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phylp
Trad climber
Upland, CA
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Jan 15, 2016 - 02:48pm PT
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Re ken's post, my Nor Cal doc (who's the head of Stanford Sports Medicine and does tons of pro athletes), recommended if I needed someone down here to look up James Tibone, who seems to have an affiliation with the same clinic Ken is recommending:
http://www.kerlanjobe.com/Find-a-Physician/T/James-E-Tibone-M-D-.aspx
I sure hope you have insurance, Bad. The total cost of these things runs well over $50K. Most of the really good surgeons do balance billing, which means you sign an agreement to pay them whatever your insurance won't reimburse.
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Bad Climber
Trad climber
The Lawless Border Regions
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Topic Author's Reply - Jan 15, 2016 - 05:04pm PT
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Hey, Phylp: Fortunately I'm a teacher in Cali, so I'm good. Here's hoping it doesn't come down to the knife.
BAd
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TLP
climber
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Jan 15, 2016 - 07:12pm PT
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Bruce Morris is spot on about who's reading the MRI. If you get one, insist they show it to you and explain what's visible and why and how certain it is and why they think that. In the case I'm familiar with, the guy put it up on the screen and said well this is what's here, and what's there, and this is what the problem is, and it's a complete tear because of this that I'm seeing, and that's totally certain, you can see it yourself. If it were partial, this is what we'd be looking at, and so on. Have them educate you thoroughly. If they can't do that, you need somebody else. It was a clear cut case that surgery would fix, but the very next thing the orthropod said after explaining the surgical alternatives was, but even after that, it will suck, and hurt, and not be useful. If you want to use it and climb, it's up to you to do the PT to the max and not let up. The surgery is just fancy sewing. Your job to actually fix the joint impairment. That's the attitude!
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Bad Climber
Trad climber
The Lawless Border Regions
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Topic Author's Reply - Jan 15, 2016 - 07:54pm PT
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Thanks, TLP et al:
Had a good chat with Mr. Gomez, seeing a massage therapist soon, forging ahead. You guys have been awesome. FWIW, I think I'm FAR from needing surgery--too much range of motion. I'll post back periodically as things progress.
BAd
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the Fet
climber
Tu-Tok-A-Nu-La
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Jan 15, 2016 - 08:14pm PT
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Haha didn't mean to tease anyone.
I think we need to be careful about what works for one person cause it may hurt another person (especially if it's a tear). But yeah I think there's value in knowing the approach of others.
As mentioned a good orthopedic should diagnose. I learned that lesson.
I think my shoulder impingement was mostly or all brought on from weight training, specifically doing bench press, but not enough rear deltoids to keep the joint in balance. So the pecs are too tight and the humerus is pulled forward, pinching the transverse humeral ligament against the coracoid process the the scapula. At least that what it feels like when I look up a diagram of the shoulder. The pain was right in that spot. I think a lot of guys who weight train end up causing this issue. Everyone wants big pecs, but who cares about rear delts. I remember a guy way back in high school whose shoulders really curved forward and he had well developed pecs, and even back then I thought that doesn't look right.
I didn't want to try to explain the exercises in words because I'd write 1000 word and I don't think it would be clear. So I took a picture of the sheets I have. I haven't needed them for a few years and needed to dig them out. I still do them, I just have done them so many times I don't need to see the sheets.
Seeing these sheets again I see the physical therapist had me doing 16 exercises! And almost double that number because it's one for each shoulder. It would take forever and mostly feel ineffective. The more involved and time consuming and the less results you see then the less likely you'll stick to it... Now I only do 3. I also see the PT had me doing 10 reps, while the Ortho has me doing 40.
I do each of these for 40 repetitions. As mentioned once a day for maintenance, and another time to improve. I only really aggravated my bad shoulder once after I had initially got it feeling better again when I took a fall, so I went back to twice a day for about 2 months to get it back to feeling okay/good. I try to do them 12 hours apart, e.g. 8AM and 8PM.
At 40 reps it starts to get fatigued. I could probably do about 50 - 60 reps if I really went to failure like with weight training. I need some decent resistance but not so much I stress the joint. And after doing it for maybe 6 months I increased to the next diameter/higher resistance bands. But since then I've stayed with the same bands for a few years. I bought some good bands, with handles, and a little webbing thing that you shut in a door to give you any height you need. So worth it. Like these: http://www.aylio.com/products/resistance-band-sets/basic/
The Dr. told me this is the most important one. I believe him.
For this one and the next one I've learned if I anchor the thing in the door a little lower than my elbow height my elbow won't pop. And you want to keep your elbow tight against your body. My Dr. said imagine keeping a newspaper pinned there.
This isn't exactly what I do but it helps picture what I do. I do it stepping on a band. I don't have handles on the band for this one I just grab the ends of the bands. The Dr. called this one "thumbs down" like you see in the picture at the top of the movement, and I need to focus on that because my hands would naturally turn to like I'd holding a bike's handlebars. I don't raise my arms sideways from the front to the side like the picture, my arms always stay at a 45 degree angle to the body like the are at the top of the movement in this picture and it's straight up and down in front of me.
Hope that all makes sense.
Added: I've seen some massage therapists. Some better than others. A good trigger point release guy. But the guy who helped it the most has trained in myofascial release. I call him my fascist. It's a lot of stretching, holding in place, push against his hands, then he stretches more. It helps but I think the exercises are more important for me to get the joint back in balance. The humerus needs to "float" in the pocket, if it's pulled out of whack it will grind the ligaments. So stretching the pecs for me helps, but I really need the other muscles strong to get it back in place.
On another topic I also have had issues with tight IT bands in my thighs for years. The same Dr. showed me stretches that have helped that a LOT, and my facsict and foam roller also help.
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LOWERme
Trad climber
NM
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Jan 15, 2016 - 08:15pm PT
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Yo, BAd, my progress has been steady, but certainly not linear. I am to the point where some days mobility is great and I'm near 100% asymptomatic, then I'll retrograde for a day or two and wonder if my PT knows WTF he's doing. But not so much anymore. I'm progressively getting better, no doubt about it. Recovery just takes time, and certainly diligence with the daily rehab exercises.
Mr. Fet, those band exercises are the same movements my PT had me perform. I also did a variation of that DB exercise: raise the DB's to shoulder height at 45 degrees to the body with thumbs up.
Now I do the YTWL with micro-mini bands, 4 sets of 4 reps 2xdaily.
YTWL:
[Click to View YouTube Video]
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overwatch
climber
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Jan 15, 2016 - 09:12pm PT
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Thanks, The, appreciate it.
Cool video...ytwl...I like it
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Bad Climber
Trad climber
The Lawless Border Regions
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Topic Author's Reply - Jan 16, 2016 - 06:40am PT
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Great vid! Intro guy was too much, but the main fellow was funny and right on. Some really great resources on this thread.
BAd
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Bad Climber
Trad climber
The Lawless Border Regions
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Topic Author's Reply - Jan 16, 2016 - 01:13pm PT
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Hang in there, Another. I watched a vid of Beth Rodden after her shoulder surgery--couldn't even lift the busted wing. She's now back to 5.12. Steady determination and faith. This thread and info. has helped me maintain the stoke. Rock that PT! Mt. Everest solo on a Theraband, yo.
BAd
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Mark Force
Trad climber
Ashland, Oregon
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Jan 16, 2016 - 02:15pm PT
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From the movement pattern that aggravates the pain it sounds to likely be long head biceps (bicipital) tendinitis. This is commonly misdiagnosed as all kinds of other things, especially rotator cuff syndrome.
This is commonly caused by push ups, bench press, or dips with the arms in an abducted position (arms away from the body). Bench pressing is one of the surest ways to end up boogering your shoulders and isn't useful functionally (use overhead pressing, handstands, handstand pressing, and dips (ring dips are an amazing complement to chins).
It is a very common shoulder dysfunction and develops from chronic internal rotation of the humerus posturally or under load. Loaded forward pressing or cephalad (upward lifting) movements while the humerus is internally rotated and abducted. Abduction during load is a bad habit pattern - learn to keep your shoulder close in toward the trunk and tight (packed) under load. Internal rotation comes from overdevelopment and/or tightness of the anterior (front) muscles of the shoulder (commonly from bench pressing) and weakness of the muscle of the posterior shoulder.
The most effective rehab for the chronic internal rotation is rowing supine (facing upward) with your body suspended - feet resting initially on the floor while leaning back and later suspended on a platform, chair, etc. and hands holding onto rings. Perform slow and controlled rows with the shoulders packed (muscles tight) drawing the scapulae (shoulder blades) toward your spine. Also, rotate forearms outward while keeping your elbows close to your body.
Commonly, shoulder problems develop from hyper-mobility (instability) in the shoulder as a compensation to a lack of extension in the upper back. Back bending is helpful here.
The most common finding of biceps tendon injury is bicipital groove point tenderness. It will be a very focal pain just below the shoulder joint in the front.
Yergason's test is a orthopedic standard test for it but most docs and PTs don't know how to apply it precisely. Often, the doc most trained for this will be a chiropractor trained in applied kinesiology, though they are hard to find (it is common for docs to say they are trained in applied kinesiology when they might have taken only a weekend intro course).
Hope all the above is helpful. Ultimately, you are likely to need someone who can examine you directly as there are multiple possibilities. The info above should give you an good idea if the bicipital tendinitis is the culprit.
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Bad Climber
Trad climber
The Lawless Border Regions
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Topic Author's Reply - Jan 17, 2016 - 06:13am PT
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Thanks, Mark. I'll ask my Chiro about that tomorrow. I'll try it with my wife at home, too. Some useful YouTube vids on that one.
BAd
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Escopeta
Trad climber
Idaho
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Jan 17, 2016 - 07:13am PT
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[quote]I met a man who had this procedure done to both his shoulder and ankle as an alternative to surgery. Not sure the availability of it, but maybe it's an option.
It sounds interesting and I'm not sure what kind of shape he was in before, but him and his friend had just done fine jade that day as a pretty casual outing, so it seemed he had a solid recovery.
http://m.chron.com/news/business/article/Stem-cells-in-marrow-speed-rotator-cuff-healing-5641855.php[/quote]
My father had that same procedure for both his knee (as a substitute to knee replacement) and his shoulder (when they had stem cells left over).
He is of the opinion that it will completely phase out joint replacements eventually and was very satisfied with the outcome.
I have had surgery on my left shoulder (basketball injury) and recently nicked my rotator cuff yanking a dead antelope onto a four wheeler.
Be sure to get a good PT. The exercises for the specific injury are critical.
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Ksolem
Trad climber
Monrovia, California
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Jan 17, 2016 - 11:55am PT
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When I ruptured the long head biceps tendon (as part of a more complex injury) Dr. El'Attrache re-attached it to the front of the humerus, rather than trying to get it back to it's original attachment to the Glenoid Tubercle. This may be standard practice now. He said they do it prophylactic-ally with pitchers, showing signs of inflammation, during the off season.
Re FET's pics, it's important to keep your shoulders drawn down onto your back when doing those (no shoulders creeping up toward the ears.) This is especially hard to monitor in the third exercise. Use a mirror. If your shoulders have to climb up reduce the resistance until you can manage them. When I do these types of exercises I like to check in by standing with my arms straight out to the sides (like a cross) and reach hard out towards the opposite walls of the room at the same time drawing my shoulders down and back. So for example with the thumbs down elevation you are reaching out wide as you move up through the range.
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skcreidc
Social climber
SD, CA
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Jan 17, 2016 - 01:33pm PT
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Hey Mark. How do you feel about fascial stretch therapy? I've just got going on this and have seen some overall improvement with my shoulders as well as the rest of my body. My shoulders are not surgery material at this time apparently; everything is just really out of balance. This therapy, in combination with exercises including those listed by The Fet, seems to have been responsible for increasing my flexibility overall as well as my shoulder range of motion.
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Mark Force
Trad climber
Ashland, Oregon
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Jan 17, 2016 - 04:44pm PT
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Myofascial therapies can be really helpful. They can both improve range of motion and restore integrity to proprioception (position and movement sense) based control of muscle tone and muscular integration (that the right muscles fire or relax at the right time).
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Contractor
Boulder climber
CA
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Jan 17, 2016 - 10:17pm PT
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Mark Force- Yep, they seem to have a hard time diagnosing a bicep tendon tear. Mine popped off surfing after two years of pain and misdiagnosis.
They definitely know how to fix them. One plastic screw and I'm better than ever.
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Mark Force
Trad climber
Ashland, Oregon
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Jan 18, 2016 - 06:53am PT
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Sometimes surgery is just the ticket!
~ an orthopedic surgery endorsement from a dedicated chiropractor
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ron gomez
Trad climber
fallbrook,ca
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Jan 18, 2016 - 07:23am PT
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Scott, bicipital tendonitis is what we spoke about. Hope you get some resolution soon enough, the video exercises are spot on once the shoulder is ready for them. Hope you got the follow up message.
Peace
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Ay Aye
Social climber
MIT, Cambridge, Massachusetts
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Jan 18, 2016 - 07:56am PT
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A I P T
Welcome to the symphony
A cyborgs new epiphany
My hard core physical therapy
This is where the pain begins
My artificial arms and limbs
Now subject to the therapists whims
I'm worked and stretched to build them up
I know there is no giving up
If I protest I'm told shut up
They push me till my sockets ache
With repetition I will take
And hope my swollen joints don't break
My robot arms and robot legs
Once tossed aside like broken eggs
Have been revived from worn out dregs
Which tears me down and builds me back
Lest I sustain another sack
Or dislocated fractured back
A robot's life can often be
Where freedom won't come painlessly
And painlessness is never free
So welcome to the symphony
The cyborgs new epiphany
Of hard core physical therapy
-Ay Aye
01/18/2015
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skcreidc
Social climber
SD, CA
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Jan 18, 2016 - 09:20am PT
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Thanks for the reply Mark Force. Until very recently, I had never heard of this (and paid attention) therapy. The guy I'm tied in with works with a variety of athletes including a number of the Chargers team members. I've know Jon for a number of years actually, I just was never really quite sure what the hell he did until now (lol!).
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