Rock Climbers’ Shoulder Pain: Cause & Treatment – Biceps Tendinopathy Pt. 2 – Hooper’s Beta Ep. 27

Welcome back everybody! If you’re new to
the channel, my name is Dr. Jason Hooper, doctor of physical therapy and orthopedic
clinical specialist. In today’s video we’re gonna do a follow-up on our bicep
talk from last time but we’re gonna talk about the proximal biceps issue, which is
a shoulder issue. So in this video we’re going to talk about the biomechanics of
this issue, we’re going to talk about testing, some treatment options, and a
little bit of differential diagnosis so we know what else could be going on with
this issue. Okay, so the reason we’re going to talk about the biomechanics of this
issue right off the bat is because that’s generally what causes this irritation of
the long head of the biceps. So when we look at the mechanics of the shoulder,
especially when we look at like overhead motions or reaching overhead, we have two
components really. So the humerus of the shoulder itself, as it elevates, it kind
of rotates in that socket. We also get an upward elevation of the scapula. So those
two motions combined are what allow us to reach our arm up overhead. Now what can
happen: you can see in this little space here we have basically what I like to
call the roof of the shoulder and then this is the ball of the ball and socket
of the shoulder. So as we elevate overhead you can see
even just this muscle, this is your superspinatus, is getting kind of pushed
into that ridge now. If we just purely had this rotation and we didn’t have any
upward movement of the shoulder blade that’s going to just run into that space
over and over again and cause an irritation. Now if we look in here we can
see what structures run underneath that roof, so we have that supraspinatus
muscle, we have our subscapularis muscle and then we have this representing the
tendon of the long head of the biceps running through here as well. So those
are some of the common structures that can get trapped underneath the shoulder.
Now we talked about that a lot as well in our shoulder impingement video, so
it’s a good reference to look for if you want more information about that as well.
So in addition to the important mechanics of that upward rotation and
that lifting overhead of the shoulder, there’s also a big one that comes into play
with regards to our posture. So a lot of times when we have that really kind of
forward posture or those rounded shoulders what you’ll get oftentimes is
kind of a forward or an anterior translation of this humerus, so the ball
of the shoulder starts to come a little bit further forward. So you can even see
here if I try and pull that forward it immediately is moving and creating some
pressure on this these structures in the front of the shoulder —
so the sub-scap and the long head of the biceps tendon. So what can happen
if you have like bad posture, you’re constantly rounded, you’re never doing
any exercises to keep your chest open, or when you’re climbing and you don’t
practice that scapular retraction, that shoulder can be in this forward position
which is going to place more strain and stress on the long head of that biceps.
So our posture and our mechanics and awareness of positioning while we’re
climbing is also really important to consider if you have this long head of
the biceps irritation. So symptoms for this issue can present in a number of
different ways based upon what might be your biomechanical issues. If your
shoulder is sitting more forward you can have other complications than if it’s
just an upward elevation issue. So you most commonly will get obviously pain in
the front of the shoulder but you may also get pain in the outside of the
shoulder or even the back of the shoulder. If the issue is that shoulder
coming too far forward the muscles in the back, that infraspinatus, are going to
be working way harder so you may get more pain there. If it’s that issue with
that upward elevation you may have other structures involved like we pointed out
like the supraspinatus, so you may get pain in the outside of the shoulder. So
those symptoms can be pretty broad but we will notice that anterior shoulder
pain which can radiate down the arm. So to test this issue we’ll start with some
of the less stressful tests and work our way up with that. So some of these
may be basic, they may not reproduce your symptoms, but if the basic ones do
produce your symptoms you probably shouldn’t go further and you might need
to get it checked out professionally. So first you should simply have full range
of motion. So if you notice that you can’t even extend your elbow fully that’s not
a great sign or if you have pain elevating and you can’t lift up all the
way overhead that’s not great either. Now if you have a little bit of pain but
it’s not so much where you can’t go through that full range of motion that’s
okay, it’s more so if it stops you from completing the range at either the elbow
or the shoulder. So if you can go through that range of motion with relative ease
we want to test our strength out next. We’ll start with more basic strength
testing. So we don’t want to just bias the long head of the bicep right away, so
we start with the thumbs up position and we’re resisting elbow flexion, so we’re
resisting this motion pulling in. If you can perform that without pain then you
go to the palms up position. This supinated position of the shoulder will
put more load on the long head of the biceps so it can help kind of
differentiate other things out. Now if the strength testing is fine in those
positions, we’ll go into our special testing. Alright so for the special tests
we need a buddy for these, so Emile get over here! Alright so we got Emile
here, he’s gonna help me do these next two tests. The first one is called the
Speed’s Test, so the starting position for this is going to be with your shoulder
straight ahead of you at 90 degrees with your palm up and your elbow straight. Now
it’s important to keep your elbow straight throughout the motion, so
Emile’s gonna apply some pressure to my forearm here now, he’s pushing down but
I’m fighting against him so I create some contraction and that really biases
the long head of the biceps. If you have pain at any point of that you want to
stop the test, you don’t need to just aggravate your symptoms more. But again
that’s palm up, elbow straight, fighting that resistance, so he’s trying to push
me down as I fight up against him. The second test that we’ll do is called the
Yergason’s Test. So we basically start off by going in this like arm wrestling
position. I want my arm in this ~90 degrees of bent elbow and towards my
side. Now the motion we’re going to be
doing is like we’re coming through here but he’s going to be resisting it, so
it’s like armwrestling but I’m trying to pin myself. So he’s not allowing me to go
through that and I’m looking to see if I have any pain in the front of my
shoulder. So those are two tests that you can do with a buddy’s help too
see if you have this pathology. Okay so now to the best part: the treatment. So
what do we do to help this out? We’re gonna break it down into the four
different sections and go through some details for each one of those, so first:
stretching. Okay so like we mentioned earlier where that humerus can be
anterior translated, or just “the shoulders are forward,” we want to kinda
reverse that and get those mechanics changed. So we’ve got to
open the chest up. So a lot of that’s gonna be done with like stretching the
pecs or getting a light bicep stretch. I always suggest doing it like in a
doorway with the hands low, medium, and high and you can do all three
of them or do what feels the most restricted to you. If you’ve had this
forward, rounded shoulder position for a long time you may actually also need to
stretch the posterior cuff or the posterior capsule of the shoulder, which
can be accomplished with this kind of basic cross body stretch here. When you
do this stretch you should feel a little bit of pull or stretch in the back of
the shoulder and it seems kind of ironic because you’re pulling it into the
opposite position, but when that posterior capsule gets tight it can
become limited and won’t let your shoulders sink further back. So pec
stretching to open it up and that cross- body stretch to stretch that posterior
capsule. Okay so for number two we’re gonna look at strengthening. Now we
mentioned that this can be an upward rotation problem, where the shoulder
isn’t getting that good clearance from the roof as we’re upwardly rotating our
shoulders, so we have to look at in particular our mid trap, our lower trap,
and the strength of our serratus anterior. So we have videos on all of
those guys but that basic awareness is: the mid trap is going to be that
scapular retraction or pulling the shoulder blade backwards in this about-
ninety-degree position, the lower trap is going to be anything above that, and our
serratus is that pushing muscle. So if you have weakness or bad motor control
in any of those positions then you want to look back at our other videos that
talk about strengthening for those muscle groups. Okay, third: technique. So we mentioned like the forward shoulders, we mentioned the upward rotation and
needing strengthening, now you have to really apply those to your climbing. So
pay atttention: if you’re even just on slab and you’re
always like just collapsed in your shoulders, work on that awareness of
increasing your your scapular retraction and that back engagement and work on,
after you’re done climbing too, not just sitting and resting in this terrible
slouched position. So work on your awareness and on that technique while
you’re climbing to keep your back engaged. It will help with both of those
aspects so you’re not just sliding forward with the shoulder and so you’re
getting that proper upward rotation. Alright for the last part it also just
started raining so it might be a little bit of background noise, but we want to
talk about just like obviously “overuse.” So if you like to climb like four times
a week and Monday Wednesday and Friday are all biceps days, just pay attention to
like some overuse with these muscles. If you’re doing a lot of cave climbing and
not mixing that training up with your rest you may be getting some overuse,
but those main three are gonna be the ones you’re gonna want to pay attention
to for healing and treating this issue. Bonus time! All right we’re going to talk
about some differential diagnosis, so basically we’re looking at if this is
one thing or if it’s possibly something else. Now because of the long head of the
biceps anatomy and the fact that it attaches actually into the labrum of
the shoulder, we have to rule out the possibility of having a labral tear. So
the way we do that is with this really cool test called the Biceps Load Test
#1 and #2. Now you can do this with a friend but you don’t have to, sorry Emile, but what you do is pretty simple: the first one you do is you just put
your palm on top of your head and you pull down. Now slowly increase, you pull
harder and harder and harder, don’t just yank on it right off the bat.
The second part of the test is to do it with the fist and the thumb down on top
of your head. If both of those tests are painful my recommendation is to go see a
specialist. Now keep in mind if you have paint just getting into this position then,
you know, you may have some impingement or other things causing it, so you need
to kind of pay attention to if that’s the same symptom you feel when you pull
down or if it’s just getting into that position. So if you do have
both of those there is a really high chance that you have that labral tear
and you need to get in to see a specialist. If both of those are negative
then there’s a better chance you do not and you can say that, “hey this is
probably my long head of the biceps that’s giving me this pain.” Alright I
hope you all have found this video informative. If you did, hit that like
button and subscribe and just one last note: just poking at the front of the
shoulder and having pain does not mean you have long head of the biceps
irritation, it’s just a sensitive spot on almost all of us. So that doesn’t mean it,
you got to do these other tests as well… and that’s when I don’t know what I’m
supposed to say. So that’s our video for today, until next time: Train, climb, send
repeat! (Bloopers) my head hello and welcome to the evening is new unique New York the
arsonists had small feet and let you learn that one it’s actually kind of
hard that doesn’t red leather yellow leather
red yeah yellow that they’re red I got that wrong bro that rapid onset muscle
soreness I’m I think I’m the only one picture why feeling so wrong is so right so this is the shoulder by try fry to
try and get the shoulder and a thing I liked it but then I lost it was it good
okay so what we’re doing we’re climbing with the upper rotation yeah gross
disgusting Bonus Time so why do I live that one that’s easy
understand Bonus Time no brow now when I sound smile if you liked it go and hit
that like button obviously you like to hit the like button if you didn’t know
already the brain named itself think about it oh hey we’re still here Jason
they’re still watching oh yeah you’d say something cool so they like the videos
and subscribe for more awesome content like and subscribe for more super sweet
vids y’all so lame dude I know it’s pretty

6 Replies to “Rock Climbers’ Shoulder Pain: Cause & Treatment – Biceps Tendinopathy Pt. 2 – Hooper’s Beta Ep. 27

  1. It took me ages to realise my biceps were part of the issue when I hurt my shoulder. Excellent informative video again.

  2. Awesome! Can you do a video on forearm pain for climbers? Most PTs just say ice and don’t climb.

    For example I’ve had 7 weeks of pain and weakness from my hand and seems to come from my forearm (bottom side that would touch a table if you put your arm in a table)

  3. Hi guys! I had just discovered climbing and was loving it so much. After only a month, my knee started throbbing every time I went down stairs, and even in my sleep, and then my shoulder started feeling tight at the front so I couldn't reach across to my other shoulder, or above my head without pain. I had to stop climbing for a month and see a kinesiologist twice a week (Feeling SO OLD at 36). I had probably gone a little too hard too quickly considering I had never done such a physical activity. Anyway, during that time I learned that I should warm up properly. Looked on the net, found your first shoulder video, bought a bunch of exercise bands, incorporated all your warm ups into my other prescribed exercises, and I've been watching your videos ever since, even though I don't need them 😀 I think I just like hearing you clear and detailed explanations about how our bodies work, and more importantly… the cheesiness Hahaha. Please keep up the cheese 😉

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