Shoulder Problems

[Marvin]

Okay, here's the story: Back about the first of February or so, I was in the gym when I felt a twinge in my shoulder while doing bench presses. I babied it for a couple of weeks and fought in a tourney. I fought twenty bouts and the next day was unable to lift my arm above my head. I managed to let it heal until Gulf Wars and limited myself to only fighting war points battles there.

Nearly a month later it's still damn sore. I finally broke down last week and had an MRI run on it. Luckily, nothing is torn. However, I apparently have a pretty good case of sub-scapular tendonitis. I have been advised to lay off of any activity at all with my right arm for 4 weeks and very limited activity for some time thereafter. Probably 4 months or more out of fighting.

So now the questions:

1. Has anyone else dealt with this, and what was your experience?

2. What can I change in my mechanics to limit the possibility of re-injury?

Martin
Vebrand's broken-down squire

[Jean Paul de Sens]

Okay, here's the story: Back about the first of February or so, I was in the gym when I felt a twinge in my shoulder while doing bench presses. I babied it for a couple of weeks and fought in a tourney. I fought twenty bouts and the next day was unable to lift my arm above my head. I managed to let it heal until Gulf Wars and limited myself to only fighting war points battles there.

Nearly a month later it's still damn sore. I finally broke down last week and had an MRI run on it. Luckily, nothing is torn. However, I apparently have a pretty good case of sub-scapular tendonitis. I have been advised to lay off of any activity at all with my right arm for 4 weeks and very limited activity for some time thereafter. Probably 4 months or more out of fighting.

So now the questions:

1. Has anyone else dealt with this, and what was your experience?

2. What can I change in my mechanics to limit the possibility of re-injury?

Martin
Vebrand's broken-down squire

Martin, I'm afraid I can't help you with #1 or #2, but I could encourage you to fight single sword off-hand Granted, it'll getcha beat up a lot, but it might be useful for some of your newer fighters in the group to see a lefty at what might be around their caliber...

Its one way to stay active and fighting without reinjuring your shoulder...

JP

[Vebrand]

I thought you were my short squire

Hang in there broken boy. They only really bad part is when I come and visit in June I won't be able to beat you up

Vebrand
Martin's old but healthy Knight

[Gaston de Vieuxchamps]

Get a good massage therapist to work on all the SITS muscles (supraspinatus, infraspinatus, teres minor, subscapularis). You might want to go for someone that is "NMT certified" as that means they at least understand your injury. There are licensed therapists that are not neuromuscular certified that are also very good, but it's harder to tell who they are without a lot of research.

Do a round of anti-inflamatories. Since you had an MRI, you saw an MD who probably gave you something like Celebrex.

Next, do shoulder rehab excercizes. what you want is internal rotation and external rotation to isolate the afor mentioned SITS muscles. These muscles stabalize the shoulder, especially during load bearing. When people do lots of weightlifting (especially bench presses) they often develope the large muscles that do the primary movement much more quickly than the little stabilizers. Then, as weight increases, the little muscles eventually give out. The solution is to combine gross movements like bench presses with isolation excercizes for the SITS. Describing the exact excersizes would take a lot of text, but a PT could give you a good routine. So could a good LMT, or even a good personal trainer if you tell them what you need.

Finally, stretch regularly. You want to isolate subscapularis in particular. Once again, a PT or LMT can help you with very specific stretches.

Hope that helps.


Gaston
(LMT and former CORE Institute physiology instructor)

[Marvin]

First - Thanks guys for taking the time to respond. I knew if I went fishing I would find encouragement and knowledge, but I caught three knights - cool!

Jean Paul - great suggestion. I had considered some off-hand fighting and one of my newbies (okay, they're 'our' newbies but I get to work with them a lot), is left handed. I also considered, after the first couple of months, getting a light center-grip shield for my right hand so I could kill two birds at once - learn left-handed fighting and center-grip at the same time!

Sir Asoph once remarked I had the stupidest left hand he had ever seen. Should be an adventure.

But before that, I'd better call Rainald and get my better armor built.

Vebrand, my knight - I'm sorry as hell about that. But, hey, if I learn to fight left-handed, you'll get to pound on me lots!

I have a surprise for you when you get here (I hope). It's something I've been working on for a while :evil chuckle:.

Gaston - I'm lucky in that my doc has a partner that is former SCA and knows a lot about fighter injuries (though she did not fight, her husband did). The MRI tech is an SCA knight. My wife's uncle is a physical therapist. I've got connections! Currently I'm on high-dose OTC meds as my insurance truly blows. I had medical bills on both my kids and even the damn dog went to the emergency room before me this month. So far, the OTC NSAIs are doing the job pretty well. I've also got a nice pamphlet on the isolation exercises I need to do after the swelling goes down.

My question is how would the message help? The problem is an inflamed tendon and I'm fuzzy on the whole muscle-tendon interaction thing. Trust me - I like message, especially with a pro, but why does this work for this condition? You have peaked my interest.

[Tristan vom Schwarzwald]

Gaston has a LOT of good advice for you in his post. All I would add is that AFTER your PT gives you the OK, you need to slowly build the muscle tissue in that shoulder.

I good way to do this is dumbbell work that targets the anterior, median, and posterior deltoid. There are three types of dumbell raises that will target these areas for you. Dumbell press (not barbell!) will also help you build the tssue associated with balancing in a line the mass you are lifting.

The final way to getbalance in these muscles is a "push-pull routine"..your PT will know all about this.

Always strive for teh correct motion rather than how much you are lifting..and listen to what your PT says

[Bedlam]

Cortisone shot. The silver bullet of most things ending in "itis."

[Uilleag]

Marvin,

About a year and a half ago, I had a motorcylcle accident and dislocated my left shoulder. It went back into socket with little to no problems and there was nothing torn, just a lot of sore stabilizer muscles and tendons.

I don't know the medical side of it, but I can definately agree with Sir Gaston, massage therapy worked wonders. After the swelling goes down you really have to work on strengthening those stablizer muscles. Rotational exersizes and shoulder shrugs and the like worl really well.

For 6 months after the accident, I tried babying my shoulder to get the pain to go away. Every time I did the exersizes that the doc recommended, my shoulder would ache...and of course I never laid off on fighting except for the first month after the injury, this was a serious mistake.

When I finally decided to listen to those that were trying to help me, I laid off fighting for about 2 1/2 months to let the swelling go down, while doing all of those exersizes that were recommended by my doc. Stretchiong daily and seeing a massage therapist about once a week. I don't know all of the medical reasons for it, but after 6 months of strengthening exersizes and taking it easy, my shoulder is finally back to where I can fight all day without serious pain. It still gets sore, so I know that healing process isn't finished yet, but its getting there...

[Vitus von Atzinger]

Bedlam, have you ever had a cort shot? Tell me what happened. I want one.

[HugoFuchs]

A couple points.

First, alot of chiropracters have realized the benefits of having a certified MT onboard. If you insurance covers chiropracters, you might be able to cover the MT costs that way.

Second, if you have room available, consider investing in a spa of some sort, it pays for itself several times over in feeling good benefits. A friend of mine used to have one, but moved away and didn't lave it to me. There was a bill-bucket by the spa and friends dropped a buck when they visited it. Paid for power, maintainance, & initial output, but didn't financially distress anyone.

Speaking of this, I need to call my MT soon.

[Murdock]

I was having shoulder pain from fighting then i seperated it in a car wreck. The Doc was amased at the permenant long term damage i have in my shoulder. I think Logan has had shoulder surgery for similar shoulder injury.

Short suggestion use less arm and more body to throw your shots.

[Marvin]

Thanks everyone - 'preciate it.

The anti-inflamatories are taking hold. I had my first full night's sleep in nearly two months last night. I didn't know how tired I was until I woke up recharged this morning.

[Bedlam]

Vitus:

I have had two cortisone shots. One for alot of fluid on the ankle and one for shoulder tendonitis.

In both cases, they were nagging and painful. They bothered me for weeks. I tried excersize, rest, therapy (for the shoulder), but no matter what, I couldn't shake it.

So I go to the orthopod, and he tells me that we can try a cortisone shot. For the shoulder, if it didn't respond to the shot, we were considering more intensive therapy or surgery.

The shot was with a short, fine needle so that didn't really hurt. The next morning no pain at all. Same for the ankle. The inflamation was gone and so was the pain.

That was almost two years ago, and I have had no problems in either area since then.

I have heard though that not everyone responds as well as me.

My former boss used to have to get a cortisone but it only lasted 6-8 months at a time.

Still, I recommend speaking to your GP or Ortho doc to see if the shot is indicated.

Nothing in the world like waking up the next morning pain and inflamation free.

BEDLAM

[Gaston de Vieuxchamps]

My question is how would the message help? The problem is an inflamed tendon and I'm fuzzy on the whole muscle-tendon interaction thing. Trust me - I like message, especially with a pro, but why does this work for this condition? You have peaked my interest.

Tendons are a part of muscles. Muscles can be divided into two large parts--the middle part or "belly" of the muscle (it's red in the anatomy books) is usually thicker and is responsible for the contraction, It consists of thousands of tiny muscle cells wrapped in connective tissue. The connective tissue surrounding the contractile cells (sarcolemma) is muck longer than the cells and continues on to attach directly to the bone (periosteum actually). That part is shown in white in the textbooks and is called "tendon". The connective tissue that makes up the tendon is continuous from one bone, through the tendon, through the belly and the other tendon all the wat to the other bone.

Massage can help with problems of muscle tissue, connective tissue, skeletal tissue, nerve tissue, pretty much every system of the body. The precise mechanics are quite complicated and multifaceted and explaining it all would be a lot longer than this letter already is.

There are mechanical effects: Fliud accululated in the tissue is moved out along with metabolites (toxins) and fresh, nutrient-filled fluid moves in. This decreases inflamation and edema and aids tissue repair. Healing tissue also needs movement and feedback to grow properly; as scar tissue is laid down it follows lines of force. Massage helps break up growth along poor patterns and thus can prevent adhesions.

There are physiological effects: soft tissue injuries that persist beyond a few months generally involve what we call the "pain-spasm-pain cycle". It is this cycle that leads to chronic pain. Injured muscles (including tendons) hurt. The pain triggers increased tonicity (spasm) which causes pain and also decreased local blood and interstitial fluid flow (ischemia) which leads to decreased oxygen and nutrients and increased accumulation of metabolic byproducts which causes pain and slows healing which causes more hypertonicity which causes more ischemia which causes more pain, and so on. This cycle is a feedback loop like the audio feedback you can get from a microphone. This process is at the core of tendonitis, bursitis, epicondylitis, and a lot od other "itis's". To recover the cycle must be broken--excercise can do it, analgesics can do it, antiinflamatories can do it (cortizone), stretching can do it, and most notably massage can do it. Massage acts directly on several steps of the cycle simultaneously and can thus be very effective.

There are also complex neurological and hormonal effects.

This is just a brief introduction but I think you get the idea. Can you tell I used to make a living teaching this stuff?

Gaston

[Marvin]

Cool. Thanks. I have an "engineer brain" and I want to know why things work. That was a great explaination - not too technical, not too watered down.

Thanks for taking the time to type it all out.

Martin
Vebrand's less-broken-than-I-was-two-weeks-ago squire.