How To Evaluate Shoulders (1)
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[00:00:00] can be so much easier than you think. And I have a very particular way in which I Do a very quick screening, which then can lead into a further assessment of what to do when I'm treating someone with a shoulder or I'm treating someone with a hand and arm problem that I think is involving the shoulder.
If you're an OT or PT and you're looking to develop your clinical skills, treating hand and upper extremity, well here is a short clip of, um, part of my lecture from my two day manual workshop. Take a look right here. It's very, very easy. Very easy. Alright, so, and all of you can do this as well. So give yourself some space, uncross your legs.
Thumbs up, elbow straight. Thumbs up, elbow straight. And you could, yeah, you can do it sitting or you could do it, you might have to sit in the chair probably. So you can do it sitting [00:01:00] or you can do it standing, right? So thumbs up, elbow straight, right? And then just bring your arms all the way up, right? And then all the way down.
Now if you look at your friends, the ones that are really stiff will pull their head forward, right? The ones that are really stiff will wing out their elbow. Somebody said that. So if you're really stiff, you cannot get your elbows by your ears. And what you're looking for is usually one will come out like this over the other, or the elbow will just start to bend.
So that's how I can tell when the elbow starts to bend, that the tricep is tight. Because when they come up, they cannot keep their elbows straight. Their elbow straights, their elbow starts to, you know, get tight. You're like, I'm gonna make it tight, right? The other way, the other thing you're looking for is as they do this, so some people who are loosey goosey, they won't bring their heads forward, but their ribs are [00:02:00] gonna flare out.
And they're gonna be like, Kim Kardashian, like, look at my butt, right? So, we need the ribs to come in. So, that's a sign. Those are some things that are very, that you'll see. That right shoulder is a little, just a little, right? So, what you're looking for is like, sometimes you have those patients that can't do anything.
Sometimes you have those patients that can do a lot and you're trying to figure it out. Those are some of the little things that you're looking for, right? So, thumbs up, elbows straight is a very neutral position. How did that feel? Did you feel tight? Yeah, so I want you to pay attention to where you feel tight, if they're pinching, if they're painful, or anything like that.
If they, uh, uh, have a hard time bringing it down, right? So now you're gonna turn your thumbs all the way in. So all the way behind you, right? And then you're gonna lift all the way up. Alright, there you go. Yeah, all you guys with internal rotation shit, right? That is [00:03:00] short forward flexion with internal rotation.
Yeah, you have to stop before it hurts. Compress. Lay down on your belly. If it hurts, lay down. The best way to fix it is lay down on your belly. Don't stretch it. Trust me on this. Lay down on your belly. Arms by your side. And prop yourself up on your elbows. Prop yourself up on your elbows. Pretty girl. Yeah, pretty girl number one.
Not two yet. Alright? Now, if you can't do one, you can't do it under. Just do it where elbow, prop your elbow. Right? So, what happens is someone is, I, I swear to God she's got a labrum issue. She thinks she has a rotator cuff, but I didn't fully test her, but I have a feeling it might be a little bit of a labrum issue.
Um, no, it's okay. Um, if you take someone and they hurt, then compress them. Prone on elbows, really great. Just take it and [00:04:00] compress them in, and it can be really, like, just relaxing. Alright, um, so that's forward flexion external, uh, internal rotation. Now we're going to take it all the way out, so thumbs all the way out like this.
And then you're going to come all the way up. And you're going to see where, right, where someone is tight, right? So relax. So you just have to do it once. So I take my patients and I only make them do it once. And while, while they're doing it, I'm watching. So now, what I'm going to have you do is watch me first.
So everyone watch me first. So you're going to sit and we're going to lock your hips down, right? You're going to put your hands on your chest. If you can't put your hands on your chest, then you're going to put your hands on your belly, right? But since you can't put it on your chest, watch me first.
You're going to turn and you're going to twist as far as you can, and then come back to the middle. You're going to twist to the other side. And come back to the middle, right? Come back to the middle, right? Which one, which side is your [00:05:00] yummy side? One side feels a little bit easier. If I made you do a hundred of them, good.
So, you're trying to think, because you're a therapist, well, if I have problems on my right side, so it should be going this way. Just think which side feels better. We can't go wrong. Right? So don't stop. Don't keep doing it. Right? So, so you're gonna go and you're gonna twist hands on your chest and I want you guys to try this without any overpressure, right?
So find yourself a chair, lock them hips down. If you can't lock them, if you don't want to sit, you would just lock your hips down here. Right? Because what happens if you go and you twist, you'll move your hips and it won't work as well. But if we lock your hips down, we're going to isolate your thoracic spine.
Right? So what I want you to do is I want you to twist only to your yummy side. Watch this. Put your hands on your chest. Put your hands right here, overlap on your chest, keep them there. So as you twist, don't let the arms go [00:06:00] and move. Right? So you're going to twist only to your yummy side, and you're going to turn and look behind you.
Who's looking for you? Nobody. Right? Ten times, ten times. All right? Without any overpressure. I just want to share with you so that, what happens here is people are like, why does this work? Well, when you do this, you're moving all your anterior groups of muscles. And you're using, and you're moving all your posterior groups of muscles, right?
So if you're in a rolling chair, spread your legs open. Alright. Plant your feet, so your chair doesn't roll. Alright, do ten times. You know people, I ain't, I'm not counting, right? Alright, now, you're gonna twist to the left side, your yucky side, one time. Did it feel looser? Just one time. And now we're gonna test your arms.
Thumbs down. Elbow straight. Thumbs down. Lift all the way up. [00:07:00] Did you feel looser? Come back down. Oh my god, your arms totally got loose. You were like this earlier. You think I'm not looking, but Alright, thumbs all the way back. And then all the way up. There you go. Yeah. Right? Did that feel looser? Now thumbs all the way out.
Lift all the way up. Did I feel looser? Right? So just on that movement alone can be really good. So now what I'm going to do is I'm going to give overpressure. Meaning I'm going to give a little bit of passive range of stretch to it. Alright? Hands on your chest. Alright? So just relax your arms like this.
So if going this side was I was, uh, better, right? So, one of the things I like to do so I don't have to work so hard is I like to bring my arms, so it's either around here like this or here on to the chest. My other hand is on to the back of the scapula, so you're gonna [00:08:00] twist, you're gonna rotate here, and then I'm gonna give you a little pressure.
So all I'm doing is with my right hand I'm pulling, and with my left hand I'm pushing. Right? Look behind you. You're like, no, that's it. Right? Right? Look behind you. Right? Now, I could do it up here, which is gonna get the upper parts of the ribs and the bones. Sometimes for people who are really stiff and really stuck down here, I'll come on the lower part of their rib, which is right under their boob.
So I always ask them, hey, can I reach around and I'm gonna So relax your arm. So I'm going to grab you a little bit lower, okay? So hands on your, um, chest. Right, I'm going to reach around lower. I'm going to be right under your breast. And what I do is I grab the ribs and I just lift up just a little bit, right?
So, because I want to get on the rib. And then now my hand is, instead of up here, I'm going to be here, down below. Now you're going to twist. [00:09:00] I'm going to take you with me, right? So she can start and then I can finish, right? Or, if someone's really tight, I might take them all the way. Take a deep breath, relax, hold that here, hold it, hold it, hold it, and then come back.
Take a deep breath, hold it, hold it, hold it, relax. And come back. I just did an isometric.
Right? So, hands on your chest. Twist to this side. Is that looser? Arms by your side. Thumbs up. Come all the way up. And then down. Thumbs all the way in. Lift it up. Thumbs all the way out.
Right? [00:10:00] Did you guys see any difference?
That's okay. What you're looking for is, I only did five reps. You'll see it easier or faster on certain people. Who did I see it on earlier? It wasn't you. Where, where is she? We saw it on you earlier. That's right. Who there was up. We saw it on you earlier. There was a big difference. So depending on how severe you're not going to see like a big difference, but you'll see like, Oh, it's a little bit looser.
Remember I said, sometimes what we want is like these fast things, but when people have like real chronic stuff, they're really stuck down. It's going to take a few reps to do it. So I want you to practice that part, right? Um, because that really helps to move the thoracic spine. Um, the other thing that's really helpful with shoulder stuff is thoracic extension, right?
So a lot of times we're here, but thoracic extension, we [00:11:00] don't need a ton, we just need enough, right? So that we're not painful. And there's a couple ways to do it. When I showed you guys prone on elbows, that's thoracic extension, right? That's just active, you know, gravity's helping you. But another way that I like to help people with thoracic extension is not only the chair,
Yeah, this one is good. I was like looking for something a little bit on the lower side. Actually, no, not this one. This one. I'm gonna borrow this one.
Alright, so go ahead and have a seat. Bless you. So, with the, oh, here, sorry. Let me have you move like, stand up. Let me have you move like this, yeah. So [00:12:00] there's a couple of ways in which you can do this. You can use a towel. I like to use a half foam roller for someone who's a little strong or who can tolerate or needs more, right?
You can put, depending on your intention, you can put the, that roll between the shoulder blades so that, um, you get a little bit more scapular retraction. Right? Some scapular retraction as you get a shoulder extension. I mean, sorry, as you get a thoracic extension. Right? Or you can put it so that it's, uh, perpendicular to the spine so that you can get very specific, at certain points, thoracic extension.
Right? I don't know if you're going to be a good candidate for this or not, but we'll try it. No, no, no. It's okay. It's okay. We're going to try it. Um, [00:13:00] clasp your hands together. And you guys can all do this. Uncross your legs. Put the hand behind your neck. Put your elbows together. When your elbows are out here, you've got more shoulder extension.
When you have your elbows forward, you're going to have more thoracic extension. You're going to drive your elbows up to the ceiling.
And then come back, right? So she can do this,
she can do this by herself, right? If I want to give her some overpressure, meaning I'm going to give her some passive stretch, I'm going to come here, I'm going to grab her elbows. Can you put it behind her neck? So she, she's tight, so she's having a hard time putting it behind her neck, which is okay. If you want, you can put it up a little higher if it makes it more comfortable.
So I'll, I'll start where she is. Relax your elbow. And where I want to put my [00:14:00] hand is back where, where I want to give her that overpressure, right? So, relax your arm. So if your scapula is here, your superior angle and your inferior angle, superior angle, inferior angle, I could be at the superior angle and I could work my way down.
Or I can be right in the middle, I'm going to give that pressure first, and then I can move into different spots as I loosen you up. Right? So go ahead, clasp behind your back. I mean behind your head. There you go. I'm gonna put this elbow here, lean forward for a second, and then I'm gonna drive the elbow up.
Dear Lord, have mercy. Relax. That's killing my shoulder. I'm sorry. Yeah, sorry. Um, it's yeah, because you're so so tight. So, wait, did I hurt you? I'm good. Are you sure? It feels tight? Can I do something? All right. Just [00:15:00] relax your arms. So, I learned this. Relax. The cerics release. Just relax your arms. Don't hold on.
How's that feel? Good. Looser? Better? All right. So, um, when they're real tight in the shoulder, sometimes that thoracic extension is really tough. So, that's why I like to start my people. If their shoulders are real tight or it's painful, then I'll put them on the mat and do prone on elbows. I'll do rotations before I do extension.
But one way, one, one good way to do, go ahead, sit back, one good way to kind of release a lot of the lats is just to hook them underneath like this, right? Now, just this right here, I'm literally using my My forearm and I'm just lifting straight up and I can stretch all of those posterior muscles And then I could just pull back and this is where [00:16:00] that towel between the scapula Go ahead.
That is parallel to the spine Relax can lift and you can pull back that feel good. Yeah So what it's doing is it's just stretching the pecs and shortening If someone's really tight, I don't know if you can't see it, but I can use my knee and brace myself, right? So that's just one way of doing it that can be really helpful if you're working with patients And they are stiff and you are already starting to feel pain in your own hands and arms You're not gonna want to miss this video.
This video is from one of my courses that I taught, uh, my two day manual therapy workshop. And one of the things that's really important to me for the longevity of my career is to make sure that my hands stay pain free and that I don't get injured and [00:17:00] that I don't need surgery. And at any time, you know, God, knock on wood.
because of repetitive type of strain or working with really, really stiff people post surgical. So if that's really important to you, watch this video. It's all about positioning, body mechanics. I think this is a clip on how I normally may assess somebody. with a wrist problem and it just allows me to easily move them around.
So take a look and then let me know what you think. Like it, leave me a comment below, or subscribe to the channel. If you're a therapist, an occupational therapist, physical therapist, Assistance. If you're interested in developing your clinical skills in manual therapy for hand and upper extremity injuries, you're not gonna wanna miss this two day workshop.
I go over heavy anatomy, but not the boring shit, the applied stuff. So you can take the skills that you learn in those two days, take it to your patients on Monday, [00:18:00] and really be able to. techniques right away. You're going to know what's safe to do, what's not safe to do, and really at the end of the day, protect yourself and your hands for the longevity of your career.
The links are below, um, and I hope to see you there.
