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Self-administered Shoulder Mobilization (Lateral Distraction)

Learn how to self-administer the most effective shoulder mobilization technique - lateral distraction. Discover the biomechanics behind it and explore various exercises and mobilizations to improve shoulder mobility.

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Transcript

00:05 - 00:10This is Brent live from Rick Richie's independent training spot, the new home
00:10 - 00:14of the Brookbush Institute. I'm very excited to be here, very excited to be
00:14 - 00:19doing our next self-administered mobilization video. In this video we're
00:19 - 00:22going to look at the shoulder and how we can increase range of motion, increase
00:22 - 00:27arthrokinematics, that surface-to-surface motion between the
00:27 - 00:33humeral head and the glenoid fossa. Now with all the changes in muscle activity
00:33 - 00:39of length, in upper body dysfunction people have a propensity towards
00:39 - 00:46anterior and superior migration of the humeral head in the glenoid fossa. So
00:46 - 00:50what we're going to be looking for is how do we stretch out these inferior and
00:50 - 00:54posterior fibers of the capsule. I'm going to have my friend Aaron come in,
00:54 - 00:57he's going to help me show you guys some techniques I've been working on. Now
00:57 - 01:03these techniques are going to look a lot like our hip mobilization video, as you
01:03 - 01:06guys remember from what I was talking about in that video, I talked about
01:06 - 01:11anterior and superior glide on the femoral head and the acetabulum. So it's
01:11 - 01:16all very similar, instead of putting the band around his hip though I'm going to
01:16 - 01:20put the band around his shoulder, and then you'll see the logic flows very very
01:20 - 01:25similarly. So let's have you getting into quadruped, put that way up high around
01:25 - 01:32his humeral head. Now you see Aaron's starting here on his hands. we've been
01:32 - 01:36experimenting with this a little bit and I can tell you up on the hands doesn't
01:36 - 01:39work out quite as well, and my thinking is is that it activates your tricep
01:39 - 01:43which the long head of your tricep does cross the shoulder, and I think it
01:43 - 01:47activates the rotator cuff a little bit to be in this position, which makes
01:47 - 01:51mobilization of this joint a little less effective. So I'm going to have him get down
01:51 - 01:56on his elbows. Now his shoulders in a little bit more relaxed position, and
01:56 - 02:00even just a little bit of force I can feel that humeral head come away from
02:00 - 02:05the glenoid fossa, and so we're gonna put this up nice and high. Now what the
02:05 - 02:11position we have here, this would be a lateral distraction of the humeral head.
02:11 - 02:17Lateral distraction just like for the hip is a nice general mobilization that
02:17 - 02:20is going to get those inferior and posterior fibers that are
02:20 - 02:24tight. In this position this is a technique I use as an
02:24 - 02:28introductory shoulder mobilization. All I'm going to have him do is rock back and
02:28 - 02:32forth a little bit. The same thing we do with our manual techniques, maybe one to
02:32 - 02:39two oscillations per second; he can count to 15 or 20, or we could go even
02:39 - 02:42more oscillations than that and say, okay go ahead and keep doing that for 30
02:42 - 02:47seconds. How does that feel? (Really good). All right so this is kind of that mobility
02:47 - 02:53work, those grade 3 and 4 mobilizations we've been taught. Like I could even go
02:53 - 02:58more towards a grade four by going okay well what if we bring your elbow in, and
02:58 - 03:03I really challenged him at his end range here all right, and then rock and he can
03:03 - 03:07adjust his hips as he needs to. How does that feel? A little more intense right.
03:07 - 03:11We could then start thinking about a little bit towards mobilizations
03:11 - 03:16in different ranges of flexion and extension; so maybe I'd been I've been
03:16 - 03:20getting him closer and closer, more and more flexion, getting closer closer to
03:20 - 03:25optimal, instead I just had him maybe maybe this is as far as he can go, I'm going to
03:25 - 03:29have him bring out both arms so he's even. Good and now he can rock back and forth
03:29 - 03:34there at a hundred and thirty degrees of shoulder flexion. Okay we can take it
03:34 - 03:40even one step further we could do these mobilizations with motion, and now what I
03:40 - 03:43could have them do is go okay we're going to do this a little bit of lateral
03:43 - 03:47distraction but I want you to keep center okay. All right and this time I
03:47 - 03:51want you to rock back and forth between neutral and as much flexion as is
03:51 - 03:56comfortable for you. How does that feel? It's great all right so now we got that
03:56 - 04:00lateral distraction while working on flexion and extension, this one works
04:00 - 04:06wonderfully, it's a very comfortable position for the client or patient and
04:06 - 04:09you can go through the same kind of reps. We're way over mobilizing the shoulder
04:09 - 04:14right now guys, please don't go through all of these in one session you will end
04:14 - 04:18up with a little htyperrmobility and that could be painful. Alright so the
04:18 - 04:22next technique we're going to work on, actually let me take one step back. The
04:22 - 04:26one thing you could do going back towards our grade ones and twos that
04:26 - 04:29we've been taught, if somebody had a painful shoulder remember we could limit
04:29 - 04:32range, you can use any of these techniques but
04:32 - 04:36limit the range just to pain free range of motion. So let's say he has a little
04:36 - 04:40bit of pain at a hundred and ten degrees, he's got a little bit of that shoulder
04:40 - 04:45impingement issue, all I'm going to do then is he'll rock back and forth just
04:45 - 04:51touching where that pain is, until that pain goes away at that range, and then he
04:51 - 04:55can move a little further. Alright so hopefully you guys are putting this all
04:55 - 04:59together. We can we can just oscillate, we can oscillate at the end of range right
04:59 - 05:05either flexion or adduction, we can isolate with flexion and extension, or we
05:05 - 05:11can just go through pain free range and start working in smaller smaller ranges
05:11 - 05:15of motion until that pain goes away. Now another technique that is definitely a
05:15 - 05:21progression from this. This technique I'm about to show you is a lot more
05:21 - 05:25aggressive, it's very effective for a stiff shoulder though. I'm going to have
05:25 - 05:32Aaron flip around so bring your backside this way, and what we're going to do is a
05:32 - 05:38superior to inferior mobilization. This is a big one, what he's going to do
05:38 - 05:44though is he's going to get his arms up on a foam roll, and what most people
05:44 - 05:48would want to do is just go forward, I'm sorry staey keep your arms over there,
05:48 - 05:52most people just want to go forward with our body. The problem with that though is
05:52 - 05:55as the band's pulling him back his arms going back, so we're really not getting a
05:55 - 05:59mobilization. The hard thing to teach with this one is they got to keep this
05:59 - 06:06in the relative relatively the same position while pushing from their feetm
06:06 - 06:11so that they maintain this and it is truly a superior to inferior glide, and
06:11 - 06:18he's just going to rock again. The foam roll allows his upper body, this little
06:18 - 06:24position we're making to stay in one piece, unless I want to get even more
06:24 - 06:29aggressive. You guys could turn this into a mobilization with movement once again,
06:29 - 06:35by having him push with his feet and reach with his hands into as much
06:35 - 06:39flexion as he can get, and I'm sure Aaron can feel that's a very very intense
06:39 - 06:44technique, I would definitely be careful with this one maybe start with just 10
06:44 - 06:49or 15 repetitions reassess before letting somebody go and
06:49 - 06:53go and go and go and all of a sudden you look over and your patients been doing a
06:53 - 06:55very aggressive technique for a minute, and it's going to start having some
06:55 - 07:01shoulder pain Once again if this if this was a painful shoulder I could limit my
07:01 - 07:07range of motion to wherever I needed him to be, so that he stays out of that
07:07 - 07:12painful arc and stays right in that pain free zone and just touches the pain
07:12 - 07:16Same thing, we could do the same thing with the mobilization movement right,
07:16 - 07:20maybe he just has a little shoulder impingement and he goes right up to
07:20 - 07:26there he feels it and backs off. Alright so that is that is a ton of stuff for
07:26 - 07:30you guys to work on. We did lateral distraction, lateral distraction with
07:30 - 07:35more abduction, lateral distraction with more flexion, we did mobilization with
07:35 - 07:40movement, lateral distraction, we did a superior to inferior glide, we did a
07:40 - 07:46superior to inferior glide with flexion. I hope that gives you a ton of stuff to
07:46 - 07:51work work on with this particular technique Guys please be careful with the
07:51 - 07:54shoulder is a much more delicate structure than the hip, make sure that
07:54 - 07:59you assess, you try a few of these techniques, you keep the rep slow
07:59 - 08:05initially and then reassess if you got a good outcome -.Stop. if you reassess the
08:05 - 08:10next session and their shoulder mobility is fine, don't do this technique, there's
08:10 - 08:17no need to start pushing them beyond what is optimal. Remember hypermobility
08:17 - 08:20is a problem as well. I hope you guys get great outcomes, I look forward to hearing
08:20 - 08:23from you. Thank You Aaron

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