♪ 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 are the most famous physical therapist
on the internet.
- In our opinion, of course, Bob.
- So what is causing your shoulder pain?
Is it impingement?
We're doing kind of a series here
things that we're trying to assess your shoulder pain
and we're gonna, this one's gonna talk purely
about impingement.
- Which is a relatively common
diagnosis. - Very common one, actually.
The best way to think
of a shoulder impingement is some structure.
Usually tendon is getting pinched.
You think that's accurate, Brad?
- Yeah. And well, that's why it's called impingement.
- Yeah, well, impingement not 'impinchment'
If the pinching continues the tendon is gonna get sore.
And if you continue the pinching it con start to wear out
get frayed, like a rope.
- Right. That tendon is through there.
We'll show you on - Yeah
- Our Sam in a little bit.
- Why don't you bring it on over, Brad?
- Oh, sure - And eventually
that tendon can even tear.
So basically an impingement can lead to a rotator cuff tear.
So Brad, you wanna show?
You got (indistinct)
- Oh yeah, he's watching over us.
So here's where the tendon is.
We got it in pink.
I think I would call that pink.
and it goes underneath the acromion here
this bone that's part of the shoulder blade.
And it goes in here and actually the muscle
belly lays right in here above the spine
of the scapula.
- Yeah so this is the supraspinatus muscle and tendon.
- Now look what happens right when you hear
where I put that pen, are you hearing that mic?
If I go up like this, it's pinching the pen
which is actually pinching the tendon
if the pen's not there.
But what happens with a healthy shoulder, the-
- There's enough room there. - Yeah.
The ball actually drops down.
They call it the caudal glide.
It drops down, maintaining a healthy space in there.
But when you have rotator cuff problems, that's not
working properly.
And then you get that impingement and then this
whole scenario arises.
- And we'll go over all that in other videos.
But a lot of times it's just poor posture.
- Sure.
- If that scapula or the shoulder blade is forward
it can cause that pinching here.
So, what are the signs
if you have an impingement?
- Are we done?
- Yeah, we're done with that, thanks, Brad.
Generally don't have pain at rest.
If the pain is when you reach like forward
to the side or to the back, like this
- Scratching your back. - A lot of times
especially you get up to a certain level
and that's where that pinching occurs.
Sometimes you can even have pinching, pinching, pinching
and then it stops pinching beginning where the, the
the irritation is located
- Painful Arc Syndrome, they call it.
- Painful Arc. Yeah.
So it actually, and a lot of times I tell this
to people a lot is pain can make the shoulder feel weak too
- Right?
- Yeah. Like you're thinking it's really weak.
It's I, I must have tore something.
Sometimes it's just so painful that it feels weak.
- Yep, the body tells those muscles to turn off
- Right - Trying to protect itself.
- Now this is something over time, the pain
and weakness can worsen because you keep irritating
you keep hitting something with a hammer.
It's gonna keep getting, you know
worse. Yeah.
- Something's gonna bend or break.
- Yeah. So obviously two
of this is gonna have difficulty lifting objects overhead.
when you have this type of problem,
a lot of times you feel a really sharp pain,
- Right - at the top of the shoulder
people a lot of times, things like something's gotta
be really wrong cuz this thing really hurts.
- And even though the impingement is there,
I have a lot of people say the pain is just down
and it's a referral pain.
It's really from there but it feels like there.
There was something else I was gonna mention, Bob
but it'll come back.
- The other thing is sleeping
on the shoulder often makes it worse.
- Right, exactly.
- So we'll start going in some of the tests here, Brad.
So we've got three tests that you can do.
My only caution is sometimes some of these tests could also
be positive for an acromioclavicular problem,
which in other words, right at the end of the collarbone
there's a joint right here.
And some of these tests are gonna hurt also with these
these tests.
Just keep that in mind.
Again, you're not trying to be doctors here.
You're just trying to maybe give your doctor a little hand
and give yourself some knowledge.
I mean, it's always good to have extra knowledge
- When the doctor or therapist is doing a test
you'll say, oh, this makes sense.
and you'll understand things better.
- So let's say this is my painful shoulder arm.
- Sure. Okay.
- I'm gonna take my hand and put it on my opposite shoulder
and I'm just gonna lift my elbow up as high as it'll go.
And I actually feel still a little bit on there, Brad.
- Yeah. - Do you feel anything?
- Even a healthy shoulder may have some impingement
with these tests, but it should, you know, like mine too.
And on this, do you ever give a little
over pressure on the elbow? - Yep. Yep.
- You give a little over pressure.
Absolutely.
- And the nice thing about the shoulders
you have two of them typically
so you can test the other one and see how they compare.
- Yeah, exactly.
If you have one, that's really been the problem child,
you can see, you know, if that one is a lot worse
with that test.
The second one is, now this is a little bit complicated.
There's a way to do this without this little version of it.
But I thought this is better if you can do it this way.
Cuz what we're trying to do.
You sit sideways on a chair.
I am trying to stabilize the shoulder blade a little bit.
I'm trying to stop it from moving up.
Your shoulder blade actually moves up and down.
So all I'm doing is I'm leaning against that shoulder blade.
- [Brad] So his shoulder blade, you know,
- [Bob] Is right there.
- [Brad] Right? The tip of it is right down to here
and that's, you'll feel it cuz when you do that
you'll feel it move against the chair.
- [Bob] Yeah. You're up against the, the bone here.
So it's very simple to do it actually.
I'm not trying to make this harder than it is.
So then you're gonna just use the opposite arm.
This one, this is the painful arm.
I'm gonna just lift it up overhead.
That's all I gotta do.
And that holds the shoulder blade in place.
And it really, if you have an impingement problem
this is really making it worse.
So, you know, if this really hurts when you're doing it
that's another possibility that you have an impingement.
- This is called the NEER test.
N E E R.
You know if you don't have a chair,
you don't wanna do it that way, you can
- Yeah. If you just want to go this way, you can,
it works a little bit better.
- You're right. - That way
with the stabilization.
- And I, always remember this because near to the ear.
- Yep. - When I was in school
that was my little rhyme that allowed me to remember
that amongst 14,000 other tests for the body.
- Yeah, no kidding. (Brad laughing)
- It's taxing the brain, that's for sure.
Okay! Next one!
This one is not as common.
I just saw it, to be honest.
Myself, I have not used this one, Brad.
I'm gonna be honest with people.
But I liked it because you can do it yourself.
- Right.
- So you put your hand out
and you're gonna turn your palm away from you.
So the thumb goes down, you turn the palm away.
That's putting the shoulder in internal rotation.
So that makes sense to me why this works.
- Right. Cause I guess that tubercle
- Yeah - in the impingement range
- So I'm gonna grab the wrist
and I'm just gonna pull it down to my opposite hip.
- Okay. - That's all you gotta do.
And again, this could also possibly cause
some AC (indistinct) problems.
- Yeah. - But, it definitely also via
some impingement.
- Sure. I'm surprised you didn't wanna do
the Hawkins Kennedy by yourself like this, but that's okay.
- Yeah. Well sure. That's all bonus.
- A real, yeah, a little bonus.
It's an easy, quick one, the Hawkins Kennedy.
Here, I'll show you.
I have one hand here and I have one hand here and I rotate.
To do it by yourself.
You could put one hand here and support and then
let that go down and then test one side to the
- Other. - Yeah. I always thought
there was a little bit of abduction tool.
- Yeah. Yeah.
There was, I've looked that up.
- I've I've seen it, people doing it different
- Ways straight in front of you or out across.
- One way or another, be consistent on both sides.
And if you do all four
of these tests in like three of 'em are very positive.
That's a pretty strong indication.
- Yeah. And the thing is
when we show how to treat impingement
there's nothing, you know, that's dangerous about it.
It's good for every shoulder.
- Sure. - You know what I mean?
It's not like it's gonna be bad for your shoulder.
- Right.
- So you're gonna be pretty safe if you train
treat your shoulder as an impingement.
- Right. I agree, Bob.
- Thanks for watching.
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