Sunday, June 20, 2010

Shoulder Instability

In summer 1997, when I was 22, I played on an intramural softball team. A fellow player gave me advice on how to improve my bat swing. I am right-handed, and he suggested that not only do I push the bat across my chest with my right arm, but I should also concurrently be pulling the bat with my left arm. This made perfect sense, as it would make use of both arms in supporting a stronger and faster swing. I took his advice on my next at-bat and it worked; I hit the ball with greater force than before, and the ball sailed into center field. However, my left shoulder was dead. It was weak for the rest of the game, and by the next day I could not raise my arm. I later got physical therapy and the injury resolved itself, but ever since then it's been fairly easy to reinjure the rotator cuff.

In fact, since I started weight-lifting in fall 2008 I have injured my rotator cuff (enough to stop lifting for a few days or weeks) at least 3 times. Actually, I've lost count, because I have also injured my right rotator cuff, too. My goal with weight-training is to strengthen the muscles and tendons in both shoulders so that I don't have to worry about old shoulder injuries, but so far that hasn't happened. It is certainly possible that I have poor lifting technique. But I also know that sometimes I simply overuse the joints. For instance, I hurt my right shoulder a few months ago after doing 6 pull-ups. I wasn't really ready for that--I don't have the strength. So I loaded muscles beyond what I had strengthened them to do, and they gave way. I have to be more patient.

Recently I have had frequent discomfort in my left shoulder. I think it started after doing another 6 pullups on June 2, 2010. But the tendons haven't had much chance to rest, since I swim 3 times a week. In swimming, my coach and I are working on extending my arms straight out in front of me to extend the catch motion of the freestyle stroke; this puts my shoulders in a position that can lead to impingement (aka entrapment). In his book entitled Strength Training Anatomy, Delavier describes this phenomenon, and it seems to fit my situation quite well:
"When some people perform exercises in which they raise the arms...the supraspinatus tendon is rubbed and compressed between the head of the humerous and the [clavicle]. Inflammation follows. This generally begins with the serous bursa, which normally protects the supraspinatus from excessive friction, and extends to the supraspinatus tendon itself, which, without treatment, ends up affecting the adjacent infraspinatus tendon posterioraly and the long head of the biceps brachii anteriorly."
Yes, this is exactly the discomfort I have experienced. I know the best treatment for this is two good weeks of rest--at least. But I don't want to stay out of the pool that long. The best I can hope for is to take ibuprofen and reduce swelling to minimize the scope of the injury. I should also lay off of the weight-lifting exerrcises that can exascerbate the problem. But again, it is the shoulder joints that I want to strengthen, so that seems counterindicated. It's frustrating.

Using an elastic band to stengthen the shoulder
 All along, since 2008, I have taken care to strengthen the small muscles and tendons of the rotator cuff. Most workout days I use an elastic band looped around the weightbench to rotate the shoulder joints. These are best demonstrated by Salo & Riewald (2008) under the exercises called "Shoulder Retraction with External Rotation," "Standing External Rotation," and "Catch Position External Rotation." I do 20 reps per arm of each of these exercises at every workout; collectively I call them the "Rotator Cuff Elastic Band Raise" or some variation thereof.

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