The Hand to Shoulder Solution
Your new resource for hand, shoulder, and elbow pain. Together, we are giving pain the middle finger and gaining knowledge to live a better, pain-free life!
Discover what might be causing pain in your fingers, pain in your hand, pain in your wrist, pain in your arm, pain in your elbow, pain in your shoulder.
Learn about your body, arthritis, tendinitis, tennis elbow, fractures, golfer's elbow, and carpal tunnel syndrome.
Hosted by Carl Petitto, OT, CHT, and Certified Hand Therapist specializing in orthopedic conditions of the hand to shoulder. Also an expert in fabricating custom orthotics.
The Hand to Shoulder Solution
Ep. 16 - Building Stronger Shoulders and Avoid Injuries With Simple Stability Exercises
This episode emphasizes the critical importance of understanding shoulder mechanics to prevent injuries and maintain wellness. We delve into factors contributing to shoulder pain, ergonomic strategies for better posture, and effective exercises to strengthen and stabilize the shoulder.
• Exploring the structure and function of the shoulder
• Discussing the impact of forward rounded posture on shoulder health
• Understanding subacromial bursitis and inflammation
• Tips for maintaining proper ergonomics in daily activities
• Practical stretches and exercises for shoulder wellness
• Recognizing the significance of strength training for shoulder stability
• Addressing common mistakes in shoulder movements and lifting
• Calling attention to the importance of patient education and awareness
Hello and welcome to the new show, The Hand to Shoulder Solution, with me, Carl Petitto.
If you are experiencing pain in your arms and hands, this is your resource.
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This is a resource to help you mitigate pain at home and become more educated on what to ask your doctors and therapists. No medical advice will be given, and you should always see your medical professional for any questions.
Thank you, and welcome to the show!
Welcome back to the Hand-to-Shoulder Solution Giving Pain the Middle Finger. I'm your host, carl Petito. I'm an occupational therapist and a board-certified hand therapist. I specialize in the rehabilitation of orthopedic conditions that affect the fingertips through the shoulder. I want to bring this podcast to the public to educate folks to basic mechanics, basic anatomy, basic conditions that are causing discomfort throughout the upper extremity the fingertips to the shoulder. Today we're talking about the shoulder. I really wanna stress that this is not treatment advice. This is basic information to empower you to make the best decisions that you can, in accordance with working with your healthcare provider. It's very, very important that you get a thorough examination, a thorough evaluation to find out exactly what is causing the pain, so that way it can be resolved in minimal time. Timing is everything, as with most things in life. The sooner you can address a problem, the easier it is to fix it. And let's go into a few things regarding wellness of the shoulder, how to take care of it and it'll be a little overlap a little bit of review about some of the structures, some of the mechanics of the shoulder. It's important to mention those things so that way you fully understand why I'm advising you the way I am as far as ergonomics and how to safely use your arm. Safe exercises, just for you know if somebody wants to go to the gym and exercise and lift weights and get stronger. But how do we prevent injury? How do we best, most effectively, use our arm? What are the best habits for prevention of injury? So I want to really go through the guideline so I don't miss anything, and I put down a few bulleted points here. One of the things is a forward rounded posture. We talked about it on a past episode and this is the right arm. This is the front of the shoulder blade. If you remove the ribs, right here you're looking at the front of the shoulder blade. This is the front of the shoulder blade. If you remove the ribs, right here you're looking at the front of the shoulder blade. This is the back of the shoulder blade, if I were to go like this. So here's the back of it. That roof of bone called the acromion bone goes over the top of the ball. There's a lot of structures, some main structures of the rotator cuff, muscles and tendons that travel underneath that roof of bone. There's also a flat little water balloon which is called the bursa sack, this little shock absorber between that roof of bone and the ball. Now if this shoulder blade posture is sitting maybe too far cocked forward this is the posture like this or if it's not rotating properly on the back of the shoulder blade, then you're going to get a lot of impingement syndrome here. This roof of bone is going to be smashing those structures that travel within this space.
Speaker 1:Let's start with talking about the forward rounded posture. So you know if just slouching or reaching for the keyboard, for the computer way forward and that's rounding the shoulder blades forward, you know, ideally the keyboard should be right up to the edge of the desk so that the shoulder blades, the shoulders, are back. There's nothing but air in the carpal tunnel. The carpal tunnel is not resting on anything. The wrist is pretty much straight, or what we call a neutral position, and the shoulders can be back.
Speaker 1:Now, rounding that shoulder blade forward, that's rolling that acromion bone forward and that's pinching off the biceps tendon we talked about earlier. It's pinching off that flat water balloon called the bursa sac, the subacromial bursa. That is a little shock absorber there. The balloon part of the water balloon if you picture a flat water balloon is living tissue. So if that's being pinched on all the time.
Speaker 1:That's going to get very inflamed. It'll get very, very painful and that's called subacromial bursitis, b-u-r-s-i-t-i-s. Again, there's the itis. Itis means inflammation, tendonitis, inflammation of the tendon. This is inflammation of the bursisac bursitis. Also, there's that tendon which connects one part of the biceps muscle to, let's, the biceps, right here over the front of the ball, of the ball and socket and inserts on the top of the socket. So that will get very inflamed. That'll become a tendonitis.
Speaker 1:The main way to prevent that is to not slouch forward. Okay, so if you work at a desk, if you do any other job that you can bring the work closer to you closer to you is always better and then you're more upright, the shoulders come back and once in a while, what's the opposite of this reaching forward is bringing it back, opening up the chest, and I like to just call it a I nickname it a big yawn stretch. So just like having a big yawn stretch. So you just like to have a big yawn. Now, instead of having the ball of the ball and soccer rotated forward and the excuse me rotated in and then the shoulder blade leaning forward, now the ball is rotating out, stretching these muscles and bringing the shoulder blades back, opening all this up and taking pressure off, very, very important. That is one of the main stretches that everyone should do. Once in a while I get out of the habit. I'll forget for a few weeks and then once in a while I'll just start doing it again, and it really does make a nice difference.
Speaker 1:Now let's talk about another muscle of the rotator cuff here, and this is supraspinatus. And remember the previous episodes. We talked about the back of the rotator cuff here, and this is supraspinatus. You can remember the previous episodes. We talked about the back of the shoulder blade. There's that ridge of bone called the spine of the shoulder blade and that muscle is connected by the tendon that goes underneath this roof of bone called the acromion, and that tendon inserts on the top of the ball, on the outside part of the shoulder, so on the side of the shoulder, on top of the ball, on the outside part of the shoulder, so on the side of the shoulder, on top of the ball. Now, when I test that in the clinic, when the doctor or the therapist tests that muscle, we put it in a position of what's called empty can position. So if you have a can and you empty it and they add resistance. Now I'm testing that supraspinatus muscle. That's one of the four muscles of the rotator cuff, cuff.
Speaker 1:If I were to do activities where I'm in this position and I'm stressing that tiny little muscle, that is going to cause a lot of strain there. It could lead to a tear, it could lead to inflammation or tendonitis on that outside part of the shoulder and the pain becomes excruciating. It becomes terrible, terrible pain. So watch this Super easy Anytime you can keep that elbow into your side. I knew I had to do some videos.
Speaker 1:I did some quick ironing and I realized that when I was ironing I I was out like this and I'm picking up the iron and I'm moving. And I've had my patients often tell me that you know, when I'm ironing it really hurts right here and it's really amazing when they just bring the elbow down, the discomfort goes away. So I changed my position. I should have brought an iron. So anyway, I changed my. You can picture it when I changed my position and I held that handle and I brought my elbow down and ironing like this instead of out here like this painfully went away. So when I came home from the grocery store. I'm taking a bunch of groceries out of the bag, right. So I'm reaching in like this, I'm grabbing heavy things, hands and other things. I'm taking them out of the bag like this, and even this, right now I'm actually having some tendonitis of my rotator cuff. I feel that right now, when I bring it down now I don't feel it anymore. So what I did was I just pulled the side of the bag down a little bit and I'm reaching in straight instead. Fully went away.
Speaker 1:But that is just having a basic knowledge of the mechanics, of you know what am I stressing? So a note here's a here's a really common way how folks are tearing the rotator cuff. There is a book bag or something forgot my book bag too, anyway. There's a book bag behind the car seat. Let's say you're sitting in the driver's seat of the car and now, before I go to the car, I'm going to reach behind the seat and I have something heavy behind the seat. It doesn't have to be very heavy and I'll explain why. But let's say there's something behind the seat like, uh, and you know, the attache bag, a bag with a bunch of papers in it, especially a book bag. That can be pretty heavy, you reach back behind the seat and pick that up.
Speaker 1:Let's talk about leverage or moment arm of force. So if you have something that weighs, let's take five pounds, okay, and let's say the arm is let's say, just for the sake of simplicity, five-pound bag, all right, and it's 30 inches from the shoulder to the bag Because of leverage. That now is five times 30, is 150. 150, 150 inch pounds of force through those tendons. And it's reaching back which puts extra force, extra pressure on those tendons. Because of the anatomy and how the muscles are arranged, reaching back is never good for the shoulder. So anytime you can keep things in front of you, that's the best position. So taking in an extra time getting out of the car, walking around to the other side of the car, opening the back door and pulling that out, now the object is in front of you and you're closer to the object. So you have less leverage, you have less inch pounds of force on those tiny tendons, and they are. They are quite small. The tendons are quite small. Now there's less force and you're in a better ergonomic position. You're within your power zone. So the power zone, ergonomics, is the most advantageous way to use your body mechanically prevent injury. The power zone is between the waist and the shoulders, so anything you can get in here in this region, from the waist to the shoulders, and you're right in here, you can lean forward and grab that bag. You're reaching forward in front of you again and you're taking that bag out and you're lifting closer to your body. That is going to prevent injury. That's very, very crucial. So let's recap real quick A couple of main things.
Speaker 1:We don't want to be in this position where the thumb rather than the thumbs up, it's thumbs down. Thumbs up is always good, right. Thumbs down is so down, like this, up, it's thumbs down. Thumbs up is always good, right, thumbs down is so down, like this, ironing, grabbing things out of a bag, reaching you know, I, I love to cook, it's a, it's a hobby of mine. I'll find myself, you know, reaching for something and I and I'm like this. But if I could just bring my elbow in, bring it down, then I'm I'm in a much safer, much safer position and my shoulder just frankly feels a lot better. Also, we don't want to reach back. No, reaching back, especially to grab heavy things. I even have patients sometimes where you know I'll say in your office.
Speaker 1:Where's the trash can? Do you use it a lot? Yeah, I'm always throwing stuff. Where is it? Oh, it's kind of behind me and to the right Move that trash can forward and have it in front of you, perhaps under the desk or to the side of the desk, but maybe in front of you is, ideally, or in front and off to the side, but never reaching back or reaching back into the side. That's really tough on the rotator cuff. How do you like that one? That's tough on the rotator cuff. Okay, now moment. Arm of force leverage.
Speaker 1:We talked about that, the, the power zone. Let me say that again. The power zone of optimal mechanical advantage, optimal power least apt to cause an injury, is the level between the waist and the shoulders and in front of you and close to the body, body, safe exercises. So what I used to do in the gym a lot is cleans and I would stand up here like this. But now watch this position. Remember I talked about the empty can position to in the thumb down position to test the rotator cuff, one of the most commonly torn muscle of the rotator cuff, supraspinatus. That's the empty can position. So look at this. Cleans, that's the empty can position. So look at this cleans.
Speaker 1:I'm in at the can position, I'm just tearing up that rotator cuff, not a not a good exercise to do, also military press, bar behind the that, the neck, or even bar in front, pushing up, really strengthening that lateral or outside part of the deltoid, outside part of the shoulder a lot, and I'm also stressing the muscles on the side of that acromion quite a bit. What's the ideal exercise is and I did do this on a previous video with a dumbbell is palm, is arnold press, palm facing the shoulder. The arm is in front of you. So here we go again. It's in front of you, palm is facing your shoulder, press it straight up and as you come up, watch my hand rotate. Now palm is facing away from me. That is working.
Speaker 1:The front. Let me get my deltoid back over here on the model here. So it's working. The front of the deltoid and the side of the deltoid. I want to take this opportunity to mention that strengthening the side of the deltoid too much, such as flies coming up to the side, strengthening the side of the deltoid too much, such as flies coming up to the side over strengthening that deltoid, will raise the ball or the ball and socket up a lot, so making this too strong to counteract the other muscles that work on keeping the ball down, to maximize that space between the acromion and the ball that takes pressure off all those structures that travel through there. If the deltoid is huge compared to the other muscles and very, very too strong compared to the other muscles, it's going to raise the ball. And now look what happens it's pinching. It's pinching those muscles, the tendons that connect the muscles to the bone. It's causing impingement syndrome.
Speaker 1:So what I like about arnold press is it's working. You're working triceps when you're straining the elbow, you're working the front of the deltoid, you're working a little bit of the side of the deltoid. And then other great exercises to work the rotator cuff, which will make everything work as a team to maximize that subacromial space, to take pressure off those structures underneath that roof of bone. You remember there's four main muscles of the rotator cuff supraspinatus, infraspinatus, teres, minor and subscapularis. The acronym is SITS, s-i-t-s.
Speaker 1:Now great, here's some exercises I do in the gym is I'll use the pulley system and I'll bring the pulley system down so that the handle is about level with if I'm standing up and my arm is against my body. My elbow is bent to 90 degrees. I can bring my hand into my stomach with resistance and I'll even do, you know, I'll do some isotonic, which is just repetitions. Then I'll do some isometric, where I just hold it until he gets tired. Then I'll do a 180, not a 360. It'd be all the way around, right. So I'll do a 180. I'll just turn around and then now I'm using resistance, pulling my hand away from my stomach. So that works.
Speaker 1:Specific muscles, so bringing into my stomach is muscle we talked about before, one of the muscles of the rotator cuff, subscapularis, that lies between the shoulder blade, the front of the shoulder blade and the rib cage, subscapularis. And that's this one right here, pelearis. And that's this one right here. That's the front of the shoulder blade. This part sits on the rib cage and I'm working that Now, this muscle right here, when you turn around, and now you're bringing your hand away from your stomach. That's infraspinatus and I'm going to strengthen this. So these muscles attach, some attach on the back of the ball, some attach on the front of the ball. So if I'm solidifying those, then I'm gaining stability, which is crucial for the shoulder because, remember, it's a very shallow ball and socket. It's like a golf ball sitting on top of a golf tee. So very shallow socket. And if I can stabilize those muscles, I'm increasing and maximizing shoulder stability.
Speaker 1:So let's talk about it again bringing in, that's a subscapularis. Bringing it out, that's on the opposite side, afros. Now I also bring it up a little bit and I'll bring my, I'll have the pulley handle, it'll bring my hand down to the side of my leg and that's shoulder adduction, adduction and that's strengthening teres minor and strengthening some other key muscles. So it's strengthening the muscles that bring it down. And what does that deltoid do? The deltoid when that contracts, that brings the arm up to the side. So that's those flies I was talking about. We don't want to over-strengthen the deltoid. So if I strengthen the muscles that counteract the deltoid, bringing it down against resistance, that is adding balance to the shoulder mechanics, adding stability.
Speaker 1:Okay, so let's start from the top. We're bringing the hand into the stomach against resistance. We're bringing the hand away from the stomach against resistance. The upper arm is right in against the body. So what? That is this rotation, this rotation of the ball on the socket, so that it's rotating in and rotating out. So it's like this in and out against resistance in, and then I would turn around and then do against resistance outward, and then do bringing the arm down to the side of the body against resistance. And then there's two others I'd like to do is holding the pulley and bringing it across my chest like this to strengthen the muscles in the front of the chest. Then I'll turn around and then pull it from the position from across my chest out to the side parallel with the floor. So it's out here and in here and that's further adding stability. So I'll do that on both sides. That's excellent for the shoulder, for stability.
Speaker 1:Another one that's just wonderful to do is rows, so upright or over the bench you can lean over, you can even just lean forward, lean on your knee and do a vertical row with a dumbbell and when you pull it up you pull that. It's very important to pull that shoulder blade straight back. So if you have, this is the right arm to pull that shoulder blade straight back. So if you have, this is the right arm. Palm is this, is the back of the hand right here. So here's the shoulder. The spine would be right here. You got your backbone, your spine.
Speaker 1:There's muscles here called the rhomboids, and they pull the shoulder blade back like this. So when you pull your shoulder blade back, that's the rhomboid muscles and those rhomboids are kind of angled upward. So when those are strong, that's what that does that raises the shoulder blade. When you're raising the shoulder blade, where what's attached to the shoulder blade, part of part of the shoulder blade, is the acromion, so you're raising that roof of bone up and that is a another nice stabilizing couple of muscles rhomboids, minor and major that help optimally position the shoulder blade.
Speaker 1:So when you're doing a row, let's say you're doing an upright row and you're on a machine, you're pulling that straight back. The last little bit don't forget about your shoulder blade and pull that shoulder blade back, okay. Now when you're doing bench press, let's say you're you're on your back doing a bench press, or you're upright and you're doing a press on a machine, okay. So for the sake of moving the, the arm and the shoulder blade, it's the same thing. So at the end of doing your row you want to pull that shoulder blade back. Same is true for pressing forward. So when you press forward watch this you press forward.
Speaker 1:That last little bit is shoulder blade and the muscles that do that in the front of the shoulder blade is called serratus anterior. So when you watch the bodybuilders and they come out and they got these wings right here and they're rippled, that's serratus anterior. And that also helps raise the roof of bones. So if serratus anterior I don't think it's represented very well on this model no, so if that is here and these muscles are tighter, what's that doing to the roof of bone? It's raising the roof of bone. So that's another important one to strengthen, which is easy to do. Again, when you're pressing forward, that lasts a little bit.
Speaker 1:Let's say you're doing a push-up, you push yourself up and then give it a little extra, like three or four inches. That's serratus anterior, very nice. So in the clinic and at home I'll have patients bring home exercise band and they'll put it over the top of the door or maybe a few quarters up the door, just shut it in the door with a knot on it and it it's on the other side of the door and then they'll push downward at a 45 degree angle and then the last all that much they'll push your shoulder blade forward and even just hold that there. Isometrics Iso means same, metric means length, so same length of the muscle. All that means is you're just holding the muscle steady. So you're doing isometric holding there until it gets a little bit tired in the front, doing isometric holding there until he gets a little bit tired in the front, boom, huge, beneficial thing to strengthen no matter what, and that should be strengthened in a healthy shoulder. If the person did that, even once a week, they had prevent a lot of shoulder problems.
Speaker 1:So proper ergonomics, proper positioning, proper posture, okay, and then strengthening the appropriate groups of muscles, which we call force couples we can get into that at a future episode force couples or groups of muscles that do specific things. So you have one force couple that pulls the ball of the ball and socket downward, another force couple that raises the roof of the acromion. So if you're pulling the ball, the head of the humerus down, and you're raising the roof of bone, the acromion, up, you're maximizing that space, you're maximizing the subacromial space. You're preventing or taking away subacromial impingement syndrome. You're preventing or taking away subacromial bursitis. You're preventing or taking away subacromial bursitis. You're preventing or taking away rotator cuff tendonitis. You're preventing or taking away subacromial bursitis, rotator cuff tendonitis. Also, let's not forget the long head of the biceps tendon. So it's a lot of prevention with just adding a couple of key ingredients to a workout routine and avoiding things that really terribly aggravate the shoulder. Quick story I had a guy in the clinic he just wasn't getting better.
Speaker 1:He was a bodybuilder, really muscled out, and he mentioned you know we were doing some healthy exercises in the office and he said you know, I've been doing this great exercise. I take a 25-pound dumbbell, I turn it upside down like this and I get a really good pump. I can really feel it on my shoulder. I said wow, I bet you really do feel that in your shoulder. I explained it to him the empty hand test that we do. I showed him on the model, the, the muscle, and why that is a terribly unhealthy exercise to do and why that's causing in his case. Now I finally figured out wow, that is why you're having and I should have. I should have asked him what are you doing for exercise routine in the weight room? Anyway.
Speaker 1:Came up in casual conversation and he said well, no, it's okay, I saw it in a weight room. Anyway. Came up in casual conversation and he said, well, no, it's okay, I saw it in a weightlifting magazine. It's well, all right, it doesn't matter what you saw in the weightlifting magazine, it's this is the anatomy, this was the mechanics of the shoulder. Just do me a favor, humor me, stop doing it for a week, come back. Come back at the end of next week, let's see how you're doing. Get back at him next week. And he was pain-free and I was able to discharge him and he was now okay. Yeah, well, this is the mechanics. This is why I can't do that exercise and that is why it's really tearing up my rotator cuff.
Speaker 1:So, patient education, taking time, asking the right questions is really. You know, I usually tell patients this is like an investigation. I'm asking a lot of questions. In a future episode I want to talk about what to expect at your doctor's visit, your therapist's visit, how to properly prepare, what kind of questions we're going to ask, because we really want to get to the bottom of the ASAP as soon as possible and really get you well in minimal time. So that is really some basics of some of the mechanics what to do, what not to do. Write in if you have some questions, let me know. I would love to answer questions in future episodes. So thank you for watching. Talk to you again soon.