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-   -   Supraspinatus relapse and suicidal tendencies... (http://tt.tennis-warehouse.com/showthread.php?t=414320)

Pacific lefty 02-21-2012 12:43 PM

Supraspinatus relapse and suicidal tendencies...
 
I never thought I'd be back on this forum so fast...I had my tendonitis/impingement well under control with my PT and after seven weeks I was ready to start hitting. I had one hitting session and on Jan 30 did some extremely light weighted lat pulldowns and sitting chest presses in gym. From that day on the pain was right back. Impossible to do any external rotation exercises, even isometric, or stretch arm across body. And even three weeks later it is still the same.

I can't believe I could have caused the problem to come straight back. My PT says that must mean that the impingement is so bad that I do need surgery. I just feel at the moment that I am never going to play competitive tennis again (not to mention having nightmares about crashing my car into a wall)...

So next week I am trying two things...accupuncture, and meeting the dreaded cortisone happy ortho. surgeon. Has anyone found accupuncture helpful? I guess I will probably have another mri to see exactly what is going on here..


Please anybody, a word of encouragment as I've been spending most of this week just reminding myself to keep breathing in and out...

r2473 02-21-2012 12:48 PM

The guy I played with this morning has shoulder problems. He's had them for years (from what he's told me). He got a cortisone shot last week and says he "feels like new", though he knows its temporary.

In the meantime, I'd strongly advise that you "keep breathing in and out"...........

Personally, I tore the hell out of my shoulder bench pressing 4 or 5 years ago. Couldn't serve for a year (and didn't). It actually hurt to raise my arm above my head for quite a while. When I "shadow hit" a forehand, I couldn't follow through and cross my body. What I mean to say here is, this injury really f***ing hurt. I actually couldn't even run for a while (hurt too much to swing my arms). I went to the sports ortho and he basically said "mmmmm....tough *****. Hurt your shoulder. Rest for a while. Then, here's some worthless PT. Now get away from me". Gee, thanks doc.

About a year ago I messed up something in my shoulder doing ring dips. I couldn't hit a proper forehand for about 6 months. Shifting my 5 speed into reverse was too much for me (I have an older BMW, and reverse is where the European reverse is. On the left of first gear). Oddly enough, serving was no problem. I hit all slice forehands for 6 months. Now, I'm fine. Like nothing ever happened.

My advise. Rest. Not "sorta rest". But truely rest. It sounds like you have not been doing this over the past few months and you are now paying for it with a longer recovery. Use the time to get into better shape (I mean running). You'll come back fitter.

Well, you'll just have to wait to see what the MRI and your doc say.

ollinger 02-21-2012 12:52 PM

We in fact are in the peak suicide months now (Feb., March, April) so consult a mental health practitioner at your earliest convenience. Beyond that, I'm not sure what your inability to do chest presses and lat pulldowns has to do with whether you can play tennis. It's not uncommon to struggle with those types of exercises with an impingement but still be able to play tennis. Has happened to me twice in the past 25 years, pain doing those things in the gym but no trouble on the tennis court.

ab70 02-21-2012 01:02 PM

Assuming it is just impingement, the surgery is not a bad option... they will clean it up, open space for RC tendons and you should be back on the court in 3 month for groundies... I can't recall whether you had an MRI done and what it has shown... Sounds like you tried all conservative options...

ollinger 02-21-2012 01:28 PM

(addendum -- perhaps being located in Europe while using the name "Pacific lefty" also contributes to your sullen mood and feelings of alienation)

Pacific lefty 02-21-2012 01:36 PM

Ha ha ollinger very funny. That is what happens when you transplant a Californian girl to a wet and windy place like Ireland...

I am truly learning the meaning of the idea of rest. I do go the gym and I have done a lot of running in the past but for me it certainly does not beat tennis as being a fantastic sport (as well we haven't got great weather here for road running every day).

In...out...in...out, thanks r2473, we'll see what the Dr says next wk.

r2473 02-21-2012 01:43 PM

^^ You have to "test it" from time to time. But that doesn't mean hitting serves or bench pressing. That is (obviously) WAYYYY too much for your shoulder right now.

As I did the rehab I invented for myself, I could "feel" my shoulder getting better and stronger every week / month. But I didn't try anything as stressful as hitting a full serve or bench pressing until I was "pain free". And that took a long time.

But, I'm VERY risk averse, so I probably rehab / rest longer than is really necessary. I just don't want to re-tear anything and have to go through THE ENTIRE process again (and risk further damage).

Limpinhitter 02-21-2012 08:27 PM

Quote:

Originally Posted by Pacific lefty (Post 6340787)
I never thought I'd be back on this forum so fast...I had my tendonitis/impingement well under control with my PT and after seven weeks I was ready to start hitting. I had one hitting session and on Jan 30 did some extremely light weighted lat pulldowns and sitting chest presses in gym. From that day on the pain was right back. Impossible to do any external rotation exercises, even isometric, or stretch arm across body. And even three weeks later it is still the same.

I can't believe I could have caused the problem to come straight back. My PT says that must mean that the impingement is so bad that I do need surgery. I just feel at the moment that I am never going to play competitive tennis again (not to mention having nightmares about crashing my car into a wall)...

So next week I am trying two things...accupuncture, and meeting the dreaded cortisone happy ortho. surgeon. Has anyone found accupuncture helpful? I guess I will probably have another mri to see exactly what is going on here..


Please anybody, a word of encouragment as I've been spending most of this week just reminding myself to keep breathing in and out...

I resolved my impingment syndrome with a combination of daily rotator cuff exercises with a "Theraband," daily NSAID therapy, and daily ice therapy. I still do 5 exercises almost every day to maintain joint stability and prevent further impingment and inflamation. The most important exercises for me are vertical rotation, inner rotation and outer rotation (bent arm and straight arm). It took about 3-4 months before I could play with confidence.

In addition, for me, the key to ice therapy is to use one of those round fabric covered rubber/pleated ice bags and apply it for ONE HOUR at a time, not 20 minutes as generally prescribed by PT's. However, it is important to use a fabric covered ice bag and to apply it over a t-shirt so that the cold doesn't cause a cryogenic burn.

Say Chi Sin Lo 02-21-2012 08:55 PM

You know, I've been in your shoes twice. Injured, had surgery, injured again, another surgery. Both times with the supraspinatus.

I will honestly say after the 2nd surgery, my shoulder didn't feel right at all. Surely on an anatomical level, the damages were repaired but it just doesn't didnt feel right. I had nagging pain and constant soreness each time served.

I kept at it, I kept working out, doing the rehab exercises as instructed by my PT. You'll be amazed by work is needed to strengthen a rotator cuff.

I could hit groundstrokes all day long, but I couldn't serve out an entire set without pain and soreness. I realized no rehab exercise would ever replicate the motion and stress that a shoulder goes through during a service motion. I call this "serve stamina", so I worked at it.

Started off with 50 balls nonstop, then 75 balls nonstop, 100 balls, so on and so on until I could serve anywhere from 200-300 nonstop and not be hurting.

After that, I worked on my motion. I could have the strongest shoulder in the world, but if my technique is flawed, then no amount of rehab will preserve my shoulder. I have since made slight changes in my original motion to take away as much of my shoulder as I can, while incorporating more legs and core while increasing power and spin on my serves.

In the end, if you're determined and willing to put in the work, the human body can come back from any non-disabling injury.

Tips for you based on my own experiences:
1) Rest until you're not in pain.
2) Work and rehab the injury. Follow the PT down to the T. If some fool at the gym shows you some random shoulder exercise that makes you raise an eyebrow or two, chances are your gut instinct is right.
3) Court stamina/serve stamina is huge I think. Muscle memory accounts for a lot of the strength/flexibility.
4) Think about your technique, if something's hurting then chances are, you're over-stressing that particular body part.

I also advise against the cortisone shot. Surely it'll relieve you of the pain, but it turns off the inflammation that starts and facilitate the healing process!

charliefedererer 02-22-2012 08:13 AM

Quote:

Originally Posted by Pacific lefty (Post 6340787)
I never thought I'd be back on this forum so fast...I had my tendonitis/impingement well under control with my PT and after seven weeks I was ready to start hitting. I had one hitting session and on Jan 30 did some extremely light weighted lat pulldowns and sitting chest presses in gym. From that day on the pain was right back. Impossible to do any external rotation exercises, even isometric, or stretch arm across body. And even three weeks later it is still the same.

I can't believe I could have caused the problem to come straight back. My PT says that must mean that the impingement is so bad that I do need surgery. I just feel at the moment that I am never going to play competitive tennis again (not to mention having nightmares about crashing my car into a wall)...

So next week I am trying two things...accupuncture, and meeting the dreaded cortisone happy ortho. surgeon. Has anyone found accupuncture helpful? I guess I will probably have another mri to see exactly what is going on here..


Please anybody, a word of encouragment as I've been spending most of this week just reminding myself to keep breathing in and out...

You can definitely impinge your supraspinatus doing lat pull downs (and hopefully you weren't pulling the bar behind your head, where maximal impingement would occur.)




I'm not sure exactly what the sitting chest press was, but it also could have pinched the supsraspinatus, even if holding the dumbells the "right way":

"Wrong way" to hold dumbells because it positions the humeral head to maximize the potential for impingement.

"Right way" to hold dumbells to turn the humeral head so that impingement is minimized.


And certainly avoid machines where the pushing angles up:



References for future use (obviously too early to do any of these exercises now):
What Exercises Cause Shoulder Impingement? by Emma Roberts http://www.livestrong.com/article/39...r-impingement/

"Contraindicated Exercises
Professional or recreational athletes with a history of shoulder instability, shoulder injuries, or pain and inflammation in the shoulder girdle need to avoid overhead and military presses, especially with a barbell; dumbbell side raises performed with thumbs pointing toward the floor, upright rows wherein the bar is lifted above the height of the shoulder, the incline bench press, and lat pull-downs with the bar placed behind the neck. Each of these exercises place inordinate stress on the shoulder and may cause impingement in vulnerable joints."


Pressing and the Overhead Athlete by Eric Cressey http://www.elitefts.com/documents/overhead_athlete.htm
"With respect to the glenohumeral joint—one of several articulations comprising the shoulder girdle—there are five different characteristics of any exercise that I take into account.

1. Traction versus approximation: Pull-ups and pull-downs (like most cable exercises) are an example of traction exercises. They pull the head of the humerus away from the glenoid fossa (shoulder socket). Conversely, pressing exercises are approximation exercises. They drive the humeral head into that socket. Approximation exercises increase the likelihood of rotator cuff impingement far more than traction, and this is why exercises like pull-downs, pull-ups, and shrugs can be integrated into rehabilitation programs before various presses. It also explains why many people with external impingement respond well to traction work with bands. They’re basically giving the rotator cuff tendons room to breath.

2. Adduction/extension versus abduction/flexion: Does the movement have the arm further away from the body (elevated) or close to the side? We know that an elbows-tucked (more adducted) bench press is much safer for the shoulders than an elbows out (abducted) style of bench pressing. The same can be said for overhead pressing (scapular plane versus frontal plane).

3. Closed-chain versus open-chain: Movements where the distal segment is fixed and the proximal segment is moving (closed-chain; e.g. push-ups) will always be safer for the shoulder than movements where we are stable proximally and moving distally (open-chain; e.g. Bench Press). For this reason, you’ll always be able to integrate push-up variations in a shoulder rehabilitation program before you move to barbell and dumbbell pressing variations. [note that Cressey's audience is largely heavy weight body builders/ahletes, so elastic bands and very light dumbells will likely be more appropriate for you than pushups eventually.]

4. Dumbbells versus barbells: We know that external rotation of the humerus repositions the humeral head and gives the rotator cuff tendons more room to “breath” without impingement as we elevate our arms. We also know that external rotation of the humerus ties in closely with forearm supination—just as internal rotation is associated with pronation.

A barbell fixes us in a pronated position so we’re locked into more of an internally rotated position. Dumbbells allow us to supinate a bit more. In turn, we are able to get more external rotation during the pressing motion, therefore protecting the rotator cuff a bit more than with barbells.

5. Isometric versus ballistic (and everything in between): It should come as no surprise that low velocity movements pose less injury risk than those performed ballistically. We don’t play sports at a snail’s pace, though, so it’s important that we prepare our athletes for the dynamic nature of their sports. However, we still need to recognize that isometric and lower velocity movements have merit in certain instances, especially if we’re looking to deload the athlete."




The good news is that you already have a couple of months of rehab therapy under your belt so you are not starting from square one. You are much more of an "expert" now on how to proceed in with your rehab.

But the bad news obviously is that pain/inflammation has recurred.

As pointed out above, a cortisone shot has the potential to turn off the inflammation. But at the expense of turning off healing of any small tear that may have occurred.


I don't think you have to consider yourself a failure of "conservative" therapy and therefore automatically need surgery. (Realise coming back from surgery could easily mean a year or more before getting back to serving/tennis.)

But I agree with the others above that the rehab therapy back will have to be slow, incremental, and not to be tempted to try new exercises without consulting with your therapist.


I know you are eager to get back to tennis. But while in Ireland, your preparations for THE big holiday should be taking precedence over tennis anyway.
So, how are your St. Patrick's Day preparations coming along?

Chas Tennis 02-22-2012 10:28 AM

Quote:

Originally Posted by Pacific lefty (Post 6340787)
...I had my tendonitis/impingement well under control with my PT and after seven weeks I was ready to start hitting. I had one hitting session and on Jan 30 did some extremely light weighted lat pulldowns and sitting chest presses in gym.

As CF points out those exercises are very questionable if you have impingement. Did a physical trainer or physical therapist suggest those exercises?

Pacific lefty 02-22-2012 12:45 PM

Gym
 
I definitely trusted the "trainer" in my gym a little too much I think in doing these exercises, but as well, when I had a light hit to test my shoulder last week I felt the pain too. I think I was crazy to have done the gym work (I didn't do the lat pulldown in back anyway) but now I have definitely learned not to do that again. On the positive side, which I can start to see now, I know better what I need to do for rehab and I am staying well away from the cortisone.

And yes charliefedererer, I will be getting ready for Paddy's Day (as we call it here). Or tennis club may even be marching in our local parade. Oh, and I will definitely be having a guinness and making a toast to you and all you great guys who have given me fantastic advice and moral support!

charliefedererer 02-23-2012 07:40 AM



"May your joys be as bright as the morning,

And your sorrows merely be shadows that fade,

In the sunlight of love.

May you have enough

happiness to keep you sweet.

Enough trials to keep you strong.

Enough sorrows to keep you human.

Enough hope to keep you happy.

Enough failure to keep you humble.

Enough success to keep you eager.

Enough friends to give you comfort.

Enough faith and courage in yourself to banish sadness.

Enough wealth to meet your needs.

And one thing more: enough

determination to make each day a more wonderful day

than the day before."

Pacific lefty 02-23-2012 08:38 AM

An Irish Blessing for you too!
 
Thanks charlief!!! I feel better already

Go n-éirí an bóthar leat
Go raibh an ghaoth go brách ag do chúl
Go lonraí an ghrian go te ar d'aghaidh
Go dtite an bháisteach go mín ar do pháirceanna
Agus go mbuailimid le chéile arís,
Go gcoinní Dia i mbos A láimhe thú.

aaandrew 02-24-2012 05:29 AM

Hi Pacific Lefty, you might remember me from your first thread

I had the same issues as you, also went through cortisone and found it had no benefit outside of the few weeks it was active

Ended up having shoulder decompression surgery to resolve severe tendonitus - less than 1 day in a sling and have regained full strength/range of motion.

Its no biggy, better having the surgery then living without tennis.

Pacific lefty 02-25-2012 08:20 AM

Quote:

Originally Posted by aaandrew (Post 6346626)
Its no biggy, better having the surgery then living without tennis.

Hey Andrew, I do remember your post. I think this is getting to be more and more an option for me now. I am really frustrated at waking up in the morning with pain in my arm and really I haven't even played this month and it is not improving at all.

I am seeing my cortisone obsessed ortho surgeon on Thu to discuss options. If it is still mere tendonitis I will probably wait it out if I can, but if he sees a definite improvement from surgery I may take that option. It is just all the stopping and starting that is driving me crazy...And major tennis withdrawal. I can't even manage a game of table tennis in my games room at the moment...

waves2ya 02-27-2012 06:39 PM

Lat pulldowns...

Enuf said.

Never...

Pacific lefty 02-28-2012 11:15 AM

So right you are...

drew2002 03-06-2012 10:48 AM

PacificLefty,

I've also suffered for years with RC troubles, and after seeing a number of PT experts, I've finally gotten relief with chiropractic adjustment and coordinated PT. I've also been able to get back to lifting. A few things that my PT said that you might want to consider:
1. Bench Presses: Don't. Just don't. I know, you want to do them, so did I. Eventually you can probably work in flys to your routine like I did, but bench presses put an enormous load on the shoulder.
2. Military Presses - My PT said not to these either. Basically he said that anytime you are lifting above your shoulder level, you're also putting a lot of stress on your shoulder. Instead he recommended this dumbbell exercise: Standing, start with your arms at your side. Lift the dumbbells with your elbow straight until your arms are parallel with the floor, then lower. You should raise your arms in a plane about 45 degrees in from your side, so that from a birds eye view, at the high point of your motion, it would look like a 90 degree "V" with your body at the vertex.

PT-prescribed workout routine: After your pain subsides a bit, have your PT put together a workout routine for you that will protect your shoulder. If they are reluctant to, find another PT. (I've noticed a wide range of skill sets in PT's.) And I'd recommend to try some more PT's before you even consider surgery. Good luck.

Pacific lefty 03-06-2012 11:18 AM

I have realised too late that I should have avoided doing those exercises in the gym, but at the time, my shoulder felt great, and there was no pain at all...See acupuncture and arthroscopy thread...I am just waiting for the pain to go away so I can get away with some isometric strengthening, but still not sure I will be able for a couple more weeks.


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