Jason was referred to our office by another patient who saw the pain he was in. Jason is a highly skilled plumber and regularly does work in tight spaces which require lifting, twisting, and moving awkward objects. Unfortunately, he began experiencing some pretty severe shoulder pain which limited his movement. Jason had bursitis in several places related to a partially torn rotator cuff tendon. Prior to coming to see us he had sen a local orthopedic doctor who was recommending surgery. Unfortunately, that surgery was not guaranteed to be effective. Worse yet, the surgery and recovery would be expensive and take him out of work for weeks, maybe even months. Not ideal. That’s when he called us.
Bursae are little fluid-filled cushions between sliding surfaces in the body meant to reduce friction and allow for better movement. We have a whole bunch of them all over. Sometimes these sliding surfaces don’t slide so well and that places stress on these bursae. These little water balloons become inflamed and enlarged and this can potentially interfere with movement and cause pain. To top things off, the added friction of a inflamed bursae was causing the supraspinatus tendon - the main tendon of the rotator cuff - was beginning to fray and tear.
VIDEO: SCAPULAR CONTROL
We performed a very thorough assessment before starting treatment. We looked at many aspects of Jason’s physical health including his blood pressure, posture, and a spinal exam. Additionally, we performed a very detailed assessment of his movement qualities and an orthopedic evaluation his shoulder.
Jason also did not have great control of his shoulder blades. In normal biomechanics, the scapula should move 2x the amount of the actual ball-in-socket shoulder joint. Jason, through years of awkward reaching and poor motor control, had lost his ability to reach up using his scapulae. This puts a lot of added stress on the small rotator cuff muscles in the shoulder. They become overworked and start sending messages to the brain in the form of pain and inflammation.
Here is one of the simple evaluations we did to test Jason’s scapular control. The controlled articular rotation (CAR) is a very easy test. Look for symmetrical movement on both sides and the ability to perform controlled circles with the shoulder blades. If someone has issues with this, scapular control training would be beneficial!
Jason came in and worked hard. Having a stellar work ethic really helped him overcome the obstacle of shoulder pain. We made sure his spine and extremities were in proper alignment through chiropractic adjustments. Our adjustments were gentle and effective and based on our findings each visit - no cookie cutter twists and pops here! Jason responded very well to adjustments aimed at the shoulder, but also the collar bone.
We did a pretty large amount of soft tissue therapies as well. I am an Active Release Techniques (ART) Elite Provider. Not to brag on myself too much, but only about 1-2% of all Active Release Techniques providers carry this distinction. We did Active Release treatments on the rotator cuff muscles, a few neck muscles, and mid back muscles. The idea was to improve range of motion, decrease pain, and provide some input that the brain can use.
When it was time to use that new range of motion is when our work really started to come together. We had to start with very basic shoulder exercises, but quickly progressed to advanced, progressive movements. Watch the videos below for a few examples of what we did.
VIDEO - PRONE PVC PRESS
This is a mid-level rehab movement used to train scapular control with reaching overhead. The prone PVC press allows us to start loading a few of the rotator cuff muscles working against gravity while also training scapular control and reaching overhead. As an added bonus, we get to train some thoracic extension as well. This exercise can also be used as a fantastic warm-up for weight lifting!
VIDEO - REACTIVE PVC CARRY WITH KETTLEBELL SUSPENSION AKA “THE DANGLES”
A long name for a great exercise! (If you have a better name for this one, I’m all ears) This is an end-stage rehab exercise which can be used to train “reactive stability,” or the ability to correct and stabilize against unwanted movement. Many times reactive stability gets overlooked in shoulder pain rehab treatments. Since Jason is a plumber and has to do all kinds of awkward movements overhead, we made sure he was able to perform this movement well. This will help him be able to stabilize things like pipes and equipment when working, helping to protect his shoulders.
His shoulder pain is gone and he is working hard again. Jason initially was unable to press my 9 pound kettlebell, but now he can rep out the 44 pounder! He was able to avoid the impending surgery and has even started his own plumbing company, Jay’s Backflow, Inc! He has been able to work hard, provide for his family, and has continued to kick some butt. Jason embodies the Invictus spirit. He has become the master of his fate and the captain of his soul.
AND THAT’S WHY WE DO WHAT WE DO.
You have what it takes to finally get out of pain and get back to what’s most important to you. We can help show you the path.
Click the link below to schedule a no pressure consultation. There are never any high pressure sales or gimmicks. We will help set you on the path to healing and wellness! Hope to see you soon.