 Welcome back to Movement Matters. I'm your host, Christine Linders, physical therapist and board certified orthopedic clinical specialist. Today, we are kicking off my Unbreak Your Body series with Everything Shoulder. You will learn everything you need to know about your shoulder, how it works, and what has led you to suffering rotator cuff tendonitis or a tear, bicep tendonitis, shoulder impingement, or even neck pain. You'll also learn what situations or postures are making your shoulder joint vulnerable, leading you to pain or injury. Let's go to video number one. Welcome to Waimanalo State Beach, where we are gonna kick off my Unbreak Your Body series. Session one is Everything Shoulder. So in today's episode, you're gonna learn everything about the shoulder, why you have rotator cuff tendonitis or a tear, how you got a bicep tendonitis, why your neck hurts when you're working all day, et cetera. The shoulder is a complex joint and it relies heavily on the mechanics of the shoulder blade or the scapula in order to function properly. So when we are hunched forward or leaning forward, this shoulder blade moves forward on your rib cage and then the shoulder becomes vulnerable and then your rotator cuff tendons and your bicep tendon, your serratus muscle, everything has to work harder in an abnormal position, leading to fatigue and eventual tendonitis or tears. Today's show, we're gonna learn everything about why you get your shoulder plane and what to do to solve it. Keep tuned. So why do we get shoulder pain? You could fall and get an injury. You can have a sports injury, but one of the main reasons why we have shoulder pain or injury is simple biomechanics. So you're doing something wrong. You may be in the wrong posture. You may have developed tight chest muscles over time, leading you to bend forward. It's all about biomechanics. So let's go to video number two where we learn more. It's important to understand the shoulder biomechanics so that you can understand which exercises may be appropriate to you. So let me give you a little bit of a lesson. So here is our little skeleton here and here's your shoulder blade, the scapula. Your rotator cuff muscles live on the scapula. Right in this fossa is a rotator cuff muscle. Right in here, your supraspinatus, the most commonly torn, runs under this little arch where my finger is and it can get pinched like that with this humerus, the ball of your shoulder socket, pulverizing underneath there. And also this is the coracoid process. Your pec minor right here in the front of your chest attaches from this, which is the front part of your shoulder blade down to your rib cage. So when you're slouching or not even slouching even, working forward surgeons, physical therapists, anybody typing on a computer, a new mom or dad, this muscle gets tighter and so it holds your shoulder blade forward like that. So now all your rotator cuff muscles here, living underneath your shoulder blade and over here on the edge of your shoulder blade and especially the supraspinatus that runs under here where my finger is, they are operating in a forward position. So it's so critically important to understand that your whole rotator cuff lives on your shoulder blade and if your shoulder blade is in an altered position, because you're tight packed because of what you're doing during your day, all of us do everything in front of our bodies all day long. You need to do these things to prevent injury. So one simple way is to stretch the pec minor out in your chest muscles to allow your shoulder blade to move back on your rib cage where it belongs. Now there's many ways to do it. You can lay on a foam roll. I have a whole foam roll series that I've shown before in these videos, but what I love is if you put your arms out like you're the letter T and you step into a doorway and your arms don't go bent, they stay straight and you do this and then you put one foot in front of the other. You know you can't see that. In a stride stance, lunge position. So one foot in front of the other, you bend the front knee and you already start feeling tension here. There should be no shoulder pain. And then the back foot raises up onto his toe, you lift your chest and you inhale and you exhale, come back. Bend the front knee, push up on the back toe through the door, lift your chest and breathe in, then you switch legs. I can probably squat a little bit here for you to see better. So you bend the front leg, push the toe, lift your chest and stretch. You can also turn your head a little bit towards the right. You'll feel a lot more. So I started to tell you before the video cut out that if you turn your head a little bit towards the right, you'll start to feel more stretch on the left. So you just angle your body a little bit, take another deep breath in, lift your chest, release that left pec minor, maybe three breaths as you lean through the door. No pain, you don't want shoulder pain only tension right in here like the front of your chest region. And you could feel tension in the front of your shoulder but no pain. And then you switch sides, lean through the door, take a deep breath, stretch the right side out, really open that up. It's so important. So I wanna ask everybody watching, have you ever had pain when you went to reach out to the side to hit the alarm clock or grab something out of the fridge or have you had pain where you go to lift your shirt up over your head or take your shirt off or wash your back in the shower? All those little symptoms are telling you that something is off with the mechanics of your shoulder especially if you haven't had an injury and it's really important to pay attention to. So you just learn about how to open up your chest to get the ball better on the socket which is the humerus, your shoulder bone sitting better on the scapula which is the shoulder blade oftentimes many medical professionals, definitely physical therapists talk about this tiny golf tee with a ball, a big like tennis ball sitting on top of it. So the socket that the shoulder sits on is very small and so you need all of your rotator cuff muscles and your scapular stabilizers and a couple other critical muscles to really help keep that functioning well. So let's go to video number three to learn about the unsung hero of the shoulder which is the serratus anterior. The serratus anterior muscle is the unsung hero of the shoulder and the shoulder blade complex and the reason why is because it stabilizes your shoulder blade on your ribcage and all of your rotator cuff muscles live on your shoulder blade. So without the serratus anterior you can't have the stability that you need to be moving your arm around like that. People will have shoulder blade winging or it will move in an erroneous fashion. So the serratus is one of those muscles that can be very frustrating to strengthen because it basically, if you're gonna use it as one action it does that like a punch forward with a straight arm. So some things that you can do that I feel like are watching grass grow but they're very important are a shoulder blade wall pushup. So you get on a wall in a plank position suck your stomach in to keep your spine safe and you push your thorax, your torso away. It is not a pushup. It is a push away. You round your upper back, push away, push away, push away. Another thing I like to do is put a band around your wrist and pretend like there's a chicken foot and you're gonna go up, out to the side. So you get in that position, you tension the band wide like this and you're basically gonna hold, push away. While you're away, you're gonna move the other hand up, out into the side. So it would kind of look like this if you could see right here but you're gonna be on the wall. You're gonna push away and go up here, side. And the whole time this shoulder right here is pushing away and holding that while you move this one out. So you would be standing here, push away, hold away and out, up, down. I do five times reset, push away and hold that up, outside. Another thing that you can do that feels really good is just take a band and put it behind your back so it stays flat like right around here. Grab some tension in the band and push away. Push away into the resistance. Push away into the resistance. Those are great exercises to work your serratus in standing. These are great exercises that I wanna give you as many options as you can to strengthen the serratus anterior. Some people actually get neck pain that kind of runs from the top of the shoulder blade up to the base of the head and that is usually indicative of a scapula or a shoulder blade that is not quite sitting on the ribcage and it can be for many reasons that it's not sitting properly on the ribcage but one of the reasons is a serratus anterior not being strong enough to stabilize it there. There's other muscles, your rhomboids, your trapezius muscle that will help that but the serratus is often the one that I see in the clinic and people with shoulder pain that has been missed or forgotten when it comes to strengthening. A lot of us like to do rotator cuff strengthening, scapula strengthening, but this muscle lives under your shoulder blade and attaches to your ribs. So those exercises that you saw, they can be a little frustrating. They're definitely tedious. They can be forgotten. So let's go to video number four to learn a few other serratus exercises for ya. Two great serratus anterior exercises to get you started while you're lying down are these. You wanna get a band loop and put it around your hands like this. So what you're going to do is you're gonna reach the ceiling but you're gonna push. You can see if you can see it, butter. You can push out into the band here like you're opening the band like this. Out into the band and then you raise and reach up towards the ceiling as you move over your head. Reach up toward the ceiling and you go from about this angle up toward the ceiling. You're not back here up towards the ceiling. Engage that serratus anterior. Reach up towards the ceiling. Another favorite I like to do is to oscillate it like this. So you reach and you oscillate. Get that muscle going. Get some of your rotator cuff stabilizers going. Work the proprioception. Reach toward the ceiling the whole entire time. It's a great exercise, very easy on the shoulder. So those are a couple of great ways that I tend to start people off on your back where you can get the proprioception of your shoulder blades touching your bed or touching the floor and you can feel them moving forward on your rib cage off of the floor while you do these exercises. But also I start many of my patients that way because they're laying down and so gravity is off the rotator cuff. So if you're suffering a rotator cuff tear, impingement, bicep tendon pain or in general shoulder pain, doing things sitting with your arms out here is more difficult because now gravity is putting a load and your body needs to react to that to hold the arm in the air. But when you're laying down, your shoulder or your arm is directly in line with gravity with those exercises. So it's a great way to get started. I found it to be the only way when someone had severe shoulder pain to get them to work the serratus without pain, which is very important. I wanna highlight that point. Okay, so you learned about serratus. You learned a little bit about how your neck can be hurting you if you're sitting in a slouched posture. Let's learn about some rotator cuff exercise that you can do in video five. These exercises are a must for anyone who has rotator cuff trouble or weakness in their shoulder blade. You need to work your rotators. So you lay on your side. This is a three pound weight. You can put your arm here and you rotate it down and up. I tell people, it's not about how far you go up. It's more that you can do it without pain in and out. So if you can only go this range or you could only do it without a weight, that's what you need to do. You might need to put a little roll between your arm here to increase some space so your supraspinatus tendon doesn't get pinched if you're having a lot of inflammation, bursitis, or you have impingement. That's a great one. Just sideline external rotation. The other one I like to call clocks is you lay here on your side and you punch forward to get your serratus involved and you do circles with the weight. So I tend to go up from the horizontal a bit and I'll do 20 circles, making sure to reach forward 20 circles one way, 20 circles another way. And the reason why I like to call it a clock, my friend Tammy gave me this exercise is go from horizontal to vertical up and down. So if you stamped a clock on your head, this would be three or nine o'clock depending on which arm you're doing. Horizontal towards vertical. Then you go up to about two o'clock. Horizontal to vertical. Horizontal to vertical. Then you go around one o'clock which is about eyeball a clock I say. Horizontal to vertical. Then you go to 12 o'clock which is straight up over your head. I like to do those. So if you're gonna watch from behind, this is how it looks. So the first one, external rotation. Work that rotator cuff. It's a great post undo the sport exercise for any paddling, surfing, volleyball, tennis, anything. Pickleball. And here's the clocks. You punch forward, do your circles just above the horizontal 20 times one direction, 20 times the other direction. Then you do your clocks. You reach forward horizontal to vertical. Horizontal to vertical. Three or nine o'clock then you're moving up. Two o'clock. Working that shoulder blade complex, working your rotator cuff. And enjoy a better feeling healthy shoulder. I know I'm giving you a lot of exercises but you can go through this video many times to digest the material and pick a few of these exercises. The next video I'm gonna show you is gonna show you some of the very simple ones that help you improve your posture which improves the position of your shoulder and your shoulder blade as well as activating the serratus and activating your scapular muscles to help you. Let's go to the next video. These are a few more of my favorite exercises to help you get a well functioning shoulder. So to start, I often have people just with their palms up or their thumbs up usually palms up, rotate their hands apart. There should be no pain. Squeezing your shoulder blades is the key. Squeezing your shoulder blades, helping to work the scapular muscles and the rotator cuff muscles. You can do it with a band or not. The key is that it's pain free. So if you're gonna use a band, palms up, rotate away. Keep your elbows in, let your shoulder blade squeeze, initiate the motion. Also, if you wanna get rid of some of the neck tension, this is one of my favorites that I've done after work for years. You take the band and you reach up to get the serratus in volume and then you get the scapular muscles and the rotator cuff, lift your chest to the band. Lift your chest up to the band. So the key is not to have your shoulders hiking up like this. To keep them down and your neck long to really work the scapular depressors, the ones that anchor that shoulder blade onto your rib cage and also pulling the band out helps to work your rotator cuff and get the tension out of your neck if you've caught yourself hunching. Another one of my favorites that works the scapular muscles and it really is great for posture is if you tie a band onto a railing or around a bar and then you pull your hand straight back. So what I'm doing is I'm lifting my chest, pulling the band straight to my thighs. You don't wanna pull the band past because you don't wanna strain the front of your shoulder here. You just wanna lift your chest, pull the hands back. Lift your chest, pull the hands back. If you wanna get a little extra lower trapezius you can rotate your thumbs back like that as you go and really feel that tensing in the back of your body, pull. Another favorite that has helped me with my shoulder pain over the years that will work your serratus as well is to, let's see, I'll show you here. Hold the band in one hand here and then you just lift your chest to get in the proper position and pull and slowly release. Pull your arms straight to your hip and slowly release. So from the side, without the band, it would look like this. You don't start here, you're up here. You pull the band straight and release. Pull the band straight and release. That is great to get your shoulder blade functioning so it can sit on your rib cage and help your rotator cuff. Now if you just have some neck tension because you've been leaning forward at work or you're caught yourself hunching, what you wanna do is stretch the muscle that runs from the top of your shoulder blade to the base of your head and how you wanna do that is not pulling your head just to the other side. I found a great way to do this and that is to pull upward toward the ceiling to elongate the libator scapula, that same with the muscle and then you pull your head over. So the key is to pull up and elongate the neck and then pull over and then you can look down to your armpit to get even more of a stretch back here. Enjoy. I have had five shoulder surgeries. I grew very fast when I was a youth and I dislocated my shoulders left, right and center and so I have had five stabilization surgeries to kind of keep my ball on my socket because all those ligamentous tissues got too stretched out. So I rely heavily on all these exercises to keep my shoulders stable so that I can help people with their bodies in the clinic every day. And I think sometimes these videos and these instructional videos might seem random. I'm talking about the neck, talking about the shoulder blade, I'm talking about the shoulder but I have lived this for, I don't wanna say how many years. So I know all the best things to do to keep your arm functioning. So I want you to really like pick those exercises, grab the band, pull straight down. This has taken me years and decades to find the best ones that you can do just say like five exercises versus 30 exercises, the most effective exercise that the majority of people will get maximum relief from. So I hope you get to watch this video over and over and over again. One of my patients favorites is the next video, video number seven, which combines everything. Now let's really improve that posture. Let's get that shoulder blade sitting up on the rib cage so that your shoulder can be supported. You can take a band and hang it up over the door and put a knot in it. I know you can't see it yet but you will in a minute. You sit with your back to the wall, elbows wide and you're gonna squeeze and pull your shoulder blades down like that. Pull your shoulder blades down, anchoring those shoulder blades onto the wall, long neck, excellent for working that scapular stabilizers, keeping all the tension out of your upper traps, out of your neck. If you want, you can also face the door and lean in a little bit. Lean forward, pull your elbows straight down, like you're shoving your shoulder blades into your pants pocket. Long neck, shove those shoulder blades down into your pants pocket. That is a favorite one of all of my patients. But also if you wanna help your neck because you've been hunching a little bit over the desk or over your job to give yourself some support and get rid of your neck pain, you can grab your thumb and your first finger right here. So the band is wide and you're gonna put it right in the back of your neck, right here. And then you're gonna straighten your arms. You don't wanna let the band pull your head forward. You wanna push the neck back into the band and then you could also punch your shoulder forward. That gets your serratus. So you're not only getting your neck stabilizers, you're getting serratus. And then you are going to open your arms a little bit to the V position and then close. Open close, open close. I usually do 20 times. Make sure it doesn't pull forward, push your head back. Then you can also turn your head to the right, turn your head to the left to really stabilize those muscles on your rib cage, get your shoulder healthy and give it a some neck pain by improving your posture. I thought it would be fun to pull some of the other amazing physical therapists that I know to see what their favorite exercises are for the shoulder. So Kiao at East Oahu Physical Therapy where I work, my coworker gave me this one as a warm-up. So you basically start, I'm gonna move back here a little bit. You basically stand up in the mirror and you keep your elbows in and your hands straight ahead. So you're aligning, you're keeping your shoulder blade in and you're not gonna hike your shoulders here. And you are gonna keep your shoulder blades down like you're shoving them into your pants pockets and then you slide up and then you slide down. And see how this elbow, whoops, this elbow is flaring out a little bit. That's the one I had three surgeries on so I'm still recovering. But you wanna keep the elbow in and develop those proper mechanics. You don't wanna see like hiking up like that. You don't wanna see the elbow flaring like that. You wanna try to develop the mechanics. So if you can only go this high with your elbows in and come down, that's okay. You're trying to improve your biomechanics. That's what we learned is the secret here to having a healthy shoulder. So again, don't let that flare out. Keep it in, watch yourself in the mirror like I'm kind of watching myself in the camera to do that. So that's from Kiao at my job. And the next video, video number eight is Chris Krug, a physical therapist here in the islands at Krugpt.com to show you some more advanced shoulder exercises. Most shoulder pain solutions are eventually going to involve strengthening of the rotator cuff. One of the most common ways to strengthen the rotator cuff is with a piece of therapy and you just pull out and slow control back in two sets of 10 roughly. But if you're an overhead athlete, your rotator cuff really needs to be strong up in this position. So baseball players, tennis players, or just someone who works overhead a lot. Then an option for you may be to step on the band. I like to use the opposite foot. Bring your shoulder up to almost shoulder height, not quite, and your elbows bent at 90 degrees. From this position, you're just going to do the exact same motion, but in an elevated position. And again, controlled motion. And that should strengthen your rotator cuff up in those elevated ranges that you need as an overhead athlete. I know that exercise all too well because it kept me on the volleyball court and swimming for more information. You can check out Chris at Krugpt.com. But thank you for sending in that video to me. And the last video that we're going to look at is from my coworker, Reina, at East Oahu Physical Therapy, where she shows her favorite shoulder exercise. This is a great exercise. So the reason why she has the blue band around the arm is I'm actually pulling back into that band to set my shoulder blade on my rib cage. And then I'm working the rotator cuff that Chris Krug showed you in that previous video. So it's advanced exercise. If you're an athlete, a swimmer, any kind of arm use athlete, that is going to be an exercise that you need. And again, I'm making sure not to hike my shoulder blade. I am retracting my shoulder blade back into the band here and then moving here, it's not this. So it's all about fine tuning these little muscles to stabilize your ball on the socket or your arm on your shoulder blade, which is sitting on your rib cage. So I hope you've enjoyed some of those videos. We do have a couple of questions. I have a rotator cuff tear, do I need surgery? So not everyone that has a rotator cuff tear needs surgery. Oftentimes you'll go to physical therapy first and you'll fix those things that you need, like fix your posture if you are hunching forward. And now your shoulder blade is forward on your rib cage. You need to fix your posture. You need to stretch that pec minor muscle if you're in front of you, like one of my friends is dental hygienist. She has a lot of shoulder pain because she's leaning forward and bending. And she has to undo her job every day by stretching her chest and re-educating her shoulder blade muscles and her rotator cuff and her neck in all of those exercises that you have seen before so that she doesn't have pain or have injury. So if you have a rotator cuff tear and you are able to go to physical therapy and fix all those things, you may be able to not have surgery and that is what we call a coper. You end up being able to move your arm perfectly without pain and do everything that you wanna do. Other times the tear is too severe. You're a non-coper and you fix everything but you still have pain or you still can't do your desired activity. And then you go have your surgery but you go have your surgery and you're more likely to have success with the rotator cuff repair and avoid future pain and impingement because you have corrected your posture and gotten the mechanics to be healthy. Okay, the next question is I don't understand what my posture has to do with my shoulder pain. Okay, so I think I might have answered that for you. And how long should I spend doing these shoulder exercises every day? So I just had a challenge for all my patients and family and friends on October 1st. I said, I think every day people should try to do seven minutes timed of some sort of physical therapy exercise whether it's shoulder blades, greases for your posture, the W stick them up, doing some calf stretches or pec stretches or something for your body. So it takes me 15 minutes to do my whole routine after volleyball. Maybe it's a little bit less than that but I do spend 15 minutes doing it. Some days I spend five minutes. Sometimes it's two minutes in between patients where I do that one band that I showed you from high to low to kind of undo my posture. I just wanna make sure that you do something better for your body so that you can unbreak your body and feel great. If you have questions or you would like to email me you can email me at clindersrun at gmail.com. If you have ideas for my unbreak your body series I would love to hear it. Thank you everyone for joining us. Thank you to ThinkTekHawaii and all our sponsors and donors for allowing us to be here today. Mahalo, life is better. We need to listen to your physical therapist.