Bicep Tendinopathy - Shoulder Rehab Part.1 | Feat. Tim Keeley | No.195 | Physio REHAB
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- Опубликовано: 4 окт 2024
- I have a rotator cuff (supraspinatus) 50% width full thickness tear that is healing and strengthening (slowly, and trying to escape surgery!!).
👉 BUT because of this problem I also have developed a long head bicep tendinopathy with tenosynovitis to boot. That hurts more than the tear! 👀 The tendon tightens up at night, aches like hell in the front of the shoulder and also inflames with too much load. Because of the stiffness and pain, inability to use much and the loss of overall function, a tendinopathy in the LHB has developed. So it’s a double whammy. Very common after a decent rotator cuff tear that puts your shoulder out of action for 6 months.
➡️ So, if you have also been diagnosed with this, and are struggling then follow my little story and what I am doing for rehab to sort it out. Remember though, I am getting lots of treatment for it and I could NOT do the rehab without the weekly Physio work, mobilisation, soft tissue release and dry needling to keep it on the right track. So make sure you’re seeing someone first and foremost.
1️⃣ First is the “FRONT SPRINTER (band) - eccentric. Meaning I am adding the load on the way down. Check the commentary for all the tips. Second is the “SIDE SPRINTER (band) - eccentric. This one gives more lateral load and minimal front load, still working the LHB tendon but combines the rotator cuff as well especially laterally which is what you need to strength to support the bicep tendon as well as work on the weakness in the cuff if you copped the tear complication in this injury. ▶️ Then back to the FRONT SPRINTER (band) - eccentric but with the anchor point low to add on more load. Be careful on the bottom part it’s where you tend to feel it the most. Sorry about the audio 😬 gets a bit muffled with the mic in my shirt!!...
Checkout the next 2 exercises in Part 2
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Thanks for this. Bicep weakness after rotator cuff injury is absolutely maddening!!!!
FINALLY! I fixed my rotator pain behind my shoulder only to have this front pain appear days later. I’ve been trying to get rid of it through rotator cuff workouts to no avail for a long time. I did these workouts and immediately it felt better! Thank you!!!!
Great news! Glad you are getting better
Same exact thing happened to me literally the same exact thing
@@physiorehab Can l ask did you get any nerve irritationm in your forearm and shoulder blade. Mine is not painful but the tendiopathy in my upper bicep is still sore although less so than six weeks ago when l, developed the problem. Have you resolved your symptoms yet?
Can I ask What I should do After longhead tendonitis iflamation to feel the muscle?
This is the first video which identified both problems which are rotator cuff injury and now bicep tendinitis. I tried your exercises but it only inflamed my bicep tendinitis. Had to ice and use no bands or weights for first week. While my bicep tendinitis was calming down I doubled up on my rotator cuff exercises (5 of them
Concentrating on good form more than I was first few months) on the advice from a different video which stated that your bicep tendinitis will never heal until your rotator cuff muscles are strengthened enough to hold your shoulder in the right place. A week of intensifying my rotator cuff exercises and rear delt strengthening and my shoulder is 100 times better. I have also been hanging twice a day for months which has really helped with strength and mobility. The turning point for me was doing rotator and back exercises which didn’t turn on the front delt and inflame my bicep tendinitis. Thanks for your video.
what were the rotator cuff exercises that u did
OT!
Had a similar injury combination. Doctors were not helpful. The thorough explanations and walk-throughs in your videos are phenomenal. It took a while of doing these every day and building up from there, but this was the info, attitude, and start I needed. Can't thank you enough
Glad it helps 😀
Awesome video! Thought I had a rotator cuff issue but the traditional theraband exercises I was doing didn't seem to help. This guy nailed it. I have a strained proximal bicep tendon (short head). The very first exercise I did I felt it exactly in the right spot (in a good way) and knew immediately this was the rehab exercise needed. No need to pay a doctor thousands for MRIs with no conclusive result.
John Channell nice one thanks john
How long it took not to feel no pain
This has helped me get rid of shoulder pain ive dealt with for years. Thank you.
Great news 👍
Thanks great video . I'm already feeling better. Half the part is how you explain ... so concise to the point
You’ve just explained what’s going on with me, great to hear some rehab advice that considers someone in pain and unable to move and train as I would like 👍
Glad it helped
16 yrs ago started my career as a massage therapist with chronic proximal bicep tendon pain. 2014-current now a licensed physical therapist assistant and still have this pain on and off. Ive had 2 MRIs and 2 cortisone shots (small intersitilal infraspinatus/supraspinatus junction and chronic bicep long head tenosynovitis. Seeing a PT for dry needling right now. Im hopeful after watching this and will incorporate this into my fitness routine.
This was just what i needed, thank you, love the simple straight forward explanation Tim.
👍
Excellent video. This has now been part of my rehab journey with my long head bicep tendon
This guy deserves an award
Haha thanks
Tim , I have exactly the same injury . thank you so much for this brilliant advice and help , its really helped me get back my bicep strength !!
Nick Vassilis great! Glad it’s helped
1:42 I haven't even gotten to the actual exercises yet, but I'm excited (& sympathetic) to hear you describe *exactly* the same problems I've had going on for 2.5 years. I've been warned NOT to stretch the area, which can exacerbate the problems, so ... I'm curious! Thanks for your time and trouble.
I am gonna sound like a broken record, but here i am again , with shoulder issues. Had left side Cuff surgery 3 years ago, and now it seems like my Bicep tendon is on fire on Both shoulders after moving some heavy weight in the garden. Damn i hate getting old. But, i am glad for Tim's expertise on addressing these type issues. Thanks very much !
If you need further guidance have a look at the shoulder rehab programs at physiorehab.com
I do the 2 first exercises and it's work for my right shoulder, I had this issue for a year now! Absolutely amazing Tim, thanks a lot!
Glad it helped! 👍
Thank you, that first exercise fixed my pain within five days doing it every day two times of 4sets with 10 reps. Pain was getting very annoying. Didn't stop me climbing but couldn't do push ups as the pain was to strong ( and not trying to push my luck just yet) , even in every day life was often painful. Now pain has gone, such a great exercise! Thanks again!
Oh great news! Glad it’s helped you out
It'd mean a lot if you could reply. I'm going through similar pain and i am wondering if your pain was partially popping in that right shoulder as well. And if so, did it go away after these exercise
@@jacebell6575 if you are asking me I had pain in right shoulder but exercise both. Yes pain has gone away after few days of doing it as described in previous comment.
Holy shit it just vanished the pain . I've been doing so many rotator cuff exercises for the past month with little to no improvement . I never realised that front delt pain might be bicep tendonitis . Thanks doc
Glad that one helped!
Life changing video! Thank you so much.
You're so welcome!
Hey Tim, I had shoulder surgery about 6 months ago, and found your videos. I used your channel videos, and what my physical therapist recommended. Shoulder doing great! Great material, and a happy subscriber! All the Best!
Thanks Richard! Great feedback and glad the videos have helped your shoulder :)
This guy is a cut above…. Great videos.
🙏
This might be the video to solve all my problems. I haven't been to a physio but I'm 100% sure I have a biceps tendonitis. I've also had a supraspinatus incident, and I know for sure my rotator cuff as a whole is weak as piss. My right shoulder clicks every tome my elbow passes behind my back doing pulls, but it's my left shoulder with all the pain and prominent issues. Thanks to this video I know for sure I have to fix my bicep tendonitis first before anything else comes. I tried these rehab exercises with 0 weight and it's feeling good. You explained it really thoroughly which I appreciate. All the other videos I've watched from other RUclipsrs don't cover the other bases. This also cleared up any overhead presses, I'll lay off them until my biceps T is feeling better.
I guess connective tissue work will now be a constant thing for me if I want to continue being injury free. Kind of annoying but that's what's got to be done I guess.
Ok glad the exercises and video helped, make sure you work on the scapula pressing and the rest of the rotator cuff too as most times there are associated or even causing issues in there
Thank you. I think I might have overdone it!
That was super helpful. I had my doubts this would do anything but I added it in and it’s great.
Good to hear! 👍
Absolutely awesome!! Where is Part 2?
It’s there!
You described my pain as if you met me. Definitely subscribing m8.
Something I recently stumbled upon during my rehab is how effective Electrotherapy has been for my recovery. I went into it with no expectations and was pleasantly surprised how well it worked to take the recovering discomfort away (25minutes of it has done wonders for me). I am still using ice but also use an Electrotherapy machine now too.
This is exactly my injury. Now I have a plan thank you.
Informed Consent great!
Awesome video Tim. Came across this as my surgeon wants me to do a bicep tenodesis surgery which i'm really skeptical about. I had a slap tear about 10 years ago but have been battling bicep tendinopathy for years. I think I am going to give your workouts a crack cos I am really worried about another surgery which changes the whole anatomy of the shoulder
Make sure you really sort the rotator cuff out with bicep issues. Having a bicep tenodesis is not all bad especially if their is a non-healing labral tear. physiorehab.com for the shoulder programs
@@physiorehab Thanks Tim. Surgeon said my labrum repair still looks ok. I want to a different surgeon who didnt even look at the imaging and just said i should do a tenodesis surgery. Just skeptical about it being the solution. Am def keen to take your advice on the rotator cuff work before surgery and giving that a proper crack
been having some bicep tendonitis. great information here. thanks for making this! cheers.
Great 👍
I PLAY CRICKET AND WHILE BOWLING I AM HAVING THE SAME PAIN. THANKS FOR THIS VID.
👍👍👍
Hope the bowling gets less painful!
Great exercises, great for armwrestling recovery!
So helpful! And well explained also 👍
Thanks!
Legend thank-you🏆
👍
I’m going to try this tomorrow, I want to rehab my biceps tendon so I can play tennis again soon
Hope it works well for you
Thank you, I started off at a thousand and now I'm in hospital.
?
@@physiorehab Sorry, I was joking.
Had rotator cuff repair 3 months ago and yesterday during one of those daily light and slow lateral raise stretching, my shoulder popped.. now I'm researching on what went wrong and here it is ...
Hope it goes ok. For the full shoulder surgery rehab program head to: physiorehab.com/rehab-programs-shoulder-injury-surgery-rehab
I healed my problems in strength and conditioning
How long does it take I’ve had it for 4 months got it through curling I’ve been in pt for 5 weeks how did u workout while having this.
Yes, what you did it
How long it took to heak
i have lower Bicep Tendinopathy and i just cant shake it. im still trainign with push exercises. just started doing the rubber band exercises two days back. its really driving me mad! I just wanna rip back into weight training but i simply cant atm
Good video, I've had a shoulder hemiarthroplasty last November 2022 and healing is slow, 8 weeks ago I've been suffering with this problem, my surgeon told me yesterday 11/07/2023 that the pain I'm experiencing is the shoulder tendon and as you have pointed out in the beginning of this video and has offered me a steroid injection in 4 months time Nov 2023, I'm going to give these a go and see if I can relieve the pain and strengthen the tendon, how often would you do these and reps/sets? Thanks in advance..
Got bicep tendonitis and tennis elbow atm so thanks for this lol
👍
Ok, now I know I have tendonitis in bicep shoulder area, I lift my arm straight up, here a pop noise, no pain but ya.
Now fixed or popping?
i have exactly the same problem with you,my bicep pain more that the rotator cuff tear.
Never knew i had a tear? I just got very bad left shoulder bicep tendonitis
I suffered this after a bad shoulder dislocation
Thank you for these. 😊
Have you a link for the bands you use?
No problem! Head to shop.physiorehab.com
Tim Hi! I have the same problem you have in you Rotator cuff (Supraspinatus) with the other aggravations, i glad i found this video and somebody who understand the impediment of this problem.
Tim the only think i would like to know how many repetitions for exercise and for how low I will practice part 1
Around 3-4 weeks, aiming for 3-4 sets of 10-12 reps
bicepSSS !!!!!
Thanks Tim. I just stumbled upon this and you hit the nail on the head! I've just started PT (had eval) and will see if they approach it this way. PT does not suspect rotator tear, but does suspect biceps tendonopathy. Question: I'm 72 y/o. And cautionary advice for the "older body?"
Go easy on the load but stay consistent. LHB tendons with tendinopathy are at risk of failure in that age bracket with too much load and/or lack of conditioning
The first 3 mins of the video were brought to you by Parkview.
Hahaha.
Just whatvi need. I have ac 1...but i was sure it was afectin my tendon 1 i have a sorefrom the tendon in the biseth....
How many sets and how many Repetitions you do? How long is the break?
Thank you very much. I have all the problems that these exercises would help. Bad posture due to excessive sitting and slumping badly to watch TV and have really have posterior tilt and forward slump. All exercises especially the 2nd exercise seems to work wonders in that I feel the contraction exactly around my spiner from top part of neck going down but one thing I noticed is my neck seems to be getting strained in those last 2 exercises as well. Any tips to help with this or is that a natural to feel, since I feel like I've to constantly stretch around my neck area as well during my day to day activities as well?
Thank u for ur exercise I have watch, my problem my left arm don't rise my shoulder dislocate my bicep affected, I from motorcycle accident
I was just diagnosed with mild tendinosis in my shoulder. Does tendinosis cause popping? I’ve heard and I’ve heard no.
Not necessarily. It may lead to instability which maybe the popping
Hello ..how many times per week please?
Got a shoulder tear and just yesterday got a bicep strain
Can't move me arm
would this work with a dumbbell aswell? doing the front eccentric portion and holding a dumbell with that position of the arm
Yes just use the other arm for a dumbbell, but bands are better
I like how you worded that you said I know ways to rehab it but how does one prevent it im a powerlifter so it’s usually wen I have a heavy load on the barbell idk wats causing it it’s like I threw out my arm throwing a football the pains bad
Perhaps get that assessed
Tim, I have had a proximal long head biceps injury alone with supraspinstus and possible infraspinatus pathology. I’m curious if it’s more important to work on my scapulo thoracic muscles, serratus anterior or my rotator cuff muscles. Genetically my scapulas rest at a downward rotating position, winged scapula. So what is more important? I have watched several seminars you have did and you are very knowledgeable!!!
Chando Armstrong you cant really do one without the other. These exercises in this video should always be done with the scapula work. Don’t choose one over the other get it all done :)
Thank you SO MUCH sir!!!!! I will continue to try my best to progress. It’s healing but very slowly. I have high laxity in my ligaments and I’m pretty sure I damaged my AC joint/labrum because of the instability and weakness after repetitive movements. MDI to be exact, I can pop my humeral head in and out of socket. I have chronic, dull pain and sometimes I feel impingement when I continue to do things at work. I DONT want surgery, it’s bilateral but the right is worse than the left. I know you can’t “diagnose” me but if you could possibly give me a little rehab workouts to do to heal my ligaments better I would appreciate it. I’ve been taking glucosamine with condroitin MSM triple strength twice a day. 😁
Really great instruction video! What brand/tension of straps do you recommend?
Thanks! For this exercise go for a medium theta band to start with. If you go too heavy the load maybe too much
@@physiorehab Thank you so much for the video. I fell on ice black and suffering exactly what you described in this video because I went back to my normal life ignoring that I suppose to let it rest to recover then, go for some physiotherapy. I got two shoots of Depo-Medrol, one in each shoulder. I was reading about the side effects and are really bad. I got dizzy as soon as I got the shoots.
I am new in this, so I am wondering if it was a typo with the theta band because I couldn't find it on my search. Do you mean Thera? Thank you
Hi Tim, I had a partial tear at the long head of my biceps 3 weeks ago, pain and inflammation are getting better so will start doing these exercises. After how long I can go back to the gym in ur opinion? and how can someone train upper push body with this problem? are pull exercises safe? thanks so much, appreciate ur insight.
If it’s a tear would work through a full rehab program to be honest which will bring you up this gym training gradually. Have a look at physiorehab.com/rehab-programs-shoulder-injury-surgery-rehab
Any info on rep and sets?
Are you in any pain during these? My pain level is a 7 and physical therapy is rough. I'm 6 weeks in and no better. Dr won't do mri until we try PT.
Hi thanks for the helpful video. I have issues similar to you, supraspinatus tendinopathy, biceps tendinopathy and subacromial busitis. Is there a specific order in which i should try amd tackle these problems e.g. biceps first then supraspinatus etc. thanks again
Rotator cuff as priority
Hi Tim...great videos and deep explanations. I have a question, hope that you will respond. I have pain in front shoulder in the most upper part where humerus meets capsule, under acromion. In flexed elbow position and shoulder extension, when pressing flexed elbow behind into wall as well as laterally pressing elbow into wall, also when tucking my shirt into pants. Is it most probably biceps tendon issue? Shoulder flexion and also lifting arm up to 180 is quite ok no significant pain but extension is terrible. Thanks a lot for your reply.
I would defiantly look at your scapula movement as well as the posterior cuff strength and function as it maybe a biomechanics issue underlying that
Thank you 🙏, during the front sprinter (3:07) is it fine if I’m
Feeling a bit of fatigue during reps , I can only do 5-10 and my tendon is fatiguing very quickly . Thing is I feel fine after and the next day . Should I stop as the tendon is fatiguing or is this normal ?
Thanks for this. What are your thoughts on using the massage gun on the area please?
It’s all about personal preference. The bicep tendon can be a sensitive spot so I would be careful how hard you go on it
The side sprinter exercise has to be done during the same phase of the front sprinter or at a later stage? Thank you
Can you also get tendonitis on the short head of the biceps?
Yes but not as common
I’ve had both at the same time. Bench pressing a lot made my chest tight and it just pulled all the way down my left arm. I didn’t tear anything but I just got this dull burning sensation that would shoot down my left bicep. It also burned on the inside of my elbow when I straightened my arm and twisted my palm to the left.
I went from doing sets with 135 lbs to doing sets with 225 lbs in like a year, but then I had to stop due to mild tendinitis that just never completely went away.
My left shoulder has never been quite the same. Most of the time I don’t have pain, but my shoulder will just randomly lock up for a few weeks at a time. Sometimes it’s so bad I will need a sling for a few days. I usually find out my shoulder is starting to bind up when I get a big electric zing down my arm when I reach behind me to grab something from the back seat of the car.
Oh, and even when there is no pain I have a weird clicking sensation in the trap area right above my left shoulder. When I move my shoulder forward and back it feels like something isn’t moving quite right.
Hey quick question for you… I have been playing a lot of volleyball and feel pain in my right swinging shoulder. I thought it was a shoulder impingement at first but then realised my upper bicep tendon hurts after a fast swinging motion. Pretty sure it’s not a tear as it only hurts during Hawkins test and speeds test. with rest/ice and these exercises, how long does it take to pass the speeds/Hawkins test? Thanks!
Keep strengthening and testing. Everyone has different recovery speeds but 3 months should be a lot better
Can I use a dumbbell instead of the band?
Not as effective
How long did you wait before you started rehab after surgery
I didn’t, started straight away. Just follow the program for all the exercises: physiorehab.com/rehab-programs-shoulder-injury-surgery-rehab
Great video Tim. Quick question, so many videos suggest stretching for biceps tendonitis but I've seen others say it's the worst thing you can do as it aggrevates the tendon. Do you have any thoughts on this?
If there is restriction or loss of range you need to address that but yes mostly it’s strengthening as the priority
How many times a week do you recommend these exercises? Is this something you can do before or after a workout?
2-3 sets of 10-12 reps 2-3 x per week depending on your conditioning
thanks, how often is very important to know
How many repetitions of these exercises should we do?
Try starting with 3 sets and then move to 4. Rep range from 8-15
I had surgery on my shoulder to repair my bicep, now I have a missing piece of my bicep. Is this normal?
Do you mean you have atrophy?
I have issues with the tendon of the short head of my biceps, any advise on how to fix that?
Hard to say when I dont know what the issues are!
Is this why my long head of my bicep on my left arm is really soft while my right hand is rock hard when flexed
If could be!
Did you get surgery for the shoulder?I have 50% tear on my bicep tendon long head proximal,im trying not to do surgery
klajdi kaca Yes i did - check my surgery videos on my site
I use to do 10kg everyday not much but just to put definition in my arms but I became ill severe anxiety I stopped doing weights 7 weeks ago and now my arms have gone weaker .. my bicep seems to shudder when I move my arm up and down it likes shakes a bit but I have been so tenced 24/7 with my anxiety my arm seems to just automatically tence now on it’s own so when I try relax it it seems to want to go back into tence mode but I am worried if the shaky feeling is normal
The shakiness may just be weakness. Aim for gradual slow increases and take your time :)
@@physiorehab ooo that’s interesting I started having all these weird symptoms after a virus 7 weeks ago x my gp thinks I might have osteoarthritis I. Hands because of my symptoms and plus I have had all other tests and mri xx
where can i get the band from?
Right here!: shop.physiorehab.com
I feel the pain only when i do chest or bicep workout. should i start those workout with light weight?
Perhaps work on the rehab first yeah?
How many rep should I do for these exercises for begin? Thanks.i have problem with bicep and scapula as well.
Try 2-3 sets of 10-12 reps of each exercise
Hi Tim, my wife has a related injury. She can't flex her right elbow. What caused this was 2 years ago, she let our newborn's head rest on her right bicep when he slept. Her right upper arm would feel numb after this. After a few weeks, her right bicep no longer had strength. It can't even lift up the weight of the right forearm.
We've seen numerous doctors but none could help. Because of this, her right shoulders and traps had to compensate, giving her pain in her right rhomboid area between her shoulder blades as well.
Will really appreciate if you've any advise for her. 🙏
Sorry they would require a full assessment to advise on this
@@physiorehab Possible to do the assessment over Zoom?
I have that same issue (partial rotator cuff tear caused bicep tendinopathy). Right now, even just doing the eccentric motion with a bent elbow and no resistance (weight of my arm) is enough to cause some pain. Does that mean it's too soon to start loading the tendon?
Not necessarily. Try follow my rehab program: www.physiorehab.com/rehab-programs-shoulder-injury-surgery-rehab
Can I do these exercises if I have a torn bicep?
Not In the acute stage
I had a rotator cuff injury 4 years ago and I did not take care. Last year I started having an extreme sharp pain in front of the shoulder every time I stick the shoulder out forward. Can this be related to the original rotator cuff injury?
Most likely. Perhaps you need to work on the rehab
Perhaps yes. I suggest you work on the rehab !
Can you reverse a biceps tendinopathy?
Reverse? You mean strengthen?
@@physiorehab well I thought tendinopathy was degeneration.
Thanks so much for this vid. The main eccentric exercise with the band brought my bicep tendonitis instant relief. Im assuming the band is at a bit of an angle as in the first few goes but arm/ shoulder kept running in to the band?
is it normal to feel irritation or burning in the bicep tendon after physio for bicep tendonitis?
That is what I feel constantly. I have been dealing with it for several months. Very frustrating injury.
When do I start these exercises
As soon as able!
On the first Monday of the next month
What is the name band to use? At where it available sir to buy.thank u so much sir
Robert Abainza have a look at the rehab video I just posted
Nw found the bands video - ruclips.net/video/WJwx0Ntp2zY/видео.html
#TimKeeley - does bursitis in the shoulder present the same as bicep tendinopathy and are they often misdiagnosed as being the other?
Bit of a hard question to answer there are so many variables
I'll like to know can this be done with resistance bands sir?
I am using resistance bands!
@@physiorehab this type of resistance bands are tough to get here in Malaysia🥺 so I was wondering if i can use the regular resistance bands?
@@CMPunkfan954 if you don't have access to smaller resistance bands try to get a few bags of rubber bands, tie several of them together until you have a good length. This is something I've been doing during the rehab process since larger exercise bands are too much for my injury.
I have that, but I did not have any assesment by any doctor, because of covid. So I’m just at home with “voltaren”, ibuprofene and waiting for the pain to pass. I should do this only once the pain disappear ?. Also it is normal at night when sleeping the pain become much stronger?... It actually wake me up!🤦🏻♂️
Maybe you then have a tenosynovitis or a bursitis - if it’s waking you up you should get it assessed. Try ice 2-3 x per day for 30min to help with the pain
Physio Fitness | Physio REHAB | Tim Keeley Thanks for your reply. I did have a bursitis year ago, but that time got my arm “paralized”. I stopped training and yes ice. The problem that I’m not going to any office Dr/ Hp at this very moment.
Physio Fitness | Physio REHAB | Tim Keeley when to start those exercises
How many reps and sets do you recommend?
Does depend but usually around 3-4 sets x 10-12 reps
How many sets and reps for each exercise?
3-4 sets 10-12 reps
@@physiorehab Thank you so much
Hey Tim I’ve got the same injury as you had in this video. Partial superspinatus tear leading to biceps tendonitis. 80% of my discomfort is now from by biceps, how often should I include these exercises? I’m currently doing rotator cuff and scapular work 3 times per week.
That’s about the right amount. Perhaps follow my program to help you further: www.physiorehab.com/rehab-programs-shoulder-injury-surgery-rehab
@@physiorehab Cheers bud.
Is it normal for my bicep muscles to be really tight? I have the same pain in the shoulder
Try the strengthening work to see if they become less tight