♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
- Hi folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Yeah, we are the most famous physical therapists
on the internet.
- In our opinion of course, Bob.
- Today we're gonna talk about why your shoulder blades
are causing your shoulder pain.
Honestly, I believe that one of the most common reasons
for shoulder pain is that something is outta place.
If your shoulder blade is outta place,
what I mean by that, if it's winging
or it's depressed a bit, you know.
It's not up and it's tight against the-
- Should we show it on Sam? - Sure.
- Because some of these terms, if you're not a therapist,
may not make sense to you.
But the shoulder blade actually slides across the rib cage.
And if it doesn't track properly, the mechanics are wrong,
it throws off the shoulder joint itself.
So winging means the blade-
- [Bob] Is winging out like this.
- Yeah, just like a angel wing.
- Yeah, and it can also be depressed, like down like this.
- Right. - Or it can be down like this.
- Right.
- And quite often, that's what we see with poor posture,
especially if we have a rounded out posture
in the upper back here, which is very, very common.
- Yep.
- In the lower neck there.
So, as soon as this is outta place,
it throws off the whole mechanics of the shoulder.
- Right.
- And it can lead to impingement,
which Brad, do you wanna show that, where that is on here?
- Sure, I got my handy-dandy pen.
So right here, this, we highlighted the tendon of
- Of the supraspinatus - Yeah with pink
or whatever color this is.
And the impingement is right there.
When you go up, if the mechanics aren't right.
- [Bob] Yeah, can you imagine
if the shoulder blade's rotated down like this,
it's gonna pinch easier, a lot easier,
and we'll show a test that kinda demonstrates that-
- Sure.
- A little bit later here.
But the shoulder blade, you gotta think of it
as the foundation of the shoulder.
- Right.
- All four rotator cuff muscles start in the shoulder blade
and then they attach to the humerus here.
- Right.
- So you can see 'em all right here.
You see the supraspinatus, infraspinatus, subscapularis,
and teres minor.
- Good job, Bob.
- Yeah, yeah.
So they're all starting here
and they all attach to the shoulder.
So if this is off, your foundation is made of sand, right?
- Yeah. - Yeah.
- Things are gonna fall apart.
I find it interesting that the whole shoulder blade,
with the exception of the clavicle,
has no connection to the rib cage except through muscle.
- [Bob] Right.
- There's a whole series of muscles across your back.
You got the, should we quickly go through that?
The traps- - Sure.
- The upper middle lower, we've got the rhomboideus
I can't even remember off the top of my head quickly.
- [Bob] Right. - I should know this better.
- But they all, I mean, yeah,
there's no way this is attaching
through ligaments or anything.
It's all attaching through muscle.
- Muscle, so if muscles get weak or stretched
that shoulder blade becomes, it can go in the wrong position
and cause problems, throughout.
- So to summarize, basically you've gotta get good posture
and you gotta get that shoulder blade in place.
There could be some bony deformities
on the shoulder blade too, that could be causing problems.
And according to Dr. Kirsch,
you maybe can correct that with hanging-
- Right.
- But we'll talk about that in another video.
So right now, how do you know
if your shoulder blade's out of whack?
And a lotta times you can just visually see it-
- Sure.
- Because it's winging way out,
but we're just gonna show you three quick tests.
- Yep.
- That I kinda give you an idea.
One is the standing slump.
So we're gonna indicate to you,
we're gonna show you the difference
between why posture makes a difference.
So, if you stand slumped like this,
I'm gonna go ahead and bring this arm up
as high as I can go. That's as high as I can reach.
I'm I'm now pinching.
- Yeah, you can feel it. It's at the end of the range.
- Right, now I'm gonna straighten up,
good posture, and look at this.
I can touch the ceiling.
- Sure.
And it all has to do with that-
- That shoulder blade. - That scapula
being in the right position
and then the joint works properly.
- And this is why it's a problem.
So, let's say I'm down like this
and day after day I'm pinching that tendon
that Brad had showed you-
- [Brad] Right.
- That supraspinatus.
After a while it's gonna start fraying like a rope.
- Yep.
- And there's also a bursa in there.
So, you can get tendonitis, you can get bursitis,
you can start getting a rotator cuff tear.
- Right, right.
- And eventually it can tear
and then you're gonna have pain and weakness
and all sorts of problems.
- These are the shoulder pain things that say
I didn't do anything to my shoulder.
I didn't fall.
I didn't bump it.
It's just been slowly, gradually getting worse
over a period of months.
- Right.
- It could be just from your posture.
- And you're wondering why did this start?
And it may be because of poor posture.
- Yep.
- Brad, do you wanna show the poor posture
in the seated position?
- Sure. - So, it's the same thing.
If you're working at a computer
and you're slumped forward.
- Your head forward, shoulders forward.
- He may actually be getting a little bit of impingement
just from having his arms up that high.
- Right, especially if you're reaching over for things-
- Right.
- And then it can cause problems.
So, you wanna get those shoulders back.
- But show how high you can reach out.
- So if I'm here, I can get up to here
and it's not comfortable.
I can feel it's not right.
Here, you know, everything is much easier
and I'm obviously reaching much higher.
- [Bob] And Brad has tight shoulders too.
- Yeah, inherently, my shoulders have been tight
ever since I was born, Bob.
- Sure, we'll blame it on that.
(Brad laughs)
You actually have tight hips though too, I mean.
You have good external rotation,
but you have poor internal rotation.
- Yeah, I have a number of inherent problems-
- You got problems.
So, the last one is a real simple test.
I want you to stand straight up as you normally do
and I want you to look at your hands
and I want you to look at the palms.
Now, if your palms are facing you
you're doing pretty decent.
But if they're facing backwards,
like this is what happens
when you have shoulders that are starting to rotate inward
and that's from your pecs getting tight
and everything turned in.
Your latissimus dorsi could be pulling on that.
- Sure.
- That means your palms are facing backwards.
That means you need to stretch these out-
- Right.
- Stretch these muscles and strengthen these muscles.
- Right, which we've got some good, easy exercises-
- Yeah, so right here, palms facing back,
shoulders rotated forward.
I've straighten up, now the palms are facing me
like they should be.
- Got that Tanner, good.
(Bob laughs)
- Another indicator, and that's a lot of the shoulder blade.
- Yep, yep.
- When I'm like this,
now the shoulder blades are moved forward and outta place.
So, we're gonna show you some exercises to correct those,
but we felt that we should take a whole video
just to convince you that this is really important,
because for many people this may be
the single cause of their shoulder pain.
- Right, exactly.
- We straighten this out and the pain goes away.
- So, what you can do is just go to our-
- Oh yeah, go to our website, bobandbrad.com.
Go to the program section.
This video is a part of a whole series of videos
on shoulder pain.
- Just on shoulder, how to assess, exercises.
So, then you'll go to an exercise video to correct this.
- Yeah, and below the video,
we have a PDF that you can click on,
you can print it out.
So, you don't have to watch these again.
You can just print them out and carry 'em with ya
and you know, do the exercises as you see fit.
- Check 'em off.
Do a little doodling on 'em if If you'd like to.
They don't have to look at our mugs,
they're much better off.
- Well, they might have some pictures of us,
or Bob and Brad crew, that's just as bad.
(Brad laughs)
Hey, what have I said, all right.
- Thank you.
- Thanks for watching.