what is possible for the shoulder?

[bryanmccarey]

HI.

I'm trying to figure out what most outcomes are for very experienced or just very awesome practitioners on rotator cuff injuries and AC ligament sprains or strains (including those where the root of the shoulder pain isn't the shoulder). I want to know what clients can expect for outcomes, now and over time, without limiting their own expectations. For example (these are just example questions, no need to read or answer all!):

-How often do you think something diagnosed as a rotator cuff tear (without an MRI) is really a tear?

-What are your outcomes for MRI-diagnosed, non-surgically-repaired tears?

-How often does pain continue for RC injuries after surgery, and what has been your outcomes for those?

-How often does your modality seem to help something that PT--or another modality--didn't seem to help?

-How often is the client's own postural/structural work (stretching, strengthening, movement re-education, etc) essential to the outcome?

-So many clients and other people I know treat rotator cuff pain (and other stuff) without an MRI--or even an x-ray. How often have you worked on something for which they finally got an MRI that revealed something extreme, such as a giant tear (I've never experienced this, but my clients never seem to get MRIs!).

-How often has someone been diagnosed with a bone spur, but working with you or another therapist, they were able to become pain-free anyway?

-How often do you think a client's emotional stresses limit recovery? For instance, I have a client who has an old rotator cuff injury she had surgery for six years ago, before I knew her (she only knows it was a "rotator cuff tear"); the surgery helped but she still has pain. She has fallen on it several times since (which might suggest another emotional dimension, but anyway), and she stores stress in her neck and seems also to store it in that shoulder. Posture is excellent, structure is great; she walks and does Tai Chi; her anxiety and nervousness can be high (when she talks and is nervous the whole back and sometimes front of her neck tighten visibly).

I know these are big general questions, and appreciate ANY thoughts, as well as replies telling me there's something wrong with my questions . I'm trying to get a sense of what people's experiences are in a vast range of modalities, and I would welcome any articles/references.

Mucho gratefully!

 

[Lilah]

what is possible for the shoulder?

Hi Learner,

I'm going to answer these questions based on my own experience as someone who has had a RC injury, not so much as a practioner as these things are very individual and one client's experience is not going to mirror another's.

-How often do you think something diagnosed as a rotator cuff tear (without an MRI) is really a tear?

No way to know. Sometimes even an MRI is unreliable as to diagnoising tears.

-

What are your outcomes for MRI-diagnosed, non-surgically-repaired tears?

I had/have an MRI diagnosed tear but both times when they did surgery, they couldn't "find" the tear. Is it there?? No way to know. So even though I've had 2 surgeries, neither repaired the tear. In theory I've been told that if I were to have another surgery, do my PT and NEVER do massage again, then my shoulder would be fine. Since I'm not willing to do that I live with my shoulder pain/discomfort. I limit the number of massages per week that I do, I do lots and lots of self-care and am very careful with how I use my shoulder.

I have had clients though that were diagnoised with torn RC and did their PT and/or cortisone injection and then were fine after that.

How often does pain continue for RC injuries after surgery, and what has been your outcomes for those?

In my case the pain only resumed once I went back to doing massage. Perhaps it would have never come back, but at what cost? I think that with any repetitive strain injury, if you keep repeating the strain, the injury will keep coming back. I think that whether or not the pain continues is determined by the client changing their behaviors.

How often does your modality seem to help something that PT--or another modality--didn't seem to help?

The PT after the surgery was invaluable but once I recovered it didn't really do anything. The ONLY modality that helps my shoulder is MFR. Any other type of massage (if done around my a/c joint) only increases the pain and inflammation. Gentle stretching also helps as does exercise and yoga.

How often is the client's own postural/structural work (stretching, strengthening, movement re-education, etc) essential to the outcome?

It is 100% essential to do self-care including those you mentioned.

So many clients and other people I know treat rotator cuff pain (and other stuff) without an MRI--or even an x-ray. How often have you worked on something for which they finally got an MRI that revealed something extreme, such as a giant tear (I've never experienced this, but my clients never seem to get MRIs!).

If I have a client who does not seem to be getting better, I encourage them to seek medical care as it is an indication to me that they have more than just muscular issues going on.

-How often do you think a client's emotional stresses limit recovery?

You can not separate emotional stress from physical stress, they are too inter-related. I know that for myself whenever my upper back/neck/shoulders are very tight, it increases the pain I feel in my shoulder joint.

as well as replies telling me there's something wrong with my questions .

There is never anything wrong with asking questions.

Hope this helps some,
Angie

 

[Pompal 09.]

what is possible for the shoulder?

Oh my gosh, thank you for the quick and thorough reply Angie. I know you don't need to hear this after all this time, but I am really sorry for what you've been through. I didn't know that an MRI might diagnose a tear that a surgeon might then not be able to find---twice! Thank you again; your experience has probably helped many others, including myself. It sounds like a very good thing that you didn't choose to stop massaging.

Thank you again.

 

[cjakes]

what is possible for the shoulder?

My first suggestion would be to check out Whitney Lowe's stuff ( http://www.omeri.com ) or Erik Dalton or James Waslaski or Til Luchau. They all have instructional DVDs that focus on specific areas of the body and they are relatively inexpensive if you are just getting one DVD rather than the whole set. They could answer most of your questions and give you a number of tools to work with.

Aside from that, I think moogie hit most of the points pretty well. Particularly the part about there is never anything wrong with asking questions, and that every client is different, and even if there is a general time line for recovery, it can vary so much depending on the severity of the injury, the clients overall health, the clients adherence to self-care and prescribed exercises (as per PT, etc).

Oh, and incidentally, I find them all to be very interesting questions.

 

[The Fat Man]

what is possible for the shoulder?

Thanks so much for the reply and support, palpable! I hadn't heard of Til Luchau and I am very curious! Am just starting on Dalton and Waslaski.

Re: "even if there is a general timeline for recovery..." I was trained for hours on the rotator cuff in school, but was also told that an actual tear takes about a year. So here's a strange anecdote: I have one friend who, diagnosed with a tendon tear, went to PT and it took a year. I have one client who came to me and it took a year (I give several referrals early on, but I rarely refuse to see someone again and in this case he just kept coming to me). And I have one client who, before I knew her, tore her right rotator cuff. She happened to be ambidextrous, so she just switched to her left side. The exercises they gave her hurt, so she didn't do them. Suddenly, "after," she said, "a year", she decided to try her right again (in the middle of a baseball game in which her team was losing), and sure enough, it was all better!

 

[nowinkidd1]

what is possible for the shoulder?

I just wanted to bump this. Am curious to hear more stories about surprising shoulder recoveries or surprising diagnoses...Would also love to hear from structural bodyworkers, Rolfers, or anyone else!

 

[Rahrah]

what is possible for the shoulder?

Hi All,

I wanted to put in my opinion on the DVDs... I purchased the set from Til Luchau and although they have taught me some new 'moves', I think that Erik Dalton's may have been a better investment. The ones Til does are just video of classes he has taught. I was more impressed with the clips that Erik Dalton has on his site than I am with these because they seemed to be a bit more in depth so far. If you just want to know about one single area, then I'd go with Til Lachau's because I don't think you can get Erik Dalton's separately. HTH!

Angela