Hey guys it’s Ashley here.
Shoulders are one of the most common 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

100 thoughts on “Understanding Shoulder Pain and How To Fix It”

  1. Wow happened to have a ball and used it on my teres minor region where I was having pain and that just freed up more range on my adductor. I will buy one of those bands next and try that stretch cause I'm very restricted there too. That was 5yrs of physio without much help and a ten minute video just made me feel better already I will keep it much thanks

  2. Dear Ashley, 
    Thank you for this video. It helped me to understand the reason for my shoulder stiffness. You are the best.

  3. Thank you so much. Perfect video. I have pain in both shoulders. Went to PT 3 weeks so far. Went to hot tub and sauna today. Felt good but later I ached. Put ice on 20 minutes now back where I started. I will do what you say.

  4. excellent video,you give complete information and also answer my questions in advance,thank you very much

  5. I looked on Amazon under "Power Bands", but what came up does not look like the band you are using. Where can I find it? Thank you.

  6. I will do these exercise stretches. My issue has been diagnosed as a torn labrum and shreded bicep tendon. Do you feel these stretches will help lessen pain?

  7. Love your videos ! I’m a 62 year old ex-athlete that plays Rock and Roll Drums 2-3 times a week . Been out for 3 months with progressive pain . My left shoulder MRI findings July 12 :
    “ Degenerative changes in the left AC joint with hypertrophy of joint capsule and inferior sprain causing impression on subacromial bursa.
    Some lateral downsloping of the Acromion is evident and these findings impinge on subraspinatus musculotendinous junctionas well.Small amount Of fluid is seen in subacromial-subdeltoid bursa. Small focal area of increased T2 signal is seen involving distal sub respond Artis tendon along articular surface consistent with small partial thickness tear superimposed on tendinopathy.no retraction of the rotator cuff is seen .
    No displaced glenoid labraltear is seen.”
    Fluid distends biceps tendon sheath. Small cysts are seen involving proximal left numeral bone marrow.
    Sorry so long . A lot going on in there !
    Dr. Gave me a couple cortazone shots and sent me on my way
    Can I do your ball and band exercises without too much worry of making things worse ? Not playing
    Drums for another month …. Thank you very much !

  8. I had a shoulder operation, RC, after watching; I understand what the doctor was trying to tell me. Thank you

  9. I really enjoyed your presentation. The very best explanation of shoulder issues that many experience. Thank you very much

  10. Still looking for my solution. I get pain at night I have to pull my left shoulder back to sleep. I get sensations that are similar to when you sit on your feet to long down my arm. But not ever durning time when I'm active. The pain and tingling comes at rest or after sleep.

  11. This is very helpful! I am recovering from removing extension ladders from the roof rack of a van that turned out to be too heavy for me in the elevated and extended arm position.
    Feeling better after two months of babying and resting the arm. Now I am ready to follow your exercise plan.
    Thanks, JIM

  12. Hi, thanks a lot for the amazing presentation. I'm suffering from the exact problem mentioned in the video from past 7-8 weeks but that didn't stop me from continuing pull-ups, push-ups and mild dumbbells lifting. What's your take on that? Should I completely stop the exercise until I recover? I'm in my late 40s.

  13. I've been suffering this for years.. just starting to do them.. hopefully will get it sorted out. thanks for this detailed video.

    Edit: You explained this way better than the damn doctor I met

  14. I've been diagnosed with having either a tear, strain, or tendinitis in my right shoulder. The doctor's words, not mine. My range of motion isn't bad. but it is definitely most painful at those points you identified as perhaps indicating bursitis. Anyway, there was no precipitating cause for my present condition that I am aware of, I simply woke up like this almost two weeks ago. After a bout of almost crazy spasming the first ten days was excruciating pain, and I noticed the middle and ring fingers on my right hand were slightly curled on their own – though I was in so much pain I didn't pay it much mind. Gradually the pain subsided to a level that, while constantly uncomfortable, is at least bearable, is at least not intense. I showed the orthopedic surgeon who examined me the odd symptom with the middle and ringed fingers, but she seemed mostly befuddled by it, and I think said something about a possible pinched nerve. What really scares me now though is that the same symptom along with some tingling in the tips of my fingers is beginning to appear in other, left or good hand. Any thoughts on what this all may be?

  15. Thank you, I have learned more from your video about the rotator cuff and the actual function of each muscle. Excellent video.

  16. You are an impressive teacher and in good shape yourself which makes it easier to believe you know what you are talking about with looking after our bodies….thanks.

  17. Thank you for the advice. I can't do the scratch test on my right side due to frozen shoulder. Have been working on it for 6 months.

  18. Well done. Very clear and concise. It answered some questions I had about shoulder OA and now I understand better what kind of help is needed. Thanks so much!

  19. Hi my ultrasound result shows subacromial subdeltoid bursitis and early supraspinatus tendinopathy. Your video explanation has helped me better understand my pain. Can this also cause Wry neck and muscle spasm. My remedial massage therapist said that's what I have before my Ultra Sound because of my pain radiating from base of neck to shoulder. Whats your thought on using ice pack on inflammed area. Thank you kindly

  20. I feel pain only when i do chest exercise
    When i pull my arms down with the dumbells then i feel pain on the back side of shoulder!
    Plz tell me what is the solution?

  21. Wow, those 3 stretches just gave me instant relief , from level 7 pain to level 1. They will be getting done daily. Thank you so so much. You nailed the delivery of the video too. Big well done.

  22. Your exercises hurt like hell even though I'm not that tight, I just have a tendinitis in the long head of the humerus that has been here for about a year and almost gone now, but it still hurts with your exercises, when I do workout I'm fine though. any ideas ?

  23. Thank you Doctor, very good explanation, I understood better of what is causing the pain and how to relieve my pain😊, thanks so much

  24. An answer to my prayers. i was playing guitar and this started to cause me pain. it was really getting extreme. this helped me to fix it. i can go back to playing without worrying of the side effects.i can recommend icing after doing the band stretches It can help prevent or take away swelling so it can heal. A doctor once told me that ice is the greatest cure for this. Also, someone else said , if its swollen it wont heal. Best teacher for this for sure.

  25. Very informative and thank you very much. I had shoulder reconstruction and replacement surgeries in the last two years and this is far the best and simple explanation I have come across. Unfortunately very few medical professionals post these kind of videos.

  26. hi! I hope you'll be reading my message…today i went to gym,trying to workout shoulder,and i was doing a shoulder press,with a dumbell,the weight was something i previously used a week before;while i was trying to put the weight in position i heard a noise in the shoulder articulation,like a crackling and i abandoned the movement as i felt pain…i could continue to do some biceps exercises..this happened in the morning,now i feel pain in my shoulder when i try to do some specific movements,like scratching my back or rotating the arm while extended; there ssno swelling,no bruise,no deformity,i can use my arm normally with the exception of those movements; i'm a bit scared and going to a doctor is a complete adventure where i live so based on your experience,does it even worth or i can recover at home and how?

  27. Thank you and your team for all the wonderful work you have done to draw a smile of hope on our faces … and wish you and your team a lot of success in life.

  28. Hello my brothers.

    I three months ago entered into a very difficult and shocking experience with ligament rupture and shoulder pain

    Through my experience and my review of doctors

    The doctor told me that I have inflammation of the muscles and ligaments and this affects the joints of the body

    Makes movement very difficult with severe pain and healing requires several months

    The doctor told me that the reason for this is that the body is known as thermal shock

    Excessive voltage will lead to an imbalance in the necessary body salts

    Such as calcium, magnesium, zinc and vitamin D 3 deficiency
    He gave me the next treatment
    ATOXIA 120 MG
    CALCICARE TABLETS
    It has already improved a little and the pain is much reduced

    But any muscle workout will lead to a return of pain attacks

    I advise you to eat vegetable mix salad + drink high-fat milk + eat cream + fried eggs fat + eat an apple a day + eat dates + quit smoking + drink water in large quantities
    + Take sesame oil + Don't eat bread
    This is my personal experience and now I started to feel very healthy

    I wish you health and happiness

    Do not forget to sleep on your back for the duration of treatment and sleep for enough hours

  29. This video was incredibly insightful for me, as my shoulder injury and tightness has prevented me from training. I've incorporated your instructions and already feel ten times better. The massage ball and stretch band are revolutionizing my recovery as a middle-aged man.

  30. Brilliant! I am now unambiguously sure of which injury I have and will crack on with the exercises, I have been told that hanging from a pull up bar will increase the space in the shoulder for the tendon, however looking at the mechanics of the shoulder am not sure if this is correct, any thoughts?
    cheers

  31. I want to thank you for the “Understanding Shoulder Pain and How To Fix It” video. I'm 53 years old and during the past 2 months I had an excruciating pain in my right shoulder due to some injuries (infraspinatus and supraspinatus small tears as per the sonogram) I suffered during the Hurricane Maria in Puerto Rico (2017) while carrying water and fuel containers, and moving trees, among other things. The pain was in and out but lately it was unbearable. The doctor gave some anti-inflammatory that worked temporary. I've been doing the stretching and ball exercises for a week now and my pain is significantly less and regained a lot of movement. Huge progress!!
    Thanks a lot, God bless.

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