- ♪ Bob and Brad, ♪
♪ the two most famous physical therapists ♪
♪ on the internet. ♪
- Hi folks, I'm Bob Schrupp, physical therapist.
- Brad Heiner, physical therapist.
- And together we are the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- Today were going to show you effective self treatments
for AC joint pain.
That's acromioclavicular shoulder joint pain.
This is the updated video, by the way.
- It is. We had by popular demand
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- That's right, so AC joint acromial clavicular,
It's a mouthful, but what it is,
it's right here at the top of your shoulder,
I've worked with patients and myself.
I've dislocated both of mine,
back when I was a little more active and silly,
but one way or another, they're very painful.
And there's some things you need to know
to make it heal faster, to make it less painful,
and have a more functional joint when you're all done.
So, Bob, should we carry on?
- [Bob] Sure.
- [Brad] All right.
How are we going to test that?
- [Bob] Well why don't you first show again.
- [Brad] Okay.
- [Bob] Show right where it is Brad.
- [Brad] Yep.
So here we're looking at the collarbone or the clavicle.
- [Bob] Right.
- [Brad] The clavicle meets the scapula,
or the shoulder blade, right here.
So we're talking right here. It's kind of more
- [Bob] This is the acromion process.
Acromion, yeah it's the acromion.
Yeah, the acromion. Don't get too technical, Bob.
- [Bob] Okay.
- [Brad] I'm getting confused,
but where those joints or the two bones meet,
there's a joint there,
and it's got ligaments holding it together,
and if you sprain this or tear those ligaments,
it makes an unstable joint,
and it makes movement uncomfortable with your shoulder,
and it needs to heal.
It needs the scar down,
and it typically will without a problem, without surgery.
- Well, this joint, actually this bone actually moves
when you actually lift your arm, this bone is rotating.
- Right. It's not a lot of movement.
- No.
- But there's definitely a movement.
- If they put a needle into it,
they actually can see it moving
- Oh, sure. Yep
But if you do injure, it it's painful.
- Yes.
- Now, typically what happens is you fall
on the point of your shoulder, if you will.
Either the clavicle fractures - Yeah
- which I've had that happen as well
or dislocates at that point
- It happened to my son.
He fell right on his side
- Yep
- and broke the collar bone.
- So you'll get x-rays. You should go in,
get x-rays, confirm if you have a fracture or not.
- Cause it could be a hairline fracture.
You won't even see it.
- And that's what I had.
- Yeah. Did you?
- Well, he called it a greenstick,
a little more than hairline,
- Oh, that's more dangerous.
- But we're getting technical.
So if it is the AC joint, it's not a fracture.
We want to stabilize this to get the scar tissue
to heal down in the right position
because this bone can, if the ligaments are tore,
can slide up over the top, and it's very painful.
and I had that happen.
- [Bob] Or it can slide forward,
either way it usually slides up a bit.
- Yeah. And it's very painful.
You don't want that to happen.
You get it in position. And sometimes they'll give you,
I'm wearing this for a reason, I call it a figure eight,
This is actually a posture strap,
but this would work in a pinch,
and it just helps hold your shoulders back.
- Back
- So you keep it in position.
There's no casting
that I'm aware of for this particular injury.
- Brad, what is the test that you might do
to determine whether or not you have an AC problem?
- Good point.
You can just feel over it, and push on it.
Point tenderness is going to be painful.
- So you follow along your collarbone,
- Yep.
- all the way to the end and push right there at the joint,
and that will be sore.
- Yep. The next thing you can do is I put one hand here,
I'm going to bend Sam forward. The other hand here,
and then you squeeze, and you put pressure on that joint.
Obviously you can't do this to yourself.
- Yeah, somebody has to do it for you.
- But that's what a therapist or doctor oftentimes will do
to test the stability. That joint is very painful,
if it's positive.
- I think isn't this one of the tests, Brad?
Just to cross over like this?
- (laughs) Yeah.
- This'll hurt.
- Yeah that's no fun.
You can feel that joint sublux or actually separate,
and you do not want to do that.
- Right.
- It's very easy, cause it hurts like hell.
Oops!
Family show.
- Family show.
- Yep 20 pushups after the video.
- Nope got to give you a whack with the boo yah.
- No, Bob, not the boo yah.
All right. Healing time for this.
It's going to take four to six weeks.
So it does not happen fast.
It can be painful, if you don't behave.
We want to talk about sleeping.
- Oh sleeping, sure.
- Cause one of the things that will happen to you
probably is while you sleep,
if you roll over on that shoulder
- Let's say it's my right shoulder.
- Yep.
- If I go right onto it like this,
Oh my God. That's the worst thing you can do for it.
- It wakes you up in a hurry, in a big hurry yeah.
You might holler, scream, or say bad words.
How do you sleep?
- Ideally you want to sleep on your back.
- Right
On your back even it's going to be a lot more comfortable
to have your arm support like this, Brad.
- You'll need two pillows: one for your head, one there.
- Or if you're on your side,
now let's pretend it's this one for me.
- Yep.
- You might use one or two pillows for that way.
You actually put one here in the, under the elbow,
on the elbow and the
- Armpit,
- Armpit, and then put another one
right over the top of that.
All right. So we need three pillows,
two for the painful arm and one for your head.
- That's right.
- But what I did, I'm fairly comfortable on my back,
and I just slept on my back,
and I did have a pillow on one side.
So it reminded me not to roll
- Sure.
- because the pain was enough after a couple of times.
But I did the pillow just to make sure.
Once you can start moving,
and after a couple of weeks, you'll feel, oh,
it doesn't hurt so much.
And you can kind of go over this way and gently do that.
- You could do a cross fiber massage.
- That would be a, probably a good time to do it.
Now, the cross friction massage,
- Cross fiber or cross friction massage.
- Yeah, so this I'm going to get this out of the way.
So where the joint is, things are starting to heal now.
- It seems to me that what works really well, Brad,
is to follow along the collar bone
until you feel the tender spot.
- [Brad] Sure. - And that's right,
- [Brad] Didn't you say that already?
- Yeah, I know. (Brad laughs)
But I was going to show where to do the massage.
- I know, I'm just,
- So go along the collarbone, - Rib ya!
- It's not a rib,
and you're actually gonna go across the fibers of the joint.
- Right. And that's exactly what we're doing.
You may want to double up your fingers.
You're going to do this till your fingers get sore.
Now, if it's really painful at first,
but within like 20, 30 seconds,
it feels clearly better or kind of numb-ish,
keep doing it until your fingers get sore.
If however you do it, and it just keeps getting worse,
it's not ready for it.
- Mine's a little sore right now.
- Is it? Maybe you fell on yours last night.
- Well, you know,
this is under a lot of stress with pushups.
- Oh sure.
- And also with bench press.
- Yep.
- So you often get pain from those type of activities,
if you do them a lot. I do a lot of pushups.
- Yeah. Yeah, it does stress that area.
Getting back to the rehab part, let's say, you know,
you do your cross friction massage,
that can make a pretty big difference in itself.
- Yes, it can help.
- And it's time to start moving it again.
And to start out with, I would take my,
if this was my injured one, my good hand,
and help out and I would go up and stretch,
stretch, stretch, and go back down, go up
- As pain allows.
- Yep, and you know you can get a little pain with it, but
- Yeah you can bump into the pain,
but don't go into the pain cave.
- Yeah. No sharp pain at all.
Otherwise you're just gonna tear that scar tissue again,
and it's gonna make things go longer
than you anticipate for the healing process.
And then I'd also go across this way.
This way you've got to be careful.
- Careful of that one, because it can make it feel worse.
- Yep. So gently this way and you know,
five to 10 repetitions to start with
going backwards as well.
I would probably use a cane or a stick and work this,
so this is a sore one.
- Paddling.
- 10 repetitions of gentle stretching.
And you'll see day by day, it's like, oh wow.
I can get back all the way now.
And once you can start to go all the way
up to here with help,
then it's time to start doing it without any help.
And just see if you can get the same resistance.
It's feeling pretty good. Then it's time to add resistance.
You know, I like to use bands with this.
I think it's a lot better than using a weight,
but you could use a dumbbell. That's fine.
Therapists are really accustomed to bands
because they work better, but you don't have to have them.
If you've got dumbbells, go ahead and use them.
So I'm going to start with some resistance,
straight up like this and up and across.
And actually what I would probably do here
- Go for a lower level.
- Yeah. I'm actually going to focus on that.
I'm going to lay down and do it with resistance.
And this is nice because you can really relax doing this.
So you know, what we call this is not conventional,
but I think I do a lot of my banding laying down, not a lot,
but you know enough to make it.
- Sure.
- Very useful and handy.
Then by that time, when you can do those with resistance,
10 repetitions, and you start to need more resistance,
then things like pushups.
- Sure.
- You can start doing those as pain allows.
- Probably pushups on your knees,
and start with a knee pushup.
- Or I think I started
- on a wall or
- a cupboard.
- Yeah.
- But you know, you might start on the wall and if that,
once that gets too easy do 10 to 20 of them,
then we'll go to here.
- Always let pain be your guide.
- Yep
- Because if you do that you're unlikely to get in trouble.
- Right. Yup.
Oh, I do want to say one more thing.
How are we doing on time here, Bob?
- We're doing fine.
- I don't want to bore people to death,
but I really like to add these scapular retraction.
- Yeah. This actually puts the shoulder in a good position.
- Yeah.
- The collar bone is in a good position,
and it's great for posture.
- Yep.
- So this, I would probably emphasize this one really.
- Sure. And then turn around and make sure you do the
- Yep.
- The opposite motion. What do we call that again?
- Well you can call it
- Antagonistic.
- Oh, sure.
- The tagonist and of course its the antagonist.
Do both of them. Make sure you don't just do one
because you want to make sure
you strengthen both sides of that area.
- When he's strengthening this way,
he's actually strengthening the pec major,
which attaches right into the clavicle or collarbone.
- Yep. Exactly. Exactly
- So it's a good one to do.
- So good luck with that sore collarbone.
It's one of those that can really be painful,
but work with it, follow this procedure.
And it's definitely going to heal you right up
in a quick hurry.
I'm saying that, I know that from personal experience, Bob.
- Yep.
- So once again, Bob
- That was many years ago, right?
- Well, I was in my thirties.
- (laughs) It's hard to believe that it was a long time ago.
- Yeah, no kidding. It doesn't seem that long ago,
but anyways
- We can fix about anything.
- Except for
- a broken heart.
- There you go, but we're working on that,
and this has got nothing to do with it.
So we'll skip today.
- Peace.
(upbeat music plays)