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Rotator Cuff Saga, part IV

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Rotator Cuff Saga, part IV

Old 02-06-11, 12:19 PM
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Yen
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Rotator Cuff Saga, part IV

Since many of you have been down this road (or are now, or eventually will), I thought I'd post an update.

About 2 weeks ago, on the advice of my PT, I stopped going to the PT center until I see my ortho sports doc again in late Feb. After 6 weeks, the exercises only exacerbated my symptoms, and pain had spread to my elbow. Clearly, the exercises weren't helping, no how mild or how few of them I did. The therapist said about 20% of his patients don't improve without surgery, and I must be one of that group.

I ordered the book Treat Your Own Rotator Cuff (on alcanoe's recommendation) and decided to give it a try. The book contains 3 different levels of easy exercises and stretches -- beginner, intermediate, or advanced -- depending on the person's level of pain and function; I chose the intermediate. The author is a well-respected PT and quotes the findings of numerous random control studies to back up his claims, including one that even full-thickness RC tears can be treated by exercise alone -- unless the tear is caused by a bone spur in the space between the acromion and the humeral head, as this cannot be treated without surgery.

My shoulder is not aggravated by these exercises, but I don't notice any improvement just yet. I'm planning to postpone my doctor appointment 2-3 more weeks so I can do them for at least 6 full weeks before I see the doctor. This is my "6-week experiment": If these exercises are effective for my particular problem, then I should feel some improvement in pain and function after 6 weeks. By then, I'll have completed a total 12 weeks of PT, and avoided riding and other restricted activities (except occasional mild gardening, to keep my sanity). After 6 weeks, it should be clear if these exercises are helping, or not.

A question for those who have been through this:
Did your pain eventually migrate to the elbow? I first noticed elbow pain about 3 weeks ago, and it has progressively worsened (intensity and frequency). I mentioned it during my last PT appointment, and he said something about the other muscles in the arm weakening. It's difficult to isolate the pain, but it feels like it's in the soft tissue surrounding the entire elbow joint.

I'll report again on my progress in a few weeks.
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Old 02-06-11, 05:05 PM
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You may have multiple things going on with the arm. I do with mine. I had forearm pain, sometimes elbow pain plus the rotator cuff pain. At first I thought that the forearm stuff was tennis elbow which I've had due to hard paddling of canoes for up to 7-9 hours/day up to three weeks. That thought was reinforced by the fact that a tennis elbow arm strap would mitigate the forearm pain. It would mitigate the rotator cuff pain as well. Very strange.

Except for the strap, the forearm did not respond to normal tennis elbow pt remedies. That was an important clue. I assumed to much thinking it was tennis elbow. My son-in-law who suffers from tennis elbow and I share remedies. He gets his from a doctor.

When the rotator cuff pain went away mostly, I found that the forearm pain responded well to a 1.2" thick firm foam pad about 3" away from the wrist when using the mouse. It gave me a better wrist angle. I found that on the web as a remedy for carpel tunnel. My forearm pain subsided in a few weeks.

It has flared up with weight training, but the forearm strap (for tennis elbow) stops the pain. I'm at a point now where the weight training doesn't seem to bother it anymore. It doesn't bother my shoulder either.

It's all somewhat confusing, but cures are better than insight. Experimenting often works and I did it professionally so I enjoy it.

I also started at level two on the Johnson pt. I felt almost immediate results. However, My problem did not sound nearly as severe as yours. Plus your previous pt may have exacerbated the damage based on the pain it caused. The Johnson stuff has been relatively pain free and it sure doesn't eat up much of my day,

Al
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Old 02-06-11, 05:08 PM
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Yen, I really hope you start to get some relief soon.
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Old 02-06-11, 05:18 PM
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I am not a doctor

as I said, I am not a doctor but having been a frequent rotator cuff patient over the past 15 years I have some self gained knowledge. when the docs refer to a R/C tear they mean a full perforation, all the way through. a R/C repair is the repair of a full tear. there is no way that a full tear will heal itself if left alone. my first tear, was in 1993, right side. after two years of bull**** conservative no-effect treatment in Boston, I moved to Northern Virgina and saw a specialist, who promptly opined why he couldnt figure out why they let this go on so long because it would never heal itself. he operated and fixed the tear. it was a horrible experience, but once healed it has been fine. I did have that same shoulder done again, had an arthritic AC joint fixed in 2000. it is still fine.

after the 1995 surgery, my left shoulder started hurting in the same way. so I had it scoped. it didnt have the (full) tear, just some torn edges. that proceedure is called a de-bridement, the doc just trimmed away some rough edges on the cuff/labrum. during both of these proceedures they shaved away some of the shoulder bone, to give the cuff a little room to move and not rub the bone. had to get the same shoulder re-scoped a year later because it healed with excessive scar tissue.

now, to your question: fast forward to 2010. my left shoulder had been hurting progressively more for the past 4 years. got to the point where it was a useless appendage. now in Seattle, had an MRI. looked like a full R/C and labrum tear, and needed that A/C joint repair. the doc did a full incision and repaired the A/C joint. thats where the collarbone fits into the shoulder. they cut off the end of the collarbone and smooth it out, and the gap gets filled by scar tissue over time.

he scoped the shoulder and luckily the labrum and R/C weren't fully torn, just a little (well a lot) ragged. I am 9 weeks after surgery now and into P/T. that pain you feel (I have it too) is the biceps tendon. feel the front of your shoulder and you'll feel a painful spot where the long arm of the biceps connects to the front of the shoulder. you'll feel a dull ache or sometimes a sharp pain right down to the elbow, sometimes for no apparent reason. it's all connected. try a shot if you havent yet, sometimes if it calms down enough to quit rubbing some small ragged edge tears will heal. no way a tear will heal on its own though. the recovery period for the full tear is 5 months. it'll be over before you know it.
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Old 02-06-11, 05:29 PM
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Altamont,

You might consider getting Johnson's book as prevention. He indicates a session or two/week will in fact help prevent recurrences. As I've been healing from my right shoulder, I noticed that it had better range of motion than my "healthy" left shoulder. So I started doing pt on the left too.

My right shoulder issue is a recurrence of a rotator cuff issue of some 14 years ago which I also had a completely severed tendon. This time, I've got it under control, at least so far.

Al
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Old 02-06-11, 07:12 PM
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Originally Posted by Yen
A question for those who have been through this:
Did your pain eventually migrate to the elbow?
NO

I first noticed elbow pain about 3 weeks ago, and it has progressively worsened (intensity and frequency). I mentioned it during my last PT appointment, and he said something about the other muscles in the arm weakening.
I was told by one doc that failure to repair a torn cuff can eventually result in deterioration of surrounding muscles and tissue to the point where it basically can't be repaired easily, if at all. I'm not saying that is the case with your situation nor do I wish to alarm you. I'm only mentioning it as it was told to me..
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Old 02-06-11, 07:12 PM
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Originally Posted by alcanoe
You may have multiple things going on with the arm. I do with mine. I had forearm pain, sometimes elbow pain plus the rotator cuff pain. At first I thought that the forearm stuff was tennis elbow which I've had due to hard paddling of canoes for up to 7-9 hours/day up to three weeks. That thought was reinforced by the fact that a tennis elbow arm strap would mitigate the forearm pain. It would mitigate the rotator cuff pain as well. Very strange.

Except for the strap, the forearm did not respond to normal tennis elbow pt remedies. That was an important clue. I assumed to much thinking it was tennis elbow. My son-in-law who suffers from tennis elbow and I share remedies. He gets his from a doctor.

When the rotator cuff pain went away mostly, I found that the forearm pain responded well to a 1.2" thick firm foam pad about 3" away from the wrist when using the mouse. It gave me a better wrist angle. I found that on the web as a remedy for carpel tunnel. My forearm pain subsided in a few weeks.

It has flared up with weight training, but the forearm strap (for tennis elbow) stops the pain. I'm at a point now where the weight training doesn't seem to bother it anymore. It doesn't bother my shoulder either.

It's all somewhat confusing, but cures are better than insight. Experimenting often works and I did it professionally so I enjoy it.

I also started at level two on the Johnson pt. I felt almost immediate results. However, My problem did not sound nearly as severe as yours. Plus your previous pt may have exacerbated the damage based on the pain it caused. The Johnson stuff has been relatively pain free and it sure doesn't eat up much of my day,

Al
Very interesting, Al. It seems that RT cuff pain and problems lead to a lot of experimentation to find what works and what doesn't. I chose the intermediate set of exercises based on Johnson's criteria for choosing each set. He describes the beginners set for those who can barely use their arm (or similar words); I can use mine fairly well, though not without pain and with limited range of motion.
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Old 02-06-11, 07:20 PM
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Originally Posted by Altamont
as I said, I am not a doctor but having been a frequent rotator cuff patient over the past 15 years I have some self gained knowledge. when the docs refer to a R/C tear they mean a full perforation, all the way through. a R/C repair is the repair of a full tear. there is no way that a full tear will heal itself if left alone. my first tear, was in 1993, right side. after two years of bull**** conservative no-effect treatment in Boston, I moved to Northern Virgina and saw a specialist, who promptly opined why he couldnt figure out why they let this go on so long because it would never heal itself. he operated and fixed the tear. it was a horrible experience, but once healed it has been fine. I did have that same shoulder done again, had an arthritic AC joint fixed in 2000. it is still fine.

after the 1995 surgery, my left shoulder started hurting in the same way. so I had it scoped. it didnt have the (full) tear, just some torn edges. that proceedure is called a de-bridement, the doc just trimmed away some rough edges on the cuff/labrum. during both of these proceedures they shaved away some of the shoulder bone, to give the cuff a little room to move and not rub the bone. had to get the same shoulder re-scoped a year later because it healed with excessive scar tissue.

now, to your question: fast forward to 2010. my left shoulder had been hurting progressively more for the past 4 years. got to the point where it was a useless appendage. now in Seattle, had an MRI. looked like a full R/C and labrum tear, and needed that A/C joint repair. the doc did a full incision and repaired the A/C joint. thats where the collarbone fits into the shoulder. they cut off the end of the collarbone and smooth it out, and the gap gets filled by scar tissue over time.

he scoped the shoulder and luckily the labrum and R/C weren't fully torn, just a little (well a lot) ragged. I am 9 weeks after surgery now and into P/T. that pain you feel (I have it too) is the biceps tendon. feel the front of your shoulder and you'll feel a painful spot where the long arm of the biceps connects to the front of the shoulder. you'll feel a dull ache or sometimes a sharp pain right down to the elbow, sometimes for no apparent reason. it's all connected. try a shot if you havent yet, sometimes if it calms down enough to quit rubbing some small ragged edge tears will heal. no way a tear will heal on its own though. the recovery period for the full tear is 5 months. it'll be over before you know it.
Altamont, I didn't mean the exercises will actually heal a RC tear. The tear itself doesn't heal, but the RC and scapula muscles become stronger which supports the shoulder and relieves pain. He doesn't claim that everyone can improve without surgery; he states that some cases (i.e. bone spurs tearing the RC) will not heal or resolve with exercise alone and will require surgery. Funny you mention the biceps tendon, I wondered if that could be the source of my elbow pain. Fortunately, my sports ortho doc specializes in shoulder AND elbows, with a special interest in RC repair. He works closely with the PT, in fact my PT has already notified him of my current progress.

I hope you heal well from you recent surgery. I second Al's recommendation of the book for prevention as well as rehab.
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Old 02-06-11, 07:34 PM
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thanks. not to throw too much info out there, but I've the elbow tendon surgery too. both sides. its a combination of bad genes, being active, and injuries, both new and old. I was gonna say, glad I am not alone, but I wish no one else had to deal with these types of injuries.
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Old 02-06-11, 07:56 PM
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Originally Posted by Altamont
thanks. not to throw too much info out there, but I've the elbow tendon surgery too. both sides. its a combination of bad genes, being active, and injuries, both new and old. I was gonna say, glad I am not alone, but I wish no one else had to deal with these types of injuries.
I wish you well, and a full recovery. It seems that the predominant health issue in my family is musculoskeletal --- osteoporosis + spinal stenosis (mom), osteoarthritis (dad, brother, me), Kienbock's (me), scoliosis (me), RC tears (brother, me). In addition, I still have 2 baby teeth because they don't have any molars to push them out. All of us are fairly active in various activities or sports over the years, including heavy gardening. But I wouldn't trade it for the effects of sedentary living.
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Old 02-06-11, 08:36 PM
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Care for a little whine? Today, I awoke with ankle pain, not unusual for me but it usually works itself out after I walk around the house a bit. I went out for a walk but had to turn back after about 20 minutes when the ankle flared up so bad I couldn't go on, and I limped part of the way home. A few weeks ago, I was unable to open a small bottle of water due to sudden onset of weakness and arthritis-type pain in my fingers.

I'm not supposed to ride or garden until my scapular and RC strength improves, but I had to get out in the garden today to save my sanity. An absence of regular activities since before Christmas --- overseeing my mom in the hospital for 3 weeks, sedentary desk job in a windowless office, rain off and on, illness last week. Tonight, my upper body aches like it used to after a full day in the garden when I was heavier, sedentary, and out of shape.

Maybe it's just weeks of stress - or, maybe I just need a good night's sleep.
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Old 02-07-11, 08:55 PM
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My doctor and my research indicates full tears will not heal by themselves, the muscle pulls the tear open and the gap won't close. The muscles will atrophy if not fixed and surgery won't work after about a year. The shoulder is very complicated and muscles adjust in bad ways. My whole arm and left side hurt in various ways which change daily. The bad news is 6 weeks after surgery my sholder still hurts more than before the surgery.

Good luck rotator cuff tears are not fun.
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Old 02-07-11, 09:24 PM
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re-read all this

Surley Girly, if your elbow hurts very acutely at either of the spots near where the tendons attach to the bone (palm up, inside of elbow is "golfers elbow", outside is "tennis elbow") you might well have tendonitis or tendonosis in addition to the shoulder pain. some people (like me) are just more prone to more brittle tendons and connective tissue. stretch as much as you can without pain and drink tons of water. you may find that icing three to four times a day might calm the elbow down. or consider a shot. if its inflamed but not too scarred the shot may be all you need. if it is all scarred up (tendonosis) it'll likely need surgery (5 months recovery too, but it works). it sure hurts to ride with pain in your arms doesn't it? the good news is that riding drop bars/hoods is itself a rotator cuff stabilization exercise.
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Old 02-08-11, 08:14 AM
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Yen - I had exactly the same thing going on at the height of my frozen shoulder problem. When I was sitting on the couch at night, I was getting acute referred pain in my elbow. It wasn't anything to do with the elbow, just nerve issues from the shoulder.

I also have a bit of golfer's elbow (discussed above) from riding a spin bike, unrelated to the shoulder issue. Apparently the way I sit on the Keiser spin bikes at the gym causes the elbow problems. Two years ago my right elbow hurt. This year it's mostly my left elbow. And it's totally unrelated to riding my bike. My golfer's elbow goes away in the spring when I stop going to spin class.

Also, based on your family history summarized above, you probably have some level of Ehlers-Danlos syndrome, a connective tissue disorder. My daughters have this, as did my wife's mother. My youngest daughter has idiopathic scoliosis and has had capsule tightening surgery on both of her shoulders from years of swimming.

Keep doing your exercise regimen. Also, the one exercise that really helped build back up my muscle strength was a hand bicycle thingy at the PT's office. You sit and grab handles and crank something that looks like a bicycle crank. Lots of places have them for recovering heart patients.

Shoulders are really complicated, so be patient. And make sure you're seeing the absolute best shoulder doc in your area.
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Old 02-08-11, 09:22 AM
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Originally Posted by Altamont
some people (like me) are just more prone to more brittle tendons and connective tissue. stretch as much as you can without pain and drink tons of water. ..
From what I've read recently from one who does aging physiology research, that may be the key. We all apparently get "brittle tendons" as we age . The tendons lose moisture and stiffen/shrink accordingly. That's why regular stretching appears to be necessary to maintain flexibility and damage when we get older and may explain the increasing numbers of rotator cuff injuries with age: I saw the numbers somewhere, but can't remember where.

Al
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Old 02-08-11, 11:09 AM
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My RC issues were severe enough that the slightest motion beyond a small and decreasing range caused extreme discomfort. A few well-aimed hits of a cortisone brew to keep swelling under control and some PT worked wonders. The PT was initially mild in the extreme and accompanied by stern lectures on patience and not overdoing. Doing too little I was told would just cost a few days while doing too much would likely set me back to the beginning.
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Old 02-08-11, 11:15 AM
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I am so distressed to see this thread as I was hoping to read how all (or most) of the pain goes away if you are diligent about the PT!

I am also about 12 weeks post diagnosis and PT with no relief and in facte have some pain near the elbow now.
My pain is not tremendous and my strength seems ok, but I can't stand the thought I may have to live with this pain the rest of my life- while fastening seat belts, opening jars, getting dressed etc. But I think the worst part may be the impact on sleep as it seems impossible to get comfortable.

Guess I need a second opinion, as I certainly do NOT want surgery, but don't want it to just keep getting worse either.

Any advice on how to locate the best shoulder MD near Philadelphia, PA?
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Old 02-08-11, 12:23 PM
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Originally Posted by bikerwannabe
I am so distressed to see this thread as I was hoping to read how all (or most) of the pain goes away if you are diligent about the PT!

I am also about 12 weeks post diagnosis and PT with no relief and in facte have some pain near the elbow now.
My pain is not tremendous and my strength seems ok, but I can't stand the thought I may have to live with this pain the rest of my life- while fastening seat belts, opening jars, getting dressed etc. But I think the worst part may be the impact on sleep as it seems impossible to get comfortable.

Guess I need a second opinion, as I certainly do NOT want surgery, but don't want it to just keep getting worse either.

Any advice on how to locate the best shoulder MD near Philadelphia, PA?
I know the feeling, especially at night. Just in the outside chance you might have missed previous posts on this, you might try the book:

https://www.amazon.com/Treat-Your-Own...7188764&sr=1-1

I've done the surgery years ago, the book did it for me this time. The surgery/recovery was not all that bad in my case, but the book is far better. According to the author, the success rate of pt either at home or professionally is the same as surgery. He cites the studies/results.

Al
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Old 02-08-11, 01:39 PM
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Thanks all.

I definitely don't have Ehlers-Danlos syndrome ---- except for osteoarthritis, I don't line up with the list of symptoms, not even remotely.
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Old 02-08-11, 02:33 PM
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Originally Posted by bikerwannabe
I am so distressed to see this thread as I was hoping to read how all (or most) of the pain goes away if you are diligent about the PT!

I am also about 12 weeks post diagnosis and PT with no relief and in facte have some pain near the elbow now.
My pain is not tremendous and my strength seems ok, but I can't stand the thought I may have to live with this pain the rest of my life- while fastening seat belts, opening jars, getting dressed etc. But I think the worst part may be the impact on sleep as it seems impossible to get comfortable.

Guess I need a second opinion, as I certainly do NOT want surgery, but don't want it to just keep getting worse either.

Any advice on how to locate the best shoulder MD near Philadelphia, PA?
Send me a message if you want the name of a very good doctor in Princeton. That may be too far for you.
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Old 02-08-11, 08:10 PM
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On a positive note:

Yesterday (Monday), my shoulder and arm were aggravated by the little bit of gardening I did on Sunday. Anyway, last night I did the intermediate exercises and stretches from the book Treat Your Own Rotator Cuff, all of which took no more than 10 minutes. I expected to have difficulty doing them, but I didn't. And, when I was finished, my shoulder felt much better and felt great today.

By "better", I mean that it doesn't throb and ache today while at rest. However, I still don't have any less pain or any more range of motion when I externally rotate my arm or raise it from the side. Those symptoms have not improved since day 1, but last night's exercises seemed to relieve yesterday's aches and pains caused from Sunday.
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Old 02-09-11, 04:24 AM
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Originally Posted by bikerwannabe
I am so distressed to see this thread as I was hoping to read how all (or most) of the pain goes away if you are diligent about the PT!

I am also about 12 weeks post diagnosis and PT with no relief and in facte have some pain near the elbow now.
My pain is not tremendous and my strength seems ok, but I can't stand the thought I may have to live with this pain the rest of my life- while fastening seat belts, opening jars, getting dressed etc. But I think the worst part may be the impact on sleep as it seems impossible to get comfortable.

Guess I need a second opinion, as I certainly do NOT want surgery, but don't want it to just keep getting worse either.

Any advice on how to locate the best shoulder MD near Philadelphia, PA?
Check out University of Pennsylvania's website. I would think you'd be able to find the best in the area there. I have friends from Jersey, 650+ & 60+ marathon runners, who go there for everything.
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Old 02-09-11, 05:27 AM
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While I think Bare Feet's suggestion is a good one, I'd also encourage you to check out Thomas Jefferson University Hospital. Most of the major professional sports teams in the area use them for orthopedic work. Here's a link to their page on rotator cuff injuries. Hope it's useful: https://www.jeffersonhospital.org/dis...2-c61141db929f

Steven Cohen or Peter DeLuca might be the guys you want to talk to there.
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Old 02-09-11, 10:04 AM
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Originally Posted by Yen
On a positive note:

Yesterday (Monday), my shoulder and arm were aggravated by the little bit of gardening I did on Sunday. Anyway, last night I did the intermediate exercises and stretches from the book Treat Your Own Rotator Cuff, all of which took no more than 10 minutes. I expected to have difficulty doing them, but I didn't. And, when I was finished, my shoulder felt much better and felt great today.

By "better", I mean that it doesn't throb and ache today while at rest. However, I still don't have any less pain or any more range of motion when I externally rotate my arm or raise it from the side. Those symptoms have not improved since day 1, but last night's exercises seemed to relieve yesterday's aches and pains caused from Sunday.
I found during the early days that if I did the stretching portion about an hour before bed time, it gave me the least discomfort at night. If I did them later or earlier, it didn't seem as effective for sleeping. I still do it that way now.

Johnson makes a comment that it's best to do the stretching after weight training and not before. I interpret that to imply it's also best to do them (except the strength training portion) at the end of the day to best accommodate the aggravation caused by ones normal activities. That seems to work for me.

Al
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Old 02-11-11, 09:18 AM
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Originally Posted by alcanoe
I know the feeling, especially at night. Just in the outside chance you might have missed previous posts on this, you might try the book:

https://www.amazon.com/Treat-Your-Own...7188764&sr=1-1

I've done the surgery years ago, the book did it for me this time. The surgery/recovery was not all that bad in my case, but the book is far better. According to the author, the success rate of pt either at home or professionally is the same as surgery. He cites the studies/results.

Al
Thanks AL- I ordered the book and it is on its way!

Keeping my fingers crossed...
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