This article is a transcribed edited summary of a video Bob and Brad recorded in April of 2023. For the original video go to https://youtu.be/I0ioJTAkQhg
Brad: All right, we are honored to have two guest speakers here. They are students from my alma mater, UW LaCrosse. About a hundred years ago, I graduated from there. These two people are going to be doctors of physical therapy in about a year. This is a wonderful thing for old therapists like me to get fresh new information from the research that has just come out. And what's the video going to be about, Kyle?
Kyle: Yeah, thanks. Today we're going to be looking at shoulder impingement, talking about what it is, looking at the anatomy and what we can do for it.
Elisabet: And finding out that maybe it's not the impingement at all, maybe it's just muscle imbalance.
Brad: One way or another we're going to show you exercises and techniques to get rid of it. And I'm sorry, it's Kyle and Elisabet. Very good. If you want to go with your whole name, that's up to you because this is going out to the whole world.
Kyle: Well, that's pretty dangerous. But I'm Kyle Terhark.
Elisabet: I'm Elisabet Pletz.
Brad: Very good. We'll be right back and show you everything you need to know. All right, Kyle, can you give a little demonstration on the mechanics of this shoulder pain?
Kyle: Yes. So we're going to look at Sam here. We're looking inside his shoulder. What we're looking at with impingement, or what people think of impingement, is there's something actually blocking. So as the arm comes up, the bone jams in there and gets blocked from going up overhead.
Elisabet: Ouch.
Brad: What's your finger doing in there?
Kyle: This shouldn't be there, right? That's just an impingement. But this is the idea that there's something in there. And quite honestly, there's not anything in there. There's something else going on.
Brad: There's some soft tissue in there, maybe a tendon that's getting pinched and it causes the pain.
Kyle: That's the idea.
Brad: Right.
Kyle: But more research is saying that's not actually what's going on.
Elisabet: So I want to bust that myth for you, guys. So if you can try this at home, if you have that shoulder pain that hurts when you lift your arm out to the side to about 90 degrees and it's like, "Oh, ah!" If you try and move your arm up here and "oh," that's where that pain is, try and take your arm and put it next to your body and raise it. If you're able to get your shoulder up higher than you were out to the side, then what that's saying is the bones are going through the same thing in both positions, but the weight of your arm is heavier with your arm straight out than in. So what that tells me is it might be a bit more of a muscle imbalance.
Brad: So can you show them how to correct that?
Elisabet: Yes, that's what we're going to do today.
Brad: Say no more. All right, so this is exciting to me because this recent research shows that people oftentimes may not need surgery on their shoulders. And I'll just give it to these experts because they have read the research in detail.
Kyle: So there's some new research coming out that's pretty interesting. And so, it's a study where they looked at people that had the surgery and people that had a fake surgery, and they looked at the differences between them and there was very little.
Brad: So what do you mean a fake surgery?
Kyle: So a fake surgery. So if we can pull your shoulder up here. Elisabet's going to draw essentially the scopes. So the scopes are just little holes they put in to basically put a camera in or to put an instrument in to try and work on either cutting, cleaning, whatever they do. So they put these little holes in there. And so with the fake surgery, what they did is they put these holes in and then they didn't do anything. They just came right out. They bandaged it up and sent them down the road.
Elisabet: And they sent the people home and they didn't know if they had the surgery or not.
Brad: But they did have the scars.
Elisabet: But they did have the scars.
Kyle: And they found that down the road, the people who didn't have the surgery were doing better than those with it. It was just kind of one of those, "That's gym class for your situations."
Brad: So it's a placebo?
Kyle: Right, exactly. So some people got the surgery, some didn't, and those that didn't actually did better.
Brad: Well, that is amazing to me. So anyway, let's go on and show you some exercises and some more information on how to improve your shoulder. I'm feeling better already.
Kyle: That's just the ink. That's all that does it. All right, so this is going to be a stretch for the pectoralis minor, and that muscle is a very deep muscle on your chest. So it sits against your ribcage and attaches up to your arm. So a way that we're going to stretch it is if you have a nice home, you have a wall, we're going to put your arm up on that wall. And then you're going to go ahead and either step forward to kind of stretch the arm back or rotate your chest away. So think about turning away from the wall.
Elisabet: Kyle, does it matter which leg I step forward with?
Kyle: It doesn't make a huge difference, but the one towards the wall would be better because it's going to help get your whole body forward.
Elisabet: Oh yeah, I feel that.
Kyle: Perfect. And then, why don't you flip around? Do it on the other side as well.
Elisabet: Okay.
Kyle: Good. So here you step through it and then you can rotate your body away to add more tension through that muscle.
Brad: What does the research say about how long should this be stretched? Hold it for 30 seconds? Go on and off?
Elisabet: Usually I'll do it really what you're comfortable with. So all of this is based on where you're feeling those benefits and you're feeling that comfort. Usually, I start with 30 seconds on each side and go back and forth twice.
Brad: So listen to your body.
Elisabet: Listen to your body.
Brad: It should not create any sharp pain. If there is, it's a red flag, stop it. A nice comfortable stretch. Let's go to the next exercise.
Elisabet: All right, Kyle. So I want to show you a good stretch that you can do in the morning or the evening to just get some more motion going there in that shoulder. And it's called a sleeper stretch. So what you're going to do is you're going to lay on the side of your painful shoulder here, and then you're going to take this hand and you're going to move the palm towards the table. And then you can use your other hand and add a little bit more pressure. Just like with that last exercise, you're staying within what is comfortable for you. So don't push it down too hard, stay where you feel that nice little stretch and hang out there for a little bit. And then you can come off and just take a little break and move that shoulder around and go into it again.
Brad: So, the elbow, do we want it at your side or out in front?
Elisabet: We want it out in front. So you want this to be like a right angle with your body. Arm straight away from you as far as it can go.
Brad: What if it's his left arm? Still a right angle?
Elisabet: Still a right angle.
Brad: I had to get something in there.
Kyle: All right, so here's another alternative you can do to those sustained stretches, and that's using a tennis ball or a lacrosse ball. We're going to use a tennis ball here. It's got a nice little squish to it, so it's not very painful. And so, the way this is going to work is you're just going to put that tennis ball right where the muscle is.
Kyle: Good, right on that pec minor. And then using that fancy wall again, you're just going to go ahead and put your chest between or against the wall there and just press into that ball. And I want you to think about doing little circles or going up and down along that muscle. When you find a pretty tender spot, just stop on that spot.
Brad: I found it.
Kyle: You found one?
Brad: I found it. Yeah, right there.
Kyle: Perfect. So stop on that spot and do small little circles about the size of a dime right on that spot.
Brad: For how long?
Kyle: So that one, again, it's going to be a comfort thing, but about 30 seconds is great.
Brad: Sure.
Kyle: So this is just an alternative to stretching.
Brad: I'm comfortably done.
Kyle: Good. You felt a good spot there. And you can do the same thing right on the backside too. So just like that sleeper stretch we were working on, you can just put the ball between the wall and the shoulder.
Brad: Let's show them. Okay. So take your tennis ball, take your sock off, and put the tennis ball in your sock. Okay, now you see I've got matching socks and shirt. You do not have to have matching, but anyway, take the ball and we're going to put it back behind your shoulder. So it's much easier if you just have the ball in the sock, it's hard to get it in there without dropping it. It's a good way to control it.
Kyle: That's perfect. And so, you're doing the same thing as you were on that front side of just looking for a tender spot. Find it, stay on it, and do those little circles.
Brad: And I'm going to go in right by my spine. I don't know if it needs it for the shoulder, but it sure feels good.
Elisabet: Well, you've got muscles that connect to your shoulder that go all the way over to your spine, so it makes sense that working on your spine would help here too.
Brad: Right. Why don't you point out exactly where we want to work?
Kyle: Right, so we're working right here. You basically take the shoulder, go up a little bit, and right on the back. That's what we're aiming for. But feel free, to go all the way along the shoulder blade, go right along the spine. There are a lot of muscles that can get tender here. So hit all of those. It's not going to hurt anything.
Brad: All right, let's go to the next one.
Kyle: All right, so one more muscle that we're going to be looking at stretching here is called the serratus anterior. Now it's a fancy muscle. It's one of the coolest-looking muscles in the body, but it grabs on from the shoulder blade and wraps around your ribs. Just kind of a spiderweb or fingers coming around. And so, a way that we can think about strengthening this one is called a wall pushup. You're just going to get into 90/90 in front of the wall. So you got that nice angle. We're not getting the shoulders coming up very high when you do this. We're going to keep them down nice and low. Then think about pressing the elbows and forearms through the wall and think about getting your back as far away from the wall as possible. So you're going to be rounding your shoulder blades around.
Brad: So this is a subtle movement, and if we look at the shoulder blade of the scapula, it's going to slide on that rib cage and work those subtle muscles in there that you don't see. Do you feel them working, Elisabet?
Elisabet: Oh yeah, I feel them.
Brad: It's one of those exercises that doesn't look like much, but you will feel it work and it's very important to keep that shoulder blade stabilized.
Kyle: Exactly.
Elisabet: All right Kyle, so for that strengthening exercise for those small muscles around your shoulder, I'm going to have you put this towel underneath your elbow and wedge it between your body and your arm.
Kyle: Got it.
Elisabet: And then you're going to grab onto that band there, and then you're going to pull that hand away from your side, taking care to make sure that the towel isn't slipping or falling to the floor.
Kyle: Sure because If I let that elbow out and it drops, that lets me know that I flared that shoulder.
Elisabet: And that's telling me that you're using the wrong muscles. All right, so for this next one, this is just a progression of the exercise we just looked at. And for this one, you're going to take something and you're going to use it to support your arm so that it is straight out from your side. So you could be sitting next to a table, or a pile of pillows underneath your arm, and that'll elevate it up. And then this time you're going to be bringing that wrist up again like you were bringing it out last time, but now it's going to be raising up as if you're going to be bringing your arm back to throw a ball.
Kyle: And that one's a lot harder.
Elisabet: This one is a lot harder. So you want to make sure you're good at the one on your side first before you try and go up here. Or maybe use a little bit easier of a band.
Kyle: Whew!
Brad: How many reps did you say?
Elisabet: So for both of those, you're going to want to do eight of them three times. So three sets of eight.
Brad: All right, man, I'd like to say thank you for coming, for showing these excellent exercises and great research. You can goodbye or say hi to anybody you want.
Kyle: Well, thanks for having us. This was so much fun and yeah, this was really cool. Hi mom, how are you?
Elisabet: I mean, I always love talking about the new research and the stuff that's out there, so thank you so much, Brad, for having us.
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