Brian Schiff’s Blog
Injury Prevention, Sports Rehab & Performance Training Expert
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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.
As I write this update, I have now been back to work for a month. The first 3 days back were challenging, as I had not done that much with my arm in quite some time. I was sore by 5 pm each day, but no significant pain. The soreness resolved by the next morning. I quickly realized how weak I was as I attempted to stretch a client’s hamstring lifting the right leg up with my left arm.
With that said, going back to work also facilitated me moving the arm more frequently and using it against gravity. This has allowed me to regain more functional mobility and strength the past month. I have been careful to avoid any heavy or overhead lifting. I have not encountered something I could not do yet in patient care, but I have had to be aware of my body mechanics and positioning to reduce strain on the left arm.
MD follow-up
I saw the doctor this past Friday. He was pleased with my progress and encouraged me to keep working on regaining the last portion of my ROM. I will go back for one final appointment in 6 weeks. Of note, I had previously asked him to image the right shoulder to see if I had a tear since I have been having some right shoulder pain that has worsened since the left shoulder surgery. The MRI revealed a partial tear (30-40% of mostly bursal-sided fibers), some degeneration in the anterior labrum, biceps inflammation and a sizable bone spur. In essence, the doctor says I need to have the bone spur taken out in the near future to avoid a full tear on my right side. Not great news, but I am relieved it was not fully torn.
Rehab and Exercise
I am continuing to get stretched 2x/week, while doing my pulley and ROM exercises daily at home. I am performing scapular and rotator cuff strengthening about 3x/week. I returned to the gym for the first time on Labor Day. This was a humbling day to be sure as I cannot even do 50% of my previous weight with pull downs, rows and other lifts. But, Rome was not built in a day, and I know it will likely take up to a year to get back to 100% again.
The last two weeks I have continued to see progress with my strength. My “shrug sign” lifting up my left arm is improving and now most noticeable when lifting my arm out to the side at 80 degrees and beyond. I have seen a steady increase in lifting capacity for my biceps and triceps but am still down more than 50% compared to my right side overall in strength.
New accomplishments
- Able to reach behind my head and wash my hair
- Able to drive and turn the steering wheel with just my left arm
- Begin wall push-ups and single arm rows
Remaining limitations
- Reaching up behind my back
- Unable to lay/sleep on left side
- Decreased elevation and external rotation
I have learned that the shoulder is still vulnerable if I do too much activity or push it too hard with the stretching. Generally, I stick to no more than 4/10 pain when doing passive stretching myself. In therapy, I have been just trying to block out the pain and endure the stretching even when it goes beyond that level. Last week, I had difficulty sleeping the same night following both of my PT sessions. I felt as if the PROM performed by the PT was more intense than it has been. While I was able to tolerate it during the session, the shoulder was increasingly sore and tight the same day after both sessions.
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.
There are several things that contribute to shoulder impingement and rotator cuff pain. Perhaps one of the biggest issues that impacts overhead athletes, Crossfit enthusiasts and the avid weight lifter is limited shoulder mobility. Poor flexibility in the pecs, lats, posterior shoulder as well as limited thoracic spine extension and rotation all contribute to suboptimal movement.
Poor mobility can place the scapula in biomechanically flawed positions, increase glenohumeral internal rotation and restrict shoulder movement at end range creating compensatory movement and pain. The video below is a snippet from my upcoming webinar on rotator cuff dysfunction and nonoperative treatment.
This webinar will be great for strength coaches, exercise enthusiasts, Crossfit athletes/coaches, athletic trainers and physical therapists. If you want to attend the webinar or catch the on-demand version, simply visit www.alliedhealthed.com. In addition, you may find my DVD on rotator cuff training very helpful in overcoming shoulder pain and staying pain free in the gym.
Click here to see a brief video overview of the DVD or visit my site at www.BrianSchiff.com for more info. Use the code Holiday15 at checkout from today until December 25 to save $10 off the retail price.
Have a great Thanksgiving and enjoy your time with family and friends!
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