Are You Really Still Using Outdated Exercises for Shoulder Pain?
To watch the full video, click here: https://youtu.be/OEy-xo_RGUs
Hey there coaches and athletes Welcome back. My name is Michael Hughes, CEO and founder of Gymnazo Edu. If you’ve ever experienced some shoulder pain and gone to a physical therapy, then your PT may have conducted what’s known as the Hawkins Kennedy test to assess for shoulder impingement. Now, I really don’t love this test to be quite frank with you. And in this video, I’m going to tell you why I don’t like this test, but give you a different, more root caused focused way to approach and fix shoulder impingement significantly. But before we dive into that, make sure to subscribe to our channel for more movement focused and principle based approaches to perform problem solving for movement related pains and dysfunctions. And all the other context that dives into movement training sphere, I really appreciate you guys’s support, in that now someone who’s been in the movement therapeutics business for last 10 years, actually, more than that, helping hundreds of people holistically find a solution for the movement related pains and dysfunctions. I’m seriously disappointed at the physical therapy industry, and that it’s still teaching to assess pain with these silly tests and protocols. Now, if you’re familiar with the Hopkins Kennedy test, here’s a basic demo of it right? You put your hand up like this therapist puts her arm underneath and across the opposite shoulder. And you basically go through an internal rotation movement of the shoulder joint, if there’s pain at the top of the shoulder. Oh, that’s a positive correlation that you have an impingement syndrome at that shoulder. Now, what is it about this test? Sure, it’s a test right? It shoulder shouldn’t hurt to do that. But whatever they don’t like about it is it treats the shoulder like it’s the only thing that matters. Like it’s all in isolation, and it just functions in its own world and its own sphere. And that couldn’t be further from the truth. The basic biomechanics of the shoulder and and anatomy is really that has multiple angulations. It’s essentially the hip joint for the upper body, right kind of a ball and socket joint. Well, definitely a ball and socket joint. And also relatively a ball and socket joint, just the socket is a little bit different. And this socket has one massive connection in it called the clavicle, where this one has worn the entire pelvis. So certainly a much more stable Ball, ball and socket, but still relatively has massive angulations in all three planes of motion, sagittal, frontal and transverse. And the second thing that really bothers me about this Hopkins Kennedy tests, it doesn’t relate to what the scapula is doing in motion as well. Because you basically pin and isolate your arm against the therapist shoulder and just go through some basically one movement called the internal rotation. Yes, there is some shoulder sagittal plane pre positioning already position, I get it. But it’s, it’s so limited. Gosh, it’s so limited. So the glenohumeral joint and the scapula are basically have this amazing relationship with each other where the scapula goes, the glenohumeral joint, or that kind of that socket also gets pre positioned. So knowing that, shouldn’t you test the scapula within the glenohumeral joint context, that make makes sense to me. And then also, we need to lengthen and strengthen muscles that help the scapula move. So again, a test that doesn’t take that into consideration that there’s about 17 different muscles that connect directly to the scapula alone from off on that number, minor detail, but there’s a lot of them, right? A good dozen plus. So here’s how I want you to kind of think about the biomechanics of the shoulder in terms of an impingement syndrome. If I were to take my hand, and I’m going to grab up my shirt and pulled down, and I take my shoulder and I raise my arms like oh, I can’t raise it up. And I’m not that far, because the shirt is blocking me but you can also see where all the lines of tension are while I’m wearing black, not not the best color to wear in this video, but you get the idea and I get all this pressure and lines right up into my shoulder. Well, that’s what hurts. So if I have all this pressure pulling downwards, and I can’t raise my shoulder up without reaching a predetermined end range of motion, then what do I how do I fix this problem? I let go of the shirt. Ah freedom of travel. We have all this musculature, chest, pec major pec minor sweetest interior subscapularis lips, let’s just MyStore sigh and just the fascia pulled in through the abdominal and through the intercostals basically anchoring this shoulder down, anchoring the shoulder down. And since we don’t do a whole lot of this in our daily lives, and hence we do a whole lot of this typing, and are kind of close to us in our daily lives. What’s going to happen to this fascia what’s going to happen to this connective tissue. That’s the thing to pontificate on as we get going. But before I get into that approach, and problem solving and addressing how I will take care of this impingement syndrome, what kind of injuries or dysfunctions Have you experienced in the past? Drop a comment below and let me know so I can make new videos on them. So we can all learn and grow together. Alright, let’s get into it. How would I approach this shoulder impingement syndrome? Well, the first thing is we want to assess, right? We want to find out where the shoulder is successful. We know that with some sagittal plane motion pattern, it’s not going to love life. Okay? So we want to get as close to the dysfunction as possible, without being on top of the dysfunction to to cause pain in the threshold meaning so I want to test the shoulder. How’s it gonna go through the sagittal? Plane? How’s it going to move, move through? Let’s say it’s painful, right about shoulder height, but it’s totally fine. Going back as far as possible. Alright, fair enough. What if it’s painful kind of coming around the abduction point or coming away from our body? And then it hurts, hurts, hurts, hurts, hurts, and then hurts us all the way up? Okay. But what about reaching behind us or in front of us? That feels fine. Okay, fair enough. What about if I stay low, a bit below shoulder height and a rotates to the right, and rotates to the left? pain free. But if I come up to shoulder height, ooh, it hurts more, left and right. Well, that’s what those are typical not saying that’s every person by any means. That’s a typical term of how to think about shoulder impingement. Once it gets to a certain height, it starts to bother us. And certain planes of motion the other four, abduction, or certainly AB duction abduction, across the body, the suits call it horizontal internal, rotational horizontal abduction. And then horizontal, AB duction. External rotation basically said, those hurt little less, okay, when we know that we have some ranges of motion to play with, that are a little bit more successful. Because we do not want to shove the shoulder into the painful motion pattern that I see a lot of traditional drills do. So we want to see what ranges of motion are the most successful. And ideally, of those six, one of them feels the best, even if we have to drop below a threshold of height in our understanding of our movement observation. So the next thing we want to do is, are we saying a pure shoulder motion, I get what plays the motions bother us. But what about scapular motion. Now this is a great tool for or trick for a lot of your trainers who really aren’t don’t have the sound soft tissue practice. But you can do this easy test, put your hand on the back of your clients shoulder blade and ask permission for this. And I want you to feel what the shoulder blade does, as their hand comes up. Now just go to the point before pain, and then feel if that shoulder blade starts to descend or go down the back of the shoulder. Now have their hand reach back behind them. And see if you feel your hand and the shoulder blade come up around the backside of the ribcage. If those two motions don’t happen, then we have an issue that we have to address. Now what about this handle on the skirt scapula when we go left and right, when the patient or the clients hand goes up to the side, you should feel the hand rotate off like the elbow and the hand are kind of following see how my elbow flies up in my hand rotates, that’s what you should feel the scapula do as well. Same thing is true when I bring my arm underneath or come in, you should feel the toughest gap and kind of start to rotate out and the bottom of it rotate in. Fair enough, right? The cool thing about the elbow and hand does a good representation of what scapula and body or or motion should it should be doing. It’s pretty cool. And then for reaching around in front of me, it should feel that that scapula kind of wrap around the ribcage kind of come on through. And then when the hand reaches back, you just feel that scapula wrap around the ribcage coming back towards the center line. If you don’t feel any one of those patterns happening, then we know that the scapula is playing a part in this shoulder impingement. No questions asked, typically around a shoulder impingement as a little bit of a hint, you’re going to find that as the hand comes up, that shoulder blade doesn’t come back as much. Again, that’s typical, not in all cases. So we want to kind of think about what’s happening there. Then the second thing we want to do is what about the thoracic spine? Interesting. Why would you think about the thoracic spine? Well, my shoulders in pain? Well, because the glenohumeral joint is moved via the scapular motion. But how does a scapula get extra range of motion via the thoracic spine? So I want to see does this class athlete client of mine have good flexion because flexion of the thoracic spine is also like my hand reaching behind me. And I want to see if has good extension, because good extension is also like the hand reaching up. That’s interesting. What about lateral flexion right left was my hand comes up overhead. If I get good lateral flexion through my thoracic spine, I’m gonna get good shoulder motion. And the same thing as I’d reach back lateral flexion to the same side or the hand reaches underneath me and then I got my transverse plane motions my hand reaches across me do I get good thoracic spine coming across and good thoracic spine as it come back. It’s really important for you we all Always look who’s the boss of that boss, and who’s the boss of that boss. And basically, when does the final buck stop, because the thoracic spine is not the final buck. It’s actually well, we can keep on going further. But the next buck, and I’ll stop at this point from the video standpoint, is the pelvis. When my hand comes up, do I get good pelvis translation forward or pelvis extension, very important piece. If you’ve been sitting at a desk all this time, and you try to get your arm up all the way through and that hip pelvis is staying relatively back here, I know I’m being dramatic about it. Right, then you’re not going to get good hip extension, then we’re not going to get good thoracic spine extension, therefore not going to get good scapular depression, going back down the ribcage, and guess who’s going to pay that price, the glenohumeral joint or the top of the shoulder in terms of an impingement case. So I want good flexion. As I go back, I want good extension as I come up at the pelvis, I’m gonna go want good, same side, lateral shifting or translation to the shoulder that’s going up, I’m gonna want good opposite side lateral shifting or translation, the same side hand, it’s going to back down, I’m gonna want good same side rotation, my right hand rotating to the left. So same side root rotation, going away from my side, again, rotate into the same direction, but it’d be right hand, and right pelvis going left upside, if you want to call it that, too. And then I want my shoulder and hand to move together in the same direction. As I go reach behind me, again, if I don’t have that at both hips, by the way, because I get good rotation here, but have poor rotation here, that limits the case. And there is a case to go all the way down to the feet and ankles. But for this video, you kind of got you got a lot of things to actually test. And that’s why I don’t like the Hawkins Kennedy test, because it’s just doing doing this. The shoulder doesn’t just do this, it does so much more. Okay, fair enough. Got a good way to assess. Right?
But what about treatment? One turn to the shoulder, because it’s such a used joint, I mean, it is part of every kind of almost everything that you do, right? It’s a very tough joint to, to help out because it’s always in motion. And it has a founder more than likely, depending how long it’s been in pain, the optimal path for to stay as pain free as possible, which is probably a dysfunctional path. It’s trying to save itself, right, it’s trying to do his very best to not be in pain. So you might find someone whose shoulders kind of just slumped down a little bit, or some shoulders kind of rotated back, a little maintenance very, very dramatic, right, you may find a few different pieces of how the thoracic spine have already started to compensate, to allow that shoulder to not be in as as much pain. But you also may find someone whose shoulders, one shoulder is relatively rotated forward, right here versus this one’s back. So we’ve got to sort of assess what’s going on already. How is the body already presenting itself? And do we just shove it in the opposite direction to just shove it in the opposite direction? I wish the body would have done that already. So it’s our job to be intuitive about saying, Hey, this is where the body is, how do I get it to where it wants to go? Well, we know the shoulder has access to three ranges of motion, sagittal plane,
on a plane, and transverse plane. Well, the scapula also has access to those to those same three patterns significance, we also know that this domestic spine, again, as the review has access to all three planes of motion, we should make sure that they have all those as much as we possibly can, and the hips. But where do we start, we want to start again with a soft tissue. Because this shirt test that I mentioned, if I got all this pulling downward, and I get all this restriction coming up, if I go hips, thoracic spine, vice versa first, I may not be playing with him. So those clients desires to reduce the shoulder pain as quickly as possible. So I’m going to want to focus directly around that spot and as much as I can, and I’m gonna start wanting to foam roll. grabbing onto my trusty foam roller here. I’m gonna start wanting to go after the PEC, pec major and pec minor. Both play an important role in shoulder for rotated motion, or resisting shoulder going up and back expecially. Well, they both have a good good play. So I’m gonna want to get down on the ground. And I want to want to spend some time on that Peck making sure that I can do some good opening up of the connective tissue. Now it’s not going to be a full detailed deep dive and how to actually foam roll these areas. But something that you can further focus on has to do have an entire foam rolling video, you can check out in our videos as well. So pec major pec minor, I’m also going to want to look at kind of the underneath subscapularis down into the straightest anterior and the lateral core. So I’m going to want to kind of peek myself down down here, I want to get to a side point. Now if I do have a foam roller, I can use the edge to get into that sub sub SCAP not the best position to wait way to do it. In fact, I’ll probably get a little bit more prone, but I know you can’t really see that. So black on black and a little bit tough to see. But getting into that sub scapularis getting into the lateral core, and then getting into the sways anterior as I rotate a little bit more forward, and anteriorly getting into those muscles as well. Now again, we have fascial lines that are not just muscle, right, it’s actually feeds all the way into the lateral core. So I’m going to want to go into the ribcage on the intercostals, all the way down, even off the ribcage, even into the lateral core, the obliques, I’m going to want to even go back into the QL slightly a little bit, I’m going to want to go into the front and even into the hip flexor slightly a little bit, I know I’m not in the best position for that. But you get the idea. All of this connection feeds into the shoulder, I miss gonna also going to want to go into the abdominal range, even into what has the abdominals fit into the ribcage. Anything that pulls me forward, or down to the side is going to restrict the shoulder going up, I’m gonna have to address those pieces. It could even be into the pelvis could even be into the into the lateral hip, not messing with you, right? The dysfunctional pattern that someone has can go deep, we have to know that that’s a possibility. And to make sure that we’re setting ourselves up for success, it’s very hard to mobilize tissue that’s literally stuck. Right? Dehydrated doesn’t have the elasticity that we want. So we can’t just go into good old fashioned grab onto a band, put a towel next to ourselves and start doing internal and external rotation drills. Like come on PT interesting. Are you kidding me? That’s going to fix this when you’re just doing this. It’s not even in the range of motion that is even similar to the biomechanics of where the problem is. I don’t get it. I’m seriously I did get it several years ago. And I’m like now like how don’t even think that that was a possibility. I digress. So what else do we do. So once we get soft tissue to start to unlock, we don’t have to go full full on lock, right, we want progressions, once we can start to get that t shirt, right all that tissue to kind of fun to unlock a little bit, then we’re going to have to start to realize that we need some lengthening through that tissue. Now, if you’re a skilled practitioner, you may have some hands on skill sets, I have a relative education called FMR that allows me to manually and guide someone shoulder blade actually put my hand on their shoulder blade as they will raise their hand, I will time that biomechanical chain, and drive and guide that shoulder blade down and lift the thoracic spine and I’ll help facilitate the proprioceptive movement pattern that they are missing. Now, I just want you to know that that’s a possibility out there. If you have more questions, throw it in the comments below. But what if you don’t have that facilitation? What if you don’t have that knowledge that education Well, grab on to a bar, grab on to a stick and grab on to anything that allows them to put their shoulder in the relative point of dysfunction, but not discomfort. What I mean by that is my arm is starting to come up, right? Doesn’t hurt though. If I go to here, ooh, that may start hurting. So I want to go right around the threshold of where they’re feeling. Well, fine, right, not painful and go a little further pain. But they’re back off. That’s where the fun we’re playing within their zone of threshold. Now, I also don’t want to put them directly in the worst positioning. So let’s say that they’re a little less pain off to the side, I want to start there maybe a little less pain, way back there, or maybe a little less pain across where I’m going to find where they’re most successful within their positioning. Most successful, because I want, like anything, we’re not just training their muscle also training their mind, right? We want them to feel like they’re gaining success. Right? If I have a board game, and I play against you, and I crush you every single time we played the board game, how many more games? Are you going to not want to play with me? Because you know, you’re just gonna lose, right? So we want to have the people have an idea like, well, I’m making progress. I’m making progress, right? We’re not just training this, we’re training the soul and the mind too. So let’s say I’m a little less or a little bit more successful here. What I’m going to want to do is I’m want to see hey, can I move my body away from now what as I move my body away from the stick? What am I doing? What’s my shoulder doing? Is my hands actually going up? Is my hand actually going up? No, my pelvis is just going further away. My watch is going for the way creating relative lift in my hand, though my hands not moving. It’s very cool. Now that’s let’s say that’s painful. Okay, well, that’s not the way I want to go. Then. What if I rotate the opposite side, right? I’m creating a distal change in the stretch of the tissue to allow more range of motion to happen here. Let’s say that’s painful. Okay. Well, I’ve just gone frontal plane, side side, I’ve just gone transverse plane rotation rotation, what else do I have the option of the option of the sagittal plane? So what’s going to create more lifting of my shoulder relative speaking me coming forward, shooting my hips going backwards, my head coming forward, or my hips coming forward, my head’s going backwards, this one, we’re gonna get that more than anterior opening up. And I want to see now I guarantee you one of those positions feels much better than the other three. And that’s where you want to start to create movement. Now do you want to do a little act of tension pushing down to that stick to create some that strength, all in the realms of possibilities, as we go, I’m showing you a central a technique versus the myriad of techniques, I just want you to get away to begin to start to think about how to process this information. So let’s say I get some good motion, I get some good motion, I get some good motion. And then after doing about, let’s just say a dozen of of each, right, I bet you can now take that hand up about an inch or so what was discomfort is now not discomfort. If you go a little further up pain, but if I go back down again, so I just gave myself an inch more height, I didn’t move my arm at all, I only move my body underneath my arm are relatively speaking. So I guess what I’m gonna do, I’m going to continue to work the different ranges of motion to allow relative lengthening at my hand. Even though my hand doesn’t move, again, our bodies so designed for for this hand to move up and down, it’s a painful cycle to dysfunctioning cycle, we have to break that cycle. So we have to show our body a different path. And more than likely a thoracic spine and scapula are not moving very well. So if we can pre position it, and start to drive through a thoracic spine, drive through our scapula in these different patterns, we’re going to start to break up the gunk that’s making the shoulder in pain. So thoracic spine, scapula, three planes of motion, start in a good position, and then create a greater and greater range of motion. Ultimately, what we want to do is get so much range of motion from a thoracic spine, from our scapula, then we start to increase momentum, then I can start to say, I’m going to actually actually step forward get some good hip extension, relatively speaking or for translation, good thoracic spine extension, gained some momentum. So I actually don’t have to use so much musculature to get my muscle to get my shoulder to drive up. But I’m starting to get the passive path, right, my proprioceptive start to feel that range of motion, I’m getting lengthening through the tissue, without over contraction of or over binding on my shoulder. And so eventually, I can start to get some good momentum to get that shoulder to move sideways. crossbody, Step Open, step closed. Again, I’m really showing you this could be hours down the line, or even days in line, weeks down the line. But I want to get some range of motion through that drive, teach my body that my pelvis, thoracic spine, scapula help in the daily function of my shoulder. And there’s a lot of drills that can actually help that process happen. Instead of just doing isolated rows, get the hips to help out, get the thoracic spine help out. That’s another video on how to actually put more treatment techniques into this understanding of what’s going on with the shoulder.
So the last thing I want to do is I want to start to think about how to strengthen that zone out. And the best thing I can say is that is that start with isometrics. When we’re talking about shoulder movement pain, think about getting into a range of motion that you found more lengthening with. Once you’ve found more lengthening with that shoulder, that’s where you can start to actually start to create strength, how to create strength, the easiest way possible, without causing any undue stress, don’t move the joint joint movement hurts. So create an isometric, or we call it an active tension type of strengthening. So with a stick very simply, I can just drive the stick into the ground, guess what I’m strengthening all these muscles that I just stretched, all these muscles that are just opened up through soft tissue. If there’s another way of I can do it, I can want to even push against here and I can start to get that kind of that retraction strength. I can push against the wall here and get that kind of what we call that kind of projection strength. Very similar to band work, I understand where that starts to come into it. But again, look how far down the process it is. Right very far down down down the process, then eventually, I can start to get my hand, maybe even here at shoulder height. And I can start to get more overhead heights and started getting higher and higher as I started to drive my hand into the wall. Again, a way for you to think about how to add strengthening to the shoulder. Is that the only technique not even close. Just a framework for you to start to understand what’s a possibility? Okay, again, that should give you a framework to experiment with. If you have any questions drop them in the comments below. Otherwise, if you want to dive deeper into understanding the chain reaction biomechanics and the foundational principles of movement that I use with my client that my team use with our clients with what our coaches learn with their clients across the nation please check out the multi dimensional movement mentorship program. It’s in the description below. It is game changing, it’s going to teach you how to think not what to think. It’s going to teach you to open up your mind to the possibilities of multiple methods and find the principles bring the principles out of those methods. So you have a framework a lens to see all methodologies with. That’s the key thing. So thank you very much again, if you learned something please sure to like this video, subscribe to our channel, hit the bell to get some notifications whenever we release a new content just like this. See you next time. Cheers.
Leave a Reply