♪ Bob and Brad ♪
♪ The two most famous physical therapists ♪
♪ On the internet ♪
- Hello, I'm Sara Meeks, Physical Therapist.
And today, we're going to demonstrate an exercise
called the arm lengtheners.
So I have my husband, John, on the table here.
And I wanna explain to you
a little bit about the positioning
and what we're going to do before we start the exercises.
Now, the first thing you notice
that John is lying in the decompression exercise position.
And I have the table raised to raise his legs
so that his knees and his hips are bent,
and that is done to relieve the pull
of the muscles of the legs on the spine.
Because I'm always looking to get the spine in neutral.
The other thing that you notice is that his arms
are turned up and that we have towels underneath his arms.
The reason for that is, that the shoulders
are generally higher than the elbows.
And also if I don't support the arms, some people,
because these muscles are also connected up to the neck,
people may have neck pain.
So by raising the arms slightly,
we eliminate that possibility.
He also has a small folded towel underneath his head,
because he does tend to have a forward head posture.
And I want to have him
in a relaxed position for the exercises.
So we're getting ready now to take him
through the exercises of the arm lengtheners.
So we're going to start with his right arm.
His right arm is his more flexible arm,
which is very common in my patient population,
because most of my people are right-handed.
And so they have more flexibility.
And sometimes it's more restricted in the other side.
So the first thing I'm going to do is ask John
to bring his arm with his palm down, close to his body.
And I'm going to take away the towel.
Then John, so what I'd like you to do now
is to keep your elbow as straight as you possibly can
and bring your arm up in the air, close to your body,
coming down toward the table.
And his arm comes pretty close.
Well, that's really touching the table.
So he's got full range of motion of this shoulder.
Now, the idea that I have is a lot of people
have pain in their shoulder and I want to eliminate
the pain or at least reduce the pain.
So I start with this exercise
by having people raise the ribs
and also the shoulder blades,
which takes some of the stress off the shoulder.
We'll still get lengthening of the shoulder,
but without the pain.
We also want the elbow to remain straight
and the fingers long
so that we get the movement isolated
as much as possible into the shoulder itself.
And I also have people do the exercise
and coordination with the breath.
So I'm going to ask John to take a breath in
and then do the movement on the breath out.
So John, are you ready to go?
Yup, okay.
So what I want you to do when I give you the signal
to do the breath, is you're gonna begin to move
from the ribs down here and the shoulder blades
all the way out to the tips of your fingers, okay.
Are you ready for that?
The idea here is there's a muscle
between the ribs and the pelvis.
It's called the quadratus lumborum.
That frequently is very tight in people
and this will create a stretch
at least on the upper part of that muscle, okay.
So take a breath in.
(breathes heavily)
And as you breathe out, lengthen this arm
out through your fingertips and have the movement start
from way down there
and come way out to the tips of your fingers.
And then relax, take another breath in
and on the breath out, lengthen again,
lengthen, hold and relax.
Now, in addition to this, what I will do once someone learns
to do that, is to drop the fingers down toward the floor.
So we get a stretch in the forearm here,
and that's the next direction I get is when
he lengthens the arm, he's going to lengthen out
through what is called the heel of the hand
or at least that's what I call it, the heel of the hand.
So let's see how you can do that too.
Take a breath in
(breathes heavily)
on the breath out.
No stretch comes from here. Pull on the ribs,
pull on the shoulder blades all the way out
to the heel of the hand.
And usually people will say, "Oh, they're getting a stretch
right here in the forearm."
So let your arm relax a little bit.
And now you're gonna keep the elbow straight
as you come back down onto the table
Turn your Palm up, out to the side
and to bring the shoulder back into neutral position,
I'll usually slide my hand underneath
for this acromion process here
and just press your shoulder a little bit down
toward the table,
so your arm comes back to neutral.
Okay. So that's what we're doing with his right arm,
where he has pretty good range of motion there.
So now, John, I'm gonna have you take your left arm
and place it close to your body with your palm down.
Okay. I'm gonna take the towel away again.
Okay. All right.
So you're going to take a breath in
as you breathe out, once again, elbow stays straight
lift the arm up and bring it down toward the table.
Keep your palm facing the ceiling
as we come back and then keep going down
as far as you can toward the table.
You can see that he has limitation in this shoulder
and he will try to compensate by bending his elbow,
because everybody's trying to get their fingertips
to wherever they are.
Of course his hand is out in the right area,
he's not gonna be able to do that.
So anyway, once again, you wanna begin your movement
from your ribs down here and your shoulder blades.
And then imagine a plumb line going right straight
through your arm and out your fingertips.
Are you ready to do this?
Okay. Take a breath in as you breathe out,
lengthen all the way out from here, all the way out
to the tips of your fingers, hold briefly and then relax.
And let's do that one more time breathing in
(breathes heavily)
and then out with a movement
(breathes heavily)
and relax. Now to gain a little bit more motion here.
What I do is, I basically try to target the muscles
that are going to bring his arm into more,
it's called shoulder flexion, this position.
So I'm gonna place my hand underneath his arm
just above his elbow.
And I'm gonna stabilize him down here on the shoulder blade.
And John, you feel my hand there?
Okay. So I want you to take a breath in
and I'm going to try to bring your arm up.
You press your arm down.
Okay. All right.
Breath in
(breathes heavily)
and press one,
two,
three,
four,
five, and relax.
(breathes heavily)
Take another breath in
(breathes heavily)
and on the breath out, press down
press two,
three,
four,
five,
and relax.
Okay. Now take another breath.
I'm not going to give you the press now.
I want you to see if you can take a breath
and lengthen the arm one more time.
Okay. And then relax and see if you can press your arm
a little closer to the table.
Yeah, he has a little bit more motion.
He may have, but he's not grimacing or anything.
So it doesn't look like he has much pain if he has any.
Okay. Now you're gonna bring your arm down
keeping the elbow straight.
So you're moving through the shoulder.
Turn your palm up.
Slide it out to the side.
I've placed my hand here underneath your shoulder.
I want you to take a breath in and press your shoulder down
toward the table.
Press, hold, and relax.
Now, roll this right arm out just a little bit more
that hand. I'm gonna place both hands here.
Take a breath in and press both shoulders down.
This creates some of a stretch across the chest.
And then lengthen out both arms in this position
from the shoulders down. And then you get just to relax
for a little while and let your body integrate this motion.
So we just demonstrated during the arm lengthener
one arm at a time.
And I usually let the person
that I'm working with, choose which arm to use.
They'll usually pick their most flexible side first,
but I like to give them the choices of how the work is done.
With John, I picked his right arm,
because I knew it was already the more flexible one.
But generally speaking, I will ask the person
which way to do it?
And then as they'd become more proficient
at the movement and doing it correctly,
we can do both arms at the same time.
So I'm going to demonstrate that now, John.
So you wanna straighten your fingers on your left hand
and then bring both arms up at the same time.
Okay. And you're going to come back as far as you can.
And if that right arm wants to go a little further
that's okay. Straighten out your elbows
and then think about the bottom of your rib cage.
Now take a breath in and stretch both arms at the same time.
(breathing heavily)
Relax as you breathe in
(breathing heavily)
and then stretch again.
(breathing heavily)
And another variation is now, even though you have both arms
out here, stretch just... Which one do you wanna do first?
Okay. And then stretch the right arm then.
Stretch it by itself.
Breathe in as you relax and then do the left one by itself.
So that's another variation.
Keeping your elbow straight, bring your arms back up,
back down alongside your body.
Turn your palms up, out to the side a little bit.
Press your shoulders down.
And now you get to just relax and breathe.
A couple of comments I would like to make,
is I usually start this exercise with the arm turned down.
This is called internal rotation of the shoulder.
And this is the position that's the easiest to start with.
Most, everything we do in life is done with our arms
in internal rotation.
If you watch yourself move around through the day
you'd probably find that the way you put your hands
on your waist or whatever you do,
you're turning your arms in.
So what happens that I've noticed in my patient population
which is an average age, or has been in the past
of about 85, that it's difficult then
to get the external rotation of the shoulder.
So I focus on the external rotation.
And I start with that easy motion.
And in the next video I'm going to do
where I'm gonna be the model.
Okay. Then I'm going to show you
how I then will turn the arm outward just a little bit
and then into a full external rotation.
So we get all the motions of the shoulders.
The muscles that are tight here, they're very big muscles.
They're called the pectoral muscles across the chest.
You also have a big muscle called the latissimus dorsi
that runs all the way up from the pelvis up to the shoulder.
And motion of that motion is also internal rotation.
And then you have another one called the subscapularis,
which is also an internal rotator of the shoulders.
So you have a lot of muscles that are turning your arms in.
So we wanna also balance the body by turning the arms out.
So, John, I wanna say thank you
for putting up with this again,
and being a very good model today.
And thank you all for watching the video.
And this is the end of the exercises
called the arm lengthener.
(chill music)