♪ Bob and Brad ♪
♪ the two most famous ♪
♪ physical therapists on the internet ♪
- We look angry.
- Hi folks.
I'm Bob Shrupp, physical therapist.
- Brad Heineck, physical therapist.
- 'Cause we have the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- Seven best shoulder rotator cuff strengthening exercises
we're gonna do with a ball and a band today.
- Right? Right.
- Beauty of the ball, beauty of the band.
- Exactly. The nice thing about these is
you can do this at home.
You do need to purchase a ball
but they're not too expensive.
A lot of people do have 'em and a band,
but they're pretty-
- They come in handy for a lot of things, so..
- Oh absolutely. They do.
And they're, they're just fun.
- Yeah.
- It, it's nice to have this.
It is the beauty of the ball.
- Right.
- So let's say you just-
- We're big advocates of it,
aren't we?
- Yeah, exactly.
Bob, you want to take care-? - Now I just cut you off.
- [Laughs] - Oh, by the way,
let's do this while Brad's regrouping here.
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- Yeah. The like.
- Bob and Brad, - Like the like.
- that's our Facebook page.
- Exactly. - So..
- I'm glad you said that,
'cause we get questions on the comment sections
and that clears it up now.
So Bob, the shoulder rotator cuff problem
after you've got a, a rotator cuff injury
and if you're in that position where this hurts
you can't reach up, out to the side, or you feel like this
this feels most comfortable, you know
that's where you gonna use ice,
so we're not gonna get into that, but we've had videos
and most people, you know, protect it, cold pack, rest it.
Once it starts to feel better where you can start
to move it, we gotta get it moving.
- You gotta get it moving.
- But we gotta get it moving in an appropriate manner
so it doesn't re-injure.
So we want to use something that can,
uh, very,
um
carefully
and controlled motion. - Right.
- So we're gonna use the ball. - Right.
- The ball on a table heighth would be good
and the size of the ball,
it really, it can be a little small, little bit bigger
It can vary a little bit. - You have to experiment
I would say Brad, you-
- It depends how tall you are.
- Yeah. But how is the size of the table
and the size of the ball. - Right.
Exactly. - So all those factors
come in.
- Exactly. So here, let's say my right shoulder here
is my injured one
and I would need to get it going this direction.
But I can't do that
'cause that hurts a lot.
If you take the ball
I'm gonna use my good hand to be the guide,
I'm just gonna put this hand on there
and it's just gonna go for the ride.
This one's gonna push
and as I push my shoulder's going
to flexion here I am at 90 degrees already
no pain because all the weights supported by the ball.
- Some people, Brad, even put the one hand
on top of the other hand.
- Yep. Good idea.
- To make sure that you're kind of guiding it.
- Yep. So it gives you a little more sense
of security with that,
that's a good point. - Again,
if you didn't understand it the first time,
this needs to be pain free. - Right.
- I mean, we're not trying to irritate the shoulder
that's just, that's all we're doing.
We're not making it worse.
- A little stretch pain maybe, but that's about it.
- Right.
- And now you can see if this is easy,
you can roll all the way up
and now that I'm going this way
you can see now my shoulder's all the way up to here.
- It's a sneaky way of getting some motion.
- Once again, the beauty of the ball
- Oh, right.
- it, it, uh, takes the weight off of it
and once that starts to feel good and you're like
oh, it is getting easy with both hands,
start doing it with just one hand,
then you introduce a little bit of strengthening.
Uh, the other thing before you get into that though,
we wanna make sure we do more than this motion
we, we do this motion with our shoulder all the time.
So with the ball, you just roll it
back and forth again.
Let's move the table over.
- So here now we're getting a little bit
of, uh, internal rotation and external rotation, too.
- Yep, exactly.
Yeah. So it's a combination of movements.
- So again, he is using the other arm to help out
- Yeah.
- And, and again, this should be pain free.
If it hurts into this direction,
just go into this direction.
- Right.
- Then it might be just this way for a few days,
and as it improves, we can start bumping
into this direction 'cause usually going
in this way will have a tendency
to have a little impingement there,
so be careful with it.
Okay. That'll come with time, alright?
And then at that point, uh, you can go to one hand.
Now you can work with the extension on this, Bob,
- Sure you can.
- and why don't you show that Bob?
- Sure.
- Um, you're actually gonna wanna start working
on, you know, going back that's where the extension is,
lifting it back this way
and believe it or not by improving this direction
a lot of times all the other directions improve, too.
- Right.
- So if it's, if it's too much to start off,
you might wanna start lower
but that's probably too low for me.
- Right.
- So you're, I'm gonna start up like this.
So here I'm not that far.
- Maybe you should go on the end of the table.
- Okay.
- So you're- - Let's slide it
down this way. - Yep.
- There we go.
- Okay. So I'm starting here.
I'm not that extended yet, but now as I go back
you can see my extension is increasing
- Right.
- and if I want to increase it even more
I can bend down a little bit like this.
- Sure.
- And do some of these.
So this, this is a great
comfortable way of doing extension
- Right. - under control.
- Yeah. And be careful with this one too
make sure it's pain free,
a little stretch pain, the same rules.
If it starts to give you some sharp pain it's too soon
or just don't go so far,
so be careful on that.
- I do this, on the fly
I can even sit down a little bit, Brad,
- Sure. and start doing it
like this now.
- After you get done with these
it should feel loosened up, maybe a little fatigued
but it shouldn't be achy or sore.
So just take your time with this initial phase.
- The other one, Brad, I was gonna include here is
is initially is you can do some circles.
- Oh, sure, yeah.
- This is just a nice relaxed one.
- Yep.
- Of, of, you know
'cause a lot of times they have you do pendulum.
I think this is better than pendulum.
- Sure.
- And this-
- You could use a good arm to guide.
- Yep.
- And then you can- - Work them together.
- Obviously, you know,
it's like I'm stirring the witches brew here.
- Oh sure, Bob.
- And then we're gonna go the opposite direction, too
- Yep. - the other direction.
And again, you can start with both hands and go to one.
- And it, those are real functional motions.
- Those are things - Yeah.
- you're doing that you- - it's wax on wax off, Brad.
- There you go, Bob, you could start waxing
that car pretty soon.
Okay,
now-
- Uh, next one was Mulligan though, Brad, didn't you...?
- Oh, yeah...
- Are you doing that with a small bar or big ball?
- Well, we could do it with either.
- Alright.
- Where is my small ball?
- I think this is a kind of a key, key exercise-
- Oh, - Oh, that's right!
- [Both] Lonnie's got it!
- Thanks, Lonnie.
- We set up this big intro
that Lonnie's gonna throw us the ball,
then we don't remember,
that's how old we are. - [Laughs] Forget about it!
What are we gonna do, Bob?
- All right, this I think is a key exercise, Brad.
It helps a lot of people.
Some people, they didn't get much out of it
but most people I work with really like this.
- Sure.
- So what we're trying to do here is we're trying to
set the head of the shoulder down in the socket.
- Right.
- and, and that often is what is causing a problem
is that's it's too
the head is too far forward.
- Right.
- So what you're gonna do is you're gonna start off-
- Maybe you should do it, the other arm
so that camera can see it better.
- Sure. So you got the fist, you know, flat on here
and I'm gonna push down into the ball.
That's one thing you can see here.
- Right. You pushing down this direction.
- And while I'm pushing down into the ball,
I'm walking back.
So this is different than just going like this.
- Right.
- I'm pushing while I'm doing it.
- Yep. Again, he is pushing.
Now you can see he's squishing the ball
that makes these muscles work
and pulling the head - and put in the socket.
- Exactly.
- Now you can also Brad and I just discovered
that we're gonna call this the Heineck Method
is that you can actually just roll it forward
while you're pushing down the whole way,
I'm pushing down, I'm pushing down.
I'm pushing down the whole way.
So,...
- [Brad] Now, Bob's pretty tall.
You know, if it was me doing this,
that might be a little too tall.
I might start out with a ball this size.
And again, I'm gonna push down.
If I do it, the first method like this
you can see I'm squishing.
And actually if you have a ball that's a little
squishy and flat it works a little bit better
than if you get a brand new one, that's hard.
So let some air out of it.
Let me do it here, here
or like Bob just showed the new Heineck Method pushed down
and then roll out.
But again, all these should feel relatively pain free
a little stretch pain.
- Oh, absolutely.
- No pain with this. - Yeah.
- Any sharp pains you stop, at all.
- Right.
- Even close to sharp.
- This is one you can do a lot of, Brad,
you could do this every hour if you wanted to
- Yep.
- because it's gonna really, um, get that, you know
ball back into place.
- Right. We wanna get that stabilized
we're, we're in the socket where it belongs.
All right, what else we got Bob?
- Now you got a co-contraction,
weren't you gonna start with that?
- Actually, I was gonna go up the wall.
- Oh, the band. - Yeah.
- Oh, up the wall first.
- Yeah, well let's go up the wall first.
So once it's, you can get through all these
and it's feeling pretty good,
it's like, and by this point you're starting to go
like this and it's like, oh, it's feeling better now
- Yeah.
- but still difficult up here.
That's when the ball on the wall, okay,
so if this is my sore shoulder this hand, I could put right
over the top and I'm just gonna use the wall
to help stabilize and this arm to help lift.
- It's still only gonna go as high as pain allows.
- Right. So if it starts- - That's always the key.
- If it starts to hurt here, I'm not gonna push
into here and think I'm just gonna work through the pain,
it'll go away.
We're just gonna go up a little bit there,
So back down, just bump into the pain a little bit
on most of these, we're gonna do 10 to 15 repetitions.
You know, you might start out with less
depending on how it's feeling.
As this gets better, you know you can go up higher.
You don't have to keep your hand,
a lot of my patients, they
they keep their hand glued in there
then you can't go any higher.
Just let your hand ride right up
and you can come under here and help with the other hand,
the good hand, and work that.
All right, now...
- [Bob] Would you, you wanna jump
into some strength theme, Brad?
- Right. I want to go into the one thing
one thing we haven't been able to figure out how to do
with the ball is some rotator cuff
specific strengthening and-
- So that's where we introduce the band.
- The band, yeah.
- The ball and the band.
- So, and there's two primary exercises
that typically work really well.
And the first one is here
and Bob you can show 'em what I'm doing with my-
- Yeah.
with my scapulas. - This is nice
because you're, you're getting, yeah,
you're strengthening the muscles around the, the, the
the scapula or the shoulder blades,
which end up being kind of the core muscles
of your shoulder.
- Yep.
- I mean, they're, they're providing the base for it.
So they're coming together and that's a great one for
to use the band for doing that.
- Right. And then the next one is
this is probably more important.
Oh, do we have a a roll
- The external rotation?
- Yep,
is this one.
- And Brad's gonna, you know, make sure
that he's got his arm in the right place
by putting a roll towel underneath the, the arm.
- The reason we put that there,
because a lot of people have a tendency to do this.
And if that drops out, you know, your elbow came
too far away from your body
and you're not getting that, that rotator cuff.
- This part is at a right angle.
- Right. So I'm not doing this
and I talked about not doing this.
It's all this,
okay.
Now what I have patients do typically,
I'll say,
do 10 of these
nine and 10,
and then do 10 of these.
You don't have to have a towel in there.
If you know you
can maintain - Keep it in place.
- The right place you can go without it.
And then I always say three sets of 10.
So that would be 30 each, but you're alternating.
And you may start with one set of 10, as it gets stronger
you, you increase your rep, your frequency.
All right.
- Very good.
Now what else, Bob?
- You gonna use the co-contraction?
- Oh, yes. I got confused.
[Bob laughs]
Now this is important 'cause on your shoulder
you're, you're pushing a lot, okay?
- Right.
- Pushing and pulling objects,
but the pushing that co-contraction
we talk about where the muscles pull that
that joint into place so that when you push it stays there.
So we're gonna simulate that with the ball.
I'm gonna push down and put some body, not big motions
but just little motions back and forth.
And sometimes I'll just, you can count 20 times back
and forth or you can use a timer.
I kinda like a timer better for 20 seconds or 30 seconds.
And then right to left, you can see me going right
to left here and do some circles in each of these.
You can time for 20 to 30 seconds and you'll get tired.
It doesn't look like a lot
- Right.
- but it will definitely fatigue you.
- [Bob] It's kinda like using the blade.
- Yeah. The body blade.
- The body blade, yeah.
- And when it feels pretty easy, then you go
up to the wall and you do the exact same thing
but you put your body weight.
So now I'm leaning
like I'm gonna push this ball at the wall.
You can see it flattening out,
and I'm just gonna go up and down
these little shaky motions
20 or 30 seconds
then right to left 20 or 30 seconds
and then circles
and then counterclockwise.
And what I found with a lot
of patients is they can go clockwise or counterclockwise
but the other direction hurts. - It's the one that hurts.
- Yeah. So say don't do that
just do the one that doesn't hurt.
And then as it gets better
they can eventually do both directions.
- [Bob] Usually keep that at shoulder height, Brad?
- That's the goal.
- Yeah. I don't know that'd go higher than that?
- Right. Yeah. Yeah.
We're not gonna go up here and do it.
- Yeah.
- We're gonna keep it right here.
- Right. -
You know, and that works out pretty well
as far as the mechanics of holding the ball
- And we're not getting impingement and such.
- Yep. Mm-hmm.
So-
- And remember Brad-
- What Bob?
- We can fix just about anything
- except
- a broken heart.
- There you go.
Coming back at you!
- But we're working on it!
[Both Laugh]