♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
(quirky upbeat music)
- Hi folks, I'm Bob Schrupp, Physical Therapist.
- Brad Heineck, Physical Therapist.
- And together, we are the most
famous physical therapists on the internet!
- In our opinion, of course, Bob.
Don't forget Sam, he's with us today.
- And his jaw is dropping. - Nah, don't worry about it.
He'll be fine. - All right, Brad.
What are we gonna talk about? - Oh, shoulder.
Now, this is a very interesting
demonstration and education on shoulder impingement,
how to test for it, how we test for it as therapists,
and you can do this at home, these three tests
do take a little practice, so.
- And, shoulder impingement is very common.
- It is, as a matter of fact, Doctor...
- Kirsch. - Kirsch.
Doctor, M. Kirsch, it's Mark, right?
- No, I don't think so, but, John.
- Doctor, oh, I'm sorry, I don't where that,
anyways, he wrote a book on this.
He's a expert in the field, Orthopedic Surgeon
on shoulders. - Yeah.
- And he feels that 70% of shoulder problem pain
is from impingement, assuming you didn't--
- I've seen some studies that show less.
- Right. - But a wide range, you know?
- Yeah, it's still majority. - Yes, exactly.
- Everyone agrees with that, so what we want talk about is
these three tests, but first let's clear
up what is impingement, Bob? - Before that even.
Let's just say we're gonna have--
- [Both] The giveaway!
- And, what is this now?
- That is the--
- X6? - T6?
- T6. (chuckling)
- X6 Massage Gun. - I was right.
- Yeah.
- So, this is the X6 Massage Gun, we'll show it at the end.
- Right, there's a nice technique for shoulder impingement.
- Yeah. - You can do with this.
- What about, Brad, they comment,
go to the giveaway section, and you can sign up
for the giveaway? - Yeah.
- It's the power wand. - It's a nice one.
- It's a hefty duty goose. - Hefty duty goose.
- Okay, here we go, let's look at Sam
and look at the impingement, so,
when we talk about impingement, it happens right here.
The supraspinatus tendon, which on this side,
we have it in pink and what happens is,
is when you lift up your arm, if you look right there,
you got the point, oh, we got the pointer,
right there, ouch, pinch, and that's no good
because what's happening is the rotator cuff
is not doing what it's supposed to and it's not dropping,
and opening that gap up which I can't do with this model.
But there's also a bursa in there, that can get pinched.
So you got a couple main structures.
- The tendon, the bursa. - Yeah.
- The bone also could be translated a little bit forward.
- Right, the humerus bone. - Right.
- And sometimes the subacromial, this bone here,
can be shaped a little weird or have some--
- Right, have a hook on it. - Yup, exactly.
So, all those things are part of it.
Thank you, Sam, we'll need you no more.
- Can't even respond because he has no jaw.
(chuckling)
- We'll take care of that later--
- We'll take care of that. - All right.
So, let's go to the tests, there's three tests,
very common, therapists use 'em,
doctors use 'em, I just had these done,
when I had my shoulder looked at, that's another story,
but we're gonna do 'em in seated position and
have a seat, Bob. - I will do that.
- I'm gonna test his left shoulder.
Okay. - Right shoulder.
- Right shoulder, that one, too.
(chuckling)
Now the tests are, there's one called The Neer
which you bring up the arm like this.
It makes a pinch in there. - Bring it near to your ear.
- Yep, next one is The Hawkins Kennedy
where your arm is like this and we do a motion like this,
and the next one is The Neer, or The Crossover
where your arm crosses over. - Right.
- You cannot do these to yourself.
Someone else has to do 'em to you to do it,
good proper, information, so the first thing, as the tester,
the therapist, there's some things you must do.
And I just took a continuing ed on this
and this is the latest information,
is stabilize the scapula, okay, so I'm gonna do that--
- The shoulder blade. - Yep, right here.
Stabilize this, I'm gonna do this by putting some pressure
down here and I'm gonna hold here,
and I'm gonna hold here when I can.
- All he's doing is basically leaning on it.
- Yep, so if I'm standing, the person getting tested
is seated, it puts me in a good position
to do what I need to do, we're gonna do The Neer first,
and we're looking for an impingement there.
Arm goes straight--
- Now, the key is to actually take the thumb
and turn it down. - Right.
And I'm gonna give a little overpressure with that.
Not a lot. - So, he's turning it in.
- Now, Bob, I would like you to relax with this.
I'm gonna stabilize here, internal rotation, Bob, relax.
I'm gonna go to the end range
where it doesn't wanna go anymore
and just put a little overpressure.
Now I've worked with enough people
where when you get up into here,
if it's positive, the person says, "Ouch."
- Right. - I don't like that.
- Might even be on the way up. - Exactly.
And the pain right here is where you wanna feel it.
- Right, it recreates your pain.
- Yeah, if they do, and they say it hurts back in here,
it's not a positive test, it has to hurt
with the motion, and hurt here to be positive.
- Right. - Okay.
Now number two, the second one,
we're gonna go into The Hawkins Kennedy which is this one.
Okay, yep, so I'm gonna again, support here.
Bring the arm out and now we're gonna do it
in two positions, this is called scaption.
Not straight out, but it's slightly forward.
And then, we're gonna do it straight in front.
Okay, so first one's first, 90 degree bend in the elbow.
We're gonna internally rotate here
and you don't have to do a lot, just, you know, comfortable.
And now, I like to maintain here,
and put my hand here, and rotate here.
I go to end range, push a little more.
And oftentimes, the person's eyes open up
when you get up out here. - Right.
- And you say, "Ah," and then, you don't push anymore,
be nice, but you do it here and then
straight in front, and same thing.
- That one I feel a little bit.
- You feel that a little bit? - Yeah, a little bit.
- Yeah so, here we've got a semi-positive one
and the other one was negative.
And I'll mark 'em that way like, eh, semi positive
or partially positive. - So, so.
- Yep, and then the last one is The Crossover.
I'm gonna stabilize here and I forgot to mention,
they do need to be in reasonably good posture.
Not all slouched over, okay, so The Crossover again,
out like this internal rotation--
- Turning the muscle, thumb pointing down.
- Yep, this one I stabilize here
and we're gonna go all the way over.
So, I'm crossing Bob's, his elbow goes right
to the opposite shoulder and a little pressure there.
How are you doing Bob? - Good.
So, that was negative. - Yeah, that was negative.
- All right, so those are the three tests.
Now, if they're all positive, it's clearly ouch,
it hurts on all of 'em, it hurts right there.
All positive, does that mean you got shoulder impingement?
- [Both] Not a hundred percent.
- Yeah. - It's a good indication.
It's pretty strong, particularly, if you're a therapist
or doctor, you've done it for years
and you know symptoms. - Right.
- And you talked and what not. - Right.
- However, if they're all negative, no pain with all those
and they're done reasonably correct,
there's a really good chance, you don't have impingement.
That's just how the statistics lay out.
So, that's interesting. - Yes, it is.
- So, there's a treatment we talked about, you know,
if you happen have a massage gun
and you use the one with the ball head
'cause there's lots of heads on these.
Typically, they'll come with five heads, ours do,
and you take that, but you don't,
we're gonna go right over that tendon,
over on the deltoid. - Right.
That tendon is, you got a tendonitis inflammation
because it is flared up, we wanna get the scar tissue
out of it. - You're right.
We wanna free things up a little bit.
So, this is a strong gun, so I'm gonna get it moving here.
Again, I'm not going straight into it 'cause it's got--
- It's got five speeds. - Yep.
Just keep it low, I'm on number two,
one or two, I'd recommend. - Right.
- I'm not gonna go straight into it.
You're just gonna beat it up. - Right.
- That's like doing major impingement.
(chuckling) - Yeah.
- So, go sideways with it, and you know,
you can do it directly on your skin or you can go, you know,
on your clothing, either way works for me.
I like to go directly on the skin
with this one and I'll work it like this.
You can massage it by hand, but what happens is
this shoulder. - Yeah.
- And fingers get pretty tired
and you haven't done it long enough.
- And this shoulder, you're almost doing
The Hawkins Kennedy on it. - Yeah.
Or The Crossover Test, so this really does work well.
Or you have, you know, a family member,
a friend, they can do it. - Yeah.
You may wanna put it on a pillow.
So make sure it relaxes, but. - Yeah.
What'd I do with that pillow? - I don't know.
- I had a pillow. - Yeah.
- Well, people can use that imagination,
but the guns do work really nice.
You don't get tired, you can do it for, you know,
two to three minutes, which is a good length of time.
- And you get a free one if you sign up.
- Oh, that's right, you'll know,
see, it's starting to get red there.
- Right. - That's a good sign.
That means we're increasing blood flow.
Things are working, it shouldn't create any sharp pain
at all, it should feel reasonably good.
Then, we know we're doing some good.
- We're proud of our guns because
they're really good quality. - Yeah.
And they really do work well for all parts
of the body. - Right, exactly.
- Not just the shoulder, so once again,
we can fix about anything, Bob?
- Just about anything. - Just about anything.
Except for? - A broken heart.
- That's right and--
- But we're making gains every five years.
- Well, every five years, we get another step forward.
We just found out the other day, if you--
- We found out some things that don't work.
- Yeah. (chuckling)
- Exactly, be careful. (quirky upbeat music)