Episode 32: Let's Talk About Necks

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• Joe Gambino
• Joe LaVacca

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Summary
In this episode of the Beyond Pain podcast, hosts Joe Gambino and Joe LaVacca discuss various aspects of neck pain, workout pain, and recovery strategies. They explore the importance of movement, proper loading techniques, and the need for a comprehensive approach to managing pain. The conversation also touches on personal experiences, upcoming events, and the significance of understanding one's body during the recovery process.

Takeaways
Pain can worsen when increasing workout intensity.

Reevaluating form and technique is crucial for pain management.

Recording workouts can help identify form issues.

Sustainability in training is key to progress.

Neck pain often relates to sedentary lifestyles.

Movement and loading are essential for recovery.

Direct loading of the neck can alleviate pain.

Understanding pain patterns helps in treatment.

Strengthening upper traps can benefit neck health.

Movement through the entire body can relieve localized pain.

Transcript

Joe Gambino (00:00)
Welcome back into today's episode of the Beyond Paint podcast. am one of your hosts, Joe Gambino, and I am here with Joe Cowboy Hat Lavaca.

Joe LaVacca (00:11)
Yo, reference in the IG posts, alright!

Joe Gambino (00:13)
I had to bring it up. Yes. Yes. You know, questionable look, but I do. I will say that maybe Mr. confidence, Lavaca, because I think you have to you have to some really good self-confidence to to rock that out. I don't think I I know I couldn't pull it off. So.

Joe LaVacca (00:27)
Well, the context was that picture was from Halloween. Yeah, so for if in case we haven't spoken about it on the podcast, I don't remember if we did Courtney's love for Pearl Jam is so much so that she has been to multiple shows. She has a tattoo on her arm that says just breathe, which is her favorite Pearl Jam song. And when we were talking about Halloween, it

Joe Gambino (00:33)
I had a feeling it was.

Joe LaVacca (00:54)
kind of came up on should we do something together? Should we even dress up? Should we go out? And then I said, well, what if I just dressed as Eddie Vedder and you just went as like a little Pearl Jam fan or something. And she loved that idea because she didn't have to do anything. And I liked it because it was actually a really easy costume. Just Googling Eddie Vedder's look on his recent tour through the Midwest. He was wearing a Walter Payton sort of lookalike jersey. That's where you see me wearing the Walter Payton jersey.

Joe Gambino (01:10)
Mm-hmm.

Joe LaVacca (01:21)
and he's been rocking a lot of these cowboy fedora hats during his shows. So that's the inspiration and yeah, it was a fun night. So I will never wear that again. So I do not have the confidence to rock that.

Joe Gambino (01:27)
There you go.

Well, you can tell court that one of my favorite albums, think like maybe like top three, top five for me is 10. So phenomenal, phenomenal album.

Joe LaVacca (01:43)
Yeah, well, 10 solid. I think at the end it also took 10 albums to get to this fairly decent new one that they have, which Court will be very upset if I forget the name of. So I'll try to research it a little bit. yeah, they kind of fell off. But when you storm the scene with 10, it's really hard to follow that up because, I mean, 10 was a masterpiece, right? It was so good.

Joe Gambino (01:57)
Yeah.

Mm-hmm. Yes.

I agree on that. I agree with that. you can I mean, I don't know if this maybe this podcast falls in the same category as 10, but you can find us on social media. I am at joegambinodpt DPT and LaVacca over there is at strength and motion underscore PT. This podcast is Beyond Pain podcast on Instagram and you can and you can watch the episodes as well on YouTube. Cups of Joe underscore P T.

I think that's everything. And if you want to work with us or need anything, there's an application form in the show notes. You can always fill that out and we will get back to you. Boy, welcome back.

Joe LaVacca (02:48)
man, it's good to be back. Quite a week, lots of travel. Back in Colorado, as you can tell. Yeah.

Joe Gambino (02:50)
Yes.

You're in Colorado now. Yes, nice new background over there. If you're watching from YouTube, he has a very sweet gym background behind him.

Joe LaVacca (03:01)
Yeah, Courtney and her team have done a really nice job, fitting this old, I think it was a paper warehouse into a nice gym facility. They have some front offices. So I love coming out here and I'm actually flying to St. Louis with court tonight. She is teaching there. So we will have to find a way to watch the Tyson Jake Paul fight. And it's probably going to be for my laptop. I am so conflicted.

Joe Gambino (03:24)
Mm-hmm you have a prediction

Joe LaVacca (03:31)
on this fight because I just watched Tyson slap Jake Paul in the face as he approached him like a dog yesterday. And I saw Jake Paul getting all amped up, you know, he was like, let's go, let's do this. I'm like, dude, you're 40 years younger than this guy. I mean, are you really getting amped up fighting a 60 year old? And but then I look at Mike Tyson, I'm like, well, I still don't want to be within 100 feet of this dude. I mean, he looks dangerous. So I think it's going to be a show. I think they'll probably box.

Joe Gambino (03:32)
Hehe.

huh.

You

yeah.

Joe LaVacca (04:01)
for three minutes in the eighth round, just for fun. But I think it's gonna be a lot of gimmicks. I haven't read on the rules of the fight. I know there's a lot of like specific rules on what they can or cannot do. So I think they're wanna make the most money possible, keep people watching for as long as possible. And they'll dance around, they'll slap each other, maybe someone will throw a kick. And then the eighth round will ding and it's like, okay, just go hard for three minutes and see what happens.

Joe Gambino (04:09)
Mm-hmm.

There you go. We'll find out. We'll find out. I'm always interested and I always want to see Jake Paul lose, but he somehow finds ways to win. I mean, credit to this guy. he's not too bad of a boxer and he's having fun. He's crushing. He's crushing. mean.

Joe LaVacca (04:40)
Hahaha

Yeah, man, look, they're both, I will say this, they're both really smart. I think they're both gonna make at least 20 mil, which I think supposedly for what I've been reading, break Mike Tyson even with all his debts and make Jay Paul just that much richer. So why not? Why not?

Joe Gambino (05:09)
Why not? Exactly. It'll be fun. Anyway, we're talking about the neck today. And I do have a question of the day for you before we jump in. This is actually from one of my clients posed it to me and I'm going to pose it to you to see what you have to say. And then I can tell you what I said back to her. But it's what should I do in scenarios where when I start to ramp up my workouts, pain gets worse.

Joe LaVacca (05:16)
Yes, sir.

Hmm. And this is like as the, this is like in a single session or like as a program is involved. guess it doesn't really matter. Yeah. I think we'll, probably goes back to some of the things that we were speaking about it last week. It's reevaluating probably form technique, volume, intensity. If we're looking at all these things, we'll start with, maybe form and technique. Eventually your form is going to start.

Joe Gambino (05:46)
Pretty much as just like, yeah.

Joe LaVacca (06:09)
to become less and less variable. Meaning you'll have decreasing options to move a weight. When things are really light, you think about dropping your keys on the floor, a couple of ounces, that's not gonna pose much of a threat for us. I can bend at my knees, I can bend at my hips, I can swing one arm across. Yeah, I know, I know. I know, I know.

Joe Gambino (06:28)
that to anybody who's had lower back pain and when they pick something up their back goes out.

Joe LaVacca (06:36)
But you have all of these different options when things are light, right? Maybe even the coffee cup is fine, right? Like I can throw it in this hand, I can throw it in my other hand, I can swirl it around, I can think, I can talk with it. But sooner or later, if the coffee cup reached 15 pounds, I'd have to really start thinking about holding it with two hands. I probably wouldn't be able to talk as fluidly without some sort of other compensation. So when people start to progress in the gym, I think recording yourself is important.

particularly with lifts you've had a hard time with in the past. So you record yourself, even if it's one set, it doesn't have to be every single rep that you do, but you just keep a log. Let's say it's squatting or deadlift. Those are usually the big ones that most people I think seem to have a little bit of a slip back on when they get back into these intensities. And then you record it you're like, okay, what changed? Did I go back to that old habit of...

really arching my back, really driving my knee in, really leaning forward with the weight. And if you're doing that and you're realizing, hey, my pain's coming back, well, maybe this is my threshold for right now on what my tissue capacity is. And then we can zone in and say, well, hey, yeah, you know what? It is the leg, it is this, it is that. Let's take some percentage points off of your intensity or your weight. Maybe let's go back and revisit some of those exercises that originally got you out of pain.

Is there a way we can progressively overload those things? And then if it's just volume, well, just like we talked about with, I think some running stuff, just take five or 10 % off your volume, keep yourself there for maybe two or three weeks. That's still okay. And I think I'm becoming more and more biased on this idea of sustainability and maintenance.

as keys to get to the next level or progress. And if you and I were going up five or 10 % in the gym every day or every time we went to lift, there wouldn't be enough weight in the world in your garage. You'd be deadlifting 500 pounds by Christmas. You'd be back squatting 1,000 pounds by Valentine's Day. So things can't be linear. And I think that's what sometimes people struggle with too. So I would go with form technique, videos I really like.

Joe Gambino (08:37)
Mm-hmm.

Joe LaVacca (08:55)
And then if that normally will lead us to a drop in intensity, and then if it's volume stuff, take five or 10 % off, stay there for a couple of weeks and see if you can come back to balance. What about you? What would you have told this client?

Joe Gambino (09:09)
Yeah, that's I mean, I like all that. I think I actually just got some videos from her today. So I haven't got a chance to look yet. I mean, our conversation was more around like the work that we're we're putting in right now is working. She's like, you know, I do X, Y and Z and then I start to feel good. And then because I'm feeling good, I try to up it a notch in the gym, which is like been her struggle. And it's kind of like led us on our journey together.

Then all of a sudden the pain comes back. So it was more talking about like our pain guidelines and like, okay Well, we need to kind of listen to our body and it's just you know If you're feeling good then keep that volume kind of there Don't go back up to those volumes that are setting you off because clearly your tissues haven't adapted yet We need to create those adaptations get your body a little bit more accustomed to it and continue to bring down that pain response and let the body start to feel a little bit more comfortable with and it's in itself and then start to kind of pick up so

Joe LaVacca (09:54)
Mm-hmm.

Joe Gambino (10:02)
She's had a of a lot of pain for for quite some time and a lot of us come down, but now there's still some low back pain stuff that's that's been kind of like a up and down. So the conversation was about that. And the other conversation was even if some of that stuff is happening, but there's been like incremental progress, even if it's still up and down, then maybe, you know, I sent her a video. didn't have like I told her, we probably need to hop on a call to talk about this in person.

But then the other thing you should think about is like if there is to leave in progress even if it's up and down then we may not even need to change anything We may just kind of let this kind of like run its course It may just be up and down but as long as the total trajectory is up each and every week Then I think we're doing everything that's right and I don't know if we need to change too much. So a couple things that we need to actually Navigate as these coming weeks come on to make sure that continued success happens. I think

Joe LaVacca (10:47)
Yeah.

Yeah, get more data, right? I mean, I think that I've been telling a lot more new patients that we're co-scientists, right? We're meeting in the lab. We're coming up with these hypothesis on what might help you and what could work and what's gonna be the best for your pain, your performance. But we need a lot more data than just one point or one workout or one day or one hour to really make good decisions. So I love that too. And I've becoming more and more, you

I'm a fan of just trying to mitigate people's fear on TrueCoach and all these other platforms or emails that I'm working with people on just to say, hey, look, stick to the course. We don't know what tomorrow will bring. We don't know what next week will bring. If we start to see a pattern, then maybe that's where we can start to dig into it a little bit deeper. you know, pain just make ebb and flow, like you said. And this is nothing to throw us off our game. So yeah, get more data. That's what I've been saying.

Joe Gambino (11:52)
Yep. And I think that's the hard part for a lot of people is like, the pain gets worse, right? So it makes people derail or shift gears or change their approach when sometimes it's not necessarily the case. It just needs to be a slight modification or in a case like, know, if it is, things are getting better, but pain still pops up and you're having these little mini flares. then, know, you do need to stay the course. You have to kind of navigate pain sometimes to get out, to get out of pain or allow yourself to

get to that next level. it's not easy to say the least, I guess.

Joe LaVacca (12:26)
Definitely not. Definitely not. Simple but never easy.

Joe Gambino (12:30)
Let's shift over to the neck here. Let's start here. think I'm actually curious when you're looking at the neck, what are you know, I guess like what's kind of like your approach or what kind of you know, maybe it's like someone's suffering from neck pain. What are like, you know, and they're doing it on the road. What are like a couple of things they should look out or a couple of things that, you know, they should start to work on that like big, big rocks for you overall.

Joe LaVacca (13:00)
Yeah, I think with the cervical spine, fundamentally, I know that there's a lot more mobility here than the lumbar spine, but I'm gonna try to compare similar frameworks. So if people are not moving enough during the day, and the neck pain comes up a lot with our sedentary office workers, maybe people who aren't as active, particularly if we're gonna start to mention this like combination of upper trap pain.

and maybe even some sort of shoulder mid back tightness. I'm always going to go with those low hanging fruits of, hey, what's your job? How long are we sitting? Maybe for periods of time. If you're sitting more than three, four hours at a time without moving, without breaking, let's maybe just start getting into a pattern of shaking that up. I often have started telling people every 20 or 30 minutes, but I lose track of the day in 20 or 30 minute increments. And before I know it,

Sitting down talking with you Working on a virtual call doing some other stuff for you know, either programming or social media I'll look up and it's like wow two hours have passed and I didn't even realize that so I shied away from this like every 20 30 minutes I pushed it to a little bit more like let's not maybe sit for longer than two or three hours Depending on if you can even tolerate that much and then let's hit steps. Let's think about just overall health Let's get you moving or loading

twice a week, it could start generically. Let's get you hitting 7,500 steps at least every day just to break up some of the monotony. Then from there, I'm just gonna start to do things the same way we would do at the lumbar spine. How well does your neck flex, right? Or your chin come down to your chest? And then how well do you extend or look up? From there, I do kind of like more manual therapy inputs for the neck.

Whether it just makes people feel safe, maybe it's just an easier access point from a sort caregiving scenario. They're usually on their back or pretty comfortable. Maybe you can flip them over. I do seem to think that people feel a little bit better more quickly with movement once they get a little hands on. So I do tend to maybe bias or flip some of my biases, I should say, with hands on stuff.

to get to neck treatment. And then from there, I wanna essentially start with just getting these segments to move, right? So we think about cat cow for the whole kind of spinal system. I'll start them off with some cat cow, maybe it goes global. Then they're going on their back and they're just kind of like pushing into their hands or pushing into a towel. I always wanna think about pumping joints, contracting muscles, and then starting them off with really just simple gentle range of motion techniques.

Because the other thing I've seen a lot is that necks tend to be a little bit more sensitive to these flares. And maybe it's just because of our eyes and our environment, you quick looks, sneezes, coughs, putting your hair up too quickly. Like Courtney was talking about yesterday, her neck got a little bit tight. So I think those would sort of be just the easy ones. Very simple framework that starts me off looking at it from a lumbar spine standpoint or even a thoracic spine standpoint.

But what about you? that coincide? I missing some opportunities here with people just to start off entry level stuff?

Joe Gambino (16:34)
As far as, mean, not from an entry level stuff. mean, I love the idea of, mean, I think this is just for anybody if with anything that's going on where pain is built up with you being stagnant for a while, just like moving more, changing positions, things like that are just going to be huge for anybody in those situations. I, again, I mean, I'm always a big fan of just like, do you even have?

the motion that you should have at your neck. The amount of people that I see that have chronic neck pain that have like 25 % of the neck extension that somebody should have or like, you know, or norms, you know, those are significant limitations. Like clearing those up are going to go a really long way for people. So, you know, can you flex, extend, rotate, side bend, have combinations of movements that aren't painful or pinchy or anything like that? Like, can you turn and look down or turn and look up without any sort of issues?

and then I mean, I've been not necessarily off manual stuff, but for me, for the neck, I've been finding that just like direct load to the neck. Like I'm a big fan of spinal segmentation. You should have it. It kind of goes into the, the bark ballpark or just making sure you have like baseline mobility there. but I find that like, if you just do some like,

you know, put a band up against something that doesn't move and then put that around your forehead and just load it in all the different directions or like, E-centrically load the different positions or add some load and or use gravity or whatever it is. Once you load those tissues, because I think people are afraid for whatever reason, anything that's around the spine to just load it. because I guess it's super fragile, you know, that's the thought process. so I think they're also just like under trained.

muscles, right? Like if someone has a lot of pain, they're likely avoiding it. They're likely not moving it as much. They're definitely not loading it. So I find that loading it creates this nice way, especially in an isometric sense, just kind of calms things down, loosens things up, give people more freedom of movement. And then even then when you try to do your segmentation work and your other mobility work, it's a nice later on. I've actually been finding

If I do that stuff before, even for myself, like we talked to, I had like that neck flare. Like I found like if I did some loading, like direct isometric loading to my neck and that did mobility work afterwards, it was like a huge difference for me than doing it like the other way around. so I've been kind of liking that and that people have been responding pretty well to that. So for me, it's, you know, loading the neck and not being, being afraid to do that since I think most people are just, you know, their muscles, their joints, just like everything else. We talked about with low back all the time.

Joe LaVacca (18:51)
Yeah.

Joe Gambino (19:14)
You should load it with some flexion. Maybe some extensions have to be a lot of weight. I definitely think it's the same for the neck.

Joe LaVacca (19:21)
Yeah, I'm glad that you said that too, because that would probably be part two. The loading of the neck, I think it's just hard. It's uncomfortable to wrap a band around your head. It's rubbing into your hair, it's pulling on your hair. People feel awkward when I hand them a five pound plate and I have them do almost like ab curls with a five pound plate on top of their forehead. I think they just sort of feel silly. The counter to that then,

is if we're going to then try to get secondary load, I think people have to be more comfortable with heavy rows, with heavy pushes, with heavy carries. And a lot of people are not comfortable with that with stimulus either, especially when they're in that kind of sensitive pain state. Because I still see that people come in and I hand them some dumbbells and I'm like, hey, you know what, we're just gonna start doing our shrugs. Let's start working upper traps.

And they're like, I shouldn't do those because these muscles are already tight. For some reason, unbeknownst to me, people still think when you strengthen your upper traps, you're going to eventually not have a neck and your shoulders are just going to be pinned into your ears. I don't know why this is the belief because the simple example I give to people is this. Let's think about any other muscle at the gym that you were training. Did you bicep curls?

yeah, of course I do bicep curls. Okay, why are you not walking around like a Tyrannosaurus Rex? Why are not your biceps shrinking and contracting because you're strengthening them? yeah, that's interesting. So what instead happens? They become more dense. They become more resilient. They are able to tolerate more load. So this is where the direct loading of the neck, the direct loading of the spine can really be helpful for people who can't lift heavy or don't have that affordance in the gym.

Yeah, it's uncomfortable, but it's kind of like what Mike Ranfone told us, right? Like, Hey, choose your hard You know, do you want to kind of have this recurrent neck pain on and off, or do you want to, you know, find it a little bit awkward to wrap a towel around your head and start strengthening, give it eight or 12 weeks, add that into your program once or twice a week after that is maybe just a warmup or as a check-in, making sure it feels okay. But I don't know why we are so averse to strengthening upper traps and

I don't know if that's still something you see in the virtual space, but every time I talk to people about it in the gym, it just always seems like this. Hold on. I can't do that.

Joe Gambino (21:57)
Yeah, I think this is like, you know, all that Yonda upper cross lower cross syndrome stuff has just gotten taken so far. And now people are afraid to like, you know, load these things because they feel like it's just going to get tighter and tighter in a sense. but I agree with you. mean, like direct loading, you know, if we're kind of bleeding it down, like, you know, we talked about loving the night directly, but, I think a lot of, you know, like when you go to physical therapy, a lot of people load.

Shoulders, know like let's do a lot of shoulder stability and that will carry over to the neck But if you're not there roughly loading the upper traps the neck and you know, I think you're missing a Decent chunk of the picture. So, you know, there are definitely times where a lack of scapula position You know a movement or lack of shoulder stability can definitely bleed up and cause things to get tight up You know upper trap and maybe even into your neck, you know There are is that relationship where the joints, know, if there's one joint that's being affected

It can bleed to the joint above it or below it. So, I mean, you can't like you should definitely screen the shoulder and stuff like that. But I think just like, you know, it's overdone in a sense. And I think that the neck is just usually often overlooked for most in most cases, at least in my experience.

Joe LaVacca (23:11)
I totally agree with you. And then to your point, if you're under loading the shoulder and the scat muscles and all the other muscles, then you're never gonna get any secondary benefit to other parts of the body. So that resiliency factor comes in, people again, come in usually inherently going lighter is a big thing, right? I have this pain, so I wanna go lighter at the gym. And I'm always like, well, if you go lighter,

What does that even mean? So I don't think light is a variable, just, I mean, we talked about this last episode, we talked about this with the question of the day, intensity is something, but it's just one part. And if you're already under loading and then you're still under loading, and we got to shake something up.

Joe Gambino (24:05)
I love that. mean, it's, I feel like everyone falls out. no one's in like the happy is like rare to find people in the happy medium. It's not like they, they underload it or they overload it too much. And then both of them can cause problems, right? Like we need to find somewhere in that center and, to, to, to, you know, get your body to be happy with load and things like that. So it's fine in that, that medium of, you know, definitely challenge it. I think we taught last episode about like, you know, sometimes you need to anchor it and kind of push it a little bit to know how much.

You can load it. So I think it's it's interesting in that respect. But I am curious, you know, what are your thoughts on like when people have like pinching sensations and things like that in their neck and how deep do you look into that when it comes into like getting them better and their symptoms overall?

Joe LaVacca (24:57)
Yeah, I think, again, with the neck, the closing angle stuff, if you're watching on YouTube, this will be easy to visualize. But if you're listening, I'll try to walk us through it. If we just look up or down, it doesn't matter, but we'll start looking up. All right, if you're looking up, the front side of your neck is opening, the back side of your neck is closing. And

The typical thought is if we're experiencing sensation on the opening side, that's kind what we want. Tissues are elongating, receptors are picking up changes in tension. These are all good. If we're not able to find that opening side sensation or instead we're met with a pinch, then the maybe thought is that we're not moving effectively at the joint itself, and that's creating this block.

I think because necks typically get so sensitive, there is always a lot of closing angle pain. But then when I go and look at them passively, their range of motion does get a lot better. And I'll always see that with extension and I'll see that with rotation. So people start looking up, they get this pinch, I lay them on the table, I have them sort of just like guide their head backwards, and they usually get a lot more motion.

Same thing with rotation. People turn right or left, right, they feel this pinch. I lay them down on the table, turn right, and a lot of times that pinch goes away and their range of motion really improves. So for me, I think it's probably more typical that I see more of this soft tissue or nerve sensitivity in and around the neck, more so than a lot of joint mobility issues. But it could also be that

Maybe my assessment strategies are not of that of like a chiropractor where I'm going into each intersegmental space to try to find one specific limitation or thing that doesn't seem like it's moving well to perform a thrust. I used to push people into thrust manipulations. I stopped. I know that's not an option for you now going virtually. So when you are trying to whittle this down virtually,

Are you taking people through different range of motions and positions? Are you having them use things like towels, props, a partner to help move their neck just to give you more information? Because I would imagine virtually there has to be some other roads that you guys have to go down to determine is this joint, is this not.

Joe Gambino (27:36)
Yeah, for me, it's, you know, I definitely changed positions when I'm assessing somebody. So what happens when they're standing versus laying down and things like that. what happens if we add an isometric to it? So if we do a muscle contraction, does that clear it up? You know, things like that. and then if they do have, you know, I'll ask if they have some towels or bands or whatever they have around so that if we, if they do have access to those things, then we'll use them on our calls. so then we can, we can test those out, but I like that. And the reason why I brought up that question and

And you started to bring up the nerve irritation stuff. I feel like those are like the two things that always pop up that, especially for people who can like never get over the hump to like, do exercise, I stretch it and nothing ever really seems to work. They almost always do they have some sort of closing angle discomfort or some sort of nerve irritation going on. And then once you clear those two things up, all of a sudden, now when they're stretching and they're doing the strengthening, all of a sudden things start to feel a whole lot better. So I think those are like.

these clinical things that I don't know, like when people are doing it and I find even if they've done PT and like caros and like whatever in the past, there are things that just seem to get overlooked unless there's like numbness tingling and like these like major symptoms. But I feel like there are signs of like just nerves being irritated, joints being irritated, even if they're not, you know, major or like popping up with some of these like, I guess that's like the problem with orthopedic tests, right? they like, unless there's like a

clear cut, rather than not always perfect, you're not going to necessarily get the answers that you may need to come to and you need to do these other positional changes and things like that to really kind of figure out what tissue is really irritated and then how do we start to navigate those things.

Joe LaVacca (29:23)
Yeah, and totally. And I think that if you can't move one thing, the neck being really sensitive, the common referral pattern a lot of times for neck for many of us is that pain between the shoulder blades. So people end up getting a lot of treatment in between shoulder blades, on their rib cage, thoracic spine, like, okay, great. You can move the whole spine, right? I know we're talking about neck pain, but rolling your shoulders.

is a common thing I'll give to people. Just to try to get them to move a little bit more, right? Moving through rotation of their thoracic spine, keeping their head and their eyes nice and firm and stable. Hey, if you can't do cat-cow at your neck or segmentation stuff at your neck, on your back, whatever, let's start on your spine. Let's just try to get some movement going through this whole integrated unit. Because I think when people have these pains in their mid-back, pains in their arm, a lot of them end up treating

the arm or the elbow or the hand or the wrist. And I found a lot of people that come to us or come to me and they're like, well, yeah, I have this spot in my back. All right, well, then we start moving your neck a little bit. wow, that spot feels a little bit better. Hey, I have this weird pain down my hand or into my elbow and they use the one finger track. So typically when people are describing their pain,