Hey guys it's Ashley here. Shoulders are one of the most common
reasons that people come to see me as an osteopath. The chances are you may even
have a shoulder problem which is why you might be watching this video. In today's
video I'm going to show you why I think shoulder problems develop and what you
can do to try to fix your shoulder problems. But before I do that I need to
just briefly explain the anatomy of the shoulder and some of the more
significant features of the shoulder and why that's relevant to shoulder pain.
Okay so what we've got here is a model of the shoulder complex. Right now what
you're looking at is from the front almost like you've got my shoulder here
and I've taken away everything all you're left with is the shoulder blade.
This bony area here is your scapula also known as your shoulder blade. Here we have
the collarbone which is also known as the clavicle and then your upper arm bone
known as the humerus. All of these muscles that you can see attached are
collectively known as the Rotator Cuff. The Rotator Cuff is made up of four main
muscles. The first one is the supraspinatus, then you've got the
infraspinatus, teres minor and teres major and then on the front side you've
got the subscapularis. Collectively the rotator cuff pulls the head of the
humerus in towards the scapula creating stability. Individually all of the
muscles have slightly different functions. Starting with the
supraspinatus it holds the humerus into the socket, tenses the capsule and
abducts the arm. The infraspinatus also helps to stabilize the capsule but its
main function is to externally rotate the arm. So if you were to bend your
elbow and take your hand out to the side, that's external rotation. The teres minor,
the one down here also weakly helps to externally rotate your arm. And lastly
the subscapularis helps to medially rotate the arm or internally rotate, so
opposite to the infraspinatus if you were to bend
your elbow you would be taking your hand across your body towards your midline.
The reason I mentioned these muscles is because most people I see are extremely
tight. This causes a lot of strain to be put on the tendons because people having
to fight against this tightness and one of the main areas that this irritation
happens is up here in the supraspinatus. Irritation of the tendon leads to
swelling and that swelling causes a reduction in space. So when people then
start to abduct their arm that lack of space is causing people a lot more pain.
All right so I've taken away all the muscles and now all you're left with is
the joint in itself. The joint is known as a ball and socket joint so here you
can see the ball and in here is the socket. What's significant about the
shoulder is that the ball and socket is quite shallow. It allows greater range of
movement in all directions but the problem with this increased range of
motion means that there's actually a decrease in the amount of stability so
people with hypermobility are often at risk of dislocated shoulders. The other
thing that can happen in this region here, more so in older people is the
development of osteoarthritis and unfortunately once you get to that stage
there's not much that can be done from someone like me in the way of treatment
and it usually ends up being more of a surgical procedure to try and restore
some of the smoothness in that joint. So the next thing I want to just point out
to you is this tunnel right here. This is where your supraspinatus muscle runs
through. The supraspinatus attaches just above the spine of the scapula and runs
through attaching onto the outer part of your humerus and the reason I mention
this is because the supraspinatus is one of the most
commonly irritated muscles in the shoulder region. So I've added all the
muscles back on. Now as you can see the supraspinatus here is running through
this tunnel but when you lift up your arm if I just take this out. When you
lift up your arm that gap becomes a lot smaller and this is the reason why a lot
of people get pain in their supraspinatus, because an irritation
occurs on the tendon and then every time they lift their arm that closing in in
size of the the tunnel causes a lot more pressure on the tendon. So let me just
put everything I've told you into context for you. Most people who come in
to see me have pain in this upper frontal region of the shoulder. To me
that usually indicates that there's some kind of tendon ligament or Bursa issue
and in my experience that is usually because people are extremely tight
through the muscles in and around the shoulder. Most commonly that tightness
comes from the rotator cuff muscles that I showed you earlier. In order to confirm
whether it's tightness causing these issues I'll usually do a couple of tests.
The first thing I usually get people to do is to show me their ranges of
movement, so I'll get them standing in front of me and get them to perform
complete abduction all the way up to the ceiling and back down and then following
on from that I'll get them to lift the arms up to the front
as far as they can and down, and what I usually see in most people is that
they're quite limited in full flexion so when I look at them from the side their
maximum range of movement is to about here. What I would like to see is full
range of movement where the arm is right up by the ear. After that I'll get them to
do the painful arc test and what you do is you stand arms down by your side
and take your arm all the way up to the ceiling and note
where they're getting pain If it's a superspinatus tendinitis or bursitis in
this other upper subacromial region though usually feel pain between about
40 degrees to about 120 degrees. Now the reason that that happens is because as
you get to this sort of area here the space between the humeral bone and these
the acromion is completely minimized like I showed you earlier. After that
test I will get them to do the scratch test and it looks like this. What you're going
to do is take one arm behind you and reach up as far up your back as you can
once you've done that take that arm down do the same on the other side and then
back down and note where both hands or both tips of fingers reach up. Quite
often what you see is the side the shoulder that has the pain will be quite
restricted and will not be able to go as far up as the good side. Now on the
demonstration that I just did what you might be able to see is that my left arm
can reach up my back fairly high but when it comes to the right side there's
a lot less range which indicates that my right side is tight in either extension
or internal rotation or even just a combination of the two together. This
would indicate to me if it was a patient that they need to be doing more
stretching in those ranges. So if you're having shoulder pain or shoulder
discomfort definitely go through these tests have a look at your range of
movement first of all see if you can get those arms all the way up to the ceiling
if you can't you know your tight. Then take your arms behind you do that
scratch test. If you're struggling to get your arm behind you then that's an
indication that there's definitely tightness in the front or in the rotator
cuff muscles and that will mean that you need to then stretch in a more extension
or internal rotation. And since we're on the subject of stretching I'm going to
show you now some really effective stretches that I prescribed my patients
all the time and also how to use some massage balls to get into those tight
areas too. The first stretch that you're going to need to do involves using one
of these which I believe is called a power band or a strength band. You can
get this fairly cheap and you get it from Amazon, this is a medium. Anything lighter
than that you're probably not going to get enough stretch anything stronger
than that and it's probably going to be too strong. So anyway with the band find
somewhere in the gym that you can hook it up or somewhere at home. Once you've
got it attached, looped over something above you put your hand through the band turn
your palm up, face away from the band. Now right now I'm close to the band so there's
hardly anything any stretch going through my arm. Straighten out your arm
lift your chest and gradually step away from where you've attached the band. You
should feel this stretch around the front of your shoulder possibly even
going into your bicep. Once you've done that same set up for the next stretch
put your hand through turn away and lean forward this allows you to get your arm
bent behind your back. With your free hand hold onto your fingers of the hand
that's through the loop and then step away and as you step away gradually lift
your chest and what you want to try and do is pull this arm this elbow away from
your body.
Once you finish, step back lean forwards and allow yourself to come out of the
band. And the last stretch I think you guys should probably do is this one up
into full flexion so get your arm through the band, take it out in front of you and
gradually walk forwards keeping your arms straight until you feel it stretch
and just try and push your chest and head through.
So here's something else I really like using and that is massage balls. This is
a lacrosse ball but a massage ball, Lacrosse ball, hockey ball, anything that's
hard enough to get into those small muscles will be perfect. I like
these because they get into those small muscles that are hard to reach when
you're using a foam roller. So what you're going to do is try it and get
into your rotator cuff. The principle is that you find a tender point press into
it and hold in that position. If you hold long enough that pain will start to
disappear. So to get into your rotator cuff get the ball, place it underneath
your arm, with your free hand pull so that you can get this ball further
around behind you. Then come up against a wall and press in
against the wall. Move around until you can find a tender point once you have a
tender point just stay there, relax and apply some
pressure. Maintain that pressure until that pain starts to go away or you've
done about a minute. Once a minute has passed move to a different point and
repeat the process again. Then to get up into these upper muscles you need to do
a bit more contortion, so place the ball up and over but this time you're going to
have to lean back into the wall. Lean up against the wall, again find those tender
points, hold and stay for about a minute. So that's pretty much all I'd recommend
for now guys. The strength band stretches and the massage balls. I would suggest
you do either of those in alternate days so for example strength band stretches
you could do on a Monday Wednesday and Friday and the massage balls you could
do on a Tuesday Thursday Saturday. And the reason I say this is because
if you do either of them too much you're only going to make yourself quite sore in
terms of how long to do them for I would suggest doing each banded
stretch for about 15 to 30 seconds, then move on to the next stretch for
about the same amount of time and then the next one for about the same amount
of time and then repeat maybe another one or two times after that if you have
time. For the massage balls find those tender points that I talked about hold
it on there for about 60 seconds and then move on to another point. Hopefully
you found this video really helpful. If you did guys give it a thumbs up, if you
have any comments or questions do stick them in the comments section below and
until the next video take care guys and I will see you soon. Bye bye