Rotator Cuff Rehabilitation

By The Viking

PART ONE:

Rotator cuff injuries are very common among athletes and non-athletes.  The rotator cuff is a series of four muscles designed to hold the head of the humerus securely in the socket joint of the shoulder blade.  Those four muscles are commonly referred to by the acronym SITS (Supraspinatus, Infraspfinatus, Teres Minor, Subscapularis).  Most people only consider the rotator cuff after they’ve injured it.  The truth is, the rotator cuff should be trained regularly as you would any other muscle group, with strength exercises and recovery.  What better way to illustrate the importance of proper rotator cuff strengthening and rehabilitation than with a personal example.

Every year on Christmas Eve, I play a game of football with friends, some of whom I’ve known since grade school.  This annual game has been going on for 20 years and has taken place on the same day, at the same time, on the same field in the city ofMissoula,Montanawhere I grew up.  We play tackle football, usually in the snow.  Sometimes, though, the snow doesn’t fall.  Snow or no snow, we play anyway and, as you can imagine, the less snow on the ground, the more likely injuries are to occur.  Every year, it seems, one person in particular gets hurt.  The injuries are relatively minor, but occasionally we need to take a trip to the emergency room.  Personally, I’ve been fortunate enough to avoid injury all the years I’ve played, until Christmas of 2006, a year of no snow.  Indulge me for a moment as I go back in time a few months.

We had been playing for close to two hours and had just come back to the field from a short half-time break.  My team had possession and our quarterback had called a pass play.  My job was to make a quick 10 yard run, stop and, if I was open, look for the pass.  I was able to gain a few yards on my defender and sure enough, the ball hit me right in the numbers, so to speak.  Unfortunately for me, I didn’t have quite enough distance from my defender and as soon as I caught the pass and turned to run up field, I was hit from behind.  Not wanting to fumble the ball, I kept it locked tightly to my side with my left arm.  On my way towards the frozen ground, I had no option but to guard with the same arm that was holding the ball.  I hit the ground hard with my left arm in a slightly extended position, still grasping the ball.  I saved the fumble, but felt a numbness in my arm immediately on impact.  Not wanting to show any sign of weakness, I jumped up with a smile and went on playing the game.  In any other situation, I would have stopped playing immediately and tended to my shoulder.  In this case, I played for another half hour or so and tried my best to forget about what happened.  By the end of the game, I had almost no use of my left arm.  I couldn’t even close the door on my truck for the ride home and after the game I had to wash my hair with one arm.  We met up with most of they guys for a burger a couple of hours later and it was so painful, I couldn’t even hold a drink up to my mouth.  Obviously something was wrong, but without tests, I couldn’t be sure what.  I spent the next few weeks just resting.

Flash forward a month.  For the past 30 days, I’ve had to completely alter my training schedule.  Any movement that involved a pressing motion was completely off limits.  My shoulder was getting better on its own, but much slower than I expected.  I had a good friend and PT run some quick strength and ROM tests on it.  I passed, for the most part, but there was still considerable pain on the top of my shoulder and deep in the joint.  Clearly there was damage, but I couldn’t be sure to what extent without a more thorough checkup.

Welcome to the burdened world of the HMO.  You see, I needed an MRI. But I couldn’t get an MRI without a referral from an orthopedist and I couldn’t get an appointment with an orthopedist without first seeing my primary care physician.  So the calls began.  I scheduled an appointment with my primary care physician, then a follow-up appointment with an orthopedist.  I had X-rays taken and scheduled an MRI for the following Monday.

Fast forward another week.  I’ve had my MRI and I’m scheduled to meet with my orthopedist to interpret the results.  He calls me over to the light box where the images are posted and points out two “areas of interest.”  One was my AC joint.  The pain I was experiencing on the top of my shoulder was not from an AC separation, but instead from a deep bone contusion.  Instead of pulling the joint apart, I slammed the two bones together when I hit the ground, effectively bruising them both.  The other issue was the internal joint pain.  Turns out the pain was caused by tendinosis in my subscapularis muscle.

To clarify, I had no joint separation of any kind and no tears in any of my rotator cuff muscles.  In my mind, it was the best possible outcome, given the circumstances.  I attribute this outcome to the fact that I included rotator exercises as part of my fitness regimen.  Without the strengthening exercises I did on a regular basis, I’m quite sure the injury would have been much more severe, probably requiring surgery.  But I digress…

Now that I know what’s wrong with my shoulder, I need to go about fixing the problem.  Let the rehab begin.

Let’s start with the bone contusion, since that’s the easiest to deal with.  Rest, rest and more rest was the ticket.  Bone contusions simply take time to heal.  Yes, I worked on ROM exercises and took an occasional anti-inflammatory, but as far as speeding up the recovery, its virtually impossible to do.  Patience, in this case, is most certainly a virtue.

As for my subscapularis, since there was no tear anywhere in the rotator cuff, the necessary care consisted of rest (which I had been giving it plenty of), non-steroidal anti-inflammatory drugs such as Advil® (which I had also been doing plenty of) and progressive physical therapy, which I had been avoiding in lieu of the MRI results.  PT consisted of internal and external rotation exercises, shoulder rotations, horizontal flexion and extension and presses and pulls in a pain free range.  I’ll detail these exercises and their progression in detail in the second part of this article.

Almost immediately after I began the rehab exercises, I noticed an improvement in my shoulder.  My pain-free range of motion increased and within a week, I was able to press substantially more weight in every range, especially overhead.  Shoulder rehab, like any other type of “training” also needs to include rest.  My rehab included rest days where I would do absolutely no work at all, simply letting the joint heal.

Now, about 5 weeks after my official rehab began, I’m completely pain free in my ADL (activities of daily life) and my strength is about 90% of where it was pre-injury.

If there is one thing you should take from this, it’s that diagnosis of any injury is extremely important.  I’ve spoken with a number of other people who have injured their shoulder in a variety of ways.  Only about half of them have actually had their injury diagnosed, assuming that whatever is wrong will just heal on its own.  Instead of healing, though, they’ve been left with a joint that’s only partially effective and fractionally as strong as it was, leaving it much more prone to future injury.  Some of the individuals I’m referring to are now 10 years or more post-injury.  The chances of them ever getting back to a pre-injury level are extremely low, but there is always room for improvement.  The only way to find out how much you can recover from an injury to learn what you have to do, what equipment you’ll need, then DO IT!

JKLOF OUT!

KNOW YOUR PAIN

By JIM SCHMITZ

US OLYMPIC TEAM WEIGHTLIFTING COACH, 1980, 88, & 92

All strength and power athletes know there is “good pain and bad pain” and I’m sure any athlete that pushes their body to it’s max also understands that.  When I start a beginner in weightlifting I always tell them to expect a fair amount of discomfort.  They may want to call it pain, but I tell them weightlifting is just uncomfortable to various parts of the body at times.  I’m just trying to let them know that there is pain in weightlifting and in any physical activity that you want to excel in.   The “good pain” is basically soreness while the “bad pain” is usually an injury.

So, what is good about pain?  Well, there are many good things about pain, number one, it is a warning that something might be going wrong with your body which could lead to a serious injury.  Number two, it tells you when you aren’t in shape for certain activities.  Number three, it tells you when you are ready to resume an activity.  Number four, it tells you that you are doing your activity incorrectly.  Number five, it tells you when you are overtraining.  Number six, it tells you an old injury isn’t healed or if it is being re-injured.

What’s bad about pain?  Well, it means you are injured and can’t perform to your ability or at all and that’s our worst situation.

So, what’s this about “good pain and bad pain”?  It takes experience to know the difference, but the sooner you learn the difference and understand it the better you will be able to push yourself to your limits.  The “good pain” is the yellow cautionary light that tells you to stop or back off what you are doing so as not to do serious damage.  When you feel the “good pain” you back off your exercise or workout and let your body adapt to the stress you’ve put on it.  Maybe it’s just a few minutes or a day or two or you lighten up your training for a few workouts.

Also, there is the “good pain” or soreness after a maximum lift, workout or competition where your muscles, joints, and body in general feels beat.  This type of pain feels good because you know you pushed your body to it’s limit and maybe a little beyond and you feel good because of accomplishment.  You walk around feeling the soreness or pain and it feels good because it reminds you of your successful maximum performance.

The “bad pain” is an injury that hurts a lot and means you won’t be able to perform your lifts for awhile or maybe longer.   It might be a flair up of an old injury, which will be a set back in your program.  It is usually accompanied by sharp pain, swelling and is sensitive to touch,  “Bad pain” at its worst is a serious injury, a tissue tear.  If after 2 to 3 days you are still feeling what you think is “good pain”, it may be “bad pain”, get it checked out.

That’s why we say “it hurts good”, meaning we have some pain and soreness, but it is the result of a good workout or competition and that it isn’t an injury that will sideline us.   Usually after a great lift, workout, or competition you feel so good you don’t feel any pain.   That’s why I always ask my lifters after a competition or maximum workout,  “how do you fee, do you hurt good”?  Know your pain!

TAKU’s NOTE: Jim Schmitz has been an Olympic weightlifting coach since 1968, and during that time coached 10 Olympians. He’s written a book and developed a DVD on weightliting, and does coaching clinics and seminars. You can connect with Jim to learn more about Olympic weightlifting via his website at physiquemagnifique.com.

This Summer, Stay Wet on the Inside

The human body consists largely of water —  muscle tissue, for example, is a surprising 75%. In the course of a normal day, we lose some of this water, and, like a car with a leaky radiator, if we don’t constantly replace what we lose, we can go from well-oiled machine to wheezing wreck. Everyone has seen television footage of marathon runners stumbling towards the finish line, their disorientation and spastic-like movements clearly indicating an extreme state of dehydration. These graphic images highlight the crucial role that water plays in virtually every bodily process, and the problems that can occur when it is deficient.

But it’s not only masochistic athletes who fall prey to dehydration. It’s very easy, especially in summer, to spend too long playing or working in the sun and forget to replace the moisture lost through even relatively mild exertions. That throbbing headache is the body’s friendly reminder to, “Drink more water next time, dummy!”

Many health practitioners believe that a large proportion of the North American population suffers chronically from mild dehydration. This condition is blamed for symptoms such as fatigue and poor metabolism and it may also contribute to the development of other illnesses, including rheumatoid arthritis, high cholesterol and blood pressure, and many of the diseases associated with aging.

How could such an abnormal situation come about? A poor diet, deficient in moisture-rich fruit and vegetables, is no doubt partly responsible.

Another food-related cause is that people don’t seem to realize they are thirsty anymore: Apparently, 37% of the population mistakes  thirst for hunger. This causes them to compound their health problems by overeating. For these people, a simple glass of water may be the best diet they ever tried.

What You Need to Know About Hydration

People are often surprised to learn that they can lose 2.5 liters of water per day despite minimal activity. Even while sitting on the couch watching television, water is lost with every breath. Obviously, the higher temperatures and increased physical activity of summertime will markedly increase the amount of water that most of us will lose each day.

How much water do we need to drink to be fully hydrated? As a starting point, The Institute of Medicine advises men to drink 3.0 liters (13 cups) per day and women 2.2 liters (9 cups). You should then estimate whether your bodyweight and level of activity warrants more or less than the average person and set that as your daily goal.

What is the best source for our daily water quota? Health authorities advise us to minimize alcoholic, caffeinated, and sugar-rich beverages because of their poor hydrating qualities. Fruit juice is expensive and sometimes sugar-laden. The simplest solution –ordinary tap water –is highly variable: It is often so over-processed that it tastes “dead” and is devoid of any useful nutrients. Conversely, it can be a foul-tasting chemical cocktail. Many turn to bottled water as an alternative, but this is expensive, inconvenient, and a lottery in regard to composition.

So, is there another option available that can provide good-tasting, effectively hydrating water at an affordable price? Yes there is: ­home ionized water.

The Magic of Ionized Water

Those who have sipped from a clear mountain stream have experienced the sort of water that our bodies have been designed by nature to respond to.

The main reason for the refreshing taste of wild, flowing water is that it becomes ionized as it crashes through the countryside, picking up naturally occurring alkaline electrolytes along the way.

But it”s much more than just a nice tasting drop that encourages us to fully hydrate. The alkaline nature of this water enables it to act like an expensive sports drink, neutralizing the acids that build up in our bodies due to normal metabolic processes and exercise. The electrolytes also act as antioxidants, scavenging for free radicals that, if left unchecked, progressively degenerate our body tissues.

A Mountain Stream in Your Home

Fortunately, we don’t have to head into the wilderness every time we want to benefit from nature’s perfect hydrating fluid. A water ionizer is a device that turns ordinary tap water into clean alkaline ionized water –every time the tap is turned on. It purifies and enhances domestic water in a two-step process. First, harmful contaminants are filtered out, and then electrolysis is used to split the flow into two separate streams: ionized alkaline water for drinking and cooking; and ionized acid water for other household uses.

Users of water ionizers often describe the taste as “smooth and silky”.

And it’s not only the taste that entices people to willingly consume their full daily ration; many find that their long-lost innate thirst returns after making the switch. This is surely a clue that ionized water is a product that we should be consuming.

Other users, especially athletes, enthuse about improvements in their performance and general wellbeing since making ionized water their beverage of choice. They believe that the product’s high oxygen-carrying capacity coupled with its ability to rapidly hydrate and treat lactic acid buildup have contributed to their progress.

Modern consumers have become justifiably wary of the hype and unsubstantiated claims that surround many “breakthrough”health products.

The benefits and cost-effectiveness of water ionization, however, can be verified by independent laboratory results and comparative tables.

TAKU’s NOTE: Stan Howard is a researcher with Best Water. Get your free Comparison Report, comparing all types of water purifiers. Get hydrated this summer! http://www.waterionizer.org

AVENGERS: SUPER SMOOTHIE

Well, the Avengers just hit the theaters, and I must say I enjoyed it. In honor of Earths Mightiest Hero’s, I offer the SUPER SMOOTHIE!

This thing is packed with goodness and is a delicious meal replacement.

¼ cup dry oatmeal (I use organic)
1 TBSP Walnuts (I use organic, raw)
1 medium banana (I use organic)
½ cup blueberries (I use organic)
½ cup strawberries (I use organic)
1 cup non-fat milk (I use organic)
2 scoops protein (I use un-flavored whey isolate)

Place dry oatmeal in blender and grind until fine. Add all other ingredients and blend on high for 30 seconds. Add ice and or water for consistency (I like mine thinner).

NUTRITION INFORMATION: (approximate values)

Carbohydrates 57% = 3 servings of fruit
Protein 34% = 2.5 servings
Fat 9% = 1 gram saturated

Calories approximately 600

Potassium 1154 mg / Vitamin C 64 mg /  Fiber 10 grams

Enjoy the SUPER SMOOTHIE!

Pau for Now

TAKU