Infraspinatus has to fight alone against this strong internal rotators and they can’t win this game without your help. So please give them a hand so you can move your body up and down. or side to side Hi guys, rehab safely! Mr. Physio here. In the last video, We talked about why the infraspinatus is so important when it comes to shoulder problems and why we need to do lengthening exercises, which I’m going to show you today and this study is worth a look before we move on In this study, they measured external rotation strength at different angles of shoulder abduction so, 0degree, 45, 90, 135 degree. and the findings are very interesting because they didn’t find any change in external rotation strength. But they also found infraspinatus activity diminished dramatically as the arm goes up. What does it suggest? There are some helpers, right? in the last video it was mentioned there are only two external rotators, infraspinatus and teres minor but the researchers believe teres minor is too small to create this effect Surprisingly, what they suggest is Serratus Anterior activity, which was three times higher at 135 degree compared to zero degree. This is not completely proven but what their theory is when your shoulder blade sits like that, serratus anterior tilts it backwards and strong internal rotators including pectoralis major and minor pull your shoulder inwards and that tilts your shoulder blade forward. that’s called anterior tilt. This is called posterior tilt so if the serratus anterior is properly activated when you lift your arm up out of the side, that will prevent the anterior tilt of shoulder blade which may reduce the strong activities of the internal rotators so internal and external rotators work against each other If the internal rotator activity is inhibited, that will help activate this external rotator. and another study shows the infraspinatus activity is strongest in the upright position sitting or standing compared to lying on your side doing that or lying on your tummy doing these kind of exercises. so If you combine those two results together, we can say the infraspinatus works best in the upright position rather than this position(anterior tilt) When you do this exercise you have to remember three things. First of all shoulder’s back! the second is always point your thumb to the direction where you are pushing your arm into the last one always have some space between your arm and the trunk about 5 centimeter zero degree neutral position push your right hand into your left hand. So that will activate my right infraspinatus and you try to pull in with your left hand. Okay, so while resisting through that right side, you try to pull the right hand in towards your belly so infraspinatus will generate about 30-40% of its power, while my left side is pulling it in with about 50% Later on, you can actually increase the strength and speed as well. So once you can do the small range, we will go into wider range. Bring your arm out to the side a little bit more and just pull it in. Do the same exercises. Especially when you have a shoulder pain, this kind of movement can be painful. So you do the exercise within that pain free range, but some people find it difficult to reach over with your left hand, especially in that wider the range (then you can do it against wall) 0 degree shoulders back 5 Centimeters away from your body. thumbs pointing that way push out. activate that muscle. and rotating that way if you can do the small range, you can do the wider range. so when you do this exercise, you have to take small steps actual steps. some people rotate their body only but you have to actually turn around while pushing in and turn towards the wall so that you end up facing the wall and you can do the same with the band. If you have this kind of bands like a rubber band ok right side holds one end. if you pull it out with your left hand, that will activate this right side muscle because it’s resisting against this Force right? And then you slowly bring it in. If you pull it out like this but you come back without your left hand moving, the tension on the band will decrease right? but to maintain the resistance on the band, keep pulling with your left hand too or you can have it shorter to have more resistance Pull it out (and slowly rotate) and it’s good to use the unaffected side too because it’s called ‘cross education’. When you use that unaffected side, that will stimulate the brain that helps to activate the affected side. If you find it difficult, you can do it with the other end of the band tied against that door knob hold the band with the thumb pointing that way again and shoulders back and down and have a bit of space there and maybe two steps out to the side, that will increase the tension that will increase resistance, which the infraspinatus has to fight against, right? So that will activate that muscle. From there, You’re rotating your arm inwards and then come back down and do the same thing going out to the side and rotation and that will lengthen up the muscle while it’s being used. and wider range is the same. Going out. two steps out to the side and rotate inwards And that’s the end of my first series of shoulder impingement and this is pretty basic but very very important Concepts but of course there are more to it to fix the shoulder problem. So I’ll probably have to get back to it after few video of other contents. Thanks for watching and see you next time Rehab safely!