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2 posts from April 2011

April 27, 2011

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.

April 26, 2011

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.