This article is a transcribed edited summary of a video Bob and Brad recorded in May of 2021. For the original video go to https://www.youtube.com/watch?v=9FRleYEHkXA&t=390s
Bob: Today we're going to talk about the danger if my shoulder clicks and pops. Learn why and how to fix it, we're going to cover it all.
Brad: That's right, Bob, we're going to carry on.
Bob: We don't want a noisy shoulder.
Brad: Okay, let's go on with these shoulder problems because it's not uncommon for people to have clicks and crackly shoulders. And people get concerned, is this something I need to see the doctor about? Very good concern, and it's possible, yes. But we're going to explain to you why you may have those clicking and popping in your shoulders. Sometimes it's just like grinding. 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.” Or it could be something like a clunk, clunk, or pop, whatever, there are several different reasons that we're going to show you why this can happen. It can make you feel better just knowing that your shoulder is not literally falling apart.
Bob: Well, we'll show you some things that might help take it away too.
Brad: Absolutely, that's going to be a little bit later.
Bob: A lot of times, you don't actually hear it, you feel it, the grinding. Okay, let's show what some of the causes could be.
Brad: Sam is going to be grateful and happy to help us out. So, we're going to look at the shoulder. If you're going to have these noises and whatnot, they're going to come from the ball and socket of the shoulder joint typically. Here's the socket which is a very shallow socket and then the nice, rounded ball on the humerus.
Brad: Keep in mind, it doesn't look so clean, it has a lot of connective tissue around it. And that can start to cause some of these problems. We'll get back to that.
Bob: One of the problems, 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 going to show that, right, Brad?
Brad: Exactly, so this represents a tendon coming through from the supraspinatus, and that comes over, and connects to the humerus. Now sometimes that tendon can slide back and forth.
Bob: That can make a sound.
Brad: Right, also there's a tendon toward the front that goes for the bicep tendon, and that can pop back and forth.
Bob: Yep, or it can also get squished right there under the acromion. And that can cause noise after a while after it gets scar tissue.
Brad: Exactly, so along with it are arthritic changes. Let's say the ball of the socket is getting arthritic.
Bob: It's getting flaked.
Brad: Yeah, it's not smooth anymore, it becomes rough. And that can also be that Rice Krispy sign.
Bob: And then there's the labrum.
Brad: The labrum which we did mention already, but we're going to show you. This brown rubbery stuff represents a capsule and some other tendons. But right here’s a labrum, and that's kind of like a cartilage material. And sometimes that can rip, Chris has one of these, it's been confirmed. And that'll make a clunk sound.
Bob: 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 put pressure on that labrum. It's just not working the way it should.
Brad: So obviously, number of reasons. Now, sometimes these can be bad enough that you may need surgery, but the big rule of thumb, is 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.
Bob: Sometimes it's a precursor to pain. I mean, I would like to take it away if you can.
Brad: Yes, and we're going to show you some good rules on how to do some exercises and how to correct it before it turns into a problem.
Bob: One other thing, Brad, we forgot to mention is the shoulder's not going to work the way it should either if the rotator cuff, the four muscles around the shoulder, they're not working as they should. So that's why Brad's going to show a strengthening exercise too.
Brad: 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 noises.
Bob: Yeah, and if the rotator cuff is working as it should, it should rotate the ball correctly and not cause problems.
Brad: Exactly. All right, so, here we go. The first thing we can look at is posture. It all boils down to the fundamentals. If the posture is not right, the mechanics aren’t going to be right.
Bob: Look at this, if I'm rounded out and I bring my shoulder up, that's as far as I can go. But now if I straighten up. Look how high my shoulder goes now.
Brad: You get about an extra 20 degrees of free mobility just by changing your posture.
Bob: Right, and this is also causing it to impinge, which can lead to some of the problems we were just talking about.
Brad: Right, so you look at your posture, and sometimes you can take a picture of yourself when you're not aware of yourself or have someone tell you, and you might find that your shoulders are forward and you're not aware of it. And we need to bring them back. So, just squeezing back, I would call them W's, if you bring your arms back, squeeze your shoulder blades behind your back, and do 10 of those throughout the day.
Bob: That's the first exercise I give patients, is I tell them, go home, and start doing some of these.
Brad: You can use a wall, and try to touch your elbows to the wall and hands to the wall. That way you kind of know where you're at, you might start out not even being able to touch the wall. And the goal is to get back there. My left side is always tighter. I work on that myself.
Bob: I can tell.
Brad: Yeah, exactly. So posture, look at that. Number two is we're going to look at two specific ranges of motion that you'll see. One is flexion, we talked about that, going up in front, or extension, going back.
Bob: You compare one shoulder to the other shoulder if you have one that's better than the other.
Brad: Let's say, my left shoulder is the good shoulder, and the other has the clicking and popping. The left shoulder goes all the way up, and the right shoulder goes up two-thirds of the way and it might start the click or pop or maybe that's all it goes or a combination, we want to see if we can get this range of motion back to normal. And we've got a couple of tricks to show you.
Bob: Yeah, we've got whole videos on this, but we'll show a couple of them right here.
Brad: Right, our favorite ones. If your hand only getting up part way, you can just take the other hand to help it.
Bob: Absolutely.
Brad: Start with posture, and then the good arm goes up and stretches the bad one. You don't push it into real sharp pain, just a little stretch pain is all and then go back down. Up and down and do those 10 times. And then do those three or four times a day. To get more aggressive, we like to use a stick.
Bob: Oh, you can hold the stick with the bad shoulder leading and bring it up. But I think you should show the Statue of Liberty.
Brad: Absolutely. So, let's talk about this one a little bit. The arm that is forward would be the shoulder that we need to stretch, then the back arm is doing the work, just relax the left. But the Statue of Liberty stretch is much easier.
Bob: Well, it's easier and it's more effective. First, you're going to start off, let's say you don't go up that high. You're going to work your way up a little bit. And then you can lean forward and put traction on the shoulder, so much more effectively. 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, 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 going to find out it improves your range rather rapidly.
Brad: And again, this shouldn't create any sharp pain, if it does, do not do it, it's just not the right stretch. Also, use a stick about four or five feet long with tips on the bottom so it doesn't slip or slide or poke a hole in your furniture.
Bob: Right, the Booyah Stik tends to have a nice grip by the way, and you can say Boo-yah.
Brad: Boo-yah! All right, and the other one is the extension, going backward. 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 farther.
Bob: This is one again you could clasp your hands and bring them back. Now, Brad has trouble with this one. So, he actually uses a towel. His shoulders are tight going back.
Brad: Oh yeah, I'm a tight-shouldered person. I'm not sure what's wrong with my shoulders, but they're getting better.
Bob: You probably don't want to reach for that wallet in your back pocket.
Brad: Well, hey, yeah, we want to keep it in there. Let's go to the next one.
Bob: Well, we just did the range of motion. I'm going to throw one more in there. How about hanging?
Brad: Oh yeah, once you get to the point where your range of motion has improved and you're almost there and it doesn't hurt that much, there's no sharp pain, but you want to get more aggressive to stretch it, just hang on a pull-up bar or something very sturdy that'll hold your weight.
Bob: Yeah, we have our wall anchors here, and we have a whole bunch of devices here. We have our pull-up system of ours, and you get three of these anchors with it, and you just put it in the wall anchor and then you can go ahead and just hang.
Brad: Yeah, obviously I wouldn't buy them just to hang, I would buy them to do pull-ups.
Bob: If you're going to do pull-ups too, this is the system you're going to want to get. Then we have the hanging handles. These are what you'd get if you just want to hang.
Brad: Yep, specifically for hanging.
Bob: And what's nice about it is you can start off by putting some weight on your feet and then eventually go to the point where you lift your legs up. It's good for your back too, by the way.
Brad: Yeah, it's good for decompression of the back. Good for posture, good for your shoulders, and hand strength. There are a lot of benefits to it.
Bob: Do you want to do strengthening it all, Brad?
Brad: Yes, I do. 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 core strengthening exercise. You're going to need something stretchy like a band and anchor it, we're using the wall anchors here because it works very well. And then we keep the elbow in and rotate out. The elbow stays in by the ribs, 90-degree bend in the elbow. Not extending the arm, not where the elbow comes away.
Bob: Yeah, a lot of times we would put a towel underneath the armpit.
Brad: 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 those, and then do those three times a day. Well, as it gets better, you can go two sets of 10, but the repetitions per day are probably more helpful.
Bob: All right, the final thing is I'm going to show you this one, this is more advanced. What I put up here is one of our looped bands, and these are for pull-up assists, and you can actually do a lot of moves with it. But this again, you're going to want to make sure you don't have loose shoulders or arthritic, like rheumatoid arthritis.
Brad: This is probably for a more active person.
Bob: Yeah, this is the active person, maybe a little bit younger. What I'm going to do is, 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 want to be too far over, I don't want to be over onto the scapula or the clavicle.
Brad: Right about where that black band is.
Bob: Yeah, there you go. See, that's going to pull the ball back into the socket. 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. After you do this a few times, the clicking stops.
Brad: Yeah, this is one, if you're a therapist and you're not aware of this, you may want to do this with your patients.
Bob: Yeah, and 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 by having it down a little bit further than have it too far up because then it's not working. So, a beautiful exercise.
Brad: It is. Since you have the big loop band, if you have those, I like the smaller one, this works well for doing that external rotation. So, you stand on it either one foot or both depending on how much resistance you want, keep your elbows bent at your sides, and rotate out. Be sure to use the right size band. You might use a smaller one like 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.
Bob: It's very mobile too.
Brad: Oh, it is, you can take the band with you.
Bob: Yeah, and you can snap people.
Brad: Well, they are fun, you must be careful. We don't want to recommend any of those childish things. We are a family show.
Bob: Right, be kind, take care.
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Where’s the video on how to use a message gun? I saw it once next day it was not there l didn’t open it