♪ 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 have the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- Today, we're gonna talk about shoulder pain relief.
We're gonna show you three ways
to get rid of that. - Shoulder blade.
- Oh, did I say oh, shoulder blade pain.
- Yes, the scapula, Bob. - I forgot a word.
- We must be concise and accurate.
- That is an irritating pain.
Isn't it? - Yeah, well Bob, we-
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- Absolutely, we got some wonderful people.
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- Yeah.
Anyways, let's talk about the shoulder blade,
which in our terms is a scapula.
One thing about when a patient comes in and they say
they've got pain right here, I'm already pretty optimistic.
We're gonna get this cured pretty quickly
because sometimes the pain
is not from the shoulder blade itself,
but it can be referred from the lower neck
which oftentimes equals a pretty quick cure.
But we're gonna go and show-
- We could also be talking about
between the shoulder blades.
- Right, yep, between here, but there could be some things
with the shoulder blade 'cause these muscles can get tight,
misplaced it, there can be some other issues involved
with nerve entrapment, whatever.
- The shoulder blade can kinda can be outta place.
- Yep, yeah.
It's really, you know, it's the connection
between the neck and the shoulder movement.
So, we gotta look at this a little closer.
Shall we go on with some more anatomy?
- Sure.
- We'd like to show you some
of the muscles that connect the blade
to the shoulder and the blade to the neck
and the spine.
- This will really help you- - Visualize.
- Figure out what we're talking about.
- Exactly.
Okay, the muscles that hold the shoulder blade
to the rib cage and to the neck
and the front part of the body.
We're gonna start on the back side of the body
and there's this large muscle here
and that is the trapezius.
We got the upper, middle, and the lower trap.
And that's a very broad, thin muscle.
If we take that out of the picture,
then we're gonna go over to this side.
There's another layer of muscles underneath it.
We've got the rhomboids here.
And then we got the rhomboid miners here.
And then we got the levator scapulator.
I pronounced that wrong, scapulae actually.
- [Bob] Yeah, that can actually cause some neck pain.
- Oh yeah. - 'Cause you can see
how it attaches to the top
of the scapula and it goes all the way
up into the first cervical vertebrae.
- Yeah, it's interesting how all these connect
to the spine itself
and to that scapula for motion.
If we go to the front of the body,
we turn around in the front.
We're gonna come over here.
Now this is interesting.
I'm gonna show this in a little bit.
These muscles are actually
on the scapula itself sandwiched between the rib cage.
- [Bob] Yeah, you can't see it this way.
It's behind the back.
- But this muscle right here is we want,
we wanna think, well- - No, no, no.
- No, no. - It's this one
right here, Brad.
- There it is.
I'm sorry.
- Pec minor. - Pec minor.
- [Bob] That red doesn't help, does it?
- Yeah, right here.
This little muscle connects to the caracoid process.
We're gonna point that out because that muscle gets tight.
It's gonna influence the movement
of the scapula or the shoulder blade.
- [Bob] It's gonna pull on it.
- [Brad] Yeah, that's why I said influence.
- Yeah, there you go.
- It's gonna cause problems and is what it's gonna do.
The bottom line.
So, we've gotta get at the muscles from the front
and the back and loosen 'em up, stretch 'em,
we're gonna do a little massage on 'em,
and we're gonna create a wonderful pain-free shoulder blade.
- This is kind of a fun board to play with.
All right, we'll catch up next here.
Okay, so let's talk about now we see the muscles
and where the muscles lie.
We're gonna imagine all the muscles are off
like on Sam the skeleton here.
And we're going to look at the shoulder blade itself.
We have the muscles here
and the blade and here are the rotator, oop,
there goes the humerus.
Don't worry, we don't need that.
- We don't think it's funny.
- No. (both laughing)
So, we got the supraspinatus, the infraspinatus muscles
and there's a few more.
And actually the interesting part is
on the backside of the scapula
there's more muscles that are actually
between the shoulder blade and the rib cage.
- Subscapularis.
- Sandwiched in there.
- It's part of the rotator cuff.
- Yeah, very important muscle group actually.
So, let's take this off and look at with no muscles at all.
And one thing I did wanna point out
is let's look at the front.
Here we've got Gumby keeping track of Sam.
But anyways, this bone right here
is called the acromion, wait that's subscapularis up here.
- Coracoid process.
It's a big one,
but that bone has a pec minor connected to it
and that's an important part we're gonna stretch out.
- Yeah, 'cause you can see if that muscle's tight,
it's gonna pull on that shoulder blade.
- Right, now on Sam we can't move it
'cause there's a bolt to it,
but we don't have bolts going through our body.
So, we're gonna make this shoulder blade
as mobile as possible
so all these muscles are not holding it in place
and there may be some scar tissue, some fascia,
which is now being researched
and finding out that it's a big part of pain.
So that's what we wanna show.
Now we're gonna go to,
like I mentioned earlier in the video,
sometimes pain at that area could be from the neck.
- Absolutely.
- Absolutely. - Very common.
- One quick test that I do
in the clinic and you can do it yourself
is sit in a chair, probably not a stool,
but this is what I have handy.
In a chair with good posture,
bring your chin and ears over your shoulders.
- Align it. - Align things up.
Do a little chin tuck.
And some people already feel pain down just from this.
- Yes. - If that happens,
there's a good chance the shoulder blade pain
is from your neck.
And if you cannot do this and it hurts there
because you're starting to do this,
I'm feeling pretty certain you gotta clear the neck.
I mean, you can have problems with both,
but you gotta get your neck moving
and you're probably shoulder blade pain will go away.
- When you're saying clear the neck,
pretty much treat the neck.
- Right. - Right.
I mean, we're assuming, pretty strong correlation there.
- Exactly.
Now, in this video we're not gonna show you
how to do that technique
because it's a whole nother treatment
'cause we wanna look at that shoulder blade.
- So, we're assuming you move the neck,
there's no shoulder blade pain.
- Yeah, yeah, everything's good with the neck.
There's no correlation.
So now, we're gonna show you some stretches.
- Gotcha.
- Mobilize that scapula.
- Well, should I do the solomen's first?
- Yeah, surely, surely solomen's.
- Surely, you jest.
- What?
- It's an old joke.
"Shirley, you jest" from "Airplane."
- Oh, oh sure.
- "Quit calling me Shirley."
- That's one of my favorite shows.
- Yeah, did you wanna check range of motion?
- Yeah, that's a good idea.
So, one thing you can do, let's see,
this is my painful side.
My left arm goes like this.
You may wanna compare both at the same time
and if you have this problem,
we need to get some mobilization
so that they're even.
We could go out to the side.
This one goes up to here.
Maybe this one is stuck here versus out like that.
I think those are probably the best thing to check.
- Yeah, that's probably enough, yeah.
So again, remember the shoulder blade moves quite a bit
on both sides. - Right.
Slides right across the ribcage.
- So, that's what we're gonna try to do
to get some movement with this and this again,
by Shirley Solomen and the quadraped position.
- Hands and knees.
- And you're trying to actually
get the shoulder blades moving
and the shoulders moving at the same time.
- Right now this shoulder blade is sliding
across that rib cage and coming back.
So, you're gonna do that.
- I don't want the neck like this.
I want it down like this
so it's level with the back.
- Right across here.
- And all the way down.
In fact, you might even feel
like you're stretching out a little bit.
- You're getting that lat muscle also in there.
You're doing this very well, Bob.
- Thank you very much.
- Oh, very good.
- So I don't know how many reps you want 'em to do.
- Five to 10.
No more than 10 at a time, 10 would be fine.
You could do this with a stick like this.
We use a booyah stick 'cause it works well.
But, so you can do it in a seated position.
It has to be something that you can grab a hold of
that's solid about five, four or five feet long.
And just lean forward and this will do a similar stretch.
You may wanna just do one arm
and this actually works quite well.
And I got the stick
so it's not moving on the bottom and I'm gonna stretch
and I could just feel that shoulder blade come up.
Actually Bob, we could show 'em some, you know,
the hanging would do a good mobilization.
- Sure.
- Do we got time for that?
- Sure, but the thing about this, Brad,
is you can start lower.
Let's say you can't bring the arm up high.
- Right.
- You can start here and work it.
- There you go.
- And then work your way up a little bit further
and do it again. - Yeah.
If you got some real tight muscles.
- And again.
- It's gonna take, it may take, you know, a week or two.
- Sure.
- If you're really scarred down from an accident.
- Oh, you don't have the hanging handles there.
- Oh Bob, what did I do with them?
So, you can actually do some hanging.
If you have a pull up bar that works wonderful.
We don't have pull up bars
'cause we use our own pull up system here.
Pull up system, our handles.
And you're just gonna simply hang gently.
I'm gonna go down and hang and right there.
Could you point out
where those shoulder blades are really?
- Yeah, they're both being stretched out very nicely here
and you actually can do it the other way too,
Brad, you can do what're bad against the wall.
- Absolutely.
- And that way you get a little support from the wall too.
- Yeah, it's more comfortable this way.
This feels good.
This is great.
This can be good decompression on your spine
as well as your- - Yeah, your low back
and mid back. - And shoulders
for that impingement.
This is just a wonderful exercise
and you're gonna hang 10 to 30 seconds.
I usually go about 10 to 20 and that's fine.
I usually do that one every day,
particularly for my swimming.
It's a great thing for shoulder blades.
- Yep.
- The chicken wing.
You wanna show 'em this one?
- Sure.
- This is a nice one.
You need a stick again.
- I wanna make sure on this case
that you don't have rheumatoid arthritis,
you don't have shoulders that dislocate.
- Right.
- Or loose shoulders, you're double jointed.
- Yep.
- So, what you're gonna do is I got the stick.
Now you could do this with a broom stick too.
- Yep. - Or a PVC pipe.
And I got my palm on the upper arm faced forward.
- So, you can see his palm is that way.
- Now, the lower arm is actually palm out.
- Yep, thumb is up, palm is out.
- And now, I don't wanna hit my head.
So, I'm gonna go off to the side a little bit
and I'm gonna lean forward and bring the stick forward.
- Yep. - I'm not going like this.
I'm going like this.
I'm actually bringing the arm forward.
- It gives you some leverage
so that you can extend the shoulder joint
which is a very critical part.
You know, McKenzie has a whole series on shoulder extension.
- You can work on this first
if you wanna just trying to get up higher and higher.
- Yep.
- And then every so often throw in the stretch this way.
- I wouldn't spend a lot of time on this,
especially if it's tight,
but as you get better, you'll find that
maybe 10 repetitions, it would be good,
when you start maybe three to five.
- Sure.
- The other thing you could do with these muscles
is you can do some massage.
Your massage guns are out now.
They're very popular.
If you happen to have one.
There's the only thing about the back is-
- It's very difficult to reach.
- Yeah, if you're doing it by yourself,
if you don't have someone to do the massage,
the gun, you know, a gun like this would work great.
You could get to your upper traps
with this and that works fine.
But if you wanna get to that-
- Shoulder blade. - Yep.
- Be tough. - Right in this area,
you can use one that's handheld.
And actually these are cheaper.
I'll get that one going.
- They're not as powerful.
- [Brad] Nope.
If you're a thin person or older person,
this is all you really want anyways.
And I can get right there.
You're probably gonna want this arm to relax
and do it with the other hand.
- Sure. - Little challenging.
But again, if you got someone in the house
that can do it for you, you wouldn't wanna do it standing.
You would probably wanna lay-
- I can really apply - Ooh.
- some pressure.
- Yeah, you can hear the ribcage getting pulsated
just by my voice.
- Now, you may also wanna hit your pectoralis major
and minor 'cause they do affect the shoulder blade.
- Right.
We talked about that with Sam when we showed
that caracoid process
and you're gonna get in there pretty deep,
especially if you've got some pec muscles,
that's when a gun like that.
- Yee. - Ooh yeah.
But that's gonna loosen that part of the shoulder blade up.
- And even the pec major attaches to the humerus
and pulls it in which pulls in the shoulder blade.
- Exactly, they're all connected.
- Yeah, it's good to stretch out this, massage this muscles.
- So Bob, was there anything else about the shoulder blade?
- No, remember we can fix
about anything on the opposite side.
- Except for.
- We can't fix the heart.
- Yeah. - It's on the opposite side.
- The broken heart. - The shoulder blades.
- Well, we don't even know our anatomy evidently, but yeah.
Well, good luck with it.
I'm sure you'll get that shoulder blade moving
and decrease the pain and improve your life.
So, just be careful.