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
Vikings won! Do they play football? Haha. Today Brad we're going to talk about shoulder impingement pain
The 7 best tips for pain relief and movement
Now I'd like to say that a lot of these are probably less common exercises and
stretches and massages that you may not see anywhere else
Well in a way but I think it's really gonna be an effective technique, yeah they're important, right exactly and the whole concept is
to get the muscles loosened up that are tight and strengthen the ones that need to be strengthened
But first of all I wanted to talk a little bit about shoulder impingement, that's what it's about
How do you know you have shoulder impingement if you're not a therapist or a doctor just by symptoms
You know I can't guarantee it but oftentimes some of the most common symptoms is the location is typically
Right in here you'll feel it not always where the impingement is there but it'll travel down the shoulder a little bit
Sometimes it makes it difficult to do isn't it because the problem is happening here but the pain goes here and sometimes up
The other thing is is once you elevate up to about 90 degrees that's when the impingement typically starts, not down here
but up here
And one thing I found and the pain for Lark syndrome I'm sure you've seen this
Where they'll get up to about 90 degrees, ouch it hurts a little bit but once they get past a certain place
Then it's okay, yeah you see both versions
Well at least I do
I see where it goes up and there's pain and then stops pain and i've also seen where it goes up and there's pain
pain pain all the way through depending which tendon it is
And where on the tendon it's hitting, either way you can think of it like the tendon is getting pinched
Which is like an impingement, and I want to show that on Bone-aparte
But first I saw a few people walking in
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Okay so we're gonna look at this red Theraband here
Stretch band, yep now that represents the tendon
and that's the one that gets pinched and you can see down in here the gap where my finger is
So right here is where it can get pinched
You can see when you get up to this range
There's less space here and that narrows up and that's where the impingement happens and what happens over time
Is this roughens up the tendon and
Eventually it can get to the point where it actually tears
And that's where you get a rotator cuff tear, and that's a problem
So we want to get this to come down drop down and have plenty of room in there and that's what these exercises
Are gonna do so
First of all a lot of times
This can come on
Particularly the people who have shoulder pain without any apparent reason, they didn't fall down they're not pitching a hard ball
But they get symptoms
Impingement symptoms and it's because of this Bob
Poor posture is very common
Shoulder is internally rotated and what does that? That's the pectoralis major and minor
Yeah it's because people aren't paying attention, then these muscles tighten up and it gets worse and worse, it compounds
So that's what we're gonna do we're gonna focus on loosening these muscles up to allow this range of motion to occur and
Right here you're gonna take a tennis ball or a lacrosse ball
And we're gonna get into that
Pectoralis major and pectoralis minor
You can just do it with your thumb, I was just going to say your thumb or your fingers
This is how I've done it, and I've been amazed at Brad when you do this and you're working
the fibers run this way, so I'm massaging this way
I'm massaging pretty deep
But I'm shocked as after I do this how much easier it is to keep my shoulders upright
You know and externally rotated and in a good position and again when we get that posture it minimizes
Greatly the impingement risk and if your fingers get sore or tired you can again take the ball and work in there and then you can
Roll on it and again up and down the fibers, get in there deep
You know if you have someone else to help you, more power to you that's wonderful
If you really want to get fancy go ahead and use the Pure Wave Massager, this is our favorite massager
On the market right now and because it has percussion, it doesn't just vibrate it percusses
So that makes all the difference and what we have on here is the pointer head
They have a whole bunch of them, they have a softer one, this is the air-filled stick
This is the pointer stick
I like this one, but this might be too much for people to start with, you may need this one
If you're a pretty muscular person, then you'll want the
Pointer stick, and you can get in there and work that, and this is a lot easier than working with your fingers
But you can still use your fingers, it sounds like you're talking into one of those fans
What's nice about this Brad, you can do this at your desk, and you can do a little bit of massaging
Like this throughout the day
Yeah while you're looking at your computer or watching TV or whatever you're doing
And then the next thing is we need to why don't you stand up and turn around
Right here if these muscles get tight here they don't allow the
Scapular to rotate up and
That's part of the mechanics that's gonna help free up and eliminate that impingement, I think we should show that just real quickly Brad
Because I don't think people understand this,
When you bring your arm up, your shoulder up, this bone also moves, and if this
Shoulder blade doesn't move
You can't get your arm all the way up and you start getting things impinged a lot faster
So like my hand is here that scapula
Has to rotate up like this and there's muscles connected from this part of the scapula
To the bones and if they're tight
They won't allow that stretch but if we can allow them to stretch out and we get that motion
We're gonna have a video demonstrating this very well coming up in another couple of days, keep an eye out for that
So it's really strange you gotta work all these muscles around the shoulder, you're thinking why aren't we working on the shoulder
Well we are because we're working these muscles coming into the shoulder and they affect the shoulder, they're all connected
And I like to use a roller to self treat, get the muscles in the back
Plus it's gonna help the spine for posture, it's a win win situation
I like this roll, it's soft density
And when you're rolling on your back, it's a little uncomfortable if you get the real hard density one
This one's from OPTP, I think they have some of the best rollers on the market
We've got it down in our link below Brad in our favorite products,
Oh I just cavitated Bob
When he says cavitated, what he means is that his back cracked
You're not gonna get up on your neck, it's gonna be from about
Where the shoulder blades start to where the shoulder blades end you're not going to go to your low back
And you're just gonna roll back here and relax
You could do that longer too if you wanted but we gotta get on with the show
Okay so easy way to stretch it
And plus you're getting a little bit of stretch on the mid-back too so you're getting a double bonus there which by the way Brad if
You are tight this way
That's also going to affect your shoulder and cause more impingement, we always like to show this little thing don't we Brad
Here I am with bad posture, look how high,
That's as far as I can go, now good posture and I go all the way up
Even if you're not really hunched over, if you're standing tall but your shoulders are forward it's the same thing
And right now he's pinching when he's going forward if he's like that
And so that does two things it straightens you up
Straightens out the back and it stretches the rhomboid, exactly okay the next thing is the latissimus dorsi
That muscle also pulls the humerus in and forward
It internally rotates, so we want to get that stretched out as well, you can go up to a wall
If it doesn't hurt your shoulder
Get your hand glued to the wall and stretch here
Or you could just do it on a table or a countertop I'm gonna kind of grab here let your hand
Stick to the tabletop and pull and stretch here and the next thing that we found to be even better yet is this
Actually one of our viewers a few years ago brought this book
to our attention, we both read the book it's by an orthopedic surgeon, we found that hanging
Like on a pull-up bar can do wonderful things, it stretches the lats, this is a cool book
And if you listen to his reasoning it's very sound, It's John Kirsch, MD
He's actually not too far here, from Stevens Point
About 150 miles or so
"Shoulder Pain: The Solution and Prevention", we'll put this down in our list too, I think we've used it enough
Brad and I both do some hanging and it's so simple, who can't do it
You know, you just hang, you have to have a pull-up bar,
He actually also then has some exercises in there you can do along with that
It's not a really complicated book, it's real simple, it's a good read for the lay person, it gives a lot of case studies
It's all scientifically based
Alright next one Brad is
Bringing the foam roller back out right? You better believe it, now you need the long foam roller for this, if you have the
18-inch one it's gonna be too short
Get the 36 inch one
And even if you don't have shoulder pain, this is a great one for posture also like the previous one
I'm gonna get my head to rest on there and I'm just gonna have it go right down the center of my spine and just
Let gravity work, he's opening things up there
Take a few deep breaths and completely relax, and you can just hang out here for 3-5 minutes
Just relax and let things stretch out, get those shoulders to go back and
Well you can just feel it open up your breathing, everything works better
It's a simple one, did you want to show strengthening Brad or have we had enough?
Well yeah so now the big picture is we've got the muscles here loosened up so they can go back
We've got the muscles in back loose so that that
Scapular can rotate forward so everything is set up, now we do need to add a little strength
We're just going to get into this but these are pretty much two gold standards for impingement
First one is external rotation
Okay you need to have some kind of resistance band like this
We've got this hooked up to the wall here now this is really important that my elbow
Stays here and I don't do this and I don't do this but it's just like this
And then the other one now this one you don't have
To have a band, Bob you can demonstrate it maybe
Without the band but with a theraband we're gonna go back and get those shoulder blades to come back and down, back and down
Oh I see yeah, just doing these, just squeezing your shoulder blades together, same motion but no
Resistance with a band but it's still and think about coming down your shoulder blades don't come down but you think about it
Then the lower traps kick in which is helpful to get that proper scapula motion, sometimes we even do this one, we do this way, hit the road Jack
And that helps emphasize that external rotation
It's a really nice way to get both of them
Remember folks, we can fix just about anything, I'm glad you said that Bob,
Except a broken heart, but we're working on it, we haven't said it in awhile,
Good way to finish it up. Thanks for watching.