Rotator Cuff

[Mary S]

Hi. I have been experiencing some pain in my right shoulder and recently my doctor prescribed physiotherapy for a rotator cuff injury.

I know a few other MA people who have had problems with their rotator cuff and wondered if is more common than I originally thought, if we are all doing something wrong, and what I can expect for physio. Anyone else out there experience this?

Is there anything I can do to help make the pain go away?

[daveA]

Mary,

A quote off a website:

"Whether you want to call it a frozen shoulder, a rotator cuff tear or tendonitis shoulder, it's really all the same. A tear or strain in the rotator cuff muscles and tendons."

I had a "frozen shoulder" about 5 years ago. I tried physical therapy, Motrin (Ibuprofen), acupuncture, heat and ice. But, the only thing that helped me was when I finally talked a Physician's Assistant into giving me a cortisone injection. Only when the inflammation was under control, could I then start to see ANY progress with my PT and resume my MA workouts.

Good Luck.

dave

[Bill Glasheen]

Mary

It's always good to hear from you. I'm sorry to hear about the shoulder problem. These can take a LONG time to resolve. You must be patient.

You started off right by going to your physician; keep up the good work.

My first advice may not be helpful to you; that is, prevention is the best medicine here. Trust me - been there, done that. I have one shoulder that will never quite be the same after hurting it on the heavy bag from doing too many hard left hooks.

On the prevention side of things, it is important to get the blood flowing in the muscles AND the tendons before you really start cranking the speed up. This becomes even more important with age. My personal preference that I have actually introduced into my own dojo warm-ups is to do a Goju-sanchin-style set of movements before doing focused thrusts and strong circle blocks (or upper body weightlifting for that matter). In other words, do dynamic tension movements combined with some proper ibuki breathing (restricting both the exhale AND the inhale). Here are the movements I do like this:

* Punching motions (Thrust/chamber style, as you would do in any karate 101 class). If you do in a horse stance, you can warm your hips up at the same time.

* Alternating overhead press / pulldown motions

* Punches up at a 45-degree angle (thrust/chamber style).

* Arm "cranks" (Make a straight line from elbow to shoulder to shoulder to elbow, with a 90 degree bend at the elbows. Then "crank" the arms alternatingly up and down with the proper dynamic tension to work the rotational aspects of the shoulder.)

These warm-ups also work great as rehab, and they work well as a kind of "healing" exercise in-between heavy upper body weightlifting days.

Ice is also one of the most highly underrated treatments for shoulder problems. Whenever you have done something bad to your shoulder or you overworked it, start with a big ice pack on the afflicted area. Sometimes it takes only one treatment to nip the inflammation process in the bud. This is cheaper than NSAIDs, other expensive analgesics, or cortisone shots. It's also much healthier for you.

- Bill

[Guest]

[QUOTE]Originally posted by uglyelk:
Bill offers great advice.

I went through this in both shoulders and had to take about ten months off.

Patience is a big key. It's frustrating not being 100% and having to lie back a bit. Resist the temptation to step it up and further inflame the shoulder. I ignored my injuries for about two years and ended up paying the price.


Do your cuff strengthening exercises faithfully. Do not rush things and increase the weight, the arm is a large lever. Let your folks at physio tell you when to increase the weight. Even though you may be frustrated, keep doing those exercises, they actually are doing something It's tough for an athlete to accept exercising with 2 and 3 pound weights.

If you want to learn more about the shoulder this is a good course but it's a bit expensive.
http://www.humankinetics.com/products/showproduct.cfm?isbn=0880119179\

Hey my training partner has some rotor cuff problems as well. He tore his in the weight room, but Uechi sure lets him know it's hurt.

Heat before and ice after!

I LOVE MY ICE PACK!

Good time to explore the soft side of things.

It's also a good time to work on those kicks.

I found anti inflames worked initially on the pain but after a while the side effects sucked and the pain came back. Best thing I found for pain was slow warm-ups and ice after. And the best thing overall was doing those silly exercises with those wimpy weights: D.

Sorry bad link. Click on sports medicine then click on athletic training & sports rehabilitation, scroll down. The name of the course is Assessing and Rehabilitating Shoulder Instability.

Good Luck!
Laird

[Mary S]

Thanks for all your advice. Appreciated

I think perhaps the most difficult thing will be the patience aspect. I have had this problem on and off for a few years and it never bothered me enough to do anything about it. Like a lot of people in Uechi I worked through the pain. However, playing on 3 softball teams this summer seems to have exacerbated the situation to where it hurts to even slide the patio door open at home. Also the cold weather seems to be bothering me more as well. Ack! I'm getting old!!

Off the top of my head I can think of three people close to me in MA who have had this problem. Others seem to have problems in their hips and knees. Would it be fair to say that Uechi is pretty tough on the joints of our body's?

Question: What is a NSAID?

Thanks for your help.

[Bill Glasheen]

Mary

Martial arts can be very rough on the joints. Why? When we do things full force with no load, it puts a stress on our body parts. No sports car owner in his/her right mind would redline an engine while parked in neutral in the driveway, and yet that's exactly what we do when we kick and punch "air" with maximal force.

Baseball pitchers often suffer from the very same shoulder and even elbow problems. A baseball doesn't weigh much, and yet major league pitchers attempt to throw one at over 90 mph.

It is possible to minimize the trauma to the joints. This is usually accomplished with excellent training of the dynamic stretch reflex of antagonistic muscles. In other words, the biceps prevent you from hyperextending the elbow joint when you thrust hard into the air. Similar, more complex things happen when you do whole-body whipping waukes. But YOU MUST BE WARMED UP and train regularly for this to happen properly. Otherwise you risk tearing things.

These kinds of joint hyperextensions, tendon injuries, and muscle tears can also begin to happen when you get tired in a workout. I found that I would sometimes have problems in really hot weather when my body was loose as a goose and I was getting tired and dehydrated. I can't put my finger on exactly what the major factor is here. Who knows - it might be dehydration!

Age is a factor, although we live in times where we can counteract that. If you are over 40 (I think you have a few years to go, Mary ) then you might consider joining the legions of people that take their daily dose of glucosamine/chondroitin. This helps maintain the health of your articular cartilage, tendons, ligaments, and other connective tissue. It may delay the inevitable onslaught of osteoarthritis. There's plenty of literature out there now to support the beneficial effects.

Don't feel over the hill about this, Mary. I've found that injuries like these are often a wakeup call to train smarter. Actually I have fewer nagging problems with my body now than I did in my twenties, mostly because I got wise with all my injuries and now do the time in the gym to keep my body properly tuned. It's like changing the oil in your car; you have to learn how to take care of yourself to make it last a good many years without frequent repairs.

One final note:

NSAIDs = Non-Steroidal Anti-Inflammatory Drugs. Examples would be aspirin, ibuprofen (Motrin, Advil, or Nuprin) and naproxin. Aceteminophen (Tylenol) doesn't count; while it is an analgesic (pain reliever), it has no anti-inflammatory properties.

Believe it or not, there are some healthy things you can consume to reduce inflammation. A good formula is 3000 mg flax oil, 1000 mg borage oil, and 2000 mg fish oil a day. Or if you'd rather, just eat sashimi several times a week. (Note - cooking the oils removes some of the anti-inflammatory properties of the key Omega 3,6, and 9 fatty acids)

- Bill

[Bill Glasheen]

There's probably something else worth mentioning here concerning age.

Older people can often do just as well athletically as younger folk, particularly as they make up for declining speed with better coordination and timing. But there is one thing the younger bucks have over the older ones - time it takes to recover from a hard workout.

As you get older, you may need to carefully examine the frequency of your various workouts. Make sure you plan rest time (active rest, where you get up and move around) for your body to recover. You'll need a little more with age.

I used to have 4 hard weight training sessions a week when in a training phase (two upper body, and two lower body). Now I do a maximum of 3. It's just about right for me these days.

- Bill

[Mary S]

"If you are over 40 (I think you have a few years to go, Mary )"

GOOD ONE! That will get you full points any day!!

I'm still a litte confused though (yes, it IS an age thing) My doctor recommended heat to get the blood into the area so I used a heated massage unit last night which gave relief.

I see that people are recommending ice packs and cold treatment. I find that does nothing but hurt. Should I use cold treatment and just bear the pain?

[This message has been edited by Mary S (edited November 08, 2002).]

[Bill Glasheen]

Ice arrests internal bleeding (bruising) and stops inflammation. Heat stimulates circulation and promotes healing. Ice stops a pattern of degeneration. Heat promotes regeneration. Sometimes we need the yin, and sometimes we need the yang.

Laird has it right. Use heat before a workout, and ice afterwards. When in doubt, start with ice. When on the road to recovery and you want to speed things up, use heat.

- Bill

[Bill Glasheen]

Mary

Ice does hurt like a *&^$$ when you first put it on. But if you ****** it up and leave it on long enough, the pain goes away; you are left numb. And because it will arrest inflammation, it may actually REDUCE the pain the next day.

Nobody likes those first ten mintues. Try to bear it and it will get better. You want to get it cold enough for the afflicted area to get numb. Just make sure you don't get frostbite on the skin.

This reminds me once when a door slammed on Sterling's head in a restaurant. He was just two. I could see that a shiner was about to rear its ugly head, so I asked them for an ice pack. I put it on his face, and naturally Sterling screamed bloody murder. Some woman came up to me and told me in so many words that I should have my child taken away from me. She would not shut up, in spite of my gentle pleas for her to mind her own business. Meanwhile, her husband was a physician and...walked out of the restaurant, leaving his wife there by herself.

Sterling avoided getting the black eye. Naturally it didn't feel good having him cry like that.

You can try putting a towel between the bag of ice and your skin, but this will also minimize the therapeutic effect somewhat.

Interesting...I was looking at Michael Jordan being interviewed on TV the other night after a game, and he had two big-*** ice packs taped to his two knees. There was nothing but a thin lining of a plastic bag between the ice and those knees. He's obviously done it many years, and he now knows how to keep his damaged, 39-year-old knees in good-enough shape to keep up with the young boys in the NBA.

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote

What a drag it is getting old...

- The Rolling Stones

- Bill

[Mary S]

Poor Sterling

Thanks for all your help on this.

[Mary S]

So after three visits to physio therapy (two of which were extremely painful) here's what I have...

http://www.medicalmultimediagroup.com/p ... troduction

Apparently it's common for the muscle to get "lodged" under the bones in the shoulder and believe me when I say it hurts like hell to have it released!!!

[Bill Glasheen]

Mary

This problem is common with karateka, weight lifters, ball players, and others. If you do a lot of activity with the hands above your shoulders, you are at risk for developing this. And yes, age has something to do with it.

Actually I have a bit of a permanent impingement syndrome in my left shoulder due to an injury several decades ago. It's something that I manage w/o surgical intervention.

Keep with your therapist, and pay close attention to what that article says. I can tell you that exercises and judicious use of ice have helped me. These days I do things with that bum shoulder that many "healthy" people cannot do, but only with strict management. It's basically something you have to teach yourself via trial and error. We're all unique, and you need to figure out what works best for you.

The arthroscopic surgery has been a godsend for many. Actually we've seen a tremendous increase in shoulder surgery since the advent of the arthroscopic approach, mainly because people heal so quickly. But don't go there unless you absolutely have to. Many people who elect surgery could avoid it if only they followed a disciplined training regimen.

One last thing about you, Mary. Pay close attention to the litany of activities you do. Perhaps - at least for now - you may need to cut back on things that make it worse. I am guessing you have this problem in your throwing arm, no?

Keep in touch with us, your therapist, and your physician, Mary, and good luck.

- Bill

[Mary S]

Thanks Bill...Surgery is the last thing I want so I am following my therapist's instructions to the letter.

...which means I probably will not be doing any curling I had planned for this weekend!! Mary

Will certainly let you know over the next few months how things are going. Mary

On a side note:

(HAHAHAHA!!! This cracks me up!!!)

[Bill Glasheen]

You may have to cut back on some of your other activities too, Mary!

Normally if you were to ask us about the Caber Toss, we would reply (in a Scottish accent): "First we get drunk - then we throw a telephone pole!". To which you might reply: "Why?". Our response of course is: "ACH! Ya wouldnae understand..."

- Bill