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This is Brent, coming at you with
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videos. In this video we're going to go over both the internal rotators of the
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glenohumeral joint, as well as the latissimus dorsi. I think when I show you
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these two techniques you'll understand why I paired them both together in this
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video. I'm going to have my friend, Yvette, come out and help me demonstrate this
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exercise. Now, first things first, we talked about body position, notice here
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Yvette's right up next to my hips so that I don't have to lean over the table.
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Since I'm stretching muscles around her glenohumeral joint, I want to
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make sure that the table is stabilizing her scapula, that the glenohumeral joint
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is just slightly hanging off the table so I have free movement of that joint.
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The first manual concept, or manual technique, we're going to have to learn
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for these two stretches is how to stabilize the scapula, keep it from
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upwardly rotating. So the first thing we need to do is we need to palpate and
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find the inferior angle of the scapula. This is not too terribly difficult. We're
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then going to try to find a way to cup the inferior angle right here, and all we
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have to do is kind of hold our hand like this, slide our fingers underneath the
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patient or client, and then actually, Yvette's body weight is doing a really good
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job of holding my hand in place. I don't need to push or shove. All I need to do
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is keep my hand hooked like this, Yvette's body weight is pushing against my
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fingers, and I have her inferior angle right in the palm of my hand. I'm then
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going to go ahead and grab her arm right around her humeral condyles. That gives
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me good control of both her forearm, as well as her humerus, and then I'm going
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to pull her back into flexion and external rotation here. Now, I can feel a
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little bit of pressure up against the palm of my left hand, I can feel a good
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stretch happening here on her arm, and where do you feel this Yvette? Your armpit?
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So, this, everybody calls a lat stretch, and the truth of the matter is
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is this is not a very good lat stretch. It is a wonderful internal rotator
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stretch. Where Yvette is feeling it is in her armpit right around her
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subscapularis and teres major. So, an important stretch, but if I'm trying to
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affect the latissimus dorsi I'm going to need to start
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here, make sure that I get a good stretch out of these limiting structures, but
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then I'm actually going to need another technique for my latissimus dorsi. For
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the latissimus dorsi, what I'm going to do is, I'm going to bring Yvette into
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this hook lying position, I'm going to posteriorly tilt her pelvis, that'll help
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lengthen her lats on this side, I'm then going to take this hand and go back to
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that lumbrical grip you saw me use in the pectoralis major stretch,
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that's going to go over her humeral head, because one of the things that happens
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when we pull the arm back this way is the humeral head tends to want to pop up
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this way. I'm going to go over her humeral head, I'm going to make sure I
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have good control of her achromion shelf and the lateral third of her clavicle,
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and I'm going to keep that humeral head down, while pushing the scapula back into
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a posterior tilt, I'm going to pull her arm into flexion, a little bit of traction or
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distraction here and external rotation, and now if I take it to the first
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resistance barrier, now where do you feel this? Notice she feels it a lot lower. She
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actually feels it below her scapula. This is a lat stretch. Now, why would I want
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to stretch the lats and not the internal rotators of the shoulder? Which is
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definitely a fair question. If she had upper body dysfunction chances are I'm
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going to have to stretch both. This is part of that upper body dysfunction.
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We have both latissimus dorsi tightness, as well as subscapularis and teres
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major. So, it would probably start with the subscapularis and teres major stretch,
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get those limiting structures out of the way, and then move to the bigger
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latissimus dorsi stretch. But, if Yvette was somebody who had, let's say, an
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anterior pelvic tilt, the latissimus dorsi are contributing to
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lumbar extension, not her glenohumeral internal rotators. So even though they
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also may be tight, if my focus is here initially, I'm going to want to do this
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latissimus dorsi stretch and be very specific to a structure that is
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going to help improve the dysfunction I'm working on. So let's go over these
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two techniques one more time. The first one was
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legs in neutral position, I'm going to cup the inferior angle of the scapula and
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let her body weight push my fingers down. I'm going to grip the humeral condyles
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and pull her back into flexion and a little bit of external rotation. She
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probably will feel this right in her armpit. This is subscapularis and teres
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major. Now if I want to stretch the lats I'm going to put the legs into a hook
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lying position, posteriorly tilt the pelvis, that's going to help lengthen the
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lats down here, I want the scapula to upwardly rotate and
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posteriarly tilt, and I want to protect the humeral head from shifting anteriorly, so
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I'm going to use this lumbrical grip up here, let the scapula move up into my
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hand, but push it back into the table, as well as the humeral head, and then pull
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into flexion, distraction, retraction, and external rotation to the first
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resistance there. I hope you enjoy these stretches. I think as your technique will
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get better, you'll get bigger and bigger results from your clients. Use a little
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bit of functional anatomy knowledge to refine which structures you're going after.