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Welcome to The Dr. JJ Thomas Podcast! Here I'll be talking all things physical therapy, raw and unplugged, giving you the unfiltered insights you've been searching for in your cash-based physical therapy business. If you're caught in the grind of the traditional model, swamped with paperwork, or feeling like you're not reaching your full potential as a physical therapist, this podcast was created just for you.
How putting the tissue, guys, be deliberate, be do everything with intention. Like, I didn't just stick it in the doubt because the motion told me to do doubt. I the motion told me to do delt, then I checked the range passively on the table, then I felt the tissue. And I'm like, oh, that band is not happy. Now that's moving way better.
Dr. JJ Thomas:Welcome to the doctor JJ Thomas podcast. Hey, everybody. Welcome to the doctor JJ Thomas podcast. I'm doctor JJ Thomas. I'm Jessica.
Dr. JJ Thomas:Jessica. Hi. Jessica here with me today. We Jessica's one of our therapists at Primal. But today's episode, Jessica has volunteered to be here for us because last episode, if you caught it, we did a, a talk about when I prioritize e stim in situ with needles in situ, versus, the in and out pistoning technique with dry needling.
Dr. JJ Thomas:And in that discussion, I talked about how much we at Primal value the use of the in and out technique for the test retest model, especially when we wanna diagnose a regionally interdependent area. Meaning that finding underlying root causes, movement deficits that are related to our patient's area of symptom complaint, but in a in a remote region to that. That'll make sense in a second. So so Jessica has volunteered. She's gonna we're gonna, on the fly, do a, movement assessment and see what comes up for her.
Dr. JJ Thomas:I don't know that you are symptomatic anywhere, necessarily. Where is my neck? Your neck. Okay. So, we'll look at that.
Dr. JJ Thomas:But we're just gonna look at her movement and use our movement assessment to diagnose which areas we might want to treat. And then what I really want to show you guys is how many times I might test retest within a session, so that really so that part one makes more sense to you in terms of that test, retest model. Here we go. So Jess, you're gonna face me. Here at Primal, we do a we do a variation, but we pretty much always start out with, like, SFMA top tier, screen.
Dr. JJ Thomas:And then we branch off to, kind of, our own method from there. But I like having a standardized test retest model that patients my patients, after we've done, a little bit of work, and I've test reted tested them on the table, will do a gross motor test again, and they know. Like, they know to standardize it. They have shoes off. They have feet together.
Dr. JJ Thomas:They literally standardize it. They'll go to the same exact spot on the room, because they know that I've in case there's floor variation, I don't want any variation. Like, we're scientists here. Right? We have to be able to we have to be able to reproduce the results.
Dr. JJ Thomas:So Jess already knows. I have her feet together, I have her shoes off. You're gonna relax your arms, Jess, and you're just gonna keep your teeth together. That's important to clear, any TMJ areas. So keep your teeth together and just look down as much as you can.
Dr. JJ Thomas:Great. And then look up as much as you can. Great. And then back to center, and then you're gonna look over your right. Centre and left.
Dr. JJ Thomas:Great. So just from that early on screen, her right doesn't move as well as her left. How does that feel to you, Jess? I feel that. Yeah.
Dr. JJ Thomas:Where do you feel it when you go right? Like here a little bit, like here. Okay. And now let's do this. Let's take your right arm and let's cross it over, and, like, rest it on yeah.
Dr. JJ Thomas:But hold on to the shoulder, so it's relaxed. Now look to the right. So much easier. Did that feel easier to you? Definitely.
Dr. JJ Thomas:She went further. Jess, can I just have you face the camera? So put that down, feet together again. Great. Can you still see her, Dane?
Dr. JJ Thomas:So, Jess, relax your shoulders and look to the right. That's what she has. And then come center, cross that arm over, and then it goes so much further. And you can see the ease that she goes so much further with. Right?
Dr. JJ Thomas:So this what did I do here? I shortened the anterior chain, I shortened the pecs, I, chi, through, together. She shortened the pecs and the anterior delts essentially. If you remember your anatomy, pecs and anterior delts all attach onto the clavicle on the underside of where upper trap attaches. So it's not coincidence that when I when we shorten the anterior delt and pec here, and she moves better, it's essentially taking off that anterior pull on the clavicle and allowing the upper trap to now move.
Dr. JJ Thomas:So already I know that I can affect her neck range of motion by changing this. How can I change this? By dry needling that area, and to confirm or disconfirm, I'm going to test, retest throughout that pattern. Let's do a little bit more digging though before we move on. So face me again, so I'm not in front of the camera.
Dr. JJ Thomas:Feet together, and then, relax your arms and I want you to go straight up here. Good. Back as far as you can. Good. Come back to center and keep your elbow really straight for me.
Dr. JJ Thomas:It just helps me standardize it again. So go back as far as you can. So she's definitely limited there. You can see that she's struggling to get to that end range. From there, Jess, can you touch behind to the opposite shoulder?
Dr. JJ Thomas:Yeah. And then so come back, face the camera for me. You can see how she has, like, a lot of excessive scap mobility here, so this is definitely something I'm gonna flag. Come on back and face me. Now let's go.
Dr. JJ Thomas:Feet together, you're going to go straight back, chest stays up, and then touch behind. Good. Relax for me. What I want you to do is keep the elbow high as you touch behind to the opposite shoulder. Okay.
Dr. JJ Thomas:So it's a little limited there as well, and you can see it pulling in the same spot. So now we have multiple checks for this anterior delt pec region. Right? I definitely wanna start there, then we're gonna retest and see if that flexion improves as well. So part of the assessment when we're when we were looking at her motion, you know, we're not just looking at, obviously, we're looking at how we can manipulate the neck range of motion through the arm pattern.
Dr. JJ Thomas:Right? That confirmed to me that I wanted to treat this area because her neck rotation improved as soon as we shortened this area. Right? As I'm looking at that motion, I'm also trying to develop that skill. I'm I'm saying, I guess I've already developed at this point.
Dr. JJ Thomas:As newer needlers and newer movement assessors, I would say it would be helpful for you guys to try to look at where the muscle looks like it's not moving. You can actually see if you if you very if you, distinctly, standardize the way you're testing. For instance, when I said, Jess, when you pull back, what she did the first time is she went like this, and then when she went to do this internal rotation, she let the arm just do this. And then it wasn't standardized for me. I couldn't tell the extension pattern versus the internal rotation pattern.
Dr. JJ Thomas:So my cue to her to fix that was, okay, keep the arm straight and go back as far as you can. Now keep the elbow high as you try to touch behind. And then I could see where she was tight in this pec region. So now I'm gonna try to target I'm gonna test my own theories, and I'm gonna target those areas. Because it was so different after we did pec and delt, I'm gonna choose at first to do the clavicular portion of of pec and also the anterior delt, and I'm gonna go through a couple different sequences of needling for that right away.
Dr. JJ Thomas:I got my friend Paul's iDry needles here. They're amazing. Jess, can you hold this with your opposite? Yep. Good.
Dr. JJ Thomas:So I will just have a disclaimer here. If you're not already a needler, don't decide to watch this video and think that you're gonna needle someone's pec. There are lungs under here. So she's pretty tight in this clavicular portion, but I can grab it right there. And see how, just for you guys, pay attention.
Dr. JJ Thomas:I'm using my knee to change her arm position so I can grab the tissue better. So there's a lot of little hints to what we do, as expert needlers that are are good to pick up on. So now I have her pretty good there, And I'm gonna go towards my fingers, staying away from lung field, getting that clavicular portion of the pec as it attaches on the clavicle. Just threading and pissing. And what I didn't show you guys is that redirection.
Dr. JJ Thomas:So in order to know I'm redirecting, that needle is gonna stop bending. I'll show it again in the in the delt. Good, Jess. So now we have anterior delt. Here, lift your arm up for a second.
Dr. JJ Thomas:Yeah. Relax. Just lift keep your head neutral, and just lift it up right there. So I wanna outline the anterior part of delt here, so that I avoid that cephalic vein. Good.
Dr. JJ Thomas:So I've marked it right there. I'm gonna put my finger right where that cephalic vein would be. And so I'm basically blocking that. And now I can needle into the anterior delt. So first pass there.
Dr. JJ Thomas:Now, if you're looking at this and you wanna know you're redirecting, if I wanna angle my needle that way, which is completely safe, there's a bend in my needle until I get to subcutaneous tissue, then I'm redirecting. Now if I'm going to go the other way, bend, bend, bend, bend, bend, straight, then I'm redirecting. She's got some tight tissue there. I'm gonna go ahead and treat this now. Getting some twitchies.
Dr. JJ Thomas:I'm not going in the same path, which is why my patients don't get as sore as some of these studies say, because I'm going in different paths. It's it's really only one, about one pass in one one particular path. Now I'm reassessing already after 2 needles just to feel the change. Now I need to reassess her cervical range, which is our reproducible sign, but I can already tell that I've made a change because her external rotation is better, the end feel is better. I want more though, I still feel a little bit of bogginess here at the end, so I'm gonna do a little bit more.
Dr. JJ Thomas:So that was 2 needles. We're gonna do let's do one more, and then we'll retest neck. Slide a little closer to me, Jess. Thank you. Can you see her there?
Dr. JJ Thomas:Dane, can you see? That's Dane, guys. He's the best videographer around. Shoemaker films. But he's busy, so don't try to call him.
Dr. JJ Thomas:Okay, ready? So I'm actually gonna peg on this one directly on. So palpating, that was a nice twitch right away. Palpating the tissue, guys. Be deliberate.
Dr. JJ Thomas:Be do everything with intention. Like, I didn't just stick it in the delt because the motion told me to do delt. The motion told me to do delt, then I checked the range passively on the table, then I felt the tissue. And I'm like, oh, that band is not happy. Now that's moving way better.
Dr. JJ Thomas:Definitely. Right? Mhmm. So let's see if that changed neck range. But be do everything with intention.
Dr. JJ Thomas:I always say, like, I sign my emails with intention, and that's not just a hog of shit. It's actually how I feel. We should do everything with intention. So we looked at her neck range, it was limited. We changed the neck range when we shortened the pecs in the delt.
Dr. JJ Thomas:Let's get to it. So she gets on the table, check her external rotate, check her pec stretch, she's limited in external rotation. Needle the pec, go ahead and stand up. Needle the pec and the anterior delt, but I didn't just needle it, I palpated and I spent time getting to know that tissue. And I felt where the tissue had good muscle play and didn't have good muscle play.
Dr. JJ Thomas:And I felt for those top bands, and then I targeted that, and I was sure to redirect my needle, rather than just blindly going in and making some crazy motion with my hand. I deliberately put that needle where the tissue was limited. And her range improved on the table, let's see if her neck range improved. Face me first and then Yeah. Thank you.
Dr. JJ Thomas:So feet together. Good. Relax your arms. And let's do all the neck range. So look down, and then look up.
Dr. JJ Thomas:So neck extension is better too, if you remember, come back to centre, because she was not quite at parallel in at first in neck extension. And then look to the right. So much better. It's not perfect. It's it's it's almost perfect, but it's not quite there.
Dr. JJ Thomas:So face them, feet together, and just do that look to the yeah. You can do down and up, center, and then look right. I mean, it's so much better. And it feels a lot better. So face me again, and then feet together, and let's do arm straight, and go straight up, back as far as you can.
Dr. JJ Thomas:She's still struggling there. She's better, like her arm is going up better, but I see 2 things. I see excessive scap lateral glide there, and I also see like this extra neck, like she's like, I'm gonna do this, because Jess is an achiever if you don't know her. She's like, I'm gonna get this range. And so I see her SCM trying so hard, but SCM should not be raising her shoulder.
Dr. JJ Thomas:So that's that's sort of a flag. So, we'll do one more set of needles then. Okay? So we're gonna go back on the table, and we're going to treat out, kind of what I saw with that lateral shoulder. We're going to do, basically, I'm going to palpate, but I expect to do lats and maybe teres major minor from the front, and then we'll retest.
Dr. JJ Thomas:Alright? So now we're gonna go after those regions that I told you I just found on the movement test. And just one little side note, if you wanna be refine your needling skills, you know, position is everything. Like, I just moved the table down. I got comfy in my seat.
Dr. JJ Thomas:I have her arm rested on my knee so that I have some control over how much horizontal a b a deduction her arm is in. I might decide that I don't want her in full external rotation. But, you know, one of my contractor friends and my husband say, measure twice, cut once. Like, before you go to needle, make sure you have them in the position that you want them in and the position that you're gonna be able to get the tissue you want access to the best. So I'm happy with where Jess is now.
Dr. JJ Thomas:We're gonna, we're gonna go after this, this area that I flagged on the, SFMA shoulder patterns and, see what happens. So mostly, I'm gonna go after that lat. And, like I said, I expect to maybe go up to Terry's major minor. Good. So nice tap.
Dr. JJ Thomas:So nice twitch right away. I'm angling towards my fingers. Again, if you have not been trained in this muscle, do not decide to use this video as your education series. We have live training to refine your needling skills if you're interested. Otherwise, I can also recommend a ton of certification courses, with some really great instructors.
Dr. JJ Thomas:But if you are already trained in this, feel free to look at the way that I'm palpating, the way that I'm defining the tissue, and making it really accessible for what we need. I'm pulling this lat away. And not only am I pulling it away, but I'm doing what I said before with, like, the delt. I am I am palpating for the most, market type like, for the most tight band that I can find, and it's right there. So now I'm gonna delineate the tissue again.
Dr. JJ Thomas:I'm gonna put my nice strong tap in, and I'm gonna go for that area that I feel with my fingers on the other side. And I'm moving that needle. I'm not going in the same path. I'm moving both my palpation hand within a safe zone, and I'm moving the needle in a new path each time. And I can feel this is what I was talking about in part 1 of this.
Dr. JJ Thomas:I can feel the tissue change as I needle it. I can feel the glide of that needle. You know, in a dysfunctional muscle it feels more like passing through like, a thicker cement. And in a healthy muscle, it feels nice and easy. It's like butter.
Dr. JJ Thomas:It's a, baby. I can just put that in there. So, it's really important to that feels better. It's important to refine those skills. I'm gonna do one more.
Dr. JJ Thomas:So, again, that was 2 needles. I'm gonna do a 3rd needle and then we're gonna retest. This is what I was talking about in part 1. It is so valuable to do a few needles, retest. A few needles, retest.
Dr. JJ Thomas:The patient is now gaining confidence every time because she feels every single time, wow, I'm actually moving better. Oh, my god. Maybe I'm actually gonna get better. And then she stands, and it translates into a regionally interdependent success. It's just so, so valuable.
Dr. JJ Thomas:So let's just do one more, and then we'll check, standing neck rotation again. And I'm gonna go a little lower this time. Good job. And I think that'll do it. So let's check range on this position first.
Dr. JJ Thomas:I mean, external's clean as a whistle now. Like, you can just see that that wants to go now. Whereas before, she had this guarding associated with it. And go ahead and stand up. Okay, Jess.
Dr. JJ Thomas:So relax your arms, feet together, good. Look down, and then look up. Brilliant. That feels good. So much better.
Dr. JJ Thomas:And I didn't touch your neck. This is what I'm saying. So when you're evaluating somebody and they come in for neck pain, neck discomfort, and you treat a regionally interdependent area and you prove to them that that area is related, not only are they going to have faith in you that you're that they're the days of them getting their pain chased are over, but also they're gonna be compliant both with your visits and with doing the exercises you give them because they're like, well, Jesus. This person finally knows what the heck they're talking about. I better do what they say.
Dr. JJ Thomas:Otherwise, I'm gonna be in pain for the rest of my life. So, they can feel it. This is this is exactly what I wanted to show you guys. So let's check neck rotation. It's Now it's perfect.
Dr. JJ Thomas:So face the camera, Jess, feet together, relax your arms, and then look right. It's like, it's virtually perfect. So now I will say, the other thing that I mentioned in the part 1 of this podcast is that sometimes when people needle the wrong area, they they needle a symptom versus a cause, there will be excessive muscle soreness. I think this is also something that happens often with newer needlers, and it's part of that You're good? You should come on the podcast.
Dr. JJ Thomas:Come on. Come say hello. Come on. You want to come say hello? No, I'm just kidding.
Dr. JJ Thomas:You come another day though, that'll be fun. Alright, see you. What was I saying? Excessive soreness. Oh.
Dr. JJ Thomas:When you treat a symptom versus a cause, that muscle is angry, that muscle is trying to tell you tell you that you treated the wrong thing. So oftentimes, newer needlers, and and I believe part of why the studies show, excessive muscle soreness sometimes with the In N Out technique has more to do with the areas that are getting needled. We have to do a better job of identifying the root cause, and when we treat that there won't be as much muscle soreness. Right? And you probably have some soreness in the muscles we needled.
Dr. JJ Thomas:A bit, but it's not bad. Yeah. And it'll come on in like an hour or so, like it'll start but again, once you get really good with your needle refinement, and I I didn't piston a ton, it's like a little bit, not going through the same path multiple times, the the overall tissue disruption is much less, and the range of motion gains right away are are noticeable. So that's really how it's done, you guys. This is literally how we teach our trinatal master classes and the functional model, the regionally interdependent model of how we treat a primal physical therapy is what our primal foundations courses are about too.
Dr. JJ Thomas:So if you really, if you like this and you wanna know more about it, check us out on our website, primalhq.com. You can sign up on that website to be part of our email list, where we have all our events posted, and I actually give a lot of clinical information on there as well. Pretty soon, I'm gonna be announcing a mentorship program, where it'll be 1 on 1 attention, with me as your instructor, and so I'm really looking forward to that too. So, lots of good stuff coming. I hope you enjoyed this.
Dr. JJ Thomas:Feel free to DM me as always if you have any questions, and I look forward to next time. Thanks, Jess. Thank you. Have good one.