Hey, everyone. Welcome to Yoga with Adriene. I am Adriene. Today, we have an awesome sequence for the upper back. I rarely meet anyone that doesn’t complain about upper back achiness or stiffness, shoulder pain, craving neck relief. So this is a sequence that you can incorporate to your daily routine, your daily practice. You can return to it five days a week, seven days a week. So be sure to favorite the tutorial so you can return to it easily, because I think this is something that everyone can benefit from. So let’s get to it,.
Hop on the mat, and let’s learn this upper back sequence. Okay. So to begin, we’re going to start in a nice crosslegged position, sukhasana, or the pose of ease here, just pressing into the sit bones and slowly lengthening up through the spine. I’ll bring the palms to the knees here, and jumping right in, I’m going to inhale, loop my shoulders, draw my shoulder blades in together and back, as I lift my heart. Now, I don’t have to crunch the neck here. Ouch. Just going to keep it nice.
And open, but I am actively drawing my shoulder blades in and together and down, shoulders away from the ears. Take a deep breath in here, long belly, tops of the thighs draw down. Then on an exhale, I’m going to slowly draw my chin to my chest, draw my naval back, allow my shoulders to round forward, kind of get a little booty massage here as I roll through the buttock and allow the weight of my head to drop over. Now, I’m going to hang here for a couple breaths, catching the weight of my.
Palms to the knees here and really just breathing, feeling that upper back stretch, creating a little bit of space here with each inhale and each exhale. Then rolling back up, I’ll loop the shoulders, rolling through, pressing into sit bones, again lifting the heart, drawing the shoulder blades in together and down, and really creating space between the ears and the tops of the shoulders. Take a deep breath in. Smile. Relax your jaw. Then send it back down. I like to call this Mr. Burns’ posture here, but we’ll put a positive spin.
On it here. Breathe some space into that upper back. Then inhaling, back up to center, head over heart, heart over pelvis. Okay. Sitting up nice and tall, I’m going to send my fingertips forward like I’m swimming, crossing them over, swim around, and then I’m going to interlace my fingertips behind the back. Again, a good marker is to keep the head over the heart center, the sternum, the sternum over the pelvis. Just notice whether maybe you tend to sit back like this, which is normal, or maybe you’re overcompensating and.
Shifting the heart forward. Let’s try to stack is nice and tall. I’m going to interlace the fingertips, and then I have a couple options here. If I can… We’ll turn to the side here so you can see. I can bring the palms together. Check that out. If that’s a little too intense at the moment, I might keep the wrists nice and square, but I’m actively drawing the shoulders down, away from the ears, shoulder blades together, kind of wringing it out in the upper back here, getting rid of that achiness, kind.
Of massaging that area of the body. What will help with that is, of course, taking a nice, juicy, deep breath in and a nice, soft sigh out. Let’s do one more deep breath in. Notice my neck is getting a little involved here. It feels good. Slowly release and palms come back to the thighs. Okay. So now, I’m going to come to an extended child’s pose for a couple breaths. So I’m going to open the knees nice and wide. Big toes are going to kiss together here. You can pad these if you need to here. If this is.
Too much extension, hyperextension in the knees, you can put a little blanket here between the knees, a little cushion. Then I’m going to sit up nice and tall. Inhale. Reach the arms up towards the sky, and then exhale. Keep the spaciousness in the side body as I dive forward into this extended child’s pose. Fingertips are going to reach towards the front edge of the mat. Palms are going to spread wide. Notice I’m still looking forward here, drawing my shoulder blades in together and back, shoulders rotating externally away.
From the ears. Breathing here, and then slowly bowing forward, opening up the shoulders, melting the heart to the Earth. Forehead kisses the mat, and the arms don’t go limp here or lazy. I kind of stay active here, reaching fingertips towards the front edge, connecting hastabana SP, that handEarth connection. Shoulders are alive as I breathe into the upper back. Then breathe into the midback. Then send a nice deep breath to the lower back. Then slowly, when you feel satisfied, drawing a line with the nose, looking forward, and then.
Using the palms to walk it back up. Okay. So now, we’re going to come to all fours here, tabletop position. I’m going to walk my right palm in towards the centerline here and, on an inhale, send my left fingertips all the way up towards the sky. Now, I’m not going to collapse into this right shoulder here. No way. I’m going to press up and out of the right palm, keeping the spaciousness that I’ve built in this little practice all along, breathing into the upper back here. Maybe the arm goes all the way up. Maybe it only goes to here. Just.
Seeing where that space is today, taking a nice deep breath in, and then exhale coming back to center. Left palm replaces the right. Right fingertips reach up. We’ll just do this side really fast, inhaling. You can move at your own pace, drawing that shoulder away from the ear, breathing nice, long, deep breaths, and then exhale back to center. We’re going to do it one more time. This time, keep the palms a little bit wide. Instead of drawing the right palm into the center, I’m going to keep.
It right where it is as I inhale. Open the left palm up. Take a deep breath This time, I have the needle. I’m going to take my left fingertips under the bridge of the right arm and come to rest on the outer edge of my left shoulder. Left ear comes to the Earth, and I begin to breathe into the upper back here, particularly the left side. For more leverage, I can tent the right fingertips here, maybe bend that right elbow up to find a little bit more in that upper back. The toes are.
Going to want to come together. I really don’t mind that. But if you like, you can just keep a little integrity here by keeping the tops of the feet pressing into the Earth. For more leverage or for a little bit of a deeper stretch, you can also add extending the right leg, just kind of using the right toes here again to press a little bit deeper into the posture. But I say start here, and then work your way up to here. So being really mindful in the shoulders here.
Let’s come out of the posture. Take a deep breath in and exhale out, following your breath back to center and planting the left palm. Again, this time, we’re not walking into the center, but keeping it nice and open. As I inhale, right fingertips reach up towards the sky, and then exhale, diving through, right fingertips under the bridge of the left arm as I come to the outer edge of my shoulder here. Hello. Breathing here, each side will be a little bit different. I can use my left.
Fingertips here to tent the palms. Bring that left elbow up. Another option that I sometimes offer students is to come palmstogether here and just kind of gently extending those right fingertips. That feels nice. Another option to go a little deeper, again, is to extend the left leg. Curl those toes under, breathing into that upper body, that upper back. Then following your breath to come out of the posture, moving nice and slow and mindfully here, and back to all fours. Okay. So now, we’re going to come onto the belly for a little cobra.
Sequence, gently coming onto the belly, drawing the palms underneath the shoulders here, and then keeping the feet just nice and hipwidth apart here, pressing into the pelvic bone, looping the shoulders. The elbows are coming in nice and close to the side body. Go ahead and rest your forehead on the mat. Then we’re going to move nice and slow here, inhaling and exhaling, pressing into the pelvic bone, pressing in your foundation, drawing the shoulder blades in together and down, as we slowly look up. Not a big move here at first, just a nice.
Gentle thing, and then exhale back down. Forehead kisses the mat, moving with the breath. Now, whether you rise up on the exhale or the inhale is totally your choice. I say for a sequence like this that’s therapeutic and about getting into those dark nooks and crannies, it’s just about following your breath. You might start to find a little more space. We’re moving in a nice speed, nice and mindful. Notice lots of space between the ears and shoulders. Then if you want, from here, you can build this into upwardfacing dog.
We’re not going to do that today. But if you already have a practice and you’re ready, you can begin to take this into a nice upwardfacing dog. When you feel satisfied, you can send it to a downwardfacing dog or just a nice little counter pose here, as we come into extended child’s pose, swimming the fingertips forward, up and back, and then resting the forehead. Shoulders melting forward as we breathe into the back and rest. Okie doke. So that was a yummy sequence for the upper back. This actually.
Yin Yoga for Neck, Shoulder Upper Back Tension Relief
Hi everyone welcome to my channel my name is Kassandra and today’s practice will be a yin yoga class focusing on neck upper back and shoulder tension relief please make sure you have two blocks handy we’ll start in a comfortable cross legged seated position connecting with the breath by inhaling and exhaling out through the nose relaxing both shoulders down and away from the ears and just taking a moment to get centered here tune into your body noticing where you’re holding tension when you’re ready start to drop your right ear towards you.
Right shoulder you might feel a little bit of a stretch to the left side of your neck here if you’d like to intensify the stretch you can reach your left fingertips down onto the mat and crawl them over towards the left see if you can keep your chin up high here and if you’d like to intensify the stretch even more you can use your right palm the lightly press down over the top of your head if this is too much just come back to the other variation.
You want to move very slowly and be very careful as the neck can be very sensitive let’s take another five deep belly breaths right here in this pose and for these last few moments let’s start to tuck the chin in towards the chest. So this should send the stretch more towards the back of your neck and starting to go down towards the shoulder blades. Take three more deep breaths, breathing into the sensation and lets release this side gently lifting the head back to center when you’re ready we’ll go and explore the second side so this time you’ll be.
Dropping your left ear toward your left shoulder move slowly and carefully here don’t go into the final variation of the pose just yet take the time to explore them breathe into the right side of your neck and if it feels appropriate for your body today you can reach your right fingertips down onto the mat crawling them over towards the right get a little bit deeper and your last option here is to also use your left palm to lightly press down on the top of your head we’re not applying too much pressure here.
Make sure you’re still sitting up nice and tall. let’s take five breaths in this pose lets start to tuck the chin in towards the chest once again sending stretch more towards the back of the neck and down towards the shoulder blades let’s release the pose, bringing head back to center coming into a tabletop pose onto hands and knees we’ll be setting up for puppy pose so please make sure your hips stay directly over top of your knees and then you can start to walk your palms forward as you drop your chest in your forehead either directly down onto the.
Mat if you can’t quite make it you can always place a block directly underneath your forehead make sure you’re not causing your lower back to sway here so you will need to keep your abdominals slightly engages so that the lower back stays nice and long we’re trying to get the stretch to come in throughout the shoulder girdle and between the shoulder blades so start to melt your heart down towards the mat taking deep breaths and really feeling the ribs spread from side to side and front to back.
Although your palms are forward you don’t want to have your shoulders hiked up all the way towards your ears so see if you can roll your shoulders down and away from your ears so that your neck has plenty of space and we’ll take five to 10 deep breaths in this pose. softening through the upper back while staying strong through the belly take your time as you start to come out of the pose coming back onto hands and knees crossing you’re right thigh over your left stacking you’re right knee directly over top.
Left so getting a little bit deeper into the hips here right arm rises up overhead bend at the elbow and maybe just use your left palm to press that elbow back if you’d like to intensify this stretch you can reach around with your left fingertips and clasp your hands behind your back make sure you not leaning your head forward here you want to stay sitting up nice and tall stay sitting down on both sits bones and no matter which variation you’re choosing you want to keep pressing that.
Right elbow back to get deep into the triceps wherever you feel the sensation most that’s where you want to see your breath deep breaths lets release the arms. keep your legs exactly as they are we’re going to come into in Eagle variation with the upper body so you’ll be crossing you’re right arm underneath your left hooking at the wrists and from here you want to lift your elbows up roll your shoulders down and away from the ears sit up tall or move into a forward fold elbows will go in front of your knees if the floors a little bit too far away for.
You you don’t need to go all the way down you can always lower onto your thighs, a block stay or stay sitting up high we’re trying to stretch throughout the upper back in between the shoulder blades little bit throughout the biceps while stretch here take 5 more deep breaths right here in this pose engage the belly as you lift all the way back up release the arms bring your palms in behind you uncross the legs and were just going to do a couple windshield wiper motions with the.
Knees just to reset the lower back so just alternate between dropping your knees over to one side and then over to the next when you’re ready we’ll go do the same thing on the other side so this time you’re stacking your left knee directly over top of your right and on an inhale left arm reaches up towards the sky bending at the left home though use your right com lightly presses back start this very she pursed if you’d like to go deeper you can feature right fingertips down in class care fingers behind your back.
The new remember that we’re trying to set up nice and tall here in really feel a broadening through the upper body you might be feeling a fairly intense sensation through Google hips due to the cross the legs if that’s the case see if you can use your breath to help alleviate some tension mealy send in your prime home the way down into your lower body along those muscles to relax just a little bit more of 0 in let’s command the Eagle arms variations sur releasing your palms this time left.
Army go underneath your rights binding once or twice either choose to stay setting up tall here or come forward into your hold 0 hubbell’s can rest on your knees on the block go all the way down to the ground wherever you are and make sure your understands that allows you to relax your hand and relax your neck ok make sure your hallways reminding your shoulders to roll down in a week from your ears 0 0 were here her about five min baths of gently start to look at yourself out of the poems.
0 bring your palms back down onto the mat on crossing your legs and once again doing that windshield wiper motion dropping these on one side and on to the next I’m sure we’ll be coming back onto her hands and knees to another cup goals the different variations time please grab your blocks place them along the sugar and ship your mount on their lowest level answer to lower your elbows down onto the books keeping your hips directly over top of your needs pressing your palms together concerning your palms.
Behind your neck so that your fingertips are pointing towards her tail you’ll know right away the stretch is too intense for you if that’s the case move the blocks and a kuwaiti place your elbows directly down onto the nut to do the same polls bring your palms together and sending them towards the back of your neck going up on the blocks will just make the stretch a little bit more intense to the triceps again remember that we’re keeping the belly slightly firms here so that the lower back stays nice.
Long 0 0 come back to your BRE of and start melting your heart down towards the Mertz of 0 your forehead me for me not to be touching the ground 0 0 good of 0 remember that this is your practice new yet to decide when you come in out polls remember to listen to your body into actions best for you its police palms back to mount months chilton let yourself back up uncertain of the blocks outoftheway making your way all the way down to your belly come to give a little bit more attention to the front body set up for spinks.
Polls bringing your four rooms down to the uh about shoulder with this is a part and you get to decide how deep you go into the stack and so if you’re feeling intention your work all you need to do is walk your calls forward so there’s less of an angle here and instead of focusing about how high up you can get just think lengthen your spine really lean your heart schoolrooms relaxing your shoulders down in a week from your years lately hugging your shoulder blades behind your back 0.
Tailbone is lengthening towards your heels how this is grounded downloaded from a and just enjoy this gentle polls for humour breaths taking deep breaths into the front to the body directly into the heart and know that you can adjust the schools and anytime either by walking your elbows in are sliding them forward to reduce the intensity the 0 0 it 0 0 0 0 in 0 0 tumor paths of I’ll and slowly start to soften down press your way back up onto his knees and will be coming into a long lunch.
Whose so something your right foot in between your palms the top in the match pat your left me maybe by double paramount for sending it down come on in when you have your balance here and we’ll be reaching right left arm across her body using your right palm sure of that arm in close it worse a chance so you should be feeling he could stretch to your left shoulder make sure that left shoulder is pressing down towards the ground and start by slowly allowing your ships to see.
Town so we’re in teaching the boxers so lasts cause it’s just a little bit stretches well you want to avoid a sweep accurate swells keep curling your Tillman staying long through the lower book integrity through the palace of bring your palms back onto Hwy will call has been switched sides so this time will be stepping your left foot forward to the top the map trading your right knee income on up when you’re ready this time you’re right arm will each cross your body using your left home to try and include.
Remember to roll out right shoulder down a phenomenal seen qichen here 0 and see if you can focus your breath was a back body here in between the shoulder blades the new along the spine up and of 0 0 0 of 0 0 0 0 let’s release homes back down the moms come through to your table top holes unwind your if you have that variations will be sending a prince but the needle so swing your left arm through so that you can comfortably rest your left shoulder and left here.
Either downed McTear force a little bit too far away can always rest your head down around two o’clock right palm can see down mark firmly pressing into the ground are you can rest your right palm onto your lower of so there’s a little bit but twisting actions here as you press your belly button tortures fine and roll your right shoulder to hem in the week year 0 try to call as little weight intention is each and Internet of deep belly breaths as he settles into this polls.
Of in in 0 of if your palms behind your back please bring it back down onto them take your time is to come back up through to your table top position and we’ll prepare for the second side but before let’s take a few rounds at Catton cow so as you exhale around your spine curl tail bone under and on the email trail the belly left the key school till up squeeze your shoulder pleats behind your back one more round exhale around your spine chin to chest elbow city streets on the in jail.
Drop the belly lift the gays slightly I’ll hmm let’s come back to neutral swinging you’re right arm down lowering right shoulder great year either onto the man term 2 o’clock shoes if you prefer to keep your left palm down onto the mount she’d like to intensify the sensation you can rest your left palm culture lover pock in Munich work rolling back left shoulder down in the week you’re here 0 your hips are staying hy Apple rules here icing belly button to spine 0 0 0 0 0 although we’ve done this.
On for site already this site might feel like a brand new experience that’s okay try not to focus too much on the differences on one side and the other and instead see thinkin simply enjoy the experience without trying to teen a call or reach certain homes whatever she your body is in right now is the perfect she great at the moment I’ll stay committed to the present moment stay within your body keep proving being deeply of step to bring your left home back down onto the mom.
Slow yes you come back up on small homes and you want to grab your crops people you simple blocks to come to support it ish holds one long local behind your upper took in between shoulder blades on the lowest or midlevel the second block will go to directly underneath her head also on the most for me double easy so down on the blocks should be blown tension in your lower back here if you feel and pinching either but the block on the lowest level slime block her.
Up towards your head block be too low you can choose to keep your life strange here but if you look a little bit with temple coming same time you can come into a butterfly she lanes green slows the into touched and allowing police to call of arms can go away and is more comfortable to you I mean a scary she can be change cool firm support her head but it puts too intense to the its shoulder girdle just keep your arms a month thank you bombing and we are here.
Permitted in her up for two minutes so you have the time to claim round the school is niece England find what works best for you when you do going to be me she numbers from your body seeking teens the still just he on reading deeply 1896 and she the I’m on allowing your Rams spread from side to side King mean long spine will not sit down lunch locks moving your hips be happy 0 just loving slowrelease cool down sports tier the new enjoying at the moment 0.
0 0 0 0 0 0 take 10 more slow deep valley spray hearings homes 0 of of in in of good of then in of in in in in in 0 let’s come up in the polls thinkers bringing step towards each other may be talking sheen towards your chest so we can rule purse law propping your subculture forms to the other block me online on the way down to bounce will be setting up her spinal twist so opening at the right knee will be bringing your right knee.
Colbert what’s the lapd me using your left palm like pressed down where you’re right hi reach your right are out see you could be the press your right shoulder blade down into the apt because this is a twist still want to keep hugging your belly button Ind mortuary spine so that your lower abdominals are hugging even and bull colin powell’s piecing up towards ceiling getting a little bit deeper into twist 0 notice if you press becomes a little short or shallow use turkey twist we want to avoid.
From happening so she una that’s the case it probably just means that you was that a little bit too hard eat to back out homes always remember that your press issue guy that will tell you whether not you concur deeper to pull out certain homes I’ll analysts say here about numbers tenors home the billy graham’s 0 0 0 0 in good in of its release and come back to center for setting up for the second side so this time will be pending at the lapd he and green.
Her towards the right side of your body may be using your buy palm like me i sat down x10 you left arm down onto the ground really increasing your left shoulder blade down into the earth’s in keep your chest facing up towards the sky maybe allow the eyes to close the supreme focused inward to back into your path can stay here her needs of of of in in in of of in the of in the in in it least this twist incumbent should last night are final St homes funny comfortable position.
Your body to rest may be extending both legs bull I’m sound palms PC what’s a skyline compact with her press is natural to you and Joost enjoy the peace few moments complete stillness rules times my of in of in of good of thank you so much for doing this class with Pete me I’m really do hope you enjoyed it please make sure to subscribe to my channel like this tutorial and leave a comment really does mean so much to me thank you so much namaste a in.
Shoulder Pain Treatment Prevention Rotator Cuff Frozen Shoulder Sock Doc
Hey this is Dr. Gangemi and welcome to our newest Sock Doc tutorial. Today we’re going to talk about the shoulder and the shoulder joint in general. Helping out today is Madison McCarroll. Thanks for joining. Madison’s a great rower in the area. The shoulder you know most people think about the shoulder as just like a certain area which it obviously is but it’s really combined of three joints and three bones. So it’s a very dynamic area that’s used to, you know, we use our shoulder all day long. We use it to support things, we use it to.
Lift things, we use it to carry. It’s actually one of the most common areas that people injure and you can injure your shoulder, the shoulder area, in so many different ways. A lot of times people will tear their rotator cuff or sprain or strain their rotator cuff. They will get stuff like tendonitis, bursitis, or perhaps a frozen shoulder is also very common. So these are some of the things we’re going to talk about. So the three joints of the shoulder pretty much we have a sternoclavicular joint. Our clavicle is here. That’s that bone running across the top.
People know it as their collarbone. And the joint here where it hits your sternum which is your breast bone, not going to talk about really today because there’s not a whole lot going on there. The two other joints are going to be our major function, or our major focus, because that’s where a lot of the injuries occur. First one we’re going to talk about is your AC joint which is also known as your acromioclavicular joint and that’s if you trace your collarbone to the outside here you’re going to hit a little bump which is the acromion of.
Your scapula which is your shoulder blade. And then that’s where it attaches to your clavicle which is your collarbone. Now if you come down just on the inside there, so you find that dip on the end of your collarbone and then dip right down, you have what’s called your coracoid process. Now this AC joint is very, very important to understand because it’s where people get things like a frozen shoulder. And they can also get generalized shoulder pain if this joint is not moving properly. So a frozen shoulder is basically if you cannot lift your arm, a lot of.
People can’t lift it at all, or especially above parallel. So if you can’t lift your arm anywhere over your shoulder or if you can’t do it freely without pain a lot of people are diagnosed as a frozen shoulder. But again, especially if you can’t even just move it at all. Typically it’s because the AC joint is locking up. Three major muscles going there. You’ve got one of your pec muscles, your pec minor, which comes up from your chest and inserts into that coracoid process. We also have your biceps, one of your biceps, the short heavier.
Biceps that has to do with this, obviously curling, flexion of the arm. That pec minor is more of an across the body, especially with your palm up, type motion. It supports a lot of the rib muscles. And then also a very important muscle called your coracobrachialis. Now this muscle we kind of associate when someone has pain if they say are washing or combing your hair, like so. And your shoulder hurts even just doing that, not necessarily if you have a frozen shoulder but if just you get shoulder pain while you’re doing this that’s probably this.
Coracobrachialis muscle. So you’re going to look for a trigger point right in that coracoid. Again, come down from the end of that clavicle, your collarbone, dip right down, and right in the divot of your shoulder in there, right where your pec comes into your shoulder joint, look for a tender area, rub that out. That’s right on your coracoid process. And you could hold that if she was having a shoulder issue she could put some pressure in there and see if she’s having more of a free movement in her arm with whatever direction she.
Might be having trouble with, okay So that’s the AC joint. Let’s talk about the major joint of your muscle though which is your glenohumeral joint which has to do with what we all know or most of us know as the ball and socket joint of the shoulder. That’s what allows you to really move your shoulder in pretty much every direction and it has to do with your scapula which is your shoulder blade and your humerus, your upper arm bone, okay So that’s the whole ball and socket motion of the shoulder.
What supports it is actually rotator cuffs. Remember the rotator cuffs, first of all, there’s four of them. A lot of people think there’s one or two. And your rotator cuffs are not very powerful muscles. These muscles are used to keep the arm in the socket so a lot of people they injure them or they tear their rotator cuffs because the other muscles, the big muscles supporting the shoulder like your lats and your rhomboids and your serratus muscles that we’re going to talk about are not working efficiently so now.
You’re trying to use more of these supportive muscles for strength and for power. So you end up getting them injured. Of course you can, you know, injure them other ways like in traumatic accidents. But the four rotator cuff muscles are your supraspinatus which is if you lift your arm out about 30 degrees that’s really your supraspinatus. It’s about just from here to here. When you get past that then you start using your actual deltoid which a lot of people think of as their shoulder muscle, the meaty part of their shoulder. Let’s have you turn just a little.
Bit here, Maddy. So your supraspinatus comes down from sort of deep in your trap here on top of your scapula, which is most people where they get sore, and inserts right into top of the humerus here. So if you have a problem with the supraspinatus and you have problems doing this, look for a trigger point in the top here and see if it’s easier to move that. Remember a lot of times there’s a muscleorgan relationship with injuries and with pain. We talk about this a lot on the Sock Doc tutorials. The one for.
This is actually excitotoxins. MSG can really affect this muscle. So can Nutrasweet which is aspartame. Any of these excitotoxin type chemicals. I talk about those on both drgangemi and sockdoc. So you can read about them there. But also high insulin levels and high stress hormones will also cause supraspinatus problems. This is the most common rotator cuff that’s injured. Actually, people fall, say you were climbing on a ladder or you just fell off something and you landed there, a lot of times someone’s going to rupture, you’ll rupture the supraspinatus.
The other three, we have our teres minor which turns your arm out like this. This is external rotation of the arm, turning it out. And your infraspinatus is similar but it’s more when your arm is actually in this position and coming back like that. And then the last one is your subscapularis which is pushing down. So infraspinatus is back like that and subscap is that throwing forward motion which is on the front of your scapula. I’m going to have you stand and turn here. So if you have problems with.
Your elbow in and as you’re turning out like this let’s do that motion like that, so that’s your teres minor. That muscle comes from your arm into your scapula like this. So you’re going to look for trigger points in here. And you can actually as you, go ahead, do that a couple times, you can feel that muscle right there moving. Now a little bit lower if you do it this way is that infraspinatus and that’s going to be about right here. Go ahead. It’s a much wider broad muscle, all right Really huge span. A lot.
Of fascia connective tissue in there. You can put your arm down. So don’t worry about exactly where they are. If you have any problems with that rotation out like that look for those trigger points here coming from the back of the arm and coming into the shoulder blade here. And look for trigger points right up to where you feel your shoulder blades stick out, your scapula, that spine of the scapula there. All in here, okay Turn back around. And the other muscle for your subscapularis, this is the one that comes.
Down like this. So if she was to push against my hand like that and if she had pain in here that muscle is deep in the armpit because it’s actually in the front of your scapula. This is a tender one even if it’s not bothering you, because the way to get that is to actually come up into the armpit area and get in the front of the shoulder blade, the scapula. So you end up digging in here. If you’re going to do it on yourself lay down so your arm is relaxed and.
Push up within that scapula there so it’s not fighting against you at the same time. A lot of times you’ve got to get way up there if you’re having problems with that, way up to the ribs. Tender, isn’t it But it’s fun. So those are your four rotator cuff muscles. So we have our teres minor, we have our infraspinatus, our subscap pushing back down, and then this supraspinatus coming out, okay Now another muscle that comes up and comes down in your ribs here on the side, let’s turn a little bit again, are these like fingerlike muscles.
Called your serratus that come over the ribs. And they’re actually going to go up and help stabilize your scapula with that subscapularis muscle. So your serratus muscle is any type of holding and supporting like that as well as pushing. It’s a really important muscle to stabilize your scapula. Doing a push up, any hanging, climbing type motion, think of the serratus as that type of motion. So I’m going to have you turn to the side again one more time. That’ll be good. So the serratus if you have problems holding, if she had problems.
Holding her arm like that out as in a push up move look for those trigger points all the way down on these ribs and they wrap around right to the back, to the sides of her body here. The serratus muscle, right down in line with basically the side of the body. You don’t have to go too far forward, typically to find where the majority of the trigger points are, and you don’t have to go too far back. But they will come up and attach, connect with the connective tissue of that subscapularis that is going to.
Help to push down. Again big shoulder blade stabilizing muscles. Another really important muscle to stabilize that shoulder blade, turn around to the back again, stand up, are your rhomboids. These muscles attach the inner part of your shoulder blade to your spine. So the trigger points, that’s where people get like they say, you know, I have pain between my shoulder blades. That’s going to be more the rhomboid. And you could have pain anywhere in your shoulder blade as you move it but especially if it’s out as you do like that type of motion, look in between.
These rhomboids. All the way down, that one or two inches you have between the spine. And a lot of times if this one’s hurting the problem’s coming from the other side. These muscles have to balance each other left to right and they’re very similar to how the piriformis muscles balance each other in the hips and I talk about that in the Lower Back Sciatica tutorial. If say the right one is bothering you, the weakness might actually be on the other side causing that one that’s bothering you to spasm. So she might have.
Let’s say a shoulder issue on this right side. This one’s really tight because this one’s the problem and you want to treat the trigger points on that opposite side, okay We also have the lats coming from here attaching to the arm which raises your arm up and helps you pull things down, your latissimus muscles. So again a shoulder problem, don’t just look towards the shoulder. Some of those points can come all the way down here to your lumbar spine. Your latissimus muscles come up and help you with shoulder motion and shoulder.
Power. These are your big muscles now, your rhomboids, your latissimus and your trap muscles which are above these lower fibers, medial fibers, and top fibersupper fibers of the trapezius muscles. Most people know about their traps here but the traps come down like this. That’s like this type of motion as you pull back to support the shoulder. So you could have any type of shoulder muscle pain, shoulder pain, rotator cuff problem and it could be coming from those lats down there on your lower back. So you have to look for trigger points in your lower back. You.
Have to look for trigger points in the mid part of your back around your traps and then going up to your shoulder blade towards the spine for your rhomboids. And even up here if her upper traps were a problem then it’s not going to help support and stabilize her shoulder blade from the top. So any motion she was doing could actually affect the shoulder blade. I’m going to talk about a little bit more in the elbow tutorial how the biceps and the triceps also affect the shoulder and you can also get elbow pain.
From that because the biceps help elevate the shoulder and the triceps can actually help bring the shoulder back. So a little bit more on that there and where to get those trigger points. If you’re having trouble getting the trigger points in the back you can roll on a ball or something like that or if someone can’t get in there. And I’m also going to show a few little climbing and crawling exercises to help with stabilizing the shoulder joint and proper rehabilitation to help that stuff out. So that should do it. Thanks for helping out. Good shoulder.
Muscles. And that’s the end. Okay so there’s a muscle that I forgot to talk about when we talked about frozen shoulder and that AC joint and it’s your subclavius muscle. It’s really a very important muscle when it comes to frozen shoulder and being unable to lift your shoulder up. So your subclavius muscle attaches your first rib underneath your collarbone here, your clavicle, to your clavicle. So it’s a very tender area anyway underneath your collarbone there, but I want you to look for tender areas. You have to dig up and underneath that collarbone there.
Looking for really tender sore spots, okay So if you find them, hold them, you can work them out, and then raise your arm up a little bit. If it releases you’re on the right spot. Again, it’s going to be tender anyway but with a frozen shoulder or shoulder issue it’ll be even more tender. The other one is your deltoid muscle, your actual shoulder muscle that people consider to be because you think about that with your shoulder as weight lifting, strength and conditioning type of issues. Look for the trigger.
Points here if you have trouble abducting your arm like that. We talked about this with the rhomboid. It could be locking your scapula, but if you have trouble coming out like this if it’s not really moving look for a middle deltoid trigger point right about where it inserts into your humerus here, your upper arm. The interior fibers of the deltoid come like this bringing your arm pushing up and forward. So they’re going to be a little bit more towards the front and the posterior fibers more towards the back here if you’re going like.
My Aching Shoulder On Demand Seminar
Brian So tonight it’s about shoulders. Dr. DiIorio is gonna draw some pictures on the board. Everybody here will understand what’s goin’ on in the shoulder, the anatomy, the common problems that we have, and then we’ll have a question and answer session. Anybody that has questions, just hit ’em with us. We can cover all the topics that you guys wanna talk about, and then at the end of that we’re gonna break up and have the shoulder screenings. You’ll see me, Amanda, Ryan or Dr. DiIorio, just kinda arbitrarily gettin’ divided up,.
Take a look at everybody, talk to ya, answer your questions on a more personal level, and get any, you know, take the next step. See what you guys wanna do, and what the recommendations that would have are. Emil Well thanks for coming out so late tonight. Brian just went over some basic questions that many people have about shoulders. But you know, let’s just take a minute here and go over the parts list a little bit. The shoulder, unlike other types of medicine or even surgery, is a mechanical thing.
And because of that it’s relatively easy to understand. If we look at the front view of the shoulder In other words, I’m standing in front of you, and we’re gonna draw the right shoulder, this view, OK So we have the shoulder blade. Well let’s draw it down here. Here’s the shoulder blade, and I’m gonna draw and then I’ll step aside a second here. Like this, shoulder blade. The ball, and the arm hanging off the ball, OK On the top here of the shoulder, like a roof sit two bones.
This is bone one, forms a joint, and connects to bone two. Bone two is the collar bone, got it Alright. And just to orient you, here is your mouth, nose, and your armpit. Make a happy face, there you go, OK Eyes. Alright, now when you have problems around the shoulder, there are basically two spots or places or compartsments where you can have shoulder pain. OK, so we’ve got this compartment. That’s the ball and the socket, OK And there are several problems that can occur at the ball and socket joint, but basically.
It’s when the ball pops outta the socket, alright And in most adult people, the ball’s not popping out of the socket. It usually happens in younger people, like a young wrestler whose shoulder ball pops out, or we could say dislocates, alright That’s not where most of the problems with people in this room are gonna occur. Where will they occur They’ll occur in this next space, and think of this space in here between the top of the ball and underneath these two bones, or the roof, OK And what lives in that space.
Well, what lives in that space is a rope called the tendon. And indeed this rope attaches to the side of the ball here and then pulls in this direction, OK So this rope, if you will, rotates your arm like this. So we call it the rotator. This rope connects to the side of the ball with a cuff, like this. Hence the word cuff. And finally this rope is actually called the tendon. So hence the rotator cuff tendon, which in one way or another is the root of most pain.
In most adult people. Alright again, this tendon connects a muscle The arrow is supposed to indicate a muscle, alright ‘Cause when the muscle contracts, it pulls, alright This tendon connects a muscle to bone. It rotates your arm, and it forms this cuff on the side of the ball. Hence the mystery of the rotator cuff tendon. Not that complicated, OK And again, so this is the tendon, and very important is this roof, this bony roof, that sits above the tendon. So above the tendon is bone, got it.
This is the major parts list you have to understand. Now what happens in almost all of us is that after the age of about 40, this bone up here, which to begin with God made with a little bit of a hook, develops a little bone spur like this, OK And when there’s a spur over there, there’s always a little accompanying spur over here as well. At any rate, what happens is that through daily use, alright, most of the time it’s through daily use unless you fall on it, and we’ll talk about that.
In a second, alright This area of bone spur is little by little, as the arm swings, pinching on that tendon. As a result, the tendon gets a little swollen like this. And right in here it gets a little bit beat up because the spur is pinchin’ on it, can you see that And then the rest of it gets kind of swollen, alright So when this thing gets a little swollen and a little beat up or thinned out where the spur is pinching down on it, we call that a rotator cuff tendonitis.
When everything gets inflamed or beat up, we just add to it itis. Hence the mystery of rotator cuff tendonitis, alright Now so again we now have a bone spur, right And we have rotator cuff tendonitis. And did anybody have pain on their shoulder when they rolled on it last night in bed I did. After a while, if this spur beats up on that area of the tendon long enough, right, what will happen is the tendon can actually tear, and now you got something that looks like this,.
With one end over here and another end over here. Can you see that So that’s a rotator cuff tendon, and now it’s not just inflamed, it’s a tendon tear. And that will really hurt when you lift your arm up, OK Because now that spur is actually diggin’ into that tendon. Sometimes it even catches a little bit, sometimes not. Every shoulder has a different personality. Same diagnosis presents a little differently in everybody. But the end of the day, you know, we’ve got a system here that was probably not initially designed what we use it for.
Dogs don’t do this, you know, they just down here. They don’t get shoulder pain, OK So it depends on how you think and how you think we got here, and you know. But there’s a lotta problems with the musculoskeletal system are directly related to the fact that we’re standin’ up like this, and we’re not on all fours anymore. So what has happened, and just in the nick of time, is that the world of shoulder treatment has gone through quite a revolution. Especially in the last decade, and even in the last five years.
And I say just in the nick of time because there are so many of us baby boomers that are been beating this up for quite a while and now have either complete tears, partial tears or just spurs that’s really beating up the tendon, and pretty painful. What has happened is like in many areas of care, the treatment, that is the surgical treatment, has gotten minimally invasive. First of all, every shoulder that’s a little beat up doesn’t need an operation. There are times when you’ve got a swollen tendon like this.
Even if you’ve got a spur, that if you get the tendon less swollen so that it can duck under that spur, you feel a lot better. And that’s usually done by putting a cortisone injection right in this area, again reducing the swelling. And then with a therapist stretching this tissues, you get to the point where even though that spur is there, you can duck underneath it, and you feel a lot better. Now a lot of people will say, when I explain that, but the spur is still there,.
Won’t it keep, you know, pinching down on the tendon The fact of that matter is, again, every shoulder has a different personality. But more and more we’re starting to realize that if you put the cortisone in, and it helps just a little bit, and then the pain keeps returning, that most likely you are continuing to dig into that tendon, and you probably should have that spur removed. When you remove the spur we use a TV camera. And because of the techniques that now are pretty proficient, to remove that spur.
Is a 15minute procedure, as well as this spur, as an outpatient. It’s still an invasive procedure, but it’s a little poke, and we remove the spur. The bigger challenge is when you have a tear. Now these are also treated almost exclusively with arthroscopy, that is a TV camera. But again, these tears come in different flavors. You can have a tear that’s this separated, or a tear that’s been torn for a while can be markedly separated, and this is a little more of a challenging tear to fix.
Are there any questions right now Let’s just take some questions before we Just we covered a bunch of stuff here. We covered basic parts list. We covered a beat up tendon versus a torn tendon and the bone spurs that go with it. Please. Student What’s the age factor You know like, does that play a part in the rehabilitation The age factor. Yeah, now again, you know when we talk about age, we have to realize today that the landscape has changed a lot, OK First of all, a shoulder like this can be very painful,.
And can go on to maybe some shoulder complications, but it can’t kill you. What kills you is when you’ve got a bad pump and the pipes that go with it, and either the pump gives up or the pipes clog, that will kill you. Well that whole area has changed dramatically today. As a result, or as one of the results but a major result, is that people are living much longer. So when you start thinking about fixing things around the musculoskeletal system, whether it be a shoulder, a knee or a hip, you have to plan on the fact that people.
Are gonna be around a lot longer than they used to be. And their quality of life will often dramatically be affected by how well their muscles and joints are. Women, for instance, the average age for a woman to die today in America is 85, average, alright I have women that routinely, and men, that come in that have shoulder pain, they’re 90. We had a lady the other day that came in, she was a hundred. Shoulder hurt, not happy. Student And she got treatment. She got treatment, alright.
You know, I just think that, you know, I have patients routinely in their middle 80’s and older that are pretty much doing everything they did when they were 60 and 65. Student Do you think it’s advisable for a 95yearold woman to get a operation Well first of all, if a 95yearold woman can’t sleep all night, and you can do a 15minute procedure to take spurs off or hook up a tendon, and do it under a regional anesthesia, why not, you know Student Out of every let’s say 10 patients you see,.
How many can be treated with cortisone slash therapy versus needing actual surgery That’s difficult to say. It has, again, a lot to do with age group and how long you’ve been beating up the tendon. But I think at least 40 percent of patients we see. You know, the key here again is to be thinking longterm. The one thing you never wanna do, and I know it’s still done, but you don’t wanna put cortisone in someone, like yourself for instance, that comes in and says, Phew, I’ve had a month or so, my shoulder’s killin’ me.
I’ve had it now. And boom, the cortisone goes in. Because you can have a tear that looks like this, and the cortisone will reduce the inflammation, make it feel better. A year later you come back, or even six months, and the tear now looks like this, OK Well the first tear, you can trim the spurs, and again, if this is what you do, and you’re doin’ a lot of it, and that’s where your focus is, you could fix it in 25 minutes. This tear, with the methods we have today,.
Is still doable, but you have to release all the scar tissue that’s formed here, and then you gotta drag this thing little by little, watching it on the TV camera, so that it looks like this, alright Well, doable. Then you gotta hook it up with some stitches. But you know, this tendon is not nearly designed as good as the original engineer. And the day we start deciding that we are designin’ stuff better than he did, we’re in trouble. Student How do you attach it to the bone.
Excuse me Student How do you attach it to the bone That’s a good question. I mean this was simple, but it was a major breakthrough about 10 years ago. Because you have to get this tissue to grow into the bone, and in order to do it, you gotta have the tissue attached to the bone. Well here’s what you use. First of all, what were designed are these little screws. Now these screws are like the tip, very, they’re a centimeter or two, alright But if I magnified one, it looks like this.
It’s a screw, here’s the head of the screw, here’s the shaft, and here’s the threads, OK On the top of the screw are attached some stitches. The screw, by the way, is a bioabsorbable material, which means after six months or more, the body breaks it down, so it’s not metal, although initially we used metal screws. Student Don’t use ’em anymore. Nah, I don’t use ’em anymore, there’s no reason. So what you do is take this screw. Here’s the ball, arm. Here’s the tear, like this.
You have to bring this tear down to the bone. Now the bone, you’ve roughened the bone up a little with a little machine so it’s bleeding, OK Then you take the screw I just showed you, and you put it into the bone. Now it’s anchored in there. Then you can take these stitches Again, you’re looking at it magnified on a big TV camera, and you run it into one end, back down, and tighten it down. So this is called a bone anchor screw, and it revolutionized attaching soft tissues.
Through a camera to bone. Student You do that arthroscopically You do it arthroscopically. Yes. Student What’s the success rate What’s the success rate You know, I think the success rate is very good if you’re doin’ a lot of ’em, and you have a team to do it, etc. It’s like anything else, you know, the more you do, the more you’re good at it, but it’s not something you wanna do once or twice a month. I think this month I’ll do 65 of ’em.
Student Oh, geez. Every day, OK. Student If you use the cortisone, how long afterwards do you have to, does it take Emil Well lemme finish that story. And I’m just saying is I’m not saying that cortisone won’t help. What I’m saying is that if you’re gonna use the cortisone, make sure you know what you’re treating with the cortisone. Because if you have a tear, you can actually worsen the tear, and now you gotta big problem comin’ back. If you don’t have a tear, alright,.
Then put some cortisone in it, but make sure that you’ve got a therapist that’s stretching that shoulder out as well. And that’s something else, and one of our therapists will talk to you, but there are therapists that are interested in shoulders, and then there are those that do some shake and bake and send you home. And it’s a difficult joint to rehab correctly. And for people like myself, that do a lot of shoulders and that’s all I do, the therapists I work with are extremely important. It’s really a team effort.
It’s a team effort doing the surgery, and it’s a team effort treating the patient after the surgery. Let me just give this gentleman Student I have a question about, if you have something wrong with your shoulder, at least in my experience, during the day I don’t have any pain. Emil That’s right. Student None whatsoever. When I go to bed at night, I don’t have any pain. When I wake up in the morning, I feel like slap What causes the fact that I can go all day.
Without any pain Emil Yeah, well again, when you’re One way to think of it is when you’re, during the day you’re moving this shoulder, OK And the shoulder’s inflamed, but the shoulder doesn’t have time for little adhesions or little scar tissue to form around it. When you then put the shoulder at rest at night, right, all that tissue can build up, and then when you start it moving. You know the way I also think about it, and maybe. I see there’s a cardiac surgeon in the.
And they think that this is simplistic, but here’s the way I think about my pain, too. You know, we’ve got this wonderful system with a main pump, the heart, and a bunch of pipes that circulate through the body. And the pipes are there to bring this fluid called the blood in and then bring it out. Well when the pump through the pipes brings in this blood, the blood is filled with nutritionist substances, or the tissue’s gonna die. But then it’s got another job, and the job is.
To remove the waste products. Well when we go to sleep at night, one of the deals here is we gotta give this pump a little rest. So the pump doesn’t work that hard. If the pump doesn’t work that hard, then the fluid, that is the blood, is not getting pumped through there as much. Maybe we just leave behind some waste products that are very irritating to the tissues. I know that’s very simplistic, Terry, but you know, it’s the way I think about it. It’s a lot more complicated than that,.
But it’s sort of a way to think about it. Student Shoulder pains are sometimes called bursitis. What’s the difference between this and bursitis, or is it the same thing Emil Well there is a little membrane here that’s called a bursa. I didn’t mention it because it’s actually plastered right on top of the tendon, alright So if I look at it like this, here’s the ball. Here’s the arm, and here’s the socket. And here’s that bone A and here’s bone C. Here’s the tendon, like this.
Now the engineer that designed this system laid a little sac, think of it almost like a little balloon that’s filled with a little water and sort of, or fluid and flattened out, so it’s like this. This is a crosssection of that sac. Can you see that And that sac is thought to help, as the arm comes up, and is gonna come into some contact with that bone, acts like a little cushion. And that little cushion we called the bursa. But again, when you actually are That tissue is like a little film on top of the tendon.
So most of the time when I try to describe this condition to my patients, I don’t even talk about it because it has so little You know it’s the tendon that gets beat up that we have to worry about, OK But it’s when that bursa gets inflamed, all it does, here’s the way you can think of it. Now that bursa gets swollen like this, because when it keeps getting beat up, the little cells in it that make fluid just make a lot more fluid, right Now we got a little bursitis.
Now there are little nerve endings in that sac, too, and that can cause some pain as well. Yeah, let me, in the back, yeah. Student What causes the spurs to form Is it a matter of genetics or activity level or age or all of these Again, as I mentioned before, I think there’s a lot of controversy about what makes them form. I think it is agedependent, I know it’s agedependent. But really what probably happens is that there are tissues, right, that attach Well, here’s the normal design like this and like this.
And there are tissues that attach from this area down to your arm bone, one of them being the deltoid muscle, OK Goes from here down to here. Well when you spend a lifetime with this arm hangin’ at your side, OK, that is, pulling down like this, it pulls on this bone. And I think what happens is this bone, as a reaction, develops what we call a traction spur, OK Where a little additional bone, or you could think of it as calcium, builds up like that. So it’s hangin’ like this.
That’s why I said with your dog, he’s walkin’ this way, he doesn’t, I never heard a vet, you know, and vets will operate on anything these days, but you know, they never operate for a rotator cuff tendonitis in dogs. Student Is it on the average here that, you know, because if you’re righthanded, it’s mostly on the right side, the left side’s almost Not necessarily, I mean sometimes, but you know, that’s not always the case. Student And if you come in there basically you’re just dealing with just the one side.
Sometimes both, many times both. Sometimes you fix one, and then the other one goes. That’s why we’re so busy. Everybody’s got two arms. laughter Please Student I play a lot of golf. Will that affect it Horrible. Stop right now. laughter No, in all seriousness, what happens in golfers is, you know, with their swing, like this, OK Can you see how you can get that pinching as the arm comes up So the most important thing is not to stop playing golf, is to make sure that if your shoulder,.
That the inflammation is down and you get the duck under, OK Student I have to change my swing. Or change, well get your arm fixed. laughter Student Thank you. Yes. Student So if surgery is recommended, can you talk about average recovery time Yeah, well here’s the way it goes. First of all, it depends on the arthroscopic surgery, and again, these are all done arthroscopically. I mean the only shoulders we open these days are either trauma, if you fall off a roof.
And break the bone and we gotta fix the bone, or if you go on to an arthritis, and we’ll talk about that in a minute, of the ball and socket, and we have to do a shoulder replacement, OK But otherwise with the arthroscopic approach, if you’re just removing the spurs and making some room, it’s about a 15, 20minute procedure. You go home the same day, and you start moving the arm outta the sling the next day. Have to go to therapy, but you stop using a sling.
Even with those procedures, you gotta figure out that it’s gonna be at least three or four weeks where you’re really moving well. Why Because this tissue with the spur pinching on it is pretty swollen, alright So you’re goin’ in there as a surgeon, sneakin’ in the back, and takin’ off these spurs. Well you know, this thing is inflamed to begin with. As a surgeon, you’re gonna introduce some inflammation by this, no matter how gentle you are, and now you gotta get the whole thing to quiet down.
And regaining your motion. So I’d figure at least three or four weeks. When it comes to the torn tissue, again, it comes in two flavors. Not so bad, and really bad, OK Now in the not so bads, right, you are in a sling for three or four weeks, but you start moving it with therapy right away. And you can expect at least six to eight weeks of therapy. If it’s really bad, you’re gonna be in a sling for at least six weeks, right Moving it, but protecting those little stitches,.
And it’s gonna take at the minimum three, four months of physical therapy. And then, you know, you’ve gotta anticipate that it’s gonna be, I always tell my patients, at least six months, maybe eight, alright, before you wanna do anything really heavy. Because it takes time for the tissue to truly heal. Student If it’s completely separated, alright, is there a point of no return, if they just keep letting it go that you won’t be able to attach it Well, you know we used to I mean before the present arthroscopic techniques,.
Anything that looked like this, torn over here and stuck way back over here, and you could see that on the MRI, people kinda said forget it, you can’t do anything, OK Now we found that if you do a lot of these, it’s patience that you need, but there’s always stuff back here, OK And you gotta take your time, and there’s a little electrocautery device that allows you to release these tissues, and then you gently take this, and you’re really surprised how much of the head you can cover.
The concept is to get something covered over that head. And every shoulder has a different personality. All you can tell on the MRi is that it’s either not too bad or really bad. When it’s really bad, you don’t know until you’re there, working, before you can make those decisions. And then the questions comes up, well if it’s really bad, should you really even bother Student That was my next question. you know, because after all, I’m old, whatever that means, you know, but I still vote, OK.
So here’s really the progression that you’re trying to avoid, OK So you start out with the ball and socket that looks like this. Here’s the socket. Here’s the ball. Here’s the arm, alright And here’s your two bones here, A and C. And here’s your rope. Well this rope or tendon does actually a couple of things. It acts like a spacer between these two bones, but actually, as your arm is lifted up by other muscles, it sorta helps keep this ball in the socket as you’re bringing it up.
But let’s say you tear it, and you don’t do anything. Well if you don’t do anything, eventually what happens is this ball goes in phases, alright So here’s the tear, alright And it’s now way back here. So for awhile, you know, it kinda hurts, especially when I roll on it at night, but I can deal with it, alright Then little by little, this ball starts ascending that way ’cause there’s no spacer, OK And the muscle that pulls it up, pulls it up this way, again no spacer, and the next thing you know,.
And this could take six months or it could take six years, you’ve got this ball, here’s the arm. Again I’m exaggerating this moving a little bit. But you’re grinding on this, can you see that And then the top of the ball starts wearing away. Now this ball was originally designed to sit in this socket. When it’s no longer quite sitting perfectly in the socket, two things happen. The rest of the ball wears off, and when it wears off badly, always there’s a big spur that develops on the lower end right here, always, OK.
And then after that’s been working for awhile, this socket wears off, OK So that’s the eventual wear that’s caused by the lack of a rotator cuff. Again, it can take six months, it can take six years, it can take ten years. Remember what I said, we’re all hangin’ around a lot longer. Once you get this, there’s no reconstruction to be done other than a shoulder replacement. And then you gotta cut this part of the ball off, and you’ve gotta put a half a ball with a metal stem down it.
And then you’ve gotta put on this side a plastic socket. And that’s a shoulder replacement. Do they work Yes, however if God wanted us to have metal and plastic in our shoulders, he woulda put it in there, OK And today we even have another system for the really, really, bad, bad ones where you’d make the ball a socket, and the socket a ball that you implant in. That’s a reverse shoulder. Do they work Well, yes. Yes. Student One last question for me. Could it happen sometimes that the nerve that’s.
Coming out of your spine gets affected and affects pain in the shoulder Emil Yes, you know whenever you have shoulder pain, especially if most of these are these wear and tear processes, well there’s no rule that says only one thing can wear out at one time. And again, if we draw the shoulder blade and the arm and those two bones, right, and here is the mouth, nose, eyes, alright And here is the cervical spine right here. It turns out that the nerves that allow you to feel.
And move the muscles in the arm come from your neck. They duck under that bone, and then they come down your arm like this, OK When you have a beat up rotator cuff tendon, remember I told you, you feel pain along the side of the arm, and because of the muscles that connect the shoulder to the neck, you can feel it up the neck as well. When you have a beat up neck, like a bad disk that’s pinching on a nerve, you’re gonna have pain that’s here in your neck, and then going down your arm.
And they’re often difficult to differentiate, OK And many times even after we make that differentiation, again there’s no rule that says you can’t have a little bit of this and a little bit of this. I think we gotta. Are we about ready, or should I take more questions Brian Any more questions OK. Student When you have an MRI done, does that require contrast And will the MRI determine the difference between tendonitis and a tear ‘Cause I know you said when you can’t tell to what extent it is until you actually go in,.
But so the MRI is Emil Well I said that it, yeah, it’s. You can tell if it’s torn or not torn by the MRI. In most circumstances, here’s what the The MRI will show you the soft tissues, the tendons, OK Now occasionally when there is a very small tear or a tear you’re not sure of or it actually is often used for the throwing athlete where they tear what we call the labrum here, these are very subtle tears. So if you inject a little dye in the shoulder.
Just before you get the MRI, that dye will seek its way into that little tear and will show you the ones that are very difficult to see. Most of the time if you’ve got a tear that, you know, in our type of shoulder with some wear and tear that you can’t even see on a good MRI without any dye, you don’t need to be doing anything invasive there, OK You treat that conservatively. And if you have a shoulder that is torn, and someone fixes it, and it doesn’t go well,.
And you’re not quite sure how many tears you’ve got, etc., before you have to go in there again, sometimes you’ll do an MRI with the dye. Yeah, I think give this fella a chance. Student Are you gonna get into arthritis of the shoulder What’s that Student Are you gonna get into arthritis of the shoulder Well we did when we showed you the ball and socket. I just didn’t call it, but when the arthritis really affects the ball and socket. So when the ball normally has this nice smooth gristle.
On the end here, and some smooth gristle on the socket. It’s when this gristle wears away like this that you develop shoulder arthritis. And that also comes in different flavors. Not so bad, kinda bad, really bad, OK And the really bad ones end up with shoulder replacements. Do you have other questions on that Student When I move my shoulder, and I can hear it going glunk, glunk, glunk, glunk. Yeah, that’s usually ’cause this is going glunk, glunk, glunk, glunk, glunk. laughter Can you sleep at night.
Student Usually I stay off of it. Can you do everything you want during the day Student Pretty much so. So you know, again, with shoulder replacement, like knee replacement, like hip replacement Student I’m in therapy right now. You’re in therapy, get that shoulder moving. Student So if you have that arthritis, the only thing is replacement Well again, if it’s not too bad, alright, and it’s just sort of a little beat up, with some little chips, you can go in there arthroscopically,.
Wash out the chips, smooth down the surfaces and back into therapy. It depends on how bad it is. Student But after you’ve had it all done, why can’t you raise your arm Well there is a couple of reasons. What raises your arms is actually a muscle that starts up here and goes like this. It’s called your deltoid muscle, alright And you need that working with your rotator cuff. If you don’t have a rotator cuff, you’re not gonna raise your arm. If this major muscle is weak,.
You’re not gonna raise your arm. If it’s stuck between the ball and socket, you’re not gonna raise your arm. So there’s a number of reasons. Yes. Student When you were talking about the nerve involved before, would that cause numbness and tingling in your hands Emil You know, there’s no question that numbness and tingling in your hand can be caused by a pinched nerve in your neck. But you know, if you get an irritated enough shoulder here, a really red hot, you know, tendonitis, there are times you’ll feel it right down your arm,.
And you can even feel some tingling in your hands. It can mimic it. Yes. Student Is it likely or probable that you’ll get tingling on top of your shoulder, up towards your ear You can. Remember that in the top of the shoulder we’ve got some muscles. Again here is your shoulder blade, arm, alright Here’s your mouth, nose, eyes. These two bones. God, if I draw this one more time today. laughter And there’s a muscle, right, your trapezius muscle that attaches like this, right here, alright.
And when you have a shoulder problem, like a tendonitis, a torn tendon, just a angry, painful shoulder, you’ll often feel the pain first of all down here on the side of the arm, And like I said before, you can even feel it down into your fingertips, but this muscle will go into spasm, and you can feel it up here, and this muscle actually rolls around and attaches to the base of your skull. That’s why people with shoulder problems many times get the pain right in their neck.
You can be the slickest arthroscopic shoulder surgeon in the world, but if you have a big ego like mine and wanna make sure you get really good results, you gotta have the therapy done afterwards to recondition these structures. And that’s why you gotta have somebody like Gary Schoenberger, and he’s gonna talk right now. Gary and I have have been together longer than we want to admit. Gary Thanks. I’d like to thank Dr. DiIorio, and I’m gonna grab something here. To talk about rehab for all the stuff he went over.
Would be to isolate each and every exercise for each and every problem. What I wanna do instead is I wanna talk a little bit about why rehab. One of the things that, before I came in with Dr. DiIorio I used to hear back I’m in this 41 years now. Student Whew. Student Whew. laughter Gary I hope that was a good whew, and not a bad whew, alright And I’ve seen things change, believe me. I have seen it change, I have seen it. Like he said, there was a time when you could not.
Fix rotator cuffs. So we learned ways to try to get something functional out of there. We learned ways to deal with pain before there was ways to take care of the things that were causing pain. What I wanna talk about, number one, before we start, we talked about coordinated health. What does coordinated health mean What a strange name. We didn’t start out with that name, we came with that name. We came with that for a reason. If I get a patient, this patient let’s say, and he’s been fixed, he had a labrum tear, he’s been fixed.
Day he walks in, before I even see him, I have. This is one I did today. I have his doctor’s reports of all the things and all the visits that Dr. DiIorio has had and whatever studies he’s had. This person had a MRI. This person then had some xrays. This person had a history, and I can tell if he’s on medications, what he was on, if he’s had a past history with that, how we can exercise him, does he have a heart problem with it I can take everything that’s known to this person.
Before I meet him. Here’s some more. My favorite, here’s a guy with a golden rod. It’s a picture of what they did to this. See that Does that look familiar When they walk in that day, even though they had their surgery done yesterday and they come that quick, I have in my hand a history and understanding of that person, his shoulder, far more than he knows about his shoulder. My responsibility now is to take this and teach you so that you can understand in a language that just says.
Dr. DiIorio talked here, what I’m talking about so that you can know that what I’m doing, why I’m doing what I’m doing, and why I can do it and not get you in any kind of trouble. I know your shoulder, I know it well. So let me talk about. You know what I’m gonna draw a picture, but it isn’t gonna look like Dr. DiIorio’s. Nobody draws like him, and I’ll tell you a little story. Back in the old days, we used to have these down in the 80’s, down at Shanersville,.
I started drawing and talking I just went over this with him. And he’d say you talk, I’ll draw. So just forgive me if this doesn’t look like the one you saw before. This is that wing bone he talked about. That’s that arm bone. Roof bone. Collar bone, your sternum, your shoulder, and he talked about these guys up here. When they bring a person in, the thing you need to know about your shoulder is that first of all, it’s held together, these ligaments, and this one has a recess down here.
That ligament, capsule ligament, as it comes off there, keeps you from dislocating. He talked about dislocations. Number one, keeps the ball in the joint. Two, he talked about this guy, the rotator cuff. That has four players. And guys that go around here and attach down here. This guy right here is unique. When you hear a person tear their rotator cuff, it’s usually this guy here, the funny name, supra spinadus. He’s unique. He’s unique in that he sits between two bones. That’s wonder for you as long as it’s working right.
It’s bad for you if something happens that pinches it between these two. And we talked about the spurs and without the spurs. The steering muscles, we call ’em. Then he talked about these big guys up here on the top. These are the movers. The deltoid. These movers cause the ball to go up in the air and move, and we can reach above our head. They’re the big guys that we see on the outside, the weight lifting muscles. Now we got a group up here, group four. They’re the stabilizers, and what do they do.
They hold this wing bone on your back with muscles so that this one can move. Otherwise this would just slop all over the place. Everybody has a job. Everybody has to do their part because if you change what was created here, you can expect something to go wrong. And the something we talk about that goes wrong is just a messenger. We spend a lot of money as a society shooting the messenger. What I tell my patients. If there’s a drug cartel over here, and I send this person out to get the information,.
And they come back with the information, it makes no sense to shoot the messenger. He’s bringing me information. But we spend a lot of time, well we do it all the time. If you got a cough, what do you do Take a cough medicine to stop your cough. Well that clears your lungs so you don’t get pneumonia. We got pain up here, and we’ll do ice, electrical stimulation, we’ll go to acupunctures, we’ll do anything we can to shoot the messenger. Why not look at this guy Let’s look at the cause of the messenger.
So as a different way of And we’ll talk about why would they do Gary, would you ever get an injection in your shoulder Yeah, I’ve talked to a doctor about that. If it’s so painful that I can’t do something to take care of the cause, there’s reason to take the injection. There’s a reason to take medicine. If the medicine is so you can kill the cause, yes. But don’t just take the medicine, because if you do, you’re shootin’ the messenger, and he will come back. Now we have those four players.
Let’s talk about a couple things. This little, you ever pick your arm up You can feel Don’t if you have a bad shoulder. I can actually feel the ball stick in my armpit, pushes my finger away. I think we were given an armpit for that reason, for the ball to get down in the armpit so it wouldn’t bump against this bone. So when this comes down here, there has to be a recess or a loose area down here so the ball can go there, and then it can come up in the air.
Because if there’s no room there, the ball will lever up, and it will pinch that tendon against that roof. Even without a spur, that’s important to know. Because many times we have Dr. DiIorio go in there, and they shave off this spur, and they say, how come I have the same pain. Because Emil You’re not supposed to tell them that. laughter Because they haven’t taken care of the reason for the spur or the reason for the impingement. One is a pathological impingement. You take this off here and you’re still hittin’ that roof,.
Now you’re hittin’ a roof, a denuded roof. Meaning scraped clean of a spur and bumping it. Many people ask me, I can’t understand, it seems to be the same pain. It’s because the ball can’t get in the armpit because that has not tightened. When did it tighten When they do the surgery up here, they don’t lay down much. Usually you sleep in recliners ’cause you don’t sleep that good right away, so consequently the ball slips down in here, tightens this up, the blood gets down there, tightens it up, or because it used to hurt before surgery,.
Everybody does this. Remember the old days and everybody wore slings You don’t see many slings anymore. You don’t see many slings anymore, why ‘Cause the slings are the enemy. Immobilization is the enemy. It’s why when a person gets heart surgery, they get ’em up the next day. The immobilization is the enemy. So why did I tell you all this I’m telling you all this because if we got this thing tight and we got a spur up here, and we don’t loosen that up first, or get something to loosen it up, and then he fixes it,.
We will still have the same kind of symptoms. We took something, same way, just think of this. We talked about redoing a joint replacement. When things are already tight, now we put a joint replacement in, we have a weak arm, we got a tight arm, and we put a new inside. That’s like. Good, bad. If you got a bad on the outside and a bad on the inside, you put a good on the inside, you still got a bad. If you can do a lot in your rehab before your surgery.
Or before anything you do, you got a good on the outside, bad on the inside, you put a good on the inside, you got a good chance. A whole lot better chance of liking me, that’s for sure. Because if I gotta stretch these structures after the surgery, that becomes hard. So number one, people say I got a rotator cuff tear, why’d they send me to therapy Because I’m going to try to get everything And tears, by the way, come in flavors. I can say this, tears can come from.
Somebody did, remember the phone book One page torn, all page torn, partial. Well I had a 50 percent tear of mine when a wall fell on me, and I did that dislocate, kind of an old baby boomer he was talking about. I dislocated it out. Fifty percent, the MRI said, do I have any problem at all No. I make a lot of noise. None, and there isn’t anything I can’t do. Fifty percent tear. So tear doesn’t necessarily mean tear. If we mean a vulsion tear, and a tear off,.
That’s something different. Now by the way, we’re gonna be doing some screening later if anybody wants to stay. One of the things, you ever see people lift their arm like this when their arm hurts Ever see this This is what you used to see all the time in the old days. That’s these guys right here, these stabilizers, doing what these movers were designed to do. They were designed to move. Ball in armpit, arm goes up in the air. Ball in armpit, arm goes up in the air.
If I can’t get up here and I pinch, guess what I do when I start to pinch I move the roof away. Why do you think you do this ‘Cause you’re moving the roof away so you can’t pinch this guy. This muscle up here on top of you neck, those of you who ever had bad shoulders will know about this muscle. You feel like you just wanna rip it outta there ’cause it’s so achey up on the top. It’s because you’re making a stabilizer a holder, a mover, and they weren’t designed.
It’s like you ever see chickens have red meat and white meat It’s because they do different things. These guys were designed to hold, you made ’em move. This was supposed to move, you make it hold. You can’t recreate the shoulder and expect to feel normal, which is what I wanna draw here. Basically when I bring people in, I teach ’em two philosophies. Normal and feel normal. It’s logical. Abnormal, Abnormal meaning even if it’s just the way you use it can feel abnormal. Never expect abnormal to feel normal.
And that’s what’s asked all the time. People say I wanna feel good, but I don’t wanna invest the time to get there. I wanna shoot the messenger, I wanna get better quick. That’s our society, so we’re leaning on. Instead we have to go back to cause and effect. So this is my favorite drawing, and I made it up some years ago, and I’ve lived by it ’cause it answers all the questions. Pain, good guy. Buy into that Who thinks pain’s a good guy You should by now, yeah, he’s a messenger.
Alright, I give it two categories. Two people in two directions that cause pain. Pathological. Physiological. Pathological, the ones that when you go to the doctor he says, this is the way he comes in, Whoa, let’s do this study, that study, this study, this is what they do is studies. The eyes inside your joint, what’s goin’ on in there And by the way, and this happened to me I don’t think a week ago. Maybe it was last week, maybe even this week. No, where are we, Monday, it was last week.
Last week I got a person come back and said, my MRI was negative. And I said, Hallelujah. And she said, no, now they don’t know why my shoulder hurts. I do, I said, and I know why it doesn’t hurt. ‘Cause they didn’t find any bad stuff, and that’s what they’re basically looking for in the MRI’s and all the studies. To get a negative is a good thing. Don’t hope for to find something. Everybody wants to find something in those studies ’cause they’re lookin’ for rotten stuff. Tumors, they’re lookin’ for fractures,.
They’re lookin’ for the worse case scenarios. They’re lookin’ for the bad stuff. That’s the pathological side. What about the physiological side This part, we’ll show it later, can feed into that part over there. When we get an injury, no matter what they find, they might find tendonitis, might find a spurs, they might find blah, blah, blah, blah. But because of that, remember, how I lift my shoulder, if I lift my shoulder, is this getting tighter down here Yes, ’cause I’m not stretching it out, not getting the ball in the armpit.
’cause I don’t wanna pinch that guy on the top, or if I have a tear, I don’t wanna lift with it. Over here, this guy has two guys. Range of motion, that’s how far something goes, and strength, what causes the motion to happen. If I have something too weak, I gotta cheat. If I have something too tight, I gotta cheat. When we cheat, we changes the mechanics of how we do something. So at the joint, if you change it, remember Abnormal can never feel normal. Abnormal can never feel normal, so something’s gotta hurt.
It can also hurt above or below. What does that mean That means if I’m starting to cheat with my arm, I can expect my neck to get sore. If I can cheat with my shoulder and start moving my hand instead of it, I can expect my elbow to get sore, or my wrist. This and this and this create this group of people, the itisis. You guys know ’em, tendonitis, bursitis, capsulitis, all by using things the wrong way, and even extending it from the injury to sites above and below, and unfortunately,.
That’s about the time we get people because that’s the time they can’t sleep. So what does that mean to me When a person comes in and we go through that, I tell them, let’s measure this, see what you got. Let’s measure this, see what you got. And then when if you’re a baseball players, and they say I wanna throw again, when can I throw again If you don’t have this, and you don’t have this, you’ll change your mechanics so you’ll be a side arm thrower, or when your speed comes,.
You’ll start hurting your shoulder, it’s hurting in the back ’cause you can’t follow through ’cause you can’t have enough time to slow your arm down. If we change the mechanics, you’re going to have pain. I can answer everbody’s question in here when it would be safe for you to polish your car or wash your windows just by measuring that. Because if you don’t have it, it’s gotta fail. It was designed a certain way. If we go against the designs, we’ll always have a cause. So when they come in and they have pain,.
They’ve already looked at this side. It has some influence, I’m gonna look over at this side because they say to me, do I think I really need that spur removed And I say to them Put your fingers in your ears, Doc. Ready And I say to them, if you get your range of motion, and you get your strength, your mechanics are good, then bless you, you don’t need to do anything. ‘Cause I got a nasty spur. We showed, we saw mine when I got that MRI to see if I dislocated my shoulder.
But do I have a problem No. Why Because Gary’s arm still has the ability for the ball to go in the armpit and get by. But because I keep everything good, if it gets to the point that it bothers me and it needs to be done, which he always says, you’ll get it done one day. If it ever happens, I got a good shoulder going in on the outside, we’re fixing the inside, and I got a good shoulder comin’ out. Why does the athlete smash down on the ground.
And then get up playin’ Three weeks later we can’t believe, how did he ever get back there that quick ’cause it takes us months to get back into doing anything. The difference is he has a good one going in. Athletic trainers and people jump on it right away to keep it, they fix the inside. It’s a now good inside, good outside, better. Rest of us, we wait until it’s going to go away. I was waiting for it to go away. Chances are you’ll go away before it does get better.
Those are the things that we need. So in rehab, number one, get in here before, and get people If you ever have a problem, see if you can talk to your doctor, get a start. Get something to take home with you. Something to get ready. If it gets better, Hallelujah, you’re done. If it doesn’t, you got a good one going in when you come out. And that’s especially true if you’re going to get one of those And if you’re gonna get a replacement, it looks like a shoulder replacement is gonna be.
The thing that you need, then the reality of it is if you wanna make your job better, my job better and your doctor happier, the more you can get done before, the better it comes the other side. Now there’s no doubt that there’s a problem with insurances today, and I know that because I live in that world. It’s a nasty world. There was a time when I lived that it didn’t matter. Whatever we said, the patient could come forever, to get him ready, then get him better.
Back in those days we didn’t get ’em better anyway ’cause we didn’t have the tools to do it. Now we have the tools to do it, we can’t get the time before it because the insurances have changed. But you can be taught what Home programs will be your life. It doesn’t matter at what level, it will be your life. And you will understand that 90 percent of the success of any rehab’s gonna come from you. Ten percent from me, showing the way, pointing the way, kind to teach.
Now we’re gonna have a little thing afterwards. There gonna be any questions, please feel free to ask questions now, or we’ll get somebody later. Anybody I either told nothing, or I explained it all, or nothing. laughter Yes Student I’m diagnosed with an impingement. Is there therapy for that Yes because your impingement may be a physiological one, or it may be a pathological one with a spur, or it could be a combination of both, but the reality is you need this if you’re gonna get anything done to have a better success,.
Just like the athlete, get it ready. That make sense. Yes. Student What exactly is happening with a frozen shoulder You know, we talked about in the beginning, first of all there’s more females than males. I have my opinion on that. You wanna hear my opinion Student Yes. Males are sissy. As soon as they get a problem with their shoulder, they run to the doctor. The woman says, it’ll get better tomorrow, it’ll get better tomorrow, it’ll get better tomorrow, maybe tomorrow, maybe tomorrow, maybe.
I can’t move it, I better go. That’s just my opinion, but the reality of it, if you think of personalities, it kinda fits. The frozen shoulder, the real name is peri. You know what peri means Peri like a round, a perimeter. Peri articular adhesive, there’s that word, capsulitis. And I’ve explained this to my patients all the time. Peri, around the perimeter of the articulation, where two things come together, alright There’s an inflammation, capsule, that ligament, itis, there’s an inflammation of that capsule that causes it to stick itself and get stuck.
And I tell you what, if you ever had one, it’s amazing how it just engulfs you. One of the things that allows it to happen, and no known ideology. People don’t even know exactly why they start sometime. But when that process starts, when you get inflammation, you have more scar fibrosis, more sticking down. It’s just a process that’s in there, it’s a good process, it’s part of the healing process. But it’s one of those that kinda runs amuck, for whatever reason it gets started. And once it gets down to where you’re starting.
To move this way, and you’re starting to protect in your sleep, and I had one come in where I can’t even get their arm away from their body to measure how far it moves. You know why it hurts so much You ever see the policeman takes the bad guy’s arm behind his back He don’t go anywhere because that really, really is stretching my capsule ligament, and the grand designer said, we’ll put a lot of sensory organs in there so the person will always know, even though we can’t see where my arm is,.
So he knows where it is in space. And the capsule is so rich in those sensory things, so you can feel it, and when they become inflamed and they stick down, when you take my arm away from my body or try to get it behind my back, that’s the same as if somebody was up at the end of my range pulling on my arm. Soon you can’t lay in bed. Every position is an end range stretch, like the policeman got my arm. And soon they come in, and that’s about the time we get ’em.
I can’t sleep anymore, do something, huh There’s a lot of things we do with that. We give it a big shot, the more we can get, the better it is, there’s some things they can do. They can go in under a scope now, and they can release some of that scar tissue. And they move it in there while you’re under, and when you come up the next day, sometimes the same day, we go to the other place, they take care of showing you how it does move and all your range of motion,.
They take pictures of it. Then you come to me the next day, we keep it going. You have to break that cycle. It’s a matter of breaking a cycle. We call it the flush. I hurt, so I don’t do this. I don’t do that, so I hurt when I do this, so I won’t do that anymore, and then next thing you know, I got the flush. The key is to bring it back up the other way, and if it’s too engulfing, to get a jump start on it.
So you can keep it going on the outside, and that’s what those guys do. Any other questions Student I was told I had torn my rotator cuff, and I have no pain at all. I can raise my arms up. Every night I sleep on my stomach with my arms underneath my pillow, every single night. I don’t have pain, but what I do have is What I measured, a half gallon of milk on the table to set in the refrigerator, I have to I can barely do it.
Sometimes I can, sometimes I can’t. From the floor, I can lift anything, and I can move my arm, everything. I had an MRI and an xray on it, and that’s what they told me, it was torn. But I really don’t have any pain. Gary Again, I had that 50 percent tear, and that’s what I need to know, and we need to know. The MRI says a tear, but is it a full thickness tear or not One of those things about reaching out in front, ah, took my picture away.
Remember the supra spinadas, the guy across the top, remember that funny named guy that gets pinched He has an incredible responsibility at initiating motion at start. So that I don’t get stuck here, he starts by ducking the ball underneath. When I get right here where it looks like the ball is gonna hit the roof, it also drags it underneath, and you’re working at that range where he needs to fire the most. So consequently, that’s where you’ll notice those tears. Now the question would be, and if you came in,.
Do you have pain when you go to lift that, or you just can’t do it Student I mainly can’t do it. Oh yeah, never get any pain with it at all then when you reach out Student Well at times I might just get very slight pain, nothing that bothers me really. In fact, I probably from using this arm more, I get more pain in this side than I do on the other side. That’s one of the things that happens when we get an injury.
We end up ruining the other side. Not ruining, we overuse the other side. I would have some questions about if that thing’s got a partial tear in there or a near tear, and Doc can repair it, remember that drawing he did, and I’ve had these, I know I had the tear, I had it six months ago, two years ago, but I decided I’d take care of it, and I lived with it. And now we say, you know what, you can’t live with it now. But you go to see Doc, and now that thing is.
Yoga For Your Back 30 Days of Yoga Day 4
Hi, everyone welcome to 30 days of Yoga with Adrienne. I’m Adrienne and it’s day four. Rawr! Feeling frisky! Let’s get started. All right my friends, so let’s take a deep breath in wherever you are and a long exhale out. And we’re going to start today’s practice, day four practice, duh, on all fours. So, make sure you take a deep breath in and out here just to arrive on the mat. So we’re moving kind of quickly into the practice today, but it doesn’t mean we’re going to speed up.
Our rhythm necessarily. But just start right away with a little gentle CatCow. Check in with your breath. Take responsibility for your own happiness here and for me that means connecting to my breath. Inhale. Drop the belly, press away from the earth and exhale. Curl the tail going under, begin to round up through the spine and then we draw the navel up as we release the crown of the head down and I speak into my microphone. Inhale, scooping the belly. Down, heart opens up, crown of the head lifts. We press away from.
The earth and exhale. Curl the tail going under. See if you can stay connected through the abdominals here so we’re not kind of linky lanky. Ah, I’ve never said that before, linky lanky. We’re not just. I usually say luky fluky. Anyway, we’re not just kind of mindlessly moving through the spinal flex, but really seeing if we can slow it down. And so maybe for the next couple passes, go ahead and take your eyes, your gaze off the tutorial and close your eyelids just so you can get into the sensation here as we continue to breathe and.
Stretch it out deep breaths. Let’s do one more, wherever you are deep breath. Visualizing space between each vertebra, those disks, really creating a little bit of softness and ease throughout the body. All right, we’ll come back to the tabletop position. We’re going to take the hips to the right, the head to the left. Notice how the arms and legs and feet kind of want to come up. Stay connected. Keep a nice awareness through your foundation, even here. So we create this crescent moon shape with the right side body. Take a deep breath in, exhale back.
To center and now hips to the left, head to the right. Stay connected through the tops of the feet. All 10 fingerprints pressing into the mat. Deep breathe in and on an exhale we melt it back to center. Cool. Hearttoearth pose. We drop the elbows where the hands are. We try to keep the knees in line with the elbows, so this kind of railroad track image here as we walk the knees back and we melt the heart. Now, this is where I’m guiding you to, but listen to your shoulders, if they are tighter.
You might widen the elbows. If the hips are pinching, you might widen the knees. So always working to create space, you might find a gentle rock here. Oh, yeah that feels awesome. And we continue to deepen the breath, find what feels good. Then we’ll press into the tops of the feet. Take one more breath here, inhale and exhale. Melt the heart down exhale breath. Inhale to come up, press into the earth, slowly come back to all fours. Day four all fours. All right, this time we’re going to curl the toes under and we’re going to send the sitbones.
To the heels here and nice and easy walk the palms all the way up to the thighs. We’ll just take a rest here. I just want to check in with the feet here and you might use this time to check in with the shoulders, the neck or you might just continue to deepen the breathe. Find that Pranayama. Breathing into the soles of the feet. And I’ll dive back forward onto all fours. All right, this time widen the knees as wide as the mat bring the two big.
Toes together. Walk the palms out just ahead of the shoulder points, and we’re going to inhale, reach the right fingertips forward stretch through the right side body and on an exhale weave those right fingertips in and underneath the bridge of the left arm. We come to rest on the right ear here, and I press into the left palm. It’s one of my favorites here. Sit bones rock up towards the sky so you can find this rock in the pelvis that feels really great on the back body and we breathe here. For a deeper stretch you.
Can press up and out of those left fingerprints, or you can reach the left palm all the way up towards the front edge of your mat. Breathe deeply here deep breath. Then, if you’re feeling a little frisky and you want to meet your edge here, have a little fun, you’ll curl the left toes under and maybe, slowly, keep your left toes on the ground, slide the left leg out. Find that sitbone to heel connection. If you feel like, Ugh, I’m going to fall over. Connect to your core navel to spine, Uddiyana Bandha. Nice, Bandha lock here to.
Engage the full body experience. One more breathe here. Press into that left heel and on an exhale, we release, and unravel and take it to the other side. All right, same thing here, we inhale. Reach the left fingertips forward keep this length in the side body as you weave left fingertips in and underneath the bridge of the right arm. Pelvis rocks up towards the sky and I use my right fingertips to find the best stretch to breath into the back body so maybe it’s here, maybe it’s here, or here. If you’re.
Feeling a little adventurous, press near your foundation, anchor navel to spine, curl the right toes under and slide that right food back. Find that sitbonetoheel connection. So I’m really pressing out through that right heel, finding my breath. Awesome. And then unraveling it back to center. Cool. Walk the palms out, curl the toes under send it up and back. Downward facing dog, peddle it out. Find a little movement here. Breathe deep. All right, then we’ll wiggle it out and then find a place of stillness here for three breaths.
So we might turn the two big toes in slightly, melt the heart back, keep a soft bend in the knees here and breathe in and out for three breaths deep breathing. Pulling through your checklist, one more breath. Awesome, my friends. Then we’ll walk the palms nice and slow back up towards the toes. So we’re coming to the back edge of the mat here. We’re folding forward, Uttanasana. Keep a generous bend in the knees if you need to or a nice soft buoyancy, so we just don’t want to lock here. Okay, stretching the lower back body,.
Stretching the backs of the legs, letting the weight of the head go, we find our breath and we maybe find a gentle sway here just working out the kinks, maybe walking to the left and walking on to the right. Maybe grabbing the elbows, of course. So we explore exhale. Then, we’ll inhale halfway lift, come to that flat back position, we’re going to hold here for a couple breaths just working out the kinks, and going through our checklist. So, pulling the elbows back, making sure we’re not locking the legs but being soft through.
The knees. Navel draws up and we see if we can create one nice long piece from the crown of the head to the tip of the tailbone. So you kind of have to check in with that inner mirror here and I love that. One more breath and on an exhale slide it down. Keep the knees softly bent and walk your palms all the way out to plank. So we’re going to bend the right knee in to center stretch through the left calf. Take a deep breath in and exhale switch. Inhale in and switch. Keep it going. Connect to your.
Core, press away from the earth with your palms. Keep it going, dipping the knees down nice and slow. Finding that sitbone to heel connection and creating a little bit of heat in the body. Awesome, now we’ll lower both knees, hug the elbows into the side body and lower down gently. Inhale. Find your cobra today. Nice and soft and slow you might move around a little bit here. And then slowly we’ll release. Come back to all fours send the sitbones all the way back for a child’s pose.
Here we’re going to actively breathe into the lower back. Send breaths and energy to your lower back. In these resting poses, for me, it’s really not about checking out, zening out, it’s really about zening in checking in. So use the power of the breath here to breath into the back body. See if you can feel the skin of the back stretch with your inhale. Imagine the soles of your feet melting down a little bit closer towards the heels on that exhale. Stay focused on your breath deep breathing. Then, gently we’ll come.
Back to all fours, curl the toes under and send it on up. Downward facing dog. Deep breath in here and deep breath out as you anchor through the heels. Don’t even worry about whether the heels are coming close to the mat or not. Who cares It’s about the experience, so really breathe, breathe, breathe. And then one day, when you’re not paying attention to the pose and you’re just enveloped in your experience you’re going to be like Wow, my heels touched the mat! That’s what happened to me. I was like Holy Moly! And still.steel.whoa.Texas.
Girl. Still sometimes I notice that, it’s okay, sometimes I’m here. Sometimes I here. One more breathe, and then we’ll walk the palms back to the toes once again and we find Uttanasana. This time, yogi’s choice, you can keep the feet hipwidth apart or you might heeltoe, heeltoe the feet together. A little softness in the knees as we relax the weight of the head down and breathe into the back body. If you’re wanting to go more into the lower back, if you’re like Oh, yeah, mama. Whoa. Then, bend the knees a little more.
I’m feeling a little frisky today. Day four Frisky! Rawr. One more breath. Deep inhale and exhale. Then we’ll inhale, halfway lift. Long beautiful neck, find it. Inflate with an inhale in and use your exhale to slide it down, so we follow the breath, breath with the movement, movement with the breath. Walk your palms back out to plank. Here we go. This time, we’re going to press away from the earth and instead of dipping the knees down we’re going to lift the heels up. What So we inhale in. Exhale, toes touch. Inhale.
In. Exhale, toes touch. Deep breathe in. Exhale, release. Inhale. Exhale. Maintain that sitbone to heel connection that we found earlier. Inhale. Keep an awareness through the backs of the legs deep inhales and exhales. One more on each side, you got it. And then, we can either stay here and lower down or lower the knees, hug the elbows into the side body and lower ourself down. Inhale cobra or up dog. Gentle back bend here keep it nice and soft. Again, you can find a little movement if it feels right. Then we’ll send it back.
To child’s pose. Again, using the power of the breathe to stretch the back body, this time you might reach the fingertips behind you, even turn the palms face up, letting the shoulders relax. So you can choose a variation that suits you today and find your breathe deeply inhales and exhales. One more breath here, take the deepest breath you’ve taken all day inhales and exhales. Nice, then we’ll send the fingertips back up. We’ll find our way back to all fours. Day four, all fours. So cheesy. And then we’ll send it up to downward.
Facing dog. Deep breathe in inhales. Long breathe out exhales. Soften through the knees, use the palms, walk them back to the toes. Uttanasana forward fold. This time, we’re going to interlace the fingertips behind the calves and bend the elbows left to right. We might, through, breathe and practice we might be able to find a little more space in the legs, but you can keep a nice generous bend, in fact that’s really nice for the lower back. So just be in the moment, listen to your body. Breathe in, and, on an exhale,.
We’ll slowly extend the forehead, the crown the head, towards the front edge of your mat. Gently release. Inhale, extend, straighten the leg. And release, bending the elbows left to right. Last time, and we release exhale. Awesome. Spread the fingertips wide, walk the palms. Last time, out to plank. So, this time we’re going to do some toetapping, but we’re going to take it to the side. So, we will inhale in and exhale, send the right toes out off your mat. Inhale to center. Exhale to the left. Maintain that sitbone to heel connection so we’re not just ehhh , but, we’re creating.
Full body strength, full body experience as we move back and forth, back and forth. Hips are going to want to come up or sink down. See if you can maintain one solid piece. It’s hard, but, we tap into that inner mirror and we use our breathe. If the going gets tough, use your breathe to let go of some energy. Stir it up. Let’s do two more breaths, you got this inhales and exhales. And then we release. Awesome, everyone. Send it back, child’s pose. Take a rest, really nice work. Relax your jaw, soften the forehead. Life.
Is good. You can bring your arms up here and if we’re still working on building strength in the wrist, you might find a little wrist relief by doing some wrist circles or a little wrist massage. Maybe bringing the palms together up overhead. Take one more deep breath in here, remember why you got on the mat today. Smile. And then we’ll release the fingertips, last time, back to all fours. Day four, all fours. And we’re going to swing our legs to one side and come to a nice flat back position. Good work, my friends.
When you arrive, hug the knees into the chest. Oh, yeah. Give yourself a nice big hug. You might rock a little gently sidetoside. All right, sending the fingertips out, left to right. We’ll inhale, scoop the tailbone up, exhale. Melt the knees to the left. Turn onto your right ear. Maybe use your left palm to guide the outer edge of your right thigh a little deeper into your twist. So if you’re hanging here, don’t worry in time we’ll begin to find that space. I used to have back pain and I have no, none. No back pain now and.
I feel like it’s from slowly finding the length and space to come into postures like this reclinetwist here. So relax, soften into the sensations and listen to your breath. Listen to what your body is telling you today inhales and exhales. Then we’ll slowly release it back to center and nice massages and we come on through and then take it to the other side. Oh, yeah. Right palm comes to the outer edge of the left leg then we turn onto the left ear here. Close your eyes again and listen to what your body is telling you today and.
Listen to your breathe exhales. Gently, we’ll release back to center. Hug the knees into the chest one last time. And then slowly release the soles of the feet to the mat, extending the right leg out long, followed by the left. Take a deep breath in, reach the arms up and overhead, full body stretch. singing Good morning, good morning, even if you’re practicing this at night! laughter Good morning. I can’t finish it. Here we go, deep breath in and on an exhale we release the arms. Sorry for that musical interlude.
Shoulder Blade Pain Relief
And showed me the picture here which is the subscapularis muscle and went on pain when he lift his arm up over his shoulder and at the same time lean forward or sideways. Also painful when he is coughing. He discovered that if he pull his shoulders back real tight cough, there’s no pain. He went on and he said he can’t think of anything specific but he mention intense golf haven’t played for 10 years started playing a lot for 3 weeks now he is hitting 50 in a couple of months. And.
Haven’t sort any medicalchiropractic or physiotherapy help yet I asked him if he can point out where the painpains is Whether it’s in middle left or upper right of the subscapularis muscle base on the pic on the link he sent me. He said it’s feel’s like it’s under the shoulder blade but suspect it’s something else and sent me to this website.This site explain the symptoms of where he thinks the pain is. BUT Can’t really id which point he feel the pain how should he go about locating.
The point By pressing on it How should it feel Ok! I’m going to show you three steps to shoulder blade relief Number one to locate where the pain is, In order to locate where the pain is, you have to figure out what is a good muscle and what is a pain muscle. How do you figure out what is a good muscle and a muscle in pain A good muscle should feel like, for instance there’s no pain on your arm.you just touch here, see how mushy it is how bouncy it is. It’s nice and soft, the muscle feels like normal.no.
Pain. He said he had a pain on the left shoulder so in order to compare to that he has to press to feel the right shoulder and see if there’s a difference. The right shoulder he should feel soft and mushy nice and no pain just like how we felt on the hand and on the pain area you will feel tightness and when you press on it you will feel the pain. The tightness is what we call knots. Now that we know the difference between a good muscle, a pain muscle or tight muscle.When.
We work on it you can feel how the tight muscle will become the soft muscle and you can see the difference. Second step is to loosen the muscles in the area. What you need to do is look for a wall hand on the wall. 90 for the middle of the shoulder blade, 45 is for the lower part of the shoulder blade, 135 is for the upper part of the shoulder. 135 for the upper part, 90 for the middle of the shoulder blade, 45 is for the lower.
Part and let take a look of the side view, one step forward hand on the wall and stretch make sure you bend your knees. Let’s take a look at he front view, step forward and stretch make sure your knee is bend. Now that we have number one locate where the pain is, number two loosen it up and number three I’m going to show you how to work on it. We go straight to the point of the area where you feel the pain, put some pressure on it, Make sure you use the tip of your fingers,.
Here finger pads press on it and then move backwards, forwards, backwards, forwards. Let me show you the front view backward, forwards, backwards and forwards, back and forward. And you can also turn it this way, start with a small circle and probably bigger go forward and then backward. Small circle and big circle. You can also have somebody rub on it and as you rub on it or you can rub it yourself like such, you can use your other hand to support your elbow and just rub this way.
The pain is here and the muscle over here is going this direction, so what you are doing is you are rubbing against the muscle this way and as you rub you can feel that the muscles become softer like the muscle that you felt the good muscle in this area here earlier and that’s when you know the muscle is loosen up and the pain will be gone! Basically what this does is when you rub you create circulation to the area and when there’s circulation to the area it will take away knots and stuff. When that’s circulation.
KT Tape Neck and Shoulder
I’m Chris Harper, and with me here is John, and we’re here to demonstrate an application for neck pain. This when you have pain at the base and along the back of the neck. Some potential causes of this may be stress, overuse such as sitting at a desk or computer throughout the day, looking down while running, or repetetive motions. Some other causes may include car accidents, sudden changes of direction, or sleeping awkwardly. KT Tape helps treat this condition by assisting in posture, relaxing muscles, relieving pressure to reduce pain, and may increase circulation.
So for this application, we’re going to have John spin around so we can see the back of his neck. We’re going to position him by stretching the skin on the back of the neck, so we’re going to bring that chin down towards the sternum or the chest, as much as is comfortable. We’re going to tear our first strip. I’m going to twist and tear the backing paper down near one end of the tape to create an anchor point. I’m being very careful not to touch the adhesive of the.
Tape. Okay, to measure where this goes, I’m going to go a good three or four inches below the hairline of the neck, and go ahead and just let this fall. Being careful not to touch the adhesive, I’m applying this anchor. I’m going right over the muscles to the side of the spine. Okay, and to apply this I’m going to take that backing paper off, and leaving a little bit of paper on there so I can handle the tape without touching the adhesive. I’m going to stretch this nice and evenly.
With twenty five percent stretch. So if that’s a hundred percent, I’m going to back that off fifty percent, and fifty percent again. I’m going to lay that down, except for the last little bit. I’m going to just let that end of the tape fall onto the skin with absolutely zero stretch. Okay, for the next piece just like the first one, I’m going to twist and tear the backing paper down near one end of the tape, and remove that. I’m going to measure as I did with the first one.
So that ends up at about the same place as that first strip. I’m just on the muscles on the opposite side of the neck , and just like with the first one, I’m applying this with twenty five percent stretch. So stretching out a hundred percent back that off fifty, and back that off fifty percent again. That should end up at about twenty five percent stretch. I’m laying that down, and I’m now going to remove the backing paper with, absolutely zero stretch , as I lay that tail down.
I’m going to give the whole application is good friction rub, and I’ve got one more piece. Just like the first two, I’m going to take a full strip. This time I’m going to twist and tear the paper in the middle of that piece, again being very careful not to touch the adhesive of the tape. I’m also going to apply a stretch to the middle of this piece, and how I do that is nice and evenly with my thumbs, I’m not trying to pull in the middle of the.
Tape, but putting my thumbs flat. And if we have a point of pain in this area, I’m going to stretch this piece eighty percent, so if I go all the way out and back that off just a little bit. I’m going to go ahead and lay that piece down with eighty percent stretch. I’m going to lay that down just like with the first two. The ends of the tape I’m going to place on the skin with absolutely zero stretch. I’m taking that paper off and laying that down with absolutely zero stretch. I’m going to give the whole application.
A little bit of friction, that creates heat. That allows the adhesive to really stick to the skin well. Okay, that looks good, now we can come up out of that position, and you should have a little bit of wrinkling in the tape. That looks great. Some helpful tips before applying. Clean the skin very well, remove any oils or lotions you may have on. Be careful with taking clothing on or off as this may roll the tape. Try not to tape into the hairline, this may cause a little pulling of the hair if turning your head.
Shoulder Stretch to Fix Your Shoulders GET DEEP!
What’s up guys Jeff Cavaliere, ATHLEANX.COM. If you get Shoulder pain or discomfort when you’re lifting weights you might be dealing with a tight Posterior capsule. Today I’m going to show you, first of all what the Posterior Capsule is, secondly a way for you to test on your very own self without needing anybody to determine whether or not yours is tight and thirdly if it is, I’m going to give you a stretch that you can do to help fix that. Now as far as the Posterior Capsule, it is a capsule structure that will contribute and.
Tighten over time to lead to this forward or rounded Shoulder posture. The way it does that is usually because of what’s going on with the muscles behind your Shoulder. So we know the Rotator Cuff muscles here, the Supraspinatus, the Infraspinatus and teres minor, they all come around here, they wrap around and attach to the side of your upper arm here and they control it’s movement. Now we know that, the rotation of it, we know that if these muscles get tight they kind of will do this, they’ll sort of stay down, tight and together, taper down and almost push this forward.
Well over time that leads to this kind of chronic tightening and shortening of that Posterior Capsule, it’s a little bit deeper right inside here, that again holds the upper arm in place. That’s a bad story though, that’s a bad situation. Because as I said, any time you’re in this position and you go to start lifting weights up over head or even Bench Pressing, you’re causing a greater opportunity to start pinching some structures in here. Because you just don’t have the room anymore to lift your arm up.
Again, I’ve asked you to do this a lot of times, try to roll your arm in and then lift your arm as high as you can. you’ll actually get a block. So I want to show you now how to determine whether or not your Posterior Capsule is even tight in the first place, which a lot of you will find that it is, and then we can figure out a way to fix that. Ok, so to figure out whether your Posterior Capsule is tight, you’re going to want to.
Do this stretch. Get on the ground here and you want to Internally Rotate your arm as far as you can. Right, not just turn your wrist here or pronate your forearm but literally Internally Rotate your arm as far as you can. Now put it up here at 90 degrees, take your other hand and hold your Lat in place. In other words try to keep your Shoulder Blade flat to the ground, ok, because you’ll see why in one second. As I push down and I have my arm internally rotated as far as I can, now I’m just going.
To try to reach across my body as much as I can. And I’ll see that, can I get this outside portion of my elbow to cross my chest, the midline of my chest. So if I’m looking right here, this is my target. Again I keep my hand in here in place, all the way internally rotated and I’m trying to move across. Now for me, I can automatically feel a lot of tightness right through the back portion here of my shoulder, right here the back of my shoulder.
So what I want to do is again, try to do that. You see if I allowed my Scapula to come up off the ground here, then I could go way over. That’s not testing your Posterior Capsule guys, because we know that the your Shoulder Blade is attached to your Shoulder, so we want to make sure that we don’t just let that happen. We’re looking for the isolated flexibility of the Posterior Capsule. So if you could do this and you can’t get it across the midline of your body, then you’re.
Going to want to try to do the stretch I’m going to show you now. If you can, you don’t necessarily have to do this. What you might want to check is the tightness of your Lats. Because we know that the Lats are going to affect how high and how freely you can raise your arm up over your head. So you might want to check Lat tightness. I often find that Lats are really commonly tight and it may not be necessarily your Posterior Capsule. So check that out if that’s something that you’re dealing with.
But for the rest of you, let’s go on to the third part of this and I’m actually going to show you the stretch. Ok so the name of the stretch is called the Sleeper Stretch. It’s actually pretty easy to perform on yourself. There’s a few things you want to do to get yourself set up right. First you want to get 90 degree bend here at your elbow. Then you want to get your arm below 90 degrees, just a little bit, about 70 degrees abducted so away from your side.
This will be 90 degrees away from my side, I’m going to go about 70 degrees. Now really important, you want to lay here, you can put something under your head to support your head here, I just didn’t bring something with me at the moment. But what you want to do is allow your body to pull your Shoulder Blade back, ok, so intra retraction, I’ll show you in a second here. This is what it looks like here as you can see my back now doing that. So I can actually pin the side of my Shoulder Blade, the outside border of my Shoulder Blade.
Down into the floor. For the same reason, like I said in testing the stretch, you don’t want to have that become part of the equation here. If you’re going to isolate the Posterior Capsule, you want to make sure you’re not allowing the Shoulder Blade to move. So the Shoulder Blade stays pinned here into the floor, then we take our hand, the opposite hand, we actually hold underneath our elbow here, to make sure it stays in position. Get them leaned into the floor here so that my Shoulder.
Blade can’t move, and now all I do is I push down here through my elbow. So I’m causing internal rotation here of my left Shoulder. Now I don’t crank on it really hard, I don’t try to lift myself up because again now we’re allowing the Shoulder Blade to move. I literally just kind of let my elbow gently push down into my forearm and I can feel that again, right in here through the back of my Posterior Capsule. Ok, now what we want to do is ultimately see if we can get to the point where we can touch.
The floor. Because you should have about 70 degrees of internal rotation. But I’m far from it, I mean I can reach my fingers down as far as I can, I can’t get it there. But it just means, I have to work on my Shoulder Capsule flexibility a little bit and mobility. Ok, so that’s all you do. You try to hold onto this stretch for about 30 seconds maybe 3 times, do it a few times a week, and you’ll gradually start to see that your internal rotation will improve via the capsular.
Mobility being improved, not just stretching out the Rotator Cuff but actually working on the adaptations that have been caused by the fact that your Rotator Cuff has been too tight all along. Guys remember, when you’re trying to train like an Athlete here, you’ve got to cover all the issues. It’s not just about flexibility, it could be your mobility. It’s not just about your mobility, it could be about your strength. It could be about tightness in areas that you’re not even considering. So you want to make sure you have all your bases covered.
I try to help you guys do that here on this channel. And of course, I try to walk you through it all in our ATHLEANX Training Program. If you haven’t already joined Team ATHLEAN, and you want to get a step by step program to start training like an Athlete, then head to ATHLEANX.COM right now and get our ATHLEANX Training System. If you found this helpful make sure you leave your comments and thumbs up below and whatever else you want to see guys let me know I will be sure and happy to help you in our upcoming tutorials.