Bumps and Bruises with Dr. Christina Pate

lifter pro wrestler and chronic pain driver. Both For Life is a podcast about living with the challenges of chronic pain. Our goal is to acknowledge, inspire, and relate to people living with chronic pain. I believe it is not only possible to survive, but to live a full life and thrive with chronic pain. No matter where you are in your journey, our mission is to give you the information and inspiration that will help you become Bolt For Life. On this episode of

the Bolt For Life podcast, we talk with Dr. Christina Pate and Christine is awesome. Her passion and drive for physical therapy and her knowledge is really impressive. And she's an impressive person herself. I was so fortunate to have a visit with her out of her clinic. She helped me with

my shoulders. She did some instruments. She did some copying. She did some taping and it was amazing

to see the amount of progress we could make just with that one session. So if you've ever considered physical therapy, I totally suggest you check out this episode. So obviously this podcast is the

“audio from that visit. But if you want to see the video, you can check us out on our YouTube”

channel. You can see all the different things that Christine did to help me out and how much she beat me up. Hey guys, welcome to the Bolt For Life podcast. Today we're here with Christina Pate, Doctor of Physical Therapy. We're here at the just a Biden health. Biden health. Christina is going to talk to us about what they do here today. I met Christina probably three or four years ago at the gym and we have a lot of mutual friends. And I remember

when you were training for your competition. And she's an incredible shape. She inspires me.

But I'm really excited to hear about what they do here at the clinic and what Christina has to share with us today. So welcome to the Bolt For Life podcast. Thanks for having us here at your clinic. So what do you guys do here? Well here we're our patient clinic, but we're a special outpatient clinic here in Wallace because such a rural community and we're pretty much the only outpatient clinic. So we see anything that can walk in the door, anything under the sign. So you get a bunch of

patients that have neurological issues from having a stroke, patients that are quadriplegic to we get orthopedic issues with athletes, total needs, shoulder replacements, anything like that. So

“you need to have a surgery. We see pediatric series as well. So we see little kids. So yeah anything”

under the sign. So we gotta be prepared for that. But we also see patients like I was telling you with chronic pain. So chronic back pain, chronic neck pain, any type of or even shoulder any type of previous injury that's led to the RSV or any type of chronic pain syndrome. So talking about chronic pain, like can you talk to us about it? I mean obviously I've pictured my story with chronic pain. You know my history with context boards and power lifting. You give me a little bit

of an assessment here. Yeah, yeah. My issues. What's your general take on dealing with patients with chronic pain? Usually when I do with patients with chronic pain, you have to take into aspect the psychosocial aspect of it. So not only are you dealing with like an acute injury, it's just that physiological aspect that people are usually focused on. With chronic pain, patients have been doing it with so long. It becomes part of their mantra, a part of their life.

“So they tend to perseverate on that pain issue. So it becomes like a psychosocial gets in their head.”

So sometimes that perception of pain can be actually a misconception. So you know they'll have chronic low back pain, but their body perceives it differently and their brain perceives it differently. So they become hypersensitive or hyposensitive. Like two sensitive to such, or they can't really feel anything in that area. So that's the difficulty with chronic pain kind of getting through the psychological aspects back to it too. So not only just kind of treating the pain,

but treating the psychological aspect up because it's been going on for so long. So then you get so many other compounding factors coming in. So usually it leads to other issues down the chain or up the chain. Like it's been explained to me and in my experience it's like it's not normal for the body have pain all the time. So there's no way that a person can at least in my case could go unaffected by that you know. And I know the thing that I'm so excited about today we're here with you is

to be able to eliminate any of the other things, you know because the chronic pain is chronic pain.

The RS which I have is the RSD, but I always feel like any little thing that I can improve on

or help is going to help the overall. Yeah, typically with the tools we're about to talk about, they go into how to fix patients with the chronic pain as well because you get that fear of audience behavior. So you know patients start to avoid moving because of that and then that just leads to a vicious cycle. So when you're not moving, everything else is just going to stiffen up, you're going to have impaired movement patterns. So all your bodies are going to start moving

incorrectly. So a lot of times we just introduce basic movements. Even if it's just let's start with

All right, let's move a little more. Let's move a little more in a teaching your body. Okay, it's okay. We can move. If they're kind of meeting in the patient where they are finding what they can do and just moving forward with that. And I can relate because like you assessed my shoulder,

“my shoulders and pretty rough shape. I think that's a fair assessment of that. My challenge has”

been for the last 15 years. Well, I need to walk. You know, I like it's hard. I can totally relate to that whole idea. Like my body's screaming at me like this is a challenge just to do basic stuff. So it's easy to let maintenance on my shoulder go. It's easy to do this and do that. Oh, yeah. So I'm excited for you to give me a back on track. Oh, we'll see. We'll try. So when some of this stuff you have here. So today, we're going to be talking about

three various types of tools that can be used in adjunct with physical therapy. One of them it's called rock blades. You don't have to necessarily use rock blades. They're brand of what's called instrument assisted tissue manipulation. So using instrument to work on tissue manipulation. So a lot of therapists we use it to save our hands. But then you can also think about the blade. We'll help give you bigger surface area if you need it. You can change the amount of pressure.

“So just by changing the position of the blade. So the one I'm holding right now kind of looks like”

brass knuckles. Big set of brass knuckles. It's going to hit me if I hit the shoulder. So you normally it'll have a concave side that's smooth and then you have a concave side that's a little bit sharper to change that perception of depth. So then we have the small concavities here that will kind of work on knuckles or get around joints. So they're all of these little concavities of a purpose. So but main thing is using instruments to help improve tissue mobility.

So you have all various types of instruments. Yes, brass knuckles. We have the mohawk, which is literally looks like a mohawk. It does look like a mohawk. This one you can get around joints here okay. A little concavity here and again it has a sharp edge and a dough edge. The change that perception of depth. Okay, how do you assess how would you reduce that? It's a kind of a patient my patient issue. Yeah, normally you can use on any type of patient that comes in because

what you're doing is you just assess the patient. You do a screening of how the patient's moving. Look at where they're limited, where they're painful, assess that area and then you go not only all that joint, but you ripple above and below to affect the fascia above and below. So everything's affected. But this tool, the mohawk, the brass knuckles and we have a fibrosus one too. Oh well. It's

a same concavity. Okay. But you just use them basically to manipulate the tissue to increase tissue

mobility. But we'll go a little more in depth and all out like with all the tools that you at your instruments. Sister tools. Cool. Then you have your cups. We use what's called the silicone cupping method. You have all kinds of cupping methods. You have the fire cupping. So if you're probably seeing that right now. Yeah, yeah, yeah, yeah, yeah. Lighted and fun. These are just a simple silicone suction cup method. Looks like a suction cup. Yeah, but literally looks like a little plunger,

a baby plunger. Yeah. So we'll go over the different techniques. But again, use for pain mitigation. Okay, use to improve tissue mobility. You can even have, you can be impaired movement without pain too. So we can use an improvement decrease pain. So you get your cups and then our fun

rot tape. So yeah, it's basically caneseology tape, but rot tape has a little extra stretch on their

tape and they're blend of how they make it as a little different than normal K tape. So you see it a lot on like crossfit gains. You've seen it in the Olympics. So a lot of athletes use it but we use it for a regular patient as well. You don't have to be an athlete to use tape. Yeah. So all of these play a part as an adjunct with therapy. You don't really try to use them along. You use them in conjunction with therapy. Yeah. Part of the piece of the puzzle will help

“improve movement and then you need to fine tune that movement after you use the tool. Right. So you”

get things moving and then you need to reinforce that. Yeah, we got a reinforced that movement pattern. Play a part in it. Very cool. We're excited to let people know this stuff is out here and what we can do with it. Yeah. So all three of them like I was telling you will go over kind of the main things. So three main effects that all these tools have. You have the pain mitigation. So you help decrease pain. Then you have a decompressive like a bond mechanical lifting effect. Then you also have

a neurochemical or a neurostensory effect from the tools. So with the pain mitigation, you're probably heard of the pain gait theory. Right. So yeah. We've talked about it before and

normally you have what's called no COceptors. Okay. They travel on basically slow pathways to your

brain. When you stimulate use these tools to help stimulate other mechanical receptors and the skin and the inner stichium around the skin, it gets kind of they travel on faster nerve pathways. So what you're doing is you're using the tools to help kind of beat those pain pathways. So these mechanical receptors when you stimulate them, they just send that signal faster to the brain.

of pain from your brain to that area. Right. So that's decreasing pain, which is going to improve

“and it's moving in itself. So you get movement and improvement from pain decreasing. So that's”

the pain mitigation or decreasing pain with all three of these tools. Then you have that bond mechanical lifting or decompression effect. So if you imagine like a sandwich that smooshed or smashed together, you're not going to have very good movement. Everything's kind of stuck together. So your tissues when you have pain in the area or just impaired movement, your tissues tend to kind of bind together. All right. And they get stuck. So when you use the tape or the cups or the instrument assisted

tools, you actually cause a lift. So you get that pieces of the sandwich separator or this tissue separated. So then you have improved glide. So improvement of the tissues, muscles, the skin, and the stichium. So everything is improved. With that decompression, you have space for the flu with the flow. So when you have swelling, usually areas that are injured or areas that are impaired movement are going to have stagnation of fluid. So your limp fluid or blood, everything is going

to be stagnant. This allows at the flow. All right. Back into lymphatic systems, all this toxins

“can get pushed out, flow through lymphatic system and move out. So then you're going to have decreased”

a deema or decrease swelling in that area, which causes pain as well. And it pairs movement. So decompressive effect has multiple factors and improvement pattern of the tissues and improve

fluid dynamics. You get all that nasty junk out basically. Yeah, yeah, clean out. And like it's

been explained to me with my surgeries, is the scar tissue just grows, it just grows. Especially around incisions, your scar tissue, if you don't take care of it, it's just going to come out and cause that heat jins. What we call it, heat jins. So it kind of grows out. So all those muscles, the tissues around there kind of just get, and he's down literally to that area. So then you can get pitting, all right, where the scarves will pit in, and the tissues literally just get pushed

in and they can't move or it doesn't even have to pit. It just limits movement and all directions around the incision. So all these tools will help improve that scar mobility because you're decompressing it. And I can speak from experience. I can say already, it's much better to get that stuff moving

“early on than waiting years and having it come in the pain of it. Oh yeah, definitely. Yeah. So”

yep, you've got to wait for that incision to fully heal first. Right. And then we can go to town

around it. But to begin with, you can go around the tissue that she's around it, if from that scar is healing. Same thing with the tape. You can even go around the tissue because when that incision is healed, you can actually put the tape right on it. Wow. But when it's not, you'll, you just go the tissues around it. So you're helping the, so you're helping the healing around it and you're helping keep this tissues around that scar moving as well. So yeah, it's very cool. So you got the

pain factor that we can control, the decompression, then that neuroscience re-emput. So the skin, and what we call the inner stitch you, which is kind of a twin, the skin, and all the fashion muscle, those are the biggest organs in your body. Right. Yeah. So they have a huge input to your brain. So when you stimulate that area by putting tape on it, the cup on it, or the instruments on it, you're getting that overflow that information to your brain to that area. Because when

you're in pain, we were talking about earlier, you get a smudging effect. It's like a road map, that area that road is smudged to the painful area. So your brain doesn't send that signal to

it directly. When we use the tools, it basically just de-smudges that neural pathway. So now you

have an open pathway and clear pathway to the brain brain muscle connection. So then you get improved movement pattern from there. Right. Because with that chronic pain or pain that if you're avoidance, you're not moving. So now we're saying, okay, here's my input to that area. So now I can actually move a little better. So it's clean up your movement pattern basically with this, that in your sense, we input. So it's pretty cool how these tools provide all that, like the brain, the body

connection. So you tap into that. Very cool. My good friend of mine, Ed Cohen the power left her when we did interview with him years ago. He wrote an article for Muslim fitness called the 10 second rep. And basically what he did was he came up with just a quick way of doing a rep, but you do two seconds here, two seconds here, two seconds here. And the whole idea is to re kind of program those narrow pathways. So you get through that movement. He used it at, we're having from his injury with

his knee and things like that. But it's so cool to hear the same thing and how I could use that with this technique. Yeah, yeah, definitely. Yeah, you've got to clean up that neurosensory pathway. Because it's all like it's smudged or fogged with pain, especially with chronic pain. You have that chronic, that fog is thick. Yeah. And with this we kind of clean that fog up. So you have that pathway going to that area. Right. And if I'm doing it without these interventions,

I'm just kind of reinforcing the ones that are already working. Yeah, yeah. Not really touching the ones that are fogged up. Yeah, definitely. So this will help open up those areas. Yeah. And you get a good neurochemical effect, too, because in certain enzymes are released, they help with healing. Oh, what? When we do the cupping, you'll see you get the red marks, even with the instrument assisted.

That you're not supposed to be bruised. You're supposed to have a little bit of kind of red pink.

“Okay. If you bruise too much, you've done too much. You don't want to hurt. You want to heal.”

So yeah, so that kind of pink red area is where you're getting histamine response. You're releasing what we call hemoxygenase 1. So those enzymes are released and they help kind of block their anti-inflammatory. So they help block the inflammation of the area and prevent inflammation from coming out of the area. So there's a lot of things that are a little more comfortable now about to use in those tools.

Definitely, especially when you see this bad boy going at you, yes. Oh, yeah, we always warn patients.

Hey, feel it. Touch it. We're going to use this on you so they're not scared of it. Yeah, yeah, yeah. And then you do what we call graded exposure. So I will go over like there's different techniques. So you have what the instrument assisted. But before I even use it on anybody, you know, like I said, I love them. Touch it. Feel it. Hey, here's what it is. It's intimidating. Then I'll start off with what's called like a feathering technique. So feathering is just literally

what it sounds like. You take the tool, barely touch their skin and feather around the area.

“So they get used to it. Great exposure. But there's also a purpose to feathering feathering”

stimulates some of the nervous sectors that will help block your pain. So you kind of get that pain mitigation right away. So you're kind of like when you hit your elbow and you rub it. Yeah,

yeah, same concept. So you're feathering to get them used to it and to pain mitigate. So then from

feathering, you have what's called more of a kind of tone down the muscle technique. Okay, downregulation is what we call it. So then you would go a little deeper into the muscle. And we have a grading system when you use it, we don't have to go on that. But you just kind of go a little deeper and it's a slow movement. Okay. And what that does is it stimulates certain mechanical receptors that will help downregulate or decrease tone in the muscle. So yeah, so you can

actually use this blade to decrease tone and prove pain. Then you can also upregulate. So you take the tool and you do that fast at different vectors and it stimulates a different set of mechanical receptors. So you have all kinds of mechanical receptors in the skin and the fascia. So when you go fast at different vectors, that'll stimulate the mechanical receptors that will increase toning in the muscle. So hey, let's work. So if that muscles is asleep after surgery or

anything like that, we can wake it up and tell it, let's kick in, let's work a little more. So you can downregulate, like decrease tone, you can upregulate, make a muscle work more, and you can use a feathering technique to kind of decrease pain and use it as graded exposures, so one is not so great of it. Very cool. Yeah, well, I'm excited. Yeah, it's all kinds of different techniques. Well, I'm really excited to jump into this. Now, for somebody listening in any part of

the country or the world or wherever, if they wanted to get this level of treatment, how would they go about doing that? I mean, you know what's on about this stuff. What would you suggest someone do? Normally, if you're looking to get any of these techniques, look around call, some physical therapy clinics, and ask, are you have anyone there that's instrument assisted certified or copying certified, taping certified? That way you'll have a clinician that is certified in the

area and kind of really knows what they're doing with the instruments, because, you know, you hear that when somebody gains knowledge, it can be dangerous at the same time, so you don't want somebody just rubbing on you with a tool that really doesn't know what they're doing with their technique. So just call a clinic. All right. And ask, do you have anyone there that's instrument assisted certified that using instruments, copying certified or tap certified? And they

can work with you. And usually most clinics nowadays will have someone that's at least taping certified. Cuppings becoming fairly more popular, especially the quick, easy suction cup technique. So you might not find many people that are copying certified, but just call the clinic. If you're interested in going to a clinic, call and ask ahead of time, do you have someone that's copying certified or that's blade certified? There's even massage therapists out there now that

are getting like certified in these areas, because it kind of goes in with their techniques too. Yeah. So if they just call and ask, cool. And then, I mean, like you stress the importance of

“following it up with therapy, with exercise, you know, reinforcing those. That's why I was”

just going to a specialist. Yeah. So that way, you're not just getting the technique being sent home. You're shown the corrective exercise to reinforce that new neural pathway and that new movement pattern. So, I mean, you're reintroducing new movement. If you work on your shoulder, like I was saying, if you're here, and we get you here, your joint has no clue how to move in this new space. So we have to teach you how to move correctly. So yeah, following up with corrective exercise is

key. You can't just do this, and it's self. Yeah. Means I'm going to have more work to do that. Definitely. Definitely. Oh, yeah. Definitely have more exercise. So for that person that's sitting on the couch, and it's just depressed, it is in constant pain, and you touch down in a little bit earlier. But what would you say to that person sitting on the couch that just feels hopeless?

The first step is try to get into a clinic. You know, a physical therapy clinic with someone

you know, baby steps, because a lot of people with chronic pain get in that vicious cycle

“and it leads to fear, fear of moving. So then they become sedentary, then that leads to a whole”

slew of different complications. So normally I was to just please try to come in to a clinic. We most clinics will ease you in to movement. You don't have to be afraid. We'll work with you,

go baby steps, and basic movement patterns first, and then you get you up. Our main goal is to get

you where you can function, not where we're getting you where you can run a marathon, or lift weights. We're just getting you back to where you can do your normal basic activities. Whether you are an athlete, or whether you're someone, you know, who just wants to get back to being able to walk to their mailbox and back, or, you know, cook, stand along enough to cook. So everyone's different in their goals. And our objective is to get you to your level of performance and function.

Insurance can be crazy and trying to navigate that whole scene, or people with financial limitations or things like that. I mean, what could you suggest for them to get in a place and work with somebody like you? Normally with patients have high copays or some patients,

“my not even had insurance, we try to work with those patients. So even if the daughter's”

cinnamon, it says three times a week on the script or anything, and we can work with that patient.

It's up to our discretion and whatever the patient feels is best for them that they can handle. So I've had patients that have $8 copays and I usually, hey, whatever works best for you. If I can see you maybe once every other week or two weeks, whatever works best, and I'll try my, I'll give them my home program. So we go over as much as we can in the email, as far as correct if exercise. I can show them how to tape through basic taping technique on

their own. So, and you can buy, K-Tate, you can buy regular canesia tape, normally in a lot of the like Walgreens CVS even Dix has it. Rock tape, Dix covers, and then like Amazon. So I'll tell patients hey, look, I'll show you how to tape, and all the tape comes with instructional pamphlets. So I'll usually handle one of those. And so here, this is all the contradications for the tape. This is the purpose of the tape. Here's different taping techniques, but I'll show them

from my assessment what's best for them. Show them how to tape so they can carry that over if they can't make it in here. But once every two or three weeks, and I'll show them those corrective exercises. And when they come back their next visit, I'll give them more more to do a home.

“So the best thing in the kind of reiterate to patients are people who are seeking treatment,”

but are afraid because of the cost. This is your movement. This is your body. This is affecting your lifestyle. So try not to let that hinder trying to at least seek out treatment and see how the treatment affects you. Because we can make a big difference in an eval, one treat. We can evaluate, assess, see where you're moving around and teach you corrective exercises. And I can even show you how to tape on your own if the tape is going to be beneficial for you.

So it's your movement, it's your life. Every state's going to be different with insurance. Some clinics are cash-based, some clinics are insurance-based, but every clinic should try to work with that patient. So whatever PT is going to try to their best to work with that patient, fit whatever fits their schedule or whatever they can afford. We're in North Carolina right now. Do you need to referral from your doctor to come and

see physical? North Carolina we're direct access. So that means you can come in. You don't necessarily have to have a doctor's order. You come in. We'll do the eval. And then we usually ask who's your primary care or who is a doctor you see. And then we'll send that eval off to the doctor. That way they're informed, and they can sign off and send back. Yeah, we're direct access. So you don't need a doctor's order.

We just need to know if you do have a doctor and we'll specs that off to the doctor. Yeah, great. That's awesome. I'm just a more available. This is the people the better. Yeah, they even have home programs out there now. Computer systems where we can actually email you your home program. So like we can call a payment at patients. Hey, I don't know a lot better with this. Is there any other exercise

that I can kind of progress to from this one? And I can give them an idea in email them kind of the exercise. And then we keep in touch. Hey, how's that one feeling? Is that good? All right, because but it's got to be a progression from that basic exercise. That'll hold different exercise. Yeah, so we keep in touch through phone and email. That's awesome. Whatever it takes and it's worth it. It's worth it to be able to move as well as we possibly can. Yes. Now we're going to put

all that into effect and let's see how it actually works on your shoulder. Okay, so first we're

going to see how that shoulder's moving. Okay. See where your limits are, where your pain is. They're going to use the tools that try to clean up that movement and we'll reassess see how it's moving and how it feels after. Okay. And then I can do a little taping technique to kind of reinforce that for three to five days after. So yeah, all right. So what I'll do, I'll let you stand.

side. There you go. So raise this arm. We're going to do a look at all the motions of the shoulder.

So first we'll look at overhead movement. So we're going to look at flexion. So raise that head.

Raise my left hand up over my head. There you go. So he has a little bit of limited motion on that left side. You can't even make it past his ear. So let's compare that turn this way. Let's look at your right. Good. That way. Now let's see your right. All the way back and then see how you can't even, well, for people that are watching his arm is actually getting past his ear on the right. So definitely limit on a left compared to the right. Now we'll face the camera.

Okay. And now we're going to look at another overhead motion called ABduction. So he's in the

“comment, like a jump and jack without the jump. Okay. All three. It poms up. Yep. And I'm not a touch. And any pain there?”

No, that's not true. So he doesn't have any significant loss of motion, but a little bit of hiking of the shoulder on the left where it kind of is hiking up to his ear. It's a compensate. Okay. Now let you face turn your back to the camera. We're going to look at some rotational movements

of the shoulder. So let's do your right one first. Reach behind your back like you're trying to touch

your opposite shoulder. So he's good here. He's right between his shoulder blades, which is good movement. Like I'm being handcuffed right. Yeah, like you're being handcuffed. And no pain on that side or any pain. A little tight. A little tight. Okay. So we'll put that one down. Now we'll do your right. So yeah, she has a little bit less on his right. Okay. And relax. But any pain or tightness there? A little tight. A little tight. Okay. And then the last one. We're going to reach behind your head.

“Like you're trying to scratch your back between the shoulder blades. Or one arm tries up extension.”

Yeah. Like you're about to do a tricyp extension there. Yeah, relax. So he's about the center point of his neck. Now let's come here. Oh boy. That's where he's definitely limited. So he can barely barely get to the back of his head with his left one. And where do you feel that? In the, I guess it'd be the front to side of the shoulder. Yeah. All right. So relax. So we've kind of looked at his motion. We've seen where he's limited. Where he's a little painful and tight. So he was complaining about

right here being a little tight. How about here in the lats? A little bit there. A little bit in the front. Okay. So the front and the lats. So now we're going to go to work on some of those tissues.

And see if we can work on loosening up the tissues first with the instrument assisted.

Then we're going to do some copying to help get further decompression and get that blood flow in there to help improve the movement pattern. And then we'll tape it and do some see how you're moving post. Okay. So we're going to use what we call as rock sauce. It's got a little bit of pain relieving cream in it. They're actually off the muscle warm up. So you get that warming filling, which will help the muscle calm down a little. But you can use coconut oil, any type of

cream to kind of decrease the friction between the tool. So we're going to use the rock sauce. All right. So we'll put a little bit on you. I feel a little tightness in the front of the shoulder, too. Is that part of the issue that I'm having? It's probably what you're feeling is a lot of the biceps comes in here and your pecs come in here. Yeah. And then a lot of times people will have that lat. Yep. You're on. And the muscle right here, part of your carter carries will come in and you're

ladding and not like a really tight. So that combination of tightness will hinder that movement pattern, especially behind your head. So in the front and in the back right through there. Wow. And that's exactly where I have the issues. So what I want to do first is get the cream in. We're going to do that feathering technique. Get him used to the tool. He's already felt it. So he knows what it feels like. I trust her. Yeah. You trust me. So we get the cream all in. And I'm

lightly, very lightly touching him. Yeah. He should feel like it's a feather on you. Like there shouldn't be much pressure. You let me know that because every patient is going to be different. Patients that are in pain. Remember, their perception is kind of miscued. So sometimes I'll do this and patients tell me it feels like I'm pressing into him like a 10 and 10 would be the highest pressure.

“So you have to just patient discretion. All right. Now I want to go a little bit deeper, okay?”

So normally we scale it. Zero would be no pressure. One would be that feathering. 10 would be and it sounds crazy. I'm ripping the muscle off your bone. We want this to be about a four to a five pressure. How does that feel? It's good. It's a pretty snowy basic. I'm not even putting you in a stretch yet. Yeah. That's great right there. Yeah. Stuff smells good too. That's what it's called rock. Rock sauce. Rock sauce. Okay. We're going to get

left wrist and pull across your body like you're doing a little stretch on that issue for that pull

here. You feel like the arm straight. That arm straight left arm. Yep. Oh yeah. So I just have and then a little more of a stretch while I'm doing the instrument assistance. I can get a little more of that tissue. Release. Can you feel where the tear was? A lot of times with this you can feel what we call fiberotic tissue. You can feel the difference that you'll have a smooth

“feel. Then obviously you'll get to a tight crackling feeling and that's what we call the fiberotic”

tissue. The tissue that's just tight is schemic. So there's not a lot of blood like right in there. I can feel some crunchiness. Yeah. Yeah. Yeah. Yeah. It's pretty cool how you don't lose the tactile perception using the tool. You can still feel the tissue. Wow like it kind of

vibrate through the tool. You can feel it. Yeah. So it's just like with your hands. Sometimes I actually

think I feel it better with the tool when I do with my hands. Interesting. Yeah. So yeah. That looks enough. Yeah. So you can you feel that? Oh yeah. Yeah. So it's probably more of my tricep that's tore when I had that tear. Yeah. Or it's just that tricep is acting up as a matter of the tightness here. So you remember all the other muscles that have a facial chain. Yeah. So you upstream and downstream. Yep. So normally with the as resisted night can relax. You don't

just focus on one area. You're going to ripple below and above because your muscles function and what's called facial chains. So if I pull on his shirt on this side, you're going to have movement

“on the opposite hip. So if you turn that way, so if I pull here, it moves here. So that's how”

literally what your muscles do. So if you're tight here, it's going to affect here. So all over is going to be affected just through a facial chain. So I'm going to let you cross your arm again and do your stretch. That's a great way to explain it, right? You pull on your shirt on one corner it moves in the other corner. Yeah. That's great. Oh yeah. Yeah. And there's a lot of different positions I can have even. This is just simple for right now. Have you been standing? I

could have you lying down on your right side with your arm over your head. You get a bigger stretch on that lat. Tissues tissue. You're just going to have to some patients who are a little larger or who have, you know, where the tissue's kind of on top. You just kind of move that tissue and you can still work in that area. So I mean, we with patients who are older, who have a little more frail skin. That's when we would do the ask about the pressure. So I would do

feathering. It's a great exposure. You never just take the tool and throw it on somebody. Okay.

So with patients, all skin types, we can do the instrument assisted on it. It's just you always ask the patient how's the pressure. Yeah. And then you look at their skin. If they're turning ready immediately, okay, we don't really need to be doing this right now. Let's do another technique instrument assisted. We put aside for now. We can do gradual with the hand. We can just do some stretching. So it's all patient perception. Okay. Now I'm going to put you in

a functional stretch for that lat. Then we'll get that front. So what we'll do? So let's see if you can get in. Oh, like a modified downward dog. So I don't have to get you all of the and child's pose. So now I'm putting him in a more functional stretch position. So we're getting in kind of like a modified downward dog. Sometimes you can go in a prayer stretch or a child's pose. That way, you put that on that lat. Oh yeah, I was just going to mention that. That way you're actually

stretching that muscle. We're trying to work so that lat's can stretch more now. While the go, we're working that cross arm stretch. We're working more on what we call like in a middle delt, the tricep, the back of the shoulder would quite a post to your cuff. Now we're really hitting that lat. Yeah. You can already tell some times when people are tightening their lat. So that limits overhead movement a lot. So yeah, I'm like in downward dog position. It's similar to like the yoga.

My hands are on the table and I'm bending over at the waist and Christine is really getting into my lat, the side of my back right under my left arm and she's got the spot. Man, that's great. Yep, deep rest in there. I'm just going to breathe without your mouth. Yeah. Like when you have that feeling like a really tight muscle in your stretching it and it feels good,

“that's what this feels like right now to me. And as you might guess, I have a lot of issues with that”

area that you're on from the tear where I was doing weighted pull ups years ago. Right now, I'm doing that down regulation technique I was telling you about to decrease that muscle tone kind of calm it down. So I'm kind of going deep that four to five pressure when we're getting it on. And I'm going for at least 30 seconds across that area because this is a long,

for a little bit. Okay. So we do a little tissue there. All right. Now we're going to work on

that pecking that bicep. Okay. So sometimes I'll have patience laid out and I'll work on it. For you, we'll try that internal rotation. So reach behind up. Okay. And then we'll come through. And again, I'm going to start off a little gentle. Then I'm going to go a little deeper. So you just let me know how the pressure feels right now. How's that pressure? That's great. Okay. Okay, if I hold on to the side of the table, they're standing out. That's a spot. I have a lot of

trouble with. So that's the front of my left shoulder. Christine is working on. Yeah, we're getting in kind of what we call those peck muscles, your chest muscles, and a bicep area at the front of a shoulder. That calmly gets tight and it'll pull the shoulder forward in the joint up and forward and cause that limited overhead movement. And it can cause what we call a pinch movement in the shoulder. And which we in the gym call the bench presser pose. The guys that work around like

they have a loaf of bread under each arm. Not relax it. Good. I'll come up. All right. Christine is just a reason why like in the gym, we hear so many people tearing their biceps or tearing their pecks is this kind of a kind of spot that we're talking about. Yes, definitely, right in there. So usually you'll hear guys, they're bicep or just one. They're pinching too heavy. That's a spot. The long head of the biceps runs in here. Now, I'm going to put you in one more spot.

Sure. For a stretch. So we're going to be here and you know the stretch where you're turning around. So I'm just going to have him rest his hand on an object. It's about shoulder height for him a little lower than shoulder. He's tall and he's just going to hold his arm straight and rotate the body away to stretch the front. Those chest muscles in that bicep. Calm down. Calm down. Yeah.

“And you should feel the stretch there. Yep. All right. Now I'm going to work the tool into that stretch.”

That breath. And again, I'm going to keep asking him how's that pressure. That's great. It really feels good, actually. Oh yeah, the crunchings have it. Yeah. So I'm feeling the crunches. When I call like rice crispies, that's that fibroidic tissue where it's tight. It's kind of a

hear down. We're going to try to get that tissue to basically loosen up and prove the glide.

Oh yeah, you. Oh yeah. Yeah. And I mean, you know, obviously there's a little bit of pain involved. But to me, it almost feels like when you have an itch that you just can't scratch and then this feels like scratching. No, yeah. We'll say the feel good pain. Yeah. Sometimes, you know, when people get the deep massage deep tissue massage, yep. Those endorphins go on. Mm-hmm. There we go. See, that feels better. Yeah. Yeah. It's not as crunchy. Do you think that's a lot of that to my

bicep? You think that's part of what's making the shoulder tight? Yeah, a lot of it can be just

“from past injuries. Remember, when you're in pain, past injuries, you're in a pair movement.”

Right. So your body's going to find a way to move. So it's going to move in correctly. Right. So it's got to move. It's got to try. It's best to work, especially when you're lifting. Mm-hmm. So you're, you might not even realize that you're moving and paired. Like your overhead movement is limited and you might not even realize it. So you saw your left where you couldn't see but it didn't even get past your ear while you go. You're right, you got past your ear. Right.

And then definitely your external was limited. So we've done a lot of the instrument assisted. Now we're going to work with the fun cops. Okay. So with the cops, we do what's called graded exposure as well. Okay. So normally with patients what I would do is introduce them to the cop, put it on their skin. The suction method is the easiest. You literally just put it on in suction. There's not as much negative pressure. Not as much pool.

Man, once they get used to what I can do, it's called the inversion. I just flip it inside out.

“Put it on there and you should feel more suction now. Yeah. So I would work with my patients,”

let them fill it, see how they respond. The first treatment, I would do what's called just stationary

cupping, which they're just kind of there and I'm cupping and I can move the tissue. Okay. With you, I'm going to go ahead and do cupping with movement. Okay. Because that would be the next step. You add a movement with the cops. So you're getting glide from the cup and you're getting internal glide from your body. They look like baby plungers. Yeah. So for people that can't see, they literally are little baby plungers. Yeah. Yep. Yeah. And literally when you put it on there,

suction's on, pull up on the plunger and it's suction's to the skin. So we'll have Garrett do. I'm going to let you reach behind her back again. Okay. I'm going to get that stretch. I'll put her

machine. Okay. And we're going to do that. Buy some stretch again where he's just turning his body

“it yep. Stretching. Yep. Here. One cup on my left shoulder and one cup on my bicep. So I've got one.”

Yep. Right there on the front of the shoulder. On his bicep, I'm going to put one a little farther down on his bicep. So there's two on his bicep now. One on the front of his shoulder and I'm going to put one right here on your pack like your chest muscle. Yeah. Cool. So now what you're going to do is a tissue glide. So you're going to rotate into that stretch. Okay. Count to 10. Back off a little and then rotate again. Okay. So we'll do that for now. Let's just do five of them.

Two, one. Back off. Sucking cups are still on there. Yep. Normally with the suction cups you do not want to leave them all there more than 90 seconds. Usually it's 30 to 90 seconds. If you leave them all there longer, you're going to call as too much of a hemostatic response or you're going to need too much of that blood flow in there. You want to take it take them all

“after about 90 seconds. Cool. With this top of technique, it's fine. Put back on there.”

I'll make a suction a little more. There we go. 10. Good. That's four. One more time. For 10, 9, 8, 7, 6, 5, 4, 3, 2, 1. And that's five. And then we'll take them off. It is put my fingers up underneath the suction cup. Wow. Oh, they leave a cool mark too. Right now he's got little red circles. Some of them are a little more purple. The purple, they want to set dark purple. That means you can relax. That's an area of greater stagnation like where it's area of greater tightness.

Those tissues are adhered down more. So you don't have this much blood flow. So now we just pull all that blood in. So it's a little more purple there. So you can definitely tell that. It's a hot spot for you. These, you could barely even see the other one. This one's definitely a hot spot.

Well, that's amazing. You can see the difference. And exactly where the darker purple

spot is is where I have most of my pain. So that's usually what we call a hot spot. So that's your spot. Okay. Now, so we did the bicep. And we did a what we call your peck, your chest muscle. Now we're going to hit that lat and we'll reassess everything. Come. I'll tape you and kind of reassess again. We'll reassess before I tape and we'll reassess after tape too. Okay. All right. So for your lat, what we're going to try, we'll get in that downward dog positioning in for you.

I'd rather have a higher surface because of the camera. Yeah. So same thing, you're just going to go down. Okay. You can hold this from for just five seconds. Okay. Come back out a little and repeat.

Okay. So the first stretch is going to put them on here. Okay. So now he's in that kind of modified

downward dog as hands around the table. He's been over. I'm going to put one here kind of along the tricep area and then I'm going to put one around the armpit where the lat comes in. Kind of the outside of the armpit area. Okay. And then I'm going to put one right here on his lat.

“And again, I have my hands on the table bent over at the waist. You feel that good pull?”

Yeah. Yeah. It's perfect. So hold it for that five and then just back off a little and repeat. What do that one ten times? And back down in position. You still feel the stretch? Yeah. Yeah. Good. Five, two, back down. So this is how we incorporate movement with the techniques. When you're doing therapy, you don't want to patient to be stationary every treatment. You want them to be able to get to move and reinforce that movement pattern. So we're adding in

the external glide from the cup and the internal glide from the patient doing the stretch. One, two, three, four, five, six, one, two, three, four, five, seven, one, two, three, four, five, eight, two more. And you can tell he's getting a little more mobile. I had to move that table back some because his butt was getting closer. Three, four, five, eight, what's that eight or nine? Nine, nine, one, one, two, three, four, five, ten.

Yeah, I can feel it around more mobile. Oh, yeah. Well, me up and down. Yeah, you can come up. So that's movement with copying and then even another step, the next step would be movement with me moving cups. But we don't really have to do that today. We just look. So because you can assess tissue movement with the cup. So if you stay facing a camera, I'll kind of explain. So if I take the cup and you see the big purple spot for those people that can't see, again, that's a hot spot.

It's nice and purple. The other circle is pretty much barely even there now. So that's one of your hot spots to around where that lat comes in and connects. So if I put a cup on his

So I can go clockwise, counterclockwise, and he doesn't move as well, counterclockwise. And you can

“also go to vector this way. Here, see, move pretty good there. You don't move that well there.”

Thank you. Feel the difference. Yeah. So use the cups for assessment as well. Okay. So you can assess where you're tight, what motion you're tight in, the different vectors. And we can actually do moving those vectors while you move even while you're stationary. It's pretty cool. Or look at your other hot spot around that web. Perfect. So we're going to reassess movement. Okay. So let's face that way again. Okay. So good posture. All right. So raise that left arm up all the way. Look,

he's behind his ear. Good. All right, back down. Okay. Now face the wall, because you're really limited with your external definitely. So reach behind again, try to touch behind the head. Look at that. Wow. I really touched my head. Yeah. So really, he was right here at the top of his head. Now he's down here at the base of his neck. So excellent improvement. That's awesome. Nice. Yes. So now we can reinforce that. Right. So we'll do the tape. And then normally I would go in

to correct the vector size. Okay. But let's tape. Okay. Right. All right. So when you put tape on,

you never really stretch the tape unless you're using it for like decompression. You stretch the

tissue, the muscle. Okay. So what we're going to do, I want you to reach behind your back. I'll measure the tape first. Come around here. Okay. All right. You can relax. Okay. That is the tape stick on top of the rock sauce. Yes. This rock sauce it does. This is a it evaporates. Okay. This type of sauce does. If you're using coconut oil, you can relax so much. If you're using coconut oil or any type of other oil, you're going to want to use alcohol to wipe it off. Okay. So clean the skin first. That's

“the key for this because it evaporates. We can we can use that. But definitely clean the skin first.”

All right. With alcohol, if you have lotion on or if you use coconut oil or anything. All right.

Because it's going to affect that he's a quality of the tape. So it always round the edges

because if you leave him square, they're going to catch on your clothing now. So now reach across through that cross arm stretch. Okay. Come around here and we'll get into that little bit. You can relax. All right. So we're going to hit kind of wrapping around the front of the shoulder. Great. To give input into kind of where that peck, like your chest muscle and your bicep. Okay. And then we're going to hit the back of your shoulder. What we call it, post your cuff area.

And it kind of actually gives your shoulder a little bit of input. Oh. And feeling a stability. All right. And that third strip after I do this is going to be for where you're really tight around that tries to go into the lap to give that normalized tissue tone. And we're going to tell your brain, hey, let's calm down if I'm really tight. Okay. So the fun part. So then we get to see how you're moving after. I mean, you're not going to have really improvement, but I want to make sure

you can move with the tape and prove that the tape moves with you. So that's the cool thing about this tape. It's not medical tape. It doesn't, it doesn't cause your joint to stay stationary. You're going to be able to move it and move it with you. Okay. So it's flexible. Yes. After about a day, you're going to note you're not even going to notice this on your screen. Oh, yeah, I have tape on.

“Yeah. So let's reach behind your back. And remember, I'm not really putting the stretch on the”

tape. I'm just laying it down tape on pressure. All right. You definitely just lay the ends down.

Never ever stretch the ends. Okay. And you always rub it, body, he activates the stickiness that he

says quality of it. Okay. So now relax. Okay. Now let's do your cross arm stretch. So he's pulling that left arm across his body. Don't shrug. Keep that shoulder down. Good. All right. And because I'm short, I'm going to stand up here from the other side. Come here. All right. Yeah. I'm going to come around. And you're never in tape on tape. So you always have to be on skin because it needs something out here too. And adhesive in the tape is activated by body.

Yep. So when you rub, it makes it stickier. Okay. Now we'll get that fine spot, that lat tricep area. Okay. So let me measure. I need the shirt off. We should be able to keep it on. So a lot of times they teach you how you can do stuff with shirt on. But if I needed to get to what I would do is take patient to the Evara and have them take their shirt off. Especially females, you know. Hmm. Okay. For this one, you can get in the basic tricep stretch. You're pulling back. So he's

lean that way. There you feel that stretch. Much better than when we started. Yes. That's a lot

better here. Yeah. Aren't you glad you came? I am so glad we came. I love being able to see. Especially when you see that quick progress like that. And it helps the patient realize, hey, I can get better.

“You know, I'm not stuck here. Okay. Right now relax it. Yeah, any little victory. I think”

especially when you're dealing with chronic pain is huge. Oh yeah. You can really see your passion for what you do. I love it. Now raise up and it shouldn't injury. Yeah. Yeah. So we got the tape on there and then what I would do normally typically in a rehab situation, I'll take you to the correct of exercises. Like I would move you through some scapular strengthening, teach those shoulders to sit back, and a postural strengthening exercises. I would work you into a little of that overhead

stretching. We do a different stretch for the pecs and lats, like a more stationary long hold. Okay. But so that would be the next step like the carryover. And that's when why you really need to see someone that kind of knows what they're doing when it comes to exercising to show you the next step. Hey, we did all the fun tools. Now what? Okay. Yeah. So keep it going, reinforce the

“new movement and reinforce a good movement pattern. Yeah. Yeah. So those good things. Yes. Definitely. Yeah.”

And now I have to work on my stretches. Yes. Oh yeah. Definitely. Yeah. But that's great that we saw that improvement. Yeah. I love it. And imagine if we did the true like 20 to 30 minutes that we'll kind of spin on that manual. So a little bit longer. I normally I would kind of have you laying

down to a little more. So we could even see more improvement. Oh, that's awesome. Yeah. I always say

the one negative side effect to working out and to being active is that things wear out. But the more you can work on recovery, the more you can work on correcting those things, the better movement patterns you have, the longer you're going to have the use of joy. It's not about how much can you lift or how heavy can I go? Can I do that correctly? Yeah. You might need to back off your weight and that's the good thing about if you're in pain, if you're injured,

or if you're moving incorrectly, coming to a specialist, like a physical therapist, we show you how to move correctly, carry that over into whatever your sport, whatever your lift technique is. We can carry that over and teach you the correct mechanics to prevent that re-endry. Right. Right. So awesome. Well, thank you for everything. You're awesome. I can see already that we're going to have to continue. We're going to have to have you back and we're going to have to go

to the next phases and talk about more of what you guys do here at the clinic. It gets really awesome.

Can you give us a quick recap of what we did here today? Definitely. So first, we kind of went

over the instrument assisted. So just using a tool to help improve tissue mobility. Kind of like on the massage technique with the tool. Then we did the cupping, the little suction cups, the like plungers. We did it over those muscles where you were feeling tight during movement. Right. Then we reassess your movement. We saw tremendous improvement and your ability to reach behind you and your overhead reach. So those cleaned up pristinely. Those looked good. Then we added

and taped the tape component to kind of continue to reinforce that for the next three to five days, like keep those muscles normalized tone. Help you keep that new movement and control for the next three to five days. Now work those stretches. Yeah. Right. Be the next step. The correct of exercises. So Christina, thank you for being on the boat for light podcast. Now, if somebody saw something that they like here or something that they want to try, what would be the next step.

The next step would be you can either contact us locally. Here in Wallace, our clinic is Vidant Outpatient Rehab and you can give us a call at 910-285-1799. And my name is Christina Pate. You can also kind of look up contact official therapy clinic, ask if they have anyone that's cupping or instrument assisted or tape certified so you can make sure you're dealing with a specialist.

“If you want to do specifically the rock tape technique, you can go online to rocktap.com.”

And they actually have a section where you can look up, they're called rock docs. So you can look us up and see providers in your area that are actually certified in these techniques. So that'll give you a quick link. But you don't necessarily have to go rock tape. There's different types of instruments, different brands, different brands of tape, different cups. It's mainly the concept behind it. You know, we talked about the pain mitigation,

alleviating pain to that pain gate they're using the tools, the decompress of the fact, and that brain to muscle or body part connection that the tools provide. So they don't necessarily

behind it and using it in conjunction with physical therapy to reiterate the movement pattern.

For me and dealing with my chronic pain, I feel like any little thing that helps and this helps. You know, helps my overall well-being and it helps what I can do. For somebody that's interested in trying this, I mean, what can you say to them that

“that might help them in order to give this a try or do something to help improve their life?”

So there's a lot of evidence-based research out, only techniques. So it's not just theory, there's evidence. There's actually a lot of research out on not just acute injuries but chronic

pain and itself and how these techniques truly do help with that pain control and that movement

pattern. There's actual studies that show using ultrasound, the physiological changes in the tissue when you're using these techniques. So there's evidence out there. So if you have any apprehension, you can look up evidence on rock tape techniques, the instruments, the techniques are cupping and how it affects or helps with chronic pain. You will find a lot of research out there,

“evidence-based research. So that might help with your apprehension, give you an idea of, hey,”

here's exmonit people. I mean, thousands of people, millions of people in these research studies

that have had positive effects from the techniques. So there is hope out there. There's,

you have faith. There's hope. We've seen with Garrett. We've already had improvement just with this quick technique. And for me, the proof is in the pudding. I mean, if you feel better, you feel better. I mean, that's definitely, I'm sold. Feel better. You move better. And that carries over into your lifestyle. So you're actually able to perform your daily activities with improved ease. You can go back in the gym and do your lifting. So I mean, that's the truth in the pudding. Yeah. And that's,

I mean, the whole goal of the book for my podcast is a Liverpool life and thrive with chronic pain. Whatever that means for each individual person and I love how you talk about dealing with each individual case and each individual individual person. And I know here at your clinic, you give the patients

“a lot of time. And I love to see that. Yeah. Yeah. It's good. You have to each person or each patient”

as an individual themselves. They could, you could come in with the same shoulder surgery. But I'm going to treat you a little differently because you have different goals. That person has different goals. Your movement pattern might completely be different from that movement. So everybody's an individual. You can't do cookie cutter treatment. Thanks again, Christina. We appreciate it. Thank you so much. It was fine. Thanks. Yeah. And I feel better. Yeah. That's a positive, right?

Man, I kind of got beat up on that episode. But Christina was really able to help me with my range and flexibility. And as she pointed out, if you've ever thought about finding a physical therapist or clinic, it can be a lot easier than you think. So listen to Dr. Christina Pate, you know, do a little research. Find somebody that can help you out. I've got bumps and bruises from this episode. But man, you know, my shoulder feels a lot better. The range of movement is already better.

And, you know, Christina's passion and knowledge really shows through. So Dr. Christina Pate, you are both for life. We appreciate you listening to both for life. Our goal is to help you or anyone that you might know to live and thrive with chronic pain. And you can help us out by subscribing or giving us a review on iTunes or anywhere else that you hear both for life. If you guys have any ideas, we'd love to hear from you. You can reach out to us at [email protected].

You can find us on Facebook, Instagram and Twitter. Bull4Life. Thanks again, this is Garrett Bull4 for Bull4Life.