 Aloha and welcome back to physical therapy for a better life. I'm your host, Christine Linders, physical therapist and board certified orthopedic clinical specialist. Today, we're gonna talk about the secret to having a healthy shoulder, a healthy rotator cuff. And we're also gonna talk about what to do if you already have a rotator cuff tear or tendonitis or frozen shoulder so that you can regain that healthy shoulder. So oftentimes when someone comes in the clinic and they raise your arms, there's lots of things that I'm looking at that a physical therapist will look at. So while you might not notice dysfunction when you raise your arms, maybe it doesn't go high enough or maybe it hurts when you get to a certain range, we are looking at a lot of the dysfunction from the back of your shoulder. So if we go to video number one, you'll see a little demonstration of what it looks like from the front. So from the front doesn't look too bad. The arms go pretty high. It's not 100% symmetrical, but in general, they go up and down okay. They rotate out to the side pretty well. It's not a whole lot of difference. But if you look at the left from the back, you'll see as the left arm lowers, the shoulder blade comes down a little sooner, especially in this image. And just we'll keep looking at this a little bit because also when you put the right behind the shoulder blade sticks on the back and you put the left, you see that lower part just pop off the back. Now I know to the not trained eye, it's not as visible. Like this probably looks perfect to most people. Maybe you'll see just a little bit of variance from side to side. This one, not so much, they look the same. But from the back now, if you look at the right, you'll see the shoulder blade come down kind of soon right there and it pops out on the bottom. And on the right, as I lower the arm, it pops across my back. This stays kind of stuck to the ribcage. This one wings on the inside. So this person had five shoulder surgeries from the time they were 17 or 18 years old. So if we go to video number two, you'll see in the second video, another gentleman, no shoulder surgery. Now if you look at his right side first, you can probably see a little bit of a difference from the video of the woman. Yeah, we'll just keep looking at the right side to start. Right side behind. Good, there's the left side behind. And then we're gonna watch it again and you're gonna look at only the left side. And so now you'll see the left side, there's a little bit of a popping out when he first raises his arm and it definitely comes down sooner. And the left side comes down sooner. And the left side looks like it's popping out on that lower angle. Right side looks okay. Left side all of a sudden you see this like struggle and it pops out on the lower angle. Similar to the woman who popped out in the lower angle. And so what I wanna explain to you is while shoulder range of motion could look good from the front, shoulder range of motion could just be limited in your range of motion. It's all about correcting the mechanics and that's why you wanna go see a physical therapist to correct your mechanics. So I got this little nifty skeleton here that I used the last time and I wanna explain to you about the shoulder mechanics. So I like to say that this shoulder blade here, which is called the scapula, is the quarterback of this shoulder joint. When this scapula, which we were just watching in those two videos moves perfectly on your rib cage or almost perfectly on your rib cage, this shoulder joint is very happy. And one of the reasons why, there's two reasons, but one of the reasons why is that there's a little joint right here that this ball sits on. And the joint is like a golf tee. It's a very shallow dish. And the ball is like a golf ball. So if you ever played golf or you know what a golf tee and a golf ball looks like, you'll know that the ball is much bigger than the tee and it overlaps the tee and it's very similar to the shoulder joint here. Now the biggest muscles in their little that stabilize this golf ball on the tee are your rotator cuff muscles and they live on the quarterback of the shoulder. They live on the shoulder blade. And so one of your rotator cuff muscles, one lives right here and attaches to the ball here. Another one lives down here and attaches to the ball here. And then from the front, there's one that lives underneath. You can't really see underneath between your ribs and the shoulder blade and that attaches to the ball in the front. And then you've got the most commonly torn one which is a supraspinatus and it lives right in this little dent right in here and it runs underneath these bones in this little hole and attaches to the shoulder blade. And so that is so commonly torn because people have a dysfunctional shoulder blade and this ball is banging into these bones and it's tearing the rotator cuff. Or if you are slouched forward, the shoulder blade is tipped forward on your ribcage and then this rotator cuff muscle has a longer way to reach to get to the shoulder and then you reach in the back of the car which by the way, I never do that, open the back seat or you go to pick something up out here and boom, you just tore your supraspinatus tendon. So I wanted to explain the mechanics of the shoulder because it is so critical to have this shoulder blade functioning properly. And because it's behind us, unless you have someone looking behind you, it's hard to really see what's going on back there. Oftentimes in the clinic, I'll take a video and say, give me your phone and I'll say, oh, I see why you hurt your shoulder or I'll see why you're still having shoulder pain. And you'll see something more than the two models in the demonstration that I gave today. It just so happened the week before the show, all I had was people who had shoulder surgery. So I didn't have anyone that could lift their arm for me to videotape. So I hope that helps. I also wanted to talk a little bit about bicep tendonitis too. Again, mechanics, mechanics, mechanics, you need a healthy shoulder blade motion and rotator cuff function to stabilize the golf ball on the tee and your bicep tendon, the big bicep muscle here goes and attaches up your arm in this little groove on the front of the shoulder, wraps in and attaches into the shoulder joint. And so if your rotator cuff has a tear and you're in physical therapy and your shoulder blade's looking great and you're still having pain, it's usually because this bicep tendon has to hold the ball on the socket. And so, so, so many times I get people with bicep tendonitis, if you're sitting forward at your desk and you're hunching or you have to reach out like to click a mouse because it puts the ball, your function is putting the ball forward on the socket and you don't know what that's doing to your bicep tendon. So this bicep tendon never gets a rest and you get this piercing pain right in the front of your shoulder. And so the solution is to work on all of the scapular muscles, opening your chest, getting mindful of your posture when you're doing things so that you can get the mechanics, the secret, fix the mechanics so that this rotator cuff tear or rotator cuff, whether you have a tendonitis, a tear, impingement will no longer get bumped in that arch. And so you can get the inflammation down and be able to be a coper. A coper is someone that we call that has a rotator cuff tear and they're able to go through all these exercises and get back to doing what they want to without having to have surgery. There's also non-copers. The tear is too severe and the physical therapies exercises don't work even when you restore the mechanics and they need to have surgery. And so we at physical therapy, we try to get everyone to be a coper or at least if it's a severe tear and we know you're not gonna be because of certain scenarios, you have a heavy lifting job or you work really overhead, lifting things overhead at your work, then we wanna strengthen and improve the mechanics before you go into surgery so that when you come out of surgery, everything is ready to go. Your shoulder blades better, your posture is better, you've learned everything of what not to do at home, at work, et cetera. So let's go to video number three where we're gonna show you how you can take care of your shoulders. So this is a little routine that I've done. I've had many shoulder surgeries for joint capsule repair when I was a teenager. And so this is regaining the range of motion. This is reaching up towards the ceiling, raising the arm overhead. I'm holding onto a little dumbbell so that it can help me. That works as serratus anterior and gets range of motion. This, you place a band around your hands, you reach up towards the sky, towards the ceiling and do tiny little pulses. It's a great way when you have impingement, a rotator cup tear, it is working your scapular muscles and the muscles that stabilize your shoulder blade on your rib cage. It's also helpful to have your pet roam around while you're doing this. This one stretches the muscle that's under your shoulder blade. So what the important thing here is to squeeze your shoulder blades back towards the surface you're laying on and let the weight fall out. Let the weight fall out. You can use a two pound weight. It should be pain-free to a five pound weight but don't do anything heavier. And this is exercising the rotator cuff and I'll go through this again when we loop but the top muscle is working your infraspinatus. The bottom arm is working my subscapularis and this is putting it all together. So you're reaching towards the camera going from about horizontal to vertical. It's teaching your shoulder blade muscles how to stabilize the ball on the socket while your arm is in a functional position. I also like to do little circles too because sometimes the motion of going from horizontal to vertical is difficult. So I wanna show you that, yeah, you reach forward towards the plants, you can raise up and down again. All of this has to be pain-free. This is the shoulder complex they call it, not just the shoulder, not just the shoulder blade. And so the last one that I think, our last series I show is now in function. A lot of people will do things at shoulder height reaching into cabinets, reaching for your job, folding laundry and so you need the rotator cuff to stabilize the ball on the T when you're at shoulder height. And this series is shoulder blade muscles. We call them eyes. There's a T and here comes the W and that is getting all those scapular muscles again so that you can strengthen your arm. And so I think that's good. I don't think we have to loop that one again but I wanted to explain and show you the routine that is something you can do on a daily basis or it can be something that you do pre-sport or post-sport. So I like to say that there's a warmup exercise that some people need to do before they golf if they don't have enough shoulder range of motion. So if your shoulder doesn't have enough motion then that first exercise where you're raising the weight overhead is great to prepare your shoulder for the task that you're about to do. If you are doing a golf stroke, let's say that you need to use your arms a bit more. I just learned of a new golf stroke one of my patients is doing. Or if you're a tennis player and you're gonna be using your rotator cuff, a volleyball player using your rotator cuff and you need a lot of shoulder stability then you may wanna do those rotator cuff exercises where I was laying on my side as a warmup and do a set of 20 to get your muscles prepared to succeed in action. Now, if you're a surfer on the other hand and you go and you do a bunch of paddling, paddling, paddling, paddling, paddling the whole entire time then you're gonna wanna do your undo the sport afterwards. So you're gonna wanna land your back and let those weights fall out and stretch all those muscles that you've been working so hard, open up your posture. You're gonna wanna do the pull backs because everything you just did was pulling forward. So you wanna balance off your shoulder after your sport. So there's lots of different ways that you can learn what your shoulder needs regardless of, I mean, depending on what kind of problem you're having or if you just wanna keep your shoulders healthy. I had a question come in that was asking about, okay, so I'm aging. How do I keep my shoulders healthy as I'm aging? Should I be swimming a lot? Should I be rowing a lot? Do I do high reps? Do I do high weights? What is the plan? And I am approaching 50 and I have had many injuries across my lifetime but I like to go with higher reps and lower weights as you age. And the reason why I say that the lower weights will be different for people that don't do sports and people that do do sports. So I have some of my patients who are aging and their lower weights are two pounds that they're doing to keep their shoulder healthy. I am a sports player. My lower weights are five pound weights and I tried to go six and it was too much. So I tell people with some of these exercises don't think that more is better. If you are healthily doing three sets of 20 with your five pound dumbbells which is what I was doing every time after my sports. I was doing it every day for about the last year and a half to try to get back to my sports after a shoulder injury and it worked great. And now I do about one set of 20 and I'm maintaining myself doing that but I had to add the three sets of 20 on a low weight which to me was five pounds but for other people, it could be two pounds that you're doing. So I wanna clarify that but it shouldn't be seven or eight pounds because it's a little bit too much. Those rotator cuff muscles where you're lifting the weights that way, they're very small muscles but they're also repetition, high repetition muscles, endurance muscles. So they need a lower weight for a longer duration, more repetition. So scapular muscles, the ones where I was bending down to in the I and the T and the W, those are larger muscle groups and they're power muscle groups. So you can do heavier weights with those because it's on the shoulder blade. They're not smaller muscle groups. They're larger muscle groups so they can tolerate more weights, less reps to get the stability back there to stabilize your shoulder. So let's also look at video number four where I show you a different way. These are with bands. This is the eye again. You wanna lift your chest and squeeze the shoulder blade back. You wanna lift your chest, squeeze the shoulder blade back. You'll notice my elbows are straight. Now we're gonna go into the T. You notice my elbows are straight. You just pull straight back. I like thumbs up. It keeps the shoulder blade open. If you got the shoulder joint open, if you go palms down, you're gonna close down the shoulder joint and you're gonna risk impinging. Now this is the W. You just pull your hand straight back. There's the rotation. You keep your elbows about 90 degrees, a little lower. You wanna make sure it's pain-free. Now here is like me laying on my side. So now I'm doing my rotator cuff muscles. I'm standing up tall. I'm squeezing my shoulder blades and then this one is a straight arm you just pull to your side. I'm gonna show you the other way so you can see my posture. Pulling out to the side pain-free. I'm doing two arms at once and then up tall, pulling straight to your side. That is a great one to do for your shoulder. I kind of discovered it years ago. Now we can loop that again and I'll show you one variance that I did with this eye is you lift your chest, elbows are straight. You pull and aim your thumbs back. You're gonna feel it right in the lower part of your shoulder blade which helps to anchor that shoulder blade down so it doesn't pop off the back like you saw in the earlier videos. Thumbs up, keep that shoulder blade. See, keep the shoulder joint open preventing the impingement of that supraspinitis tendon. And then your W. You're just looking like the letter W. Your elbows are low. You're pulling your hands back more than your elbows back. And here you're just keeping your elbow stationary and you're rotating your hands back. We go into the rotator cuff exercises again. If it hurts, you can put a towel between your elbow and your side if you have a narrower waist. And this one is great. You just pull straight to your side. It helps to anchor that shoulder blade where it needs to be right on your rib cage. And here's another view of that. Very good. So we learned a little bit about how you can get hurt if you have your posture that's forward. If you're reaching at work or your mouse clicking in your arm is always reach forward and that bicep tendon has to constantly stabilize that golf ball on the tee. If you're reaching in the back seat of your car to grab something, I always tell people never do that again because that sets up the supraspinitis for a tear. And a lot of times people will get a shoulder injury not because they actually hurt their shoulder. They'll reach across at the alarm clock and one day go, oh my gosh, I hurt myself. And then they get an MRI and they see they have a supraspinitis like a rotator cuff tear. They'll reach in the back seat and grab like something very light, not even a purse. Oh, my shoulder, that's all I could think of. And now I can't raise my arm. It hurts when I sleep. It hurts when I put my shirt on. What did I do? And they get an MRI and they have a rotator cuff tear. So those are kind of the last straw in your rotator cuff. And as we age, all of our tissues become a little less elastic-y. More brittle is kind of a harsh way to put it, but it's the mechanics of our body that are leading you to being vulnerable to having that little wear and tear where you just reach and the straw breaks the camel's back or you're reaching at the alarm and you're like, oh my God, my shoulder. And then now you can't sleep. Now you can't enjoy your activities. You can't play golf anymore because you hurt yourself reaching for the alarm clock. You can't play tennis anymore because your shoulder hurts because you didn't know your posture was forward. You weren't aware that your shoulder blade was winging, we call it, off your back. And so those are the why's. Those are why you're having shoulder pain and you don't know it. There's other instances where you trip and fall and you hurt your shoulder and you tear your labrum or all of a sudden you get a frozen shoulder. A frozen shoulder is very poorly understood. It's related to various things, but inevitably what happens is the joint capsule in your shoulder here underneath gets really inflamed and it starts to lay down a ton of scar tissue. And pretty soon this shoulder ball won't move anymore like that because the tissue down there is so tight. And normally the shoulder when it raises like this, this guy's got a frozen shoulder, I think. But when it raises like this, the ball doesn't just roll up because then everybody would have a rotator cuff there. It would bang into this bone here and you would get a rotator cuff there on the under surface there, which is very common in overhead people, overhead athletes, overhead workers. But the ball will roll down and roll up and slide down. When you have a frozen shoulder, the slide down no longer can happen. And so it's so painful and people will be reaching like this and hiking instead of seeing this open space right here in the shoulder. They'll go to reach up and they hike immediately because this ball needs to roll up and then slide down to keep that space. And that's what becomes very dysfunctional in a frozen shoulder. And so why we like people to get physical therapy is because we don't want you to get impingement or a tear in your rotator cuff while you're getting over your frozen shoulder. So we will stretch you and do joint mobilizations in certain ways so that we can loosen up all the muscles on the bottom that will get tight because you aren't able to move your arm as it hurts so much, so much in the beginning of a frozen shoulder. So I'm not sure if that was confusing but I wanted to explain to everybody some of the why you're hurting your shoulder you're not aware of until you come into the office. So watch this show, digest this message, watch the videos, try them slowly, start with two pounds. I do 15 to 20 repetitions but when I have someone in the clinic I'm always checking like, okay, squeeze your shoulder blades back, let it fall out, does that hurt? If it does hurt at a certain point you can still do the exercise. Just don't, you go one or two times you see where that pain point is that your body doesn't want it to go past and then you stop just above that and you do what you can. When you're laying on your side doing the circles is the reason why I show people that if you can't raise even your arm weight up and down from horizontal to vertical when you're laying on your side you can hold it at a pain-free point and do circles and work all those very important scapular and rotator cuff muscles to stabilize the ball and the T in the pain-free zone. Those are all the modifications that we can give you so that you too can be a coper and you can get over your shoulder pain and get back to doing what you love. And I know I've had five surgeries by the time I was 18 I had four. I grew very fast and my joint capsules were so stretched out that my golf ball was swimming on my golf tee and so they had to tighten up the joint capsule and I've been very fortunate. It drove me to be a physical therapist and I've been very fortunate to be able to take classes and learn all different kinds of joint mechanics and the little details. I got my manual therapy certification so I could learn more and now on myself and thanks to my injuries I can innovate specific exercises and have that insider knowledge as to guide all of you what to do because you can still do it you just have to do it without pain. It's very important with shoulder exercises that it is pain-free when you do them. We do not wanna irritate your shoulder. So I mean, think if I have any more questions, reps. Oh, swimming and rowing, I didn't touch on that. So I have a lot of swimmers that end up with shoulder shoulder pain, tendonitis. It can lead to a rotator cuff. You may already have the rotator cuff tear but the key for shoulders and the number one reason for swimmers to have shoulder pain is they don't have the strength and the function of the serratus anterior and the serratus anterior is not a rotator cuff muscle but it does live under the shoulder blade. So it kind of comes from this side on the rib cage and attaches to this angle of the shoulder blade. And what it does, I think I can show you is it does this and it reaches forward. Maybe I'll come up a little bit here. It moves my shoulder blade forward. You could see mine is weak. I'm having problems with that side right now but it stabilizes the shoulder blade and you can see right here, mine is not stable. I can reach forward more and get it but that is the exercise that I showed you with the yellow band around my wrist when you reach up towards the ceiling and you do the oscillations. There's a lot of different ways to strengthen the serratus anterior and they're all in essence like watching grass grow but they're so important. You can do a plank kind of on a wall and then press your chest away. That's another way. There's lots of different ways that you can do shoulder exercises. So I hope that answered everybody's question about the secret to a healthy shoulder and rotator cuff. You've got all the exercises, the best ones that I know from my experience with my shoulders from 25 years of experience working with athletes, non-athletes, every kind of professional, no mom who's lifting babies, Danny's everyone who has shoulder pain. So please try these exercise and please start with light weights or just the weight of your arm so that you can get your mechanics better and feel free to reach out to me. You can connect with me on LinkedIn if you just search Christine Lenders on LinkedIn you'll be able to find me and I hope everyone enjoys healthier and happier shoulders. Thank you so much for joining us on physical therapy for a better life and thank you so much to ThinkTek Hawaii, our sponsors and our donors for allowing me to bring this to you today. Aloha everyone. Life is better when you list your physical therapist.