November 18, 2023 • 22 mins
I see patients in their 70s 80s and 90s that I don't run through a range of manual muscle testing for their pain.
This is how I prefer to assess and treat. And it works very well.
https://richardhazel.podia.com
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:01):
Welcome to the Acupuncture Outsider podcast.
My name is Richard Hazel and in the time it takes for you to commute to or from work,
I hope to have shared something of interest about orthopedic acupuncture using motor points,
trigger points,
(00:23):
myofascial slings,
uh neuro functional acupuncture segmental treatments.
Anything that crosses my mind that seems to be of interest.
I hope you'll enjoy it.
Hello and welcome to another episode of The Acupuncture Outsider.
(00:46):
This is Richard Hazel.
Today.
I want to talk about some tips on shoulder pain assessment that do not require manual muscle testing and I'll get into why in just a minute,
I wanna say any time you suspect that your patient should be getting imaging,
(01:10):
you should be sending them to imaging before um doing a full,
you know,
assessment if there's,
if they're in a lot of pain,
um,
people tend to want to avoid the doctor and they want to go see their acupuncturist and see what they can do.
If you suspect that they have a serious injury,
(01:33):
a full thickness tear,
you should send them to be um evaluated with an MRI and if you're not sure,
then it is completely fine to treat.
But if you have a feeling that there could be a full thickness tear,
(01:54):
then of course,
you may not want to um use too uh too much stimulation,
electric stimulation.
Um That said many times we're seeing people with shoulder pain who have already been assessed by a medical doctor and are still having pain.
(02:14):
And the thing I wanted to talk about today is uh how to assess the shoulder for your elderly patients who often have serious restrictions on shoulder abduction inflection,
(02:35):
um,
may not be able to reach their back.
Um,
may already have a full thickness tear that the doctors do not want to do surgery on because of their age.
They,
the,
you know,
the trade off is not worth it for someone in their,
(02:56):
maybe in their eighties or nineties if they have a full thickness tear and it's healed.
Um,
but now they have shoulder pain and you need to try to help them.
So you'll see,
uh,
I have a lot of patients in their seventies,
eighties,
even nineties.
And,
um,
they have shoulder pain and they can't,
(03:19):
um,
they,
they had limited range of motion before they had shoulder pain.
So,
you know,
if,
if you have relied on manual muscle testing because you were taught how to assess the shoulder using manual muscle testing and length testing.
And that's all good.
(03:40):
And well,
because your primary focus is treating young,
healthy athletic adults,
then this is not for you.
This is for those of you who have a patient population well into their seventies,
eighties,
nineties.
(04:01):
Um It's a little different.
We're not doing that length testing.
We're not doing pack length testing.
We are trying to eli eliminate pain.
We're trying to improve the quality of life for somebody who already has poor scapular stabilization.
(04:28):
So the,
the,
the issue uh we're going to have is how do we best help them um with acupuncture without overdo it and without um treating a lot of muscles that are at this point,
(04:49):
not really um firing and not really going to fire because they're not going to go for physical therapy.
Um They just want to be able to uh as one patient said yesterday,
put a plate into the microwave.
That was her top priority.
That was her main concern.
(05:12):
So,
um so this is about how to treat those people.
Um You're gonna use palpation and you're gonna ask questions more than you're going to put them through full range of motion or um you know,
a lot of resistant uh manual muscle testing.
(05:33):
So the,
the tips that I have for you are ask them if they can raise their arm in front of them,
then to the side already,
there's your flexion and abduction muscle test,
ok?
Just the weight of their arm is sufficient for that test.
And um I'm not concerned if they can't get their arm all the way up over their head,
(05:59):
I just need them to be able to perform movements without pain.
So,
um so you start with that flexion and abduction.
Those are key and that'll tell you already where they're having pain now.
So,
so for anterior shoulder pain,
there are a few things to consider.
(06:22):
Very likely you'll find that their uh coral brachialis and anterior deltoid are,
are injured and causing pain.
The infraspinatus can also cause anterior shoulder pain on shoulder flexion.
So that's another consideration.
(06:44):
Um Biceps can be considered,
but they're,
they're usually not the problem.
It's usually in,
you know,
percentage wise,
it's gonna be coral brachialis and anterior deltoid and possibly infraspinatus.
So that's a good place to start and I tend to treat them on their side.
(07:04):
And if that were the only thing that seemed to be causing pain,
then that's what I would treat coco brachialis,
anterior deltoid infraspinatus and Terry minor because it always gets injured with infraspinatus.
So just those,
those four points electric stem up to 10 minutes,
one Hertz.
Um assuming that they can have electric stimulation.
(07:25):
If they can't have electric stem,
then you're gonna retain needles for 20 minutes.
Um And,
and then you're gonna retest and see how that feels.
Um pain on abduction.
Very likely we're talking supraspinatus and the middle deltoid.
So they're gonna have pain at that uh acromion area at the top of the deltoid and or pain at the deltoid tubercle of the humerus.
(07:58):
So,
right where the deltoids insertion attaches to the humerus,
they often will have pain when there's a middle deltoid issue.
Um That pain can radiate,
refer down the humerus.
Um So you'll have some patients tell,
show you where they have pain and it's right over the humerus where there doesn't seem to be much bone because it's not bicep and it's not deltoid.
(08:26):
So that's a good sign that it's a middle deltoid issue.
Um So on abduction,
I would treat supraspinatus and the middle Delwin posterior shoulder pain,
very likely teres minor,
sometimes posterior deltoid.
(08:49):
Those are your two main ones.
Occasionally,
subscapularis can cause pain in the back of the shoulder,
but on someone that age,
it's likely not the injury.
Um but keep it in mind,
it can cause the subscapular can be injured on someone that old in their seventies or eighties,
(09:14):
but not likely they're just not doing a lot of um things that require a lot of internal rotation force.
Um It's an injury that you see more on someone who's doing a sport or swimming,
something like that.
Um So those are my go to sometimes it can be a tricep injury,
(09:37):
the posterior shoulder,
but really most commonly it's terri minor and sometimes posterior deltoid.
And how do you,
how do you confirm it?
You push on them,
you ask permission to press on some muscles and then you press and you see where it's tender,
(09:58):
they're probably going to have a very tight upper trapezius because that's the compensation that you know,
when,
when the shoulder flexion and abduction,
which require upward rotation of the scapulae um are injured,
then they're going to use upper trap for upward rotation.
(10:20):
So upper trap will get injured and that can cause pain as well.
So those are my go to muscles for the elderly.
Now,
there are also a lot of older people who will have anterior shoulder pain,
(10:44):
that's not actually anterior shoulder joint.
It's further down at the intertubercular sulcus,
the attachment area for the peck major,
latissimus,
dorsi and the teres major.
And on most of them,
(11:04):
it's the lat,
it's not usually the terrace major or the pecs.
I'm not saying it's not always,
I'm saying most of the time it's the lat and those people may actually point to their lateral rib cage area as another area of,
(11:26):
of pain or soreness.
And that'll be the lat and then you lie them on their side and you can,
you can work on the lat with them on their side,
their arm will be at about 90 degrees.
So definitely be aware of that.
Um when people have pain on shoulder flexion and you ask them where it hurts,
(11:48):
they're not always very exact and they'll put their whole hand on the front of their shoulder like at the deltoid in the anterior deltoid area.
So it's easy to miss because the anterior deltoid is there,
the coral brachialis is there.
Um But if the pain is really primarily from the labs,
(12:09):
then um that's what you need to confirm.
So you will do some palpation and you're gonna feel the lot.
And um just remember that um upward rotation of the scapula that helps flexion and abduction gets limited and inhibited by tight lats.
(12:34):
And most of us have tight lats and when you're 70 or 80 not only is it tight,
it,
it might be so short that you really can't even raise your arm.
So,
um,
that should always be paid attention to,
for people where you,
where you are trying to improve their ability to um do shoulder flexion and abduction.
(12:56):
The latissimus dorsi gets very,
very tight and inhibits upward rotation of the scapula.
Um,
always should be considered and you'll see it in the elderly,
um,
pretty regularly.
So that's something you'll definitely want to consider.
Sometimes you do have to treat the peck major.
(13:19):
Sometimes you do have to treat the peck minor on older people with shoulder pain,
especially if it's a source of pain.
Um But I'm trying to give the 80% and not the 20.
Um There's plenty of exceptions to what I'm saying.
But if,
(13:39):
um the,
but the,
but if you're,
if you're dealing with this population,
um that's the,
that's the,
you know,
80% maybe more.
It's going to be those muscles,
the anterior shoulder pain from anterior deltoid coral brachialis for Spinatus,
(14:01):
rarely biceps,
um abduction pain,
the supraspinatus in the middle deltoid,
especially if it radiates into the humerus.
Middle deltoid is primary there.
Um posterior pain from teres minor and posterior deltoid,
sometimes tricep.
And then that anterior deltoid pain on flexion and abduction because of the lat and occasionally peck major or terra major.
(14:33):
Um This is uh this is something I rely on heavily,
a lot more palpation with,
with my older patients because you really,
um,
one by the time they come and see you,
they're in a lot of pain.
Um,
two,
they don't have great mobility or strength.
(14:54):
Um So you're really,
you're really better off if they're gonna do something painful,
you're really better off with them doing it than you.
Um,
uh eliciting that pain with a manual muscle test.
So,
um,
so I would just let them use uh gravity for their reflection and abduction and get a sense of what they can and can't do.
(15:18):
Um,
and you can always check the better side to see what their mobility is on the other side.
That'll give you another clue about what's going on.
But,
um,
I don't know if people will think it's scandalous or not,
that I'm gonna tell you that I'm not that worried about.
I,
I do sometimes treat serratus anterior on the older people,
(15:41):
but I don't tend to treat a lot of the mid back stuff for a couple reasons.
One,
I'm really afraid of pneumothorax on someone older where they just have these,
these ischemic,
thin plod layers of muscle in their back because they don't exercise.
(16:02):
And I'm just really too afraid on a lot of them of needling into rhomboid,
uh lower trapezius area.
Um And I also just don't think a lot of those are inhibited,
um,
muscles and not really short or tight.
(16:23):
So they're not upwardly rotating well because they're weak.
Um I'm not,
I'm not that concerned with treating those muscles.
They're not,
they're not gonna get much better by treating them.
I would serratus anterior.
Yes,
you can treat serratus anterior and hope to improve their scapular upward rotation.
(16:48):
Um But a lot of my seniors,
I'm not even that concerned with it because I know that they're not in their day to day.
They're really not um raising their arm above shoulder height.
In many,
many cases,
they really just want better quality of life.
(17:08):
They're not looking for the same mobility that you and I need for more active lifestyles and they're really looking for pain management,
um or you know,
relief from their shoulder pain.
So I'm not as focused on the things that are important for athletes,
(17:30):
younger people,
um people who really do want to have full mobility and strength.
So it's a different population,
it's a different goal and therefore a different assessment and,
and often a different treatment a little more abbreviated.
Um especially if it's the first time you've seen that patient,
(17:51):
you don't know how they respond to acupuncture or electric stimulation.
The older patients are often more fatigued um by acupuncture,
even if you don't use electric stimulation.
So you just have to uh proceed with caution and see how they respond.
(18:14):
And based on their feedback,
you can um increase or decrease the amount of stimulation that you're providing in that session and always consider treating older people in their seventies,
eighties,
nineties,
um less frequently.
(18:36):
So,
not necessarily once a week that might not work for a lot of them.
They might need two weeks between sessions because of healing time.
Um When you get into the older populations,
their healing is slower.
They have um muscle soreness for longer,
(18:59):
two or three days sometimes.
Um And you want them to have time to enjoy feeling better.
So it's not urgent that they get better by the end of the month or whatever the short timeline is in our heads.
Um You can spread it out and explain it that,
(19:22):
you know,
we don't know how quickly you heal.
I'll see you next week and then we'll discuss if we need to go every two weeks instead of every one week.
Because if you're a slow healer,
it's better for you to have some time um between sessions and there's no,
there's no deadline.
We'll get you the,
the results you're looking for.
It might take us longer.
(19:43):
It,
we might have to do this with fewer needles,
less stimulation,
et cetera.
But we'll get you there and this is how,
this is how we're gonna do it.
Um,
so that's my two cents about,
um,
shoulder assessment for seniors.
It's,
um,
it's a little different and,
(20:04):
um,
might not be the way you currently assess shoulder problems.
Um,
but I encourage you to consider,
um,
using palpation more than manual muscle tests and leg tests for your older populations.
Uh ok.
(20:25):
So,
um by the way,
my podia courses I'm doing um a Black Friday 20% off all courses.
Um The code at Checkout is Black Friday.
No surprise there.
Um All caps and there's a link when you're at,
(20:47):
check out there's a link for the discount code.
Um That'll open a box.
Um I'm just putting this in as like an Easter egg.
Um You'll,
if you listened this far,
you,
you get the code before everybody else.
Um It's Richard hazel.podia.com.
Ok.
(21:07):
Um Have a great Thanksgiving if you're American and uh and you have Thanksgiving.
Oh,
I'm going to Italy.
Um I'm driving on Thanksgiving day with my dogs to New York City and flying to Rome on that Saturday because I'm teaching a group of doctors in Italy in Sienna,
(21:27):
the weekend of December 123.
It is on my web page,
Rich hazel.com if you want to see what,
what I'm going there to do.
Um,
but I'm excited about it and um,
it'll be the first time.
The majority of the people in my course are medical doctors.
So it'll be fun,
I think.
Um,
and um,
I'm hoping that I'm bringing them some new interesting information using motor points and electric stimulation.
(21:55):
Ok.
So have a great week and I will talk to you soon.
Welcome to the Acupuncture Outsider podcast.
My name is Richard Hazel and in the time it takes for you to commute to or from work,
I hope to have shared something of interest about orthopedic acupuncture using motor points,
trigger points,
(00:23):
myofascial slings,
uh neuro functional acupuncture segmental treatments.
Anything that crosses my mind that seems to be of interest.
I hope you'll enjoy it.
Hello and welcome to another episode of The Acupuncture Outsider.
(00:46):
This is Richard Hazel.
Today.
I want to talk about some tips on shoulder pain assessment that do not require manual muscle testing and I'll get into why in just a minute,
I wanna say any time you suspect that your patient should be getting imaging,
(01:10):
you should be sending them to imaging before um doing a full,
you know,
assessment if there's,
if they're in a lot of pain,
um,
people tend to want to avoid the doctor and they want to go see their acupuncturist and see what they can do.
If you suspect that they have a serious injury,
(01:33):
a full thickness tear,
you should send them to be um evaluated with an MRI and if you're not sure,
then it is completely fine to treat.
But if you have a feeling that there could be a full thickness tear,
(01:54):
then of course,
you may not want to um use too uh too much stimulation,
electric stimulation.
Um That said many times we're seeing people with shoulder pain who have already been assessed by a medical doctor and are still having pain.
(02:14):
And the thing I wanted to talk about today is uh how to assess the shoulder for your elderly patients who often have serious restrictions on shoulder abduction inflection,
(02:35):
um,
may not be able to reach their back.
Um,
may already have a full thickness tear that the doctors do not want to do surgery on because of their age.
They,
the,
you know,
the trade off is not worth it for someone in their,
(02:56):
maybe in their eighties or nineties if they have a full thickness tear and it's healed.
Um,
but now they have shoulder pain and you need to try to help them.
So you'll see,
uh,
I have a lot of patients in their seventies,
eighties,
even nineties.
And,
um,
they have shoulder pain and they can't,
(03:19):
um,
they,
they had limited range of motion before they had shoulder pain.
So,
you know,
if,
if you have relied on manual muscle testing because you were taught how to assess the shoulder using manual muscle testing and length testing.
And that's all good.
(03:40):
And well,
because your primary focus is treating young,
healthy athletic adults,
then this is not for you.
This is for those of you who have a patient population well into their seventies,
eighties,
nineties.
(04:01):
Um It's a little different.
We're not doing that length testing.
We're not doing pack length testing.
We are trying to eli eliminate pain.
We're trying to improve the quality of life for somebody who already has poor scapular stabilization.
(04:28):
So the,
the,
the issue uh we're going to have is how do we best help them um with acupuncture without overdo it and without um treating a lot of muscles that are at this point,
(04:49):
not really um firing and not really going to fire because they're not going to go for physical therapy.
Um They just want to be able to uh as one patient said yesterday,
put a plate into the microwave.
That was her top priority.
That was her main concern.
(05:12):
So,
um so this is about how to treat those people.
Um You're gonna use palpation and you're gonna ask questions more than you're going to put them through full range of motion or um you know,
a lot of resistant uh manual muscle testing.
(05:33):
So the,
the tips that I have for you are ask them if they can raise their arm in front of them,
then to the side already,
there's your flexion and abduction muscle test,
ok?
Just the weight of their arm is sufficient for that test.
And um I'm not concerned if they can't get their arm all the way up over their head,
(05:59):
I just need them to be able to perform movements without pain.
So,
um so you start with that flexion and abduction.
Those are key and that'll tell you already where they're having pain now.
So,
so for anterior shoulder pain,
there are a few things to consider.
(06:22):
Very likely you'll find that their uh coral brachialis and anterior deltoid are,
are injured and causing pain.
The infraspinatus can also cause anterior shoulder pain on shoulder flexion.
So that's another consideration.
(06:44):
Um Biceps can be considered,
but they're,
they're usually not the problem.
It's usually in,
you know,
percentage wise,
it's gonna be coral brachialis and anterior deltoid and possibly infraspinatus.
So that's a good place to start and I tend to treat them on their side.
(07:04):
And if that were the only thing that seemed to be causing pain,
then that's what I would treat coco brachialis,
anterior deltoid infraspinatus and Terry minor because it always gets injured with infraspinatus.
So just those,
those four points electric stem up to 10 minutes,
one Hertz.
Um assuming that they can have electric stimulation.
(07:25):
If they can't have electric stem,
then you're gonna retain needles for 20 minutes.
Um And,
and then you're gonna retest and see how that feels.
Um pain on abduction.
Very likely we're talking supraspinatus and the middle deltoid.
So they're gonna have pain at that uh acromion area at the top of the deltoid and or pain at the deltoid tubercle of the humerus.
(07:58):
So,
right where the deltoids insertion attaches to the humerus,
they often will have pain when there's a middle deltoid issue.
Um That pain can radiate,
refer down the humerus.
Um So you'll have some patients tell,
show you where they have pain and it's right over the humerus where there doesn't seem to be much bone because it's not bicep and it's not deltoid.
(08:26):
So that's a good sign that it's a middle deltoid issue.
Um So on abduction,
I would treat supraspinatus and the middle Delwin posterior shoulder pain,
very likely teres minor,
sometimes posterior deltoid.
(08:49):
Those are your two main ones.
Occasionally,
subscapularis can cause pain in the back of the shoulder,
but on someone that age,
it's likely not the injury.
Um but keep it in mind,
it can cause the subscapular can be injured on someone that old in their seventies or eighties,
(09:14):
but not likely they're just not doing a lot of um things that require a lot of internal rotation force.
Um It's an injury that you see more on someone who's doing a sport or swimming,
something like that.
Um So those are my go to sometimes it can be a tricep injury,
(09:37):
the posterior shoulder,
but really most commonly it's terri minor and sometimes posterior deltoid.
And how do you,
how do you confirm it?
You push on them,
you ask permission to press on some muscles and then you press and you see where it's tender,
(09:58):
they're probably going to have a very tight upper trapezius because that's the compensation that you know,
when,
when the shoulder flexion and abduction,
which require upward rotation of the scapulae um are injured,
then they're going to use upper trap for upward rotation.
(10:20):
So upper trap will get injured and that can cause pain as well.
So those are my go to muscles for the elderly.
Now,
there are also a lot of older people who will have anterior shoulder pain,
(10:44):
that's not actually anterior shoulder joint.
It's further down at the intertubercular sulcus,
the attachment area for the peck major,
latissimus,
dorsi and the teres major.
And on most of them,
(11:04):
it's the lat,
it's not usually the terrace major or the pecs.
I'm not saying it's not always,
I'm saying most of the time it's the lat and those people may actually point to their lateral rib cage area as another area of,
(11:26):
of pain or soreness.
And that'll be the lat and then you lie them on their side and you can,
you can work on the lat with them on their side,
their arm will be at about 90 degrees.
So definitely be aware of that.
Um when people have pain on shoulder flexion and you ask them where it hurts,
(11:48):
they're not always very exact and they'll put their whole hand on the front of their shoulder like at the deltoid in the anterior deltoid area.
So it's easy to miss because the anterior deltoid is there,
the coral brachialis is there.
Um But if the pain is really primarily from the labs,
(12:09):
then um that's what you need to confirm.
So you will do some palpation and you're gonna feel the lot.
And um just remember that um upward rotation of the scapula that helps flexion and abduction gets limited and inhibited by tight lats.
(12:34):
And most of us have tight lats and when you're 70 or 80 not only is it tight,
it,
it might be so short that you really can't even raise your arm.
So,
um,
that should always be paid attention to,
for people where you,
where you are trying to improve their ability to um do shoulder flexion and abduction.
(12:56):
The latissimus dorsi gets very,
very tight and inhibits upward rotation of the scapula.
Um,
always should be considered and you'll see it in the elderly,
um,
pretty regularly.
So that's something you'll definitely want to consider.
Sometimes you do have to treat the peck major.
(13:19):
Sometimes you do have to treat the peck minor on older people with shoulder pain,
especially if it's a source of pain.
Um But I'm trying to give the 80% and not the 20.
Um There's plenty of exceptions to what I'm saying.
But if,
(13:39):
um the,
but the,
but if you're,
if you're dealing with this population,
um that's the,
that's the,
you know,
80% maybe more.
It's going to be those muscles,
the anterior shoulder pain from anterior deltoid coral brachialis for Spinatus,
(14:01):
rarely biceps,
um abduction pain,
the supraspinatus in the middle deltoid,
especially if it radiates into the humerus.
Middle deltoid is primary there.
Um posterior pain from teres minor and posterior deltoid,
sometimes tricep.
And then that anterior deltoid pain on flexion and abduction because of the lat and occasionally peck major or terra major.
(14:33):
Um This is uh this is something I rely on heavily,
a lot more palpation with,
with my older patients because you really,
um,
one by the time they come and see you,
they're in a lot of pain.
Um,
two,
they don't have great mobility or strength.
(14:54):
Um So you're really,
you're really better off if they're gonna do something painful,
you're really better off with them doing it than you.
Um,
uh eliciting that pain with a manual muscle test.
So,
um,
so I would just let them use uh gravity for their reflection and abduction and get a sense of what they can and can't do.
(15:18):
Um,
and you can always check the better side to see what their mobility is on the other side.
That'll give you another clue about what's going on.
But,
um,
I don't know if people will think it's scandalous or not,
that I'm gonna tell you that I'm not that worried about.
I,
I do sometimes treat serratus anterior on the older people,
(15:41):
but I don't tend to treat a lot of the mid back stuff for a couple reasons.
One,
I'm really afraid of pneumothorax on someone older where they just have these,
these ischemic,
thin plod layers of muscle in their back because they don't exercise.
(16:02):
And I'm just really too afraid on a lot of them of needling into rhomboid,
uh lower trapezius area.
Um And I also just don't think a lot of those are inhibited,
um,
muscles and not really short or tight.
(16:23):
So they're not upwardly rotating well because they're weak.
Um I'm not,
I'm not that concerned with treating those muscles.
They're not,
they're not gonna get much better by treating them.
I would serratus anterior.
Yes,
you can treat serratus anterior and hope to improve their scapular upward rotation.
(16:48):
Um But a lot of my seniors,
I'm not even that concerned with it because I know that they're not in their day to day.
They're really not um raising their arm above shoulder height.
In many,
many cases,
they really just want better quality of life.
(17:08):
They're not looking for the same mobility that you and I need for more active lifestyles and they're really looking for pain management,
um or you know,
relief from their shoulder pain.
So I'm not as focused on the things that are important for athletes,
(17:30):
younger people,
um people who really do want to have full mobility and strength.
So it's a different population,
it's a different goal and therefore a different assessment and,
and often a different treatment a little more abbreviated.
Um especially if it's the first time you've seen that patient,
(17:51):
you don't know how they respond to acupuncture or electric stimulation.
The older patients are often more fatigued um by acupuncture,
even if you don't use electric stimulation.
So you just have to uh proceed with caution and see how they respond.
(18:14):
And based on their feedback,
you can um increase or decrease the amount of stimulation that you're providing in that session and always consider treating older people in their seventies,
eighties,
nineties,
um less frequently.
(18:36):
So,
not necessarily once a week that might not work for a lot of them.
They might need two weeks between sessions because of healing time.
Um When you get into the older populations,
their healing is slower.
They have um muscle soreness for longer,
(18:59):
two or three days sometimes.
Um And you want them to have time to enjoy feeling better.
So it's not urgent that they get better by the end of the month or whatever the short timeline is in our heads.
Um You can spread it out and explain it that,
(19:22):
you know,
we don't know how quickly you heal.
I'll see you next week and then we'll discuss if we need to go every two weeks instead of every one week.
Because if you're a slow healer,
it's better for you to have some time um between sessions and there's no,
there's no deadline.
We'll get you the,
the results you're looking for.
It might take us longer.
(19:43):
It,
we might have to do this with fewer needles,
less stimulation,
et cetera.
But we'll get you there and this is how,
this is how we're gonna do it.
Um,
so that's my two cents about,
um,
shoulder assessment for seniors.
It's,
um,
it's a little different and,
(20:04):
um,
might not be the way you currently assess shoulder problems.
Um,
but I encourage you to consider,
um,
using palpation more than manual muscle tests and leg tests for your older populations.
Uh ok.
(20:25):
So,
um by the way,
my podia courses I'm doing um a Black Friday 20% off all courses.
Um The code at Checkout is Black Friday.
No surprise there.
Um All caps and there's a link when you're at,
(20:47):
check out there's a link for the discount code.
Um That'll open a box.
Um I'm just putting this in as like an Easter egg.
Um You'll,
if you listened this far,
you,
you get the code before everybody else.
Um It's Richard hazel.podia.com.
Ok.
(21:07):
Um Have a great Thanksgiving if you're American and uh and you have Thanksgiving.
Oh,
I'm going to Italy.
Um I'm driving on Thanksgiving day with my dogs to New York City and flying to Rome on that Saturday because I'm teaching a group of doctors in Italy in Sienna,
(21:27):
the weekend of December 123.
It is on my web page,
Rich hazel.com if you want to see what,
what I'm going there to do.
Um,
but I'm excited about it and um,
it'll be the first time.
The majority of the people in my course are medical doctors.
So it'll be fun,
I think.
Um,
and um,
I'm hoping that I'm bringing them some new interesting information using motor points and electric stimulation.
(21:55):
Ok.
So have a great week and I will talk to you soon.
Popular Podcasts
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations.
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
The Nikki Glaser Podcast
Every week comedian and infamous roaster Nikki Glaser provides a fun, fast-paced, and brutally honest look into current pop-culture and her own personal life.