Understanding Shoulder Pain and How To Fix It


Hey guys it’s Ashley here.
Shoulders are one of the most common reasons that people come to see me as an
osteopath. The chances are you may even have a shoulder problem which is why you
might be watching this video. In today’s video I’m going to show you why I think
shoulder problems develop and what you can do to try to fix your shoulder
problems. But before I do that I need to just briefly explain the anatomy of the
shoulder and some of the more significant features of the shoulder and
why that’s relevant to shoulder pain. Okay so what we’ve got here is a model
of the shoulder complex. Right now what you’re looking at is from the front
almost like you’ve got my shoulder here and I’ve taken away everything all
you’re left with is the shoulder blade. This bony area here is your scapula also
known as your shoulder blade. Here we have the collarbone which is also known as the
clavicle and then your upper arm bone known as the humerus. All of these
muscles 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 the
supraspinatus, then you’ve got the infraspinatus, teres minor and teres
major and then on the front side you’ve got the subscapularis. Collectively the
rotator cuff pulls the head of the humerus in towards the scapula creating
stability. Individually all of the muscles have slightly different
functions. Starting with the supraspinatus it holds the humerus into
the socket, tenses the capsule and abducts the arm. The infraspinatus also
helps to stabilize the capsule but its main function is to externally rotate
the 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 to
externally rotate your arm. And lastly the subscapularis helps to medially
rotate the arm or internally rotate, so opposite to
the infraspinatus if you were to bend your elbow you would be taking your hand
across your body towards your midline. The reason I mentioned these muscles is
because most people I see are extremely tight. This causes a lot of strain to be
put on the tendons because people having to fight against this tightness and one
of the main areas that this irritation happens is up here in the supraspinatus.
Irritation of the tendon leads to swelling and that swelling causes a
reduction in space. So when people then start to abduct their arm that lack of
space is causing people a lot more pain. All right so I’ve taken away all the
muscles and now all you’re left with is the joint in itself. The joint is known
as a ball and socket joint so here you can see the ball and in here is the
socket. What’s significant about the shoulder is that the ball and socket is
quite shallow. It allows greater range of movement in all directions but the
problem with this increased range of motion means that there’s actually a
decrease in the amount of stability so people with hypermobility are often at
risk of dislocated shoulders. The other thing that can happen in this region
here, more so in older people is the development of osteoarthritis and
unfortunately once you get to that stage there’s not much that can be done from
someone like me in the way of treatment and it usually ends up being more of a
surgical procedure to try and restore some of the smoothness in that joint. So
the next thing I want to just point out to you is this tunnel right here. This is
where your supraspinatus muscle runs through. The supraspinatus attaches just
above the spine of the scapula and runs through attaching onto the outer part of
your humerus and the reason I mention this is because the supraspinatus is one
of the most commonly irritated muscles in the
shoulder region. So I’ve added all the muscles back on. Now as you can see the
supraspinatus here is running through this tunnel but when you lift up your
arm if I just take this out. When you lift up your arm that gap becomes a lot
smaller and this is the reason why a lot of people get pain in their
supraspinatus, because an irritation occurs on the tendon and then every time
they lift their arm that closing in in size of the the tunnel causes a lot more
pressure on the tendon. So let me just put everything I’ve told you into
context for you. Most people who come in to see me have pain in this upper
frontal region of the shoulder. To me that usually indicates that there’s some
kind of tendon ligament or Bursa issue and in my experience that is usually
because people are extremely tight through the muscles in and around the
shoulder. Most commonly that tightness comes from the rotator cuff muscles that
I showed you earlier. In order to confirm whether it’s tightness causing these
issues I’ll usually do a couple of tests. The first thing I usually get people to
do is to show me their ranges of movement, so I’ll get them standing in
front of me and get them to perform complete abduction all the way up to the
ceiling and back down and then following on from that I’ll get them to lift the
arms up to the front as far as they can and down, and what I
usually see in most people is that they’re quite limited in full flexion so
when I look at them from the side their maximum range of movement is to about
here. What I would like to see is full range of movement where the arm is right
up by the ear. After that I’ll get them to do the painful arc test and what you do
is you stand arms down by your side and take your arm
all the way up to the ceiling and note where they’re getting pain If it’s a
superspinatus tendinitis or bursitis in this other upper subacromial region
though usually feel pain between about 40 degrees to about 120 degrees. Now the
reason that that happens is because as you get to this sort of area here the
space between the humeral bone and these the acromion is completely minimized
like I showed you earlier. After that test I will get them to do the scratch
test and it looks like this. What you’re going to do is take one arm behind you and
reach up as far up your back as you can once you’ve done that take that arm down
do the same on the other side and then back down and note where both hands or
both tips of fingers reach up. Quite often what you see is the side the
shoulder that has the pain will be quite restricted and will not be able to go as
far up as the good side. Now on the demonstration that I just did what you
might be able to see is that my left arm can reach up my back fairly high but
when it comes to the right side there’s a lot less range which indicates that my
right side is tight in either extension or internal rotation or even just a
combination of the two together. This would indicate to me if it was a patient
that they need to be doing more stretching in those ranges. So if you’re
having shoulder pain or shoulder discomfort definitely go through these
tests have a look at your range of movement first of all see if you can get
those arms all the way up to the ceiling if you can’t you know your tight. Then
take your arms behind you do that scratch test. If you’re struggling to get
your arm behind you then that’s an indication that there’s definitely
tightness in the front or in the rotator cuff muscles and that will mean that you
need to then stretch in a more extension or internal rotation. And since we’re on the
subject of stretching I’m going to show you now some really effective
stretches that I prescribed my patients all the time and also how to use some
massage balls to get into those tight areas too. The first stretch that you’re
going to need to do involves using one of these which I believe is called a
power band or a strength band. You can get this fairly cheap and you get it from
Amazon, this is a medium. Anything lighter than that you’re probably not going to
get enough stretch anything stronger than that and it’s probably going to be
too strong. So anyway with the band find somewhere in the gym that you can hook
it up or somewhere at home. Once you’ve got it attached, looped over something above
you put your hand through the band turn your palm up, face away from the band. Now
right now I’m close to the band so there’s hardly anything any stretch going
through my arm. Straighten out your arm lift your chest and gradually step away
from where you’ve attached the band. You should feel this stretch around the
front of your shoulder possibly even going into your bicep. Once you’ve done
that same set up for the next stretch put your hand through turn away and lean
forward this allows you to get your arm bent behind your back. With your free
hand hold onto your fingers of the hand that’s through the loop and then step
away and as you step away gradually lift your chest and what you want to try and
do is pull this arm this elbow away from your body. Once you finish, step back lean forwards
and allow yourself to come out of the band. And the last stretch I think you
guys should probably do is this one up into full flexion so get your arm through the
band, take it out in front of you and gradually walk forwards keeping your
arms straight until you feel it stretch and just try and push your chest and
head through. So here’s something else I really like
using 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 those
small muscles will be perfect. I like these because they get into those small
muscles that are hard to reach when you’re using a foam roller. So what
you’re going to do is try it and get into your rotator cuff. The principle is
that you find a tender point press into it and hold in that position. If you hold
long enough that pain will start to disappear. So to get into your rotator
cuff get the ball, place it underneath your arm, with your free hand pull so
that you can get this ball further around behind you.
Then come up against a wall and press in against the wall. Move around until you
can find a tender point once you have a tender point
just stay there, relax and apply some pressure. Maintain that pressure until
that pain starts to go away or you’ve done about a minute. Once a minute has
passed move to a different point and repeat the process again. Then to get up
into these upper muscles you need to do a bit more contortion, so place the ball
up and over but this time you’re going to have to lean back into the wall. Lean up
against 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 stretches
and the massage balls. I would suggest you do either of those in alternate days
so for example strength band stretches you could do on a Monday Wednesday and
Friday and the massage balls you could do on a Tuesday Thursday Saturday. And
the reason I say this is because if you do either of them too much you’re
only going to make yourself quite sore in terms of how long to do them for I would
suggest 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 then
the next one for about the same amount of time and then repeat maybe another
one or two times after that if you have time. For the massage balls find those
tender points that I talked about hold it on there for about 60 seconds and
then move on to another point. Hopefully you found this video really helpful. If
you did guys give it a thumbs up, if you have any comments or questions do stick
them in the comments section below and until the next video take care guys and
I will see you soon. Bye bye

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