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