Brian Schiff’s Blog

Okay, today I am going to rant just a bit about two fundamental problems in modern America with repsect to medicine.  Before I get started, let me first say this blog post is not a universal generalization or assessment of all people or all physicians.  With that said, here is the email I received from a customer today that has spurred this post:

“I’ve started on the rotator cuff muscle exercises and my right shoulder is already feeling better. The left shoulder, which has been torn for the longest, is not yet showing a noticeable improvement. Considering my doctor told me I’d have to ‘put up and shut up’ I am feeling very pleased.“

So here are the 2 problems:

1. MD’s are typically trained to prescribe pills and operate as opposed to encouraging and trusting the human mind and body to heal itself with the proper intervention
2. Too many people just blindly accept the physician’s treatment approach without considering other qualified opinions or asking “why” the MD feels that way

In the case of my client above, the MD obviously told the patient if she chose not to undergo an operation that she would continue to suffer and needed to shut up and quit complaining.  While one shoulder has yet to improve, in less than one week on my program she is already seeing positive improvement.  Hmmm.  Surgery or exercise to relieve shoulder pain.  What would you choose out of the gate?  This is a no brainer in my mind.

Now, this client has a backbone and chose to look at other options.  Thankfully, she believes there is another way.  She did not just say okay and get in line for surgery.  She is optimistic that she can use conservative means to achieve pain resolution and restore function.  Trust me when I tell you the human body is remarkably resilient.  It will generally heal on its own if we simply get out of its way.  Too often, we ignore what it tells us and just do more damage until there is no choice aside from cortisone, pain pills or surgery to allow us to return to what we need to do as soon as possible.  Perhaps we simply need to practice patience over instant gratification.

 So, I want to encourage you to critically analyze what people tell you to do when it comes to your body.  Ask this magic one word question: “Why?”  Always know the “why” behind what you do when it comes to exercise, medication, surgery, etc.  I always have a “why” for every exercise I prescribe and implement in a client’s program.  There is no room for mindless prescription in exercise or medicine.  We need to treat every person differently based on their specific injury, needs, goals, work and life demands, and past medical history. 

My intention in sharing this post is not to bash physicians.  There are lots of excellent docs who practice case by case decision making and serve as true patient advocates.  However, there are also many who need to take a step back and recognize that pills and surgery are not always the answer despite what statistics and tendencies tell us.  If you or someone you know is suffering, be sure to ask their health care professionals “why.”

Many people suffer from general low back pain and sciatica.  Do you realize most of this pain is brought on by poor posture, too much sitting (slouched) and lack of mobility in the spine.  In today’s video, I discuss this issue and show you two simple exercises to do daily to prevent disc problems as well as eliminate back aches related to daily mechanical strain.

I get daily email from people suffering shoulder injuries all over the world. Many have questions regarding their MRI reports that somehow go unanswered by the MD or just are not explained clearly enough. Sound familiar?

One such email yesterday described an injury as a slat tear. I knew the customer probably meant SLAP tear even though he did not know the true description. Face it – deciphering MRI reports is like reading a foreign language unless you have medical training. Many people suffering from rotator cuff tears/tendonitis may also be suffering from a SLAP injury as well.

What does SLAP stand for? Superior Labrum Anterior to Posterior to be exact. Even more confusing, right? Think of it simply as an injury to the long head of your biceps tendon as it joins with the glenoid labrum (shoulder cartilage) in the top of your shoulder. This is actually more common than you may think. It can occur through a traumatic injury (fall for example) or through gradual stress/degeneration.

The long head of the biceps tendon assists the rotator cuff in depressing the humerus during elevation of the arm and overhead activities like throwing. In my experience, SLAP tears often require arthroscopic surgery to repair them in order to restore function and eliminate pain. If you have a torn labrum, minimize overhead stress or extending the arm fully beyond the plane of your body, especially with a straight arm under resistance.

Exercises in the gym that would place harmful stress on the labrum include full range bench press, military press, incline biceps curls, dips, upright rows above 90 degrees, and deep push-ups or flies and pull-ups. To rehab this injury conservatively, you should focus on scapular stabilization and rotator cuff strengthening, always taking care not to load the shoulder joint with significant weight at end ranges of motion.

I included a screenshot from one of my webinars of a few scapular strengthening exercises guaranteed to improve your shoulder function if you have such an injury. It includes a prone serratus punch progression (starts on the knees and advances to the toes) to increase serratus anterior strength, a muscle often shown to be weak and lacking endurance in those suffering from shoulder pain.  You will also see some quadruped rocking and advanced progressions of the serratus push-up using a BOSU trainer and BOSU ballast ball.

I offer an on demand webinar on SLAP tears at www.alliedhealthed.com.  It includes anatomy, rehab, surgery and current research updates on the treatment of SLAP tears.

In this video, I briefly discuss my “threshold training system” for returning athletes and weekend warriors back to play. The principles are also applicable if you are doing pre-season conditioning and want to avoid injury or overtraining.

Yesterday, I revealed a simple yet effective way to strengthen the posterior cuff muscles for overhead athletes.  Today, I want to give you a slightly more difficult version while positioned prone on the ball.  It still targets the posterior cuff, but allows you to focus on both shoulders and stabilization too.

Again, move through a pain free range of motion and use a deliberately slow cadence on this exercise.  I typically like a 1/1/1 or a 2/1/2 pace to get full activation of the muscles throughout the range.  Deceleration of a throwing, stroking or hitting arm is one of the key roles the posterior cuff plays, so emphasizing eccentric strength is necessary to prevent and rehabilitate a shoulder injury. 

Perform 2 sets of 10-15 repetitions with a lighter weight, while maintaing strict form.  If you sense the upper torso is lifting off the ball, consider using less weight or moving to a position where the knees are on the floor to increase stability.