#25 - Shoulder Injuries and the Throwing Athlete, Pt. 2

FAKTR, spelled F-A-K-T-R, stands for Functional and Kinetic Treatment with Rehabilitation. Over the past decade, this unique approach to treating pain and dysfunction has been utilized by healthcare providers on 6 continents. Serving as a framework that guides clinical decision-making in patient visits around the globe on a daily basis. With this podcast, our goal is simple: to bring the best and brightest in clinical education to the forefront and empower practitioners with cutting-edge, evidence-based content that improves patient outcomes and inspires healthcare providers to continually evolve their approach to treatment. In each episode, we will feature a training or interview with some of the top minds in healthcare in a short format that is easy to consume. to digest with actionable information that you can implement into practice right away. Let's get started. Hi guys, welcome to a new episode of The Factor Podcast. I'm your host, Jessica Riddle. If this is your first time tuning in, welcome and thank you for listening. Today we finish up part 2 of shoulder injuries and the throwing athlete with Dr. Ross Keese. Now, when it comes to treating any athletic injury, it's vital that you as a clinician understand the sport-specific biomechanics and the physical demands of the most common movements of that sport. This is especially true when it comes to movements that require a great deal of repetition coupled with velocity or heavy load. In part 1 of this training, in episode 24, we focused on shoulder injuries that are common in throwing athletes. and went step by step through how to assess sagittal, frontal, and transverse plane movements to develop effective treatment plans. Today, we talk more about the biomechanics and physiology involved in throwing and where things typically go wrong. We will also discuss effective treatment strategies to get athletes back in the game, including soft tissue treatment, joint mobilization, and exercise prescription. Dr. Ross Keys is our instructor for today. He has an elevated level of experience with athletics and the stress that comes with training and competing at a high level. During his time playing college football, Ross sustained a variety of soft tissue injuries. Having to work through these injuries has helped him develop a level of empathy that provides a solid foundation for working with athletes to help them to continue and prolong their athletic journey. These experiences have driven him to better understand sports injuries, with a specific emphasis on the shoulder and how to help athletes get back in the game quicker, safer, and stronger. Dr. Keyes has completed advanced training in evaluation and treatment of athletic injury, is a certified chiropractic sports physician, as well as a certified strength and conditioning specialist with experience coaching high school, collegiate, and professional athletes. Currently, Dr. Ross runs a sports performance-focused clinic in Franklin, Tennessee. And with all that being said, guys, part 1 was excellent, provided a ton of great information. Definitely tune in, take some notes on part 2 today. Let's get started.

So we'll go through what a general examination assessment is gonna look like with me, especially with the shoulder. I want to look into multi-segmental range of motion. And this is Spinal. So we'll start— I like to put the feet together, that way we can limit the amount of range of motion they're going to be getting out of their ankles, knees. Not that I don't want them to have that, it just kind of standardizes the movement side to side. So we'll go through flexion, extension, lateral flexion, rotation, and then getting into the shoulder, active and passive range of motion, internal, external rotation, adduction, abduction, flexion, extension. In the supine position. It's usually easiest that way. And then, we can also remove the gravity in most of those. And then, also with the shoulder, very important, very overlooked and often not done is looking at the hips. We need to know how the hips and the low back and the pelvis are moving. Because if you think about the shoulder, most often you're going to have an issue with the shoulder blade moving and how if it's moving usually not enough or if it's in a bad position. And, one of the biggest muscles in your body, I don't know if it is the biggest, the latissimus dorsi, it attaches to your humerus all the way down through fascial links through your low back into your pelvis. So to try to address a shoulder problem without looking at someone's hips and low back, I just don't know how you can do that. Some of it's going to be limited time, but then limited time with the patient and visit. But you're doing them a disservice by not looking into that stuff, because there's often a lot of things that are linked with the low back and the hips and the shoulder. So make sure you're looking into those things. And I like to look at that. in supine external rotation, internal rotation, and flexion. And the internal and external rotation, I like to do primarily at 90 degrees hip flexion. And then I don't— it's not showing on my screen, but underneath that I have it in prone. I like to do internal rotation, external rotation, and then hip extension. And with those, the internal and external rotation, And all of them, I'm basically looking for symmetrical movements on those. If what I find often happening is when they lay down on the table supine, you're gonna see— if you see one of the feet flared out laterally than the other side, usually they're going to have an internal rotation deficit compared to the other side. And so in many cases, that can be a first sign of a instability in that side hip, which can translate into most often in my clinic up to the opposite side shoulder. So getting into how we look into the planes of movement, sagittal plane, frontal plane, transverse. A lot of this stuff is— I learned from Dr. Pat Davidson. If you haven't heard of him, you need to look him up. He's brilliant. I give a lot of thanks to him helping me understand these concepts. And so a lot of these terms are going to be things that I learned from him. When we look at the plane competencies, we want to look at sensory and motor. Sensory side of things, can you feel the right stuff happening? Can you feel the right tension? Motor, are you in the right position? If you're not hitting both of these, then you got to keep working on it, because if you're not hitting these things, then you're not properly stressing that plane. First, sagittal plane. It's usually the one that I'm going to attack first because it's the easiest one to attack with resistance. So, what we want to do there is prevent our— so, the sagittal plane, the muscles of that are going to prevent your axial skeleton from falling forward or backwards. Looking at humans, when people talk about fundamental movements of humans and a lot of people will say like, oh, squatting. No, it's deadlift, whatever. The most fundamental movement a human does is gait. Bipedal, upright bipedal movement is what humans have over every single species of animal on this planet. We are primed to do that. So, that is our fundamental movement, our most functional movement. And so, sagittal plane muscles, which we're going to look primarily hamstrings, glutes, Abs are preventing you from falling forward or falling back as you walk forward. So, getting into the sensory, so we want to be able to feel the hamstrings. We want to be able to feel the gluteus maximus and then the abs primarily in the internal obliques. A good cue to try to get someone to feel hamstrings is they need to feel their heels. So, if they're pushing their heels down, that's going to help them engage the hamstrings. And a lot of movements that I do, especially if we want to do like a plank, having their feet up against the wall. So their feet flat up against the wall is going to allow them to actually feel the heels while they do a plank, because otherwise you're just going to be on your toes. And it's a lot easier to get in a better position if you have their feet flat up against the wall, toes on the floor, pushing those heels into the wall, and then pushing using their the serratus anterior muscles to push their upper back towards up through the back. A lot of people will just be totally flat when they do plank, but we want to actually protract the scapulae and get those serratus anterior muscles working because that is another group of muscles that is very underserved in strength and conditioning. Motor, can you have your skull over your pelvic floor? And, can you retract your rib cage without distorting your skull-pelvic relationship? So, if a lot of patients will come in and they're very hyperlordotic in the lumbar spine, so their belly's sticking way out and their head's kind of flexed down, can you bring your rib cage back down and keep yourself there while still keeping your skull over your pelvis? And, that's what we're looking for. Being in the right position. Frontal plane, how well can you center your axial skeleton over your base of support? And so this is going to be one where, like, if we're walking, if we're doing any athletic movements— put in here, not band walks. Going back to Pat Davidson, if you follow his stuff, he's very, very against banded walks, and he has a very good explanation as why that is. And that's probably one of the most common exercises I see people doing when they're trying to deal with hips, but it does not help with the frontal plane movements. That's a lateral shifting movement, but the muscles that you're working with that don't help with the frontal plane movement and that stuff. I could go into a long talk on that, and I don't think we have enough time for that, but let's go. So Can you feel your adductors? Can you feel your gluteus medius, transverse abdominis, and serratus muscles when you're getting into your frontal plane movements? One of my favorite frontal plane movements is going to be the rear foot elevated split squat. Some people call it the Bulgarian split squat. It's a beautiful way to get you on one leg shifted and work on keeping the line. The line that I talk about when I get someone into a frontal plane is You got to keep your nose over your belly button, over your zipper, over your knee, over your toes. And that is a position that you need to maintain throughout the entire movement of that rear foot elevated split squat. A lot of people will feel lots of adductor stress with that as well as in their back pocket in those lateral hip muscles, the gluteus medius, Primarily, that is what we're missing in a lot of these athletes. One of the biggest issues with strength conditioning, especially with squatting, is this whole knees out thing. For some reason, everyone's like, we got to keep knees out, knees out, knees out. What that did is it led us to think that knees not out is dangerous. And so now when you look at the hip, And I know I'm going very far into hip here, but when we look at the hip, if not enough internal rotation is just as bad as not enough external rotation. So bring your base of support over your foot or bring your axial skeleton over the base of support is going to activate those adductors, is going to keep your leg in. And getting back to that person that was on the table when their leg flared out, This is going to help them bring that back in. It's going to help put their pelvis in a better position, which then is going to lead into the decrease of added stress to their lat that ties into their shoulder. So, if I'm running and/or just walking and I'm having added stress because of that hip deficiency, now each time my lat on the opposite side has to do more work to swing my torso to keep up with that movement, And that's just going to lead into some issues into the shoulder. So getting into frontal plane motor, like I said here, can your nose be over your sternum, over your belly button, over your zipper, over knee, over big toe? Tilting your pelvis, we're going to have a little bit of a higher ilium on top of that. So we're talking about the rear foot elevated split squat, higher ilium over the down the front leg. And then the ribs are gonna be depressed over that leg as well. That's gonna engage the lateral abdominal muscles, the obliques. Foot position. So we're gonna be supinating a little bit more on that front foot, and that's the accepting foot. So as we lean over to shift our axial skeleton over our base of support, we need to supinate a little bit on that foot in order to create that line that we need. And then we're gonna pronate on the contralateral foot. And then getting into the transverse plane, which is more of your spinning and turning. Sensory, we got ribs, external oblique muscles, gluteus maximus. Motor, can you get into the right position? Can you disassociate? So disassociation here, we're going to be talking about like your pelvis and your low back. Can you disassociate those 2, or do they move as a block together? I work with a lot of bodybuilders and they cannot dissociate at all because of their posing and how often they're in that chronic stress and just the movements that they're doing. So, a lot of work, they can get a lot of benefit from working on dissociation between your upper and lower half as well as your joints as far as the shoulder and the hip goes. And then mirror asymmetry assessment. Where are the special orthopedic tests? I kind of mentioned it before, But I don't really dive too far into special orthopedic tests because they often don't mimic positions that are needed for this athlete or what they're doing or what they need to do, or quite frankly, just in a position that would actually give me information. Some of them are great, but you miss a lot of the picture if all you do is orthopedic tests. I'll use them often. For labrum, I like to use some of those to check, see how the labrum is functioning. But if we do all the movements, as I talked about before, I often get enough information from that that I'm like, well, yes, the orthopedic test could confirm what I'm thinking a little bit more. But positive or negative, if the test is positive or negative, if I'm thinking, well, it's not going to change how I want, how I think they need to be. Addressing this, then it essentially is going to turn into a wasted time. So that kind of leads me into a little bit of an off tangent here. I'm trying to be overly specific on your diagnosis. Yes, diagnosing is important, but I find if you try to be too specific on what you're diagnosing this person with, you have a greater chance of being wrong as you narrow down that light. There's a lot easier for you to stray outside the light. So, we can keep our thoughts a little bit more broad, then we can catch more things under that as well as going back into looking at the hips. If I'm like, okay, this is a shoulder issue, we got to look at the shoulder and work on this. But, if I don't open my lens a little bit and like, well, man, look at his low back, he's just not turning that far on that side when he's walking, I wonder if that has anything to do with that shoulder being an issue. And most often, yes, it is. These are the areas that are primarily looking at when we're doing the evaluation. AC/SC, like I talked about, it's going to be more pinpoint on the ligaments themselves and often very visible even before you do anything. And the patient is usually holding their arm up because it's just too painful to let it hang there. Thoracic spine, is their range of motion good? I mean, can they rotate? Can they extend or flex? And Many cases, a lot of shoulder issues come from an inability to move the thoracic spine, especially in high schoolers, is they're slumped over a desk, their computer, their books, studying. So they're in a bad position already. So if we can't move the spine properly, the ribs that attach to this thoracic spine can't move properly, which then means the shoulder blade can't move properly over the rib cage. Which then adds more stress to the glenohumeral joint, which is easily picked up because the glenohumeral joint has so much range of motion. But after time, those tissues are going to get wore down and they're going to strain, tear, and then we have to work back in. And so yeah, getting back into the rib cage, can they properly expand the rib cage and compress the rib cage? Especially in those extreme ranges of motion where we have our arms overhead or have our arms out in front of us in shoulder protraction. Is their rib cage matching that? Especially when they're getting into strength and conditioning. If I'm pressing overhead but my breath is irregular, I'm trying to push my shoulder blade, shoulder complex up. And, if I'm exhaling, I'm compressing my rib cage. So now, I have some opposing movements. And over time, that can add up and lead into some negative effects. So, those are some things you need to look at to make sure that everything's kind of moving together. Glenohumeral joint, yeah, looking to see what the rotation is like, how they're stabilizing inside there. The scapulothoracic joint, again, getting back to how the thoracic spine and rib cage are articulating. The pelvis and hips, like I Just talked about a couple minutes ago. Interventions, I won't go deep into this stuff, but because there's so many things that we can do to have some sort of effect, but we have to make sure that they're done with intent and that they align with what your assessment told you and what your goals are for their treatment. No blanket therapies. How I approach things, I want to do as little as possible. So I often tell— I always tell my patients, We need to do lowest possible dose. Essentially, that's what we want to do. If I can give someone one thing to do and that helps them and it gets the goals that we want, then there's no need for me to even add 2 unless our goals change or unless the situation changes. So as little as possible. And then these things need to assist our active strategies. So any of the soft tissue mobilization, any of the joint mobilizations. It's very hard for me to do those alone without then doing something with that range of motion that we just gained through doing that. Because ultimately, what we're trying to do is either unlock, quote unquote, range of motion, which is going to be happening through desensitization of the tissue and mechanical stimulation. We're not actually changing the structure of the tissue. So what we want to do is restore that range of motion or decrease the sensation of pain Or discomfort they get through range of motion. But then we need to immediately follow that up and reinforce it with resisted activities. And then leading into what the domains that I like to look at, and again, huge credit to Pat Davidson for putting these pillars and just making it very easy to look at and understand what those movements are and then basing a program off that. So knee dominant, which we got squatting. Hip dominant, things like a hip hinge, RDL, deadlift, vertical push, vertical pull, horizontal push, horizontal pull, locomotion. Remember, functional movement there. Throwing, breathing, core, both in the pelvis and the thorax, change of direction into triple extension. And these aren't things that you're gonna be giving everyone. When we talk about general population, You're going to be looking primarily to keep it knee dominant, hip dominant, vertical push, vertical pull, horizontal push, horizontal pull, and then getting into the core stuff and breathing. When you get into the athletic population, that's where you have to throw, get the throwing, get the locomotion, change direction, triple extension, especially for the high-powered sports. And then always when we're looking at what we're prescribing, you have to keep these things In mind, so there can't be any blanket like prescription as far as okay. Well, I'm change. I'm doing custom movements for you, but then keep all the sets and reps the same for everything. You have to understand the load, the intensity, the volume, the range of motion at which they're going to be doing it in, how much rest they should do in between each set, each rep, and each session. And then, like I talked about before, knowing their practice. And competition schedule to be able to modify that stuff and make sure that you're not giving them their hardest prescribed workout the day before a big game or something like that where it can have more negative effects than you would like. Sometimes, yes, I do need to push my patients to a little bit of failure to know where it was too much. We got to get as close to the sun as we can without getting burned to know what What is our limit? And which is another issue that I see too often is keeping patients at such low-level movements. You're not stressing tissue enough to change. And so that's what I want to do every once in a while. I need to push them to make them see if they can fail a little bit. Nothing dangerous, but fail more in probably like a technique or competency based on our planes that we talked about and see, okay, That was your stress point, then we need to build up through that and then move past it. Here's some areas to start with those previous domains or those pillars. Static stance, bilateral sagittal movements. We can minimize gravity. We can shorten our levers, minimize the load, maximize the constraints. So things that can help you get into that position better, external means. minimize the range of motion. Because obviously, if I have a shoulder impingement, I'm not going to be like, all right, well, go to full overhead lat pulldowns day one. That may not be the best idea unless you can improve the range of motion to hit that based off treatment. Then yeah, you could get into that, but you're gonna have to lower down the load intensity and stuff like that. So I had him— I worked on his cervical spine. I did a diversified adjustment to his lower C-spine, and then I did thoracic spine mobilization, and then did some soft tissue mobilization of his lats up in the armpits, and then also the biceps and pectoralis major. Those things basically gave him full range of motion without pain. So then what we did after that Is we went and did some movements to help with his posture. So, we went into single-arm rowing. We did single-arm lat pulldown. And, the reason I like doing single arm, especially in the lat pulldown, is we can incorporate those things we talked about with breathing. Lat pulldown. So, I'm up. A lot of people will just kind of stack the shoulders and pull here. But, if I can take an inhale, I can expand the rib cage, which allows me to get more scapular movement. So, I got more range of motion here. And then, as I exhale, then I can bring it down and I can squeeze down the other way. So, I'm getting full compression, which then adds in some of the abdominals. So, the obliques, transverse abdominis, getting those things involved with the pull. And then, the single arm with the rowing because then we can really get the hips involved with that. And, if you're doing a single arm, you can get more range of motion in that protraction specifically. Because you'll be able to allow that shoulder to move more forward. So we're going to be stressing the eccentric portion of that a lot more, which those guys and girls really need improvement on when they have shoulder pains. All right.

Have you ever thought about teaching or launching a podcast? Maybe creating online courses for your patients or a YouTube channel to gain exposure? Or maybe you want to pass on your expertise and knowledge to the next generation of healthcare providers but don't really know where to get started. If this sounds like you, then we would love to have a conversation. For almost a decade now, Southeast Professional Education Group has helped healthcare providers, national organizations, and product companies create and launch content for the purpose of educating and engaging their target audience. Whether you want to establish your credibility in your hometown as a means to grow your practice, or if you're looking to enter into the exciting world of continuing education, We would love to talk to you. The great W.B. Yeats said, education is not the filling of a pot, but the lighting of a fire. And I guarantee you there's someone out there waiting for you to light that spark. Simply fill out the interest form linked in the show notes and let's have a conversation. Who knows, maybe a few months from now, you're the one that our podcast subscribers are tuning in to learn from. So click the link to request a time to chat. Let's have a conversation and see how we can help you make 2022 the year that you launch something great.

Awesome.

Thank you so much, Dr. Keyes. We have had a few questions submitted here. We can kind of dive into those. One of the questions was, with lateral shoulder pain, how often do you find it is referred pain from an RTC tear versus a delt strain?

I would Lean more on palpation. If it was a delt strain compared to the rotator cuff, I think you're going to have a bit more superficial tenderness upon palpation. Then you can get into muscle testing, put their arm into abduction and press down and see if that causes them pain because the delts are going to be more primary movers. So they're going to be dealing more with the heavier loads. For me, I would probably treat them very similarly, like I talked about, because if it is a rotator cuff tear, then there's a chance that your deltoids aren't properly doing things. So we're going to address the deltoid already. In either event, you're likely to have issues down the chain towards the spine and everything. So I guess that would be how I would go about it. Wonderful.

Absolutely. So how would you do a hip strengthening with a female who has a very large Q angle and has trouble keeping her body in line due to that?

You need to look at your interventions. And primarily, we're gonna have to look into constraints in order to get you into that position by holding certain— adding in foam rollers or something you could, like, press down in to help your body get into the proper position and then working on that and reinforcing that position. It's very difficult to answer that. I don't have a whole lot of information to go off of, but I would start like what I talked about with doing— you could even go into a lunge or just a split squat and then try to maintain that line of the eyes, belly button, knee, toes, and try to line that stuff up because we're not going to change a Q angle because that's an anatomical thing. In most cases. So like, well, in all cases. So trying to maximize our constraints to try to get you into that position, it would be where I would go. But yeah, based on the information, that would be how I would suggest you doing that.

When you work with rowers, kayakers, and canoers, how do you kind of cue them on ways that they can avoid injuries during training and competition? I'd imagine this group, their shoulders probably take a beating. How do you combat that?

I don't have a whole lot of that population in my area, but I would say— so they're doing a lot of protraction and retraction. Disassociation of the lumbar and pelvis would be huge to look into because you're looking at a fixed lower body And lots of rotation through everything above the pelvis. I'm trying to think. I don't think there's many other sports that are going to be like that where you're— you've fixed your lower body. And so that can add into some lat strain, some specific lat strain. So making sure that, again, getting into the single arm movements where we're doing overhead, we're doing lat pulldown. So vertical pull, vertical push. I forgot to mention earlier with doing like a dumbbell overhead press. Making sure we can inhale and expand the rib cage. I would say making sure that you dive into horizontal and vertical push and pull and incorporating the breathing with that to help make sure that you're incorporating that movement with your lower body. So I guess I forgot to mention, I would add then in probably a staggered stance, so front-back stance. So we're adding in a little bit change in your pelvis movement. So then we're making sure we're using the lats with the pelvis in different positions.

What do you mean by the feel part of the planes section? And I'm assuming this has to do with planes of movement. Does that— are you referring to being able to feel your heels kind of digging in there?

Can you feel— so if I'm doing a sagittal movement, can I feel my hamstrings engaging?

No.

Well, then there's probably a good chance that my heels aren't fully engaged with the surface that I'm on. And, that's what I was talking about with the plank against the wall. That gives me something to push my heels into the wall. And, when I push my heels, I mean, everyone right now, if you're just sitting with your feet on the floor, if you push your heels into the ground, your hamstrings should probably fire up or go put your feet up, stand up and Try pushing your— feel your heels into the floor and see if that engages your hamstrings. That's what I mean by that. So, yeah, I think that answers that.

Can you advise on how to treat a female who is in her 50s that has anterior hip pain related to chronically weak ipsilateral glutes? Bridges and exercise of that nature are not really strengthening the glutes.

Okay. So, that would be another thing that I would dive into, the frontal plane movements, because the glutes do a lot more than hip extension. And, that's where you're primarily targeting with the glute bridge. But, we often forget that the glutes do rotation, external rotation, and abduction. So, We need to challenge it in those ways. A good way to do that is we have to get into positions to stress the glutes fully. And, that's getting into that rearfoot elevated squat or split squat and aligning those structures like I talked about will help your pelvis shift in a way that will add adduction and internal rotation stress to your glutes as you go through the movement. So, we can fully tension the glutes in order to build up their strength and their capacity to perform frontal plane movements. Yeah, that's how I would go about that. Because if we're looking at a stabilization issue, I'm wondering if you have like a psoas area type pain. I often see that the psoas will try to tag in to stabilize the lumbopelvic and hip area. And it can only do that so long, and then you get a lot of the anterior hip pain and even low back pain with that. And so trying to work on the structures that are going to help stabilize your pelvis and hips better, the adductors and the lateral hip muscles, those are going to help take some strain off the anterior hip muscles or the hip flexors.

Wonderful. Another question here just about cueing. I know you had mentioned really kind of emphasizing with the patient that You're not trying to do a ton of things at once. You're kind of simplifying it a bit for them. What type of conversations do you have with patients as you're going through your exam so that you're addressing what they have going on without making them worried that this is a catastrophic injury? Or I'm sure many people come in already with an idea of, well, I think it's this, or I think it's that. How do you calm that response they have? And then how do you essentially explain to them, this is what you have going on and this is what it's going to take to improve this for you?

Yeah. And that, I think, is what drove me— that whole scenario, like I talked about beginning with my shoulder injury— is I didn't have that good conversation. And I think that drove me to actually want to be a chiropractic physician and work on the people I do, is I didn't have that person tell me like, you know what sucks right now? Your tissue is beat up, but we're going to go through the surgery and we're going to get you strengthened up and then we'll see where you're at. I think that's kind of how I take the approach is, hey, this sucks. You got some pissed off tissue. I mean, as long as it's not something where I'm like, I think they need to go see someone else, I can be like, hey, let's just take this one step at a time. We'll go through treatment. Usually they're going to feel better. That first session, so they're like, "Oh wow! Yeah, this is great." And so you can build off that, but just making sure they understand that we're just going to take it step by step. And if things come to understand that there are peaks and valleys in your rehab process and your healing process, and oftentimes you can just draw that out. And as long as you're trending to improvement, they understand that. Things are going well, but it's just being totally transparent, I think is huge for me. I, I like to just speak what I'm saying, like thinking as I go through the exam because I want them to know what I'm thinking unless it's something that is just completely irrelevant. But yeah, just keeping them involved with the process. And I think a lot of that comes too with like talking with the other coaches and trainers and stuff that they interact with.

Yeah.

That helps them know that I'm doing as much as I can to make sure that they're getting the proper treatment they can, 'cause I try to get as much information as possible.

Along those same lines, when it comes to especially your youth athletes who are still playing and they're trying their best to get back into the game, how do you approach both the patient and the parents on things like rest and recovery and maybe holding off some on playing time While they're going through rehab with you.

And now that I'm thinking about it, that parent-patient interaction with me, there seems to be a shift. I feel like when it's younger, maybe like more middle school and younger, the parents are less likely to be like, oh, you need to take a break, versus when they get into high school. I feel like it's a lot more like the kids like, no, I want to keep going, and the parents like, no, you should definitely take a break. But it is a tricky dynamic. I like To have the parents there because like my situation, they offer more information because a teenager just wants to get back out there and play. So they're going to leave some stuff out, whether that's intentionally or unintentionally, where they're just, they just want to get back in the game. So how do I approach that specifically? Speak to the athlete. Don't speak to the parent. Like when they're in here, you're asking questions. It's just like if you were working with a translator, you still want the patient to know you're talking to them and you're talking about them. So you talk to them unless you have a specific question for the parent based on things. But as soon as you just start asking the parent about what's going on with their kid, then I think you lose some of that rapport and that athlete's going to be a lot less likely to give you information in the future.

I had one more question here. Any videos you can recommend To understand tests better. And I'm assuming they mean some of the orthopedic tests that you would be utilizing for assessing shoulder injuries. Is that correct?

I'm trying hard to build up like a YouTube channel to put that stuff in because doing a YouTube search on a lot of these movements doesn't really give you the cues necessary. So this will be my kick in the butt to really get going on that. And so stay tuned, like, look me up in YouTube and check out As I get videos out on that. As far as orthopedic tests, a Google search, there's plenty of PTs, chiros, physiotherapists that have done all of the orthopedic tests on that stuff. But again, tests are information, tests don't direct care. So understand what information am I likely to get out of a special test, and then compile that together with the movement deficiencies that you find. The videos on the specific movements I talked about, like she said, in that— the expanded course on this, I will incorporate those videos into that. But I will also like to release those publicly, the videos themselves. So yeah, just try to stay tuned on my stuff. Like I said, Pat Davidson has a lot of movements directed toward— or a lot of videos directed towards those things. You can check him out. I don't know if he has specific channel or anything like that to look those up, but those would be good sources for that.

We also have an assessment course on the Southeast Sports platform that is our— it's our factor assessment course, but it's available for anyone to watch. And through that, we go through different orthopedic assessment clusters. So essentially, the research supports that there are certain combinations of orthopedic tests that can give you a higher level of certainty when diagnosing specific So we have an entire segment on there on the shoulder, on cervical, lumbar. I think we go through all of the different segments of the body. And then likewise, again, for any of you guys that are looking for more information regarding Dr. Key's course, we will be sending that out via email as soon as that is ready for launch, which will be here shortly. Likewise, many of you have attended some of our webinars in the past. We're going to continue doing these on a regular basis. We're aiming for 2 a month at this point. Again, thank you all so much for joining us today, and thank you so much, Dr. Keyes. This has been a great informative webinar. We appreciate it.

Awesome. Thank you so much for allowing me to do this.

Thank you so much, everyone. That's it for today's episode. Be sure to tune in for episode 26, where we change things up a bit and feature an exclusive interview with a healthcare provider who has used his FACTOR training to work with professional and elite-level athletes. If you're interested in sports medicine or would love advice, guidance, and best practices on leveraging your certifications to grow your patient base, then this episode is one you'll want to bookmark now. You won't want to miss it. Episode 26 drops in 2 weeks, or 1 week for our Patreon subscribers. If you have questions about working with high-level athletes, please submit them in the Q&A link in our show notes. We will be sure to have our special guest answer all of our listeners' submitted questions. You can subscribe to The Factor Podcast on Apple, Spotify, iHeartRadio, or the podcast app that works best for you. Please give us a 5-star rating to help us grow the show. Every little bit helps. And last but certainly not least, be sure to visit the show notes for a link to download the PDF of today's full presentation, as well as learn about any special offers that we featured in today's episode. We'll see you next time. Hey guys, if you like what you heard today, I encourage you to visit our website at factor-store.com. That's spelled F-A-K-T-R-store.com to find out more information about all that we have to offer. We have a variety of online offerings as well as our hands-on Factor Rehab System course scheduled in cities around the globe. Be sure Be sure to also check out our event calendar and bookmark any of these upcoming live webinar dates coming up in the near future so you can join us live. And of course, the biggest compliment we can receive is for you to help us spread the word to your friends, colleagues, and classmates. You'll find all the important links as well as info about our sponsors in the show notes, so be sure to check those out.