Shoulder Impingement, Pain and Injury Rehabilitation Seminar | Feat. Tim Keeley | FILEX

phew thanks Luke okay today what I wanted to start off with is just working out who you guys are because you sort of know who I am and just so we get an idea when you ask questions and who you are how I'm going to answer them so how many of you guys are fitness instructors or personal trainers in the industry okay this is about half here and any physios in the crowd as well awesome and exercise fizz on top of that okay great all right and how many of those people put up their hands I've got a shoulder impingement quite a few as well as I heard to do that no today I've got some videos that I will show you to help you understand what we're talking about but if some of you or one of you wants to be a volunteer who's got shot of injury we've got what they call a painful arc where they raise their arms they're keen to get up here and get this shirt off and don't mind so I can show the crowd live exactly what I mean then feel free to come up when I ask okay so today we're going to do it in two parts hopefully about 45 minutes each which gives you an hour and a half the first part a lot of us theory and video and trying to understand the whole concept of subacromial Benjamin so we're going to go through three sections what's going wrong getting you guys in your head working out exactly why people get this and what structures are affected as well as when you see clients or in yourself the signs and symptoms of when people start to get a shoulder impingement even before the injury it's very easy to get it when they come in the clinic and they were fully injured but when they're in the gym or they are training to actually spot it early and there's a lot of things you can actually spot and we'll show you those today all in outline so what we do in physio we're not going to go into too much because that's a whole another lecture but then how we go from physioroom.com to training and the second part we'll try and work on the rear pet we have exercises so going through from scatter exercises through to rotator cuff exercises getting you understand why we're doing each one that's the hard stuff that's getting people to do these exercises which is difficult then we progress to normal training so trying to take rehab exercises making them harder and blending them into exercises that are closer and closer and closer to conventional training and then teaching you and giving you tips about how you're going to get that person doing them for a long period of time because there's the most crucial thing at the end if they stop their exercise which we'll talk about soon how they break down and then their problem comes back so first up subacromial Benjamin now subacromial meaning below the acromion subacromial and impinging we're sort of blanket that work involve a lot of structures you can have your superspinatus 10 and you're gonna have your Bursa you could have bony encroachment all sorts of problems that give you that impingement pain and the pain may vary and maybe in the front and maybe in the side you may have a field at the back immaculate under some where they're not sure you might get referral okay so don't sort of try and think oh it's definitely something there must be that must be super splatters tendonitis and maybe a lot of different things depending on how the shoulders moving and at what point they're catching it so the shoulder pressing mechanism and why it gives you an opinion I'll show you on a video soon but if you think about the shoulder pressing position you start from there now what people don't really realize is that is in full and Punishment at that position there okay so when my shoulder well my glenohumeral joint is in that position there I've got most the time all my structures touching each other under under their chromium so if any one of those structures are swollen or sore from that point is going to hurt okay and when I go from that point to that point it's going to hurt even more because I'm compressing those structures even more I'll show in a video all right so just remember when you're in a shoulder position when you start you're already in impingement okay therefore when you go from here to here or here to here the mechanism of your scapula versus your humerus has to be absolutely perfect so when the scapula rises up when it abducts and elevates your humerus has to move absolutely perfect inside that scapular so you don't catch structures all right especially from here to here you've got to give us that cameras moving perfectly so when you get to here it's in the right position if there's anything that happens from there to there it's already getting caught from there to there when you get to this point you're already losing okay so let's talk about degrees of movement when the shoulder blade when you're from here to here the shuttle bade is not supposed to move okay from there to there it's a zero to thirty degrees now in some people and you'll see on the videos it moves a little bit this is why sometimes you see people putting their thumb behind to try and work out how to stabilize that shoulder blade from the thirty degrees the scapula moves one degree and the arm moves two degrees so two-to-one on an even ratio all the way up so if you think from here to here zero to 30 you've got to stabilize so if it's moving at that point there you don't have a stable platform to go higher at the same time when you go from there to there if you're skeptic enough you won't get a full opening of the shoulder blade and you won't get full range through the shoulder and so if they push it they all catch structures on the way up and this all makes sense when I show your video what's going on and the other problem is when you've got a shoulder wound cleaned up short that joint is nice and stable you've got a big bony socket lots of big muscles around it very tight ligaments that's good for stability okay so it's really good because we can run on and stand on it the shoulder blade is designed for mobility that kind of shoulder joints for mobility what that means is you're going to have a lot less stability in that joint and it relies a lot more on muscle control so if that muscle control breaks down you're going to get changes in the joint and then you're going to lead to further problems so if you think about shoulder blade muscles control the scapular get that moving okay then you've got rotator cuff muscles keeping the head of the humerus remember the primary function of the rotator cuff muscles is to keep the head of the humerus and dynamic center of motion it's not for rotation it does do that but its primary function is when I move my arm is to try and keep that ball perfectly in the socket as it moves because the muscles that are moving the arm majority our delts picks slaps and then we'll attach the arm bone to humerus down the shaft so when they pull and I press or push up or pull this way my rotator cuff have to try and work to keep that ball perfectly in the socket and it's a sloppy socket it's not a bony sockets that the actual bone in socket is very very shallow it's it's a little ditch the rest of it is soft tissue okay so if one of those muscles are not working you're going to start having this not in the perfect center of motion and that's when you start getting in finding problems so the number one cause for impingement is a positional fault so when that ball head of the humerus is not sitting in the soccer perfectly when you move your arm that's what is causing your impingement so let's have a look at a video I will sort of show you what I make now we're going to go on you to a little bit here this some of the videos are they're animated so not exactly perfect but you'll get the idea if you look at their to chromium you're looking obviously Sidon yeah and what you can't see is all the soft tissues in between so you imagine this space is completely filled up with Bursa and tendons and fluid and soft tissue and caption alerts or things there's no room to move there's no ear or anything like that okay now this point here is your humor tuberosity so your rotator cuff muscles hook on around this point here now what I'm going to show you is flexion first now when I get to that point there okay can you see you guys still got a gap here yep and when even when you go higher there's still a gap okay you've still got a room to move in there and most people with a shot impingement basically go that's okay it's not too bad that way but when they go this way so Oh crikey that's sort okay and that's why when we get the end of us next you'll find front pressings a lot more safer than shoulder pressing simply because if you remember that point there there's less impingement with the hand going forward if we keep going don't worry about that one it's this one I want you to see now when you go into abduction what happens is the space here get very very small okay now yes when you're swollen when say you've already got the injury you've already got mg and say you're super space is a little tear it butts swollen the burst is swollen that point is going to hurt when you raise your arm okay but we're also talking about how they get the impingement all right so when I raise my arm if my rotator cuff is not working perfectly if my shoulder bait is not sitting correctly then I've got a chance of that point they're getting actually smaller and the reason being that this deltoid muscle here hooks into the arm bone so if I had no rotator cuff at all and I raised my deltoid I would shove my humerus up into the socket so my rotator cuffs job is to make sure it rotate and keep that ball in the center so it doesn't elevate too much and most of the time the positional fault is elev so the ball goes up into the socket too early on the first bit of movement and jams oh structures you keep jamming and jamming and jamming and jamming they eventually end up with swelling and inflammation and pain all right so just remember that point if we go a little bit higher you see it through there now can you see now at this point here this point is passed there chromium you see yeah and this is where the painful arcs syndrome comes in so before it was underneath it wasn't nearly chrome yet that's fine and it goes under the chrome owl and then it goes to go it's better and then when they come downs like oh oh and then it gets better again an actual classic and pigment of your rotator cuff structures or your subacromial structures on that point bear that goes back and forward past the acromion okay so it's very very important that we assess what this glenohumeral joint is doing and what the shoulder blade is doing to get them better okay we have to door perfect function through there which is really difficult when it's sought because you're dealing with trying to get muscles it exercise data saw and you're trying to make them work but when they work they're not working properly and they catch the joint and all turns into a bit of a nightmare so I'll give you another example this is your elevation of the head now that's what I mean okay so the deltoid is going to pull that up okay you want to see that again that's what I want to say so the imagine there's your structures now superspinatus okay subscapularis Empress Spanish you've heard of those terms before you but sitting in there as the burster as well so if my super Spanish doesn't roll the ball probably administer space doesn't hold it back and the subs' captain hold it forward properly and I get too much elevation from my deltoid I will smash so structures and the more I injure them or the more I irritate them the weaker they get and so the worse the problem gets so people go from yet a little bit sore that's not bad it's all there - really really sore very very quickly as that rotator cuff muscle starts shutting down and switching off and winter switches off your whole problem gets worse now to try and switch their back on and get that strong it's very very difficult I'll give you another example let's have a look at this one okay here's a person now okay so they're with them a little light there's what we're talking about that subacromial bursa okay now it sits on top of the tendon to protect that tendon from rubbing on the bone and a lot of people get their size not you to necessary from lots and lots of shoulder press but they may get it from a fall okay with a goal and and they Jam that Bursa but they haven't gone over use a tendon or anything like that and they may get subacromial pincher it but the symptoms a little bit different the users and the painful arc it just goes pain pain pain pain pain pain my pain all right because that Bursa goes all the way through so if you look at this position here the negative there that's squashing it you major that was swollen okay you get that pain symptom and then just basically as they keep raising their arm it just keeps getting squashed so that's the if you can understand that and get the idea of what happens to impingement you do a lot better with your rehab them with your clients okay so let's go back what are we dealing with so remember it's a positional fault plus overload will give you the injury or the symptoms all right now that movement primarily is going to be up into the subacromial it can be fooled and it can be back so sometimes people will get pain and Cheerilee especially on a bench press as that ball moves forward too much and gets caught doesn't sit in the socket perfectly as I as I press forward okay so it's not just elevation the primary one is elevation especially with shoulder press so what will people get they'll get tissue damage and use just repetitive tissue damage because they do it over and over and over again pain information sometimes that's all it is just a little bit of paying a little bit of information because they're getting something caught it's getting irritated they've done some permanent damage to it if you can catch that early then it's great we can seal it down quickly get them rehabbing fixing what is going on the scapula position and movement and rotator cuff strength might sort of thing if they've had it for a long period of time what's recurrent what can happen is the tendon starts to generating because it's had so much pain going through it and it starts weakening now when it weakens doesn't function as well doesn't control the ball as well and then gets worse and worse worse because every time they raise their arm then they start raising a coffee cup and it starts hurting because they just got no control going on inside the shoulder joint some people end up tearing s but most of the time it's a traumatic experience they might fall over well that oh one more shot of press and it goes in tears a tendon then they're in a little bit more trouble ever tend T is small then they go over there permanently they can strengthen around it and it will nearly be perfect if they do really well if they do a big tear they're more in for surgery which is another killer fish and again like I said this bursitis ligament problems laven problems that sort of thing and don't forget things like dislocations so people had dissertations before then they'll get shot and pendant due to laxity there's such laxity going on and not control the rotator cuff is going to shut down and most people will find that there when they test that if from their right ear rotator cuff is weaker and their skippy of stabilizers was just weaker which is one of the most important things you guys have got to work on is getting skeptic control not just working on bands and doing rotator cuff work everything starts getting tight the back of the shoulder blade starts getting tight a sagging knots and infraspinatus that all gets tight the upper traps start working far too hard the lower traps switch off disarray switch off they start winging which is that shoulder boat starts tilting outwards ok tilting inwards and the body is very clever at then trying to compensate so when you've got pay messages going up from the injury to the brain the brain and say ok shut down everything that saw including everything that stabilized that shoulder beta matter and helps them work in case it's trying to shut you down but you keep going now I've got to keep working got to keep moving and if you then keep pushing it without getting it fixed what happens to the brain within compensate it'll help you through the movement by using other muscles because it's not going to use the correct muscles until that pain goes away or the strength returns so it has to use of stronger muscles that are not injured that are not giving the pain is like upper traps and rhomboids ok so you'll find that people with impingement down the track will have a little bit of an elevated shoulder and there they've got knots and the objects they're using too much and they're a little bit retracted and you'll see the definition of the rhomboids and the chaps almost increased in these people because if it's commentating anything else it's decreased and that pattern of movement they then get used to and we've got to try and bring them out of that the only way to bring them out of that is to provide a brain with less pain and more strength than the ones that have been weakened ok so teaching someone just to relax and won't work you've actually got to give that brain and positive feedback like hey take them out of pain give them the strength and those muscles that are injured and then the brain will let go on the state on the compensating muscles because it doesn't need them anymore all right so massaging out and loosening up compensating muscles is not the answer it does help their symptoms but you've got to look at the root cause of what's going on we talked about that in addition weakness so muscles get the problem the rotator cuff it gets weak and weak and weaker the problem gets worse and worse and worse and a lot of people want to go I'll just rest it because the saw I'll rest it but that is one of the worst things you can do so if you rest the rotator cuff you rest everything and you stop shot oppress I'm not going to do anything in six weeks they get better and pain because they're not shoulder pressing not doing anything that's irritating they're not lifting their arms out hurts but it I won't do it but what they don't realize is they're getting weaker and week and week is over that six weeks to the point where they're weaker than when they started yeah but the injury and then they try to go back at that point now it feels good it feels fine yeah and they go straight into doing bench your shoulder press or whatever their supporters and their pain comes back to fold and very quickly and that's when they sort of start seeking some advice okay we try and pick them up as quickly as we can get them out of pain of course they're not going to do shoulder press exercise but get them doing rehab very very non injury very very quickly to try and halt that drop and strength okay try and keep those muscles alive because we know if those muscles start switching off their problem gets worse of course you can't exercise the muscle in to pain because that will make it worse but we've got to get that muscle working or that group of muscles working sub pain threshold keep them alive while though killed and start getting this less information keep it going don't drop the strength and then start building it up as they get better I can that's the physios job is to try and get the most low-level boring exercise that everybody hates and then get them on board for long enough that they get better well this is getting better and then start working with the trainer and start trying to get their program sorted so they keep doing rehab throughout which we'll talk about later the other few things I want you to remember is some people have a bit of a disadvantage some people completely hypermobile on one side they might have been a tennis player but since they're a kid and then they stop doing that so lots of nothing like the tennis or lots lots of squash they've got quite a loose shoulder it was very good while they're doing because it's very dominance and then they stop doing that sort of exercise but I still got a loose shoulder they lose all the coordination in the control because they haven't done it for ten years and start wanting to go back to the gym start doing work in the gym with a loose shoulder and they don't have the control there and they start getting injured they go why is my good shoulder getting injured now and that may be because that problem might be an overload problem because their other shoulder sets their left shoulder is a weak shoulder and they start doing saying military press like this and their weak shoulders not as coordinated not as strong but you're expecting it to do what the others will the right shoulder can do and that's when they break down and they don't feel it for a while until they start getting and pendulum so if you guys can take that understanding of how it will happens and then when you've got a client explain to them what is going on with their shoulder and why they have to do their rehab then you'll get a much better outcome because this is all about keeping this client on board for a very long period of time to get them perfect because if they get to 90 percent and they stop the rehab everything starts falling apart and some people say well how long after they my rehab before and I say well yep as long as it takes yep absolutely yeah I like yeah the older you get and the more exercise you try and do I call it a sort of a accumulated wear and tear yeah so if they'd be working for long period of time but they've got the thing is if you're older you've got a lot more time to do bad patterns with exercise okay when you're younger you might have a bad patent but you're going very hardcore so we see a lot of young guys trying to get you know very fertile very big very quickly and we see that in the clinic and they're doing too much overload it's not necessary a bad pattern problem that's too much overload but the older people may be doing a very small problem change in the positional fault for a very long period of time and a slow slowly aggravating attendant okay bigger ones that we see though they might have done when they're 20 a big tear they recovered but then 20 years later that tears to generate it very quickly and then they try and keep doing what they're doing and they run into problems very early so your age is a factor okay let's look at those symptoms I videoed a patient the other day was actually very lucky that he came in because I was struggling for videos on the incent because the entity doesn't provide us with lunch let me let me show you one and then set that is really really bad and you won't see people like this but this is someone who's chronically got serratus anterior weakness now you're pretty bit shot of this now lift shoulders good right and what I mean by good that's really good his left shoulder is perfectly flat it's looking great you can see the definition outline of shoulder blade there it is there okay if there's as infraspinatus looking good all right okay that's the angle of the scapula there now he's got his arm against the wall and it you can see see and I'll tell you in a minute see their line of their scapula is out on the movement angle so it's working because when you put your arm out like that to 90 degrees your shoulder blades should have been abducted by them so that's working can you see this one not only is it winging now when you look if you try and give you 3-d brain on that shoulder blade is sitting like that and what you've got to remember the muscle that is not working is serratus anterior it's reyes interiors nose muscles that doesn't have much sensory and put by tippet lots of sense room you can really squeeze it and get it it you talk sort of tennis razor saw and they sort of do you want to know what you mean there and I don't know why but it's like subscapularis you can't feel that either and it may be it because underneath the shoulder blade all right and there's no sensory input going on there no it's not near the skin it Maps but if you look at here the strays interior is in there on that inside that shoulder blade going around to the rib and when it's switched off it can't keep that shoulder blade flat and it can't push it forward so you need your serration tear to raise your arm because with serratus anterior pulls your shoulder boat out to help it rotate and elevate and then you can move your armor otherwise you're going to get to there all right so if I can't raise my if my shoulder is not coming up I'll catch and get an opinion early why not because if I can't get my shoulder they open and up my cranium is going to catch on my humerus all right so I have to get abduction on that shoulder blade and you'll see on the sky he's winging already which means it's not working so when you're winging you're not going to get abduction therefore you won't be able to get your arm up - I know you guys without impingement and you'll see he just can't raise it there there doesn't see that now you've probably all seen that before some of you may feel like Noel so it looks like my shoulder blade some people have us on both sides and we've got clients at the moment that have wing on both sides just naturally they just don't have good serratus anterior yet they're doing lots lots of classes and the shoulder that breaks down is the weaker one because they've got problems on both sides but it's the weak or less coordinated side that gets the problem now to try and Rehab those people who have already got this as a problem and then get shot and pin to it because of that you just go all the way back and try and fix that and that takes months and months and months of getting that muscle working which is why a lot of people don't recover from this very well unless they've got a good trainer or good physio helping them through it and they get on board with it let me show you a little more subtle than that so this is my patient the other day and he has shoulder impingement now the Lighting's not that great but see if you can see that can we drop the lights off the top of us from the screen we do that not sure just the lights of the front just here you're not sure to do that okay it is the left shoulder that's the problem okay I'll give you him now can you see the difference already what's ailing the left shoulder higher than the right okay so straps has already see that little divot there see a bulge of his traps okay so left traps is already activated in that position he's already ready to go now what happens is it's not that subtle on the way up on the concentric phase but it is on the II centric phase and that's where people struggle the most with strength is essentially that's why we try and work essentially with these people so when he raises arm up to there his other traps is working a little bit harder all right now what almost so I know if you can see the slope I can't cuz I look at this every day but I really need those lights off for how long this shoulder blade is sitting in an out sort of direction this shoulder bag is sitting more of an angle can you see that you see that l outliner this one's correct so when he gets to 90 degrees he should have abducted already the left one is not so great it's sitting more on a more vertical angle okay and when I may can go above 90 degrees I mean but that position there is the shoulder press position okay plus external rotation which makes more impingement through that joint so he's already at that point if he was going to do a shoulder press his shoulder is not abducted enough which means as a chromium is sitting down which means he'll catch and that humerus all right now if I look at this he goes all the way up and when you get to the top he's not too bad but he's still sitting not as high what I want you to watch is what's happening with his rhomboids and it's upper trap this is a classic thing for you look at when you're true when you're training people you're looking at people of what to see when people compensate and then when they're compensating there's something going wrong there now can you see the over activity going on on his left side here all this here look as all that rhomboids going nuts and it's upper trap going up and what's happened is on the way down figures shouldered still sitting out an angle here and this one's almost vertical so he's dropped down way too quickly on that because what's happened is his lordship and estrellas intuitive split guys did not can't do that and the other traps trying to hold it it's a dog you know don't let it drop down that's why it's trying to work very hard and the rhomboids are trying to pull back to stabilize bushy he gets stuck from that little bit of pattern because we haven't taken his pain away yet so he has to do that pattern because he can't switch on astraeus and conceptions lower traps because of his pain messaging all right so that's what I want you guys look for when people are doing pull downs or shoulder presses or moving their arms up important I want you to look for that early drop down of the scapula and what it means is their center no traps are just letting go and just letting that shoulder blade Jopp into a reduction and then you'll see that over activity of what's happening to try and compensate for that you imagine like the other trips just hanging on to try and stop it dropping down because then it drops down that a chrome is going to hit and UF you'll find that's when they get to this point i'll they drop their arm down okay so that's what I want you to look for or you can put those lights on if you like now Zeeland got something like that we can see live do you want to jump up yep come up yep Fisher we're looking for a painful art okay efforts from 0 to 30 degrees from here to here they're in a bit of trouble right so if I've got someone do you mind popping your shirt off is it off and you can turn around fast this way a lot we're looking from 0 to 3 degrees which shoulders are so on okay turn face that way so I'm just going to guess and see if this works he's looking right so far yeah if you put your thumbs out to the side for me yeah and I want you to very slowly go up above your head all the way up with shoulders it if where you go all the way to the top good now slowly down for me he's not too bad is it now he's the thing I tell you if he was a skinny bloke you probably see a little bit better because he can compensate very well with lots of muscles all right just try again let's go through five or so and see if he starts fatiguing hope you go go down again dad you see that perfect right up you go slow down this next slow slow see how that's dropping here there it is see that okay it's exactly what we saw in the video yeah it's not the same bloke exactly same sort of problem and you'll see this it's very common it doesn't there it is yeah okay awesome thanks my dad hurt okay I'll pop your shirt on so that's what I want you to look for and it's very easy test to do if they've got I've got a bit of shot of pants but saw okay can you just missed his job in this room here and take your shirt off and have a look at it all right and it does really matter what your diagnostic upon the goal what's the diagnosis don't know is it the surprises the bursar it doesn't matter at this point he's got sharp injury you need to get that assessed yep yep you catch catches you and when it's more fiction you've got to think okay is it more of a subscapular strain that you're feeling where the subscapular comes in is it a bicep problem other time it's not bicep they feel like feels on my by fit but the biceps tender anyway on people who train a lot all right so don't something I stiffly long and advice it's because it usually isn't because usually what's happening with the shoulder joint when you raise forward you might have a different problem than just plastic supraspinatus issue and sometimes the shoulder blade muscles are fine it's just that when you raise your arm okay and your pecs and your front delt pull that bone forward your rotator cuff is not holding it in the socket perfectly and it goes too far into your translation which gives you stress loading pain in the front and the subscapular is going oh my god you know what am i doing and you need that subscapular article pushing forward and that may be your problem okay but no matter what get that assess and see what the problem really is because you may find that you're doing different exercises to someone with classic abduction impingement okay yep yeah you can cause that yeah reason no not necessary because you've got a look at the root cause if the root cause is too much if you think your pics or doubts are stronger then they rotate a gaffe then you need to increase the strength the rotator cuff to match what is going on the pics and doubts and the reason a lot of people get wise they've got on me on trainer Jim I'm doing lots and stuff why it's my rotator cuff not as good as my pics and delts and lats it's because the Train they're probably doing the conventional trainer doing as a bias towards picks and delts and power muscles not postural endurance muscles like the rotator cuff so they're training slowly so try it slowly change over long period of time they get a little imbalance plus they might be left to right handed it's a little bit more complex than that oh and I would try and focus on their movement rather than thinking like I've got to test our strong as it compared to and you know is that strong as a pax or anything like that left has got equal right for start so use your figure on one shoulder it's because it's difference between left and right yeah but then try and focus on their movement get their movement correct stop it compensation stuff rather than trying to just work on the stream okay so the content your faith except your abduction and work on the etheric face you're looking for that movement there winging elevation and of course they'll be in here most of the time it's tightness in the back of the shoulder blade even though the pay might be in the front and it's quite funny if you even been you guys been headed child infringement the physio and they go you have a pain sort of here and they focus on loosening up the back and or something but you worked on a different muscle with my painters but now I gotta have money pain because they're changing the mechanics of what's going on and sometimes people just come in and they have the shoulder impingement yeah saw and I just loose them up and they're already better because some of the tightness is causing that impingement as well not just the fact that the muscles weak and that's where the rehabs got to come in straight away because if I loosen them up that feels really good that's awesomeness is that fixed in two days time they go back and it's all tightened up again that's back oh because you didn't work didn't work so I've got to get them in doing exercises straight away so that I maintain that you know that good movement I maintain it sort of feeling better phase and then slowly get them stronger because of a yo-yo too much they'll feel like the or treatment all your exercise is not working hmm perfect yep so what's the problem when you just looked at all that moving the shoulder babe what's the problem of trying to hold your shoulder blades down when you're trying to move your arm you're not going to get that abduction area and a lot of the time people the classic is hold your shoulders down the back when you row in bench press okay to try and stabilize so you're trying to use your traps and rhomboids to try and lock themselves due to a lack of control and strength because the heavy the weight goes the video serosa lower trap and rotator cuff have got to be so people will tend to compensate we have got that weakness there they want to go heavy okay you got to lock that shoulder way down and unfortunately they don't get beautiful movement going up the shuttle bay they'll get impingement so remember the shoulder doesn't move from 0 to 30 price 30 it's got to move two to one okay so two movement humerus one movement shoulder load to get me up if I don't have enough move my scapula I'll get impingement some way some at some point in there all right so train your shoulders down is it sort of like a quick sort of calm satury fix but it's not the answer at all yeah when we go through the exercise you'll see what I mean have had us how to move the shoulder blade a lot of it is think it's very hard to feel the movement and see the movement and especially on someone again I don't move they're more a little bit more you've actually got to get this muscles working propping get the strength going through exercise and then your movement pattern usually naturally comes back because the movement pattern of this you don't think about you don't go - one two - I'm - one two - I'm - two one to them okay your brain does that for you and it's got a perfect mess it's got a perfect rhythm unless you're very uncoordinated I go without a massive injury it's got a perfect rhythm it just goes works perfectly if there's nothing negative telling it not to the negative things are pain inflammation okay weakness right so if you try as high as you like to get that perfect movement but you've got weakness and pain it's never going to happen you're always going to go the brain is going to go not happening common side right so you've got to work on the things that a week to allow give that brain an environment of okay yep got all the right message there he's worked on that that's strong that's working no problems got good messages I'll let that patter movement happen alright so don't try and think I've got a try and work on my rhythm provide the brain with good environment and then the rhythm will come some people have got very bad like that guy you saw in the video the really really bad wing he'll have to go through a lot of neuro rehab to try and help that and hands-on stuff and guiding that shoulder blade that's a lot of hands-on physio that's a much more complex case than plea what you'll see I'm testing stuff okay so when people have got a shot and Benjamin okay we contested it painful like you've got it right we as physio things know okay what's exactly the injury there so we can tailor make and focus our problem little bit better if they've got a superspinatus tear when they push outwards against resistance very lightly it'll be painful straight away you can almost guarantee that when some pushes against something Alvis external rotation about 10 20 percent of their strength and is pain immediately it's most likely a tear in their super spoon okay you can almost bag every dollar on that empty beer cans out of this you've seen it before so rotate their hands then a little bit elbow bent and then try and push up against resistance and they hurt okay so they may not get to pain that point but as soon as they try and push and use the Tanners their rotator cuff to lift up they hurt and that's usually a tear as well okay and when we do what we call passive range through quadrant we push them through a position like this when they're on their back and that's testing whether they actually getting a catching under their chromium with the bursar or the tendons we can really push them and see if we squash those structures are they inflamed - do they hurt or is it simply just a weakness issue okay so you guys can sort of use that if you like we've gone through those videos okay so what do we do best thing to work on if you see those two the science kid to see a physio get a good diagnosis first because a lot of time people will go if they give the diagnosis from the physio and you refer them to a physio yep I've got that problem okay cool I'm on board because you will hopefully get them on board enough and then you guys can work together because you need to work together to solve this problem that they're going to go back to training the physio needs to be there all the way through up to the training point and helping you as there's person traffic so it supposed to make sure you understand what's going on what they can can't do all the way through most facilitating that person on board doing the exercises a lot of time we'll see people that have had the problem before benefits yo come assess and I got here I did those exposed for a little bit and some seem to work and then I sort of stopped and then I had a rest for a Behrman or hi and in a sort of it just came back and I don't think they worked and it's we hear it all the time they did work you just didn't keep doing them and some people say well how long have to do them for and it depends on the level of injury some people some people can get away with doing rehab and stopping and never doing ever again and everything just switches back on they give a strength back or look specifically but this is where the diagnosis things comes in if you've got a tear and super-spin a that's permanent because most of time they are they just streak that around and it heals up but it's a permanent tear there because of that injury and the brain knows all about it it doesn't keep the same strength up forever you can get the strength up okay but as soon as you stop it starts slowly getting leaking in and if when it gets weak you get your impingement back and so this is where people will do really well and then they stop and then the problem comes back and they'll blame it on the physio or the exercise or that didn't work I won't do it again and then you've really lost them because they're not doing their rehab again and they go I'll just do something else they then to get worse again and hopefully they'll eventually come back to you so getting them on board is one of the most important things you guys can do as practitioners to make sure that their long-term gains are succeeded I like to think of it as a car tire with a slope one type for four tires a car like for rotator cuff one tire has got a slow leak and you have to keep pumping that up every week all right just keep pumping it up slow leaks keep pumping it up think of fitness and a lot of you've been on you know you do hips head spinach you go on holiday for three weeks Dean fitness come back you've lost it all okay why not stay up there you got fit wonder stay there okay now an injury is that but worse so if your base drink hear of your failure rate it will just pull your rotator cuff say you're super smash your base drink is here okay this one gets injured and some coordinated and it's weaker anyway right then you bring it back up to speed great okay you might bring both them up higher you go on holiday this one drops star still because they're injury and they've got to bring it back again but you won't feel it until you start doing this alright so make sure they stay on board our job is and John taking little exercises build and build and build and build and build progress and make them more interesting make them more fun keep on board the whole time speak the trainer okay and then integrate them into their training and most the time what I found is the best thing right at the end when they're really good and they all find it so this is really good thank you so much for our is okay now once you exercise and I want you to use them as warm-ups in your routine okay so you're going to do some media rotation before you do bench press like you need some letter attetion before you do a shoulder press and if the trainer can then write that in their program and they're always doing them then they'll hopefully keep that rehab going throughout their training because you call it warm up instead of rehab right because people won't do these exercises forever at home it just won't happen no matter who you are you won't keep on Friday but you're going to home gym exercises it just won't happen because they the pain is not reminder if they lose pain it's not reminding them that they need to do their homework okay so if you can put in the program long-term then they'll do really well and in eventually if they've done it for a few years maybe they're don't need to do it after that start yep always to start why is that different activation yeah no no I don't think like that if a rehab has always got a sub pain threshold okay so the pain you're going to benchpress when you're fit and fine oh we're going come on you yeah okay that muscle pain that's fine but energy pain is way different it's giving negative messaging going back which will shut it down okay so all your rehab of an injured muscle or a sore muscle weak muscle has to be pain-free bottom line write that down has to be pain-free remember the most if you don't get enough treatments and sound like a car here but if you don't get enough treatments you won't get better fast enough in the time frame of your patients you go vision they want to get better in this time frame here you know explain it's going to take this long they think it's going to take this long but if you don't get them if they don't have enough treatments per week they see once a week and they don't get better enough I think it's not working it's not working looking better enough because you haven't told them to come back enough times or you're trained not they're not coming in two or three times a week the only coming once every two weeks and of course you're not getting better because you're not doing exercises I don't I just sort of just fix it so it'll just you don't get better yep absolutely yep do it okay but you know focus on the weaker side more than that strong side when you're doing that sort of thing but listen if that person is not getting better okay when some of this doesn't get better and we test them that's no good they're off to a film maybe they need a core zone shot in that verse because that business not sitting down maybe they need to go get a scan and see if that tendon is a really big tear okay so you don't persevere with stuff if it's not working all right so second section rehab we want to split this into two sections now I've just done that to give you a definition of skip your exercises versus rotator cuff but when we write a program depending on the person will pick different ones this goes relatively in order of difficulty and activation but you don't just do skip your exercises and then do all those wait wait wait - they're better an MD rotator cuff you're doing a little bit of a mixture but the bias at the start is scapula okay stabilization because if you don't have that there's no point doing rotator cuff work have your shoulder bow is not moving properly or moving too much okay so when you're doing skipper style I think surveyors interior remember is a protractor and therefore it keeps this shoulder blade flat and moves on the on ribcage well and abducts all right works in conjunction with other traps and lower traps well the tires have time the lower traps which is off as well and the large chaps is the one where you need that eccentric work down here to try and hold and slowly lower but also when you're coming up to pull upwards okay they'll work in a rotation mechanism that's how it works up a trap lower trap serratus anterior and the upper trap one seems to be the one that doesn't switch off sometimes it doesn't people to move their shoulders way on here okay but most of Tomas want it if the brain uses to overcompensate so we focus on raised here and lower traps as the ones we want to work on there for exercise are based on that okay remember the role of the rhomboids is retraction okay so you don't use it to stabilize your shoulders you've got to use stress interior and lower traps and traps okay it does of course it stabilizers and shoulders up its pulls it backwards how you going to raise your arm if you pull it backwards and locked it down yep but if it's weak it needs to be strengthened rotator cuff so primary goal well primary role I wrote a cup is stabilization of that humeral head and keeping that ball perfectly rotating in the socket and setting the socket as the arm moves stick me roll rotation excel internal different degrees adduction abduction right extension flexion does a lot of different things and think of it as a working unit underneath the delts and all the other muscles okay because if you think like that then you won't just go straight for the band to start doing this all right and then you also go think isokinetic and isometric isometric meaning not moving isokinetic mean moving and some people who really saw just start with just pushing their hand against the wall for external rotation ok we'll push it off add optional adduction okay pushing it something because they can't move through range yet because they're so saw and a lot of the scapula stabilization stuff is isometric to start with because remember from the first 30 degrees that shoulder is not supposed to move so those muscles are weak and it moves all around and the upper trip is doing this to it ok there's no point doing isokinetic work if you haven't even got the isometric work first so you see a lot of us shoulder stability stuff is isometric and then moving to isokinetic and you also see I got here yeah oscillatory work which is this is isokinetic oscillatory meaning this movement okay so trying to start getting that very quick rotation movement of the rotator cuff working rips and sets my experience try and get four sets of 15 as your goal they may start off with two sets of eight because they saw and they fatigue and they can't do anything but you're trying to get four sets of 15 on isokinetic isometric as ten-second holds and trying to do ten of them if they've got 20 of them that's great the 10-second hold something isometric 10 second holds isokinetic 4 sets of 15 reps you've got to get that endurance up and you'll find that because if they start doing is in band here and here and going because I don't even feel it I'll go harder and then their load is too hard you finally give a slight ban on this what is this they get to the third set of 1500 oh my god this is you know really working me now they go get through 4 sets of 15 on whatever color they've been issued and then increase the strength of that band after that yep yep yes exactly yep so one second out three two one on the way back okay because that give them up time to try and work out how they're going to control the shuttlebay which I'll go through in a minute okay prone scapula press wall press what I'm Skydive absalom leg raise one arm row you've got all these on your sheets okay basically going to look this is your upper trap here can you see that triangle of how it's going to work surace and tear pulling out larger pulling down upper trap pulling up to get that shoulder blade moving so that alignment of the sock is perfect so I can get my arm up in the air with my dot from my rotator cuff let's go through these ones that that's a good order for you of difficulty and stabilization yeah yes so fara bands is an increasing resistant there's no muscle shortens and as we know when a muscle shortens it gains relative strength so therefore when a muscle shortens and gains relative strength I need that resistance increasing to keep it even throughout the movement so I'm getting even resistance throughout the whole move it is relative to how strong the muffler's okay whereas a cable does the same sort of thing but it's just using gravity and it's going that way vertical on a weight so even though you're pulling it the weight is going that way but the ban is directly related to the excess of movement here always prefer bands over cables you only go to cables when you need to restock up the weight and you're going back to functional move it or the train that they want to do just pull down to the stuff like that and the user in cable is is because you can't do that pull down with one arm user will use a cable okay and then that they get that right there left hand right bus there right and then they can do that pull downs and dumbbells yeah I see people doing this in the gym and almost feel like going to go from Stefan alright because the weight is that way so they're basically doing bicep work and a tiny little bit of external rotation one there's no resistance going that way against my muscle is it make sense am I gone their side but again there's no there's only gravity changes here okay and they usually do it because it's easier than the ban you try and go on your side and use the band it's a gravity and a band that's real hard now we trying to adhere to start with and then go up with like this so try and avoid blowing aside doing a dumbbell doing a dumbbell here doing a cable but that's all you got and fine but bands are pretty cheap again they do different grades and different resistances and they take them home and they do my home that's one of the major things about them okay let's have a look so we're going to touch through these ones just briefly try now I'm just going to pick out little things that I find you guys need to use as prompts and cues and things to work on because you can do the exercise at home and you've probably gone through a lot of exercise and go I know these ones but it's about how well you do them and making sure you know why you're doing them just remember with every one of the exercises the rotator cuff is working don't you think I'm just doing scapular work the rotator cuff is working so if they've got an injured rotator cuff you're trying to fix the scapular movement and control but they've got an injury rotator cuff just be careful how much you load them up on these things because they might start getting sore because every time I put my hand on something or move it I'm using my rotator cuff to do that right so just remember that so prone scaping press the most boring exercise in the world of physio now this one's very important host:2 caught the cat press but I just I changed my mind prawns kept your press so four point nearly right neutral spine the hardest thing for these people who've got winging is trying to work out what the hell they're supposed to do so I give them here and I say now push your ribs up in your shoulder blades need to this and they don't know how to do that movement there because they haven't practiced it because they've sat on a bench and lock their shoulder blades back and they haven't learned how to protract fully okay so they've got you've got to try and get this person into neutral and learning how to retract drop down and push up that position and you're trying to get protraction only using this Rose interior and that'll help get their shoulder low fat and when they're doing it correctly you'll get that nice flat shoulder blade across okay just make sure you don't get them drop down into attraction to it pick of the e centric phase it's very important because you're working stress essentially which is how you build the strength the quickest so they just drop they're not going to get any work done properly alright the harder one is working on a wall now if I do this way the reason I've got to come behind the back is I'm feeling what that shoulder blade is doing okay I want the shoulder blade moving away from my thumb and then coming back to my thumb now most people when their brain that patter moon as soon as I start doing press they want to do a push up the radio said be no baby no no don't bend yellow hey what am I supposed to do they got to learn a new movement because they're moving us that all right so it's let him out so they come back and then pushing it forward what if that's too difficult for them they have to do it two hands okay silly little movement boring as helll makes a massive difference but they need to do it a lot and every day when I'm skydive looking like you're skydiving over plane okay one arm meaning your lower traps are working the most so when you're doing this one make sure they don't go and lift their shoulder boat up with your upper traps you've got to guide them that shoulder blades got to come back and down towards the opposite hip okay so if you think back and down towards the opportunity so their bias is working on their mid to lower traps okay and then you can add in some external rotation that's an isometric hold ten seconds yes yeah don't let them go of that okay because we're trying to stop that compensation patterning like so don't let him go go yeah like that go okay they've got to get it and it takes a lot you might spend 20 minutes on that it's harder than that boring when they progress to that obviously get them into extended session bear in mind if they haven't got a range of movement like me see you know I feel I'm doing my wrist this is showing my flaws here trying to give my acceleration will extend my wrist all right napkins fire I can't even get a zero Degree bit okay I'm sort of sitting below do you think I should be shoulder pressing above my head I'm going to pin her though but I don't have the range of mood on my shoulder joint because I'm just naturally really tight I should work on it but I choose not to do shot press ok on your front press and I'll be 45 but I will not get here because I just can't get there and if I keep doing that I'm going to get impingement just do to my biomechanics which one the first one the yep summer here and I'm going up into that position there and then hold into there okay and you're trying to teach them to so I usually try to trust get that lower check working right awesome exercise yes you use your rhomboids but not as much as you large have because the way your rhomboids are angled they angled up on it this way so if you're pulling down you're not going to use them as much that make sense yep if you don't it doesn't fender review your Nana me okay obviously that's my favorite my favorite by far because this one does Reyes interior and your rotator cuff isometrically most people use it as a core exercise right yep train your core now big floors this one is people do this don't know if you can see me or do this way I'll stick my bum here not they will go like that Lotus move completely alright so if I go from here they might raise their arm and they'll shift on to their knees the first thing they do because they don't trust their shoulder so the injured shoulder here don't soon as they raise down they'll shift away and then you try and move the opposite leg and I'll shift right on to that this one here and it's hardly any way here that's not really doing much cool anyway so with this one and you guys got to practice this it's really really really hard because what you've got to try and do is have full protraction okay and then I've got to shift all my weight out of my right arm and my left without moving okay so I'm three points now even 33 3333 yeah and then what I got to try and do is put fifty-fifty so then I've got to put all my weight through my right knee in my left hand and then also you'll see I'll start shaking a minute and then I got a float like that and then I'm going to do a ten-second hold and most people if you watch my shoulder here you can see this most people were negative D and then move the leg they'll get to the end then I'll start dropping and they'll go into retraction because the serratus goes I can't I can't I can't I can't I can't I can't do that but so you've got to constantly prompt them get up up up into projection and try to get out straightest endurance and strength building an isometric position yep the whole time that rotators rotator cuff is going oh my god and trying to hold on isometrically which is great it's not hurting it you're not actively moving it people are really injured will find that hurts a little bit okay so you'll watch that you may just do just one arm okay not the full load but you've got to practice it yourself before you even think about giving it to clients because it is really hard and it's really taxing because they don't ten cents for that of ten seconds it's going to take me five minutes all right it's a hard thing to do but it's an awesome exercise you can then add on Pilate stuff you want to know circles and squares and things so the arms and legs to challenge here the more you get this better and your back better the bit everything connects more core stability more posture is working the bit of things are going to happen all right Farra bands as well you can start putting their bands on arms and legs and you can make it very interesting if you like but this exercise you know people ask for the exercise I keep in my regime keep this one and bottom line keep it in ok warm-up are you going to do bench so that's why put the one on one legged over the core what you see secretly doing is trying to get their rotator cuff really working they're shot about really fired up okay when I'm rose you're pretenders a lot as well okay make sure the one I'm rose you are shoulder blame first second a lot of people will are man sure they'd together as soon as you do that moving then okay I haven't got my shoulder blade retracted enough that point there so when I pull back I will pull back there like that and then I'll eventually get it back at that point there I'm irritating and this really sets up your pattern of movement when you're going to do rows and pull-ups and that's I think okay is getting that shoulder blade back first and then pull through the now I'm going to him on back there but keeping that feeling that shoulder they come back to my finger when I pull through and the trick is keep it on my finger essentially as I move my arm and then let it go forward okay so promise that US shoulder blade arm shoulder blade when you're telling our client simple things they need to remember no no shoulder wait arm and then also what they'll do is I get to this point there okay and then put the shoulder foot okay and just put their finger my neck or put your finger there and tell me to keep it there so when they are rolling they are trying to train their brain to work correct lower traps a little bit about correct movement as it is the key you're promoting correct moving to the brain and providing that nice messaging system to try and get them moving better so it happens naturally when they go heavy yeah if they're too tight they'll start doing that yeah you can go some people go all the way back because they can keep retracting and they can kick in elbow back further because they can keep going but as soon as it starts doing that you've gone too far so some people be too tight here they get the point they go they won't push the elbow back up just rolls okay so they can only work in their available range don't try and push it isolation ball will press many of you might not have seen this one this is taking stress anterior to another level so what I'm doing is I'm pushing backwards and upwards on a diagonal so you go into a 45-degree press position put the ball on there and the reason we do this for sports because it you have to balance it and control it rather than a weight which makes you switch on way more partial systems in your brain which is what you need for the sort of rehab and I'm pushing that angle okay but I'm not pushing and extending my arm okay I'm going from here and trying to get protraction I'm doing that movement so my elbow and my shot has to work together I can't do this movement and I can't do that movement alright so when I push up in the ball and lift my showboat off the floor it's that move in there and then I hold it ten second holds maximal push yep you caught that sorry just doing push yeah all right one arm will press now this is active now that our last one was isometric this is isokinetic same movement but now I'm getting in so it's the press up on a wall with one arm the trick with this though is make sure that their shoulder BAE doesn't crash back so when they come into the wall they go back and do that they've got a slowly control and usually having that as a guide and when they press four they've got to push that shoulder back forward again that's getting their bench pressing mechanism better so there's a good luck for bench okay just get remember that movement you got to get that movement going all right that's taking your large haps it's another level isokinetic and you can do it isometry you can hold up if ten seconds or you can do a kinetic movement up and down up and down up and down and down again look at people like me with my range I purposely do this I can show that I'm not perfect look at my range there now why do you think it's worse than that position that it was on the floor what else is what else do you think is tired of me that is affecting my shoulder blade of not being able to get back and not the rotator cuff not be able to get back we think no one forensic okay so my thoracic spine movement is atrocious so I haven't got enough extension genetically I've just got a fixed kyphosis I don't have enough extension that way so when I come up with that movement I'm already round right so I can't get back I can't get my shoulder back on my spine because it's too rounded alright so watch people like that fix kyphosis they might have ed Sherman's disease when they were little kid now you go watch those two people because they can't miss you or do everything that you want them to do so you might have made that exercise you might do the backward one you get t-rex awesome but you city centrically okay to up hold that one down control that movement so you're training you're stabilized by your lower traps to control essentially and then let it go you're also controlling a pattern of movement or push and pull teaching that brain when you're going to move the shoulder babe when that arms got to come back for some exercise all right two up one down supine ball press and I'm using a medicine ball for postural control I'm not using a dumbbell because when I got that dumb ball I'm going to start using all these other muscles that are power related doesn't matter how heavy the ball is it's about activation getting it working and it's just this moving here don't move the elbow and this is what I call open chain so open chain stratus on the floor was closed chain same movement exactly the same movement as that one's open ones closed I need more postural strength to be able to open chain movement then I do a closed chain movements what we start with a closed chain moves the open chain ok the great excit if you ever have done it before you'll be surprised had that again that one else as well alright make sense so rotator cuff now where's physio start rotator cuff day one sometimes day - depends on how sore they are but they've got to have remember in your brain sketch the stability over rotator cuff stability or strength think of your muscles you look for them infraspinatus teres minor superspinatus subscale remember yes they're four different muscles they got their biases you know I care that one knows rotation that one does abduction they work as a unit to stabilize and key that ball in the center of the socket there's your primary goal then you work on okay strengthening source up alright but when we've got an injured superspinatus we can work on the other muscles individually that's why we do ban work because we know the super splice is working a little bit every time I work any one of those muscles now if I can build up strength around it it helps support it helps you give more overall strength and then I start getting better rotation control and function they're like a start not hinging and working on my superspinatus later that's so order of exercise probably that order there is the safest depends on the energy again the physio may advise you different exercises in different orders extension that movement there all right there's your first one make sure when you pull back you don't roll your shoulder before you learn all everything you've learned about Skippy stability it has to come back as you go back you can only go back as far as you can control boring exercises boring size number two oh my god this is so boring and it makes a massive difference you start working on little shoulder muscles for 6 or 15 every day a couple of days or something like that feels better because they're getting muscles engaged to help them with their movement stop that impingement ok very safe exercise especially people like really war the first thing they can usually do is that it's a forgot an exercise adduction now an option using teres minor and infraspinatus to pull it and think about squeezing a muscle in your armpit keep your elbow straight start a 45 degrees have a tension there and pull inwards make sure they're not you know rotating forward or rotating back your that shoulder the center of the scapula centered alright this is working on those muscles because when I come up like this I want my adductors making sure they're strong enough to keep that ball down and not rise up does it make sense so work on down down down down down we do this in the clinic near 360s and then they go that's better how can I be better and even work my superspinatus well you did okay but you just made you fired up and activated all those muscles that control depression of that ball because your problem is elevation now you've got less impingement great all right work on that one it's a forgotten one as well people don't do this they start doing this so work on the adduction about three seconds yep okay one down three seconds he centric okay some people with really bad scatter control have to go slower than that because that just be shorter blade moves too quickly okay the classic yeah anyone hasn't seen this as lying right classic and even stuff do you have done some rotator cuff stuff okay but you've met and we've just been through about 12 exercises that should be done as well okay so this one is again if they're really saw they're doing an isometric first but this is isokinetic size they have got to work in the pain free range you can't go and go oh it's out there no point doing that work in the range they've got and sometimes they're really tight so they only got a little amount of range the working the range I got big mistakes are keeping this elbow lock against your side do not have it down here have it out here having it down there is cheating and using your adductors to lock that and say who's easy okay nice and stable hang out here is harder because now I've got to work it on an axis that I'm not sure of so you've got to work on this axis here and so the elbow is not allowed to move so when I go from here to here my other pivots on the XS I'm not allowed to do this because if I go if I could have sought super spinasse and I abductors Oh extenuating it's going to hurt we're going to load it up too much I don't want to load up too much I want to load up my external rotators right to make this harder like they may spend one or two weeks doing that then they move to 45 when you guys move to 45 with the internet experimentation face 45 degrees to the band okay so I think 45 and 45 this is 0 45 0 45 and pull on that ankle there so now my axis of rotation is here what am I using now more than I did before superspinatus ok so I'm using my abductors to hold it there while I'm doing this I'm not doing isokinetic much on Super Smash I'm doing ice kinetic on my lateral rotators and my super space is holding controlling holding controller holding controlling I'm building up the isometric strength first before I move into isokinetic and then the last ones 9xo face 90 that way okay I have to have really good control before I even get to here because the vomit impingement there's no point during that me rotating my shoulder okay so before I get to 90 I probably had to go through internals and abduction so you build your strength down here so you can actually get to there and it's 0 to 30 why isn't it about 30 because a shoulder blade moves yeah we're trying to teach your brain to work on scapular stabilization down here and isolate that movement to build up that strength you try and isolate a little bit everything's working but the bias is more towards the abduction okay if I start doing this when it's not strong enough I'm just going to impinge it especially with my shoulder base not working well enough yeah okay how we going to make it harder make sure you warm up that rotator cuff and every time you're doing stuff it's close to conventional training or harder stuff you've got to apply the principles that you're using before ie when I pull back I've got to make sure I keep that what I learned all right all that pressing movement all right let's go through these ones BOSU push up big thing with that don't lead oh sure that's crash together make sure your weight is over that BOSU it's harder than you think BOSU because you get any bit of stability work you get away more posture work going you have to have any call over more right and it stops them from doing too many pushups all right one arm cable pull down this is a precursor to lat pull-downs two chin-ups all right again you're going that angle so I'm not in full elevation trying to do it that way I'm still out of my impingement zone really but I can only do that when I've got enough strength to be able be stable in that position without impingement make sense that's what's down the track a little bit this one you can add up the weights stronger and stronger stronger apply the principles you've got to pull down and back and through okay and it hold now go back the heavy the weight goes the harder that is to do so there'll be a limit on however you can go because you'll start sacrificing your range when I'm cable press is the precursor to benchpress getting that movement forward okay again remember it's arm shoulder blade shorter ladar don't even get confused about the putting on which is shot at arms all about okay band diagonal this is to get them into a start of a shoulder press position so they're building strength from here to there make sure when they pull they've got to get that shoulder blade back early they can't pull there I've got to get back early and up and then when they come down down it'll pop fortuity they've got a control and then shoulder bow again shoulder boat arm shoulder blade all right so that gives them enough strength to get to this so they can press TRX more difficult push up more difficult bench because it's all wobbly the harder you go the further you go down you know TRX okay very difficult to get there full protection with that prime wise gets you upper traps strong if they're weaker but also teaching you to not use momentum and front press is the precursor to shoulder press so from here it's like an Arnold press but it's not sort of as much rotation remember I'm shot I made sure little play arm most people want to go bang straight up okay so you've got to get that thumb behind and make sure from zero to thirty it's not moving and then it elevates and then comes down early a lot of people just don't leave it up they leave it up there okay it's got to come down that you use for your shoulder pressing mentality and as you get better go why to the 45 they can do that they can start to wait and then this is all about have they got the range of movement have you done all your homework and how they got actually got the range of movement to build a shoulder press okay long road isn't it all out to get to a back to a shoulder press so a lot of people skip those steps things to be around remember just to finish off if they're tight like me through a sec get them on the foam roller loosen up as much of that soft tissue as you can to get it back to maybe they've just got a little bit of threats going to Mellie maybe it's just a lot of tightness from sitting in an office shoulder chest movement okay if I pick some I pick mine up my picture is so tight because they're so big not mine though but I can't get back here okay work on stretching that out long-term alright won't get fixed in a week it's going to get fixed in six months chest versus back okay too much chest not enough back they will just sit naturally for a little bit more they'll find it harder to raise their arms ten and tears if it's diagnosed and they've got a permanent here in there you need to be aware they're probably not going to do a classic shoulder press ever again but they need to be educated on that why they can't do it now so choose front press open or press 1 press meeting in here and 45 degrees it's a functional movement more than this this is for bodybuilding mags okay you don't put a box up in the cupboard like this you put it up like that okay and you're in a pain you're enough shoulder non and shoulder impingement position here you're always in shoulder impingement you have to have everything working perfectly is it worth it sometimes it is okay and some people get away with it but if you've got someone with problems and they're having right and not quite right there's still difference choose front over classic and again incline over incline press over that way okay I wouldn't do military press ever with these sort of clients dumbbells over a fixed bar meaning left and right because they're using lot more postural muscles left and right which is great for strength but if they've got a fixed bar I don't need my rotator cuff from skipper sellers as much as I used to with dumbbells therefore if you're using a fixed bar you're promoting power over posture will you then slowly get worse again and swimming there swimmer get back swimming other things you be aware of a long lever so front raises are out right and little raises are usually out for these sort of people they don't have perfect control which is all the conventional stuff you think why can't I get back to it well they can give back to once they're absolutely perfect yeah okay given thing about programs whoops so we aim to get them pain-free at rest the first two weeks ago pain-free easy they need to have a pain-free ARCA two-three weeks so they need this is the giving back training they need to have this pain-free other ones the physio hasn't done their job or the injury is really bad then they need to be doing rehab below 90 degrees they should be all pain-free down here everything's great all down here everything's pain-free three to four weeks is how you progress it so the four week mark you should be looking at getting sort of above 90 up into here pressing an external rotation up here I can do diagonals only the forelock maybe they eight-week mark depending on their injury and then normal wax or weights or trainer sport is way down at sort of six or eight weeks then you start integrating that in now you as a trainer or trainers out there might think well they're not training me until six for six weeks you say ah they're just not doing conventional stuff that you used to do in your program they're doing rehab with you and core and running and all their leg stuff yeah you're just pulling out stuff with the physio pulling okay Pueblo put us in put a symbolism because if they're doing seeing the physio once they're seeing you twice there's three times they can train with a person helping them so you need have those exercises then if you're not doing them then they're not getting their rehab like I said using a warm-up choose exercise on body part days so for the Hang I I'm going to press what I use my presley's my sub skate more so I might do some internal rotations because I won't have time to the whole rehab thing it's just not feasible we're going to shoulder press like Alderson Leverett owners might do some fall on the floor okay so start picking those exercises and putting them in depending on what they're doing on that day one day might be completely devoted to rehab a bit of cardio or something and getting back to see the physio every now and again if I start breaking down you think things aren't working this isn't getting right getting back in get a person back on board we talked about pumping up the tires okay so hope that makes sense I'm here available for questions and things like that come up and talk to me one thing I want you to take home is we do in our clinics I'm in the East Sun bono Junction my colleague Dennis is in the West castle we do consultations senior physiotherapy consultations for pts added like a cheaper rate so if you guys need consolation for yourself or you actually want to come for education one on one we can do that for you so just take down ideas I don't think that's on your on your homework sheet so take down my details and yeah come and see us and we'll help you out it's almost like workshops things like that and Facebook's up there everything that we release like videos articles exercise less stuff it was already leased on our Facebook so just go to our Facebook account and like that so you get those feeds coming through for you you've got the handouts which are on our website if you click on our products thing but the exercise sheets with all the cues of what we went through today if you go to that website there you go to the exercise lie but you'll see that shoulder and skip the exercises click on that PDF you can download and print off yourself okay after one we use for our clients all right and all those videos I went through today with you or on a YouTube see the go to youtube and type in physio Fitness Ostrow Oh we'll just click on the youtube link on our website and you'll see those there in a little playlist folder if you want to go through them they're great to use for your clients to show them even your phone this is what's wrong with you so they go oh okay got it right very good way of explaining all right hope you enjoyed it thanks a lot

Channel: Physio Fitness | Physio REHAB | Tim Keeley

Views: 4,776,711

Rating: 4.2152209 out of 5

Keywords: physio, physiotherapy, physical therapist, physical therapy, scapular winging, winged scapula, scapula, scapula push hups, shoulder impingement, winging of scapula, scapula push up, rehabilitation, rehab program, shoulder external rotation, frozen sholder, how to fix winged scapula, external rotation shoulder exercise, external rotation shoulder, shoulder impingement exercises, how to fix winging scapula, rotator cuff surgery, rotator cuff exercises, yt:stretch=16:9, yt:quality=high

Id: XF6JvfpxRSg

Length: 89min 40sec (5380 seconds)

Published: Mon Jun 03 2013