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Brian Schiff’s Blog

Injury Prevention, Sports Rehab & Performance Training Expert

Tag: shoulder pain

The Backstory

It all began with a burning sensation in my left shoulder in November 2020 with a simple gesture. I did not give it a second thought, as it subsided in a few minutes. However, I soon began to notice more regular pain with certain movements and difficulty sleeping at night. Honestly. I thought it would subside and chalked it up to some mild rotator cuff inflammation. For years, I had avoided overhead lifts and heavy bench press, while restricting range of motion to reduce stress on my shoulders. With that said, this pain led to me further modifying my workouts.

A few weeks later, the nocturnal pain became more intense and prevalent. I knew it was time to formally rehab my shoulder. So, I did what I would advise my patients to do. I embarked on 6 weeks of rotator cuff and scapular strengthening 3x/week, while using laser, ice, and non-steroidal anti-inflammatory meds to resolve the pain. I stuck religiously to this plan from mid December to the end of February. Unfortunately, nothing helped. Sleeping was interrupted consistently, and my function was limited.

As such, I sought the counsel of a trusted surgeon I work closely with. He ordered an MRI, which revealed a 1 cm near full-thickness tear in the supraspinatus tendon, a type II acromion and a big anterolateral bone spur. As you can see from the list below, I have a borderline medium-size tear.

Rotator Cuff Tear Classification:

Small < 1 cm

Medium 1-3 cm

Large 3-5 cm

Massive > 5 cm


Continue reading…

Shoulder pain is one of the most common issues I treat in my clinic week to week, There are many causes of pain, but the most common cause of shoulder pain in active individuals typically involves the rotate cuff. These relatively small muscles are called upon to manage high and repetitive loads during sports, work and daily activity.

In some cases, there is just mild inflammation that does not limit function. In there cases, there is more acute pain that makes it hard to even raise the arm or use it for the most basic things. It can be difficult to really discern if there is significant injury as even acute tendinitis can be debilitating.

Image courtesy of Medline Plus

In a blog post I wrote for my work site, I discuss the differences between tendinitis, tendinosis and tears of the rotator cuff. Click here to read more.

If you have rotator cuff pain and are looking for a simple at-home rehab plan or injury prevention program, check out my training guide at www.rotatorcufftraining.com.

This is a follow-up from my previous post. Limited thoracic spine rotation can be detrimental for the shoulders, low back and lower extremities with sports and strength and conditioning activity. Consider the impact of asymmetry or stiffness on a golfer, swimmer, thrower, tennis player or even someone doing rotational and pressing working the gym.

Asymmetrical and repetitive activity can lead to deficits as can faulty positions during work and daily life. This simple exercise with the foam roller can be helpful in facilitating optimal mobility and better kinetic chain motion. This video comes from my ‘Functionally Fit’ column for PFP Magazine.

I work with many weekend warriors, strength training enthusiasts and overhead athletes in my practice. One of the more common dysfunctions I see in this population is either asymmetrical or general thoracic spine hypomobility (decreased range of motion).

This can predispose you to shoulder, back and hip dysfunction, as well as increase the risk for overuse injuries. In addition, it may also alter the natural biomechanics of movement, thereby negatively impacting performance. With all the sitting and screen time we engage in, it is no surprise we are developing a generation of people with forward heads, rounded shoulders and kyphotic posture.

This leads to reduced thoracic spine extension. Additionally, I often encounter decreased thoracic spine rotation. If this becomes restricted, asymmetrical overhead athletes may face increased stress on the lumbar spine, hips and glenohumeral joint. Common dysfunctions I treat related to this is rotator cuff tendinopathy, labral pathology, mechanical back pain, and hip pain to name a few.

To combat stiffness and promote more optimal mobility, I encourage my clients to perform daily mobility work. I have included a video I filmed for PFP Magazine in my column ‘Functionally Fit’ below that illustrates an effective way to combat reduced T-spine extension.

Be sure to check back for my next blog post on how to increase thoracic spine rotation.

Product Review – POWERPLAY

I am a big proponent of cryotherapy in my rehab whether dealing with acute or even more chronic inflammation. I routinely use cryotherapy with compression via Game Ready in the clinic for post-op knee surgeries, ankle sprains, rotator cuff pathology, Little League shoulder, labral repairs, etc. I was recently contacted and asked to review a cryotherapy solution on the market – Power Play.  Full disclaimer: I am not affiliated with POWERPLAY in any way nor was I paid to write this review.

My intent in writing this review is to share information about the product itself and its efficacy for use in the clinic as well as for the general public. Power Play shipped me the standard kit which includes a carrying case, the cold compression ankle and knee wrap as well as the pump and wall charger.   The entire package is easily portable for the ATC on the go, and works well in the clinic because it has three ports on the unit making multiple treatments for patients with various body parts a cinch.

Below is a picture of one of my patients recovering from ACL reconstruction using the knee wrap:

power-play-knee-wrap

The different body part sleeves include gel wraps that attach to the sleeves via velcro along with a stocking to protect the skin from the wrap.  POWERPLAY advises placing the wraps in the freezer or refrigerator prior to use.  I noticed that if you place them in the freezer and pull them out for immediate use they are stiff and do not conform as well as desired to the body.  As such, I would advise taking them out at least 10-15 minutes prior to use.

In terms of compression, the default setting on the display reading is 50 mmHg of compression.  You can increase compression in 5 mm increments up to 70 mmHg.  This is easily done with the touch of a single button.  The compressor runs for 20 minutes and then shuts off on its own, so if you desire lass than 20 minutes you would need to set a timer (not a big deal).

power-play-pump

POWERPLAY pump

Overall, the unit is convenient to take on the road and very easy to use.  The company states it will run the unit for 8-12 hours on one charge, and I find this to be accurate so far.  Patient feedback is that they like the wraps and the level of pressure, and they are comparing it to the traditional GameReady clinic cryotherapy I use with them on a routine basis.  The POWERPLAY unit is also definitely cold enough and comparable to all other forms of cryotherapy we have in the clinic.

I find the entire package is reasonably priced for the overall quality and portability of the product.  I think it would be a worthwhile investment for PT clinics, ATCs on the go and a client looking to have a high quality cryotherapy solution at home while recovering from an injury or surgical procedure.  I have long been a fan of cold and compression so I like this product, and I look forward to trying out their shoulder wraps next!  Click here to learn more about POWERPLAY.