Health & Fitness

Shoulder pain leads to a search for realignment

Trying to get rid of shoulder pain using physical therapy, massage, more walking
I thought I was an outlier, but at physical therapy, about 75% of those in the room had a shoulder injury
.@latimes: Her shoulder pain leads to a search for solutions

Whether it was years of swimming, too much sitting at the computer or too much driving, life was taking its toll on my body. My shoulder was messed up beyond belief; the pain seeped down my right arm and across my back, up into my neck.

With a mile-and-a-quarter open water swim race just three months away, and a shoulder so rigid I could no longer raise my arm over my head, I went to the doctor. First he tried to decide if I had bursitis or a rotator cuff injury (common in swimmers). I was put on Advil and taken off swimming. Things calmed down, but not enough.

I thought I was an outlier, but at physical therapy, about 75% of those in the room had some kind of shoulder injury. Friends have complained of debilitating shoulder pain from working too many hours at the computer, from overdoing it at yoga or from jumping too fast into a hard-core fitness program.

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FOR THE RECORD:
Shoulder pain: An article in the May 10 Saturday section about finding relief from shoulder pain misspelled the last name of physical therapist Drew Jenk as Jenks. —

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"What we are doing today does not support our eons of evolution," said Heath Reed, a licensed massage and yoga therapist who practices in Phoenix. "There is no way our biology can keep up with technology. The lack of movement at all is our first problem. The secondary problem is our dysfunctional movement."

I wanted to try every option before I considered surgery. Here's my path:

Physical therapy

With my doctor's referral, my first stop was physical therapy. My therapist asked me about the pain and when it started, and she felt around to find out where exactly it hurt. She swung my arm up, down, across and over, to isolate the pain. Swimmers, she said, are often weak between the shoulder blades.

First, she said, I needed to make sure my computer was at eye level, my arms were at my sides, my phone was not stretching my arm and I was not reaching for my mouse. In the car, I need to wedge a rolled-up towel between the base of my spine and the seat, to keep the curve in my lower lumbar spine.

I also was given a stretchy rubber sash for a series of arm exercises that used the wall, the door, doorknobs and the floor. They were short repetitions that required little effort, and, frankly, I was skeptical. I like to push until it hurts. I was told I could swim, but not hard, and no butterfly.

Drew Jenks, a physical therapist from New York who works with athletes and specializes in shoulders, said physical therapists look at movement impairment and work to fix it. "Do you have tightness in the back side of your shoulder? Do you have poor posture? Poor thoracic spine mobility? Poor stability and tightening of the muscles around the shoulder blade? We might get a doctor giving us a diagnosis for therapy for rotator cuff impingement, but that is not specific," said Jenks, chairman of the Shoulder Special Interest Group for the Sports Section of the American Physical Therapy Assn.

I did my exercises. I came back for five sessions of physical therapy. I swam tentatively at first, then harder. After five weeks I had regained almost complete mobility. I could not push myself. But my arm was functioning.

I competed in my race, and my shoulder did not hurt much. Still, I wanted no pain. Was that possible?

Massage

My physical therapist said massage complemented her work.

Reed, the Arizona massage therapist, teaches workshops on medical massage that focus specifically on rotator cuff injuries, shoulder bursitis and tendinitis. He said massage can help prevent shoulder injuries and rehab them, and help clients recover from shoulder surgery.

After an injury, there is an inflammatory response, Reed said. Traditionally experts have recommended RICE (rest, ice, compression, elevation). Once the inflammation eases, many experts recommend MICE (movement, ice, compression, elevation). In the past, experts immobilized the area of injury, to give the body a chance to recover. But, Reed said, too long a rest can lead to stiffness. This is where movement and massage can make the difference. "In our practice, what we try to advocate is a union of physical manipulation of muscle, massaging, working with ligaments, tendons, joints, range of motion, stretching, strengthening to begin to bring balance to that joint," Reed said.

Massage loosened my shoulder in the short term, and it felt good.

Walking more, driving less

I knew that part of my problem was that I spent too many hours in front of the computer or in a car. Walking might not help my shoulder per se, but I felt that it would help my body overall.

Dr. James Levine, a Mayo Clinic endocrinologist who invented the treadmill desk, coined the mantra "sitting is the new smoking," and Reed agrees. "Movement is the missing ingredient in our modern, technologically oriented society," Reed said. "We move significantly less than we did just a couple of generations ago."

Even 15 to 30 minutes of walking every day would alleviate tens of thousands of injuries, Reed said.

To make that walk more effective, Reed said, exaggerate the swing of your arms and look about 20 degrees above the horizon. When you look up, he said, it activates parts of your brain that help with coordination. Studies have shown that walking is one of the best therapies for lower back pain, the pelvis, the bottom of the spine and for getting the synovial fluid moving.

I hiked every day. I hoped that would gently nudge my body back into alignment. I still spend many hours in front of the computer, but my shoulder feels better.

Rolfing

I've long been curious about Rolfing, named for Ida Rolf, a New York biochemist who studied alternative methods of body work and healing beginning in the 1920s. I had heard it hurt but that the results were phenomenal.

Rolf developed a theory that the body's aches and pains arose from basic imbalances in posture and alignment, which were reinforced over time by gravity and learned responses among muscles and fascia — the sheath-like connective tissue that surrounds and binds muscles. Rolfing developed as a way to "restructure" muscles and fascia.

I felt like overworked muscles on my dominant right side were pulling across my back and yanking everything out of alignment.

Jan Sultan, a Redondo Beach-based Rolfer who was trained (and Rolfed) by Rolf and who has been practicing for 45 years, said that if a patient is orthopedically compromised with a rotator cuff injury, it lowers the probability that Rolfing will help. But it can help if the shoulder has a sprain, a muscle tear or imbalance to the joint.

My Rolfer, Maria Cristina Jimenez, discussed my history, symptoms and what I hoped to achieve. She had me walk, move and raise my arms over my head. Then she had me lie down on the table.

Her hands moved over my body, realigning and trying to find the pain. She was like a masseuse with extra-sensory powers. She found an upper rib (on the side of my injured shoulder) that had popped out, and with some pressure got it back in. Instantly my whole back and shoulder area felt better. The session ended with her gently cradling my sacrum and rocking me back and forth. There are many nerve endings there, she said. It felt weird, but good.

I walked home feeling clearer, taller and spaced out. After a lifetime of swimming, running, hiking, working, carrying children and sheer gravity, I realized that this is the crux of it: My body needs serious realigning — just like my car.

(I never got an official diagnosis because I chose not to get an MRI. And so far I'm not choosing surgery. I have just started swimming again after the race, so far without pain. I walk and practice yoga.)

health@latimes.com

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