Personal Health Scare Leads Dr. Premer to Alter His Life's Work

Beau Beard (00:03.561)

We're back. Episode 48. I think it's 48. Yeah, we were just saying why it's important not to forget the basic sciences once you learn those because if your child drops a sulfuric acid bomb on your hardwood floor and it starts to smoke and burn through the floor and the towels that you throw on it, you got to remember what you put on it. So what do you put on it? You're supposed to vinegar would be number one.

or it literally says when I read the back of the bottle, things to have on hand. Baking soda, vinegar, there was one other thing I don't know what it was. I was like, yeah, I understand why now. So yeah, it was my fault. I put the stuff on the stairs to take upstairs to store it away from where little kids could get it. But in that transition time, a small Tasmanian devil by the name of Kit dropped it on the hardwood floor, which will now cost us unforeseen amounts of money, stress, and yeah.

So the farm shut down because we couldn't afford to fix the hole in our floor. Yeah. And there were other little kids over there playing that I probably traumatized for life. So for good reason. Don't know not to use white lightning, which you know who told me about that the first time ever? Dan O'Quinn. Really? Because you've never seen that stuff in the jug that has to come in the bag and it stays in the bag because it's so like noxious. Now I know why they keep it in the bag. I thought I was talking about Bailey.

On to brighter notes, was, oh, we've got a speed demon in the house. So you gotta tell him that one mile time trial, what'd you drop on that? When was that and what'd do? That was on Saturday. Yeah. And I clocked to 5.36 miles. Yep, he'll be in. Without training, I was pretty happy with that. But all thanks to Alex, he was there to run with me. Non-paid rabbit. Any other updates on that?

before we give away some of this. When's your race coming up? Dude, you've asked me this 18 times and I have no race coming up. I've literally never said I had a race. He asked me this. He's a professional trainer. He has asked me this probably at least three or four times this week. The pendulum swung. We spend no time together anymore. I was going to say and they live together, yeah. I did tell you, this is where it gets confused. Okay, I did tell him that I was training for the race of life.

Beau Beard (02:31.598)

And ever since then, he has stuck that I'm More than more than those thoughts. And that's a long, long nobody's beaten that. They played a game. That's a daily Roger Bannister moment. Constantly, they're all trying to seek the first ever sub four second thought. Yeah. And they don't quite win. All right, let's give some away. So we.

said, so the podcast was two Thursdays ago and Trent had thrown down the gauntlet of guess how many times we use a rock tape product in the clinics. That would be all clinicians using, we were kind of debating about the guess that was given. There was only one guess so things goes. But the guess was 26 times over two treatment days and I kind of said I think I agree with that. Between, you know,

I don't use Flossaton. I use it sometimes. I saw yours on Apple. Did you use yours the other day? I used it four times on Friday. Yeah, that's just on himself. And then they have, I thought I said military grade, medical grade silicone. So they have cups. So we're cupping a lot of people for variety of reasons. Vibrating cups, which is a separate subset. We have all the stuff back here. Blades. have a, what's that actually called? What's the description on the top one? What do they call it?

Rockwave Pro. What's the description say? So this, it just is different languages. Rockwave Pro Vibrating Massager. It's like four different frequencies. It's got some different heads. I use that a lot and kind of mimic Steco. then, yeah, tape. So again, you some pink archival up there. Rocktape was nice enough to send us a bunch of Rockfloss tape, their new Rion tape, which is basically when you basically

tape, doesn't have any give. If you're just loading it slow, it gives just like regular rock tape. Cups, vibrating cups and the blades. So today from our one guest, or one guess from a guest, not a guest, I don't know. Griffin Maloney. he guessed 26 times over two treatment days. You're wrong. I actually don't know. I think it's more, but you get a, these are XLs. don't know. yeah, I that one. There you go. I didn't know these were bigger.

Beau Beard (04:55.79)

So you get the XLs there, Griffin, and you also get some rock floss. So what I need you to do, and this is also going to prove out if you continue to listen to the show, you have to me your address where you want these things shipped and we'll also throw in a farm hat. I expect, fully expect some sort of picture with your farm hat on, with cups on your face, with something on your body rock flossed. If I don't get that, I'll send you a return label. yeah, anything else?

So theme of the day is overhead athlete. And we have, sport-wise, have swimmer, runner, volleyball player, and then a softball player. So we're gonna play spin the bottle to see who's going. This seeming little weird already. We got some Pellegrino here.

Okay, so the theme is, boy. He's so He loves slamming at you. Golly, man. Okay, so the theme today is overhead athlete, but we're gonna see one of the, because we all know the injuries that are going on, only one of these injuries is really around the shoulder, we think, you know, typically shoulder, neck, maybe upper back stuff for overhead athlete.

So mine is a 13, 14 year old softball player. She's played softball since she was seven or eight years old. She's a beast. She plays third base in pitches and likes pitching, but plays more third base. So she would rather pitch more. She's doing the typical thing that kids are doing now. So she does, you know, travel ball. She's doing school ball. She's also doing pitching and hitting lessons and her week and then training like strength conditioning stuff. So her week looks like a professional athlete. I have

We'll leave that for a different podcast. It's a bit much and well, guess it does. That is important to her case. I think the entire reason what she came in for, which was low back pain, the reason it started was she was doing too much. I don't think it's necessarily all of what I'm going to talk about on the mechanics of her throwing. think that definitely plays into how we're going to back her out of the pain scenario she's in. But she came in doing everything I said, like within any given week and it also added school ball and games and stuff back in in the prior.

Beau Beard (07:14.722)

her three weeks prior to seeing me. there's, don't think I need to go through like, what her top tier SMA is and things like that. If I'm being honest, like she moves pretty well. When we went through the first day, like, you know, bending forward to touch her toes, bending backwards, rotation to the left, like everything hurt her low back. So a lot of things hurt. Jumping on one leg, jumping on two legs, heel slams, all these things. You're like, ooh, does she have some sort of paris injury or, know, facet driven pain? Yeah, she did.

So we go about, you know, typical treatment using, you know, another shameless plug, you know, cupping and I think I needled like multifidus or something like that. We do some dead bug things, we get her moving and she gets up off table. I think it was 90 % resolution pain, right? And she's coming in saying like, I don't think I could pitch tonight nor do I think you should. But then she literally, when she felt that much better, she's like, could I, I was like, we literally just talked about how much stuff you're doing. Maybe we'll just take tonight off, ease back into it.

You know, I thought this was going to be, hey, she's going to get out of pain. She'll basically attenuate to how much stuff she's doing and she'll be right on her way. Next visit she comes in, she's probably about the same. And it was down to only left rotation was creating pain. So I don't know who was with me. We started working like some hip stability with rotation. If we got her to basically create a good hip hinge and go through rotation, no pain. If she's just standing, she'd dump right back into her back. So you could kind of, the writing's on the wall. You don't access your hip awesome or you.

you know, have a preference what you'd rather choose, which will be like an extension based pattern, your back drives pain. go, Hey, that's my job. Like if you're going to jump from your right leg to your left leg to throw a softball, you've got to, you know, preferentially load your hip rather than just like slam your back into extension, just rock the ball. So she comes in the next visit worse or no, her mom actually calls and she says, Hey, she's complaining of back pain, like outside of practice to the point where, you know, it's really bothering her. She's not a complainer.

So I go, hey, we need to go ahead and get an x-ray, right? Just rule out pars injury, which I didn't think there'd be anything, but it's a kid. So what's our two rules in here? Like kids and pro athletes, like we pull imaging earlier. So we pull an image, it's clean as a whistle, which is good. I see her two days after mom had called and it already calmed down quite a bit. Why? She wouldn't do anything. Just shut it down. She's like, yeah, I'm like, it's a one out of 10 again. I'm like, okay, well, there's what we thought in terms of how you got here.

Beau Beard (09:41.838)

Now we've got to start figuring out is it just too much or is it how you're doing stuff? So I started looking at softball pitching mechanics, which is not, if I'm gonna be honest, that's not my forte. Lucky enough to know Brett Winchester. Brett is probably one of the best in terms of like rehab and treatment and biomechanics, not just the biomechanics of softball pitching. He's worked with some of the best in the world. Still works with a bunch of SEC teams in that respect. But know enough to know that I don't care if you're hopping, you're trying to,

crow hop into it, slide, whatever, that how you, like we said, transfer force from the ground eventually to the ball is gonna determine how you do that, where you try to get force, which is just like golf or hitting baseball. And what we could see is, and her dad was in here and he goes, yeah, she does this big jump into extension motion and then they wanted to get really far in her stride, like jump further. So I well, show me what that looks like. And once you do that, it would hurt.

and remember like pogo jumps and jumping hurts the impact. I was like, I think you're just getting too far out in front of yourself and you can't like, you can't get into your hip and you're literally just falling and then you it's probably all arm. So we went through a bunch of different assessments like Troy was helping me other day. Like if we just had her kind of rotate to the right and kind of be in a hip hinge and then chuck the ball at Troy as hard as she could, how would she do that? I just all arms, right? She wouldn't stand up out of her hip at all.

where she like if you're gonna do a power clean or a hang clean in particular. And we even like I put her in the position to like have to do that and she still would just all arm roll back and you're like, it's kind of interesting, right? Like I literally coach her, just be like, okay, all your weight on your left leg, hinge your left hip and like let the ball rip. And she just like completely stay in her hip and just like this rather than like standing up out of that or driving force. So we started coaching her up on that and pretty soon two things that came.

that came of that assessment style, which led way further away from clinical and more into like that top tier of the function pyramid of like skill is she just would much rather arm the ball. So I think she's done that forever. I think that's how she learned to do it. Even though she's done pitching lessons and one other interesting thing that first visit, her mom had an Instagram post that her pitching coach had put up side by side with a pro and then her. The pro, if you looked at her lead hip, so left hip for right handed pitcher,

Beau Beard (12:06.762)

you never see that hip deviate in the side to side or chrono plane at all. It just drives towards target. On hers, as soon as her foot landed, yeah, she would go bump her hip left. And then it's all moving around her low back, which is just like early extension in golfer, right? Like bump your hip out and then just fall onto the right leg. So I go, okay, that's what we were talking about, right? I go, what's your coach want you to do for that? And it was like push harder off your back leg and all these things like, I'm not a pitching coach, but whatever.

So then I go, what would, like what feels the best to you? Just show me a good pit. I mean, it was like a foot less of basically jump, right, or stride. And I go, why can't you do that? And she goes, well, cause they want me to do it longer. I go, have you like tested your like velocity or like spin rate when you just do that little like powerful jump, which she actually came out her hip. She goes, I don't know. I go, would you get in trouble if you did that? She goes, I don't know. They really want me to do it that way. I bet you throw it aim. I know you'd throw more accurate for sure. Cause the shorter motion is more compact.

But I bet it's the same. I think it's all arm versus body. then eventually that one would trump. she, I didn't even ask her, should. said, know, John Rahm has one of the shortest swings, you know, I guess in live tour now, not PGA, and also has some of the higher swing speeds and you have distances out there. And she goes, oh, I love John Rahm, which I now I should be like, what are you, 14 year old girl loves John Rahm. I did not ask, but.

But she knew so it kind of hit home of like you don't have to have a giant wind up or a giant stride or a giant push to create power It's how efficient you are in that movement So we worked obviously central stability stuff again She didn't have big mobility issues working here and then it was mainly trigger points around her, you know left low back that were driving most were pain the toughest thing in the world with her and I that's where I'm gonna hear on your guys cases too is now I'm competing with a amount of stuff which is tough because

If I don't do stuff for, mean, me hitting 500 golf balls, not doing a perfect back, pay the price, right? It's not that I hit 500 perfect shots and my back's just weak or something. It's like, no, you, you got a problem there in your swing. Well, now I'm competing with a lot and it's probably not perfect, but then it's very hard for me to create a change in a skill specific thing. Cause I'm not the coach. I'm not at the field. You also have a skill specific coach that she's working with and has worked with for five, six years, right? That she has trust in.

Beau Beard (14:24.546)

And I was like, you I keep having this idea of, you know, if she came to me as like a gray girl, gray girls is absolutely changing your swing to get you out of pain. It's not just, we're gonna do mobility stuff and exercise. It's like, you can't keep doing this thing. That's her and I've had a very hard time because like, I can't say shorten stride, do it this way, or hey, tell your coach, I mean, that's not gonna work out. So that's, I mean, I explained that to her mom. She was actually supposed to come in today, but they had to reschedule for tomorrow or Monday.

So yeah, it's just a tough scenario at that point, but like I know unequivocally that's what's causing it now. And now I have a decision-make of do I try to talk to that coach and you know, is that going to be an ego battle or you know, how do I get that message across? But I think, you know, in the golf world, mainly because of somebody like Gray Gross, we've painted the, a picture of a team, right? That you have a medical person, a fitness person, a skill person. That's every sport has that at the pro level, more or less.

Right? Baseball is probably the most, I don't know, old school is not the right word, but like where they feel like, no, no, no, no, the way we do it is the way we do it. It's very not very, oh, this is your baseball swing. This is how you pitch. like, it's very archaic. But that's changing too. But I think we need more of that in particular in youth sports realizing like, I get you got a skilled person, but if the medical person's like, hey, this is not the best way for them to do it, that it shouldn't be like, well, this is the way we do it or the way she needs to do it.

Because they, I would guess, assume somebody that's working with a bunch of youth athletes at that level is not having a movement assessment. If they are, good for them, but also why are they getting coached like that? So I'd like to open that door with that person. just, don't know how to do that, if I'm being honest, because I think that would be tough. Yeah, what are your guys' thoughts on, I mean the case is kind of, it's not the most exciting one in world. Like we can do minimal stuff, get her out of pain really fast in office. You're like, okay, this is not.

an injury per se, it's compensation. Then like I said, I don't think there's like glaringly obvious, like functional things other than like I would want to manage her hip in a strain conditioning scenario, right? In terms of like, hey, how you load your hip, what are you doing with it? You choose that, know, movement pattern when we're doing things that are explosive, like jumping, cleans, stuff like that. Outside of that, like any thoughts on the transition from like clinic to coaching or a clinic to skill?

Beau Beard (16:47.47)

And again, I'd like to hear how it correlates with your guys athletes too. You said that she is doing some strength and conditioning with their teams? Yeah, think it's, yeah, with the team or through the school. And then did you, well, it sounded like you at least tested something similar that she might do when she was throwing the ball. And did you test some of the things that she's doing with the inner strength and conditioning? Not necessarily. mean,

So the other thing is nothing would hurt her in strain conditioning. Okay. Yeah. That's what I was curious if they were doing any sort of lunging that she doesn't get, or she gets back. She would literally say, no, I'm fine at strain conditioning. It would literally be play. And the one time when she was really flared up, her mom said, that's why she even called, she goes, she was even having pain, uh, grounding balls, like it's her base. I was like, well, yeah, like it makes sense. Your back's hurting. Like it's going to hurt. So I don't think it's like how you're doing that. It's just like flared up.

But yeah, all other things weren't painful, which that's why I really siloed into like, it's when you pitch, right? No. I know. I feel like at least the kid that I'm going to talk about for running his dad as his coach. So he's there for some of the visits, the swimming aspect of it. I told him, cause I remember having a, one of my first patients, she was a college swimmer and she had brought me a video for swimming and I was like,

Yeah. I don't know ton about swimming. I could see a difference from what was happening with her arm underneath the water. Obviously you can't get less was underwater camera for it be perfect angle. so like for him, the big before we get into his case, when he, when he's pulling his shoulder comes way up into his ear and he kind of over recruits pack and pulls forward like that. And I said, if you want to explain that to your coach, like that's what I see you doing. Maybe he has a cue.

that would be different for you to do whenever you, we had done some, like a dry land cable pull that I seen before where you basically stay in a hip hinge and pull over my cable. Like he's acting like he's pulling. It's not the same obviously because recreating water tension versus the band is not. So I said, I don't have a way of telling you, you should do that when you swim other than chat with your coach about it and see if he maybe knows, or cause he's probably seen people do that.

Beau Beard (19:05.901)

I guess that's my frustration here is, you know, when her dad was with her on the second visit and he was saying, oh yeah, like she for sure does this like giant like extend and then like she never recovers. She never gets back into her hip, right? Just stays in extension. That's why was like, well, what are they working on? And that's the cues that we're working on it. A, it won't change anything. B, I was like, oh, okay. So that's where I was like.

how do you step in and be like, what you're doing isn't working. Here's my idea. And then they're like, well, how's that going to correlate to pitching? I don't, that's where I'm like, that's why I told him like, I don't know how this is going to affect velocity and spin rate and extra big thing is her ability to move the ball. That's why I said like, I would want to be in a, it's like a, you know, ping pong player. I want to be in an ideal position if I want to put a lot of spin and like English on a ball. Cause if I'm like out of position, you're just like recovering and that's like her pitching. So if my job is like,

more spin, you know, in particular outside to end for a softball pitcher, you can't be out of position. Otherwise, you're going to start. That's why I told her I go, don't want to see shoulder and elbow problems because it's just all this. her coach recognizes that she over extends. Yeah. Yeah. And then that's her pain thing. And then even was, mean, she put the perfect coach, one for the post-up showing the hip difference. And I'm like, well, what's, what are we doing for all that? Cause yeah, feel like if you were able to say we both

agree on the fact that back hurts because she overextends and the way that we see her not do that here in the office is if she keeps her. I be clear. I have not reached out to her coach. So don't want people if say somebody's listening that knows the first and or whatever, like I reach out because I'm just, need to this follow up to be like, Hey, how are we done? Because we just said she had a four or five day like weekend break. And that's why I said, like, I want her to pitch better, but let's say we can just get her built back up and she can tolerate it. I don't think that's the best scenario in the world.

But like as long as she knows what the issue is and like works on that and that's why I was just like, you know, and I told the mom like the coach wants to call me and tell her what's going on and stuff. Like I think I'd be more passive until I saw that every time she goes to pitches or goes pitching lessons, she blocks out hurting and I'm like, whoa, like let's get a hold of that. Yeah, it's just tough. Much easier in the golf world. Maybe that's just my mindset. Maybe that's my own bias. Like if I had a kid that was being coached by a golf coach that I didn't know.

Beau Beard (21:22.546)

It's easy with the ones we know. Somebody I didn't know and then I was like, I see this from the movement thing that's affecting your swing. I'd have no problem calling them at all or emailing them or something and being like, hey, I found this. Maybe that's just because I'm certified or something and I feel like I can dip my toe in that world. don't know. Yeah, golf coaches easier to... That's what I'm saying. I think we built that mindset because of TPI. There's baseball stuff. I think there's a softball thing too, but it's as well known in terms of that team approach.

Like I said, in my opinion, I'd like, you know more than I do. Baseball and softball are more, again, like stuck in a rut in terms of like, this is the way we do it, tends to be. I mean, Mark Blackburn, golf coach, you know, of the year again is like, there's a million swings. We've got to find the one for you. That's like a lot of sports now. Football, how you throw a football. I just watched the new season. I think we were talking about of Hart Knox and they have the biomechanist out there. He's like, he's talking about all the different quarterbacks now. They all throw different.

like what Josh Allen does different and how they're maximizing on that. And yeah, cool. So it even plays there. It's not just, I remember when I was in high school, my coach was like, no, we're going to throw this way. And that created a ton of problems for me, versus like, why didn't you just like try to figure out why I throw the ball good to begin with rather than throw like you, know? And then my elbow starts flaring up and can't throw the ball at all, which basically kept me on the NFL as a quarterback. I think some of that as well is in the

pitching world, everybody wants to try and maximize that whole like anterior sling to get as much whip as possible. And it's kind of like, it's not the same analogy, but it's like a rubber band eventually, like the longer you pull on a rubber band, the farther you pull it, eventually it snaps, right? Eventually something has to give. And I think there's like certain people, like you mentioned, have like a certain pitching mechanic that's going to feel comfortable to them. And she picked like, she's been throwing what thousands of pitches in that new way that she's been taught how to do it.

And then you're like, show me what would be comfortable to you. And she like immediately can flip a switch. it's like, she doesn't get into extension at all because she never like, I was like, it's like, how can we not capitalize on that? And it's like, she's, she's, she's 14. So I mean, she's like, just kind of getting through like the end of the puberty almost. it's like, which the other part of which I didn't mention, I think that part of why she's hurting like gross for hormonal changes. Yeah, for sure. It's like, she's got to learn like one, what her body feels like again, two, it's like,

Beau Beard (23:49.838)

Well, she's 14, so she's still got like four or five more years before she even hits like college. I mean, she's got four years of high school that she can still work on velocity. It's like, let's work on like the good mechanics and then let some of the gym work, some of the gym work and other stuff like that start helping with some of the velocity. I mean, they just have a, I can feel like when they go through puberty, they just have like a smaller like engine to be able to like build stuff off of until later on. It's like, why are we trying to like.

open up this huge range of motion when she just went through a huge growth spur on top of just like the flexibility that they already have. And then it's like, they can't control it. When my opinion, like we showed her, you know, Jenny Finch, huge stride when pitching, but like she recovers and like a hip hinge, like she's literally just like, you know, 35 degrees knee flexion, hip hinge, and just throws like Nolan Ryan, right? It's just her body's like stacked. was like, yeah, she has a huge stride, but she like gets into a great like controlled position.

And that's why I told her, go, maybe you can work backwards. you're, you're shorter now. Cause like you said, you lack control as you learn, like, Ooh, that is powerful. Like you might be able to jump further and you know how to load your leg. And now you can just like add room until you start seeing a breakdown again. That could be over years. Like, Oh, like you look back at film from sophomore, you're like, Oh my God, look how short it was. But like your position you pitch from never changed once you got like stacked rather than pitching from extension and you know, whipping your arm around you. yeah, that was, that was the other thing is like,

Start with something that you're like, I feel my hip like load when I like land, right? Like, I don't want you to think about this in the games. Like, I want you like, this is like where her skill positioning or her skills coach, like whenever she goes to like those private lessons, that's where she gets to work on this. So it's like, find a position where you feel your hip, like when you load into it and then like, okay, I know I lost velocity. I didn't stride out very, like very far. So now can start increasing that. And it's like, I still feel really strong when I get out here, velocity is maybe about the same as it was before and I don't have any pain. But why don't we just like dial in there?

And then you use the gym, in my opinion, of like some of those sled pushes, like you start learning how to like hip drive through it. And like now you can see what that feels like to then push off the rubber. Cause it's the same motion. Like baseball, you're pushing sideways. So I get to push kind of straightforward. it's a little bit different. And then, mean, if we didn't do an arm circle, you can also use in my, like, I would use heavy, like I'm saying heavy, not like 30 pounds, but like heavy med ball. So it's like, if you're gonna throw that thing, you're not gonna do it with your own. It's like, you know, just having to throw from like a six o'clock.

Beau Beard (26:12.686)

position to new or, you know, or I guess nine o'clock to like six and just be like, what would you do if I had to get that across the room? That's what we were trying to do in here. cause that's what I'll do with some of my not to catch up. That's what I'll do. Some of my softball pitchers is they have back pain. Like they're getting in a half kneeling position and they have to throw it to me with their hip. Like if they use their arm, don't count. Like, don't care if we're doing seven reps, if we're 50 reps and you haven't given your hip yet, like it sucks. Like I hate that for you.

But the thing that, and I mean, we could talk about like, you had sent me a text this morning about like gate stuff. Like then it also gets into like, you can show us that you can do stuff different here and like you'll do it the exact same way when you got in play. And that's like really tough because that's a lot of practice. I golf, I mean, you'll literally do it perfect on the range and you go out and like hit a shot right back to the old way. Cause you're trying to perform rather than practice. And that's, that's what's hard for people to understand. Like I was having a pain until I played this term this weekend.

It's like, yeah, you probably think you're doing it the way we practice and you're not still. That's time. So that can be frustrating for people too. The other part too for your girl as well, she's probably thinking about it a ton while she's in the game. Well, and that's what I, I mean, I tell everybody, you know, like, Hey, we're just doing this drill for warmup. You may have to go in between innings and do some stuff to like get your hip kind of like feeling it. I this is where she'll look for feedback loops. That's why I was like, you cannot think about this during the game. Now she probably is. I'm talking about like from like her coach. Oh, if it's not, cause like you said, like,

But we'll be comfortable to you and she immediately does like pulls out a new stride. It's kind of like well in the game maybe every pitch she's having to think about which I got to push off in order to throw instead of just like. I can see the velocity drop just that thought. Yeah. It's a good point. Locate the ball. Like locate like where did you catch her set up. And then that's your spot to hit. That's a good point. Yeah. So now she's doing like reps on reps of I got to think about long stride every time. That's a point. Yeah.

We'll see. mean, maybe they change stuff. Maybe they talk to her pitching coach. She's like, oh yeah, just pitch like that for a while. I don't know. So we'll all get feedback on that next time when I talk to her. All right. Let's have you go next. And see you're talking about your case a little bit. Yeah. So this is 16, 17 year old swimmer. Primarily he's also running cross country right now. Back in April, he started having anterior shoulder pain. going to his pec. He had seen an ortho previously. They had diagnosed it as a pec tendon injury.

Beau Beard (28:32.142)

And he took some time off. Then he got back to swimming. That whole time he wasn't doing any weight training for his upper body at all. And then swimming was still bothering him. So he came in and this was sometime this summer. I was working primarily on shoulder stability from a sideline and then a quadruped position. And he had gotten back to doing some swimming, no more than like 800.

meters, which is pretty light compared to what he was used to doing. Basically just their warm up and a few drills. Then he started at the same time getting into running for the fall and we hit a little plateau where he starts to swim about 800 meters in, starts to that pain in his shoulder. And then he started also noticing it when he was running. So I had seen him a few visits.

change pain in office and some of the audits function that I was paying attention to were shoulder internal rotation on the right side, pec major trigger point. And again, I had needled some of those, done some sideline quadruped positions and those things would change. They would come back. And then I chatted with Bo about it. He had come in, palpated as well and been like, yeah, he's got some stuff going on with his CT junction. And

In addition to that, prior, like a minor audit I was paying attention to was just lat tone on that side. And when we were working along that side there, the long thoracic nerve was actually tender to touch. And so in line with the CT junction stuff, when we adjusted there, mobilized it, all of that stuff, all of those audits started improving.

essentially it was still, he needed to be able to stabilize his shoulder better, but the restriction there in his CT junction was contributing to some of those nerve pains that he was having. and long story short, we just regressed what he was doing because he wasn't able to do it properly. his shoulder would wing off of the rib cage in even not even a lift off position from sideline.

Beau Beard (30:59.246)

tried looking at that from top down, eccentrically loading, lowering, I should say, and it was still really hard for him to do. as of late, I had sent him home with just an isometric where he's pushing up against the wall, kind of like a five-month sideline, trying to feel activation in the posterior capsule. And then the last visit, an MDT.

right lateral flexion and extension at CT junction. His swimming has gotten a lot better. So where he can swim for longer, he started to, he swam like an hour practice, didn't have any issue. All of that was easy swimming. The next practice he did some faster intervals and halfway through those intervals, he started to the pain in his pec again, which we talked about how his ability to basically whenever you watch him,

when you watch him do that sideline drill or anything where we're asking him to use his arm, his shoulder will elevate and then it'll protract where he gets a lot of contraction of that pec. And I haven't seen a video of him swim. I would imagine he does the same thing when he's swimming. I tried to replicate that with that cable pole we were talking about. And I just told him, the more tired you get and the higher the intensity, the less likely you're able to hold the position that you're

you're working on. But he's able to do more before that happens. that's progress. also in the last race that he ran, he didn't have any, he's not really having any issues with the shoulder when he's running now. I, the last visit he was here, still limited shoulder internal rotation, trigger point still there.

He's come back in today. So we'll see how he's doing with, uh, with swimming. ran last week and didn't, don't think he had any issues at that race. So what did you mention the MRI? Like that he came because he had that before he started seeing you or a way. I didn't order one. I thought he had an MRI. I don't have it written on the note. So I don't completely know if he did or not, but he had been seeing an ortho for like, he had seen him and then done like a four or six week followup. I thought they had ordered imaging, but I,

Beau Beard (33:21.07)

didn't write it down. Okay. I was under the understanding they told me had pectin and stuff off the MRI. Yeah. I thought I remembered that again. I thought I wrote that down. Yeah. so in his scenario taking, mean, so skill, it's going to bleed into skill, but like more foundationally, like how he's doing stuff. So like whatever, say strategy motor control. do you think with all of our, I mean, all our people were talking about,

So if we were like DNS purists and we're talking about, okay, how your shoulder blade is on your rib cage, obviously how your hip operates around, you know, your torso, like how much are we either missing or, you know, could we actually make it easier if we really like just focused on central stabilizing strategy? It's like, my girl, I'm going to be honest, like we, that's the first thing we started looking at. was like, this is actually pretty good. That's where I was like, I think it's like almost a rule out of like, oh, you can do everything pretty well.

But then my thing is why, and I'm just like throwing out an idea, why would you not preferentially load your hip to create power? Right? It seems like, well, not a weakness thing, but like, it's how you use something, right? Or learn behavior. Maybe she got coaching to that from seven years old or eight years old. Right? I don't know. In his scenario, it's like, why did he start using a shorter like that? You know, is it, you know, range motion thing from

early age, which could still have started as disability motor control thing. Or do you think it's, you know, just a shoulder? Like maybe you had an injury and he started doing it different at some point, like anything with his case. So you're like, Ooh, yeah. Like there's other things that he doesn't do awesome around like central stabilizing strategy. Cause his left side means swimmer, no issues on that side, which again, we can have a dominant like breathing side and stroke length and stuff. anything else that you kind of thrown in there? don't know how to, I don't know how to answer it when you know, don't know when

or if he started swimming differently or if he was crushed that way. Same thing with mine. I don't know, but like anything else stick out with him. You're like, yeah, he's pretty solid. Like on other stuff. Cause like with mine, I was like, you're pretty good. Some people are like, there's a ton of stuff to work on. Yeah. Right. And you're like, it's not even perfect. And I have been working on it yet. I'm still going to go from like, you know, it's always a marriage of the two. get that, but like, I'm to move from central stuff to, you know, scapula thoracic specific or hip, you know,

Beau Beard (35:46.51)

limbo, public hurdle, that make sense? What I'm asking like mine, I'm not saying she's perfect by any means, but I was like, you're pretty good for a 13 year old athlete. That's what your gross burden doing way too much in your life. For some people are trained rack and you're like, who if I want to keep him swimming or running, I have to make a decision at some point of like where I put all my effort. Right. Um, yeah, I was just curious if you're like, yeah, it's pretty good overall or yeah, there's a lot to work on. we like chose that or yeah.

I don't think so. if I would compare him to another high school athlete that I have right now, that's about the same age who plays a different sport, plays basketball. he, if you had from a strength conditioning standpoint, I think this guy would be, would look more textbook technique in the weight room. Better movement competency, I guess we're saying. Only main difference, like even on a low level, something like a quadruped rock back or a, you know, a bear position that.

Right shoulder is yeah, he lives there whenever yeah, that's kind of what I'm saying. Like that thing sticks out amongst all the other stuff. Yeah. Okay. Yeah. Cool. Any other ideas or thoughts on that?

And again, I mean, we've talked about this case a lot. think one of the big questions that all of us ask, I don't think you ever know, is like why do joint restrictions occur when you decide to work on that succinctly versus just motor control stuff? And I think with him, there was nerve and like motor control and joint restriction, but it's like you have to still be extremely systematic. Because again, somebody could have a pattern that you see and you're like, well, the pattern...

I would assume existed for him. He's been swimming a lot. Like he swam multiple years. It's like wine now. Yeah. Yeah. Right. Or what changed and it's, you know, it could be a culminating effect to get that or with this athlete that I was talking about a lot all at once and then doing the same thing forever. But then that's why you have to be systematic. Cause like you said, you don't know, you just see him today. You don't know how he swam before. If he's changed since then, that's why we're almost like playing the simple game of, yeah, we see this complex, like your shoulder does this. We can assume that.

Beau Beard (37:55.714)

gets thrown into this big like activity like swimming that you're gonna do a thousand strokes and then you're just doing it over time over time. It gets worse with tea. They're like, we get all that. Let's do our job and like, you know, get a CT junction moving, calm down, soft tissue stuff, work on the motor control and then see how well that bleeds into sport. And then my athlete, I thought I was like, I think I could do that till the cows come home. You will have to work the, you know, coaching aspect.

What are your thoughts on him? Do you think you have to go to how he's swimming eventually to overcome that? Or are you like, I think I could work on a shoulder like stabilizing strategy and like, I think he'd be good. I feel like there's so much room for improvement with that, he, with the shoulder stability that is, that if we cleared all of that up, I would imagine his swimming is going to be way better. Yeah. Because now if like, if it was, if we had tested him all the way up to, I don't know, like a

push up or apply metric push or something that's way higher level than just a non weight bearing or a quadruped rock where he's not even knees on the ground. Yeah, he's failing that versus if he was a lot farther along there. Yeah. And again, nobody has the right answer. mean, I don't think. Because I would imagine also, because you think about, you mentioned, we don't know what, if he started swimming differently, what it was. April, I think was the end of his season.

So he was also probably peaking for competition. his, it's kind like when we see kids in here after towards the end of cross country season, or even towards the end of a training block for a road race, it's always close to the taper week that something starts to pop up on somebody and they've probably done the thing for months, but it's just, had cumulative increased work volume on the same pattern. that cumulative and like swimming.

Like I just think, you know, asking people or it's like you think of like biomechanics and maybe the way he swims does stiffen up his neck. His neck getting stiffer, especially through CC junction doesn't allow him to rotate his neck. So I asked her rotate more. like, yeah, all these things you're like, suppose you have no clue, but you're like, oh, I can see why like this would get worse if your shoulder operates like this. So then it brings you back to, yeah, we're just going to really even long-term, like make sure your shoulder operates really well so you don't go backwards and then start affecting the swim strip.

Beau Beard (40:16.494)

It's just interesting that he also started having pain running. Yeah, that's like super. That's the other one that just doesn't, that doesn't, to me that doesn't add up to like it's his running or it's his swimming skill to me. I think once it was irritated. So what I found is like I could palpate down long thoracic nerve. And again, if from a breathing, I guess the first time I heard Ronnie, I was like, Oh, it's gotta be something with breathing, right? Irritation, not like how he's breathing, but like it's irritating it.

So people get long thoracic nerve entrapment, like anterior middle scalene, right? And then obviously it's still pec could be like, was like, yeah, that's what I think that is. And that's what I asked them, do you get like, you know, ice pick in your trap or anything? like, no, not really. Like, okay. And that was a big key part of it. And which is why I was glad you were able come in and look at it. Cause the visit prior, we had talked about his CT junction and I went in, I Trent was with me and I went in and I've MDT'd it every which way except for extension N.

I had done just a lot of reflection, extension, done flexion repeatedly and looked for has that changed pain and functional audits. Didn't really see much of a change. Now, granted, also whenever we were in there and you mobilized them that way, it wasn't like a, that's a lot different afterwards from what I remember. Maybe the sensitive go to the long thoracic nerve was not as much or the tone around the lat. I don't know. You did it. I didn't work with them. That's true. Yeah.

I just palpated. I wanted to. It was like palpating. was like hitting this table. was like, I'm just going to blow that up. Salivating. Yeah. But it's, yeah, it's just, it goes back. I wanted to say that for the clinician students listening, like palpation is still your biggest, I mean, I'm reading Clayton Skaggs new book and he talks about other medical professions still saying that like,

manual dexterity and like a hands-on approach to medical care, even from like a primary care physician is like kind of a lost start that's gonna probably become more important as we see the healthcare system get turned upside down like a housing bubble and AI come about. So it just like makes us all double down on like, what do you feel? Cause you could look at mechanics, looking is big, right? Seeing and observing. You could listen to their history. That's important. But at end of the day, you still gotta see with your hands and like tell like, oh yeah, like that is what's, cause again.

Beau Beard (42:37.742)

You watch them do this, that doesn't mean that a CT junction is restricted, Like a bunch of people could do that and they don't have that because that's not the way that they compensate for it, right? That's the key is like mechanics don't lead to a compensation specific thing. It's just like, I don't know, how do you handle it? That's hands on. Cool. We got one more. Let's try and get after it. So I've got a, I think she's 16, 17 year old female volleyball player.

I had seen her for a long time. I'd I've seen her for over a year, just with like off and on different stuff. This time she came in, she has low back pain that has started to like increase since she's been doing like club volleyball and also starting school ball at the same time. She plays front row, so she's hitting a lot. And she got to the point where like her mom actually called up here and was like, hey, she acts like she's a pretty tough kid.

but she's coming home crying every night right now with the way her back feels whenever she gets done hitting. And then I see her in clinic and I'm like, so how's everything? She's like, yeah, everything's doing great. And so just kind of navigating that anyways. yeah, she, just knowing her a lot of extension-based patterns reproduce her pain. Her mom also went and kind of got an MRI just because she had been dealing with all that, but like,

Here's the other part is like she hadn't told me that her back had been hurting for like few visits. She had just been like, yeah, know, my shoulder's been a little banged up. So her shoulder started, you were telling us It's her hitting shoulder. So her right shoulder has been having issues. Prior to her back. Prior to her back. And so that's what we've been working on because she'd also, you know, she's playing two different seasons. She's traveling a lot anyways. So her mom goes and gets an MRI.

MRI comes back clean. like, there's no fractures or nothing like that going on inside there. Which kind of gives me the green light that like, we don't have any know, spondees or anything like that in her back. because it kind of presents that way. Like when you see everything where like, you know, opposite side storks and all those different things are producing, you know, right low back pain, extension based pattern, reproduce it. She's doing a sport that is highly like conducive to like that injury.

Beau Beard (45:00.312)

kind of begs the question of like, okay, well, if her back's hurting, like why, like what else could be the issue? And so we've been looking at her right shoulder a little bit. Well, every time she came in, she also doesn't like her neck being like touched. like palpating like her neck is tough to do, but she always has like left upper trap tightness, right? So she's a right-handed hitter, left upper trap tightness, and like that whole left shoulder girl just feels like there's a ton of trigger points in there. But she has right-sided low back pain with everything that she does.

So I had been working a ton of like central stability. Cause I mean, you can work on that to the cows came home for her. Cause she can't really create inter-bondinal pressure at all. Like she has to give like she either, you know, it like a pretty flat back where she has to like be able to like create some pressure, she cannot do both. She can't even hardly breathe at the same time that she's like trying to hold this dead buck position. And I'm like, there's so much we could do here. But like it wasn't, it wasn't fixing, I say fixing our issue. Like it wasn't even touching it. Cause she'd leave and be like,

Some days she'd leave and be like, I feel the exact same, which kind of like sucks. But I've done a ton around your core and like, we have not changed this trigger point hardly at all in your low back. So then I just kind of was like, well, I just kind of want to test some stuff. So multi-segmental rotation to the right is obviously painful. And she kind of dives into her low back a little bit. And so I just brought her arms up because I know it's a little bit different, but I just brought her arms up to kind of get in the position that she would do for like volleyball where you have to stabilize with that left arm to come over the top to hit.

And she does that and she's like, yeah, that really, really starts to like aggravate my pain. so I was like, okay, well let's look at this left shoulder. so quadruped rock left, left scapula wings, wings, a decent amount. and then I think I have her go into like a little bear position, just loaded that left shoulder. Her back starts to hurt again. which again doesn't add up cause there's, there's no extension moment there, except maybe like her pelvis dumps a little bit. so we.

I don't say I cut ties with just working on just sagittal plane stability but I'm like I got to attack this left shoulder because volleyball is one of those sports that you produce a lot of force not on the ground. It's one of the only sports that I feel like because you jump and that's your ground force. Once you leave the air or once you leave the ground like to me your legs are kind of taken out for a second. So she's got to pull a ton with that left shoulder for stability. So I go into just a three month kind of prone position because I just want to

Beau Beard (47:25.256)

used that as some spinal up writing and getting her shoulder in overhead position with her right shoulder being overhead and her left shoulder also having like stability play. I have her hold that for probably like 30 seconds I go back trigger points I completely gone her back and have her do rotations. She's like, yeah, it doesn't hurt anymore. Yeah, just bilateral here. So then we worked a little bit of, cause I know Trent had been in on a few visits, but there's one where I had her,

do like a five month sideline position where like I'm pushing on her hip to kind of just like stabilize that left hip because she's going to rotate around it. But I want her to work on upper body a little bit more. So I have her come up on her left shoulder like I wouldn't a five month sideline. But I pin her hip and I have her go through just right rotation with stabilizing the left side not letting her body roll which I know is not like super DNSC. But I am like she does good on her lower body. I need her work upper body. So go back to just doing a ton of just left side or right side of rotation to work on this.

where she's like winding up to go ahead. Cause this is like getting down to like, think some skill involvement is where her issue is not necessarily always. She has a pathology cause MRIs roll out pathology. doesn't have anything with like, anything there. So have her do that. And she comes back and ever since I've seen her probably like three or four visits since then, and we've just been working a lot of left shoulder stability, getting her up into basically a side plank low oblique sit for some people who know some DNS positions, but, that trigger point in her back is like.

almost like non-existent. She's come back, she's like, yeah, I feel really good. And even on days that she doesn't play, because she'll travel sometimes, like her brother and stuff. But yeah, she's like, yeah, my back doesn't hurt. And on days she doesn't play, her back feels better. So there's still a big left shoulder stability, even though she had right shoulder pain to begin with. But her right shoulder always felt pretty good, for it to be an overhead, for an overhead hitting all the time. I didn't really find really anything in her right shoulder. It was always the left side and her right low back.

So what were you working on when you're working on her shoulder before you went to the left shoulder? I'll work on her right shoulder for union central stability. Mm-hmm. And sagittal pain. Mm-hmm. There's two things I think are kind of key to point out is you know, we talked about yeah, you can do Palpation you can do like DNS tests and do orthopedic tests, but like I don't know what you guys or your thoughts or agree or disagree is like

Beau Beard (49:46.327)

I'd say 99 % of the time, thing that gives me the two things that give me the most in on a case or the history and then like the sport specific or activity specific, which is also like McKinsey talks about that a lot, like all that stuff, right? Like, it's kind of when you're doing this stuff, it's like how you pitch, it's, you know, when you lift your arm up. And then in this case, that way we're gonna say sport task specific, you know, kind of test, then it just kind of makes me think about like,

the old school research they talk about and like, you know, even when they were talking about transverse abdominus activation, then it bled into like DNS with like intravenous pressure is like when you go to lift your arm, your core has to activate first, if you do it in reverse, like it's kind of a nightmare, right? So just like lifting something out in front of me like this, if I don't have some activation here, it's like arm in the ball and softball, like you will create compression rather than decompress or at least neutralize spinal compressive forces.

to rotate, extend, flex or whatever. And that's kind of the key is you need pre-activation, which is we falsely do that, right? We'll be like, hey, we're have you breathe. I'm gonna have you create pressure. We're gonna put you in a good position. Then we'll have you move around, right? That's what you're doing in a lot of DNS stuff. But then it's like that has to become subconscious of it's, you know, this first, that second. And with her, it obviously wasn't because you lift and you're like, that's worse. So like she's set to what? I'll just use a bunch of upper.

has to put you in your extension position because you have something out in front of your center of gravity and then what do you do? You have to compress more. That's a clever way to get around it. like I said, I think that's way more my lead in. Palpation is the thing that's like your compass through all that. it's like Levitt says, by the time you're done listening to him, you probably should know what's going on. Then you're just testing to rule out, are you right or wrong? So yeah. Which that's kind of like, because SFMA knows very like.

We don't use it necessarily as being like, that's the issue. They need to get better at right side rotation. It's just a look at how they move overall. And I'm like, well, if you move relatively okay, well, let me put you in a position that's like your sport and rotate there. That's my selective functional movement assessment, if I was to say so. Like I selected that functional movement and show me how you do it. And it's like, yeah, it's even worse. Perfect. And that's why I added your shoulders into it. Now your back hurts even worse. And that's why I honestly think those are

Beau Beard (52:01.74)

you know, outside of like a truly positive orthopedic test that has pain, because again, that can be testing like a tissue or something specifically, or a joint complex. Like those things are much better pain audits to me, because it's us trying to see how you do something and do you have pain doing that thing? Because then that bleeds into, yeah, we might be testing like, maybe your facet's getting overloaded and, you know, unilateral stork test. But then also if we have you do it, it's also like, well, the way you do it will overload that facet, not just the stork test.

I think that's kind of key for people to realize, cause it's not like your stork test is normal. And then you might go right back to pitching and literally that could be, I mean, this is my patient extensions, normal. We haven't go pitch like position and she'll like, that still hurts. You're like, but only thing that makes sense is how you're doing it. Not just the structure being loaded. I think that's like really key for people to hear. it's again, not like, you're good. You're good clinically. You're like, see you later. It's like, we have a lot more work to do in terms of helping manage and seeing, you know, force through the, or,

force through the trees kind of deal of like, we can't stop here. And that's, I said, that can be tough in scenarios where you don't have the branch to kind of go out and talk to the position coach or skill coach, or you're like, even in swimming, how do you translate that to their coach? Like, hey, I know you're doing this, but like, I don't know, can you work on it? Like, yeah, just, it's very three different cases, but then they all kind of lead back almost to the same place of like, hey, how you're doing the thing probably got you in here, but then it was like specifically how you're doing it.

like a stability strategy thing and then maybe a long term just like overall life strategy thing of like how you're using that. And then it's like, well, where do you work on those things? Okay. All ended up in different places. Yeah. All right. Any feedback on any of stuff? What do you see out there?

Beau Beard (53:49.487)

light flashing. I can't see that further. Who knows?

We hope. Okay, so we wanna give away more rock tape stuff. So what's the competition gonna be? We need now, we need a picture or we need a video of you and your clinical setup, your student setup, wherever it is, using something where a rock tape product would be better. So maybe you're...

Instead of you don't have rock blades, you're using a butter knife because that's just how you roll and you want to be in a redneck OG. It's like everything but a water bottle. It's like everything but a water bottle, right? I don't even know what talking about. You know what I'm talking about? Where you drink things out of like water. Instead of a coffee mug, you drink it out of a detergent water bottle. Or you it out of a shampoo bottle. I have to check it out. It's all the rage the kids are doing it.

Yeah, if you're using, you know, instead of cupping, you're using like a sucker fish out of your aquarium. Instead of tape, it's duct tape. Like I want to see a picture or video where you're, you know, rednecking it, making it work, but you'd have a product based on the product that you use. So if you're scraping and we decide to use it, we'll send you some rock blades. If it's a sucker fish, we'll send you some rock pots. But that's what I want to see for this. You have two weeks again. So this is...

episode 48. So when 49 comes out, we'll choose. And I don't know what we're giving away because it's going to be based on the input on that one. Are they just going to DM a picture? DM the farm. So at CarreFarm on Instagram. That's how I want you to send that stuff. We'll repost it. We make a little carousel of those for a special one. But they have to be in by when's the next show? Two weeks? Yeah, but Wednesday the... That's what? The 9th? I think the 8th. Wednesday the 8th.

Beau Beard (55:51.33)

Yep, ideal world by like before noon on the eighth. That'd be awesome. So again, send it in, anything but a water bottle. Yep, that. No white lightning. Yeah, if you have a fun chemistry story, let us know too and we'll see you next time.