Rotator Cuff Problem

[janm]

I'm still trying to get an appointment with the GP and will try and get some research done as to referal preference before I go.

I'm in sheffield Btw

[Pacific lefty]

Hi Janm, you may have seen my few shoulder injury threads. I live in the south of Ireland, and found it really hard to finally get a solution to my problem. For basic general info, I did find the shoulderdoc.co.uk helpful as very few people here (doctors, physios, people) have much experience with tennis injuries. I had a gradual development of pain serving which one day after a long match, caused me to wake up and find it really hard to reach up or back. Long story short, I had no tear, just supraspinatus inflammation and impingement, had the SAD surgery, lots of rehab, and am back playing tennis (conservatively for the moment). I really had to push to get the MRI and had 4 cortisone injections (would not do that again). 18 months after the original injury the ortho specialist and I finally agreed the SAD was the best way out. In Ireland anyway, I really had to push to get the problem resolved, could be similar where you are, not sure. Having private insurance made a huge difference for me.

Best of luck getting the problem resolved.

[janm]

Well finally got to see the doctor today and more of the same, just advises rest. I guess I just have to see how this plays out. Its looking like a long process unfortunatly.

Thanks for everyones input really appreciate it. I will have a look through the shoulderdoc.co.uk resource later this evening.

[charliefedererer]

Did you see a general practitioner?

General practitioners are great to control blood pressure, treat diabetes and take care of medical problems.

Very few general practitioners know how to diagnose a shoulder problem.

But it is also true that statistically, most shoulder problems represent an inflammatory condition (tendonitis, bursitis) that will respond to rest.



If this is indeed tendonitis, doing some rehab exercises like the thrower's ten (once all the pain has gone away) is less likely to result in an early recurrence once you return to tennis. http://www.muhlenberg.edu/pdf/main/a...throwers10.pdf

And later restarting your tennis with short hitting sessions without serving is a better way of easing back into the game.

[janm]

Yeah saw the GP and he's not going to budge on the referal just yet.

Thanks for the pdf on shoulder exercises i'm going to print them off for future reference.

If this does improve with rest I will only start very lightly. Just hope this starts showing signs its going to improve as its not at the moment

[janm]

Hi guys,

Just to say a lot of the pain has gone but some still remains. It gets to the stage I have no pain and one day I wake up and it starts again.

I have been refered to the physiotherapist so just waiting for the letter to come which will confirm appointment.

[LeeD]

Does you arm like being above your head when you lay down, or go to sleep.
That is one indicator of rotator cuff problems.

[janm]

I usually sleep supine, occasionally on the side but not the side i'm hurt on. I don't sleep with my arm above my head.

Empty can test hurts only when someone is applying force now. Before it would hurt without force being applied.

Most of the time I just have a mild pain when its hurting now.

I have developed a little bursitis around the area since the injury.

Overall I think I might have gotten away with it.

[Chas Tennis]

Empty can test? Do you have a link? Did you get it from the Dr?

I believe that raising the arm with the shoulder inwardly rotated leaves less clearance space under the acromion. That's because there is a bone protrusion with attached tendons there. I would not be making it hurt to see how it was unless a Dr was doing it.

[janm]

Yeah it was done when I went to the doctors a few days ago.

its similar to this test on you tube

http://www.youtube.com/watch?v=qjHOqydDhxo

[Chas Tennis]

Originally Posted by janm

Yeah it was done when I went to the doctors a few days ago.

its similar to this test on you tube

http://www.youtube.com/watch?v=qjHOqydDhxo

OK, I see, this is a 'Empty Can' Test.

FYI

There is also an 'Empty Can' Exercise. (The exercise may also be called 'Pouring Water'.) This blog explains the issue and the anatomical reasons why the movement might be an issue as an exercise -

http://coachhook.blogspot.com/2010/0...cise-rant.html

I read in a book by Horrigan, The 7-Minute Rotator Cuff Solution, an older book, that the exercise 'upright rows' also puts the shoulder in a bad position, internally rotated, while raising the arm too high.

I don't know what to make of these but I would study the issue before doing these or similar exercises (raising the arm when the shoulder is internally rotated).

[janm]

Thanks for the link it was really good, when I do start rehab i'll be sure to avoid the empty can exercise.

[Pacific lefty]

Originally Posted by janm

Thanks for the link it was really good, when I do start rehab i'll be sure to avoid the empty can exercise.

The article on empty/full can is really interesting, and made me realise that after the surgery I wasn't given either of those exercises to do at any point. I am doing some of the thrower's ten ones myself now, but instinct was telling me to avoid the empty and full can ones...

[Frank Silbermann]

I guess the only option for people in America without insurance or for people in Europe without private insurance is to read everything on the web that one can find to diagnose one's own condition, and to devise one's own physical therapy program.

Unfortunately, this is not something everyone is capable of doing. At least there's a lot more information on line that would not have been available a few decades ago.

[Pacific lefty]

Yes Frank, unfortunately you are completely right. Even in cases like mine, where I do have private health insurance, I live in a place (Ireland) where tennis medicine and generally accessible sports medicine and knowledge are very very scant! Although my actual surgeon was excellent, he had no idea really when I would be able to realistically go back to tennis (6-8 weeks for most activities was what he said). So my PT, who isn't experienced in tennis herself, and I played touch and go for a number of weeks and luckily got the combination right of what to do. I did find it helpful to supplement some of her exercises and to check the Rehab protocols by well known sports medicine institutions in the U.S.

[DInosaurTT]

I agree Frank, but with things like the shoulder you can easily end up with the wrong diagnosis. Through my reading and the reading of my wife who is a doctor, but not specialising in this area, we did narrow down my problems to what were broadly the right answers. It is pretty easy to get wrong though and make things worse. As long as I can afford it or work pays and I am playing sport I will keep my private health cover.

JanM. Glad to hear things are improving and you are waiting for physio. Hopeffuly you are more patient than me as my keeness to get back from previous rugby injuries always made the recovery process longer.

Pacific Lefty. How is your progress now?

[Pacific lefty]

Hey DinosaurTT, things are going great now. It is really only in the last two weeks that I feel I have been playing really well, with my arm loose and relaxed and the pain and stiffness have dissipated. I started back hitting in mid-July (about 10-12 weeks post-surgery) and it was a little sore and uncomfortable. I needed a good two or three days in between sessions to recover. Now that it is nearly 5 months, I find I can play more frequently and not have that niggling feeling that I could be stressing my arm.

I got some great serving tips from a local coach (the first one I met here who understands proper arm/body mechanics for serving) and that helped a great deal.

Still stretching every day and doing resistance band exercises nearly every other day.

[janm]

Hi Pacific Lefty,

Thanks for adding your thoughts. I must admit the past month i've been looking at pretty much any information I can get on shoulder injuries and now feel much more informed about what to do and what not to do when I get into rehab and thereafter.

I urge anyone reading this topic who plays regulary to look up rotator cuff exercises and start doing them. They don't take long to to ( 2 mins on daily rotation) and could save you a serious injury down the line. Also when doing your regular exercise routine take time out and look at the proper technique for that exercise. For example I have recently found out whilst doing bench press type exercises the normal way could break down rotator cuff tendons through impingement... the video below shows a better way...

http://www.youtube.com/watch?v=wfgicn-Z574

Just wondering if anyone has gone through this type of injury and back into the game has any tips about how to hit serves and other shots so there is as little stress as possible around the shoulder area.

thanks,

[charliefedererer]

Originally Posted by janm

Just wondering if anyone has gone through this type of injury and back into the game has any tips about how to hit serves and other shots so there is as little stress as possible around the shoulder area.
thanks,

Preventing Rotator Cuff Injury http://www.youtube.com/watch?v=lTRvxaBMh8s
Your serve technique doing more harm than good? http://www.youtube.com/watch?v=GgdXawklcZk

Good luck!

[Chas Tennis]

Originally Posted by janm

.................................................. ..................

Just wondering if anyone has gone through this type of injury and back into the game has any tips about how to hit serves and other shots so there is as little stress as possible around the shoulder area.

The best thing that I have found by far is the Todd Ellenbecker video with the link in reply #9.

Ellenbecker also has some books

Complete Conditioning for Tennis I have, excellent book with targeted conditioning for tennis.

Effective Functional Progression in Sports Rehabilitation- I have, excellent book with many insightful discussions and clear descriptions.
http://www.amazon.com/Effective-Func.../dp/0736063811

Shoulder Rehabiliation Non-Operative Treatment
- do not diagnosis & treat yourself.
http://www.amazon.com/Shoulder-Rehab.../dp/1588903702

You need to take videos of your serve especially from behind to know for certain what you are doing. This is especially important regarding the shoulder orientation & impingement issue described at minute 8 in the Ellenbecker video (Reply #9). I see many players who don't orient their shoulders correctly for a proper serve - they are doing their own thing.......... Smartphones are not good high speed video cameras but they can catch the orientation of your shoulders which is relatively slow.

I tore my RC, I believe, from exercises in the gym. I think that external shoulder rotations with too much weight on the pulley may have contributed, but I don't know. Later, I read that external shoulder rotations should not be done with heavy weights. Fortunately, it was my non-tennis shoulder and I could play. Give the gym exercises as much attention as tennis.