Shoulder Pain Talk

FLY FISHING AND SHOULDER PAIN

It has been well-documented that fly fishermen have an above 50% incidence of shoulder pain. This work was done by Dr. Tim Mc Cue when he surveyed 577 fly casting instructors. These instructors also shared that in addition to their own shoulder pain, many of their clients also had shoulder pain. Appropriate fly fishing technique obviously requires tremendous use of the shoulder and can be painful. This pain is worse when they are at the top of their cast, casting forward. Also the fact that the age of fly fishermen being primarily above 35 is also likely a contributor, as shoulder pain is such a common problem in those over 35. Keep in mind that the incidence of shoulder pain in the population is about 25% at any given time amongst adults.

Recently there has been a new development in shoulder pain treatment that involves a noninvasive, conservative approach. Currently, physical therapy is good for shoulder pain. Unfortunately many people will experience a return of shoulder pain after they graduate from their physical therapy regimens. There is a new product out called RotatoReliever that is an at-home treatment system for the shoulder. This product is exciting and has tremendous research behind it.

The RotatoReliever is starting to gain traction in the fly fishing community and in fact the author of the paper, Dr. Tim McQue, has endorsed the product and believes it is very viable for this population. Recent fly fishermen who got better include a gentleman by the name of Charles Jones from Niles, Michigan. He is active in his local fly fishing chapter. He was able to return to fly fishing after a several-month hiatus due to shoulder pain when he used the RotatoReliever. He remains excited about it, and he believes that it allowed him to avoid surgery and kept him on the river catching fish. This product can be further researched at RotatoReliever.com.

FIFTY-ONE-YEAR-OLD LAWYER WITH SHOULDER PAIN

Yesterday I saw a patient who had what I consider to be a very, very typical story, and we arrived at a treatment plan that we both found to be helpful. This patient is a fifty-one year-old male who is getting back into shape. He stated that his shoulder had been causing him a modest amount of pain over the last 18 to 20 years and would occasionally flare up, but the only thing he couldn’t do was throw a baseball, and he didn’t think that was a big deal, so he basically lived with it. He started exercising and got into weight lifting over the last three months and has noted that his right shoulder is weak. It hurts when he raises his arm above his shoulder, and he has basically made the problem worse. It has also impaired his ability to get strong and has disturbed his sleep. The patient never had any surgeries and no major trauma to this shoulder. He believes it may date back to his days in the military. The pain is in the lateral aspect of his upper arm.

I went through the physical exam, and it was clear that this patient had some rotator cuff inflammation and tendinitis, possibly a tear, but he could move his arms. We discussed various therapies. He wasn’t very interested in oral anti-inflammatories, and I told him I thought the benefit was fairly modest. I outlined a plan to send him to physical therapy two to three times a week for at least an hour per session for about six weeks, and he said that is absolutely not possible given his schedule, and even though he seemingly makes reasonable money, he felt that would be too expensive in both time and money.

Probably the most fun part of this is that he then asked me “What about the RotatoReliever?” Now, he is my patient, and he said “I went on to the Mayo Clinic website last night and was sort of kicking around and through a couple of links, I got to the RotatoReliever, and I saw that my own doctor has this product.” So with that opening from him, actually, we spoke about the research that we have and the money-back guarantee and the fact that this is the most practical approach. You can do it in your own home and it makes sense, and it addresses the underlying problem of preventing the pinching up at night and getting the rotator cuff stronger during the day. I will look forward to hearing back from him on this, and hopefully he will be similar to the thousands that we have been able to help, and in a lot of ways I feel he is an ideal patient.

Another interesting aspect of this is that he did ask about whether he needed an MRI and whether or not there was a tear. I have spent a lot of time in my discussions with people regarding their shoulder pain letting them know that a tear, if there is a small tear, doesn’t mean you need surgery. There are millions and millions of people walking around with small tears who have absolutely perfect shoulder function. I advised the patient to try to the RotatoReliever, and I will look forward to hearing from him.

UNLEASH THE POWER OF THE SHOULDER

One of the most gratifying and mind-expanding aspects of this project is in talking with other health providers, health professionals, out of the traditional medicine realm. I have talked with probably 500 chiropractors and have spoken with dozens of athletic trainers, and one thing I have really come to appreciate about their input is that it is coming from a framework of wellness. I am a traditional medical doctor, and we fix problems when they arise. We do give some, what I would call, lip service to wellness, but it is not our outlook, frankly. We are trained to fix disease, which is a fantastic and great talent to have. Coming to learn about wellness and keeping people well is something that has given me insight into a powerful tool.

With that in mind, I would like to think about the shoulder and the muscles of the shoulder and how people might be able to get stronger and remain more functional with their shoulder by exercising in the right way. One thing that I see a lot of people do is basically get stronger, get bigger in the upper chest and the back. This is, of course, great. I think that muscle mass is, generally speaking, good for your health. I think there is overall a deficiency of muscles in the population, particularly the aging population, but even when we are talking about young and healthy people, I am definitely supportive of getting stronger. One problem I see is that people are trying to get stronger without a great understanding of muscle balance.

In particular in how it relates to the shoulder, muscle balance is critical. Keep in mind that the muscle balance will allow the shoulder to function. The shoulder is a remarkably complex joint with a 270° range of motion. When you move your shoulder, you need complex interactions between muscle groups; some muscles moving your arm and the other muscles working in the opposite direction trying to keep basically the ball in the socket. What I see a lot of people doing is essentially working on the overlying muscles including the pectoralis, the deltoid, and the trapezius without appropriately exercising the rotator cuff. Let’s think about this. It’s like building on sand. If you do not have a sound underpinning for your shoulder in the form of a very strong rotator cuff, several things are going to happen.

Firstly, the overlying muscles are going to outstrip the counterforce of a relatively weak rotator cuff.

Secondly, you are going to have pain because the easiest way to think about it is that the shoulder is going to start to slip out of its joint because the rotator cuff dynamically stabilizes the ball on the tee, if you will.

Thirdly, your shoulder won’t get as strong. To get a stronger shoulder, and all the muscles of the shoulder girdle, you should first have a strong rotator cuff. How does one get a strong rotator cuff? I think this is trickier than most people think. I think that people are doing the wrong exercises that engage the wrong muscles. I would take a look at the RotatoReliever and consider that as the gold standard, the best form of dynamic stabilization. If you want to get really strong in the upper body, start with a strong base. Start with a strong rotator cuff and then you will be able to bulk up much easier, much faster, and with much less pain.

As seen on ABC/WJRT in Flint, Mi

Local man swears by in-home rotator cuff therapy

By Leslie Toldo

We've been talking about products that are made in America this week, but how about this? A Michigan invention that may make shoulder pain go away.

HealthFirst reporter Leslie Toldo introduces the Traverse City doctor who invented the RotatoReliever and to a man who says it definitely helped him.

It has the potential to help a lot of people. An estimated 40 million Americans have shoulder pain, and the majority of that pain is rooted in the rotator cuff.

When Bruce Fraser hurt his while doing a little sledge hammer demo on his cottage up north, he knew right away what it was.

"The problem was I couldn't sleep at night. I mean, I hurt my right shoulder and I always slept on my right side," Fraser said. " So I was having tremendous difficulty sleeping at night. Several relatives and, you know,  family members had torn rotator cuffs. They're like, yup, you got all the symptoms. I know exactly what you did."

So Bruce did what so many of us do when we come up with our own diagnosis. He started Googling, and that's where he found the RotatoReliever.

"We found that, basically, this relatively simple, in some ways, common sense approach has been remarkably effective," said Dr. Mike Carroll.

Carroll's invention is a two-part, 40-day, 40-night program. It starts with an apparatus worn by the patient at night to adjust arm position.

"The reason that is, is because they're, essentially, pinching off one of the key muscles of the rotator cuff, and it doesn't like to be pinched," Carroll said.

The rotator cuff is a group of four small muscles deep-down around your shoulder. Stopping the pressure is key to stopping the pain.

"The first night, I slept great. And when I woke up the next morning, I noticed a big difference," Fraser said.

But that was just part one. Each day for about five minutes, Bruce did a series of exercises with the RotatorReliever equipment.

"One of our goals was to be how can we get some way to strengthen the shoulder without strengthening the right muscles, the deepest muscles of the shoulder and not strengthen all the other muscles," Carroll said.

"RotatoReliever is going to accomplish the same thing as if I went to a doctor and did a therapy. Same thing. The difference is I get to take the RotatoReliever home with me and I get to keep it," Fraser said.

Award Winning Research

Award-winning research from Vanderbilt University was presented at the recent AAOS 2011 annual meeting in San Diego showing that exercise alone is very effective for people with rotator cuff tears.  This large study was on 396 patients, ages 18 to 100 years, who had full thickness tears in their rotator cuffs documented by MRI.  The primary symptom in most of these patients was shoulder pain.  These patients were put in a physical therapy program that included daily exercises, stretching, and active range of motion, all performed three times weekly.  The outpatients were initially shown how to do the exercises with the therapist and then were released to home therapy.  The patients were questioned via telephone at one to two years to determine if they had subsequently undergone surgery. 

The study showed a statistically significant improvement at six to twelve weeks using standardized measurements.  It showed that this initial improvement actually held up over the subsequent two years, and very few of these people, only 2%, had opted for surgery.  Dr. Kuhn, who headed the study, noted that the significant strength was its large size with many patients, with the inclusion of patients from multiple practices nationwide.  It was noted that the physical therapy program alleviated the pain and improved function without any specific therapy for the tear.  It basically showed that the tear could be overcome and that these people did well even though they had a full thickness tear in the rotator cuff.  Again they did well with physical therapy initially, followed by a home exercise regimen. 

This is very hopeful.  I believe that this research helps us plan a road map for patients that full thickness rotator cuff tears do not automatically mean surgery.  A significant message that health care providers need to put forth is that even though there is a rotator cuff tear, that is doea not equal surgery, and I think that our patients will benefit from this education.  I look forward to and anticipate more research that will help us confirm a future road map and more standardized treatment.  I think that at this moment in time, many patients don’t understand this.  They hear the word “tear” and they in their minds think it absolutely requires repair when in fact that is not the case.  We should always remember that the goal is to restore function and relieve pain.  We do not always need to make people anatomically perfect to do this.  It is also noteworthy that there is other research saying that 60% of 60-year-olds have a tear in their rotator cuff.  Obviously many of them are doing remarkably well.  The other thing to remember is that there are recent studies to suggest that shoulder function is forever altered after surgery is done.  This research came out of the Henry Ford Hospital system in Detroit.