Why Your Shoulder Treatments Might Not Be Enough
In this week’s episode of the Unreal Results podcast, I revisit episode 16, Why The Shoulder Comes Last. Part of the reason why has to do with a story regarding my sister who has been dealing with chronic shoulder pain, which resolved immediately following a treatment that wasn’t for her shoulder. But in this episode, you’ll hear me challenge the traditional approach of treating the shoulder by first understanding the surprising connections & influences of shoulder pain from the nerves and visceral organs.
Resources Mentioned In This Episode
Episode 16: Why The Shoulder Comes Last
Episode 5: Thoracic Outlet Syndrome
Online Course: Never Treat The Shoulder First
Birthday Sale: Get the savings HERE
Upcoming In-Person LTAP Courses
LTAP Level 1 in San Diego, November 2024
LTAP Level 1 in Boston, October 2024
Considering the viscera as a source of musculoskeletal pain and dysfunction is a great way to ensure a more true whole body approach to care, however it can be a bit overwhelming on where to start, which is exactly why I created the Visceral Referral Cheat Sheet. This FREE download will help you to learn the most common visceral referral patterns affecting the musculoskeletal system. Download it at www.unrealresultspod.com
=================================================
Watch the podcast on YouTube and subscribe!
Join the MovementREV email list to stay up to date on the Unreal Results Podcast and MovementREV education.
Be social and follow me:
Instagram | Facebook | Twitter | YouTube
-
Anna Hartman: Hey there, and welcome. I'm Anna Hartman, and this is Unreal Results, a podcast where I help you get better outcomes and gain the confidence that you can help anyone, even the most complex cases. Join me as I teach about the influence of the visceral organs and the nervous system on movement, pain, and injuries, all while shifting the paradigm of what whole body assessment and treatment really looks like.
I'm glad you're here. Let's dive in.
Hello, hello, and welcome to another episode of the Unreal Results podcast. So, uh, just a reminder that the podcast for the summertime, so about a month and a half between the beginning of July and the middle of August 2024, We're going to be doing some, um, reruns, but not whole episodes, just clips of some of my favorite things that I've covered in the last 66 episodes.
I'm going to be focusing on more of the episodes that haven't got as many downloads as others. Um, just thinking that, you know, Not sure why you missed it, whether it was timing of the year, or the title, or whatever. Um, want to make sure you get the information, and then also I know that when you, when it comes to learning stuff, whenever you can hear it repeated again, it's going to have a better opportunity to sort of be absorbed and stick.
And then also, um, my experience and a lot of the mentorship alumni. Experience is when you re listen, re watch material, go back to it in a, you know, in another year, in another time, sometimes you hear and catch different things because often what we pick up in a class or what we pick up in a lecture is what we need to hear in that moment.
And you are a completely different person now than you used to be, um, a completely different practitioner, especially if you. been listening for a while and implementing some of these practical tips of utilizing a more true whole body approach, uh, that considers the viscera and the nervous system in your, uh, assessment and treatment plan.
So, um, Maybe it is exactly what you've already heard, but you're going to hear it in a different way and pick up different gems and different information from it. So I hope you enjoy it. I'm curating this specifically for you. And, uh, thanks for being here. Enjoy this episode.
This episode clip is going to be from season one, episode 16 called why the shoulder comes last. Um, it is one of my favorite, uh, episodes because it's one of my favorite topics. I have a whole online course that came after this, um, podcast episode called never treat the shoulder first, which is one of the courses that will be on sale during the flash sale.
Um, but I wanted to share it this week because um, I recently shared a story about my sister who has been suffering from shoulder pain for about a year and a half I knew it was coming from somewhere else, but I don't live in the same town as her, so I couldn't evaluate and treat her to like, figure it out.
But she recently had emergency dental surgery, and literally after surgery, woke up without shoulder pain. Because it turns out, her shoulder pain was from a silent infection of an old root canal in her mouth. And so I'm going to quickly, before we dive into the clip of the episode, I want to quickly talk about the anatomy of that relationship and probably what was going on.
It was probably a combination of one, her lymphatic system on that side of her head and neck being very overwhelmed with pain. You know, from an immune response dealing with this infection and as well as the relationship of the trigeminal nerve, which is the sensory nerve to your teeth, to your gums, to your mouth, and the relationship of the trigeminal nerve to the cranium and the neck itself.
So that's more than likely how it works. created shoulder pain for her is a backed up clogged up lymphatic system, either creating pain itself or just compressing on the brachial plexus and the cervical plexus nerves because her pain was very cervical plexus, superclavicular nerve pain, or a combination of the relationship between the trigeminal nerve.
The Tentorium, general cranial tension, um, which is reflected in cervical plexus nerves as well and can cause that referred shoulder pain too. So it's something. Um, not specifically that I talk about the dental piece in the episode, but it's definitely similar anatomy that we talked to talk about in the episodes as well as in the Never Treat the Shoulder First course.
And so, it just goes to show you that indeed, We have to be aware of the whole organism, this whole organism, the viscera, the nervous system, the lymphatic system, the immune system, and how that influences the musculoskeletal system. And so this is why for this week's rerun clip, I am picking episode 16 from season one, Why the Shoulder Comes Last.
I hope you enjoy it, and we'll see you next week.
part of the reason why the visceral pieces are gonna come up when it comes to pain secondary to movement dysfunctions. Of the upper extremity as well, because we look at the visceral organs and we look at the way they refer to the upper extremity and it's, it comes down to the nerves that innervate or, or, yeah, the nerves that innervate, the visceral organs and their containers from a sensory standpoint.
So these are going to be. The organs that are innervated by the phrenic nerve and the vagus nerve, so specifically the phrenic nerve. The right phrenic nerve especially is a sensory nerve to the upper. Abdominal peritoneum as well as in the mediastinum of the thoracic cavity and the pleura. So the, the phrenic nerve is going to be sensitized when there is an issue around the liver, around, uh, the gallbladder, around the duodenum, the.
Pancreas, the stomach and all of the area of those organs, right? So the upper perin peritoneum, so the ligaments between those organs, the hepatic duodenal ligament, the gastric hepatic ligaments, the gastric duodenal ligaments, this suspensory ligaments. Uh, holding the things into the diaphragm, the underneath, the, the diaphragm itself, right?
That upper peritoneal area is one of the main sensory nerves is the phrenic nerve. Another one of the sensory nerves. The most, the more famous of the two. Of the nerves is the vagus nerves, and so when there is something wrong with the organs, right, either the organ is diseased or inflamed or not moving well, or just not functioning well.
The message gets relayed on the vagus nerve and on the phrenic nerve up to the brain stem in the cervical plexus, and then the cervical plexus, and specifically the phrenic nerve in this sense shares nerve roots with the brachial plexus. That means that anything along the brachial plexus, which is the nerves that go to the upper extremity, can be affected.
In addition to that, maybe more even common from a movement dysfunction standpoint is the cervical plexus nerve and the air, the nerve roots that the phrenic nerve comes from. Also give off this nerve called the nerve to the subclavius. The nerve to the subclavius is also the nerve that goes and innervates the SC joint.
So not only does it innervate the subclavius muscle, which is the muscle beneath the clavicle, but it innervates the sternoclavicular joint. And the sternoclavicular joint is the joint that dictates movement of the entire upper extremity because that is where. We are connected, right? This joint is reflected in all the ranges of motion of the scapula.
So in order for the scapula to elevate depress protract, retract, anterior tilt, posterior tilt, it needs to have good function of the SC joint. So if that joint is getting mixed messages from the influence from the phrenic nerve. From the viscera, then it's gonna affect the motor control of the upper extremity.
Why does this, why is this interesting too? Because when we look at the scapula thoracic joint, which is the, you know, a false joint because it's not an actual bony articulation, but the dynamic interaction between the shoulder blade and the ribcage, which is what dictates where the arm, bone, and forearm and hand get placed in space.
That motor control is very dependent on all of these good motor patterns and musculoskeletal balance of everything as well as the. Movement of the SC joint. So oftentimes when we see scapular thoracic motion, that is not good. Alright? Or often called scapular dyskinesis. We blame the muscles. We say the muscles aren't strong.
Um, or they're not turned on or they're too active or underactive or inhibited or whatever, right? But oftentimes they're not able to do their job because the clavicle specifically at the SC joint is not able to move very well. Then when we get the fine tuning motion of upward rotation and downward rotation, that motion is happening at the AC joint.
But the AC joint is very dependent on what happens at the SC joint, right? So again, or the SC joint. So again, if, if our SC joint is not free to move and does not have a healthy message to it, then everything else down the chain falls apart.
especially too, when we consider that a lot of the input to those muscles that control the Scapulothoracic movement. Come from nerves that are part of the brachial plexus. So then we have kind of a double whammy from the influence of the viscera. Is that maybe that means the SC joint is not moving very well because the subclavius is not moving, or just the joint itself is kind of funky message, right?
Or. But then too, it has, it shares nerve roots with the brachial plexus. So then the message to all of those terminal nerve branches at each level, because we start, we're starting at the root level. So the roots, the trunks, the divisions, the chords, and the terminal branches are all affected by this message.
And it's those terminal branches or those branches that come off the the roots or the trunks or the cords. That go to the 18 muscles that attach to the scapula, those 18 muscles that attached to the scapula is what gives that fine tuning balance of mobility and stability to the upper extremity. So then all of the theories of why someone might have shoulder pain due to poor scapular thoracic control.
They're still true, but the way you go about treating them are different. You're not gonna jump to smashing a muscle, dry needling a muscle, cupping a muscle, or strengthening with like traditional scapular stability exercises right out of the gate because you're, you see this cascade of how it's influenced by the other stuff going on in the body.
Now also, it's important to remember that you can have other stuff going on, and this is why it's like, okay, well Anna, sometimes maybe it's not a visceral thing. Then can I go to the shoulder first? No, because most of the time if it's not a visceral thing and it's not the upper, like it can't, it's usually not the upper extremity itself, then that means it's coming from the cervical spine or the head.
And cranial nerves, right? Because the head is often placing itself wherever it needs to be to keep your eyes horizontal, right? Like. Parallel to the horizon to keep your body level. And so sometimes like if our eyes are not functioning well or our smell's not going well, or our hearing or our vestibular system off is off, we will change the position of our head and neck and then that also can change the input through the BR brachial plexus or just change the length tension relationship.
Of the muscles that go attach from the spine, from the cervical spine to the shoulder blade or to the shoulder itself. The other thing that happens is issues down in the lower extremity, right in the lumbo pelvic area, the rib cage, the the lower extremity itself. If these things are altered, right? If, if we're protecting a visceral down lower and we're in a protection pattern around that and we cannot move through normal ranges of motion, then this gets translated to the shoulder because again, 18 muscles are attaching to the shoulder blade, and those 18 muscles are attached to ribs, they're attached to spine, they're attached to, um, like.
Other muscles that connect into fascial chains that go across our abdomen or across our back to the opposite side, hip and down the leg. And so oftentimes too, what we see with shoulders or upper extremity issues is it tends to then that would fall under the category of like kinetic linking issues. And oftentimes people think of kinetic linking when it comes to throwing or like swinging a golf club or a bat or something like that, which is a great example of it.
But just life, like in just lifting up my arm, I have to stabilize my core. And stabilizing my core means I have to ground through my pelvic control on one side and ground through the leg on both sides, really to lift my arm up. And so sometimes when those things are compromised from a visceral issue or from just a a, a strength and stability issue, that our shoulder is compromised. So oftentimes the pathology comes out in our shoulder. But it's not where it's coming from. Okay.