♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
- Hi folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Together we are the most famous
physical therapists on the internet.
- In our opinion, of course, Bob.
- Today we're gonna do what is causing your shoulder pain,
tests you can do yourself, plus we're gonna show
a couple self treatments.
It's an updated video, we did this one before,
but we're trying to improve upon it.
Give it a little better sound.
- Bob, it's not uncommon to have shoulder pain,
particularly in the back side,
and it's not from your shoulder at all,
it could be from your neck,
and we're gonna show you how to do it on this video.
How to test.
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Let's start with a test, Brad.
- All right, Bob.
So we're gonna right to beginning,
and this is what I always do in the clinic,
if I get someone with shoulder pain,
I screen the neck first to make sure there isn't--
- What he's referring to is yeah, quite often,
neck problem can send pain down into the shoulder.
So you wanna make sure, 'cause you don't want to treat
your shoulder, if it's actually coming from your neck.
So you can do these simple tests.
- Yep, it may sound funny, but it's happened.
- Yeah, it happens quite often.
- Yeah, more than you may want to think about.
So I have someone sit in their chair, and I say
scoot your bottom back in your chair, look down--
- Good posture, good posture.
- Yep, good posture, shoulders back, look down.
Go to your right shoulder, right ear to right shoulder,
left ear to left shoulder, look over your right shoulder,
rotating, rotate over your left shoulder.
And then I'm gonna have you look back like this
as far as you can.
Now if all that is normal just like Bob and I demonstrated,
and you have no pain associated with your shoulder pain,
it's probably not your neck.
I'm gonna make this brief, but typically,
if I have neck problems that are referring pain
to the shoulder, I'll see a limit range of motion
to the right or to the left, in other words,
to the left they can go this far, and to the right,
that far, and then it hurts here.
And then looking back like this, it hurts right about there,
and it hurts in the neck and in the shoulder,
and then you can assume you've got a neck problem
- It could be flexion too, flexion could bring it on,
but if you're moving the neck and it's hurting the shoulder,
could be a neck problem.
- Right, and it's possible you have neck
and a shoulder problem.
- Yep, yep, we've seen that too.
- But if you've got normal range with the neck,
doesn't bother your shoulder at all,
then we're gonna go on to the next thing,
is the shoulder itself, and this is a simple test.
Just see if you can straight in front of you
lift your arm up, and if it's real painful,
and you can't get it up, and you're kinda doing this,
I'll have patients, they're using their--
- Yep, they're compensating.
- Yep, the body's doing the work, and it's painful,
that's almost certainly a shoulder problem.
I'm thinking maybe rotator cuff, maybe a tear,
we don't know, but--
- Even a really bad impingement
can feel like that at first, so.
- Yep, and then the other thing,
if the person can go like this,
and it hurts, it hurts but they can get through it,
and then they get up to here, oh, it doesn't hurt any more,
that's called a painful arc syndrome,
very common with impingement syndrome.
And that happens going out to the side
with abduction I've seen that, where
ah, it hurts, ah, not so bad up here,
going down it hurts in there, and then it's better,
that's that painful arc, and that can be helped
with some of the treatments that we're gonna show
at the end of the video.
The next one is with your arms like this, okay,
with one hand you're gonna reach over and pull your fist
towards your stomach, but with the other hand
you're gonna resist it, so it's like an isometric.
So if the good side, I always test the good side first,
this is my sore shoulder, it's strong,
and then I do the same thing here,
and it's weak and a little painful,
it goes right in quite easily,
that's a very good sign it's in that rotator cuff problem.
- Yeah, and you can also actually test it this way too.
Put the arm up, let's say this is the side
that's giving you trouble, take the other arm,
and push right above the elbow, and push down,
see if you can hold it up.
If you have a rotator cuff and you push it,
it almost immediately gives away, so.
Very common, very classic sign for a rotator cuff tear.
- Right.
And then there's some specific tests for impingement.
We're gonna go through three of 'em,
you can do all of these yourself.
And by the way, impingement problems
are probably around 80% from--
- Very common to have impingement,
and impingement problems can lead to rotator cuff tears, so.
- If you--
- If you let it go--
- Don't work through the pain on 'em.
Okay, so the first one is quite simple.
Here's the shoulder that's in question, the painful one,
take the right hand, put it over the left shoulder
just like this, and then lift that elbow up
while the hand maintains contact on the shoulder.
You can put a little overpressure here.
If that creates that shoulder pain, that's a positive sign,
there's a good chance it's impingement.
Then do the second one.
It's kind of similar, except for you're gonna go
up like this, you may have to help with the other hand,
and it's near, and I always remember, because
you're bringing the arm near to the ear.
And when you get up here and you give a little overpressure,
if you feel pinching and pain in the shoulder,
probably impingement syndrome.
The next one is crossover.
This is the sore one, you bring it over this way
to the opposite shoulder, and you get some pinching there,
it's like, oh, that hurts.
Again, if all three of those are positive, it's very--
- Right, if this one just is the only one,
this could be the end of the clavicle, or collarbone too,
that's a test for that too, so.
Yeah, you're looking for...
An approximization with each one of these,
and you'll want to get it confirmed by your doctor then.
- Exactly, exactly.
Now if you have impingement problem,
again, the painful arc one is you have that,
and the tests are all positive,
and your shoulder is usable, but it's painful,
particularly reaching things out of the cupboard,
or reaching overhead is uncomfortable,
here's some nice exercises, and we've been using these
for a long time, and we find that they're probably
the easiest to do, and we show 'em to all of our patients.
- Yes we do.
- So the first one, Statue of Liberty.
Actually this one, I named it, and I guess I did get
the name for this, huh, Bob?
- Oh yeah, absolutely, yeah,
you got the name for both of 'em.
- I had a 13 year old baseball player, he was pitching.
And obviously, overhead pain, and we showed him
the Statue of Liberty, and so he was sitting on his chair,
and he goes like, what you need is a billiard stick,
a broomstick, something that you can put on your chair here.
And you can do this--
- Five feet high, right?
- Yep, five foot long works good,
and a diameter you can grab a hold of,
something you can get a good grip on, doesn't slip.
And Bob's gonna do it seated, I'm gonna do it standing,
'cause you can do it either way.
- Yeah, sideways.
- And I'm gonna reach up here.
If you're standing, you're gonna put the stick
on a cupboard or chair, and you simply lean forward,
and you relax the arm.
And I had one person I had him do this,
and he came back and he went like this,
he would slide his hand down.
(Bob laughs)
You can't let your hand slide down,
you're giving it a stretch.
- You might even start a little lower,
and stretch, and then work your way up.
I've had a lot of elderly people do it this way,
where they work their way up, and start out lower.
By the way, Brad, we got an email from somebody,
he was a swimmer in college, national champion,
of that caliber, and he said this helped him greatly.
- Oh, I can imagine, because
you really want to reach out there, yep.
Swimmers, it's definitely a good.
Now, if you do this, and it creates sharp pain
and it just hurts, you're not ready for it.
This should just-- - This should just feel good.
- Yep, should be like a stretch,
maybe a little pain at first, but within seconds,
it calms down and feels like a good stretch.
So be mindful of that, don't overdo it.
And you're gonna do it between five and ten times,
as long as it feels good, and you can do that
every two, three hours throughout the day.
- Sure, you can throw it in
throughout the day, exactly right.
- Don't do it while you're driving.
(Bob laughs)
Just a joke, okay.
Next one, Bob?
- We're gonna do the Chicken Wing.
- Chick, should we do the Back Scratcher first,
and lead that into the?
- Sure.
The Back Scratcher?
Oh, that one, okay, I didn't know what you're calling it.
- Well I call this the Back Scratcher now.
- Okay, sure, sure.
- So if this is the arm that's got the impingement,
the painful arc syndrome, you're gonna put -
now, if you do this with a stick
other than the billiards stick,
make sure it's slippery, it's got a smooth surface,
'cause you want to slide it on your shirt.
Because here's the problem right here.
Typically it's hard to do this.
- Yes, initially you're probably only gonna go down to here.
If you compare the two, this one's gonna be up here,
this one's gonna be only that far.
So you're gonna want to start working towards
getting equal with the other side.
- And that's a motion you do every day
with getting dressed, tucking your shirt in,
taking your wallet out of your back pocket.
And we need that.
- Putting on your bra.
Brad, I hope you haven't been doing that lately.
- Well, Bob, I don't want to talk about it.
(Bob laughs)
Anyway, so here we go, we re, digress.
We gotta go up--
- We regress. (both chuckle)
- You're not gonna go into the pain,
you're just gonna go up till it starts to hurt,
and then go back down.
Up, stretch, gentle stretch, back down.
Do that maybe 10 times, and give it a break,
and then come back and do it every couple hours.
- The advanced version of this would be
then you're gonna work to the point where you're doing this,
and you find this is getting pretty easy,
then you can actually bring it up and also bend the
billiards stick or the stick forward like this.
Not bending your body forward,
you're keeping a good posture,
but you're bending that arm forward.
Don't hit your head, and this actually stretches it,
and this really worked for me on an impingement, it worked.
I do it every morning yet, I do it preventatively.
Because it's funny, when I forget to do it
for a couple days, it starts coming back, I feel it, so.
- Well, you gotta do the maintenance.
There's one warning on this, if you're doing this,
in particular if you're a larger person,
and if you use the broomstick,
be careful so it doesn't break,
because you'll never break a billiards stick, but.
- Also, I don't want you doing this if your shoulders
are prone to dislocation, I don't want you--
- Well, that's a good point, Bob.
- I don't want you doing--
- Again, it should not be painful, just a stretch.
- You want to show a hang?
- Oh, yes, there is one other one we do want to do,
and that's the break aiding that we learned from Dr Kirsch,
an orthopedic surgeon.
- Yep, his book is right here.
'Shoulder Pain? The Solution and Prevention'.
It's by Dr John Kirsch.
And he's made believers of us.
He had that study in Kauai, that it was amazing,
there were some people that were actually
scheduled for surgery for a rotator cuff tear,
and they just tried simple hanging like this,
and they actually recovered to the point
where they didn't need surgery.
- Now in the book, and he promotes using a pull-up bar,
we use these hanging handles.
It's the same concept, you're still
hanging your body weight.
There's some advantages, 'cause you get to use the wall,
and it keeps your body in good alignment.
- So the advantage is you can take these off
and you can just, we just have the wall anchor there,
and it's also the wall gives you some support for posture,
and such like that, but it's a great way to hang.
- Right, and then for if you do have some strength issues,
if you got the wall anchor, this works really good for--
- Yeah, it gives you a double benefit, so you can hang,
and then you can also do some strengthening
by just getting a couple bands.
- And this is pretty much the go-all
strengthening exercise for rotator cuff strengthening.
- Yeah, we're big on doing that external rotators,
aren't we, Brad?
- Yep.
Working that-- - Posture.
- I just wanted to throw that in,
'cause there's more than just the stretching,
you do need to do some strengthening.
You can see that on some of our other videos
under Bob and Brad rotator cuff strengthening exercises.
- 13 minutes, Brad, we rambled on for 13 minutes.
- Oh, Bob, I don't know what we're gonna do.
- All right, thanks for sticking with us, folks.
(chime)