♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists on the internet ♪
- Hi, I'm Sara Meeks, Physical Therapist.
And I'm here today to show you two exercises
that I use for osteoporosis.
One is called the elbow press
and the next one is called the arm press.
Now, I wanna explain this just a little bit.
I like to do site specific strengthening
and flexibility exercises
with my patients with osteoporosis.
So when they are up and moving
they have maximum and optimal movement in their joints.
And the two major forces on the bones that
we wanna have, are site specific muscle contraction
which is what we're gonna show you today
and then also weight bearing forces
which means bearing your body weight through your bones.
So this is my husband, John, and he's decided
to be a model today for these two exercises.
Hello, John.
- Hello. - Okay good.
Now, so John is lying totally supine
his legs are straight.
Sometimes I should tell you with these exercises
depending upon the person I'm working with
I do have them bend their hips and knees
but it's just easier today to just have him lie
in his most comfortable position
so I can demonstrate the exercises.
So he's lying in partial decompression.
Okay. So, and you notice that I have towels
underneath his arms and I use something
like this on most of the people I see
because the shoulders do tend to be a little bit higher
than the elbows.
And sometimes that pulls on the muscles
on the neck and actually people can have neck pain.
So the first thing I'm going to do here
is not exactly the elbow press.
It is a rotation of the arm.
What I have found is that the internal rotators
of the shoulders are usually quite restricted
and it's much more difficult
for people to externally rotate.
So I work on the external rotation.
Now, before we do the exercises
I'm going to do a little bit of flexibility exercises.
So I'm gonna take out the towel, the towel on both arms.
So if you'll just raise your arm and most
of the activities that we do in life, we turn our arms in.
So what happens is we lose the ability to turn our arms out.
So turning in is called internal rotation
turning out is called outward rotation.
So we're looking at two muscles that need work
in the shoulders that internally rotate the shoulders.
One is called the sub scapularis.
And that is a muscle that's located
underneath your shoulder blades or your scapula.
So that's why it's called the subscapularis.
The other one is one called a latissimus dorsi.
Maybe you've heard of the lats .
That's a muscle that actually attaches
to your pelvis, comes up the back, okay.
And then makes a twist and inserts into the shoulder.
And that one also is an internal rotator.
So I'm working at trying to get the people more
into external or outward rotation.
So this exercise is something that you can do
before you start these exercises just to loosen
up your shoulders.
So he has his palm turned up
and I'm gonna take his hand right
at his wrist just to hold his hand, turned up this way.
And John, can you bend your elbow?
And then John, you're gonna do is rotate this arm
out to the side, as far as you can.
And I'll hold his wrist
because he has a tendency to wanna turn it in.
So I wanna get all the outward rotation I can.
And then relax, take a breath and press out.
I hold for a second or two and release breath in
(Sara inhales)
and then breathe out as you press out, hold and relax.
Okay, and then straighten out your elbow
and then we'll do the other arm.
So I'm going to hold your wrist.
The palm is turned up.
We want to bend the elbow
and now rotate this arm out to the side,
hold and release up,
and then hold again down,
hold and release.
Take a breath in, (Sara inhales) breathe out.
(Sara exhales)
Helps to breathe with my clientele.
Okay? Bring your hand up and then bend the other elbow
and then do both arms together.
So you're gonna press both of them out hold and relax.
We're gonna do three repetitions.
I use a formula of three, five or eight
for most of my patients, three for more physically frail.
I'm using three today
because we're doing a video and we just
want you to see what the exercise looks like.
Okay. And then I would use five with some people.
And with my more athletic individuals,
I would do eight repetitions, 10 maximum.
Okay. So we're ready to do the elbow press.
So John, if you'll clasp your hands together
and then lift your hands up and bring
your hands down underneath your head, not your neck
but the back of your head.
Now you'll notice that his right arm
is pretty much down on the table, but the left arm is not
he has some limitation in motion here.
And because this is an isometric exercise
I'm going to take a towel
and just place it underneath his arm.
So he has something to press against.
An isometric exercise is defined
as muscle contraction without joint movement.
Okay, all right.
So take a breath in.
I'm gonna place my hands run under your elbows here.
And what I want you to do on the breath out
is to pressure elbows down toward the table.
Are you ready?
Okay. Breath in and press two, three and relax.
Breath in and press two, three and relax.
And one more, press down, two, three
and hold it right there.
I'm gonna slide my hands underneath your elbows.
And I'm going to try to pick your elbows up
and you don't let me, ready?
Big breath in and then hold one, two, three.
I'm gonna go to five, five and relax.
Okay. Now take your hands out from underneath your head.
Bring them back down to the side of your body.
Turn your palms up.
Slide them out to the side and then press your shoulders.
Lengthen out your arms and just let yourself relax.
Now, sometimes what I do is depends
on my patient population and who I'm working with.
Some people are not able to get both arms up
over their head.
So if they can do one arm
we'll start with one arm and then we'll go as far as we can
with the other one to try to get this motion.
So sometimes these exercises have to be modified.
What I've shown you here is the full elbow press.
It's an exercise that I really like
because it stretches out the chest muscles
the pectoral muscles here tend to be restricted in people.
It also causes the muscles
in the back and the shoulder blades to contract.
So that's what I'm after is contraction mostly
of the postural muscles in the back
and stretching out the muscles in the front.
The second exercise is called an arm press.
So John, if you'll turn your palms down
and then slide your hands close to your body.
This is the starting position.
I start in this position because people are mostly used
to using the arms in internal rotation.
So I start in internal rotation
because that's easiest for people.
And then as we progress, we will turn,
turn your hands facing your body,
just facing, your hands facing your body.
That would be in the middle and then turn your palms upward
and that would be the third position.
So we work towards the external rotation.
So for today, we're gonna do the one
with the hands down the internal rotation.
So turn your palms pressing down. Okay.
And keeping your elbow straight.
Take a breath in as you breathe out
bring the arm up alongside your ear.
Either arm, which one, okay.
Well, let's start with the right.
Okay. Now he's gonna be able, I think
to bring this arm right down to the table.
Okay. He's got his elbow straight.
I'm gonna have him drop his fingers down.
So he gets a nice stretch on his forearm.
Now what happens with this exercise,
people have weakness in the muscles
used to press the arm down.
They will try to push the arm out to the side instead.
It's a modification
or a compensation that they make to try to do the movement.
So I want you to feel your arm
between your shoulder and your elbow.
Okay? Take a breath in and press the arm down
into the table.
Press two, three, and relax.
Breath in, big breath in, press down, hold and release.
And one more time, breath in always do the exercise
on the breath out, the hold or the movement.
And then sometimes what I do is I'll take
I want you to lift your arm just a little bit
and I'll take his arm, put my hand just
above his elbow and do that movement again.
Ready? Breath in, press down two, three and relax.
So I give them a little bit
of resistance in that final movement.
Okay. All right.
Keep your elbow straight.
Bring your arm back down to the side of your body.
Turn your palm up, out to the side
and just let the shoulder relax.
Okay? Bring your left arm now,
keep the elbow straight up alongside your ear.
Now you notice
that this arm does not come all the way down to the table.
And what he's trying to do is bring his arm away
from his ear.
And I'll show you this now.
So bring your arm out and bring it down to the table.
So he can get it closer to the table.
If he's a little AB ducted.
So I'm going to let's call it abduction.
So bring your arm closer to your ear
'cause we want this full motion
and I'm going to take this towel again
and place it underneath his arm
so he has something to press against.
Straighten the elbow pressure fingers down.
Okay? Take a breath in.
And as you breathe out, press down into the towel
press straight down toward the table.
Not out to the side, press down hold it and release.
Big breath in (Sara inhales) and out and press.
Keep the elbow straight,
two, three, and relax.
And one more breath in and then press down, hold and relax.
Okay. Now I'm also going to let get
your fingers down there a little bit more.
I'm gonna put my hand right underneath.
Just it's called proximal or just above his elbow.
So I'm giving his resistance close to his shoulder.
Okay. Which is where we want it.
Take a breath in, I'm gonna try to pick
your arm up don't let me.
Ready, one, two, three, press.
Two, three, and relax.
Bring your arm back down to the side of your body.
Turn your palm up.
Slide it out to the side a little bit more, that's it.
And just let your shoulders relax down.
Okay. Now we also in a previous video that I did
we went through arm lengtheners.
That's a little bit different than the arm press.
So we tried to get a little bit more motion
before we do these kinds of movements.
Okay? Bring your arms both close to your body, palms down.
Bring both arms up towards your ears.
Come all the way back and you let the arms go.
If this one wants to go all the way down, that's fine.
They don't have to be even, okay.
Straighten out your elbows.
Drop your fingers down toward the floor.
Take a deep breath in
and press both arms down toward the table.
Press, hold and release another breath in.
Keep this elbow straight.
Now on this left arm, I know it likes to bend.
Okay. Take another breath and press down, hold and relax.
He's pressing against my hands
hold and bring the arms back down along
the side of your body.
Turn your palms up,
out to the side and let your shoulders relax.
You can actually do a shoulder press.
So you notice that I, when I'm finished with the movement
I always have him bring his arm down
put them out to the side.
This is usually I call it
bringing the shoulder back into good alignment, okay.
Letting the shoulders and the arms relax.
And he just lies here and breathes
and what I call internalizes the effects of the movement.
So that's a demonstration of the elbow press,
how to rotate the shoulders
in a safe way and also the arm press.
And I'd like to thank you,
thank John for being such a good model today.
And thank you for watching.
(gentle upbeat music)