♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
- Hi folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- We are the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- Frozen shoulder?
We're gonna show you a step by step exercise,
and pain relief for the three phases
of adhesive capsulitis, which is a frozen shoulder.
Now this is just gonna be for the first phase,
which is called the freezing phase.
I'm just gonna give a quick review, Brad.
So the freezing phase is the first phase.
The shoulder start to feel painful.
You start to lose motion.
This phase can last up to six to nine weeks.
The second phase is the frozen phase.
And these are medical terms.
- Right, legitimate terms.
- Yeah.
Frozen phase, there's less pain, there's stiffness.
The stiffness remains, it lasts four to six months.
- Mm-hmm.
- The last phase, the thawing phase, it improves.
Strength and range of motion gradually return.
That can last six months to two years.
Right now, we're just gonna talk about what to do
in the freezing phase.
- So in this phase a person has had it for a while,
but didn't know what it was?
- They may have.
- Painful, less range of motion.
And then they went to the doctor,
and the doctor diagnosed 'em.
- Yup, in the freezing phase, yup.
- So, you know what I mean?
So there's a few weeks that...
- There can be.
It might be, some people go in right away
when they, you know.
I just think of one of workers, right now.
He got it and he went in fairly quick.
- Sure. - Fairly quick.
- Yeah.
- So probably wasn't a couple weeks.
- It all depends on how stubborn the person...
- Or how bad it is, yeah.
(chuckles)
Okay, during the freezing phase, the first phase,
the first thing, we're gonna look at three things.
A: You want to manage the pain.
- Sure.
- And you might take an anti inflammatory.
This is gonna be on the recommendation of your doctor.
- Right.
- Pain relief medication,
like Tylenol or something like that.
- Mm-hmm.
- Quite often doing an intra-articular,
which means in the joint, corticosteroid shot may help.
An injection.
- Right, so put that needle in there and...
- Yeah.
Tim, the person that worked for us, he had it done.
He had good relief from that.
- Sure.
- And does give you, the studies have shown,
it does really good short term relief.
Not great for the long term.
- Okay.
- But it does improve your motion
in the short term and long term.
- Okay.
- So I think I would not be opposed to having it done.
- Sure, right, if you can function better.
- Right, so some of the things you can try
without getting so invasive, you could use an ice pack.
Brad, you want to?
- Sure.
So, with the shoulder particularly, it's really nice
to have one of the these ice packs that are gel filled,
that are flexible, and it's big enough.
- Yeah.
- To go around your shoulder.
Usually I always have my patients sit in a recliner,
so you can go back and it has less tendency to fall off.
You can buy fitted shoulder ice packs
that are kind of wrap around the shoulder.
- Yup.
- And they're fitted, and they work really nice.
But they cost more, too.
- Right.
- So you don't need to spend that kind of money.
- In other words, they're actually made for the shoulder.
- Right.
- They're shaped to stay on the shoulder.
- I had one where you could put your arm through it
and it pulled up and over, it was really nice.
- Sure.
- But, again. - More pricey.
- Yeah, and not necessary.
You can get away with a cheaper one.
- That's a good ice pack from iReliev.
- Yeah.
- They make a nice one, so...
- You can make your own.
We got a video on how to do that, to their...
- Sure.
- Maybe not quite as nice.
- Using some alcohol and water.
- Yup, rubbing alcohol and water, yup.
- Rubbing alcohol.
Brad, do you want to show the TENS unit?
Which is also from iReliev.
- You bet.
- So this is a very non-invasive device
that you don't have to use medication
if you're opposed to using medication.
This comes in a little box.
It's an electro-stimulator
that can actually provide you some relief.
And it's easy enough to use.
They've really come down in price, now.
- They've been around for 30 years plus.
- Yeah, for 30 years.
- And so they've got it down pat on how to make 'em.
So this might be one option.
And where you put the pads depends on where the pain is.
- Right.
- But so this is an example.
- You got those far enough apart there, Brad?
Remember they're supposed to be at least...
- Yeah, they're pretty close, I'll go a little further.
- There we go, yeah.
Usually we want 'em a pad's width apart, at least.
- Right, so. - Yeah, there we go.
- Now you could use, if the shoulder is painful
in a large area, you could use all four pads.
- Yes. - And it covers a larger area
with the same device.
So you'd put those on, and then you have to
tuck this through your shirt, the lead.
And then put that in your pocket.
- Yeah, so people don't even know that you're wearing it.
- Right, yup.
- And you can turn it on, and you can adjust the intensity
and find out, and a lot of people
get relief from a TENS unit.
- Oh, right.
Right, if you're allergic to pain...
I had one patient, she couldn't take pain medication,
she reacted to it.
- Sure.
- You know, that's a perfect situation for...
- Great for chronic pain, that's for sure.
- Right, yeah.
- Because, you know, when you don't want
to be on medication for the rest of your life,
it can really work well for that.
- Exactly.
- So, all right, that's the pain relief section.
Now let's talk about, you want to maintain motion
as much as possible, and this can be hard.
You don't have to do all three of these.
I'm giving you three examples, pick one,
do it maybe three times a day.
Just to get some motion going.
Brad, do you want to show towel slides, first?
- Yup.
- So this is an easy one to do,
everybody's got a towel at home.
- Right, a towel and a smooth surface,
- Surface.
- a table or cupboard.
- I'm actually gonna use...
- Brad's gonna come over to the corner, here.
- Yeah, this is a nice smooth surface.
And again, we can't get the shoulder up that high,
'cause it hurts and it's stiff,
but you can use that towel
so it smoothly and easily glides forward.
And you can see as I push forward,
my shoulder's actually flexing up.
But the weight of my arm is being supported by the towel.
And you can use your body as you go further forward.
What are we gonna go,
are you gonna go to the pulleys next, Bob?
- [Bob] Yeah, I'm gonna do the pulleys next,
then we're gonna do the pendulum next
and maybe the booyah stik after that.
- Sure.
So again, and how many minutes are they recommending?
- [Bob] I would just, we're just trying to keep
some motion there, I'd do it three times a day
maybe for ten reps.
- Yeah, so you're not gonna be here for ten minutes.
- Right, right.
So, if you want to come over here now, Tanner.
What we have here is, you can buy these pulleys
and they can actually, you can hang 'em up into a door.
You can just close the door.
- [Brad] Right.
- There's a little piece on there that.
- [Brad] You really can't see it here,
but you close the door on it and it will not come through.
- Or you can put a hook up on the wall
or something like that.
- [Brad] I've had people go up to
the joists in the basement.
- Oh, sure.
- [Brad] Wherever you can get something to hold
the pulleys.
- What's nice about the pulleys,
you're really under control.
You determine how high you're gonna go.
Let's say this is my painful side,
usually what I recommend is that you do short
oscillations to start off with.
Just short, getting a little movement,
making it feel good.
And then every so often give it a stretch.
- [Brad] Yup.
- Short little oscillations,
and then every so often give it a stretch.
- [Brad] Sure.
- And people really like this.
To be honest, this is probably one of my go to things
with when you have a frozen shoulder,
because it's a great way without causing too much pain
and you're under control.
- [Brad] Right, right.
- So do you want to show the pendulum
and the booyah there, Brad?
- Sure.
So the pendulum, this is also known as Codman's
in the therapy world, but it's where you just use
the weight of the arm itself and relax the shoulder
as much as possible.
You're gonna breath relaxed.
I'm gonna lean on this chair.
A lot of times people lean on a table.
And you just lean forward, and you can see my shoulder
is coming away from the body,
so it's flexing, we're gonna call that.
And then what we're gonna do is just,
I can move my body and see if I can get my arm swinging.
One mistake a lot of people do is they
just go like this.
- [Bob] Right, right.
- And it's really not the way we want to do it.
We just want to have it relaxed, relaxed, relaxed.
I say, just pretend your arm is like Jello.
Move the body to get the arm moving like a pendulum.
And that's why they call it "pendulum."
- [Bob] Right.
- And otherwise Codman's, 'cause Dr. Codman evidently...
- [Bob] Yeah, and you can go in a circle if you want.
- Yup.
That's a little more...
I'll have people go forward and backwards
for ten repetitions, right to left for ten repetitions,
and then circles ten repetitions.
And that kinda covers the whole range of motion.
- [Bob] The whole ball of wax there, right.
- You can use a stick like this.
This is five foot long.
You know, you don't need it five foot long.
It's probably gonna be not needed up here at this phase.
But later on you would use it.
So I'm just gonna grab here.
A tall cane would work.
And I'm just gonna go forward
and have a pivot point on the floor.
And here, let's show at this angle.
And that will get it to stretch.
And if it's too much stretch,
simple let your arm lower on the stick.
If you want more, you go higher.
And you just go back and forth.
- And I want to emphasize, you don't need to all these.
Just pick one, do something to get motion.
- Right.
- You can also, did you mention the ball, Brad?
- No!
- You could use the little ball
on the flat surface, too.
- I've used this a lot with patients,
'cause a lot of people have a little ball of their own.
And they're just so frictionless,
I like it better than the towel.
Because it just rolls, and you just do this.
And you can have a higher surface or you simply,
as it gets better, lean more into it.
Oh, is Sam in the way, Tanner?
The skeleton?
It's okay? Okay.
And again, you do that for ten repetitions, as well.
Either one of these.
- And some people take a ball like this,
if they have an exercise ball.
- [Brad] The big exercise ball.
- And they can do the exact same thing.
- [Brad] Yup.
- So the third thing we want you to do
when it's in the freezing phase:
We're always concerned that you maintain your posture.
- Mm-hmm.
- Especially when this is all said and done
we want to make sure you have good posture,
'cause it's gonna make sure that you get
full recovery of your shoulder.
- Right.
- So I like to do the W's, just squeeze the shoulder
blades together as much as the shoulder will allow you
to do this.
And doing a chin tuck while you're doing it.
Now you can also do T's, which is straight,
making a T going straight back for the pack.
And you can also do a reverse Y.
- Yup, these are done best standing.
- Yeah, yeah.
- We're sitting, because Bob's too tall.
- I'm too tall, you wouldn't be able to see me.
(laughs)
- You can't see his head.
- So that's basically it right now, during this phase.
You want to get through it,
because it can be a painful phase.
And it also can affect your sleep.
- Oh, sure.
- So that's why it's good to do these things
and like sometimes put the ice pack on
before you go to bed.
- Sure, get you to sleep.
- Yeah, so the pain won't come back
until it's thawed a little bit.
(laughs)
Oh I failed to mention that, again,
this is part of a series of videos on shoulder pain.
And this one actually, there's three videos
on how to treat a frozen shoulder.
This one was for the freezing phase.
The next one's for the frozen phase.
And the last one's for the thawing phase.
So go to bobandbrad.com, go to the programs section,
go to shoulders, and you'll find it in there.
You'll find the titles.
- Right, and again, all these videos do have PDF print outs,
so you can get on paper the exercises
if you can't remember 'em.
You'll be able to see it on paper
and then you don't have to go back
to see the video every time.
- For your convenience.
- There you go. - Thanks.