Right Upper Arm...

[dcg1952]

Martee,
If you have no pain with palpation of the area it would lead me to believe you might be having "referred pain". This might be a nerve being aggravated by something in your neck and you are feeling the pain in the area of innervation. Difficult to say without examining you (cyberspace is great for a lot of things, but long distance diagnosis isn't one of them). It could also be a subdeltoid bursitis, but ,having seen 4 docs, I'm sure someone would have picked this up. That's why I'm suggesting looking more proximal. Just my 2 cents. Good luck and keep us posted. Vickie and Physioguy deal with the musculoskeletal system a lot and hopefully will add to my stuff. Stay healthy! Dr Dave

[Vickie]

Hi Martee,

Sorry to take so long. I actually have a new client with a similar discription of discomfort. With the kinesthetic testing we have done I have found a mismanagement of the agreements in the medial deltoid, posterior deltoid, triceps brachii, primarily two of the rotator cuff muscles teres major and the subscapularis, not to be undone by the tricep participation. Basically his shoulder articulation is out of agreement. In the advanced stages you could have some heavier problems as Dr. Dave has mentioned. Best case scenario you just need to create a new awareness of the proper alignment of these muscles and your symptoms will subside.

Now for the fun part. That means exercising these muscles slowly and deliberately everyday. The primary key will be to start with a properly aligned whole body and then thru the exercises renegotiate the agreements for easier movement.

Dr. Dave asked about neck pain and I couldn't agree more. Even if your pain is not in your neck, if you can see that your ear lobe is forward of your shoulders when you stand comfortably, then you are probably looking at the origin of these misagreements and you will have to make corrections in your posture to even appropriately apply the exercises.

Most of the exercises we do specifically to reintegrate a sounder participation of the muscles are not written in text, I just teach them. I will work on putting these in type for you over the weekend and get it to you by the first of the week. In the mean time I will paste two exercises that you can start with to begin to improve your posture and to begin to open up your shoulder joint.

Don't try to discipline yourself to do the exercises. Instead think about ridding yourself of the pain. That will be all the motivation you need. When the video of the class I taught at "Three G.O.L.F. Guys and You" is posted, the standard form exercise is demonstrated and you'll see that it is really as funky as you feel when you try it.

Standard Form (Basic safety position for all exercises)
Stand with your feet shoulder width apart, weight evenly distributed
between your hips.
Let your weight move back to your heels which will encourage you to
bend your knees slightly to keep your balance.
Your back should still be straight .
Lift your shoulders straight up toward the ceiling as high as you can trying to touch your ears.
Push your shoulders back as far as you can still keeping them raised.
Draw your neck back and up (pulling your chin under) to be even with
your shoulders.
You will feel your neck lengthen as you keep your chin down.
Note: You will feel your back and your chest stretch in this effort. Do Not let your head rock back to hyperextend (your chin would lift to the ceiling in this inappropriate position).
Deliberately bring your shoulders down allowing your chest and back to
expand to full breadth.

Key: In this position your chest will feel forward and 'soldieresque' .This does not feel natural! But we all know exercise is NOT natural, but it works.


Shoulder Stretch Deltoid / Rotator Cuff Joint
Lie on the floor on you back, with your feet flat and your knees bent,
arms byyour side with the palms down
Your shoulders should be down and your lower back will have a natural
curvature, in some cases keeping your low back off the floor.
Do not allow your back to change position through out the movement.
Lift one arm completely straight up, around, and over the shoulder to lay
it along the side of your head with the palm facing the ceiling.
Keep your arm straight through the elbow and hand and only stretch as
far as the shoulder joint will allow. Never force it or just let the hand
fall to the floor.
In the early stages (or on tense days) your arm may not go to the floor
but with time it will comfortably rotate around.
Hold for 20-45 and then engage your shoulder to lift the arm around
to the starting position.
Check to be sure your torso is flat and relaxed. Repeat on the other side.
Key. Your goal is not to lay your hand on the floor, Your goal is to create enough flexibility capability in the shoulder joint that the arm bone can smoothly complete a 180 degree rotation that results in your hand being on the floor.

Read one exercise, try to do it, then read it again to see which little piece you didn't get. Since they are not normal nor familiar they will be hard to impliment in the beginning. But you will get the feel quickly if you give yourself several tries.

Repeat the Standard Form exercise several times everyday to encourage better neck and shoulder alignment. You can do it seated also. I would encourage you to do it in the mirror initially to give yourself some reinforcement.

Repeat the Shoulder Stretch slowly and with great attention to keeping the elbow straight three times on one side before moving to the other side. Initially just do these once a day and after a couple of days try to do the in the morning and again later in the day. By then I will have more movements to incorporate the rotational aspects of your problem.

Ok get started and I'll get to work for you. Vickie

[Martee]

I was going to say I didn't know where to start, but I think Vickie might take exception to that.

Will start the exercises tomorrow morning.


'Referred Pain', hadn't heard that term used before, of course I hadn't heard 'mismanagement of the agreements' either.

Now after reading the post, I quickly jumped up and ran over to a mirror to see where my ear lobes are, that is with respect to my shoulder. My first few attempts yeilded nothing since I keep turning my head to see. This obviously isn't correct. So next it was to bathroom of mirrors. Finally I just grabbed a pencil and held in place when I turned my head to see where. It looks as if....just forward of center of the shoulder, I think...

Anyway it is off to print the instructions for the exercises and see what happens..

I assume the standard advice applies, if it hurts, stop. Either I am doing something wrong of I have discovered a way to demonstrate it the doctors....????

Thanks...everyone....

[Vickie]

Yes, yes Martee, your flexibility work should not hurt. You should become very aware of the muscles as they elongate to stretch out of your torso by way of the shoulder joint but if you move slowly enough you will be very aware of when to stop just before you impinge the joint. All that means is that you shouldn't feel any acute pain. This particular shoulder stretch shouldn't instigate the pain you suggested to me. It does, however, stretch out all of the same muscles and the big core lat muscle (the large back muscle that creates the 'V' shape of a gymnist). This muscle is responsible for drawing the shoulder down when you articulating (rotating and/or moving) the shoulder.

Don't worry to much about the language. To clarify, I talke about the ability of the muscles to work appropriately as an agreement they make. Some muscles have to contract and others have to elongate (stretch) and others are just stabilizing. When your posture is off they develop patterns to create motion that compensate for that mis-alignment. Then, if anything else in your swing or your life activity (strangely getting a car with a bigger stirring wheel, or a new seat changes one of your life patterns) the muscles are not in their optimal 'agreement' to make appropriate changes. Likewise, once you agrivate a muscle or your soft tissue with a particular activity, it is hard for the body to correct and recover if your starting posture is off.

For the record, my client is already feeling relief. The physical relief is great but I think he is most relieved mentally because he thought he was going to have to live with this and it had continued to develop to a point that he was skipping 'golf day'.. Mon Dieu!

Will get into the injury specific exercises this weekend as promised. Glad to get you a jumpstart.

Vik

[Willow Golf]

G'day all, new to the site and saw this thread. I am just coming back from 7 months on the sidelines due to similar symptoms but in my left arm.

I was diagnosed with an adhesive capsulitis caused buy both rotator cuff muscles and the AC joint. I was also very stiff in my neck.

Even though the shoulder was the problem I suffered nearly no pain in the shoulder itself. I suffered sharp stabbing pains about 4 inches down from my shoulder on the outside of my arm.

None of this showed up too much on all my scans except for an MRI which showed some thickening of the tendons.

I was administered a cortisone injection into my rotator cuff followed a week later by a hydrodilitation. The shoulder improved somewhat but returned after about 9 weeks. I was referred to a shoulder surgeon and after noticing I lacked rotation in my arm he gave me a cortisone injection into my AC joint followed by another hydrodilitation. 6 weeks on my shoulder feels alot better. First time with no pain since October 2004. I still have weakness in my shoulder with my outward rotations but started gym to help strengthen. Also throwing a tennis ball against a wall while keeping my arm in an "L" shape straight up (technical term.. haha)

I'm not saying this is what you have... but I was certain something was wrong with my arm and was only convinced it wasn't until it went away after shoulder treatment.

If it isn't being resolved then seek a second and third opinion. I had a great team working for me and if one wasn't sure they referred me to someone who could help. I am still having physio once a week and in the gym 3 - 4 times a week and alot of stretching.


On a side note: I have just started with a new coach... TGM A-I here in Australia. Looking forward to making my mark now.

Good luck with the shoulder!!!!

[Yoda]

Welcome aboard, Willow, and thanks for this insightful first post. Keep'em comin!

Our 'Down Under' ranks are growing, and we look to add many new friends in the coming months. If your new TGM Instructor isn't already rambling around these halls, please give him a strong #1 Pressure Point thrust our way.

[Willow Golf]

Paul Smith is my new coach even though he is a 4 hour flight away. Technology is a wonderful thing.

After seeing my swing improve remarkably after 2 days with Paul I am excited about the future... As long as I can get my body right.

Nice to meet you Yoda and all on your great site.

[Vickie]

Hello All,

Actually, Willow Golf, I liked your technical description of the lateral rotation stated as "'L' shape straight up. It is certainly a phrase everyone can relate to. (And there I go dangling a participle) For clarification, "adhesive capsulitis" is more commonly known as a Frozen Shoulder. There is much controversy about the diagnosis and the treatment. Cortisone truly works in that, in my esoteric opinion, it interrupts the distress on the central nervous system and the joint can relax and do it's job of healing. Chronic pain is a great deterrent and distracter of the bodies ability to 'get on with the process of healing' no matter what you do; rest, stretch, or strengthen. Unfortunately, too many people take advantage of the interruption of pain and over-do during this reprieve from pain and do deeper and more permanent damage. Sounds like Willow Golf continued to get great information and created a healing protocol.

As Willow Golf typed, even though the pain is in your arm it truly does all initiate with all of the shoulder muscles and then impacts the extremities. Since the extremity muscles also attach to the core (the bicep muscle attaches to the top of the shoulder blade where the tricep muscles attach to the side of the shoulder blade) and the core attachments in this case are shoulder muscles everything becomes complicated to diagnose and treat.

Allow me a moment of over-simplified and not too politically correct anatomy. On the most basic level the inside of the shoulder blade is a muscle called the rhomboid, which participates with,among other attachments, the rotator cuff muscles, biceps, triceps, traps and lats all of which keep the shoulder in place for ease of movement of your arms. In my practice I find that by correcting the postural alignment of the torso, core, muscles you take away the confusion that creates mis-management of the connections that allow the extremity muscles, in this case arms, to move freely through the joint without discomfort.

All of this to say hurrah! Physio for specific and improved joint articulation, strengthening and flexibility; that’s the secret. Posts from every conceivable resource and experience are what make a thread like this most beneficial. Welcome and thank you Willow Golf for participating and offering your great insights and experience.

Vickie

[Vickie]

Ok Martee, I simply can't figure out how to post pictures but I can certainly post text. I promised and here is a delivery. Hopefully you have been doing the two simple movements I posted a few days ago. The Standard Form exercise is going to show in every single exercise forthcoming. I'm going to make some suggestions and explain my philosophy and then post the exercises. I have put then in a tiny font to take up less room on the thread and it is still a space hog. If you cut and past them onto a word document and put the font at 16 the layout will reestablish itself and it's large enough to read without glasses.

I recommend reading the exercises through, then doing the movement as best you can, and immediately re-read while your muscles are sensitive to recognize the aspects you may have missed. These are all very specific

This is certainly not the end of the exercises that will be needed for full recouperation but they should take you out of pain and start creating a sounder alignment. As you go thru these over the next week I will post another level to integrate along the way.

The exercises are listed in a specific order , beginning with larger muscles and grosser motion, that I think best facilitates the work and prepares you for the next, more refined movement. Please read the instructions carefully and allow your work to grow over time.

Here we go:

Rehabilitating an injury, no matter how slight, requires frequent session but with less attention (repetitions) as the tissue is already inflamed. Each time you allow your body to review the work, you are imprinting a new neurological agreement between the muscles of your core and extremities. You are also bring blood to the muscles involved in the disfunction which provides healing nutrients to the site by way of the increasing in blood supply. Since your body has created a movement that is causing restriction and discomfort you want to interrupt that agreement and create a new one. For this reason your movements must be very ‘on purpose as you are interrupting the involuntary motion the body wants to create. Another way to think of it is that you are retraining your muscle memory.

Increase your work only moderately each week to allow for full muscle adaptation without aggravating your condition. Sometimes slower really is better.


Execution

Start with a very low guage therapy band (not the sergical tubing) and build to more tension as you improve.
Move slowly and deliberately through each motion.
Really think about the movement you are creating as
opposed to “just going through the motions”.
Remember to keep your torso, your core, stationary as
it is the foundation for this extremity work.
We are holding steady the attachments to the core in order
to improve the quality and capabilities of the
attachments to your arms

Sets, Reps, and Frequency
Perform the motion twice a day the first week and three times a day the second.

Keep the band on your door so it’s always easy to remember
and just get the job done. Two favorite ‘success sites’
are on your bathroom door and your office door

A mirror is your training partner and will let you see when you go out of alignment long before you can feel it.

Begin with only 4-6 repetitions during each session building to 8 repetitions in the second week and 10 the third.


Theraputic Band Exercises for Shoulder Health

Band Lat Pulldown
Tie a knot in the center of your band and place it over the top of a door
that you can close securely.
Both sides of the band should be visible.
Stand facing the door so that you can stretch your arms out completely
without lifting your shoulders
Step back from the door until you can raise your hands to eye level with
a taunt band.
Create Standard Form.
Squeeze your latissimus dorsi muscle (the muscle that create the “V” on
gymnists) and pull the hands to chest level ond off to the sides.
Your elbows should always be lower than your hands
You should not over arch your low back. Sit into your hips to avoid this natural
tendency..
Let your arms come back to the starting position without rolling your shoulders
forward and loosing standard form.
Repeat.

Tip: You can do this seated if you have a band that is long enough. If you go to a physical therapy (and some gyms) you could ask them if you could buy a band the length you want. I would call first, some are more willing and able than others.

Band Row

Wrap the band around any stationary object or you can again close it in
the door, I recommend wrapping the band once around the door knob on the
opposite wide and then closing the door securely.
You can stand or sit for this exercise as long as the band is placed at waist level.
Create Standard Form (whether seated or standing) which should bring tensio
to the band.
Squeeze your rhomboids together (the muscles between your shoulder blades
and pull your elbows back bringing your hands to your hips not your ribs.
Release the tension between your shoulder blades and allow your arms to come
forward without rolling your shoulders and loosing standard form.
The tops of your shoulders should remain still, not lifting up toward your ears.
Repeat


Standing Band Stretch
Stand in Standard Form holding your band in both hands at your thighs and your
band taunt but not stretched.
Lift both arms straight up and over your head allowing the arms to stretch out
allowing the band to keep them from dropping all the way out. You will
be making a “V” like a victory celebration.
Keep your shoulders down as you lift your arms.
Only go back over your shoulders to the extent you can keep your back from
arching and your elbows straight. Keep your abdomen engaged.
Bring your arms down slowly without rolling your shoulders forward or losing
Standard Form and repeat.


Standing Abduction Band Stretch
Stand in Standard Form holding your band in one hand at your thigh and your
band taunt but not stretched.
Hold the band with your palm facing the floor.
Stretch your band up to shoulder height and out about half way between a
forward lift and a side lift. (about 25 degrees)
Resist as you bring the arm back to your side without rolling your shoulders
or leaning forward.
Repeat on the other arm.

Tricep Band Stretch
Standard Form.
Hold your band at one end in your right hand and throw it over your shoulder.
Lift your elbow toward the ceiling which puts your hand behind your head.
Reach around with your left hand and grab the other end of the band to take up
the slack. Place the back of your left hand on the back of your left hip. Your left shoulder should feel relaxed.
Keeping your right elbow in place, stretch your arm out so that your right hand
is over your elbow and the arm is as directly over the shoulder as
possible.
Resist as you bend the elbow and bring your hand back down to starting
position.
Repeat

Shoulder Adduction with a Therapy Band
Wrap a therapy band around the outside of a door knob and
bring the length of the band inside then close the door
securely.
Stand with your right shoulder perpendicular to the door and
hold the band in your RIGHT hand with no slack.
Get into standard form, bring your right elbow to your side
with your elbow bent and your forearm parallel to the
floor.
Take ½ foot step forward allowing your shoulder to rotate
so that your forearm is now perpendicular to your side.
Keep your shoulders level during this rotation; the door knob
is behind you.
With your palm facing upward and keeping your elbow
stationary on your side rotate your hand around to the
front and center of your body and then resist the tension of the band as you rotate your forearm back around.
Only rotate forward as much as you can without lifting your elbow off your side.
Feel the resistance as you hand comes back to a
perpendicular position to your side.
When you get to this point try to allow the tension of the
band to rotate your shoulder and therfore your arm
back a little further and deeperagain keeping your shoulders stationary.
Repeat on the opposite side.

Key: Your stationary torso position provides the foundation for your shoulder to expand capability safely. As soon as your shoulders drop you have limited the true opportunity for rotational improvement.


Shoulder Abduction with a Therapy Band
Wrap a therapy band around the outside of a door knob and
bring the length of the band inside then close the door
securely.
Stand with your right shoulder perpendicular to the door and
hold the band in your LEFT hand with no slack.
Get into standard form, bring your left elbow to your left side
with your elbow bent and your forearm parallel to the
floor.
Take ½ foot step backward, your left hand is now comfortably at the center of
your torso.
Keep your shoulders level during this rotation; the door knob
is forward of your hips.
With your thumb pointing upward and keeping your elbow
stationary on your side rotate your hand around the
front of your body to your left.
When you get to this point try to rotate your shoulder a little
further around and deeper again keeping your shoulders
stationary.
Feel the resistance as you hand comes back to a central
position on your torso.
Repeat on the opposite side.

These exercises are the property of The Physical Experience with Vickie Lake.
Please use them and share them but do not publish them without the written consent of Vickie Lake. Thank you.

The Physical Experience with Vickie Lake Atlanta, GA
404-630-6703 for phone appointments or training sesions.

[Martee]

Thank you...Have printed it out. Next will read them and then follow your instructions.

I will keep you posted.

Yes I am doing the first two. I have printed out the instructions and have them pasted up in various rooms so I see them. Then I do them.

Thanks Again....