Hey guys it's Ashley here.
Shoulders are one of the most common reasons that people come to see me as anosteopath.
The chances are you may even have a shoulder problem which is why youmight be watching this video.
In today's video I'm going to show you why I thinkshoulder problems develop and what you can do to try to fix your shoulderproblems.
But before I do that I need to just briefly explain the anatomy of theshoulder and some of the more significant features of the shoulder andwhy that's relevant to shoulder pain.
Okay so what we've got here is a modelof the shoulder complex.
Right now what you're looking at is from the frontalmost like you've got my shoulder here and I've taken away everything allyou're left with is the shoulder blade.
This bony area here is your scapula alsoknown as your shoulder blade.
Here we have the collarbone which is also known as theclavicle and then your upper arm bone known as the humerus.
All of thesemuscles that you can see attached are collectively known as the Rotator Cuff.
The Rotator Cuff is made up of four main muscles.
The first one is thesupraspinatus, then you've got the infraspinatus, teres minor and teresmajor and then on the front side you've got the subscapularis.
Collectively therotator cuff pulls the head of the humerus in towards the scapula creatingstability.
Individually all of the muscles have slightly differentfunctions.
Starting with the supraspinatus it holds the humerus intothe socket, tenses the capsule and abducts the arm.
The infraspinatus alsohelps to stabilize the capsule but its main function is to externally rotatethe arm.
So if you were to bend your elbow and take your hand out to the side, that's external rotation.
The teres minor, the one down here also weakly helps toexternally rotate your arm.
And lastly the subscapularis helps to mediallyrotate the arm or internally rotate, so opposite tothe infraspinatus if you were to bend your elbow you would be taking your handacross your body towards your midline.
The reason I mentioned these muscles isbecause most people I see are extremely tight.
This causes a lot of strain to beput on the tendons because people having to fight against this tightness and oneof the main areas that this irritation happens is up here in the supraspinatus.
Irritation of the tendon leads to swelling and that swelling causes areduction in space.
So when people then start to abduct their arm that lack ofspace is causing people a lot more pain.
All right so I've taken away all themuscles and now all you're left with is the joint in itself.
The joint is knownas a ball and socket joint so here you can see the ball and in here is thesocket.
What's significant about the shoulder is that the ball and socket isquite shallow.
It allows greater range of movement in all directions but theproblem with this increased range of motion means that there's actually adecrease in the amount of stability so people with hypermobility are often atrisk of dislocated shoulders.
The other thing that can happen in this regionhere, more so in older people is the development of osteoarthritis andunfortunately once you get to that stage there's not much that can be done fromsomeone like me in the way of treatment and it usually ends up being more of asurgical procedure to try and restore some of the smoothness in that joint.
Sothe next thing I want to just point out to you is this tunnel right here.
This iswhere your supraspinatus muscle runs through.
The supraspinatus attaches justabove the spine of the scapula and runs through attaching onto the outer part ofyour humerus and the reason I mention this is because the supraspinatus is oneof the most commonly irritated muscles in theshoulder region.
So I've added all the muscles back on.
Now as you can see thesupraspinatus here is running through this tunnel but when you lift up yourarm if I just take this out.
When you lift up your arm that gap becomes a lotsmaller and this is the reason why a lot of people get pain in theirsupraspinatus, because an irritation occurs on the tendon and then every timethey lift their arm that closing in in size of the the tunnel causes a lot morepressure on the tendon.
So let me just put everything I've told you intocontext for you.
Most people who come in to see me have pain in this upperfrontal region of the shoulder.
To me that usually indicates that there's somekind of tendon ligament or Bursa issue and in my experience that is usuallybecause people are extremely tight through the muscles in and around theshoulder.
Most commonly that tightness comes from the rotator cuff muscles thatI showed you earlier.
In order to confirm whether it's tightness causing theseissues I'll usually do a couple of tests.
The first thing I usually get people todo is to show me their ranges of movement, so I'll get them standing infront of me and get them to perform complete abduction all the way up to theceiling and back down and then following on from that I'll get them to lift thearms up to the front as far as they can and down, and what Iusually see in most people is that they're quite limited in full flexion sowhen I look at them from the side their maximum range of movement is to abouthere.
What I would like to see is full range of movement where the arm is rightup by the ear.
After that I'll get them to do the painful arc test and what you dois you stand arms down by your side and take your armall the way up to the ceiling and note where they're getting pain If it's asuperspinatus tendinitis or bursitis in this other upper subacromial regionthough usually feel pain between about 40 degrees to about 120 degrees.
Now thereason that that happens is because as you get to this sort of area here thespace between the humeral bone and these the acromion is completely minimizedlike I showed you earlier.
After that test I will get them to do the scratchtest and it looks like this.
What you're going to do is take one arm behind you andreach up as far up your back as you can once you've done that take that arm downdo the same on the other side and then back down and note where both hands orboth tips of fingers reach up.
Quite often what you see is the side theshoulder that has the pain will be quite restricted and will not be able to go asfar up as the good side.
Now on the demonstration that I just did what youmight be able to see is that my left arm can reach up my back fairly high butwhen it comes to the right side there's a lot less range which indicates that myright side is tight in either extension or internal rotation or even just acombination of the two together.
This would indicate to me if it was a patientthat they need to be doing more stretching in those ranges.
So if you'rehaving shoulder pain or shoulder discomfort definitely go through thesetests have a look at your range of movement first of all see if you can getthose arms all the way up to the ceiling if you can't you know your tight.
Thentake your arms behind you do that scratch test.
If you're struggling to getyour arm behind you then that's an indication that there's definitelytightness in the front or in the rotator cuff muscles and that will mean that youneed to then stretch in a more extension or internal rotation.
And since we're on thesubject of stretching I'm going to show you now some really effectivestretches that I prescribed my patients all the time and also how to use somemassage balls to get into those tight areas too.
The first stretch that you'regoing to need to do involves using one of these which I believe is called apower band or a strength band.
You can get this fairly cheap and you get it fromAmazon, this is a medium.
Anything lighter than that you're probably not going toget enough stretch anything stronger than that and it's probably going to betoo strong.
So anyway with the band find somewhere in the gym that you can hookit up or somewhere at home.
Once you've got it attached, looped over something aboveyou put your hand through the band turn your palm up, face away from the band.
Nowright now I'm close to the band so there's hardly anything any stretch goingthrough my arm.
Straighten out your arm lift your chest and gradually step awayfrom where you've attached the band.
You should feel this stretch around thefront of your shoulder possibly even going into your bicep.
Once you've donethat same set up for the next stretch put your hand through turn away and leanforward this allows you to get your arm bent behind your back.
With your freehand hold onto your fingers of the hand that's through the loop and then stepaway and as you step away gradually lift your chest and what you want to try anddo is pull this arm this elbow away from your body.
Once you finish, step back lean forwardsand allow yourself to come out of the band.
And the last stretch I think youguys should probably do is this one up into full flexion so get your arm through theband, take it out in front of you and gradually walk forwards keeping yourarms straight until you feel it stretch and just try and push your chest andhead through.
So here's something else I really likeusing and that is massage balls.
This is a lacrosse ball but a massage ball, Lacrosse ball, hockey ball, anything that's hard enough to get into thosesmall muscles will be perfect.
I like these because they get into those smallmuscles that are hard to reach when you're using a foam roller.
So whatyou're going to do is try it and get into your rotator cuff.
The principle isthat you find a tender point press into it and hold in that position.
If you holdlong enough that pain will start to disappear.
So to get into your rotatorcuff get the ball, place it underneath your arm, with your free hand pull sothat you can get this ball further around behind you.
Then come up against a wall and press in against the wall.
Move around until youcan find a tender point once you have a tender pointjust stay there, relax and apply some pressure.
Maintain that pressure untilthat pain starts to go away or you've done about a minute.
Once a minute haspassed move to a different point and repeat the process again.
Then to get upinto these upper muscles you need to do a bit more contortion, so place the ballup and over but this time you're going to have to lean back into the wall.
Lean upagainst the wall, again find those tender points, hold and stay for about a minute.
So that's pretty much all I'd recommend for now guys.
The strength band stretchesand the massage balls.
I would suggest you do either of those in alternate daysso for example strength band stretches you could do on a Monday Wednesday andFriday and the massage balls you could do on a Tuesday Thursday Saturday.
Andthe reason I say this is because if you do either of them too much you'reonly going to make yourself quite sore in terms of how long to do them for I wouldsuggest doing each banded stretch for about 15 to 30 seconds, then move on to the next stretch for about the same amount of time and thenthe next one for about the same amount of time and then repeat maybe anotherone or two times after that if you have time.
For the massage balls find thosetender points that I talked about hold it on there for about 60 seconds andthen move on to another point.
Hopefully you found this video really helpful.
Ifyou did guys give it a thumbs up, if you have any comments or questions do stickthem in the comments section below and until the next video take care guys andI will see you soon.