EP 133 WTH?!? The Doctor's Chat: Make Your Pain Go Away with Rick Olderman

Hello, everyone. This is Dr. Jonathan Nadal over in Nature Cures Clinic in Portland, Oregon. And we're here for another episode of what the Health. And today we have Rick here with us. Orthopedic physical therapist. Rick, why don't you tell us a little bit about yourself.

Well, thanks for having me, Dr. Nadal. It's a pleasure to be here. Yes, I'm an orthopedic physical therapist. However, by necessity, I've become a chronic pain specialist. From a musculoskeletal standpoint, that's just because early on out of PT school, I felt I was a miserable failure as a pt. Yes, I could solve simple acute things, but when it came to chronic problems, chronic back pain, headaches, neck pain, things like that, I just couldn't help these people as well as I thought I should. And that's what kind of led me on my journey. Probably similar to your own journey with trying to figure all this stuff out.

Yeah, absolutely. So it was more like, so you did the physical therapy and then how does it become that more specialized orthopedic. I always think kind of an orthopedic realm with physical therapy to begin with, but it sounds like it's a lot more specialized and focused.

Actually, most physical therapy seems to be pointed towards more acute issues. You're right, it is all orthopedics. It's just what we're taught in school. I term it as component thinking where we put shoulder pain in a shoulder pain box and back pain in a back pain box and neck pain and so forth. And so while that works well for more acute issues, it doesn't work well for chronic pain issues. And so my journey has been really trying to put the body together as a system to understand how it is that we are causing this pain to happen in our bodies and how we can solve pain.

Great. Yes. And I think so, as we discussed briefly a little bit before this. So it more of a systems based approach to really get at underlying causes. Correct. Yeah. Not just. All right, show up for two to four weeks and let's get that specific joint matter. No, let's dig a little deeper.

Yeah. Frankly, this is why I believe that we have chronic pain from a musculoskeletal standpoint is because we take that approach, that component thinking approach. And as you know, there are people with more, deeper problems going on. This component approach doesn't solve those deeper issues. You need a systems approach, and that's, I think, what's been missing.

Great. Do you find that more and more physical therapists are Going on into the workforce and finding some of the limitations that you found and taking it steps further to go in this direction, which seems to be the way that it should be going.

Gosh, I sure hope so. Because unfortunately, what's happening in physical therapy is that we are going down towards more into a manual therapy approach to solving pain, which is more manipulations, mobilizations of joints, soft tissue work and things like that, which is part of that component thinking of things we're going away from. The broader systems approach that I think we started at as a profession long, long ago is understanding movement. And, you know, we can understand maybe this movement, you know, isolated, but we don't understand, say, how the foot is connected to the shoulder. Well, and those are the kinds of things that I've been figuring out for these past 25 years.

That's fascinating. I, you know, I just remember even because. So besides naturopathic medicine, I also do acupuncture. And there was more than one of the. The guys I studied under and they always talked about, there's Chinese words for it, but as far as, like, there's kind of a. If you picture a fault zone, like during an earthquake. Right. Similar kind of zigzag patterns. And at first it was kind of hard to see, but after you see a handful of patients, you get it how you go from the shoulder to the hip and to the opposite knee to the opposite ankle. And it really does follow this. This. It's. It's not the most linear thing, but it helps to understand how the body compensates and shifts around in different ways. So you can't just look at the shoulder or you can't just look at the ankle. You have to go from proximal to. To. To further down the midline of the body and get at the root of it.

Correct? Yeah. And yeah, what you're describing is a. From a musculoskeletal standpoint, I don't know how it works from a more of an internal medicine standpoint, but from a musculoskeletal standpoint, yeah. Your brain takes your body through a series of compensations because something is happening that you're trying to avoid, and your brain is registering that, and it makes those compensations unconsciously. And so you're not aware of the compensations. All you're aware is that your job is to get from A to B. Right. And that's what the brain's job is to help you do. And so it's going to get you there anyway that it can figure out how to get you there. But over time, your body doesn't go back to those original way of moving. It sticks with these compensation patterns. Mostly because you haven't addressed the original reason why you had the compensation pattern in the first place. So your brain just continues to create this and all of these and it becomes this kind of convoluted web of dysfunction in the body.

Yeah, it's true. And I just, I think to, to all the, you know, patients undergoing different surgeries and, and just getting physical therapy, I mean, how often do you find yourself wishing that you had met a patient way before it had gotten to that point? Like, do you find that once you see a patient, they've already. There's just so much work to be done that if only you had started working with them five years prior kind of thing?

Oh, you know, I see that all the time. Absolutely, absolutely. I think back to old patients that I couldn't solve back in my earlier days and oh, if I only could see them one more time, I know I could solve their pain now because it continues to bother me that the people who I couldn't help have always stayed with me. Now that I've learned so much more, I wish I could go back and help them again. So it works both ways. Yeah, yeah, yeah.

It's a, it's a practice after all, right?

Yes.

Yeah. And so let's see. So if we think. I mean, I'm really tempted to just ask about the fixing you method, but we can kind of table that for.

A little later if you want. You know what? I can describe the fixing you method through a test for back pain, if you would. This kind of, kind of tells you what I'm talking about. So most people out there listening of any injury in the body, back pain is probably the one that most people are having. So let's just take you through a little test to understand exactly why you're having it and what you're doing that's contributing to it. So the first test is really simple. We're just going to have you lie down on the floor. Usually a solid surface is better. It gives you more feedback into your body. But if you can't get down on the floor, you want to lie down on the couch or your bed, that's fine too. Just lie down with your legs straight and we're going to stay there for a few seconds and just feel how comfortable your back feels in this position. You can reach your hand underneath your low back if you want to and feel the curve in your low back. How much Curve is there. Okay. Now you have a sense of how your back feels in this position. So let's go ahead and bend your knees and have your feet flat on the ground. Or if that doesn't make a difference in your back pain, then go ahead and hug your knees to your chest. And one of those two positions should feel better for your back. Either legs straight or knees bent. And I bet Dr. Nadal, you know which one that is.

Yeah. Well, hold on, because I feel like this is like an interesting therapeutic reverse version of like the active straight leg raise. You know, I mean, like the test to see, like, what's going to help with it.

Right.

When you relieve the tension from the low back, it's going to help. Or whenever there's some stabilization that's in place, right?

Yeah. Yeah. So kind of what you're getting to is that more back pain will be felt with someone with their legs straight versus when the knees are bent. And that's probably 99% of the people listening to us right now who have back pain will find that this is the case with them. They found also that when their knees are bent, the curve of the back goes down and becomes flatter. And that's one of the reasons why they feel better, but it's not the whole reason. So let's go ahead now and stand up and listen to the rest of the podcast. And what you all will notice is after about a minute or two of standing, that your knees have started to lock backwards in a straightened position. This is an energy conservation move because now we get to stand in our joints without actually using our muscles to hold us up anymore. But your. You'll also notice that if you lock your knees backwards, your back arches more. If you unlock your knees, even ever so slightly, it unlocks your back, your back flattens a little bit more. We've just found on the floor that you have more back pain when your back is more arched and less back pain when your back is flatter. Then we've also found that when you stand for any period, usually over a minute or two, your knees tend to lock, which then arches your back. The easy conclusion of this is that, oh, my back should be flatter, but it's not so much that your back should be flatter. The difference between bending the knees and straightening the knees is that we're removing the forces from your legs that are acting on your pelvis, which is then acting on your spine. By unlocking the knees, you've now removed those forces. What this is really telling us is that Something going on in your legs is contributing to your back pain because it's causing the back to arch more. Does that make sense? Then what we've also found out is that your normal way of standing, and this goes for walking too. Most people listening to this, if they start to pay attention, they'll notice that they lock their knees when they walk as well. If you walk 10,000 steps a day and your knees are locked every step of the way, then you've got 10,000 little hammers hammering on your back. And if you stand in line at the bank or the grocery store and your knees tend to lock, then that's another big hammer on your back. So just by simply unlocking your knees, that will remove forces from your back and help a lot of back pain. So that's kind of the fixing you method in a nutshell, is that I figured out what these habits are that are contributing to chronic pain. And those habits not only change the alignment of our bodies, but they cause tighter weak muscles to occur, which then pull on our joints or muscles excessively or not enough and then cause pain. So it's kind of that whole systems approach is understanding that.

Love it. Yes. God, yeah. And you described it really well because, I mean, almost the way that you can picture the, the legs straight on the floor generating more pain if you just, I mean, with the relation of the pelvis and the lumbar area to gravity and then just stand it up. And it's, it's a similar effect when you're locking out the knees.

Right, exactly. Absolutely. And, and most people will say then that, you know, like a lot of therapists will then try to have you tilt your pelvis underneath you and what, what we call a posterior pelvic tilt to flatten the back. But that's an unnatural solution. Yeah. Why not just stop locking your knees? That's a more natural solution. Right. So unlocking the knees will solve that problem in that particular way.

Good. And I mean, I like the metaphor of a little hammer because say you have someone who started working at the age of 15, 16, maybe retail, whatever it is, like, and then by the time they're 30, 40, 50, and they've had all these little hammers or standing anything all day, all night, you know, just going out, it's so easy and we don't even think about it. Right. Especially with what's a lot becoming a lot more popular now, where we have the, the desks that can be raised to be standing. That's great. But it, you know, maybe it's taking a little bit of toll on our knees if we don't employ the right ergonomics or biomechanics when we're doing that, you know.

Absolutely. And, and so these habits are found in how we stand, how we walk, how we sit, how we bend over, all sorts of things. So if you're a person who locked your knees and you have back pain and you bought one of those standing desks, but you lock your knees when you're standing, then that's actually going to contribute more to your pain. It might temporarily feel good because you've changed your body position, but ultimately it's just causing the same problem.

Exactly. Yeah. How we move, how we stand. It's the more, I mean, I just wonder what I'm going to be telling people when I'm 80 or 90. It's like guys just move. Right.

Eat right. Right. Drink right. Yeah, yeah.

I mean, it's just getting to the source really. So let's think about acute versus chronic. You know, you have a 20 year old that's standing up all day in that way just to continue with that example, they may not notice it unless there's some acute injury to their knee and then they compensate with the other knee and then they stand up straight, then their back is hurting. Sure. And it's gone in a few months versus chronic pain. Just let's open that up a little bit. Acute versus chronic, you know, we can, you know, how long one versus the other. But, but, and how does it really manifest in time?

Sure. So, you know, I've listened to your other podcasts and you talk about the body's innate ability to heal. So if, if you cut your finger, it heals. If you break a bone, it mends six to eight weeks. So our bodies have systems in place to heal problems in our bodies. The thing that wouldn't cause allow that bone to knit would be if it was displaced and it couldn't align correctly. Right. Or the thing that wouldn't allow that cut to heal would be if there is some irritant to, in the, in the wound that wouldn't allow the, the tissues to come together or something was pulling the skin apart, preventing it from healing correctly. So I see chronic pain is the same thing, is that chronic pain is. So the technical definition of acute pain is anything less than three months and anything more, any pain more than three months is typically chronic pain. Who came up with that division? I don't know. But the way I think about chronic pain is that you have a perpetually reoccurring Acute issue that's going on, but in a chronic fashion, because you haven't solved that acute issue that has originally caused you pain. Well, why would you assume that just over time that acute issue would be solved if you hadn't solved the reason you had the acute issue in the first place? Such as how you're walking, how you're sitting, how you're standing, how you're moving. So you've just taken. All you've done is just caused the problem to occur over a longer period of time. To me, this explains why, for instance, someone with 10 years of back pain or 20 years of migraines can feel better within a week. Because what we're doing is eliminating those things that are causing them not to heal. If we can just simply identify those things and change how they're using their body or correct them, why wouldn't the body be able to respond quickly to that? Because it has all of these innate mechanisms to help us heal already. All we have to do then is get out of the way. But to me, chronic pain just means that you haven't identified the right issue that's causing your pain. That's what I've been trying to figure out these last 25 years.

Yeah, I think you're doing it well. I hope so.

Yeah.

And then, not to make it more complex, but there's. I find that there's. And it's just for fun, but then there's like the acute manifestation of chronic pain or chronic condition.

Right.

Where things flare up. Right?

Correct. But they're flaring up, I think, because of an existing issue that you haven't solved. So there's. There's an existing issue that's causing some flare up or causing you to be. If we think of pain as we have this critical threshold above which we have pain, well, you could be right here right next to that, you know, lower part of that threshold. And it takes just a little nudge to get you up there. Or my goal is to get people down here way below that critical threshold. So they have a lot of, you know, wiggle room before they can start to experience that pain. And that's kind of what I do with the body.

Awesome. Huge. And I see you have some fun things back there. Is this like a typical.

This is my home studio, so if you don't mind, I'll show you. Over the years, I've realized that there are three patterns that are causing most back pain. So we've talked about one of them, and that is one with a spine that arches too Much. Now, why is the spine arching too much? Well, we talked about the knees locking, which then tilts the pelvis forward, which then arches the back. But we've got thigh muscles on the front of our legs, too, that attach to the front of the pelvis. And when the thigh muscles become tight, they then pull the pelvis forward and cause the back to arch. But it's not only this is if I were to push you as hard as I could, Dr. Nadal, on your chest with my finger, and you didn't move, let's say you didn't move at all and I'm pushing as hard as I can, you're generating force against my finger push. The fact that you haven't moved doesn't mean that there isn't any force that's acting on you. It just means that you're overriding that force. The same thing goes with something like tight thigh muscles. The pelvis doesn't actually have to tilt forward. All we need is the force trying to push it forward, pull it forward, which then your back is responding to. That's one pattern of. That's the most common pattern behind back pain. But if you have unilateral back pain, let's say on one side, or sciatic pain down one side or a side joint pain down one side, usually the pattern that's going on is that you have an elevated pelvis on one side, usually that same side, and a ribcage that's also depressed on that side. Why is that occurring? Usually because there's an older problem in that same leg that your body is responding to. And so your brain over time. We talked about this just a couple minutes ago. Your brain over time says, I got to get off that thing that's really bothering me. So I'm just going to hike that hip up a little bit here. There we go. Now I'm off of it. And then you have other compensations that occur because of this, that then maybe now you're off that old sprained ankle, it doesn't hurt anymore. But now you've developed sciatic pain down the same side. And so I found it's really interesting, a lot of patients with these chronic issues, we're not trained to think of our older issues as a source of our current pain. And really, that's what often I end up doing is, you know, I trace the stuff down. I said, I thought you said you didn't have any other injuries, but I'm finding this. Oh, I completely forgot about that old time. Back in high school, I was Playing football. And I, you know, fractured in my ankle, but I healed from that. That doesn't bother me anymore. Well, it doesn't bother you anymore because your brain has done this to your pelvis to get off of that. So that's the pattern that's responsible for most unilateral back pain, sciatic pain, SI joint pain. And usually if you, if your listeners really think if they're having unilateral pain, this is probably the pattern. Oh, and the easier, easiest way to figure out whether you have this pattern is just take off your shirt, have someone take a picture of your back, and you'll see that there's a bigger crease on one side than the other. That means that you've got what I call a side bedding problem. And why is it happening? Because of some old problem here in the same leg. Now, that's probably 80 or 90% of the time that's occurring. Sometimes, you know, 10 to 20% of the time it's a response to some compensation for the other side. So. But 80 to 90 of the time, it's the same life.

Interesting. Really good explanation. Yeah, like just putting it all together and then even an actionable item where, yeah, just have someone take a picture and you can see it. Because you, you made me think of like, like discrepancies as well. Like how, how often do you find that to be like, an actual, like, common?

I, I've been doing this for 25 years and I've probably found less than five actual leg length discrepancies in my whole career. But I can tell you, I've had hundreds of people come to me who've told me that their doctor said that they have a leg length discrepancy. What their doctors are seeing is that elevated side of that pelvis. But what they don't understand is that there are several compensations that can occur at the SI joint, the hip joint, the knee joint, the ankle joint, all the foot bones that make it look like one side is higher than the other. And so that's the problem. And I've got an upcoming book called Solving the Pain Puzzle, and I talk about this is that believe it or not, in medicine, we still haven't standardized how to measure the length of a leg because everyone keeps saying, oh, you've got a leg line discrepancy. No, it's not a leg length discrepancy. It's a compensation pattern. And 99% of the people listening out there who have been told that they have a leg discrepancy have been given a heel lift or some other thing to compensate for it, and they wonder why their pain hasn't resolved. And it's because the source of the problem hasn't been solved yet.

Yeah, it's true. There's so many. There's quite a few patients that roll in with, like, different orthotics, and they've seen this person and pay decent money for it.

Oh, yeah, lots of money.

It's not like you're getting to the root of the cause here, you know, and then, I mean, so even other things that people think are, you know, like, it's kind of just a sentence and they have to deal with it the rest of their life, you know, like kyphosis, lordosis, skull, any. Any of the. The misalignments of the spine. Like, do you find that there are, you know, things that people can do, whether it's scoliosis or whatever it is, that that can actually help reduce pain?

Oh, absolutely. Scoliosis. So in medicine, scoliosis just means lateral curve. It means the side bending curve. Well, if this side bending is occurring because of some compensation pattern, fix the compensation pattern and you resolve the scoliosis. And to some degree, we all have some scoliosis because we're all compensating for something in our history. There's congenital scoliosis, which is the classic S curve, and then there's the functional scoliosis, which is usually just a C curve. There's only one curve instead of two in the spine. But I've helped people with congenital scoliosis, too, because what I found is, what's happening is that the scoliosis continues to deepen because of the lack of correction of the compensation pattern in the body. So if we're not correcting the things that are causing, that are becoming weak or tight or whatever because of the scoliosis, why wouldn't it get worse and worse over time? Right. So, but if we. And there's this. There's a method of correcting scoliosis called the Schroth method. It's developed by a German physical therapist back in the 1940s, I believe, and they. They exclusively address congenital scoliosis. But I found that my corrections for functional scoliosis also work well for congenital scoliosis, too, for those reasons. There you go.

Awesome. Yeah. Because there's nothing worse than thinking you have something that you can never correct.

You're just born with it.

Right.

Don't you find that this is the case often in medicine is that I find that a lot of medical practitioners blame something that someone can't change as the source of their pain, such as, oh, the shape of your neck bones, your curve is wrong, or you've got the scoliosis, or oh, your core is still too weak, you got back pain. That means your core is not strong enough. No, it has nothing to do. I almost never work on core strength to fix back pain or sciatic pain because that's usually the last thing in the puzzle that we need to worry about, you know, and so that's, you know, my message to a lot of people is, you know, if you've been told that you have some unchangeable condition that's at the source of your pain, keep looking because that's likely not really the answer. It's just that that medical practitioner, you know, that's what that one person thinks rather than what the truth is.

Yeah, it's true. Keep questioning. There, there is a way.

Absolutely.

Yeah. And then even arthritis too, just to throw in another. It's like, what was that? There's people with, with herniated discs, arthritis, who are walking around, they don't even know it, they're not in pain. Right.

And absolutely.

And yet then there's a percentage who may have the same thing less severely. And you have horrible pain.

Correct.

There's just a curious relationship between what we actually see on X rays or actual objective findings, and then the subjective pain experience with our patients.

Absolutely. And that becomes more pronounced as we get older. As we get older, we have more degenerative changes that occur naturally in our bodies. Disc changes, arthritic changes and so forth that cause no pain. So we should expect that as we get older that we should have these kinds of changes happening to us because we're human and we're using our bodies. Right. But those changes don't necessarily have anything to do with why you're having pain.

Yeah, it's true. Even, just, just kind of dispelling that myth, Even the old age idea, you know, I, I see sometimes 70, 80 year old patients walk in here that are actually healthier than some of my patients in their 50s. So it's like good genes. I think it's more than that. Right?

Yeah, yeah. A little bit of luck, a little bit of genetics, a little bit of knowledge.

Yeah, exactly.

A nice mix of all of those things.

Yeah. So. And so you said your next book is going to be on something with pain.

Yeah, it's called Solving the Pain Puzzle and that comes out in early next year. And it's basically, it's Cases, it's, it's cases I've had over the years that use my approach to solve pain. But it, it kind of shows you how I did it, how I solved that, these people's different cases of pain. And so it, it talks about, I don't think I mentioned it specifically in there, the fixing you method, but basically it's my fixing you method and how it works, given real patient scenarios. I wrote another series of books about 10 or 15 years ago called the fixing you series. Those are more explaining the mechanics of what's going on and causing pain and gives you exercises on how to fix it. I have little tiny stories in there, like a paragraph or two of patients that I used that got better using these techniques and how. And so over the years, so many people have said, you know what? I really love Debbie's story. I'm just like that person Debbie in your book. And I said, and so I had so many of these people commenting, how did she do? So I thought, what if I flipped this on its head and wrote about the patients instead of the mechanisms and highlighted. Just kind of went more lightly into the mechanisms, but talked about the patients and what was happening with them instead. So that's the next book coming out.

Awesome. Well, I will definitely read it. I, I'm definitely curious. Yeah. Because it pain everybody. Like, I, I still have yet to meet a patient that, that isn't in some kind of pain somewhere in their body. And what I'm curious about too. So just to gain some clarity, the fixing you method, we talked about the low back and that was solid. But then are we, are you saying that like this is a method where you can like shoulder pain, neck pain, low back pain, knee pain. Like this is kind of a systematic everything.

Head to toe. Head to toe. So basically what I've, what, what I've broken, what I've done over the years is I've broken the body down. If you come into my clinic and have back pain or knee pain or foot, brain, anything like that, you get an exam that starts at the rib cage on down to the foot. Because this is the typical system that's involved with that. Any of those problems, if you have shoulder, neck or headache pain or elbow pain or anything, we, we start at the pelvis and work our way up to the head. That's the system for the upper body system, of course they cross, but. And I'll bring that into, you know, I'll address those things if they are causing, if the lower body is causing upper body or upper body Causing lower. But that's so rare that I have to go to that extent to solve a problem in the upper body, that I can safely break the body into these two systems.

That makes a whole lot of sense to me. I mean, it's the, the word like a kinematic chain or like, really like the way the dominoes are going to fall. It makes the most sense to go in those directions.

Yeah, yeah. It's just, you know, from experience, I just whittled it down. It's like, wait a sec. I, I, over the years, I've just kept simplifying and simplifying and, you know, you might find this in your own practices that sometimes you can find a few key issues that have huge ripple effects in the body. And so that's my exams are looking for those key issues that are causing the ripple effects in your body. And then I dig a little deeper into those and solve whatever I need to solve around those. That's why it seems so simple, like unlocking the knees. I can almost guarantee that if most of your listeners just decide to unlock their knees for the next three days, that their back pain or sciatic pain would decrease probably by 50%. It's those simple things because there's a large ripple effect that goes up and down from those changes in the body. If you know what you're changing and why, you can have a huge impact on other systems in the body. Anyway, that's how I've broken down the body, and it works pretty well.

Yeah, no, it's amazing. That's a powerful message, too. You tell anybody you can get their back pain down by 50% in three days, their ears will perk up for sure.

Yeah. I had a woman walk in. Now, I've sold my clinic this year because I'm focusing more on online work, but one of my last patients was a Division 1 swimmer who walked into my clinic, came to see me for her plantar fasciitis. I watched her walk to my table, and she was literally grimacing. And so she sat down in the chair and she had to close her eyes and breathe for a good full 30 seconds or a minute. And then I would take her history, and her history included back pain. She was a Division 1 swimmer who had to leave the program because her back pain was so bad she couldn't continue swimming. No one could figure it out. That was 15 years ago. And so then I asked her to stand up and she had to hold onto the table to steady herself. I said, my gosh, that plantar fasciitis must be killing you. She says, oh, that's not the plantar fasciitis. That's my back pain. You can't help me with my back pain. No one's helped me with my back pain in 15 years. So I said, and I don't know about you, but if someone tells me that, that really gets my hackles up. But she was in so much pain, I couldn't even conduct an exam. However, just by watching her walk to my table, I saw exactly what the first thing was that she needed to do. She was locking her knees. So I put a little piece of tape on the backs of her knees to keep her from locking them. And in three days, she was 75% better, not only in her back pain, but also her plantar fasciitis pain. Because they're connected. When you understand the body from a system standpoint, these are the kinds of changes you can make. And I expect to see that kind of recovery with most of my patients.

That's amazing. Like, yeah, 10, 15 years, tape on the knees.

Boom, done. Yeah, yeah, that's.

But it takes that understanding and experience and. And constantly questioning and digging and reevaluating. I mean, it's. That's impressive. That's good. I bet she was grateful.

She was very grateful. It was the first time I've seen her smile. And, you know, then I could conduct the rest of my exam and solve all the other problems that were going on, too. But we had to get her to a point where she was able to go through the examination. Yeah.

Yeah, definitely. Is she swimming again, by any chance, or.

I don't know where. I think she gave up swimming, but she's walking and living life great now. Yeah.

And so, I mean, that relates to, well, two ideas. I love patient stories like that. Like, I mean, if you have another one or two that you want to share, it's inspiring and exciting. And then. And with that, I wanted to kind of dovetail into just general, you know, words of wisdom when it comes to, like, natural approaches to pain reduction. And even some of the things you were talking about, like unlocking your knees and whatnot, are useful, but if there's any other common things that you find yourself telling most of your patients.

Yeah. So, well, regarding the stories thing, I put three stories from my upcoming book on my website so anyone can go to my website and read those stories. I. I've even created audio files of me reading them, so I'll read them to you if you want more stories. But regarding other things, so the Other system I wanted to talk about we touched on a little bit was the upper body system, because I think neck pain and headaches are sorely misunderstood. The surprising cause of most chronic neck pain and headaches is the shoulder girdle system. If you look at the body, most of our bones are these long bones like the leg bones, the arm bones. But we've got two areas of the body that have these broad, flat bones. One of them is the pelvis. We know that this pelvis is the center of function for the lower body and back system. The same goes for our shoulder blades. There are significant attachments from the shoulder blades into the neck bones and the base of the skull. When there's dysfunction happening here, stress is transmitted via these muscles to the neck bones and base of the skull. Many people listening if they've had chronic headaches, including migraines. I've even helped people with trigeminal neuralgia, you know, tension headaches, cluster headaches, whatever. Chronic neck pain you've been told that you've got arthritic changes in your neck or disc issues, it doesn't matter. The thing that's creating all of that stress to your, to your system are usually the shoulder girdles. I can't remember the last person I've seen in the last 20 years who didn't have the shoulder girdles as the cause of their chronic neck pain and headaches issue. So that's the. And I say this to give hope to people because these are miserable things to have, you know, chronic headaches and neck pain and to. There's a really simple test. I can, I can show you to determine whether the shoulders are the cause of the neck pain and headaches. If you want to. Okay. It's really simple. You can do this in your clinic today if you wanted to. So you have your patient stand in front of you and basically you put your hands underneath their armpits like this. Now what you want them to do is move their head around first, look up, look down, look over your shoulders and get a sense of your pain restriction and all that kind of stuff. Then what you're going to do is you just lift up their shoulder blades about a half inch to an inch and you just move your hands around a little bit to make sure that they're relaxed in the shoulder system, they're not holding on anymore, and then you have them look around again. I can almost guarantee just about anyone with chronic neck pain or headaches will have significantly more range of motion looking over their shoulders, up and Down. And their immediate response will be like, oh, my God, that feels fantastic. And right off the bat, you're going to know that this is, this is the cause of their pain. Right? So you hold it up there for about 30 seconds, maybe a minute, and you just make sure that they're relaxed. And then if for the rare person that doesn't feel a difference during this test, once you put the shoulder blades back down, then they feel the weight of their shoulder girdle system on their neck again. And then they're just like, oh, my God, that's killing me. That's why they didn't recognize that you had unloaded it until you reloaded it again with the same problem. And so that's a really. Anyone at home can do this. You don't need to be a trained therapist to do this. Just get your spouse to do this for you. And if you test, if you have any relief with someone holding your shoulder blades up like this, it means you have a percentage, probably a very large percentage of your pain coming from your shoulder girdle system.

Amazing. Thank you. Good.

Yeah, it's really easy to do and solve.

That's incredible. I mean, now you got me thinking, Rick. You know, it's in the, in the realm of integrative medicine and working in tandem with other providers, acupuncturist, physical therapists, MDs, NDs, the works. But you got me thinking about like some of our training, like naturopathic kind of different adjustment or manipulation techniques, which pretty similar to some chiropractic care. So in your mind, you know, it could be as. But your opinion as far as what stage in the game does chiropractic work make sense? And do you find that if you're really getting at the root causes of some of these issues, it's not needed as often as some would think. Right.

Well, my approach is really solve the source of the problem. Now, those manipulations can be really helpful and get people out of pain. And so, but if, if someone has, if you have to do the same manipulation or similar manipulation, just another level up or down, week after week after week, then you're not really getting to the source of the problem. Right. What is pulling those vertebrae out of, out of position? So I believe that my information would only enhance your outcomes, as if you're doing those manipulations, not instead of. Because I think those things are useful for a lot of people. Now, I've never had to manipulate Anyone in my 25 years of practice, and I've solved all pain so that. But There are times I wish I did know how to do that, because they would have speeded things up a little bit. But, you know, I think combining this. This more specific adjustment with a systems solution will kind of blow your outcomes out of the water.

Yes. I like that. Yeah. Again, it's not like one doesn't replace the other. It's more like, all right, how can we get the most efficient, effective care?

Right.

So, if anything, because, you know, you have kind of this formulaic, like, maybe a center has multiple people in it. Maybe they get a massage and then get adjusted and then acupuncture. Awesome.

They're melted.

They're relaxed by them, and it'll work. But then I just. I. What I'm getting is that I think physical therapy like this, through the lens of what you're describing needs to be talked about more and needs to be part of the like. Just as common as, like, some of these other modalities.

I agree, Dr. Nadal. Yeah. I. In fact, I've created a training program for health and wellness practitioners to learn this approach. So that's also on my website, but I don't believe that just chiropractors and physical therapists should know it. I think anyone from a coach to a surgeon should know this.

Yeah.

Anyone who deals with movement and has. Anyone who ever comes to them with complaints of pain needs to understand this type of information. And it's so simple to solve chronic pain looking at it from a system solution. So simple. Yeah. So I'm with you on that one.

Well, is there. I could have asked this in the beginning, but what, like, what inspired you to get into this in the first place?

Well, kind of, you know, just kind of what I said is my failure as a physical therapist, you know, early in my career was my inspiration. I just, you know, I don't want to be a. A mediocre, you know, that practitioner who just helps some people and not others. I was just like, I've got to know. I've got to figure this out. And that's one of the things I enjoyed about your last interview with Dr. Herman. He kind of had that same drive, you know, it's just like, well, this wasn't solving everything, you know, and he went into much more extensive education than I have. But, you know, I just. I have this drive to just. I'm not satisfied until I have all. All of my answers. From a musculoskeletal standpoint, I feel like I've got a lot of those now. Great.

Solid. And then also, even what got you into physical therapy to begin with? I was curious, too.

Oh, well, you know, I'd always been interested in medicine and exercise, and I wasn't cut out to really be in medical school. My brain doesn't really work like that. So I kind of stumbled onto the. Someone had mentioned physical therapy. I grew up on a farm in Ohio, so we had never heard of physical therapy my entire life. Even all through college, I had never heard of physical therapy. And then, you know, I'd done some traveling around the world, and I came back, you know, what am I going to do? And someone had mentioned that her dad was going to see a physical therapist. I'm just like, physical therapist? What's that? And so I went and investigated. I'm just like, holy smokes. I think this is for me. So. And that's why it was, you know, it was a long time before I discovered it. And this is why I was doubly passionate about trying to figure it out, because I spent all this time trying to figure out what I was going to do with my life and to go through the schooling to do it and then be a failure, I just couldn't. I just couldn't handle that. I was sunk into a deep depression because of it for years, until I started putting all this together and getting the results that I expected to get as a physical therapist. Yes, thank you.

Okay.

Yeah, my pleasure. Oh, and by the way, I've come up with downloadable home programs to help people solve their pain, too, in addition to the training program for the health and wellness practitioners. And if anyone decides to purchase anything of mine, if they type in fixing you all one word, they'll get 20% off.

Thank you. And that relates like. Yeah, besides getting some more training and understanding and your methods, I mean, is there. What's maybe your top advice to other health practitioners that are trying to help their clients eliminate pain?

Yeah, my. My top advice would be to. There are solutions for your patients out there. And, you know, if you haven't considered something, if you've always suspected that there's a larger reason for what you're seeing, what you keep correcting is going on, and it has something to do with how that person is using their body, then I think this approach is really what you've been missing, because it's really all about how people are causing their own pain and how they can solve their own pain, fixing how they're using their bodies. It's that simple, really. And it can be so simple. It doesn't have to be as complicated as we Typically make it.

Yeah, that's true. Good. I mean, we. And I'm sure we could both riff on this for a while, too. I mean, especially with the amount of, like, pain meds and the way that pain is handled in this country and it leads to just people being shadows of themselves and it's. It's kind of sad, actually. So this is an as important a time as any to really kind of a call to arms to like, bring more attention and awareness around pain and how us as practitioners have almost the responsibility to be more informed and educated about how to manage it in such a usable way. You know, it sounds like it doesn't even have to take long, like, just to actually sit with your patients, listen and observe, and then employ some of these strategies. Right?

Yeah, yeah. You just have to know what you're looking for and looking at. And once you learn what those things are, you won't. I mean, you. After this one, after our podcast, you'll probably start noticing whether your patients are locking their knees when they're walking into your place. Or you might try this, this little armpit test that I've created, Right?

Oh, yeah.

It's going to distill it down into such simple ideas. It's. It's really. Can be quite simple.

Yeah, yeah, no, instead of waiting for my patients to be in the room, I'm just going to follow them down the hall.

There you go. Yeah.

Awesome. Well, is there any. I mean, we're going to post a lot of it, like, with the show notes, but any shout outs for, like, you know, Instagram, Facebook, your website, anything you want to just mention out loud?

Well, you know, I have a lot of different things, but if you just go to rickolderman.com, you'll find everything that I have. I have some free stuff on there, too. And my message to people who are listening here, who are not practitioners but who have pain, is that, you know, you're often made to feel that you're broken and you're not broken. You just haven't had the right information yet. And if you have some kind of musculoskeletal condition, I believe you'll find some of those answers in my own programs. I really do. Keep looking.

Great, Rick. This was awesome. Seriously, great information. I've always had a passion for orthopedics and physical medicine, so it was a real treat talking to you about these things. Thank you for your time.

Thank you so much for having me, Dr. Nadal. I really appreciate it.

Yeah, my pleasure. All right, everyone. Well, there you have it. Rickalderman.com Just brilliant mind here. Good healer. Reach out and check them out. Until next time. We'll see you guys next week. Be well.