♪ 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 therapists
on the internet.
- Ah, my shoulder's popping.
Oh, in our opinion, of course, Bob.
- All right, you're popping off,
that's for sure, Brad.
Today we're gonna talk about danger if my shoulder
clicks and pops.
Learn why and how to fix, we're gonna cover it all.
- That's right, Bob, we're gonna carry on.
- We don't want a noisy shoulder, not a nosy shoulder.
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And Brad, what else do we have?
- We have the podcast and some excellent interviews,
but what about the clips or the chirps?
- Oh yeah, the shorts.
- The shorts, yeah.
- Bob and Brad clips, that's another channel.
Okay, once again, say anything else about this?
- Oh, we love it.
- This is a sample by the way. - It is.
- It comes in a big normal size.
- This changed my life, literally.
Okay, Bob, let's go on with these shoulder problems
because it's not uncommon for people to have clicks
and cracky shoulders.
And people get concerned, is this something I need to see
the doctor about? - Exactly
- Very good concern, and it's possible, yes.
But we're gonna explain to you why you may have
those clicking and popping in your shoulders.
Sometimes it's just like grinding, you know,
I'll say to my patients is it like Rice Krispies?
If you ever had those, and they say,
yeah, that's kind of like it. - Sure.
- Or it could be something like a clunk, clunk,
or a pop, whatever, there's a number of different reasons
that we're gonna show you why this can happen.
It can make you feel better just knowing
that your shoulder is not literally falling apart.
- Well, we'll show you some things
that might help take it away too.
- Absolutely, Bob, that's gonna be a little bit later.
- A lot of times, you don't actually hear it,
you feel it, Brad, you're grinding.
Okay, Brad, let's show what some of the causes could be.
- Sam is gonna be grateful and happy to help us out.
So we're gonna look at the shoulder right here.
If you're gonna have these noises and whatnot,
they're gonna come from this part
of the shoulder joint typically.
Here's the ball or the socket
which is a very shallow socket.
And then the nice rounded ball on the humerus.
And keep in mind, it doesn't look like this,
it looks more like this
with a lot of connective tissue around it.
And that can start to cause some of these problems.
We'll get back to that.
- One of the problems,
do you mind if I say this now, Brad,
is that quite often the shoulder bone here
moves forward in the socket.
It's not back in the socket where it should be.
And that causes things to grind,
it can put pressure on the labrum
and it can put pressure on the tendons coming through.
And you're gonna show that, right, Brad?
- Exactly, so this represents a tendon coming
through from the supraspinatus,
and that comes over, connects to here.
Now sometimes that tendon can slide back
and forth like this.
- Sure, and that can make sound.
- Right, also there's a tendon right here that goes
for the bicep tendon, and that can pop back and forth.
- Yep, or it can also get squished
right there on the chromium.
And that can cause noise after a while
after it gets scar tissue.
- Exactly, so along with it is arthritic changes.
Let's say the ball of the socket is getting arthritic.
- It's getting flaked.
- Yeah, it's not smooth anymore, it becomes rough.
And that can also be that Rice Krispy sign.
- And then there's the labrum.
- The labrum which we did mention already,
but we're gonna show you. - I think we can kind of
see that.
- We're gonna, this brown rubbery stuff
represents a capsule and some other tendons.
But right in here-
- Can you see any of than tendon?
- There, yep, right there's a labrum,
and that's kind of like a cartilage material.
And sometimes that can actually rip,
Chris has one of these, it's been confirmed.
And that'll make a clunk sound.
- It's not holding the ball in the socket
the way it should be.
And again, if your ball is not in the socket
like it should be, it could actually put pressure
on that labrum.
It's just not working the way it should.
- So obviously, number of reasons.
Now, sometimes these can be bad enough
where you may need surgery,
but the big rule of thumb,
if your clunks or snaps and Rice Krispies
and there's no pain with it, you just feel it,
that's a pretty good sign,
you don't have to get too concerned about it.
- Yeah, if there's no pain or not.
I mean, to me, sometimes it's a precursor to pain.
- Right.
- I mean, I would like to take it away if you can.
- Yes, and we're gonna show you some good rules
on how to do some exercises and how to correct it
before it turns into a problem.
- One other thing, Brad, we forgot to mention is
the shoulder's not gonna work the way it should either
if the rotator cuff, the four muscles around the shoulder,
they're not working like they should.
So that's why Brad's gonna show
a strengthening exercise too.
- And that goes back from, Bob mentioned,
that ball can come forward oftentimes out of that socket,
if you will, and then you get those-
- Yeah, and if the rotator cuffs' working like it should,
it should rotate the ball correctly
and not cause problems.
- Exactly.
- Exactly. (both laughing)
- I think it's a funny joke.
I'm gonna bring an egg in here.
Come on, Sam, get out of the way.
All right, so, here we go.
Let's just the first thing we can look at is posture.
It all boils down to the fundamentals.
If the posture is not right, then we can't-
- Look at this, if I'm rounded out like this, look,
and I bring my shoulder up, that's as far as I can go.
But now if I straighten up.
- Shoulders back.
- Look how high my shoulder goes now.
- You get about an extra 20 degrees of free mobility
just changing your posture.
- Right, and this is also causing it to impinge,
can lead to some of the problems we were just talking about.
- Right, so you look at your posture,
and sometimes you have to take a picture
of you when you're not aware of yourself
or have someone tell you,
and you might find that your shoulders are here
and you're not aware of it.
And we need to bring them back like this.
So just squeezing back, I would call them Ws,
if you bring your arms back,
squeeze your shoulder blades behind your back,
and do 10 of those. - Just today.
- Yep, help promote that.
- That's the first exercise I give patients, is I tell them,
go home and start doing some of these.
- You can use a wall, try and touch your elbows to the wall
and hands to the wall.
If that way you kinda know where you're at,
you might start out not even be able to touch to the wall.
And the goal is to get back there.
My left side is always tighter.
So I work on that myself.
- I can tell.
- Yeah, exactly.
So posture, look at that.
Number two is we're gonna look at two specific
range of motion that you'll see.
And one is flexion, we talked about that, going up this way,
or extension, going back this way.
- So you compare one shoulder to the other shoulder
if you have one that's better than the other.
- Let's say, this is my good shoulder,
this one has it clicking and popping.
And this one goes up like this,
and this one goes up to here
and it might start the click or pop
or maybe that's all it goes or a combination,
we wanna see if we can get this range of motion
back to normal.
And we've got a couple of tricks to show you.
- Yeah, we've got whole videos on this,
but we'll show a couple of them right here.
- Right, probably the two, our favorite ones.
- Sure.
- Let's see, Bob.
One of the thing, it depends on the level.
If your hand only getting up to here,
you can just take the other hand like this.
- Absolutely.
- Start with posture, and then the good arm goes up
and stretches the bad one,
and just you don't push it into a real sharp pain,
just a little stretch pain is all
and then go back down.
Up and down, and do that 10 times.
And then do that three or four times a day.
To get more aggressive, we like to use a stick.
- Oh, you can do it this way.
I mean, you can actually just work on,
moving it up like this, but you can,
I think you should show the Statue of Liberty.
- Absolutely.
So let's talk about this one a little bit.
This would be the shoulder that we need stretch,
then this arm is doing the work, just relax this.
But the Statue of Liberty stretch is much easier.
- Well, it's easier and it's more effective.
- Yep, I agree. - Because first,
you're gonna start off,
let's say you don't go up that high.
You're gonna work your way up a little bit.
And then you can lean forward
and put traction on the shoulder, so much more effective.
Don't let the arms slide down, but you come back
and work your way up a little higher.
To progress the Statue of Liberty,
Statue of Liberty is obviously high, right?
- Right.
- So eventually you hope you get all the way to the top
and you can just give it a little good, long stretch,
and you're gonna find out it improves your range
rather rapidly.
- And again, this shouldn't create any sharp pain,
if it does- - We're not looking for pain.
- You do not do it, it's just not the right stretch.
Also use a stick about four or five feet long,
and tips on the bottom so it doesn't slip or slide
or poke a hole in your furniture if you're-
- Right, these tend to have a really nice grip by the way,
and you can say Boo yah.
- Boo yah! - Boo yah!
- All right, and the other one is extension going backwards.
And you can just take a cane even for that,
you don't need such a long stick for this one.
And it's like you're paddling a canoe
and you just stretch back.
And again, you'll check
one side compared to the other,
the good side goes back to here.
This side goes back to there.
- This is one again where you could clasp your hands,
bring them back.
Now, Brad has trouble with this one.
So he actually uses a towel.
His shoulders are tight going back.
- Oh yeah, I'm a tight shouldered person, Bob.
I'm not sure what's wrong with my shoulders,
but they're getting better.
- Probably doesn't want to reach for that wallet
in your back pocket.
- Well, hey, yeah, we wanna keep it in there.
- Speaking of tight.
- Yeah. (laughing)
Yeah, some people say it's frugal, not tight.
- Brad's no tight, I don't wanna give any impressions here.
- I've been called that before though, Bob,
it doesn't bother me. - Okay.
- Let's go to the next one, where were we?
- Well, we just did range of motion.
I'm gonna throw one more in there, Brad.
How about hanging?
- Oh yeah, once you get to the point where you're up here
and you're almost there and it doesn't hurt that much,
there's no sharp pain, but you're in the more
to get more aggressive to stretch it,
just hang on a pull-up bar or something very sturdy
that'll hold your weight.
- Yeah, we have our wall anchors here,
and we have a whole bunch of devices here.
So I don't want you to get too big stop here,
but this is one itself,
this is the pull-up system of ours.
And you get three of these anchors with it,
and you just put it in there
and you can actually go like this,
and then you can go ahead and just hang.
- Yeah, I mean, obviously I wouldn't buy them just to hang,
I would buy to do pull-ups.
- If you're gonna do pull-ups too,
this is the system you're gonna wanna get.
So this one actually,
you can actually throw some pull-ups in here,
and you can twist the arms so that you can do
actual pull-ups, chin-ups, and neutral grip.
Now these are the hanging handles.
These are what you'd get if you just wanna hang.
- Yep, specifically for hanging.
- Yep, and what's nice about it is you can start off
by putting some weight on your feet.
- Right down here.
- And then eventually go to the point where you actually
lift your legs up.
It's good for your back too, by the way.
- Yeah, it's good for decompression of the back.
Good for posture, good for your shoulders, hand strength,
there's a lot of benefits to it.
- Do you wanna do strengthening it all, Brad?
- Yes, I do, I wanna show you-
- I wanna finish up my advanced one.
- Oh yeah, okay.
Now the strengthening part we mentioned before about
a weak rotator cuff,
probably 90% if not 100% of the therapists
are going to show you this exercise
for the course strengthening exercise.
You're gonna need something stretchy like this, a band,
put it on, anchor it, we're using the wall anchors here
'cause it works very well.
And then we do this, the mechanics, the elbow stays in
by the ribs, 90 degree bend in the elbow
and it looks like this.
Not like this, not like this where the elbow comes away.
- Yeah, a lot of times we would put a towel
underneath there, Brad's gonna grab it.
- If the towel drops out,
it means your elbow got too far away from your ribs.
And this is a great way to get that posterior
rotator cuff strength which is usually the problem,
that's why we do it so much.
10 of these, and then do that three times a day.
Well, as it gets better, you can go two sets of 10,
but the repetitions per day is probably more helpful, Bob?
- All right, the final thing is
I'm gonna show you this one, this is more advanced.
Well, actually what I put up here is one of our
looped bands here, and these are for pull-up assists,
and you can actually do a lot of moves with it.
But this again, you're gonna wanna make sure
you don't have loose shoulders or arthritic,
like rheumatoid arthritis.
- This is probably for more the active person.
- Yeah, this is the active person,
maybe a little bit younger.
What I'm gonna do is I'm gonna actually,
you know, when he was showing the ball in the socket,
I'm trying to put the band right on the ball itself.
So I don't wanna be too far over, I don't wanna be on,
yeah, if you wanna show,
I don't want to be over onto the scapula or the clavicle.
- Right about where that black band is.
- Yeah, there you go.
See, that's gonna pull the ball back into the socket.
- How does that feel, Sam?
He loves it.
- He's having pain because Gumby is on his shoulder.
- Oh, our little Gumby.
- So anyway, this is pulling the shoulder back.
And while it's in this position, I can work on flexion,
I can work on external rotation,
I can work on internal rotation.
It's just a great way of teaching that shoulder
to stay back in the socket.
And this alone, after you do this a few times,
the clicking stops.
- Yeah, actually this is one,
if you're a therapist and you're not aware of this,
you may wanna do this with your patients.
- Yeah, and I actually, a lot of times I'll put my thumb
or hand on the band to keep it from sliding,
I'm trying to keep it on the shoulder itself.
It's better to error and have it down a little bit further
than have it too far up like this
'cause then it's not working.
So beautiful exercise.
- It is, I did want to,
now that you mentioned you got the big loop ends,
if you have those, I like the smaller one,
this works really good for doing that external rotation.
So you go like this, stand on it either one or both
depending on how much resistance you want,
bring it up to here and do this.
It's a little bit, you know, use the right size band.
You might use the smaller and the yellow one.
But I like this because
you get both sides and it puts some pressure down,
so it does a little more strengthening than the other way.
It's just another option.
- It's very mobile too
- Oh, it is, you can- - Yeah, you can.
- Yeah, you can take this with you.
- Yeah, and you can snap people.
- Well, they are fun, you got to be careful.
But Bob, we don't wanna recommend
any of those childish things.
- No harmfulness.
- That's right, we are a family show.
- Be kind, (laughing)
take care.