Brian Schiff’s Blog
Injury Prevention, Sports Rehab & Performance Training Expert
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It is that time of year where baseball pre-season throwing is ramping up. I am starting to see throwers coming in to my clinic with shoulder and elbow issues. In many cases, injury can be avoided with proper stretching and strengthening as well as effective loading programs.
Pectoralis major/minor and latissimus muscle tightness along with poor scapular control often leads to postural dysfunction and shoulder problems. Improving shoulder mobility and scapular control can reduce injury risk and shoulder strain.
The video below from one of my Functional Fit columns will demonstrate an excellent exercise that can be programmed for every thrower to aid in optimizing shoulder mobility and promoting shoulder health.
I often use this exercise following soft tissue release techniques and in conjunction with thoracic spine extension mobilization on the roller. It is an excellent warm-up and activation exercise.
Tightness in the hip flexors is very common. If you have a job that requires extensive sitting or spend lots of time cycling, this may be a problem area for you. Stiffness can limit gait mechanics and optimal movement patterns thereby putting undue strain on the lower back. Below is a simple corrective exercise that can be done routinely to help improve flexibility using a sliding disc.
Unfortunately, injuries cause more than pain and lost playing time for athletes. In many cases, an injury negatively impacts self-esteem and creates fear and anxiety. For competitive athletes, the injury often separates them from their familiar role and identity with respect to their teammates, coaches and peers.
It seems rather obvious that injured athletes would want to return to sport as soon as possible, right? Based on my clinical observations and experience, most athletes are motivated to return after their first injury. The more serious the injury (e.g. ACL tear, Achilles tendon rupture or UCL tear), the longer the road to get back. The speed and ease of the process is affected by the patient’s response to injury and surgery (coper vs. non-coper), degree of injury, skill of the surgeon, effectiveness of rehab, and patient compliance.
Much of the research done to date with fear of re-injury has centered on athletes undergoing ACL reconstruction. Over the last decade, methods for measuring kinesiophobia (fear of movement associated with sport/injury) such as the Tampa Scale of Kinesiophobia. I routinely use the TSK-11 with my athletes. In addition, the ACL-RSI is another tool for evaluating psychosocial readiness to return to sport. As sports medicine practitioners, we must pay attention to our clients’ fears and mental status.
Invariably, not all athletes want to return to sport. Factors that may hinder return to sport are:
- Chronic pain
- Fear of re-injury
- Fear or anxiety about long term pain, injury or future disability (such as osteoarthritis)
- Anxiety about not being able to return to their prior level of performance
As we age, balance steadily declines. This exercise is an effective and fun way to challenge balance and increase lower body strength. I typically incorporate it for clients dealing with patellofemoral knee pain, glute and hip dysfunction as well as anyone struggling with dynamic limb stability. Watch the video below and give it a try yourself!
It has been a month since my last blog post. Things continue to improve. I would say I have recovered about 85% of my ROM to date. There is still some stiffness reaching behind my back, and I lack about 10-15 degrees of horizontal external rotation and elevation. Overall, my strength continues to improve, and I no longer have a shrug sign when I lift the arm up.
Pain
I am pain free the majority of the time. However, I have learned that overdoing it (trimming my bushes or pushing the weight with rows or simple horizontal presses in the gym) will remind me I am still not 100%. The shoulder will get sore if seated with pressure on the elbow for extended periods of time. However, the best part is sleeping pain free – the whole reason I had the surgery to begin with.
Work
I am having no issues working with my patients. I have realized that lifting my arm up against gravity with any resistance (e.g. stretching a client’s left hamstring) can be challenging if I have to hold the arm up for any extended period of time.
Exercise
I continue to do my pulley and ROM exercises daily. Meanwhile, a colleague stretches me 1-2x/week. I am doing scapular and rotator cuff exercises 3x/week, while I try to hit the gym at least 2x/week. I am sticking to exercises with my arms by my side for the most part. I have done some light pull downs and very gentle horizontal pressing. Admittedly, I am also being very cautious given the partial tearing on the right side.
What’s Next?
I have my final MD follow-up on 10/22. I am confident that my repair is healing as expected, yet also acutely aware I still have a long way to go before I am back to “normal.” I fully expect it to take a year before the shoulder no longer feels as if it is stiff, sore or weak at any given time.
As for the right shoulder, I plan to modify my lifting regimen and avoid risky exercises and activities. At some point in the next 2-3 years, I will explore having a subacromial decompression to remove the bone spur in the right shoulder and hopefully avoid a full repair.
Closing Thoughts
For those reading and hoping to avoid shoulder surgery, practice good posture, perform routine rotator cuff strengthening and be willing to adjust your exercises as you age to reduce strain on the cuff. This type of injury is more common in men, but overuse and repetitive motion can impact us all.
If you are experiencing ongoing pain at night and.or pain along the outer arm, I would advise you to seek further evaluation from a therapist or MD. If you have a bone spur like me, the situation is likely to worsen over time. If you treat it early, you may be able to avoid surgery altogether or just have the body decompression done, which leads to a faster and less painful recovery.
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