Thinking about having rotator cuff surgery? Listen to this episode !

Open to the set of the Chad G. Authorities podcast. I'm your host Chad Carrero. And today I want to talk about rotator cuff surgery. So how many out there are considering rotator cuff surgery or your doctor or somebody's told you that you need to have rotator cuff surgery? What does that look like? What does the recovery look like? I mean, because there's a lot of things that may not get covered. You may not find out about until after the fact and it's like, oh, wait a minute. There's some things here. I didn't realize that we're going to have to. We're going to happen. So I think just starting back with it, there's different types of rotator cuff repair. And the most common now for medium into small tears is an orthoscopic repair where they go in there, you know, make usually four portal holes, you know, orthoscopic holes. I have seen some physicians make a fifth hole. It just depends on technique and kind of what they have going on with that, how they want to do it. But they make these holes for medium to small tears. And when you're talking about like for large tears, those are done with what's going to a large over repair. There's a big incision that's made and they have to cut through more of the tissue. And so obviously, aside from just being a larger tear, then that also the recovered from that is a little more in depth because there was more tissue that had to, you know, kind of grossly be cut through. And so anyway, so regardless of which one you have afterwards, this is going to be completely physician preference. Some doctors will immobilize you. You're going to have a splint or a sling rather. You're going to have this arm sling on with a pad that keeps your arm propped out to the side that's called an halveductor pad. And that takes pressure off of the cuff repair itself. And so you're going to, you're going to be wearing that, you know, regardless. And then depending on the physician, sometimes they want you in therapy as fast as the day of. I've had patients the day, like they had surgery that day, that evening. We were having them move them around and do range of motion stuff for them and things like that. And, but then others are going to be more, you know, one to three days after surgery. They're going to want you to start therapy. And then you're going to also have some that are going to say, you know what, we're going to wait five to six weeks. If it was a really difficult repair, if the tissue quality was poor, then they're going to wait a little longer because the physician wants the rotator cuff to scar down. You know, that scar tissue to form because it's kind of like forming a glue or a weld, you know, and it was metal would be like a weld to try to hold this together and then at the same time, therapists, of course, we want you to have that appropriate scar because that's important for, you know, the integrity of the repair. But we also want you to be able to have mobility. And so mobility equals function. So if we don't have the ability to raise our arm up and put our hand behind our head and things like that or back behind our back or whatever, then we're going to lose some functional use of that extremity. And so, you know, it's kind of like a balance. You have to find that balance of which way is the best way to go as far as, you know, how aggressive you are and all of that. And again, the physician is going to dictate that initially as to what can be done and what can be done. And then at my clinic, I follow protocols, so post surgical protocols. I have my own protocols that I've developed. I also use protocols that I got from Dr. Mike Ronhold, Kevin Wilkes and folks with that have developed some. So I use their protocols. I also will use the physicians protocols. If the physician sends their protocol, then obviously that's going to supersede all the other protocols. And what I typically will do is if unless a physician is just wanting me to be really aggressive, this is a difficult repair or a large open repair, then I'm going to err on the side of a little more caution because knock on wood. I've not had a single surgery mess up, including schooling, gave or take 19 years and some change. So I prefer not to, you know, have that happen now. So I like to go a little conservative with that. And so we're going to go by those protocols and usually what you're going to be looking at right afterwards. There's big bandage stuff all on there that can be changed out depending on the doctor. So within three days you can change that out. You can't soak it in the bathtub, which is going to bring me to something super important that you really need to do is when you go to shower, right? You're going to want to get one of these slings like a mesh sling. You can get them on like, you know, Amazon's got them on your walmart.com wherever you want to get them. I think I have more for about 10 bucks. I did a video on one. I don't know if it's on my Instagram or where it may be on my website, the Chagy OrthoT, or Chagy OrthoT.com. You can go there and go under, I think it's shoulder videos or something like that. You can find, you should be a video on it. But you're definitely going to want to have one of those because when you get in the shower, you know, how are you going to let your arm? It's very difficult to hold your arm plus bait, plus bait yourself. And so unless you have someone to help you and then even then a lot of people just want to do it themselves. And so it's really, I think best if you use one of these slings because it's at least better than nothing. You can put your arm in a sling. It also helps to kind of give that extra support. So you're not having to hold it just with the other arm so much. And so one of those I advise you to get, the other thing is going to be, you're going to be sleeping in a recliner. So if you don't have a recliner, you just have a regular chair of some sort, couch whenever you get that prepared with some pillows and all that to sleep in that for a little while, you're going to be sleeping with this sling on, which is going to be super comfortable. And so you're going to be sleeping with a sling on in the chair for a little while before you can go to a bed. And even when you go to the bed, you're going to have to prop pillows up and all that. Or you may still be wearing the sling or parts of the sling at nighttime just to protect that because when we're asleep, we don't know where in the world our arm goes, right? Like, you know, be behind your head or behind your back or maybe in the next room. I mean, I don't even know. So it'd be very difficult to keep that from where you wouldn't wake up in the morning and your arm is killing you because somehow you've managed to put it above your head, none of the pillow or whatever. So you're going to be using the sling still for a while. Initially in therapy at my clinic and less again, unless a physician has something specific, we start off using things like electric stem for, you know, neuromussel reeducation. We may use a laser to try to speed healing up. We're going to do passive range of motion. We just let you lie there and we take your arm and move it different directions. We may go ahead and start some elbow work and some hand strengthening type stuff, hand range of motion things. And then what's called pendulum exercises, you may be doing some of those pendulum exercises, scapular exercises, stuff with the scapular muscles on the back and the neck may have you start doing some of those. And then also something that's really important makes me think about when I talk about the hand is own your sling that you're going to have. You're going to have a ball on the end of it. Most all of them have a ball, which is kind of funny because a year ago, I had a lady that I don't know after about a week, I said, you're squeezing the ball right on there that you've been, that you were given. She's like, what ball? I'm like, well, there's big red ball at the end of your, like the end of your sling right here. And she's like, oh my gosh, I wondered what that was for. I thought that was to prop my hand on it. So you're going to actually use that ball to squeeze. You just, even if you just squeeze your hand right now, and you had something in your hand, you squeeze your hand out, you work your fingers in and out, you can feel even like in the arm going up in the shoulder, you could just feel activation of just muscles. Even if you're not really using them, it's just, there is some activity that's going on in there. So anyway, you're going to want to do that just as much as possible, just throughout the day and all that. That also will help us sweat like. And then, usually as I tell people, if you can get through the first couple of weeks, usually first two weeks or so, the toughest, just uncomfortable. You can't get the arm comfortable because it's a ball and socket joint. That's how it's put together. And so, at best, on the hemorrhoid, so the bone, the humerus bone, the bone from the elbow of the shoulder, at best, only about 30 to 35 percent of that bone is in contact with the bone of the scapula. So the glenoid fossa, what it sits in. So think about like a teacup sitting inside a solsor, it has to stay in that solsor as best as it can when it moves around too much out of that. It becomes unstable, et cetera, et cetera. So it's very difficult to keep this nice, unstable, and steel. Because you almost just can't, because the shoulders are very, very mobile. Well, it doesn't have the stability of, say, the knee joint does. You could jump off a five feet in the air or something and jump and land on your feet. And it doesn't really hurt anything, right? It doesn't really bother your knees, maybe. But if you jump the same five feet and you jumped off and try to land and do a handstand or something like that, you might tear something in your shoulder. It could hurt something pretty easily. Because the knee is not as mobile as the shoulder. The knee is a hinge joint and the shoulder is a ball and socket joint. So anyway, so that's usually what you're looking at with that initially. And then as far as how long do you need to go to therapy or how long does therapy take? With I do therapy at my clinic, I've been very fortunate over the years. And with the physicians in agreement, I will see the patient regardless of how long it's to say the insurance only allows them for 20 visits. And this patient needs 50 visits to get back to where they need to be. Then I'm going to continue to see them for those visits. And then there's no charge to the patient. Just because I feel like I need the patient to be well. I need to be where they need to be and be satisfied at the end of the day. I have to feel like if I see these folks out the grocery store or something like that, I need to feel good about it. And plus, it's reputation. Now it's very important to me to be able to do it. be the best at what I do. And so my success is my patience success, right? So, you know, so usually though, the recovery from that, it just depends. I use it to help people at minimal of like 16 weeks. High, if you're an athlete, whether you're playing sports or whether you're an industrial athlete and you're someone who goes like, you know, I'm say industrial athlete, you're doing, you know, working in, you know, factories or real yards or, you know, pipeline or all field, those kind of things that consider kind of an industrial athlete because you're having to do very, very physical things, you know, a lot of the time during the day. And so, you know, all those types of things take a little bit longer, you know, upwards in the 20 plus weeks, you know, 25, 26 weeks, something in that range. And again, that depends on several factors, you know, what the physician says, when you're good to go, we do testing on that as well. But at some point, even then we're using these therapeutic modalities, these lasers and different things, and you're trying to speed up the healing of tissue, tissue is what it is. And it's only going to heal so fast regardless of what you do to it. So, so that's just kind of what you're looking at with that. So you can plan for, as you tell people, plan for a minimum of, you know, somewhere between, you know, four, four months, you know, maybe five months, give or take somewhere in that range to be where you need to be, although I will tell you this for a lot of people, especially how the authors copy repair for small to medium tears, they do really well. So like, pretty fast. So after that initial few weeks have been uncomfortable and very difficult to deal with after that, you start doing pretty well. We have to kind of hold those people back because they don't, you know, they feel like, gosh, I could go do whatever I want to do. And so we just have to really hold those people back. So you will start feeling much better and that like you could do a lot of things. But there's a big difference in I feel pretty good. I can do everything I want to do around the house and get dressed and, you know, even leisure stuff, maybe I'm able to fish or whatever, but that's a lot different than pulling yourself up a ladder or pulling on pipe or throwing a softball or or whatever that is. So more strenuous activities. So that's just something to kind of keep in mind. So if you have any questions, you can message me through here. You can go to my website, chaggyorthoot.com, head down to the or over to the context section. You can message me there. You can also check out my Facebook page, have chaggy ortho tea, Facebook page, all of my social media links are on my website, also my business, career rehabilitation, I have a Facebook page there. So you can reach out there and with any of your questions or or comments that you have. So thanks so much for listening everyone. You guys have an awesome day. Welcome to the chaggy ortho tea podcast. I'm your host, Chad Guerrero. I'm an orthopedic occupational therapist, strength and conditioning coach, sports trainer, and I hold over 40 special certifications in manual therapy orthopedics and sports medicine. On this podcast, we will discuss everything orthopedic therapy sports medicine and more. If you're a therapist, health and fitness professional or someone just want to learn more about the orthopedic and sports medicine world, then this is a podcast for you. Let's get started. Before we get started, I want to let you know that if you have an interesting case for topic that you want me to discuss, head over to my website, chaggyorthoot, go down to the contact me section, fill out that form and let me know what you have going on or what topic that you want me to talk about on an upcoming episode. Thanks so much. Welcome to the episode the chaggy ortho tea podcast. And today we're going to talk about rotator cuff surgery. So you know, how many of you out there thinking about having rotator cuff surgery or you've been recommended to have rotator cuff surgery. And you just don't really know, you know, kind of what you're you're looking at. What does this whole process look like? How long are you going to be down and not able to, you know, do the things that you want to do? And so I'm going to go over that with you today. So a little background of rotator cuff repair is they basically what they go in and do. And again, this depends on physician and it depends on, you know, what their particular technique they like to use is going to be they're going to go in and repair this tendon or ten dunes, depending on which of the four rotator cuff muscles because they have four of those muscles, which one of those four muscles have damage and need repair. And they can do this one of two ways for large tears. Then they're going to make a full incision. So a longer incision single incision usually. And so that takes a little more to recover from and that's something that, you know, it's it's a little bit about yet to be a little more careful in some aspects. When you're going through the rehab program. But and then the other is going to be orthoscopic repair. And that's where they make these little holes using, you know, four portal holes, you know, give or tag depending on physician that they make to go in there and repair this through these small holes. So those are four small and medium tears. And so whenever you you're going to go in, you know, prior to having surgery, I would advise this. And I recommended this on several other videos and things that I've done. Number one, you're not going to be sleeping in a bed. Okay, you're going to be sleeping in a recliner if you have a recliner or a couch that has a recliner or on the couch or in a, you know, a big chair in the living room, something like that. With your your sling on and your sling is going to consist of, you know, this traditional like a sling, you see go around the, you know, around your neck and all that. And it's going to be a pad between your, your side and your stomach and where your forearm is. And that's called a nap doctor pad. So those pads are put on there to kind of bring the arm out. It takes pressure off of the repair and it kind of allows things to heal without this excessive tension being on it. So you're going to be sleeping in that position, you know, kind of a recline position with that sling on. And so you don't, don't even plan to go back to your bed for a little while. You're going to be in this, you know, it depends on the person how you feel. Some people go back fairly soon to the bed, but a lot of people are like, I'm slipping this recliner for a couple of weeks sometimes. Again, just depending on just how things are going and what your pain tolerance is and all that. And even when you go to the bed, you're still going to be in this sling for a while. And then when you come out of this sling, you're going to go to, you're going to want to prop pillows up. So that's like, you know, on your back, prop and pillows up so that your arm doesn't drop back behind you, this kind of thing. So you're going to want to make sure that you've got some sort of sleeping arrangement, you know, kind of set up, you know, when you come home after after surgery. And then the next thing is going to be you're not going to be able to bathe in most cases for around three days. It depends on, again, physician and, you know, how they feel about it. But you're not in and when I say, when you do go to bathing, it's it's going to be a shower. It's not going to be, you know, lying in the, you know, resting in the bathtub, something like that really submerging the incision site. So it's going to be something more shower related or sponge bath type thing. Something that I recommend and I did a video on this and have a video. I think it's in the shoulder video section on my website, chaggorthot.com. And it is a sling. You can get them online, you have different places. Just a mesh arm sling, you know, nothing fancy about 10 bucks. And a lot of them you can get wet. And so you're going to want to swap out from your your post surgical sling with this bracing pad and all on it. And then go to maybe using this sling while you shower because it's going to be very difficult for you to hold your arm, you know, cradle your arm and then try to bathe. And so you're going to need help. You may need help either way, but at least if you have this sling, you can put that one on, shower with it, and then afterwards hang it up, let it dry whatever. And so that's a really good idea that you could do just to help with the bathing process because that can be a whole nother tricky situation. And then of course things like I always recommend people wear shirts that that button that makes, you know, things easier as far as putting those putting shirts on. You're going to make sure you have something that buttons, you know, up and also that makes that easier. And as far as pants or shorts, something that has elastic, drawstring, knot buttons and snaps and stuff like that because that just obviously makes that more difficult. And then some sort of footwear that's easy to get off and on. And be careful, don't fall, you know, but something that's easy to slip off and on for a little bit. I always also recommend to people make sure you have an ice pack, you know, some physicians, not a lot for the shoulder, but they may, they may send you home from the hospital, some sort of ice machine, polar ice machine or whatever company or brand it is. That's more common for the knee. And so for the shoulder, I would recommend like make sure you have a couple of ice packs in your freezer because you're going to want to keep these ice packs on to help with swelling and pain. Now here's the trick with the ice pack. You're going to want to put the ice pack in a plastic bag. Don't use paper. Actually it's a money ask if they can use paper. I don't think that's a good idea. But put it in a plastic bag with a damp, you know, like a dish towel or a small hand towel, get it wet, ring it out. You could put that on the ice pack, put it in the plastic bag so that the the wet towel would be facing downwards. So the towel would be between the ice pack and your skin. And of course the bag keeps your skin and everything from getting wet because again we don't want to saturate these incision sites with water. And so the moisture helps the ice as far as the deeper in the body, you know, it helps. to transfer that cold a little deeper in the body. So it's like an osmotic effect. And so that makes it really easy. Plus it doesn't get your clothing wet, your furniture wet, all this kind of stuff. And you leave the eye foam for maybe 20 minutes at a time. You have to monitor the skin a little bit with that. Kind of be careful because if you have nerve blocks and things like that, you might not necessarily feel the skin. So you don't want to get crazy with it and end up giving yourself a frostbite of the skin from leaving it on too long. So you're going to want to have the ice pack or ice packs together. If you don't have several ice packs, you can make them pretty easily. I come across this bag as it years ago. You can take just water and put it in a ziplot bag. And then you can either mix rubbing alcohol or dish washing liquid. Now as far as how much, I don't have an exact two parts of this and one that I don't exactly know. But you can mix it up a little bit there, shake it up really good. Put it in your freezer. It will not freeze solid. It makes like kind of a mushy ice pack that you would buy at the store somewhere. If you don't have access to be able to get some ice packs, but you do have access to rubbing alcohol, ziplot bags, and dish washing liquid that works really well. So you're going to use either-- you either use a dishwasher liquid or the rubbing alcohol to need their work kind of a thing. And let's just want to use both. I mean, I guess you could do that too. So the end afterwards, you've had surgery, then you're going to come home. How soon you start therapy? And really, what does that look like? And so I'm going to speak for my clinic and myself, what I've done over the last year, we're taking, including, schoolwork, 19, almost 20 years. And so basically, depending on the physician, you may start therapy the very next day. They may defer for like three days before you start. If you have surgery on a Friday, you may not start until Monday. It just depends on when the physician sends you. And then, of course, wherever you're going, whenever they have availability to get you in, get you started, which for us, we always try to get everybody in really quick, and especially a surgical patient that's priority. So you may use it within about three days or so. Now, some physicians will want you. And I've had this the day of surgery. So you had surgery this morning. And then I've already seen you this evening for therapy. And you say, what in the world would you possibly do? The same day. And so what we would do in that case is start things like electrical stimulation. So for neuromuscle reeducation, we may go ahead and start educating both the family and the patient. These are the things, kind of like some of the stuff I'm going over right now with you. These are the things you need to prepare for. These are the things that you need to kind of think about at home that you're going to do. These are the do's and don'ts. You're going to be careful with this, this, and this. And you can expect this, this, and this. And then we'll start things like passive range of motion. So gently moving the shoulder, the elbow, things like that. Go over any questions or concerns that you may have. And then you go home from there. Now, in some cases, especially in complicated cases or cases where the tissue quality was really poor. And so the surgeon maybe had to use extra anchors. They had a very difficult time. And a lot of times they'll send on the prescription or they'll fax this and things like that or let you even know or family member know. You know, I'd be really careful with this. This was a difficult repair. So let's go easy. And a lot of times they'll write on the prescription, you know, to tell you to wait five weeks before you go to therapy or six weeks or at that time frame. So sometimes I have people wait. And the reason that they're waiting is because they want that scar tissue to really form. So scar tissue, there's pros and cons, a scar tissue. And I've talked about scar tissue a lot in previous videos that I've done and social media posts and things like that. So it's a fine line of like what's enough scar tissue and appropriate scar tissue formation. And then what is not good? So that's a whole separate episode. But, you know, the physician wants to preserve the integrity of the surgery site, right? And so do we, as therapists, but we're really also concerned with mobility and movement. And that doesn't mean the physician's not concerned with that. But our big thing is, is, you know, movement and mobility equals function. And so you're returned to function. You know, if you have an arm, let's say, a shoulder that is scarred really nicely, doesn't hurt, doesn't really bother you anymore. The repair is great. But you have very limited range of motion. You can't raise this arm. You can't put your hand behind your head. You can't put your hand behind your back. You can't raise your arm to the side. You can't carry and push and pull things. Well, that's not very functional in daily life. So you basically then have this appendage is there that you really use. Yes, it doesn't hurt, but you don't use it. So we would like to have it to where it doesn't hurt and maintain the integrity of the repair and then still had this return to function. So knock on wood. In my whole career, I've never had a single surgery mess up of any kind of any part of the body. So I'm very proud of that. And that's something that I use. A lot of these protocols and all experience to kind of gauge what I need to be doing. And so, and that's the next thing is, you know, we use a protocol. So at my clinic, I have protocols that I've developed. I have protocols that use that other clinicians that develop, other physicians have developed. And then of course, if the patient comes with a protocol or we know this physician and we know what they like and how they like things to be done, then we go by their protocols on things. And that kind of supersedes everything else. So the physician, the referring physicians protocol would supersede anything else in most cases. You know, now unless they're just very, very lax or like I get to do whatever, I'm probably going to be a little more cautious and I may use one of my protocols or one of, you know, one of the clinicians that I trust and follow, you know, and follow their work. I might would use one of theirs to go a little bit on the side of caution. So we use those and we know like week by week, what's safe to do, what movements should be safe to do, what movements are still difficult, you know, those types of things and where we should be at range of motion wise, you know, how much movement you should have in mobility. So that's it, you know, we just kind of keep track of that that way and in measure periodically. And so, in how long it's a recovery with that, well, this all depends on, you know, how many of the four tendons repaired, how good of quality was the repair, was it a large repair or was it as small or, you know, a medium-sized repair and then also things like, did they have to do anything with the bicep tendon because that's a whole, you know, another component to that is, you know, the long-hand bicep tendon sometimes has issues, did they have to do a labor repair because the labor, which is a collection of fabric cartilage within, in and around the shoulder joint, did they have to do something with the labrum? You know, there's several things here, you know, did they do a bersectomy, did they take the bursus sack, bursus sack out, did they do shave the underside, the acromion process, that kind of bony spot out on the side of the shoulder there on the top. You know, so those are all some things that kind of factor in to the whole process of how we would kind of go about things and what speed and then, you know, where we're at with our progression. So those are all things to be considered. By the therapist and then, how long does it take? I usually tell people this, for much rotator cuff repairs, you can plan on, I mean, the very minimal 12 weeks and I mean, that's being pretty, that's being pretty pushing it, I think. I like to see something in the 14 to 18 week range and then if you're an athlete or you're an industrial athlete and an industrial athlete would be like someone who works, you know, maybe works in a meal or a factory or pipeline or or rex, you know, in logging industry, those types of things that we consider an industrial athlete where you used to have a very physically demanding job that requires a lot of muscle stamina, muscle strength and all those types of things. So those things go into factor and then if the patient has the ability to be off work for longer or they can work their schedule out or they can still come to therapy, maybe they go back on light duty and then eventually they go full fledged. And so, you know, in those cases, you're looking at some around the 24, 26 week range give or take. And this also would depend on other things. Like I said, if you had a very limited time frame where you had to get back to work or you're an athlete, you know, you're a collegiate athlete or you know, a high school athlete, a professional athlete, you know, there's deadlines that have to be met. So some of those things that may have to try to, you try to squeeze in as much as you can and try not to cut any cords, but squeeze in as much as you can and push the limits that are to try to get back to, you know, what you have to do, especially if your livelihood depends on it. You know, so anyway, so that's kind of what you're looking at. In most cases, this is a very, it's relatively, I don't wanna say simple 'cause it's still not simple, it's complex. But this is a much better surgery than it was when I started, you know, with my career in therapy. The physicians have gotten much better with technique. The recovery is better. Thank goodness most of them will want them in therapy as soon as possible so that we can start things like range of motion and education and the use of modalities and all these types of things. So all of that stuff really speeds this process up so that you have a lot more comfort with it. You don't have as much pain. And I always tell people to, like, if you can make it the first two weeks, like if you can get through the first two weeks, sleep in your recliner, not really able to get comfortable sometimes, you know, all that, then after that you've kind of got things, kind of whoops, so to speak. I mean, you know, it's really you start to get to a point where you can do more, or you feel like you can do more faster than you actually are as far as your recovery. like I had people like I'm literally holding back the reins like you can't go do this yet You're not ready. They're like but Chad. I feel great like no, I thought you'll do this this niss I'm like yeah, I still want to be a little careful with that because again Regardless of how much you're loading the tissue and exercises and in lasering and ultrasounds and all these other things that you're doing Regardless of how much of that you're doing still tissue is what tissue is and it's only going to heal so fast At least for now with technology. I mean you can try to enhance that and speed that up. They're you know Different again different modalities the stuff that you can use But you know, you don't want to fool around and you spent you know three months or four months and all of a sudden You're like I'm ready to go you know sling sledgehammers or I'm ready to go you know split wood or whatever that is And you end up retiring this and now you've kind of got you know even more of a situation on your hands So you don't want to have to repeat that so But that's in in a nutshell that's basically what you're looking at with a rotator cuff repair Again, I've treated. I don't know what that number would be At this point, but a whole bunch of people with various types of rotator cuff repairs And I've been able to have been fortunate to have you know some of the really Some of the greatest shoulder and elbow surgeons patients probably in the world You know some of their patients which has been really really incredible throughout my career to see how that you know how that is when and So anyway if you have any questions related to rotator cuff surgery rotator cuff recovery rotator cuff therapy Anything You can go to my website chaggorthot.com you can go on the contact me section there Feel that out send me a message You can also All my social media links are on there so you can find like all my Instagram all that stuff you can follow me Instagram I'm pretty active on Instagram and Facebook not as much on Twitter. I put out a lot of TikTok videos I think total I have around 300 something videos For education both for you know a clinician and then a lot of stuff just for General folks maybe the Arn in healthcare that um, you know just have some questions and want to check a few things out at home You know, I'm a big fan of You know, you google your symptoms look it up. See what you have you know, maybe going on get a rough idea And then maybe don't necessarily treat yourself I'm not seeing treat yourself But you know get get a rough idea so that when you go in and you talk to your doctor your therapist or whoever you know depending on whatever the um, you know place that you're at or country or in or how that process works for you At least then you have an idea of kind of the you know, what you might have going on or what direction you want to go so Thanks so much for listening guys. I appreciate You guys so much. I appreciate all the support and uh just uh keep listening and you guys have an awesome day. Thanks so much This podcast is brought to you by Correo rehabilitation set in the bar for rehabilitation and sports medicine care