with the golden rules and with the stop-light analogy then. We're ready to roll, right? So, I don't expect you to have zero pain, but once we've kind of calmed it down, you're not acutely just ow, ow, all the time, then we can move over to phase two. So, phase two, we really start to work on building up that strength of the shoulder and around that area. Once again, we talked about we're using this when daily pain is minimal, we're ready to roll, but it doesn't necessarily have to be zero. But so you could start right away at phase two. So if you're saying, hey, my pain's actually like a two, I don't have to do, that's fine. And you can always revert back to phase one. As needed. So, if you're having irritation in your shoulder and you're really flared up, going back to phase one for a couple of days or a week is going to be totally fine just to calm things down. So, this is kind of fluid. It can go back and forth. But, phase two, If you have minimal pain, you can start right here. And the good news about this is look at eight, you know, eight weeks here, eight weeks there. It's still 16 weeks. It's still a long time to get strong. We can go from there. And as I mentioned, all these things, any of the activities or exercises I'd recommend are just literally. Recommended because I pick them. They're not magic exercises. I know I see a lot of things online talk about the big three, this and this, that. Literally, I just picked them because I thought they were easiest for people to do and like simple, people can do them at home. Like, there are so many exercises you can do that will work. So, if you feel like, hey, I didn't like this one, I want to do something different, like, that's totally fine. This is just me saying, hey, I think this is helpful. It's nice for people to have like one definition, like, do this, because sometimes when you have multiple choices. Of, like, oh, this, this, this, that. It's too much for people, and they get overwhelmed. And so, this is just me saying that. And so, if you say, Hey, that's stupid, I want to do something else, that's fine. I don't care. But phase two is where we build it up, right? So, we're strengthening rotator cuff. For the scapular stabilizer muscles, improving our movement patterns and range of motion, hopefully a little bit, and just start to build that load tolerance. So your shoulder can get used to it. I use sideline external rotation, banded rows, push-up plus motions, and all of in the actual, you know, there are exercises that will be listed. For Specifically, there's links to them, and you can see demonstrations on how to do that here in the actual program. But those are what I picked. I picked an external rotation one, I think that's very important. Banded rows, if they're looking at our Kind of scapular stabilizers looking at our posterior back and then push-up plus is looking at our serratus and kind of once again more scap stabilizers so I'm just working on a rotator cuff scap stabilizers like that's The big thing that I'm looking at there. And once we're good there, we're doing lots of things. I mean, complete with good form, minimal pain, full comfortable range of motion. We can move on to phase three, which is just more of that, essentially, more building strength. All that stuff. I choose full cans here. So, standing abduction and getting more into the abduction of the shoulder, which is kind of bringing your arms up to the size of bringing them like that. That's our abduction. That's what we're looking for. We can also do push-up variation, so actually getting back into pushing and more challenging rows as well. And this is really, once again, just building capacity. And So, phase two and three is kind of like a continuum. Like, really, you could just do like ride out phase two forever and just choose new exercises, phase three, new exercises. Like, they're kind of blended. I just chose phase two as like a gentle strengthening, and then phase three is like more, just harder, I guess, more difficult exercises. And so, once again, there's so many things we can do and kind of go from there. But I'm just going to take you through what the rest of it looks like: phase one, as I talked about, calming things down, talking about golden rules, pacing, sometimes little Bits of exercise feel better than long durations of exercise. That's something to think about. There are links here. So we have the isometric external rotation. We're getting up to a wall, going into external range of motion, not pushing out with our arm. The big thing for that is we are not trying to do this motion. We're trying to do this motion. So, externally rotate. That's what we're going. And internal is going to be opposite, coming in this way, just isometrically holding it there. We found that tendons like isometric load, it just like sometimes can be analgesic for them, meaning it decreases the pain. So, this is like really, I'm just using these to just calm things down. So, we have those, and then on top of that, we have scap squeezes as well, which is just pulling our shoulder blades down and back. And so. You could do this for a couple of days if you need to. You could do it at any time. They're pretty simple. This is just more of a, hey, like, how do I troubleshoot if I'm having pain? And then moving on to phase two, this is once again, we talked all that stuff, building strength and control. Exercises. So, sideline external rotation. And the big thing, the cues I want to talk about here is having someone underneath your elbow is very helpful. It just puts your arm in what we call the scapular plane. So, right in front of you is right in front, and then scapular is kind of out to the side. That we tend to have a little more isolation on rotator cuffs. So, putting something underneath your elbow is helpful. If you don't like sideline, you can do this with a band standing. You can do really anything for external range of motion. There's no big deal. But I like it sideline. It's just easy. And you know, it's everyone can do that pretty well. And so that's when we do banded rows. I have this doing one-handed pulls. You can do two-handed pulls. You could do. Lots of different things, tons of different ones. You know, for banded rows, we could either do, if you wanted to, you could also, this is looking right back, kind of the shoulder and the scap stuff. You could do, you know, eyes-wise or T's. Eyes usually early on probably don't feel good, but T's or A's, you could do those as well, which is worse since you're bringing your arms back. Into extension a little bit, or we could do teaser coming out to the side. Those are all acceptable as well. Once again, find what works for you and do it. This is just a sample of what you can do. And then the other one I have is push-up plus, which push-up pluses can be helpful. That's working on that sterratus. Once again, those scaps. Kind of stabilizers. It's getting a little weight bearing through the shoulder, which can be helpful. Sometimes we can just tolerate when we have closed chain. When I talk closed chain versus open chain, what I mean there is an open chain means my hand's open to the air, whereas closed chains, it's against something, either the wall or the floor. And sometimes we can do. Handle a little bit more load when we have a closed chain as opposed to open chain. And so I just did that to try to introduce a little bit of load through the shoulder, which can be helpful trying to get used to that because most people want to get back to doing something with load through the shoulder. And so that's there. And then phase three, as I mentioned before. I call it advanced. It's all just a spectrum, but it's just more just getting bigger. So, you know, A-B-duction, kind of the shoulder raises we talk about that come out to the side, shoulder full can. Empty cannons, the tests we do, full cannons with a thumbs up. You're just getting to be able to handle a little bit more load here, is what it's going to come down to. It's going to be there. And I should mention all these things I want tempo. Tempo, tempo, tempo. So, like, for that, we're going to do three seconds up. Hold for split second and three seconds down. Once again, because we find that tendons like load. That's the big thing. Tendons like load and this heavy slow resistance is Slow up and slow down. You could just do up regular and slow down. That's called just eccentric, but I like heavy slow resistance because it's just easy to count, right? One, two, three, one, two, three. Gets lots of force through those tendons and can be very, very helpful for just loading them up well. It gives them enough force through them, and tendons need load to get better. That's what I typically Prescribe for patients, and so just nice and slow tempo. You're going to be humbled by that. When you do a three-three tempo, it is very humbling. You're like, wow, I'm really weak. And so, the goal here is just to get stronger but not have to overload you. So, you can use lighter weights here. And still gain that confidence, but still get a good workout in, which is very important. So, we talked about the full can, and then moving on that is high rows or face pulls. Once again, just looking for the scapular stuff, right? So, we're just trying to get strong back there. And this is an option for high rows versus face pulls. High rows are a little more at the chest, face pulls are going to be up towards the face, and that puts in a little external range of motion as well. And that can be a little more irritating when you get those arms above head. So you have options there to play with. And once again, any rows, totally fine, no problem with whatever you want to do. And finally, push-up progression where we're talking about going on the wall to your knees to a bench to the full push-up. So, lots of things just once again getting load back and getting you stronger is the big thing. And after you've done that, hopefully you're feeling good, right? And the question might be: well, when do I graduate the program? Or when am I ready to get back? And it's when you feel like you have strength on both sides, that's pretty equal. When you can perform your daily activities, including lifting, reaching overhead, and you're not really thinking, right? You're not hesitating. The big thing when people have pain, they're like, oh, I can't do that. That's hurting. It's when you can just get back to your normal function and do things without thinking. That's a big thing. And then, if you want to return to high-demand activities like throwing sports, swimming, functional fitness, or a physically demanding job. That's when we're ready to go and continue on. But you'll need extra stuff. So, as I mentioned here, graduating the program. What do you do next? Awesome. We figured it out. That's great. But how do I get back to my specific activity, Jordan? I am an ex-person. I am an athlete doing this or that. Well, first things first, it's going to be slow, right? So, increase over time and then listen to your body. Some specifics I talk about are for like weightlifters. If we're going back to wanting new big benches or overhead pressing or something like that, starting slow and building up, I know it sounds like a broken record, like Jordan, let's want to get back, and you might be able to get back fast, and that's totally fine and great. Slow and steady will win the race. Just in terms of that, what we know we're appropriately loading there. But if you're a weightlifter, let's say you're benching, start with something light, whether it's PVC or just the bar. And go from there. Work on. I like doing tempo still, work on that and slowly add our form, kind of going up higher and higher, adding on reps as we need to go. If you need to modify range of motion, you can do that. But either way, that's what we're doing. And if you are an explosive athlete, well, that's going to take a while as well, right? So, if you are an athlete who needs to get back to an explosive sport, hopefully, you're actually working with a physical therapist, right? Like, this will never replace a physical therapist. That's not my goal. My goal is to. As a primary care doctor, I see people who have shoulder pain and then they get you know some exercises they see online and they just do stretches and it's not really a solid program. And like my goal is just to give you a solid program that like you could use and just go. And like that's that's the main goal there. But this will never replace a physical therapist or a high-level athlete. Like, there's just nothing that will come close to having a hands-on person and a personalized program. But that's just to there. But if you do want to get back, we're going to have to build up some power. Introduce some plymetrics, which are kind of like you think about if you're throwing, it's going to be some wall throws or some medicine ball throws or something like that to kind of get there, and then slowly mimic your sport. If you're a throwing athlete, Starts slow, maybe 25 to 50% effort, kind of slowly going up, gradually increase your effort and then your volume, or vice versa. Never at the same time, don't. Increase your volume, like meaning how much you're doing and your intensity at the same time. Just pick one variable and tweak it from there. But really, for most people, they don't need that, right? They're just like, I'm gonna get back to living my life and like going to the gym feels good. Now I'm fine. That's fine. This is just more for giving you a guide. That's going to be kind of niche cases of when Silman needs to get back, but that's something I want to think about. And then As with all rehab programs, it's really important to be consistent, right? And patient. So, you putting in the work is going to do it. That's why I believe so strongly in home exercises and physical therapy that involves. You're doing something. So there's nothing wrong with passive modalities. Passive modalities mean like electrical stimulation or massage or manipulations, like those all have a place in the rehabilitation spectrum. Absolutely. I mean, I mean, I do injections all the time. Like that is a passive modality. Like that, there is a place for that. But the vast majority of people would do fine with just active activities and progressions, which is. I like that the best because it's going to be the cheapest in terms of like, hey, go home and do the exercises, and you're going to get better. You don't have to keep coming back. You're not relying on someone or something to help you. You're giving yourself like the autonomy to do this. And so I believe strongly in that, but you have to be patient. This will take a while. Continue to use pain as your guide. Listen to your flare-ups. If you have it, don't push through it. Just live to fight another day. So there's going to be good days, bad days, and that's okay. And then just kind of see where you are. I always tell people that when we're exercising, if this on the y-axis, if this is pain and the x-axis is time. I really don't care where your slope of your line is as long as the slope's going down. So we're saying at the start, it's really high, and as we go down, you know, as we go further in time, it's going down. That's great. And some people have a very steep slope, meaning they recover really faster. Others, it's very gradual. But Look back and say, Hey, where was I three months ago? What couldn't I do back then that I can do now to remind yourself you're making progress? And so that's just a big thing: be consistent, but also be patient. And this is just a starting point, right? Everyone's recovery is going to be different just because your friend recovered in four weeks doesn't mean you're necessarily going to do that. It may take a while. But once again, If there are ever concerns, like this is not, I'm just, I'm just a dude on the internet, right? So, this is not formal advice. Check in with your doctor or physical therapist and get a hands-on assessment. That's always going to be the best answer if you're confused. Like, this is just more for me to inform you how I think about things and how I go from there. Other things that I will see people will ask up in programs. Hey, I feel some clicking or popping when I do these exercises. Is it bad? Well, like, no, we can have some clicks and pops. That's totally fine. Big thing for me is if we're consistently having pain with the clicking and popping, then we might need to consider: hey, maybe we need to alter something or look at there. But if it's pain-free, then we're good to go. As I mentioned before, how long will it take? I've been doing this for two weeks and I don't feel any better. I feel it all the time. You know, I see that all the time, unfortunately, patients will go to their primary care doctor and then get referred to me and they did physical therapy for two weeks and say, hey, I'm not better. I want an injection or something, and I have to kind of have to talk with them saying, Hey, like, I wouldn't expect you to be better in two weeks. That's that's not the case. And do I love doing injections? Yeah, they're great, but I want to do them when they're the right time for the right patient, and we'll actually get the most benefit out of it. So Stick with the progress. I've talked before, stick with the program. It's going to take a while. Next question is: hey, I had an MRI, and it says I have a small rotator cuffed here. Can I do this program? As I mentioned before. This is not specific advice, but if we have a very minor rotator cuff tear, this would be an appropriate program for there. I think there's, I haven't met many people in the world who are ready to go to surgery after a minor rotator cuff tear. Obviously, if you're an elite level athlete, maybe that's different. But for most people, you're going to find these small tears on a lot of people, and we can rehabilitate them usually pretty well. And so that is not an indication for why you can't do rehab. If you have a small rotator cuff tear, that will probably be the first thing a surgeon does. If you go to a surgeon, they'll be like, hey, did you try rehab first? And they'll send you there, anyways. And so, totally understandable that it can be scary to read that, but it is not necessarily a game over. And then talk about flare-ups. What do we do? As I mentioned, just don't panic, stick with the process, go back to don't push through flare-ups, listen your body, all those things, no big deal. Equipment-wise, this is pretty minimal. I just talk about bands and a little bit of weight. Stretching, we mentioned that as well. Why don't we stretch more? You can totally do it. That's totally fine. Why don't have more of it? It's just my personal preference. But you can totally knock yourself out. If you feel like stretching is good for you, go for it. And the last question is: well, do I have to do this forever? Like, am I now, if I don't do these, I'm going to be weak and whatnot? Well, the answer is, you don't necessarily have to do these forever. In fact, I don't encourage you to do the entire program forever. However, it may be helpful for you to incorporate some of these exercises. In phase two and three, for you know, a couple times a week, or for a warm-up before you're doing an upper body day. It can be helpful for you sometimes. You know, they talk about activation, activation, you know, activation of the rotator cuff there. I find sometimes people just Tend to feel better when they do these before they exercise. I'm not going to say I have a magic reason for it, but some people just feel like it's, yeah, maybe it's the placebo of, hey, I'm doing something for my shoulder, but or it's just truly doing a warm-up, right? Warm-ups are super, super important to get blood flow and warmth to the area. So, that's kind of how I'd recommend doing that. And so, overall, that is how I think about shoulder pain. Is this the program for you? Is this the one program for everyone's shoulder pain? And the answer is no, because that doesn't exist. You'll see on things on social media. Say, do these three exercises for shoulder pain. And maybe that'll work for people. And that's wonderful. It's great if it does. But at the end of the day, if those three exercises worked for someone. Three other exercises probably would have worked as well because the odds are they would have gotten better. The cool thing about sports medicine is that a lot of times people regress to the norm, meaning, hey, they have pain. A lot of times things just get better. That's like what the human body does. But occasionally we get stuck and then we got to kind of nudge it and guide it in the right direction. That's where we come in with physical therapy or formal programs like this. Totally fun. Yeah, but Ultimately, I just want you to have the freedom to know that, hey, it's a process. You can listen to your body. You can select things if you want. I just made a sample, like a just a, I really made a sample for this talk so I could give this lecture and just say, hey, this is how we do it. And then in the programs, there as well. So. In the links of the show notes and links in the description, there will be a link to this program. I want this to get into as many hands as humanly possible. So I'm making it a pay what you want starting at $5. I did put $5 in there because. There's an FAQ I've explained on a website that when you have a buy-in, like when you've physically paid for something, you are more likely to use that and get better. And so people will hoard free things, right? Never use them. And so even just a small nominal amount. Can help you in terms of your commitment to doing something. And so it's not a, hey, I'm trying to get money out of you. It's just more, hey, it helps you have a buy-in as well. And it helps maintain things as well and keep the website out. But the big thing is, it really helps encourage you as well. So. But it should be out there. My goal is so anybody can use this, right? I want this to be accessible to everybody. I know a lot of people go to primary care and they can't afford physical therapy. And so I wanted to have a program that At least we'll get you in the right direction. Now, am I saying I'm a physical therapist and this is good? No, absolutely not. I want any physical therapists in my audience to hear that and understand that I appreciate you and I love what you do. I'm not a physical therapist, but I want to create tools for my patients that I feel. Confident that, hey, we're at least in the right direction. Is this as good as hands-on? You know, tweaking things week to week. No, it's not. But at least I know here, working through a progression. And if they fail this, saying, Hey, I got no better, then we at least have had a good start at home therapy and we haven't just spun our wheels for multiple weeks. And so Links will be there if you want to. If not, I just walked you through the entire thing. You could just watch this video and do the program yourself, and that's totally fine as well. Either way, to me, my main goal is to get people better and being active and healthy for life. That's really what I care about. And so. Hopefully, you did find this helpful. If you did find this helpful, it would mean the world to me. If you shared this with someone and sent it their way, saying, Hey, I thought this was helpful. Maybe this is helpful for you. Or if you liked or commented, that would also mean a lot to me as well. Either way, I really appreciate all support, but it's time to get out of here. Now get off your phone and get outside, have a greaser day. We'll see you next time.
