Seventy percent of chronic
shoulder pain that I see is caused by a disease that has many names.
You probably heard of: Impingement syndrome, Subacromial Bursitis and Rotator Cuff Disease
Well, they are basically the same problem. I will explain what they are and what you
can do to avoid shoulder pain and stiffness. I will demonstrate 15 exercises
that you can do at home. SO, LETS TALK ABOUT CHRONIC SHOULDER PAIN If you know someone who has chronic shoulder
pain, hit the “share” button below and send this video to them.
The person usually has pain that interferes with sleep, especially
when they roll onto the involved shoulder. They have pain with overhead
activity, pushing and pulling objects. It is hard for them to lift loads and this problem
interferes with work, dressing, and specially putting a shirt on over the head.
Well, the shoulder is an amazing structure in the shape of a ball and socket.
Look at the range of motion, power and speed that the shoulder can perform.
To maintain the ball in the socket, there are many tendons, ligaments and muscles
that attach to them and keep them in place. A very important structure that keeps the
humerus in place is called the rotator cuff. Look at these muscles, they cover
the humerus like a sleeve cuff. A bursa is a small sac of fluid that
sits between these bones to act like a cushion and reduce the bone on bone impact.
So, when the supraspinatus tendon is pinched during the movement of arm elevation,
this is called impingement syndrome. The bursa can get swollen (or
inflamed) which is called bursitis. The tendon can get irritated or damaged, and
can also have a partial or complete tear, called rotator cuff disease, injury or tear.
Rotator cuff disease is generally a chronic degenerative disease that
affects people older than 40. However, younger people may also be
affected specially if they practice sports like swimming, tennis or baseball.
The main symptom will be pain when the arm is in the elevated position, or at night when
there is pressure on this tendon and bursa. So, to reduce the pain and swelling from shoulder
impingement, it is necessary to do a few things: And to remember these things,
you can remember "Be-Ma-MeMoRSS" BE is for Bed positioning and posture in general.
Ma is for Manual therapy and self-massage. Me is for medication. Anti-inflammatory medication.
Mo is for Modalities to reduce pain. R is for Range of motion exercises
to avoid frozen shoulder. The first S is for Stretching of tight muscles.
The last S is for Strengthening of weak muscles. We spend one third of our lives sleeping. If
we pinch the tendons and bursa when we sleep, this can cause or perpetuate the shoulder problem.
If you are a back sleeper don’t raise your arms above your head like this, keep your arms on
the side of your body, and make sure that the pillow is filling the space below your neck,
but the pillow is not under your shoulder. If you are a side sleeper, it is better
not to sleep on the painful side. But some people have shoulder pain on both sides,
and then, it is really hard to find a position. You may need to get a second pillow to support
your back, so you are not putting too much pressure on the shoulder underneath your body.
And get a third pillow to put in front of you, so the upper shoulder will not be
dropping in front of your body. Now, a stomach sleeper is the worst thing, not
only for the shoulders, but also for the neck, because you have to turn your
head to the side to breath. Make sure you keep your arms
on the side of your body. Not only sleep position is important, but also
the position that you have when you are in the computer, watching TV, or doing crafts.
This slouched position can cause rounded shoulders and lead to shoulder pain.
As the shoulders get rounded, there is a limitation of space for the cuff tendons to
impinge, could lead them to tear and rupture. The exercises I will show you today are
excellent to correct this slouching posture. In the early stages of impingement syndrome, it is important to reduce the
inflammation and control the pain. (MA) is MASSAGE
The first thing is to try to find a tender point and massage with friction. You may apply a topical
cream that contains some analgesics in them. This can also be done on the muscles
around the shoulder: Trapezius, Latissimus, Pectoralis, and Deltoid (ME) is for MEDICATION
Over the counter anti-inflammatory medications (NSAIDs), especially in the early stages or
beginning of the disease. 10 days of NSAIDs is all that is needed. If you can’t take NSAIDs because
of a stomach bleeding, kidney insufficiency, high blood pressure or cardiac disease, then you
can use the modalities to alleviate your pain (MO) is for MODALITIES
Apply HEAT before you do your exercises. You may use a bean bags heated in
the microwave, or a hot water bag. If you apply an electrical heating pad when you
are sleeping, be careful not to sleep with the heating pad on, it can cause skin burns
Apply ICE after you do the exercises. To reduce swelling, inflammation, and pain.
Leave the ice pack for about 20 minutes. Don't forget, use a piece of fabric
between the ice pack and your skin to avoid skin irritation and burn. You can find a link to these products
in the description of this video below. Next I’ll show you 15 exercises
that you can do at home. You don’t need any specific equipment
to do them. But you will need: A kitchen table, at the height of your hips
A bottle of water approximately 500 mililiters A wall
A corner A doorway
A towel A lower bench or a sturdy
chair, like a lounge chair. A mat or carpet So, the first exercise that we'll
demonstrate are range of motion exercises. So this is exercise number
one or pendulum exercise. All of this exercises I'm going to print in
a paper and you can download this description of all the 15 exercises down below. If you go
there, there will be a link to this document. So, the pendulum exercise basically you need a desk
that is about the height of your hip around here, and what you're going to do is you're
going to lean on the desk or table, and the arm is just going to hang there.
What you're going to start doing is you're going to start moving your legs so
then to create a pendulum for your shoulder then the shoulder capsule starts
relaxing and removing any adhesion removing any stiffness of the shoulder. You
see, I'm moving my hips and you can do this back and forth, and if possible also do some
movement, circular movements, opening circle and closing. Inwards and outwards,
and you do this for about one minute, and sometimes we recommend a person to hold on
some sort of weight, just to pull the capsule of the shoulder a little bit more, so then
if you have a water bottle, you could be doing the pendulum with a water bottle, just relax
the shoulder and move your knees, bend the knees, back and forth, and relax the most
important thing is to relax the shoulder. So this is exercise number one. The exercise number two is fingers on the wall.
There are two ways of doing this you can do this looking to the wall and go up, but for shoulder
impingement problems, i usually prefer that you stay on the side. so here's the wall on your side,
and because then you will be doing this movement, which is really painful people who have shoulder
impingement when they do this it really hurts, so let's do this, you start
walking on the wall here. and you go up, and sometimes, just getting
here is very painful. so if that's the case stop and then go down but if you can go up if you
can go higher, uh let's say that you can get here. what you can do is if you can write on the wall.
i'm not going to write a pencil mark on my wall. but if you can, you can do a pencil mark
there and see when you start this exercise, what was your maximum range of motion for
abduction? and so here, it is. try not to bend your body. so your body should be straight,
and then you just go up and then the more you do you'll be gaining more range of motion, always
remember to relax the shoulder, don't get tense your body straight and go up all the way up,
and if you can reach all the way up that's excellent, it means that your range of motions for
abduction is practically normal, and then you can go down. but as i said most people with shoulder
impingement, bursitis, they can't do this movement because it hurts, but that's okay, just go until
you start having your pain and then go down. and you can repeat this eight repetitions,
go to as far as you can and you can rest, you can if you're getting tired you can
rest your hand here, and then keep going. The exercise number three is the wall angel
and what you have to do is find a wall behind you. touch your hips, the shoulders,
the shoulder blades, and your head on the wall. so when you're touching this what you
can you starting what you're going to start doing, raising your hands, and keep your palms down, and
try to touch the wall and go all the way up. again this is similar to the fingers on the wall, we're
trying to improve range of motion for a abduction, and sometimes it's hard, and sometimes one
shoulder you can go here the other one you can go here, and then you start having pain, if
that's your case, just do that, and then lower, and try to improve your range of motion,
slowly slowly, and you can measure this if you're improving, you will see that each
day you'll be able to go higher and higher ,and this would be normal, so this is the wall
angel and you can do this eight times, wall angel. and lower, try to touch the wall, when you
do this and keep your hips, shoulder blades, and head touching the wall behind you. The exercise number four is to gain
range of motion for internal rotation and external rotation. so again in the same
position on the wall, your hips shoulder blades, and head are touching the wall, what you're
going to do is internal rotation, and you do both shoulders, and you should be able to touch
your belly, so to do this your elbows are touching your body, here touch your chest,
don't open your elbows, keep them here, bend the elbows at 90 degrees, and just go
in this is internal rotation, and this is neutral position and now this is external
rotation, so you see a normal external rotation you are not supposed to touch the wall,
it's about here this is normal external rotation and internal rotation normal is touching your
belly, and about 70 degrees here, internal and external, when a person has frozen shoulder this
is one of the first movements that they lose, they are unable to do external rotation, and this
means that the shoulder is starting to get frozen, internal rotation, external rotation, and
remember to keep the elbows close to your chest. And the exercise number five is
shoulder circumference, which is another range of motion exercise we're
just going to do this movements, so forward circumferences, forward and backwards,
so backwards, you can do eight backwards, five, six, seven, eight, and now eight forward, one,
two, three, four, five, six, seven, eight, and then what you can do when you finish
is try to squeesh your shoulders against the wall ,so try to touch the the shoulders the
back of your shoulders on the wall and squeesh, squeesh, squeesh, so then you're contracting the
rhomboids, and getting the shoulder blades close to each other, so do this and squeesh and relax,
So now we're going to start doing the stretching exercises, and the first one we're going to do
is stretching the pectoralis muscles or the pecs, and the pecs have fibers that are lower
fibers, medium fibers, are upper fibers, so we need a doorway, and what you're going
to do is to stretch the upper fibers you're going to keep your elbow down like this,
and what you do is you move your body, you move your body backwards, so just
keep the elbow here, don't move, and just keep doing this and you should feel stretching
the pecs here, keep doing this, and just stretch, stretch, stretch, and do a good stretch here, come
back, and you can do this eight times, stretch, and stretch, leave your elbow touching
the doorway, don't move it, and then to stretch the mid fibers you put your elbow
at about 90 degrees here, with the shoulder, at the same level the shoulder
and do the same thing, you go backwards, and then you feel stretching
you feel all this fibers stretching here and it should not hurt, if it's hurting then you
don't need to do it, and stretch stretch, stretch, and move your body backwards, that's good and
then the last one is to stretch the lower fibers, you should be putting your elbow your hand and
elbow all the way up, and do the same thing, then you turn your body away from the doorway and
then you'll be stretching those muscles there, okay, and you're stretching also the
latissimus dorsi and the pectoralis muscles. For the exercise seven, which is still
a stretching exercise, you need a towel, and what you're going to do is you grab the
towel with one hand and the other one like this, so ideally you do this and then you raise this, and one hand you're going to pull
up and down, eight times, two,three, four, five, 6, 7, and 8, and then change to the
other side and this is important because when a person has problems with their shoulders, usually
one thing that is very difficult is for them to do their bra, tie their bra, put on a shirt,
wash their hair, and that's all because these movements are very hard for them, and so this is
a kind of exercise, and you do within your limits, if you can't do all of this just do your limits,
if all you can do is here that's where you do, try to improve, ideally all the way up
and all the way down, all the way up and all the way down so
this is the towel exercise. The other exercise is the cross chest
stretch you're going to go across your chest, and with one hand you're going to stretch, you're
stretching the posterior capsule of the shoulder, which is usually very painful, especially if the
person is starting to develop frozen shoulder, if this is too painful to you you should be
doing this exercise with a physiotherapist, but if you can tolerate this, just stretch, pull
some pull them the back of your shoulder here, and do the same thing for the other one, so bring
all the way down here all the way across the other shoulder, and then you pull and try to relax when
you do this don't get too tense, relax, relax, and feel the fibers on the back of your shoulder
stretching, this is the cross chest stretch. Now the exercise number nine is the strengthening
of the shoulder against the wall, so what you're going to do is with your elbow straight, you're
going to put your hand here, and you're going to press the wall, just be careful if you have dry
wall, and you feel too heavy you're not going to punch a hole in the drywall, so here press against
the wall, press, press, press, press, press, so you should be feeling that you are
strengthening these muscles here of the anterior side of your shoulder, and you can do with the
other one, press, press, press, press, press, so you're strengthening the flexors of the shoulder,
which are the anterior, the front of the shoulder, you can also do on this side, so press against the
side, and remember your elbow should be straight, so press, press, press, press, press, press,
and the same here, press against the wall, this is isometric exercise should not hurt when
you do this, now the other one that is important is now you bend your elbow, touch the elbow and
your hand here, because we're going to do here, first is you press the elbow against
the wall, press, press, press, press, and now you're going to press the hand,
so now don't touch the elbow on the wall and press just the hand, so this is
strengthening for the external rotators, so press the elbow, and now press the hand, and do the same thing for the other side, bend the
elbow, press the elbow, and now press the hand. press the elbow and now press the hand. so this is exercise number 12. And for
exercise number 12 you need a corner, and for this corner what you're going to do is
you go a little bit, maybe two steps away from the corner, raise your elbows to the level of
your shoulders, and what you're going to do is, you're going to go all the way down, and up,
so all the way touch all the way the corners, and then come up, and again be careful if you
have dry wall and you are too heavy not to punch holes on your drywall, and go all the way up, make
sure that your hips are not bending, so you're not doing this, your whole body is like a plank,
and all you're doing is using your shoulders, the idea here is to strengthen the muscles of your
shoulder, so you're going to do this eight times, make sure that they are at the level
of the elbows, and shoulders here, and you do this and when this becomes easy for
you, you're going to start doing 12 repetitions, 15 repetitions, and if you can do 20 repetitions,
you're going to feel that your muscles on the shoulder are getting stronger, and of course
if you're not used to do these exercises the next day they're going to hurt the muscles
are going to hurt, but that's normal it's the muscle pain that is the good muscle pain, just
because you're exercising those muscles they're going to hurt for maybe 24 or 48 hours that's
called delayed onset muscle soreness or "DOMS". This is exercise number 13, which is the shoulder
press down, you need a bench, a lower bench, about the height of your knee, and this could also
be a lounge chair, but something that is sturdy, you're going to put both of your hands in the
edge here, and go forward and what you're going to do is, you go down and up, and when you go
up go all the way up, so then you're putting strength on your shoulder here, and go
down and do this eight times, three, four, five, don't forget to breathe, six, seven,
eight, so this is shoulder press down. So this is exercise number 14, for the shoulders,
which is a kind of advanced exercise, because you need to be very fit to do a front plank, and you
can start doing 10 seconds 15, 20, 30 seconds, or one minute, if you can, but it's important
that you do right, so the right plank is if you get a mat, what you're going to do is your your
elbows need to be below your shoulders, here, so don't put too much up, or down here, they
should be here, and then you're going to don't look ahead, you're going to look dow,n don't arch
your back too much, and don't lower the hips, if you do this you're going to do a right plank, so
when you're ready just go up and start counting, You can start counting the seconds,
and if you can tolerate, you can do 10, 15, 20, 30 seconds, and
look down, don't look up, stay in this position and go up with put
that feel the strength on your shoulders, and stay there this is an excellent strengthening
exercise, for the muscles around the shoulder. So the exercise number 15 is the side
plank, and there is an easy way that you can do the side plank, which is
if you raise your body on the knees, and the hardest one is if you raise your body
on the ankles, like this. and it's important that when you do the side plank, again, the elbow
is under your shoulde,r at the same level here, and you are like a plank you are like a straight
line, so don't go don't put your legs in front, they should be like straight,
like a straight line like this, and you can do the hardest one or the easiest
one, and you can hold up for 10 seconds, 15, 20, 30, or one minute if you can, okay,
so let's get started? one, two, three, up, and you feel the your shoulders getting
you're doing some movements there, and go down. Don’t forget to apply ice
after you finish this routine. You can do these 15 exercises 4 times a
week and progress by doing more repetitions, let’s say, increase to 12, 15 and
20 repetitions of each exercise. I have some patients who use
tight bras with narrow straps, and this compresses the muscles, tendons, veins
and nerves that go from the neck to the arm. I usually examine the shoulder
for any mark of skin compression and I recommend them to
wear bras with wider straps. The same for people who carries bags or
backpacks on their shoulders. It is good if they can distribute the weight of their
backpack on both shoulders with a wide strap. In some rare cases, the shoulder impingement
syndrome may lead to frozen shoulder, which is a condition where the shoulder gets
stiff and unable to perform all movements. If this is your case, you may
need a different type of exercise. Also, in some people, the rotator cuff
will have a partial or complete tear, and the person may need to see an orthopaedic
surgeon to fix the problem under surgery. It is important that you have a proper
diagnosis of impingement syndrome by a doctor or a physiotherapist. Please remember that this
video is intended for educational purposes only. If your shoulder pain is not getting better, then
talk to your doctor or your physiotherapist. They should be able to help you to get individualized
exercises that are specific to your problem. If you like this video, don’t
forget to like it below. You may subscribe to this channel, and turn on
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Bye
