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

  • reasons that people come to see me as an osteopath. The chances are you may even

  • have a shoulder problem which is why you might be watching this video. In today's

  • video I'm going to show you why I think shoulder problems develop and what you

  • can do to try to fix your shoulder problems. But before I do that I need to

  • just briefly explain the anatomy of the shoulder and some of the more

  • significant features of the shoulder and why that's relevant to shoulder pain.

  • Okay so what we've got here is a model of the shoulder complex. Right now what

  • you're looking at is from the front almost like you've got my shoulder here

  • and I've taken away everything all you're left with is the shoulder blade.

  • This bony area here is your scapula also known as your shoulder blade. Here we have

  • the collarbone which is also known as the clavicle and then your upper arm bone

  • known as the humerus. All of these muscles that you can see attached are

  • collectively known as the Rotator Cuff. The Rotator Cuff is made up of four main

  • muscles. The first one is the supraspinatus, then you've got the

  • infraspinatus, teres minor and teres major and then on the front side you've

  • got the subscapularis. Collectively the rotator cuff pulls the head of the

  • humerus in towards the scapula creating stability. Individually all of the

  • muscles have slightly different functions. Starting with the

  • supraspinatus it holds the humerus into the socket, tenses the capsule and

  • abducts the arm. The infraspinatus also helps to stabilize the capsule but its

  • main function is to externally rotate the arm. So if you were to bend your

  • elbow and take your hand out to the side, that's external rotation. The teres minor,

  • the one down here also weakly helps to externally rotate your arm. And lastly

  • the subscapularis helps to medially rotate the arm or internally rotate, so

  • opposite to the infraspinatus if you were to bend

  • your elbow you would be taking your hand across your body towards your midline.

  • The reason I mentioned these muscles is because most people I see are extremely

  • tight. This causes a lot of strain to be put on the tendons because people having

  • to fight against this tightness and one of the main areas that this irritation

  • happens is up here in the supraspinatus. Irritation of the tendon leads to

  • swelling and that swelling causes a reduction in space. So when people then

  • start to abduct their arm that lack of space is causing people a lot more pain.

  • All right so I've taken away all the muscles and now all you're left with is

  • the joint in itself. The joint is known as a ball and socket joint so here you

  • can see the ball and in here is the socket. What's significant about the

  • shoulder is that the ball and socket is quite shallow. It allows greater range of

  • movement in all directions but the problem with this increased range of

  • motion means that there's actually a decrease in the amount of stability so

  • people with hypermobility are often at risk of dislocated shoulders. The other

  • thing that can happen in this region here, more so in older people is the

  • development of osteoarthritis and unfortunately once you get to that stage

  • there's not much that can be done from someone like me in the way of treatment

  • and it usually ends up being more of a surgical procedure to try and restore

  • some of the smoothness in that joint. So the next thing I want to just point out

  • to you is this tunnel right here. This is where your supraspinatus muscle runs

  • through. The supraspinatus attaches just above the spine of the scapula and runs

  • through attaching onto the outer part of your humerus and the reason I mention

  • this is because the supraspinatus is one of the most

  • commonly irritated muscles in the shoulder region. So I've added all the

  • muscles back on. Now as you can see the supraspinatus here is running through

  • this tunnel but when you lift up your arm if I just take this out. When you

  • lift up your arm that gap becomes a lot smaller and this is the reason why a lot

  • of people get pain in their supraspinatus, because an irritation

  • occurs on the tendon and then every time they lift their arm that closing in in

  • size of the the tunnel causes a lot more pressure on the tendon. So let me just

  • put everything I've told you into context for you. Most people who come in

  • to see me have pain in this upper frontal region of the shoulder. To me

  • that usually indicates that there's some kind of tendon ligament or Bursa issue

  • and in my experience that is usually because people are extremely tight

  • through the muscles in and around the shoulder. Most commonly that tightness

  • comes from the rotator cuff muscles that I showed you earlier. In order to confirm

  • whether it's tightness causing these issues I'll usually do a couple of tests.

  • The first thing I usually get people to do is to show me their ranges of

  • movement, so I'll get them standing in front of me and get them to perform

  • complete abduction all the way up to the ceiling and back down and then following

  • on from that I'll get them to lift the arms up to the front

  • as far as they can and down, and what I usually see in most people is that

  • they're quite limited in full flexion so when I look at them from the side their

  • maximum range of movement is to about here. What I would like to see is full

  • range of movement where the arm is right up by the ear. After that I'll get them to

  • do the painful arc test and what you do is you stand arms down by your side

  • and take your arm all the way up to the ceiling and note

  • where they're getting pain If it's a superspinatus tendinitis or bursitis in

  • this other upper subacromial region though usually feel pain between about

  • 40 degrees to about 120 degrees. Now the reason that that happens is because as

  • you get to this sort of area here the space between the humeral bone and these

  • the acromion is completely minimized like I showed you earlier. After that

  • test I will get them to do the scratch test and it looks like this. What you're going

  • to do is take one arm behind you and reach up as far up your back as you can

  • once you've done that take that arm down do the same on the other side and then

  • back down and note where both hands or both tips of fingers reach up. Quite

  • often what you see is the side the shoulder that has the pain will be quite

  • restricted and will not be able to go as far up as the good side. Now on the

  • demonstration that I just did what you might be able to see is that my left arm

  • can reach up my back fairly high but when it comes to the right side there's

  • a lot less range which indicates that my right side is tight in either extension

  • or internal rotation or even just a combination of the two together. This

  • would indicate to me if it was a patient that they need to be doing more

  • stretching in those ranges. So if you're having shoulder pain or shoulder

  • discomfort definitely go through these tests have a look at your range of

  • movement first of all see if you can get those arms all the way up to the ceiling

  • if you can't you know your tight. Then take your arms behind you do that

  • scratch test. If you're struggling to get your arm behind you then that's an

  • indication that there's definitely tightness in the front or in the rotator

  • cuff muscles and that will mean that you need to then stretch in a more extension

  • or internal rotation. And since we're on the subject of stretching I'm going to

  • show you now some really effective stretches that I prescribed my patients

  • all the time and also how to use some massage balls to get into those tight

  • areas too. The first stretch that you're going to need to do involves using one

  • of these which I believe is called a power band or a strength band. You can

  • get this fairly cheap and you get it from Amazon, this is a medium. Anything lighter

  • than that you're probably not going to get enough stretch anything stronger

  • than that and it's probably going to be too strong. So anyway with the band find

  • somewhere in the gym that you can hook it up or somewhere at home. Once you've

  • got it attached, looped over something above you put your hand through the band turn

  • your palm up, face away from the band. Now right now I'm close to the band so there's

  • hardly anything any stretch going through my arm. Straighten out your arm

  • lift your chest and gradually step away from where you've attached the band. You

  • should feel this stretch around the front of your shoulder possibly even

  • going into your bicep. Once you've done that same set up for the next stretch

  • put your hand through turn away and lean forward this allows you to get your arm

  • bent behind your back. With your free hand hold onto your fingers of the hand

  • that's through the loop and then step away and as you step away gradually lift

  • your chest and what you want to try and do is pull this arm this elbow away from

  • your body.

  • Once you finish, step back lean forwards and allow yourself to come out of the

  • band. And the last stretch I think you guys should probably do is this one up

  • into full flexion so get your arm through the band, take it out in front of you and

  • gradually walk forwards keeping your arms straight until you feel it stretch

  • and just try and push your chest and head through.

  • So here's something else I really like using and that is massage balls. This is

  • a lacrosse ball but a massage ball, Lacrosse ball, hockey ball, anything that's

  • hard enough to get into those small muscles will be perfect. I like

  • these because they get into those small muscles that are hard to reach when

  • you're using a foam roller. So what you're going to do is try it and get

  • into your rotator cuff. The principle is that you find a tender point press into

  • it and hold in that position. If you hold long enough that pain will start to

  • disappear. So to get into your rotator cuff get the ball, place it underneath

  • your arm, with your free hand pull so that you can get this ball further

  • around behind you. Then come up against a wall and press in

  • against the wall. Move around until you can find a tender point once you have a

  • tender point just stay there, relax and apply some

  • pressure. Maintain that pressure until that pain starts to go away or you've

  • done about a minute. Once a minute has passed move to a different point and

  • repeat the process again. Then to get up into these upper muscles you need to do

  • a bit more contortion, so place the ball up and over but this time you're going to

  • have to lean back into the wall. Lean up against the wall, again find those tender

  • points, hold and stay for about a minute. So that's pretty much all I'd recommend

  • for now guys. The strength band stretches and the massage balls. I would suggest

  • you do either of those in alternate days so for example strength band stretches

  • you could do on a Monday Wednesday and Friday and the massage balls you could

  • do on a Tuesday Thursday Saturday. And the reason I say this is because

  • if you do either of them too much you're only going to make yourself quite sore in

  • terms of how long to do them for I would suggest doing each banded

  • stretch for about 15 to 30 seconds, then move on to the next stretch for

  • about the same amount of time and then the next one for about the same amount

  • of time and then repeat maybe another one or two times after that if you have

  • time. For the massage balls find those tender points that I talked about hold

  • it on there for about 60 seconds and then move on to another point. Hopefully

  • you found this video really helpful. If you did guys give it a thumbs up, if you

  • have any comments or questions do stick them in the comments section below and

  • until the next video take care guys and I will see you soon. Bye bye

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

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肩の痛みの理解と治し方 (Understanding Shoulder Pain and How To Fix It)

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    Li-chieh Young に公開 2021 年 01 月 14 日
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