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