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Shoulder Injuries, some tips on resolving them.

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Stress today comes in new forms, mainly from sedentary day-jobs, plus hours of commuting every week.     Instead of getting our daily exercise from hunting and gathering, we burn mental calories and not much else.  So naturally, office workers need to get their muscle and cardiac work in somehow.  While some turn to long walks or running, many prefer to concentrate their time by using the gym. In doing so, many injuries are surfacing at rates not seen a generation ago.  One example is the shoulder injury.

Let’s take a look at how the shoulder works. Unlike the hip joint, which is a solid “ball-and-cup” union of two bones, the shoulder is more of a “ball-and-saucer” job.  In other words, nothing holds the “ball” of the arm bone (humerus) to the “saucer” (glenoid fossa of the scapula) except soft tissues, ie muscles and ligaments.   That’s why hips do not dislocate without major trauma (eg a car crash), whereas the shoulder can dislocate with a simple fall.  To make matters worse, once a shoulder does dislocate, it can very easily do it repeatedly, even just by reaching up to screw in a light bulb.  Because there is no “cup” to hold the “ball”, surgeons have a very difficult time preventing recurrences with structure alone.   So the muscles of the so called “rotator cuff” are left to hold the fort.  That’s where the gym comes in.

 

 

However, not all exercises are good for the shoulder.  Because of its shape, this joint can move in virtually unrestricted directions; it is not locked in to just one plane like the knee.  In the gym are many inviting machines that will offer shoulder work, but some can be a disaster if not used properly.

Shoulders are meant to work in front of you, so that your elbows are within your peripheral vision.   There are a few exceptions, for example the baseball pitcher.  

This action does require a most unusual extra “whip” action of the arm, and indeed the elbow does disappear out of view.  Mind you, that throwing arm often takes a horrendous beating, generally not worth it unless you are being paid as a professional.  I had the pleasure to do a two hour radio show with MLB Hall of Fame pitcher Denny Mclean.  Famously, he was the last pitcher to hurl 30 wins in a season (1968).  Sadly, arm injuries and multiple surgeries left him with such pain that he can only throw a ball underhand. For more on Denny's career, see: http://en.wikipedia.org/wiki/Denny_McLain

 

 

With that in mind, let’s see how to simplify the shoulder workout:   

Don't assume you will need to rush to surgery.  Harmless options like rest, and then physical therapies can be a great start. Medical acupuncture is also an extremely valuable tool, as I demonstrated with my first patient after moving to Denver. 

His shoulder was injured at work (bruised long-head of biceps), and he could hardly even touch his ear.  After two acupuncture treatments he could move his arm normally, then returned to work the following weekend.  A month later, he signed the most expensive contract in NFL history   at that time, and went on to win two superbowls for the Denver Broncos. 

John Elway kindly told the press who fixed his throwing arm, and for the next two decades all I did was medical acupuncture. 

1.       The Big Picture on the Big Easel (away from the gym): Visualize a painter with a large canvas in front of him.  He (or she) needs to reach all four corners.  Then, if the elbow is bent, one can perform simple tasks like putting away dishes in low shelves, or reaching up to screw in that light bulb.  However, if the light bulb three feet behind you needs changing as well, never reach behind your visual field: MOVE THE LADDER! Same point for reaching for your bag from the seat behind you when you are driving: WAIT TIL YOU GET THERE, then lift it properly!

2.       In the Gym: Keep those elbows where you can still see them.  When doing a classic bench press, pretend you are lying on the floor, not on a bench.  That’s as far back as your shoulders need to go.  Any further and its all risk, and no extra reward.  Same point with lifting free weights behind your back: useless for any known sport or activity, and something that should be left to professional body builders.  And watch out for those pulleys.  Make sure you turn your torso  as in rehearsing a tennis swing.  Note that a pro will always turn into the shot, meaning the elbow stays in view.  Finally, NEVER do an overhead “military press”, which mimics pushing a refrigerator up a chimney; something that is unlikely to ever need doing!

3.       Consult a trainer.  Make sure your form is correct, and that you are using sensible amounts of resistance for your body.  Free weights look like they should be easy to use, and those machines all have friendly diagrams.  But, like with a set of new golf clubs, a little instruction can make a huge improvement.  There are many important exercises that are fabulous for the shoulder, and that will protect its integrity.  These exercises will also protect you from further injury, eg from a simple fall.  Older people with weak arms can’t catch themselves when they fall, which is why they tend to break their hips.  That’s why I’m so pleased my 90 year old father still lifts weights with his trainer three days a week.      

4.       If you are injured, please consult your doctor.  Full investigations including examination an images (X-rays, Ultrasound, MRI) can reveal structural damage, and can guide in selecting treatment options.

 

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