My shoulder works now!(warning,longwinded)

Starting this thread to document my shoulder rehab @ Nik's suggestion. Original thread was "UFC 83 submission of the night" . In June '96 i was riding my bike home after kf class and was hit head-on by a drunk teen-ager driving a sports car (I'm lucky to be alive). One of the major long term issues i've had to deal with was a separated shoulder, the two orthopedists i went to both said that they wanted to remove part of my clavicle, which i declined. Pain would be bad enough at times that i could not sleep or move my arm. But due to my active lifestyle, i refused the knife
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A curious thing happens when you get this type of injury. The muscles in the area all tighten up in an action called splinting or guarding, so while some muscles are now too long and others are too short, they all cinch up and hold the new position to avoid further damage. Here is where a lot of healing ends, and the affected joint suffers from instability, weakness and many times a decreased range of motion accompanied with some crunching or popping noises as tendons etc, slide over surfaces not intended for it. Then it can get real interesting.

What happened next for me, and what i suspect may be the same in Nik's case, is that the entire body starts to compensate for the injury, especially during sleep and walking. These changes brought a whole wealth of other problems and brought back old injuries to boot!

I started chiro, acupuncture, pt, and had much Tui Na done at first. The pt was the only thing that felt like it WASN"T helping, it seemed that the increased tension on said injury by the "strengthening" exercises was only setting it in deeper and solidifying it.
Here i feel is the biggest point i want to make, TRUST YOURSELF. You know better than anyone what is going on inside of you if you just listen. I tried to learn as much about shoulders as possible, so i could take control of my situation.

At that stage, the biggest things were just getting the shoulder loose again, this part took years! Those years were very frustrating as i wavered around the same state, but all the while i kept working on the joint myself, and tried to correct any postural things at the same time.

Fast forward to Nov. '07, and i am receiving some great massage and the therapist goes, "Hmm, feels like this tendon is sitting incorrectly.."
I go, "Yeah , tell me about it..."
Which to my surprise she does, at great length. After about five minutes of monologue on shoulders, she grabs the tendon with her thumbs and just rolls it back up into place. This hurt quite a bit but the relief was immediate. Although my shoulder was far from perfect, it was quite a revelation that you could just put it back! At this point my optimism renewed and i once again began to pursue my healing with vigor.

This brings up the second point, DON"T GIVE UP! It is very easy to identify with an injury, so it becomes who you are, this mindset is very limiting. Soon after that i learn and receive the first phase of a massage technique called Reflexive Neuromuscular Balancing (RNB), which helps my shoulder even more. This technique was developed, in my understanding, by monitoring which muscles fire in what order, and then treating them in the same order.

Fast forward to about three weeks ago. I am actually teaching the second phase of the technique to a fellow therapist(he was working on me and i was talking him through it), which involves some resisted movement. So during the resisted movement phase i hear at first a loud pop, the second move brings on a snap, the third a small crunch and finally an audible slurp on the forth and final movement.(We both likened it to picking a lock!) I am now near 100% in mobility and stability, with a very smooth track in all directions, i am amazed that i feel this way after all these years.

So to sum it up, first step was to educate myself and get that thing loose. Knowing intimately your structure and what exactly (by name!) is going on is very valuable not only for you to visualize what needs to happen, but also to help you communicate with your therapists. Knowing that anatomy stuff will also help during the painful types of massage you will need to break up adhesions and move stuff because not all pain is good pain, so your feedback is vital to the therapist. Myo-Fascial Release, Tui-Na Trigger Point and the like should be available in most major metro areas.
As a muscle sits in one of these contracted, incorrect positions it may tend to stick to surrounding muscles or other structures. The same glue like tenacity that keeps your muscles from snapping is responsible here, so peeling layers of muscle can hurt a little, but if you're reading this you are hopefully a maist, so suck it up wuss.
Once the muscles are sufficiently loose to move everything back into place, only then can you start to strengthen them to hold the correct position.


That's it so far, i will post the RNB sequences soon. Hope this helps, and good luck all.

Ps. Funny thing is i can't hit the speedbag as well now cause my arm feels so different!

__________________
"It is better to keep your mouth shut and be thought the fool, than to open it and prove it so." KungFuTze
"Be who you are and say what you feel, because those who mind don't matter and those who matter don't mind." T. Geisel

For reference, this is my current problem, most definetly for the reasons Mr. B mentioned above:

The elbow snapped out the wrong way, immediately back in, but not in the same position, or the sinew/nerve went into a wrong place in the elbow. No strength in the hand for a while, tremor, couldn't fully bend the hand upwards, finger start to tremble when I put some load on it like when playing basketball. Cannot do a normal throw movement because in a certain position I get a sting in the shoulder on doing it, cannot rotate the arm like in that warming up move without it feeling clumsy and not being smooth. Hand feels clumsy as if the fingers don't point in the right direction, which I also feel when throwing in basketball, can't roll the ball over the fingertips like I used to. Shoulder and elbow crackles like hell when moving and always feels tight, not loose like my left one. Since I needed to quit competitive sports for other reasons anyways, I never bothered to visit a doctor in that 8 years. The thing looks like a simple moved sinew, so the sinew now isn't long enough to cover all the way. I didn't risk a surgically relocation for fear that some not so smooth surgery could inhibit my typing skills that I need for my job.

The problem loosens up once in a while, at the moment for example with "different" sounds, more like something popping in place.

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"Fawning, but proud!" - (at least sometimes, in rare cases)
"Killing them all didn't make it any better..." - "Are you a freak or something ???" - Max Payne
"Theft is a crime, even in Iraq." - Me.

That is some great info bobblehead, I'm glad things worked out for you and are getting better.

I will look forward to these RNB sequences

RNB for Shoulder
This phase is done until the scapula moves freely at the superior angle(top). Client lies supine, therapist does one arm at a time with fairly deep pressure. For almost all of my shoulder clients, this alone is amazing. On the individual muscles, start inferior and work superior(feet to head). Last one just slide your hand underneath and bend your fingers up just medial of the scapula, as they relax you can gently pull their arm and your hand laterally.

Lev. 1
Passive para-scapular treatment sequence
1. posterior deltoid motor point stimulation
2. massage length of arm, asses forearm relaxation
3. palpate and stimulate serratus anterior
4. palpate and deep tissue release pectoralis minor
5. repeat step 2
6. palpate and deep tissue release latisssimus dorsi
7. treat scapular retractors, serratus posterior superior and levator scap.

__________________
"It is better to keep your mouth shut and be thought the fool, than to open it and prove it so." KungFuTze
"Be who you are and say what you feel, because those who mind don't matter and those who matter don't mind." T. Geisel

...The second phase.
Rotator Cuff Activation

1. subscapularis deep-tissue release
2. infraspinatus motor point stimulation
3. resisted eccentric internal humeral rotation
4. resisted eccentric external rotation
5. teres minor motor-point stimulation, concurrent with resisted eccentric humeral abduction
6. supraspinatus motor point stimulation concurrent with resisted humeral adduction

__________________
"It is better to keep your mouth shut and be thought the fool, than to open it and prove it so." KungFuTze
"Be who you are and say what you feel, because those who mind don't matter and those who matter don't mind." T. Geisel