The real cause of supraspinatus injuries
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- Опубліковано 4 січ 2018
- Injury of the supraspinatus muscle tendon is extremely common, but why? And shoulder mere rotator cuff exercises (the ssp included) be considered as an adequate intervention? In my opinion, absolutely NOT! - Because there is almost always an underlying cause of the injury, and it must, of course, be dealt with.
To avoid subacromial impingement (which most commonly leads to supraspinatus injuries as well as subacromial bursitis), the supraspinatus has to be able to function as an abductor, as it prevents superior humeral translation. However, the supraspinatus is UNABLE to function if the scapula depresses as abduction is performed. Thus, both scapular upwards rotation and adequate strength of the supraspinatus is paramount during humeral abduction.
Wow. I've been suffering with pain for 6 months and researching the cause. This is the first time I've heard this explanation. Thank you.
You have just brought to light something that I have been struggling with r/t my left shoulder Kjetil. Your knowledge, insight, skills, and educational talent is nothing less than STELLAR.
Just came across this. It is the most simplest yet detailed explanation of the supraspinatus problem I have had for years. Thank you for sharing your knowledge. Subscribed and hope your page is doing well.
This world is a good place because of people like you.
Thanks for sharing of knowledge sir.
If only someone explained this to me a few years ago. Thank you for your knowledge, science man.
@Westward Thinking It's the same thing with orthodontists. Their solution to everything is extraction and braces, when all you have to do really is have good body and tongue posture, and chew hard foods and you won't need either.
This is the clearest explanation I have yet encountered on this type of impingement I have yet to encounter, Thanks
Yes I see the video is 2018 but time did not lessen the value of the information
You have a gift for explaining these concepts with clear motions and props. Very educational! thank you
Thanks!!
Wow this really cleared a lot of my understanding up for me. Thank you!
Sigma male right here.. practiced the movement at 3:40 and noticed it felt smoother than expected
Top notch video, thanks for the solution others miss.
Hey, Kjetil ... you nailed it! It really works and I just feel instant relief while raising bended arm when focusing into shoulder blades. Thanks a lot ! :)
Well done
oh my gosh thank you so much!!! I have been in some seriously intense pain and couldn't ever recall an injury to the area, but upon feeling my shoulder with my hand as I raise I can notice a difference. thanks heaps
thank you... ur video solved years of why i'm always hurt my shoulder when doing lateral rise..
This is an amazing video. Respect.
I get pain and clicking in my shoulder when I do cable lateral raises while leaning in the direction of the raise (because everybody on yt says you should do it like that)...
You are completely right that it causes the problem !
scap must accommodate humeral movement.
Reading through your comments, you tend to have a bit of attitude towards people watching your videos and not totally understanding. As a youtuber, you never want to make your viewers feel stupid. Anyways, you did explain this issue very well. Currently, I am studying to become a physical therapist. Thank you.
Feel free to take your thin-skinned self to another channel
Trainingandrehabilitation lmao, that’s exactly what I mean. There are other physical therapist doing the same videos as you. You need to change your attitude or you won’t grow.
Woe is me
@@MSKNeurology Your topics and explanations are one in a million. You focus on common maladaptive patterns that everyone else either glosses over or ignores altogether. Your UA-cam channel has been more helpful to me than any other channel.
He talks like an idiot anyways
A man with knowledge but with no manners is an idiot
Wow! I shrugged my trap and then tried the abduction and was able to get higher than previous! Thank you
Excellent. Thank you.
That was helpful. Many thanks.
Great application of knowledge n experience
Really useful, thank you!
Since I watched this I've been having huge improvements. Although self-diagnosed, I'm certain I've had thoracic outlet syndrome (which has caused varying levels of numbness and weakness in my right hand little finger at the piano). I've found a constant trend towards downward shoulder rotation in basic walking. Over the last couple of weeks, by making this the main point of focus in all exercises and movements, it's made a huge amount of sense of why I was sometimes getting improvements before but not keeping them with consistency.
One question just came to mind, in relation to this- what do you think of those ergonomic mice for computers? They're the ones where you rest the hand sideways on the mouse, instead of having the palm face down. I've been using one and it suddenly struck me that (although you don't absolutely have to go into significant downward rotation of the shoulder), it's at least going to encourage that to be likely. Particularly at the piano, turning my hand inwards far more clearly from the shoulder is exactly what I need to do more of (just like with a conventional mouse), to stop slumping into the downward rotation that has caused TOS.
Any thoughts on this? Are ergonomic mice just bullshit in general? Or are they good for those without an existing downward rotation habit, but perhaps not so much so for me?
Thank You So Much💪🏻
Another thing you could do is to train lower traps and serratus anterior as those two work with upper traps to upwardly rotate the scapula. This force coupling is often disturbed due to over-firing or inefficient upper traps.
Serratus is inhibited if the trap doesn't work. Trap must work first, then serratus may co-engage. The notion that the trap is "over-firing" is a pure myth based on misunderstood EMGs. See my paper on this. In Conlusion: THE SERRATUS CANNOT FUNCTION IS THE UPPER TRAP DOES NOT FUNCTION.
www.apicareonline.com/postural-cues-for-scapular-retraction-and-depression-promote-costoclavicular-space-compression-and-thoracic-outlet-syndrome/
this is beautiful , subbed
Very good!! Thank you
Very nice. I just tried this, and it DOES make a huge improvement.
I slightly contracted my trap muscles and then did side laterals..... and it felt much more solid. Thanks.
Great! Totally makes sense thank you thank you
Maaan! You are AMAZİNG!!!!!!! Thanks!!!
Thank you very much
Thank you so much
amazing vid, thank you!!!
I have a question about Impingement due to anatomical acromion variation. I was told I have a hooked acromion and therefore external rotation and flexion of humerus is inhibited. I checked my MRT pictures of the shoulder and compared to other hooked acromions mine does look rather curved than hooked. I wanted to know if this is BS and i am inhibitied due to muscle imbalance if thats a real thing.
Brilliant explanation- the penny has dropped! I must stop lifting buckets of water out of a 45 gallon drum! Thank you!!
Thank you for your explanation. I have a full-thickness 2cm tear of my supraspinatus muscle - don't know how it happened though I hear it can come with age (I am a 70 year old female & in good health). I did not have a fall or a particular injury. Now doing physio, surgeon says I don't need surgery. Have little pain - so am happy to go to physio instead of surgery!
How are you getting on with it now?
Thanks!
👍👍👍 thanks for the information..
Hi! I am doing a lot that you are suggesting!
I've read your article on scapular dyskinesis and you wrote there what you say in this video.
My right scapula is a bit downwardly rotated compared to the left and it is clear that my right shoulder/upper trap rest lower than the left. I have been dealing with pain in the right shoulder while lifting heavy weights only, regardless of the movement (except a row movement when pulling bands from the wall from above - I can do this with a loft of resitance for a long time with no pain - guess it is because the lats do not attatch to the scapula). I have full range of motion with no pain. It all started 9 years ago when I wasn't in medical school yet, working out at the gym. Then, shoulder ultrassound showed a slight thickening of the supraspinatus tendon. I rested but it never got better. I had an MRI done 2 years ago that showed no problem whatsoever with my supraspinatus tendon nor the acromion. Only showed a slight edema of the medulla of the acromioclavicular joint - it makes sense as the mechanism is what you described.
My ortho told me I have a light scapular dyskinesis on the right and anterior/inferior shoulder instability also on the right (which I can see). He suggested strenghtening the periscapular muscles (serratus anterior, rhomboids, lower and middle traps and the core). Did not mention the upper trap (which I see why it is important reading your article).
I can hold my right scapula in the normal resting position as you suggested, which I am trying to make into a habit. I am also doing exercises to improve the periscapular muscles using a device similar to the Crossover symmetry bands (have you seen it?). I even bought adjustable dumbells to "progress" holding my scapula in the resting position - I use the dumbells on both hands to force my arm down while I hold the scapula in place. Doing that, I can clearly have the proprioception to engage serratus anterior and upper trap.
Doing these things, I noticed a very slight improve in the pain while lifting heavier, although I haven't been super consistent.
But I noticed that if I hold my scapula in place and try to engage the upper trap at the same time while doing bicep curls I still have pain. I am trying to figure out why this is the case since the scapula is, supposedly, in the correct position as I am mostly moving forearm when doing the curl (the mechanism). Maybe because I have not gained enough shoulder/scapular stabilization via the exercises yet and this predisposes to the humeral head hitting the acromion?
What are your thoughts on this? I would really appreciate your input, you clearly are very well versed on the matter. I just haven't gone to see you in your practice because of money and distance (from Brazil here).
Thank you for taking the time to post all of this on the internet and I hope to get an answer from you!
don't have time to read all this
@dnfa Maybe Evan Osar on youtube has time, since this guy mentioned him in a previous reply lol... ua-cam.com/users/fitnessseminars
4 generations of my family end up with rotator cuff injury of the right side, so something is going on idk if its learned abnormal movement patterns or a anatomy issue. So far my son and I are the only ones who have avoided surgery by using physio therapy how ever it can take a while in the US to find a therapist who properly treats this.
So should I NOT be keeping my scapula down and back while, for instance, doing lateral raises, but rather be using more upper traps, unkike it's always taught??
Your a genius!
How many time u are doing the 90 degree exercise please? I've been doing this exercise for two days and it's the only thing that stopped my shoulder pain. It's early days but also amazing. Thank you 😊❤️
You don't get the point. This is not an exercise, it's a permanent change. in your movement pattern
i guess supraspinatus (and this whole scapula stuff as well) is very important to stop the humerus pinching the bursa, isn't it?
what position of humerus(externally rotated or internally rotated or neutral) maintained after 90 abduction
Thanks, excellent presentation.
I’m suffering from Supraspinatous tendinosis past 6 months and I got tricot 40mg injection at the joint area, it doesn’t seems that beneficial. I’m trying few exercises to raise my shoulder to 90 degree level.
It doesn't work like that
I used to have this cue during over head press that i should have my scapula retracted and down, like in the bench. Might have created the same problems i guess?
best info out of 30 +...... my injury makes my humerus head move up after 30 degrees . .... gets worse ..... no lift strength ..... after 4_5 reps without weight ????? home rehab ???? start with mid /lower trapz????
I think doing lateral raises with the "back and down" cue explicitly caused this for me.
Yep, completely inaccurate way to perform them.
Thanks for the video. Please could you tell me how you rehab a chronic supraspinatus tendon injury? Research has suggested Heavy Slow Resistance and Eccentrics. Also, with the exercise you suggest would you recommend keeping the inside of the elbow facing forward as the shoulder flexes past 90 degrees? I appreciate any advice on this matter. Thanks.
Proper scapular movement always comes first. Second, strengthen the supraspinatus. See my supraspinatus exercise video.
You’re a genius. I did what you said it works
Another example of where "back & down" don't always work
just holding my shoulders up when i do this motion stops the click
So If the scapular doesn't move correctly can that cause the pain on the shoulder? I have pain on the upper and middle part of my scapula then the pain radiates to my shoulder I have trouble doing the side arm race, and can it also be the AC joint?
I explain this in the video!!
Thanks for the advice, I've been dealing with supraspinatus tendinosis for a while now and both PT's I've been to just give me the same old routine of rotator cuff exercise without mentioning this tip. Do you have any other recommendations such as stretches or exercises to help with proper scapula movement?
Did you even do what I recommend in the video?
so i tight trapezius can also become weak..... so a tight trapezius for long time can create limit of functionallity and strenght, that can cause the lack of scapula movement, as you say,,and thats why after the supraspinatus impinchent...to me have sense
I’ve never done this wrong movement and still have supraspinatus injury
Thank for advice. I'm doing Eugen Sandow 5 pounds dumbbells exercises...is this program good for musculo skeletal system ?
Thanks for answer.
I don't know
Thank you for this information Kjetil. I have had an aching supraspinatus in my left shoulder for over 4 months. Discomfort is now only overnight when I am in bed and the shoulder area is inactive.
Arm movement during the day is not an issue. I do a series of shoulder exercises every day similar to what you describe here. My belief is that my injuries have been caused by sitting at a desk/computer for many years, and that bad posture is probably the cause. I now finally understand the importance of posture. What do you think..?
Sounds like a nerve problem
@@MSKNeurology Thank you for your suggestion Kjetil. I've Googled several sites on shoulder/supraspinatus nerve problems. My symptoms don't relate to that information.
I think the best I can do is get an Ultrasound, and see what the problem actually is. I thought I may be able to "exercise" it out, but clearly not. Any other advice gratefully received. Cheers.
@@johntait491 this intricate problem is not something that you exclude by Googling, especially not as someone without necessary experience. Set up a skype consult and we will assess both the potential musculoskeletal and neurogenic causes of your issues.
JOHN ... did you resolve your issue? I have this; ok during day; pain in bed. What was your process and outcome, please? THANKS!
Hello Kjetil, is it still possible to get a physical appointment with you due to Covid ? I am from France. Take care
I think it'll be possible soon. My clinic is open, so as soon as you can travel, feel free.
Hey Kjetil, Where are you from ? Look like a vertable Bodybuilder 😊😊😊 !!!
Idk if u are gonna read this, but what are your thoughts on scapular retraction when doing bench press in this context?
I have a video on that
Where my side deltoid joins into bicep I feel a weird numb pain and it makes my arm go weak when I do heavy bench press but pressing overhead is fine ?
You're pushing your scapula down when benching
I threw the basket ball from halfway up the court like a tennis ball about thirty times - I'm almost 60 - Yep, they said it was supraspinatus and CT Scan said one third torn muscle. Physio said after two visits, it was too early for exercises ... 1/ Is the activity consistent with the injury, and 2/ Is it too early to do exercise - your thoughts?
you'd have to book a session
Thanks for your help. I just subbed. Can you share any ideas for my MRI results below? I have been going to a PT for 7 months already and will continue with them results we found out this week.
IMPRESSION:
Supraspinatus low-grade partial thickness articular surface tearing with central propagation along the intrasubstance. Findings superimposed on insertional tendinopathy which extends into the anterior infraspinatus.
It just implies chronic impingement with a small tear. Do what I recommend in this video.
could you please make a video for recovery form impingement
Sure.
yes, much needed
do you recommend ovehead shrugs to kepp shoulders abducted whilst scapula is upwardly rotated
Only for advanced patients. this will kill the shoulders if done wrong
Maybe monkey shrugs (with dumbbells or preferably with cables) is a better alternative for the not so advanced patients. Yot get some upward rotation but it´s fairly easy to do.
See, I just wish that all physiotherapists would explain with such clarity what's really happening when you are experiencing pain. Instead, most of the time you get next to no explanation with liitle relief and hefty bill at the end. Reason why I come on youtube: To better educate myself. But it's a long road.
Upper side of my arm will start to feel painful when I'm about to reach 90 degrees angle.
You're doing it wrong
sir I've watched all your videos but I don't know how to feel keep tension in scapula movement it's very difficult and mind confusing 😢😢😢😢😢
Gently elevate it by feeling the trapezius contract, the keep it there while moving the arm carefully. Do not allow the trapezius to disengage. Sorry, no easy answer here other than what I showed in the video. It takes time and patience to get right, which is also why so many patients are having these issues for years and years (they're rehabbing it wrong).
3:16 sounds like bane😂
Hi,
I suffer a supraspinatous tendinitis, but luckily there isn't full or partial tear. My enquiries are:
1. Is there any medicine, like local cream or ointment, or any pills?
2. Do the pain killers and anti inflammatoires help to recover, or they don't?
3. Is the physiotherapy and exercises are the solely effective treatment, or there is something else?
4. Can I do boxing with relatively weak and slow punches by my injured shoulder, or I must entirely quit it?
5. Is it a chronic syndrome, or it could be recovered and I can normally practice my harsh exercises?
6. How to avoid turning to tear?
Regards,
Ahmad,
Most of these questions are answered in the video, have another look (or three).
Medicine will only help the pain, not the cause.
4. depends on your scapular mechanics, although they most likely suck, seeing as you've acquired SIS.
5. the requirements to fix it is mentioned in the video, so why are you asking this. Fix the cause and it'll go away
6. ....
@@MSKNeurology I recently had an MRI and was diagnosed with frozen shoulder, but the MRI also showed "Mild supraspinatus tendinosis with tiny bursal-sided tear partial tear and additional possible very tiny rim-rent tear at the insertion of the anterior fibers." Does this mean anything signinficant, bec doctor said i don't need to restrict anything once frozen shoulder is recovered, what exercises should i avoid?
@@JitinMisra It means chronic shoulder impingement which has led to partial supraspinatus tear. Follow the advice I give in this video + postural advice given in other videos
Can such partial tears heal on there own?
You catch more flies with honey than vinegar. I just love that saying.
Can shrugs on a pull up bar cause Supraspinatus problems
You can do shrugs while hanging, that'll target the lats.
I am not getting proper advice from my surgeon. I have a 50%tear of my supraspinatus as well as a failed SLAP repair done 15 months ago. My surgeon wants to do a soft tissue tenodesis (attaching the biceps tendon to the supraspinatus) Does this make sense to you? I am trying to prevent another surgical disaster.
It won't matter because the underlying problem (scapular dyskinesis) is still there. The surgery is rarely the problem.
What is your opinion on having a bicep tendonotomy for pain relief. I have been in tons of pain it is seems the surest way to deal with the diseased tendon and pull on the labrum. I have been to five PT's and none have identified scapular dyskinesis which frustrates me because I can feel a movement problem but I cannot figure it out on my own.
Book a skype session, I need to evaluate your case.
Michael Dooley give more information .I have a tendon tear on the right shoulder
I have been unable to work for two years. Please forward me to your rates or let me know if you do this type of thing without pay. I had the soft-tissue LHB tenodesis in July 10 and I am really not experiencing any relief. In fact, I have several increased problems.
How can I implement that to atoher exercises like bench press or Rowing exercises?
In essence, keep your shoulders up.
@@MSKNeurology when I keep my chest/sternum up, it is the same with shoulder up? Or cue can help?
@@zaziro obviously cues for the sternum vs scapula are not the same
@@MSKNeurology but if I keep my shoulders up while benching or rowing it feels unnatural and unstable while performing these exercising
@@zaziro Spare me for nonsense replies like this. If "natural" worked out well for you then you wouldn't be here. It takes time and effort to change a faulty movement pattern.
How about this: Shrug (elevate) the shoulder, i.e., the scapula, first. Then abduct the arm, second...
Shrugging (& isometrically contracting the trap) will create an upward angle of the scapula along the horizontal (transverse) plane. This will create more room & clear the path for the supraspinatus to glide through the subacromial tunnel and raise the humerus without impinging the acromion. If the thoracic spine is "straight," in other words, if the thoracic spine is not overly kyphotic, then the thoracic spine & ribs/thorax will not obstruct the scapula (from swinging sideways) and the lower traps & anterior serratus will be able to assist the shoulder's side-lateral raise (through a greater range of motion.)
I think people have problems with supraspinatus impingement because a lot of people are too kyphotic and are unable to swing their scapula properly relative to what they visually perceive as up & down, i.e., relative to the floor (instead of relative to their rounded upper back.) However, if a person does not have kyphotic posture problems, then they'll lift their scapula & arm naturally without any thought or technique.
The other solution is: "Straighten out" the back so that the scapula can move properly. But that really means one has to "straighten out" the entire, whole body (since the spine compensates for the rest of the body.)
Why are you Norwegian but you look like russian with even that slight accent😃
Thank you for your content👍🏻
so the main cause is depressed shoulders
Even just raising my arm body weight I can clearly feel the difference when I slightly raise my shoulder
Music is terrible
Bye, then
Excessive masturbation contributes to rotator cuff injuries. I know this, "first hand"...
I can’t really understand your English due to your accent mate
Listen more carefully, and with an open mind. Everything that he says is clear. Your prejudice is the problem.
Yeah wtf he’s clear as day. You must be inbred
Excellent, thank you.