That does what’s called downward rotation.. backwards this way? It’s actually making the problem worse Again I would like to emphasise you shouldn’t stretch your tendon problems. Hi guys, Rehab safely. Mr.Physio here. I’ve done two videos so far about shoulder impingement and the rotator cuff muscles today is the third one about supraspinatus the victim of shoulder impingement. Okay, let’s get it supraspinatus sits on top of the shoulder blade. This is my left shoulder. There’s a Groove On Top of the shoulder blade and starting from here all the way to the tip of the upper arm bone So from here to there when it contracts it lifts your arm up like this. Okay, when you lift your arm up Deltoid muscle is the one that does the most of the activity. The primary mover of the upper arm bone is Deltoid muscles So when the deltoid muscles lift your arm up the rotator cuff muscles pull the head of the humerus downwards Again, when the deltoid muscles pull your arm up the rotator cuff muscles pull the head of the humerus downwards. without this action the humerus will definitely hit the undersurface of the acromion, which is shoulder impingement. That’s why the rotator cuff muscles is so so important the rotator cuff muscles including supraspinatus finetune the movement if the rotator cuff muscles don’t work properly the supraspinatus on top of the shoulder blade will get pinched all the time. Every every time you lift your arm up. That’s why it’s a victim of shoulder impingement. If you keep irritating the muscle, it can get tensed up so it gets quite tight. Let’s say when you watch a boxing game. So if one player keeps spitting his opponent that person who’s being hit keeps shrinking down like that. Shrinking down(?) protecting himself like doing this (Defence) your muscle is the same it gets tensed up if you keep irritating the muscle on top of the shoulder blade. Once it gets tight, it also has a secret function so this tissue muscle, attached like this. if this muscle’s getting tight in the middle. That’s pulling your shoulder blade towards the spine so that does what’s called ‘download rotation.’ So this is called upward rotation(away from spine). The opposite movement is called downward rotation. Remember? In the first video of the shoulder impingement. I told you your shoulder blade has to go out to the side(away from spine) every time you lift your arm up without the shoulder blade movement. You get stuck at 90 degree. You keep hitting that undersurface of the acromion, which is the tip of the shoulder. so to avoid impingement. you have to be able to bring your shoulder blade out away from spine all the time Every time you lift your arm up, the shoulder blade goes out to the side to assist arm movement, but now the supraspinatus tightens up in the middle. That’s giving the force to bring the shoulder blade towards spine we want that movement going out to the side, but it brings your shoulder blade inwards that way. To solve the problem that muscle needs to learn how to lengthen up while generating power which is called eccentric contraction. So that mucle is quite tight at the moment so if it contracts. at that lifts your arm up. That’s what it’s meant to do. But at the same time it actually brings your shoulder blade towards spine if it does the normal contraction, so we want to teach it how to lengthen up while activating. So when this muscle activates, it lifts your arm up at the same time that shoulder blade has to rotate out to the side it has to do the upward rotation so this muscle has to elongate while activating.. hope that makes sense. I’ve done a few videos about tendon Rehabilitation and this is also a tendon problem tendons attach muscles to bones and tendons don’t like compression and stretching if you actually stretch out your muscle like that. So some people do this kind of stretching or just a backwards this way. It’s actually making that problem worse So don’t stretch on the tendon if you have a trouble. I’ll give you a very simple technique to loosen up and evidence-based. Strengthening exercises for the supraspinatus to massage that muscle, you need to find this bony area. shoulder blade sits like that and this is the tip of the shoulder try to palpate along the bony area so once you find a bone, just bring your fingertips a little bit on the top of the bone Palpate the bone and bring your fingertips in there. so you have to press down like that. Okay? so I find a bone first and bring My fingers a little bit upwards 2-3cm and Just press down. Yeah from here all the way in and out we can press down and just go side to side(front and back) About 5 seconds here five seconds there all the way about 10cm (about your shoulder width) that’s where I’m pressing down. And next is different technique. you activate that muscle while pressing down. While massaging that muscle, you just activate the muscle Okay, press down onto the same spot and just lift your arm up about 45° out to the side In-N-Out initially maybe slowly and once you get better, you can go a little bit higher. When you do that, palms pointing the ceiling. palms Few spots maybe five times here. One, two three. 5 and maybe move on to the next. so few different spots maybe starting from here 5 * 5 * 5 * if you feel some areas tighter, you just do more massage on those tighter spots and then we’re going to finish with eccentric contraction again, I believe a lot of our muscles need to be trained in that way. Once they can do that, they can do normal Shortening lengthening exercise concentric and eccentric exercises at the same time that’s called isotonic. But for now in Rehabilitation your muscles are normally really really tight so it’s kind of forgotten how to be lengthened under loading. So I normally use this kind of loaded eccentric contraction at the beginning of the rehabilitation and then teach them how to shorten or lengthen while generating power(weight training) your muscle gets shortened when you lift your arm up and when you bring your arm down your muscle is being lengthened. so we’re going to use that muscle in that lengthening phase bring them out to the side a little bit forward about 30 degree and try to press down with the other hand while you are resisting with this right hand so your muscle’s activated when you resist your left hand and slowly go down (muscle lengthens). in that way, your muscle’s activated but lengthens as you bring your arm down push down with your left hand and the power is about 30-40% of your full power. Don’t push too hard and don’t bring your arm too quickly Nice and arms out to the side and 30-degree forward. Just press down so you can do them about five times to start with and then just start slowly build up 10 times 15 times two sets of 10 or three sets of 10, 15, even if you work at office, you can just do some repetitions when you have like free time and if you have mastered the slow movement, You can go a little bit quicker going down going up going down. I’m going up going down but still resisting with your hand. If you can do the fast movement, you can do some weight training. Okay, so I just going up and down going up and down 1kg..2kg.. you just slowly build up according to EMG study. This is the exercise where the most activation of the supraspinatus occurs. Please apply and leave comments. If you have any questions, and I will see you in my next video about infraspinatus most important muscle out of the four rotator cuff muscles. Rehab safely. Thanks for watching!