Need quick advice! rotater cuff injury!

[Tsai li fu]

It's kind of freaky, maybe 2-3 yrs ago i was putting on some lotion and out of no where i dislocate my rotater and end up putting it back in place myself. So i go to this Doc (a quack you could say) and he sees absolutely nothing wrong with it and tells me to just continue doing all the excercise im doing now. This happened before i seriously started doing martial arts. So i do martial arts and everything and had no problems and infact it felt alot better.

Now just yesterday i sneezed (how should i explain this?) on my left side of the same shoulder and it ends up sliding out of location again (3rd time its happend now) so here i am trying to put it back in place and my arm is moving in different a different motion and shacking and i figure it out and....POP! back in place. I talked to sifu over the phone about it and he gives me these excercises and says wait till 2wks to do them. Can't go to a professional unless the (quacks) see anything wrong with it. I'm looking for some professional adivce, anything that you guys could tell me I would really appreciate alot.. :(

[Chief Fox]

Ok, I'm not a doctor so you won't be getting any professional advice but I have a rotator cuff injury so I can speak from experience.

The first thing I would do is go back to the doctor. Not just a regular doctor but an orthepedic surgeon. If he can't do anything try to get him to prescribe some physical therapy at least. In physical therapy you'll learn all the exercises that you need.

Again, I'm not a doctor but it doesn't sound like you have an injury. Maybe just a joint that is prone to dislocation. You should be able to fix this by strengthening the muscles of the rotator cuff.

Rotator cuff exercises are not heavy weight exercises. They are done with light weights (10 to 20lbs).

I did a search on google for "rotator cuff exercises" and got many results back. Here is one of them. http://www.bodyresults.com/E2RotatorCuff.asp

In addition to the rotator cuff exercises I would do some standard exercises that will strengthen the other muscles of the shoulder like: Pushups, military press and lateral raises.

For my shoulder I use some homemade clubbells (plastic bats from WalMart filled with sand). I intend to eventually buy a real clubbell but they do the job for now.

Hope this helps. Good luck.

[Merryprankster]

Go see a doctor. It may not be a rotator cuff problem. The shoulder is extremely complicated, and all kinds of things could be causing your instability.

If one of those things is a labrum tear, then the LAST thing you want to be doing is overhead movements to strengthen your RC's

[Oso]

yep, see a doctor. I'll add that you probably want to find one that specializes in sports med versus a general ortho as they'll have a better insight to what your goals are.

interesting that a sneeze caused a dislocation. I can get tremendous pain in both my shoulders if I sneeze hard (and I have some bad allergies so it happens often) and I thought I was just wierd.

good luck

[Ho Chun]

The Rotater Cuff is a very thin muscle, if something is poping out of place, it's not a rotater cuff problem. You need to get with a doctor and get a MRI done.
I had a slight tear of the rotater cuff some years back, getting a MRI done is the only way to see it.

I hope this helps

[chud]

Sorry to be thread digging, but I just got back from seeing a sports medicine doctor and I have a rotator cuff injury (tear?). If anyone else can expand on what's already here, maybe talk about exercises and how you dealt with it, I'd greatly appreciate it. The doctor kinda ticked me off because he just gave me a shot and told me to come back in two weeks. No meds, no other advice, nothing.

[cjurakpt]

ok, for the record, and pay attention to this:

rotator cuff injuries / tears have almost nothing to do per se with things "popping out"; when the shoulder subluxes/dislocates, almost always it's in an anterior direction, which has to do with lack of anterior support: tears of the anterior ligaments / glenoid labrum or both; of course, you can have issues with RTC at the same time, but etiologically it's not the cause of the anterior dislocation - that's usually trauma based

it sounds like the poster is a chronic anterior dislocator (but I can't be sure because I haven't examined him): to treat this, there are typically two options: train the rotator cuff to help keep from dislocating or get a surgical repair of the torn anterior structures (guess which one chronic dislocators typically end up getting? you guessed it...#2); regardless,

again, you can have a rotator cuff tear and be at no risk for dislocating; RTC tearing is typically due to imbalance of the anterior mnuscles (pecs, biceps), being chronically hypertonic (a typical postural issue in general), and also the RTC also can be stressed over time due to rapid decelleration demands (such as a baseball pitcher) requiring the RTC to eccentrically contract way harder than it ought to;

regardless, the poster should go see a qualified doc ASAP as this probably will not get better on its own (the more it happens, the worse it tends to get)

[cjurakpt]

Sorry to be thread digging, but I just got back from seeing a sports medicine doctor and I have a rotator cuff injury (tear?). If anyone else can expand on what's already here, maybe talk about exercises and how you dealt with it, I'd greatly appreciate it. The doctor kinda ticked me off because he just gave me a shot and told me to come back in two weeks. No meds, no other advice, nothing.

go see a good physio / PT - that will solve your problem usually; if the shot is what I think it was, cortisone (or some similar steroidal anti-inflammatory), it will help with the immediate acute issue, but in the long term won't do much to deal with the cause - as far as dealing with it, typically (and this may not be the case with you), I personally spend time doing several things: mobilizing the rib cage / thoracic spine primarilly, secondarilly the cervicals, them lumbars if needed, occasionally the pelvis; I spend time working on rebalancing the balance of the RTC to the pecs / bicpes / upper traps, and more specifically the external rotators (supraspinatus, infraspinatus, teres minor) to the internal rotators (subscapularis and latissimus), the latter of which are typically hypertonic; again, this is a general approach, so it may not apply in your case - a good PT will know what to do

[cjurakpt]

ok: version 2 (hopefully the non-argumentative one)

1) the exercises linked above are in the post by Chief Fox, are as he stated, one example of and are pretty typical for RTC rehab and there is nothing wrong with them per se; they will be helpful to many people, as was the case with CF above;

2) there is, however, a not insignificant percentage of patients with RTC issues for whom these will be less successful, or not at all, depending on the specifics; therefore, if someone were to use them and not get the results they were hoping for, it would not be out of the realm of possibility, and it doesn't mean that their injury was beyond help - it wold just mean that the typical approach was not appropriate for them

3) some of the potential shortcommings of the standard methods are as follows:
a) doing open chain free weight training of the external rotators does not address their functional in-context roll either posturally or activity wise;
b) the door frame stretch is VERY non-specific and can actually put strain on the anterior sholder ligaments as opposed to doing anything to work on lengthening pecs;
c) the one in standing is not a great idea for some people because of what it can do to the low back, and to acurately isolate lats, requires a more specific position of both the arms and lumbar spine: lats go from the upper arm and attach contractile fibers from T6 down to like about L1 or L2 (and non-contractile down the whole lumbar spine, sacral spine and cocyx), so you have to do simultaneous etension of thoracics and flexion of lumbars, al the while maintaining your arms in external rotation with scapulae roatated upwards, flat on the rib cage - bottom line, you really need someone to show you in a specific step by step sequence to get the full benefit

4) in light of this, developments in the field have come up with alternate methods that are a) more structure specific and b) take into account the in-context functional relationships of the RTC to surrounding structures; decribing them is difficult and lengthy, because they are detailed and more complex, and need to be taught in person for reasons of specificity and safety (although I have describe the one for pectorals later on for illustrative purposes only)

5) my overall point is that if someone were to employ those medthods and didn't have success, they still have options available to them, but would have to seek out someone trained on a more advanced level;

I hope this is a more palatable restatment of my point

[Chief Fox]

I don't mean to be a PITA, but, honestly, in terms of what is considered state of the art approach to exercise for rehabing an injured RTC, are pretty out of date, largely because they lack the degree of specificity to what you are trying to do; for example, doing open chain free weight training of the external rotators does not address their functional in-context roll either posturally or activity wise; the door frame stretch is VERY non-specific and can actually put strain on the anterior sholder ligaments as opposed to doing anything to work on lengthening pecs; the one in standing is not a great idea because of what it can do to the low back, and to acurately isolate lats, requires a more specific position of the arms and lumbar spine: lats go from the upper arm and attach contractile fibers from T6 down to like about L1 or L2 (and non-contractile down the whole lumbar spine, sacral spine and cocyx), so you have to do simultaneous etension of thoracics and flexion of lumbars, al the while maintaining your arms in external rotation with scapulae roatated upwards, flat on the rib cage - bottom line, you really need someone to show you in a specific step by step sequence to get the full benefit

not to say that these won't work for some people, just that if they don't there are plenty of reasons why not...
Dude, if you're going to quote me at least make sure you do it in the correct context.

This is what I wrote "I did a search on google for "rotator cuff exercises" and got many results back. Here is one of them. http://www.bodyresults.com/E2RotatorCuff.asp"

The point of the sentence was not that the exercises in the link where state of the art. The point of the sentence was that there's tons of information about rotator cuff injuries on the web.

[cjurakpt]

Dude, if you're going to quote me at least make sure you do it in the correct context.

This is what I wrote "I did a search on google for "rotator cuff exercises" and got many results back. Here is one of them. http://www.bodyresults.com/E2RotatorCuff.asp"

The point of the sentence was not that the exercises in the link where state of the art. The point of the sentence was that there's tons of information about rotator cuff injuries on the web.

ok, I hope that my repost has satisfied your concerns

[BoulderDawg]

what do you mean out of context? I just posted the link by itself as a reference to your post, which was only a few posts away, so I didn't feel the need to re-quote the whole thing: obviously, anyone reading this thread would not take it out of context - it was quite clear what your intention was - to show an example of some standard RTC exercises you found: in no way does my post contradict what you said, nor does it criticise you for posting it - obviously, anyone who did a google search would come up with the same results; and I didn't say that anyone shoulddn't do them, nor did I suggest you were even recommending that someone try them

however, some people might be inclined to try them; that is why, in my post, I stated that a) while these were typical, they were not optimal and that b) while some people might benefit from them, that if someone didn't, it would not be surpising - that way, if someone tried them, and had no results, they wouldn't think "oh no, I'm screwed, these don't work"; I was also pointing out some of the potential shortcommings of them in case someone tried them, so as to give them a guide to avoiding unecessary secondary complications

yes, there is tons of info out there: I was trying to give some sense to people about how to differentiate between standard and optimal approaches: this would apply to any links that they found not just your

I really don't see why this is problematic...

At it again I see........

This A hole thinks he is the only one that should be allowed to give advice on this board!:D

[stricker]

I don't mean to be a PITA, but, honestly, in terms of what is considered state of the art approach to exercise for rehabing an injured RTC, are pretty out of date, largely because they lack the degree of specificity to what you are trying to do; for example, doing open chain free weight training of the external rotators does not address their functional in-context roll either posturally or activity wisecool. trying to engage in constructive dialog:

so i've been given similar exercises by physiotherapists, variants with therabands plus some extra shoulder exercises (eg pulling the shoulder back) but im not concinved there optimal either. so moving on, what is state of the art?

thanks in advance.

[Chief Fox]

what do you mean out of context? I just posted the link by itself as a reference to your post, which was only a few posts away, so I didn't feel the need to re-quote the whole thing: obviously, anyone reading this thread would not take it out of context - it was quite clear what your intention was - to show an example of some standard RTC exercises you found: in no way does my post contradict what you said, nor does it criticise you for posting it - obviously, anyone who did a google search would come up with the same results; and I didn't say that anyone shoulddn't do them, nor did I suggest you were even recommending that someone try them

however, some people might be inclined to try them; that is why, in my post, I stated that a) while these were typical, they were not optimal and that b) while some people might benefit from them, that if someone didn't, it would not be surpising - that way, if someone tried them, and had no results, they wouldn't think "oh no, I'm screwed, these don't work"; I was also pointing out some of the potential shortcommings of them in case someone tried them, so as to give them a guide to avoiding unecessary secondary complications

yes, there is tons of info out there: I was trying to give some sense to people about how to differentiate between standard and optimal approaches: this would apply to any links that they found not just your

I really don't see why this is problematic...
I don't have a problem with it. I gave advice on an injury that I myself have experienced. I did a google search and picked a link at random that had some of the exercises that I was instructed to do by a physical therapist and had worked for me.

You went to the link, stated how the exercises were dated and not "state of the art" and proceeded to pick apart each exercise. At the same time you offered up no alternatives.

I don't find this problematic, just strangely argumentative.

[cjurakpt]

I don't have a problem with it. I gave advice on an injury that I myself have experienced. I did a google search and picked a link at random that had some of the exercises that I was instructed to do by a physical therapist and had worked for me.
You went to the link, stated how the exercises were dated and not "state of the art" and proceeded to pick apart each exercise. At the same time you offered up no alternatives. I don't find this problematic, just strangely argumentative.

again, I hope my repost has addressed this

[cjurakpt]

At it again I see........

This A hole thinks he is the only one that should be allowed to give advice on this board!:D

ah, the Armchair Physician: I wondering what happened to you after our last "exchange" - I figured you were off somewhere figuring out basic definitions of kinesiology (and, BTW, you never did respond to my comments on the thread in question)

as for your assertion, lets point some things out:

a) I have never given anyone direct advice on this forum: I challenge you to find a single example of where I told someone what they should do specifically for their complaint, beyond generalities, and I have never made promises about results; if I do discuss treatment options, it is always in generalities, stating what is typical for what someone seems to be describing; I always preface everything with the caveat that I can't specifically tell what is the deal with them because I haven't examined them, and that they shouldgo see a trained professional for an accurate assessment of their situation

b) i have never told anyone not to give advice: people can do whatever they want; but if someone with no qualifications gives some "advice" to someone that is dead wrong (as was the case with your comments), i will explain why I think this is the case, because someone might follow that advice and go make themselves worse - the kicker is that, because YOU are an unlicensed individual, they have no recourse if your advice causes them harm; on the other hand, if I post something deleterious, I can get sued for malpractice, and even loose my license

c) it strike me as pretty funny that you think me an A-hole: you are the one promising a specific outcome to someone's medical condition without having any qualifications and without properly examining them...sounds like you are engaging in a little transference...

[cjurakpt]

cool. trying to engage in constructive dialog:

so i've been given similar exercises by physiotherapists, variants with therabands plus some extra shoulder exercises (eg pulling the shoulder back) but im not concinved there optimal either. so moving on, what is state of the art?

thanks in advance.

well, there are a couple of basic considerations in regards to the issue; first off, it requires an understanding of the concept of force couples and agonist / antagonist balance of muscles in general and specific to patterns of postural dysfunction and injury; rather than get into too much detail, I'd just say go read up on anything by Shirley Sahrman,PT (US) or Vladimir Janda, MD (Czech Rep.) - they are generally the agreed upon authorities in the field;

that said, in regards to the options that I (and, of course, those who taught them to me) find to be the most efficacious, I will describe the pectoral stretch that I use with clients (bear in mind that I am not giving this out prescriptively - it is meant for general infomation, and I DO NOT advocate anyone try it for their own use, rehab or otherwise - it is illustrative only, so that you can have a frame of reference if you want to go find someone who uses it):

Pec Stretch: to repeat, the door fram stretch is non-specific: you can't isolate pecs enough, you can get too much movement through the upper quarter in other associated structures (kindds the same thing) and you can stress anterior glenohumeral ligaments unecessarilly; so, what really nails pecs is this: stand with your feet together, toes pointing at the wall and get as close to the wall as you can (nose almost touching); to stretch the left pecs, place your left palm against the wall at shoulder level, so that your upper arm and forearm make a an approximately 135 deg angle "v" (elbow is the bottom of the "v", and the elbow will prbably not actually be touching the wall); turn your head to the right; then do 2 things with your elbow: move it towards the wall and at the same time try to pull it down to the floor by "settting" your inferior scapular angle (that is, try to approximate it to the underlying rib cage) it's almost like you want to think as if you are putting your elbow into your back pocket; if you do this corectly, you will feel a super stretch to the pecs, because a) you are isolating them and b) you are stretching them directly along the line of pull of the contractile fibers (because you are horizontally abducting and externally rotating the shoulder right at the glenohumeral joint); oh, if you want to increase the stretch, a) stand with the feet at a 90 deg angle to the wall, toes pointing to the right, and b) slide the left palm ****her away from the left shoulder (make the elbow angle more obtuse); if you are actually motivated enough to try this based on my very crude description, then for God's sakes, PLEASE be careful - it's very easy to overdo it because it's so isolated (this is why you need to do constant feedback with a client while teaching it)

if this was interesting / of use, I'll consider posting the lats stretch I use (although given the degree of negative feedback I seem to be generating of late, I am seriously considering discontinuing my posting activity in a "professional" capacity)

oh, and BTW, the guy who taught me these is Mark Bookhout, PT - he is affiliated with Michigan State Univ., and teaches this stretch as part of a course entitled "Exercise Prescription as a Complement to Manual Medicine"

http://www.com.msu.edu/cme/courses.html#e1


Description: This four-day program was developed in 1992 by Mark Bookhout, P.T. based upon the work of Vladimir Janda. This unique course is designed to complement the muscle energy biomechanical model. The exercises taught assist the participant in developing an individualized exercise program based upon the patient’s biomechanical findings and help to maintain the changes made with manual therapy treatment.

Objectives: 1) to understand the functional anatomical connections of the upper and lower quarter musculature to the proximal trunk and pelvis; 2) to introduce the concept of neuromuscular imbalance as a contributor to chronic musculoskeletal dysfunction; 3) to be able to identify local versus centrally mediated causes of neuromuscular imbalance; 4) to understand the role of adverse neural tension as a contributor to neuromuscular imbalance especially in chronic pain patients; 5) to learn specific exercises to refine neuromotor control in both the upper and lower quarter; 6) to learn exercises to address specific somatic dysfunctions found in the vertebral column and pelvis; and 7) to be able to develop a treatment program and rational to address musculoskeletal dysfunction related to the vicious overload cycle.

notice the term "prescription" and "adjunct" to manual therapy - again, I do not recommend trying this on your own...it is purely for illustrative and discussion purposes

[Chief Fox]

Strangely argumentative. :rolleyes:

[BoulderDawg]

Strangely argumentative. :rolleyes:

I don't know about that but I think "Strange" is a good word for this guy playing doctor :rolleyes:

I know if I'm ever hurt I'm coming here to the board to ask advice from the great Dr CJ. Then I'm going to do the exact opposite of what he said!:D

[cjurakpt]

Strangely argumentative. :rolleyes:

and for the third time around, changed it, hope it clears things up

[cjurakpt]

I don't know about that but I think "Strange" is a good word for this guy playing doctor :rolleyes:

I know if I'm ever hurt I'm coming here to the board to ask advice from the great Dr CJ. Then I'm going to do the exact opposite of what he said!:D

are you mentaly defective? I am a licensed physical therapist, giving my perspective on things that I know about; why is that impossible for you to comprehend? (throws troll a scrap of food)

I have given clear reasons for why I disagree with what you have said in the past:
my only issue with you is that you offered what i believed to be some really bad advice to someone else, I explained why I thought it was bad, and you got your panties all in a wad because you had nothing to respond with to support your position except sarcasm and insults (drops some more food to troll, knowing it will only make troll want more)

your only pathetic tactic is to resort to sarcasm and smarm because you have nothing to say that can back up your statements; now it appears you are moving into the stalker category, talking trash on this thread, but only when you feel safe about it because you think that you now have someone else on your side...(dumps big wad of troll-food onto troll's lap, clearly ignoring posted "Do Not Feed the Troll" signage)

say what you want, it's cool; you can tell everyone not to believe me, that's also cool: do you really think that anyone will take you seriously? I'm simply discusing things reasonably from my perspective and experience and you are calling me an A-hole - that cetainly enhances your credibility! anyway, I will let my comments stand for themselves and not justify them if you belittle them; and please come back and post more of your pearls of wisdom so that we can have some more fun...(gives troll key to refridgerator and leaves room, in direct violation of "Anti-Trolling" legislation)

[chud]

Getting back on topic... :)

I know everyone said the original poster (Tsai li fu) sounded like he had a dislocation issue and not a rotator cuff issue, and I initially agreed, but I just had something funny happen to me that mirrors his experience. I woke up this morning and my left arm was hurting as usual, in fact I couldn't even fully extend it (straighten it). Then when I was in the shower I had to move my arm a bit and something 'popped'. Now I can fully extend my arm, and I actually have full range of motion! My arm is still very very sore, but I feel like everything is in the right place now.
Another interesting tidbit, my sifu is an OMD (chinese medicine doctor). Two days ago I went to him about the pain because I was ticked off that the sports medicine doctor just gave me a shot and sent me home. My sifu acupunctured me and did some chi healing, which provided some initial relief. He told me it would continue to get better over the next couple of days. Yesterday I emailed him to thank him and told him I felt a little better but was still having some pain; he replied that I would be 'much better tomorrow'. So this morning my arm pops in the shower and now I feel good except for the residual soreness. Very interesting.

[BoulderDawg]

you are calling me an A-hole - that cetainly enhances your credibility!

The A Hole tag is spot on! You've earned it with your smugness and air of vast superiority.

I will continue to give layman advice here just as everyone else should also. I assume whoever is asking for it knows this board is made up of a bunch of average people who train (to a lesser or greater extent) and have had experience dealing with injury. They don't come here for professional advice.

In any case come back and answer this post (as I know you will) with a bunch of BS of your qualifications and don't forget to include another reference or two!:D

[cjurakpt]

The A Hole tag is spot on! You've earned it with your smugness and air of vast superiority.

posting on topics with some authority based on study and experience in that area = smug and superior? ok, whatever...I guess that apologizing to CF (albeit on another thread) and rewording stuff to accommodate his reasonable contention and to try rectify my oversight is further indication of this...



I will continue to give layman advice here just as everyone else should also.

go for it - never said you or anyone else shouldn't...if you give good advice, that's great; but if it's poor advice, there's a chance someone might call you on it - simple enough?



I assume whoever is asking for it knows this board is made up of a bunch of average people who train (to a lesser or greater extent) and have had experience dealing with injury.

that's probably correct (OMG - we agreed!:eek: ); oh, wait - except for the people in the past who, based on reading my public posts, have PM'd me asking for specific advice about their situation - guess they wanted something a bit different...



They don't come here for professional advice.

that, however, is an interesting assumption: of course, why would they want some input from someone with actual experience dealing with similar issues offering a perspective, when they can have totally uniformed conjecture from you?

I'll tell you what BD - I'm a fair minded guy: why don't you start a poll thread about that? if at least 10 people answer and more than 30% of them echo your sentiment, then I will gladly bow to public opinion and refrain from answering any more queestions of this nature (and don't just go inventing aliases now...)



In any case come back and answer this post (as I know you will) with a bunch of BS of your qualifications and don't forget to include another reference or two!:D

so, my PT license is a BS qualification? hmmm, I'll have to remember that next time I try to treat someone; as for the references, someone asked me specifically about something and I provided an explanation as well as a source for that information - yes, a straaange practice no doubt, backing up what one writes with authoritative sources...

anyway, this is getting boring: it will be my last post directly to you on the topic; I will continue to give an opinion (unless you do the poll thing and I am veto'd), and so will you; if I disagree with something you write, I will provide reasons as to why I do, whereas you will probably respond with name-calling and sarcasm - whatever;

[Mr Punch]

At it again I see........

This A hole thinks he is the only one that should be allowed to give advice on this board!:DGreat advice, to the point, helpful to the OP, and wait a minute, where did I put my heroin... [wanders off].

And Chief, what's more strangely argumentative than a man trying to give an educated opinion on complicated issues in layman's terms, which understandably soemtimes sounds a little high-handed, or a man repeating 'Strangely argumentative' despite receiving a placatory explanation?

[tokes]

[BoulderDawg]

I just have my doubts about this guy. The rambling posts like the last one he left tells me that he is a Doc wannabe...also that he has a screw loose somewhere.:D I don't know of any medical professional that would get as violently upset as this guy has.....It's either "You don't know what you are talking about" or "How dare you question ME!"

In any case, it's my belief that this guy is in no way, shape or form a medical professional of any kind. Take his advice if you like but be forewarned that you are taking advice from some guy who reads medical journals and medical internet sites in his spare time.

[stricker]

well, there are a couple of basic considerations in regards to the issue; first off, it requires an understanding of the concept of force couples and agonist / antagonist balance of muscles in general and specific to patterns of postural dysfunction and injury; rather than get into too much detail, I'd just say go read up on anything by Shirley Sahrman,PT (US) or Vladimir Janda, MD (Czech Rep.) - they are generally the agreed upon authorities in the field;

that said, in regards to the options that I (and, of course, those who taught them to me) find to be the most efficacious, I will describe the pectoral stretch that I use with clients (bear in mind that I am not giving this out prescriptively - it is meant for general infomation, and I DO NOT advocate anyone try it for their own use, rehab or otherwise - it is illustrative only, so that you can have a frame of reference if you want to go find someone who uses it):

Pec Stretch: to repeat, the door fram stretch is non-specific: you can't isolate pecs enough, you can get too much movement through the upper quarter in other associated structures (kindds the same thing) and you can stress anterior glenohumeral ligaments unecessarilly; so, what really nails pecs is this: stand with your feet together, toes pointing at the wall and get as close to the wall as you can (nose almost touching); to stretch the left pecs, place your left palm against the wall at shoulder level, so that your upper arm and forearm make a an approximately 135 deg angle "v" (elbow is the bottom of the "v", and the elbow will prbably not actually be touching the wall); turn your head to the right; then do 2 things with your elbow: move it towards the wall and at the same time try to pull it down to the floor by "settting" your inferior scapular angle (that is, try to approximate it to the underlying rib cage) it's almost like you want to think as if you are putting your elbow into your back pocket; if you do this corectly, you will feel a super stretch to the pecs, because a) you are isolating them and b) you are stretching them directly along the line of pull of the contractile fibers (because you are horizontally abducting and externally rotating the shoulder right at the glenohumeral joint); oh, if you want to increase the stretch, a) stand with the feet at a 90 deg angle to the wall, toes pointing to the right, and b) slide the left palm ****her away from the left shoulder (make the elbow angle more obtuse); if you are actually motivated enough to try this based on my very crude description, then for God's sakes, PLEASE be careful - it's very easy to overdo it because it's so isolated (this is why you need to do constant feedback with a client while teaching it)

if this was interesting / of use, I'll consider posting the lats stretch I use (although given the degree of negative feedback I seem to be generating of late, I am seriously considering discontinuing my posting activity in a "professional" capacity)

oh, and BTW, the guy who taught me these is Mark Bookhout, PT - he is affiliated with Michigan State Univ., and teaches this stretch as part of a course entitled "Exercise Prescription as a Complement to Manual Medicine"

http://www.com.msu.edu/cme/courses.html#e1


Description: This four-day program was developed in 1992 by Mark Bookhout, P.T. based upon the work of Vladimir Janda. This unique course is designed to complement the muscle energy biomechanical model. The exercises taught assist the participant in developing an individualized exercise program based upon the patient’s biomechanical findings and help to maintain the changes made with manual therapy treatment.

Objectives: 1) to understand the functional anatomical connections of the upper and lower quarter musculature to the proximal trunk and pelvis; 2) to introduce the concept of neuromuscular imbalance as a contributor to chronic musculoskeletal dysfunction; 3) to be able to identify local versus centrally mediated causes of neuromuscular imbalance; 4) to understand the role of adverse neural tension as a contributor to neuromuscular imbalance especially in chronic pain patients; 5) to learn specific exercises to refine neuromotor control in both the upper and lower quarter; 6) to learn exercises to address specific somatic dysfunctions found in the vertebral column and pelvis; and 7) to be able to develop a treatment program and rational to address musculoskeletal dysfunction related to the vicious overload cycle.

notice the term "prescription" and "adjunct" to manual therapy - again, I do not recommend trying this on your own...it is purely for illustrative and discussion purposesthanks for taking the time for a long reply amid all the noise!

i've followed up those links a tiny bit, im gonna try and check out sahrmanns book, but i havent been able to find any info about jandas approach to shoulder rehab. i get both their approaches is to do with diagnosis and bringing balance. can you point me to some more/better info about the training side more than diagnosis?

thanks!

[Chief Fox]

And Chief, what's more strangely argumentative than a man trying to give an educated opinion on complicated issues in layman's terms, which understandably soemtimes sounds a little high-handed, or a man repeating 'Strangely argumentative' despite receiving a placatory explanation?

[tokes]
That's easy. It's the man repeating 'Strangely argumentative' despite receiving a placatory explanation.

Sorry guys, sometimes I'm a total A hole.

Thanks for calling me on this one Mr. P.

cjurakpt - I owe you an apology as well.

[cjurakpt]

I know that I said I wasn't going to post anymore, but in this case, I actually think that BD has brought up an excellent point:

but first, the by now obligatory re-contextualization phase:


The rambling posts like the last one he left tells me that he is a Doc wannabe...also that he has a screw loose somewhere.:D I don't know of any medical professional that would get as violently upset as this guy has.....It's either "You don't know what you are talking about" or "How dare you question ME!"

rambling? you mean the way I answer your post chronologically point by point? well, ok, I guess that's the new definition: so, let me "ramble" on some more:

screw loose? you stalk me from one thread to another in order to specifically shoot me down and insult me; and I have the loose screw...gotcha...

violently upset? umm, again, I'd like to ask specifically where you see me posting as if I was violently upset (I mean, ok, so maybe I did throw the keyboard into the monitor once or twice whilst typing, but hey, that can happen to anyone...)? oh, and as far as upset medical professionals, man, you obviously haven't met too many orthopedic surgeons!:D

as for telling someone that they didn't know what they were talking about: - to date, you are the only, that's right, the only person I have definitively shot down in that manner - welcome to #1!

now as for the "how dare you question me" thing - actually, that's fine - feel free to question me at any time: but first, you have to actually ask a question: so far you havnen't - you've only insulted me; you will notice, however, what it is like when someone does ask me a question: I actually (:eek: ) give them an answer!


ok, so anyway, on to the second part of what is now no doubt being perceived as an irrational rant:

BD makes this statement:


I just have my doubts about this guy. In any case, it's my belief that this guy is in no way, shape or form a medical professional of any kind. Take his advice if you like but be forewarned that you are taking advice from some guy who reads medical journals and medical internet sites in his spare time.

now, I'd like to say that, for once, BD has actually made an excellent point - that is, how do you know that a person claiming to be a licensed healthcare practitioner really is? I mean, he is absolutely correct that I could just be someone freak "who reads medical journals in his spare time" (although, good God, I can barely stand to read those things even when I have to...); so, how does one go about verifying credentials? it's a great question...

so, let's see: how can I convince you all that I am , in fact, what i claim to be, which is a NY State Licensed Physical Therapist? hmmm...

well, one way would be to have some of the people I know personally who post regularly on the forum post on this thread about how they've known me for up to ~ 20 years, how they have had me treat them, how they've seen me work in a clinic with actual patients...but no, that wouldn't do, because, yeah, you guessed it, that doesn't prove anything, except that I could get a bunch of people to lie for me;

ok, here's another way: provide some links on the internet to sites where you are listed in a directory, or where there's a bio about me, or...no, wait - that could also be made up, just as easily...

oh, ok, wait, here's another idea: try this link

http://www.op.nysed.gov/home.html

hey! that's the New York State Office of the Professions homepage...I wonder what they do?

ok, now, you see where it says "On Line License Verifications" at the top? great - click on that - it will take you here:

http://www.op.nysed.gov/opsearches.htm

whoa - that's pretty nifty: ok now, go to the that box in the middle of the page entitled "Professions", and scroll down until you highlight "physical therapist"; then go to the little empty box in the middle of the page and type in "Jurak Chris" (no commas, now); then click on the button that says "search"

well look at that: you go to another page, and right at the top, #62 015172 JURAK CHRISTIAN ALEXANDER comes up; wow, that's cool...

ok, you're almost done: finally, go click on the number 62 015172- go ahead, don't be shy...

well look at that! it seems as if, unbelieveably, someone (at least in NY State) has actually come up with a way to reliably and validly verify not only the credentials of an individual but the current status of their license as well!

oh, and for those of you that couldn't follow the directions, here's the direct link:
http://www.nysed.gov/coms/op001/opscr2?profcd=62&plicno=015172

there you have it folks: a government sponsored mechanism by which you, the healthcare consumer, can check the veracity of someone claiming to be a doctor, a chiropractor or any other type of licensed healthcare professional in NY State

but wait you say, what if I don't live in NY State? can I also verify the truth about someone claiming to be a PT?

well, darned if you couldn't just go right to this link:

http://www.fsbpt.org/licensing/index.asp

and right there are links to the licensensing bodies websites for all 50 states for the PT profession!

so you see, you don't need to take my, or anyone's word for it - as a licensed healthcare professional, the burden of proof is on me to provide evidence of my credentials, so that you, the consumer, feels safe and secure that you are not in the hands of some charlatin "wannabe"

and hey BD, we'd thank you so much for being on the show, it's been really great having you as a contestant on the latest episode of "Open Mouth, Insert Foot", hope you had fun!

Good night, ladies and gentlemen!

[cjurakpt]

Sorry guys, sometimes I'm a total A hole.

I disagree - it was simply a minor misunderstanding, and an appropriate response on your part to what was easily misconstrued as an unwarranted critiscism of your post; I changed what I wrote because I value your opinion in general - your posts are typically well thought out, balanced and respectful, so if someone like you has an issue with something I wrote, I take it seriously

BTW, I would thank you to remember that I am the official A-hole on this thread, not you (see abov post if you have any doubts about it at this point...:D )


cjurakpt - I owe you an apology as well.

If anything, I should thank you for making me be more aware of how sometimes I can post something with one intention and have it perceived another way, so I will be more circumspect in the future; no apology is necessary and as far as I am concerned, the matter is concluded.

[Chief Fox]

I know that I said I wasn't going to post anymore, but in this case, I actually think that BD has brought up an excellent point:

but first, the by now obligatory re-contextualization phase:



rambling? you mean the way I answer your post chronologically point by point? well, ok, I guess that's the new definition: so, let me "ramble" on some more:

screw loose? you stalk me from one thread to another in order to specifically shoot me down and insult me; and I have the loose screw...gotcha...

violently upset? umm, again, I'd like to ask specifically where you see me posting as if I was violently upset (I mean, ok, so maybe I did throw the keyboard into the monitor once or twice whilst typing, but hey, that can happen to anyone...)? oh, and as far as upset medical professionals, man, you obviously haven't met too many orthopedic surgeons!:D

as for telling someone that they didn't know what they were talking about: - to date, you are the only, that's right, the only person I have definitively shot down in that manner - welcome to #1!

now as for the "how dare you question me" thing - actually, that's fine - feel free to question me at any time: but first, you have to actually ask a question: so far you havnen't - you've only insulted me; you will notice, however, what it is like when someone does ask me a question: I actually (:eek: ) give them an answer!


ok, so anyway, on to the second part of what is now no doubt being perceived as an irrational rant:

BD makes this statement:



now, I'd like to say that, for once, BD has actually made an excellent point - that is, how do you know that a person claiming to be a licensed healthcare practitioner really is? I mean, he is absolutely correct that I could just be someone freak "who reads medical journals in his spare time" (although, good God, I can barely stand to read those things even when I have to...); so, how does one go about verifying credentials? it's a great question...

so, let's see: how can I convince you all that I am , in fact, what i claim to be, which is a NY State Licensed Physical Therapist? hmmm...

well, one way would be to have some of the people I know personally who post regularly on the forum post on this thread about how they've known me for up to ~ 20 years, how they have had me treat them, how they've seen me work in a clinic with actual patients...but no, that wouldn't do, because, yeah, you guessed it, that doesn't prove anything, except that I could get a bunch of people to lie for me;

ok, here's another way: provide some links on the internet to sites where you are listed in a directory, or where there's a bio about me, or...no, wait - that could also be made up, just as easily...

oh, ok, wait, here's another idea: try this link

http://www.op.nysed.gov/home.html

hey! that's the New York State Office of the Professions homepage...I wonder what they do?

ok, now, you see where it says "On Line License Verifications" at the top? great - click on that - it will take you here:

http://www.op.nysed.gov/opsearches.htm

whoa - that's pretty nifty: ok now, go to the that box in the middle of the page entitled "Professions", and scroll down until you highlight "physical therapist"; then go to the little empty box in the middle of the page and type in "Jurak Chris" (no commas, now); then click on the button that says "search"

well look at that: you go to another page, and right at the top, #62 015172 JURAK CHRISTIAN ALEXANDER comes up; wow, that's cool...

ok, you're almost done: finally, go click on the number 62 015172- go ahead, don't be shy...

well look at that! it seems as if, unbelieveably, someone (at least in NY State) has actually come up with a way to reliably and validly verify not only the credentials of an individual but the current status of their license as well!

oh, and for those of you that couldn't follow the directions, here's the direct link:
http://www.nysed.gov/coms/op001/opscr2?profcd=62&plicno=015172

there you have it folks: a government sponsored mechanism by which you, the healthcare consumer, can check the veracity of someone claiming to be a doctor, a chiropractor or any other type of licensed healthcare professional in NY State

but wait you say, what if I don't live in NY State? can I also verify the truth about someone claiming to be a PT?

well, darned if you couldn't just go right to this link:

http://www.fsbpt.org/licensing/index.asp

and right there are links to the licensensing bodies websites for all 50 states for the PT profession!

so you see, you don't need to take my, or anyone's word for it - as a licensed healthcare professional, the burden of proof is on me to provide evidence of my credentials, so that you, the consumer, feels safe and secure that you are not in the hands of some charlatin "wannabe"

and hey BD, we'd thank you so much for being on the show, it's been really great having you as a contestant on the latest episode of "Open Mouth, Insert Foot", hope you had fun!

Good night, ladies and gentlemen!

Yeah, but we all know that this can be faked on the internet. What do you take us for? :D

Ok, now I'm done.

[cjurakpt]

Yeah, but we all know that this can be faked on the internet. What do you take us for? :D

Ok, now I'm done.


curses, foiled again...:mad:

[BoulderDawg]

My My.......I type several sentences here and it's met with 5-6 pages of rant about qualifications. All in all I may have typed about a half of a page while you have typed about 12-13 pages to put me in my place! Not only that I saw where you were ranting about this in the Kung Fu forum. You must value my opinion highly!

Me personally I could care if you're up for the Nobel prize in medicine I will still tell people that they would be ill advised to take your treatment. To start with going to the lenghts that you have to somehow convince people that what you say is the tell all, end all is troubling to say the least.

In any case, take this post, break it down sentence by sentence(like you have done with the rest of my posts) and tell everyone why you are a healing genius!:D

[cjurakpt]

My My.......I type several sentences here and it's met with 5-6 pages of rant about qualifications. All in all I may have typed about a half of a page while you have typed about 12-13 pages to put me in my place! Not only that I saw where you were ranting about this in the Kung Fu forum. You must value my opinion highly!

that's it! - I've officially achieved "rant" status - wow and it only took 5 - 6 pages this time (funny, the thread only runs 3, but hey, whatever...)

funny though, you also keep coming back for more (and more, and more) - must be mutual, the adoration :D

I must say though, your trolling skills aren't bad - I actually took you seriously at the beginning - well done, well done...



Me personally I could care if you're up for the Nobel prize in medicine I will still tell people that they would be ill advised to take your treatment. To start with going to the lenghts that you have to somehow convince people that what you say is the tell all, end all is troubling to say the least.

troubling is that you can't seem to tell the difference between knee flexion versus knee extension, but hey, what's a minor detail like that to a genious such as yourself?:D

but yeah, go ahead, broadcast away - anyway, I think the point has been made that pretty much nobody is gonna listen to anything you have to say at this point, so my work here i s done - you may now post your irrelevant reply...o wait:



In any case, take this post, break it down sentence by sentence(like you have done with the rest of my posts) and tell everyone why you are a healing genius!:D

Why I Am Healing Genius:
Well, just because I am - and you'd better accept it if you know what's good for you!:D

[franco1688]

hmmm.......:eek: :eek: :eek: :eek: :eek: :eek: :eek: :eek: :eek: :eek: