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Hey guys it's Ashley here. Shoulders are one of the most common
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reasons that people come to see me as an osteopath. The chances are you may even
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have a shoulder problem which is why you might be watching this video. In today's
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video I'm going to show you why I think shoulder problems develop and what you
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can do to try to fix your shoulder problems. But before I do that I need to
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just briefly explain the anatomy of the shoulder and some of the more
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significant features of the shoulder and why that's relevant to shoulder pain.
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Okay so what we've got here is a model of the shoulder complex. Right now what
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you're looking at is from the front almost like you've got my shoulder here
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and I've taken away everything all you're left with is the shoulder blade.
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This bony area here is your scapula also known as your shoulder blade. Here we have
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the collarbone which is also known as the clavicle and then your upper arm bone
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known as the humerus. All of these muscles that you can see attached are
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collectively known as the Rotator Cuff. The Rotator Cuff is made up of four main
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muscles. The first one is the supraspinatus, then you've got the
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infraspinatus, teres minor and teres major and then on the front side you've
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got the subscapularis. Collectively the rotator cuff pulls the head of the
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humerus in towards the scapula creating stability. Individually all of the
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muscles have slightly different functions. Starting with the
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supraspinatus it holds the humerus into the socket, tenses the capsule and
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abducts the arm. The infraspinatus also helps to stabilize the capsule but its
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main function is to externally rotate the arm. So if you were to bend your
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elbow and take your hand out to the side, that's external rotation. The teres minor,
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the one down here also weakly helps to externally rotate your arm. And lastly
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the subscapularis helps to medially rotate the arm or internally rotate, so
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opposite to the infraspinatus if you were to bend
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your elbow you would be taking your hand across your body towards your midline.
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The reason I mentioned these muscles is because most people I see are extremely
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tight. This causes a lot of strain to be put on the tendons because people having
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to fight against this tightness and one of the main areas that this irritation
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happens is up here in the supraspinatus. Irritation of the tendon leads to
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swelling and that swelling causes a reduction in space. So when people then
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start to abduct their arm that lack of space is causing people a lot more pain.
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All right so I've taken away all the muscles and now all you're left with is
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the joint in itself. The joint is known as a ball and socket joint so here you
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can see the ball and in here is the socket. What's significant about the
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shoulder is that the ball and socket is quite shallow. It allows greater range of
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movement in all directions but the problem with this increased range of
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motion means that there's actually a decrease in the amount of stability so
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people with hypermobility are often at risk of dislocated shoulders. The other
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thing that can happen in this region here, more so in older people is the
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development of osteoarthritis and unfortunately once you get to that stage
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there's not much that can be done from someone like me in the way of treatment
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and it usually ends up being more of a surgical procedure to try and restore
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some of the smoothness in that joint. So the next thing I want to just point out
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to you is this tunnel right here. This is where your supraspinatus muscle runs
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through. The supraspinatus attaches just above the spine of the scapula and runs
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through attaching onto the outer part of your humerus and the reason I mention
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this is because the supraspinatus is one of the most
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commonly irritated muscles in the shoulder region. So I've added all the
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muscles back on. Now as you can see the supraspinatus here is running through
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this tunnel but when you lift up your arm if I just take this out. When you
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lift up your arm that gap becomes a lot smaller and this is the reason why a lot
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of people get pain in their supraspinatus, because an irritation
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occurs on the tendon and then every time they lift their arm that closing in in
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size of the the tunnel causes a lot more pressure on the tendon. So let me just
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put everything I've told you into context for you. Most people who come in
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to see me have pain in this upper frontal region of the shoulder. To me
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that usually indicates that there's some kind of tendon ligament or Bursa issue
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and in my experience that is usually because people are extremely tight
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through the muscles in and around the shoulder. Most commonly that tightness
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comes from the rotator cuff muscles that I showed you earlier. In order to confirm
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whether it's tightness causing these issues I'll usually do a couple of tests.
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The first thing I usually get people to do is to show me their ranges of
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movement, so I'll get them standing in front of me and get them to perform
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complete abduction all the way up to the ceiling and back down and then following
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on from that I'll get them to lift the arms up to the front
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as far as they can and down, and what I usually see in most people is that
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they're quite limited in full flexion so when I look at them from the side their
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maximum range of movement is to about here. What I would like to see is full
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range of movement where the arm is right up by the ear. After that I'll get them to
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do the painful arc test and what you do is you stand arms down by your side
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and take your arm all the way up to the ceiling and note
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where they're getting pain If it's a superspinatus tendinitis or bursitis in
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this other upper subacromial region though usually feel pain between about
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40 degrees to about 120 degrees. Now the reason that that happens is because as
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you get to this sort of area here the space between the humeral bone and these
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the acromion is completely minimized like I showed you earlier. After that
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test I will get them to do the scratch test and it looks like this. What you're going
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to do is take one arm behind you and reach up as far up your back as you can
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once you've done that take that arm down do the same on the other side and then
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back down and note where both hands or both tips of fingers reach up. Quite
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often what you see is the side the shoulder that has the pain will be quite
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restricted and will not be able to go as far up as the good side. Now on the
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demonstration that I just did what you might be able to see is that my left arm
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can reach up my back fairly high but when it comes to the right side there's
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a lot less range which indicates that my right side is tight in either extension
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or internal rotation or even just a combination of the two together. This
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would indicate to me if it was a patient that they need to be doing more
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stretching in those ranges. So if you're having shoulder pain or shoulder
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discomfort definitely go through these tests have a look at your range of
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movement first of all see if you can get those arms all the way up to the ceiling
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if you can't you know your tight. Then take your arms behind you do that
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scratch test. If you're struggling to get your arm behind you then that's an
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indication that there's definitely tightness in the front or in the rotator
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cuff muscles and that will mean that you need to then stretch in a more extension
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or internal rotation. And since we're on the subject of stretching I'm going to
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show you now some really effective stretches that I prescribed my patients
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all the time and also how to use some massage balls to get into those tight
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areas too. The first stretch that you're going to need to do involves using one
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of these which I believe is called a power band or a strength band. You can
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get this fairly cheap and you get it from Amazon, this is a medium. Anything lighter
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than that you're probably not going to get enough stretch anything stronger
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than that and it's probably going to be too strong. So anyway with the band find
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somewhere in the gym that you can hook it up or somewhere at home. Once you've
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got it attached, looped over something above you put your hand through the band turn
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your palm up, face away from the band. Now right now I'm close to the band so there's
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hardly anything any stretch going through my arm. Straighten out your arm
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lift your chest and gradually step away from where you've attached the band. You
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should feel this stretch around the front of your shoulder possibly even
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going into your bicep. Once you've done that same set up for the next stretch
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put your hand through turn away and lean forward this allows you to get your arm
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bent behind your back. With your free hand hold onto your fingers of the hand
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that's through the loop and then step away and as you step away gradually lift
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your chest and what you want to try and do is pull this arm this elbow away from
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your body.
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Once you finish, step back lean forwards and allow yourself to come out of the
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band. And the last stretch I think you guys should probably do is this one up
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into full flexion so get your arm through the band, take it out in front of you and
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gradually walk forwards keeping your arms straight until you feel it stretch
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and just try and push your chest and head through.
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So here's something else I really like using and that is massage balls. This is
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a lacrosse ball but a massage ball, Lacrosse ball, hockey ball, anything that's
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hard enough to get into those small muscles will be perfect. I like
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these because they get into those small muscles that are hard to reach when
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you're using a foam roller. So what you're going to do is try it and get
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into your rotator cuff. The principle is that you find a tender point press into
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it and hold in that position. If you hold long enough that pain will start to
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disappear. So to get into your rotator cuff get the ball, place it underneath
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your arm, with your free hand pull so that you can get this ball further
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around behind you. Then come up against a wall and press in
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against the wall. Move around until you can find a tender point once you have a
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tender point just stay there, relax and apply some
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pressure. Maintain that pressure until that pain starts to go away or you've
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done about a minute. Once a minute has passed move to a different point and
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repeat the process again. Then to get up into these upper muscles you need to do
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a bit more contortion, so place the ball up and over but this time you're going to
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have to lean back into the wall. Lean up against the wall, again find those tender
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points, hold and stay for about a minute. So that's pretty much all I'd recommend
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for now guys. The strength band stretches and the massage balls. I would suggest
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you do either of those in alternate days so for example strength band stretches
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you could do on a Monday Wednesday and Friday and the massage balls you could
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do on a Tuesday Thursday Saturday. And the reason I say this is because
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if you do either of them too much you're only going to make yourself quite sore in
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terms of how long to do them for I would suggest doing each banded
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stretch for about 15 to 30 seconds, then move on to the next stretch for
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about the same amount of time and then the next one for about the same amount
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of time and then repeat maybe another one or two times after that if you have
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time. For the massage balls find those tender points that I talked about hold
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it on there for about 60 seconds and then move on to another point. Hopefully
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you found this video really helpful. If you did guys give it a thumbs up, if you
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have any comments or questions do stick them in the comments section below and
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until the next video take care guys and I will see you soon. Bye bye