"Pain Free" by Pete Egoscue

[TennisCJC]

Originally Posted by tennis forlife

Sorry. I meant palm-down. If I have my arm at my side and lift straight out slowly, at about 2" there is a pretty sharp pain, in addition to a constant sort of low pain. HELP!

I have had this condition in a severe form twice in 35+ years of tennis. My right arm was basically dangling from the shoulder. Place it by my side while standing and it was impossible to raise the arm to the side. Doctor said tendinitis in the rotator cuff area - I can feel acute pain on the upper front of the joint where the arm connects to the shoulder. Both times, pregnizone 6 day pack helped where you take 6 pills the first day, then 5, then 4, and so on for 6 days fixed the acute pain. Now, I do shoulder strenghtening and streching to avoid acute issues but still get a bit of soreness at the top front of the joint if I play a lot.

I use the following exercies:

1. wrist curls: forward, backward and rotate L to R with ball of 5 lb dumbell in hand.
2. bicep curls
3. tricep pull overs and sometimes kick backs
4. chest flys
5. back flys
6. chest press
7. back rows
8. push ups
9. shoulder lifts - arms at side with thumbs up and dumbell in hand - raise arm up and slightly to outside
10. streches for front of shoulder and back of shoulder

Search "throwers 10 exercies" and you'll get examples of most of these plus a few more. I use light weights 5, 8, 10, 12 lb dumbells and hi-reps 2x15 or 3x10.

[Roforot]

Originally Posted by Posture Guy

One piece of advice: if you're doing stuff from the book, do the exercises in order. Don't treat them as a 'buffet'. One sets you up for the next, etc... They're not just thrown together, but have a method to their madness, so to speak.
<edit>

I'm not the OP but I did get the book. It's very interesting when he talks about racquet sports, he says something to the effect that these sports aren't hard on the arm or elbow but actually unmasks symptoms in those of us who have postural imbalances. It was an interesting perspective I hadn't considered given how much attention we take to racquets and strings.

Correspondingly, his elbow chapter actually focusses more on the shoulders and hips... That being said, I feel improved. Full disclosure, I am also doing wrist/forearm stretches and just started using the red flexbar.

I'm wondering though about adding other "body parts" to the list as some exercises are repeated. If I also have a sore neck, do you do the full menu of exercises for the elbow in order then do the neck? Or if I did the Gravity drop for the elbow, can I leave that one off when I do the neck routine?

[Posture Guy]

My apologies for not being around of late to answer questions on the thread. Had an accident that tore up my right shoulder (and yes, I'm right handed) and had to have shoulder surgery. To say shoulder surgery sucks is an understatement. Hope to be back on the court in March.

In any event, if anyone has specific questions about the book or this type of therapy in general, I'm happy to answer them. Feel free to either post here, or if you'd like to discuss something privately, feel free to email me at rickATegoscueDOTcom. I'm the clinic director of the Egoscue Clinic in Austin, TX.

[r2473]

Sorry to hear about your shoulder Posture. What happened?

[boramiNYC]

hey PostureGuy,

Ever since I found out and practiced the Alexander Technique, I came to the same conclusion what Mr Egoscue is saying about a lot of the musculoskeletal disorders. Do you know about the Alexander Technique? If so what's your opinion?

[Posture Guy]

r2743....it was dumb. Was at a team building event doing K1 go kart racing. In the middle of a really tight turn with my shoulder fully loaded, another kart crashed into me really hard and pushed my shoulder in a direction it didn't want to go. Tore the labrum. And was pretty sure I tore the labrum. Weird thing was, I could still play tennis without pain except for serving, had to serve side handed but other than that could play full out. So I pursued the surgical side of things, getting the MRI, etc..., but kept playing because I knew surgery was coming. Then the last day I played, I was at the net and had to reach out and behind me for a backhand volley and when I made the shot I heard something in my shoulder pop, and my shoulder pain escalated dramatically. At that point I knew I was really screwed. What we think happened was the initial accident tore the labrum, which then created some instability in the joint. Then the tennis shot rotated the humerus into a weird angle and it lost positional integrity because of the labral tear, and I knocked a big piece of cartilage off the head of the humerus.

Had surgery in July to fix the labral tear and that's when they found the cartilage defect. Said it was weird, my shoulder looked like a 30 year old shoulder (i'm 51) except for the damaged stuff. Rotator cuff, glenoid, all looked great. So she repaired the labrum and smoothed out the cartilage as best she could, but predicted it would become an issue and it did. So in December we did something called 'hemi cap', basically a humeral head resurfacing. Hope to be back on the court in march doing light hitting.

BoraminNYC....re the Alexander technique, I know it at a very passing depth. My view of it is very positive and I've had a number of clients who have used both to good effect.

[Chas Tennis]

Posture Guy- After your first accident on the go kart - Any injury is not that well know - its exact structure and the tissue/cartilage strength are not know from an MRI. That structure and strength depends on where splits are in the cartilage. These splits can be difficult to see in MRIs. With a labrum tear why should a person expect that it would function for tennis which is stressful to the shoulder?

In 2011, I kept playing when I knew my knee was having joint issues. I left the courts a few weeks later from sudden pain unable to play - a meniscus injury. That was my turn for a dumb move in order to play tennis.

If someone has a labrum tear how should they interact with their Dr and, in your opinion, what should they do about playing tennis?


Reference Labrum Injury -
http://www.hopkinsortho.org/labrum_tear.html

[Posture Guy]

Chas_Tennis.....i'm a big fan of "if it hurts, don't do it. If it doesn't hurt, chances are doing it is ok."

If I just went out and did light hitting on the court with no overhead motions, then I don't think I would've made anything worse. But honestly, I'm neither that bright nor disciplined. I love the game and love to compete. I knew a surgery was coming so I kept playing my ladder matches and would go after shots I should've let pass.

How should a person interact with their physician? If you suspect you have an injury you should consult with a qualified physician promptly and follow their advice. Do not engage in any movements or activities that provoke pain.

I did most of that, but would occasionally reach for a shot I shouldn't have, or toss my serve more upright than I should've. Just HATED serving side armed.

Basically, try to use a bit more common sense than I did. But I'll tell you what. The last match I played, the one where I felt the shoulder pop? After it popped I KNEW I was done. But it was the second set against a guy I had never beaten. And I REALLY wanted to beat him. So I kept playing, lol. And actually played pretty well. Looking back on it, I'm not sure how the shoulder kept functioning. Must've been adrenaline. In fact, on match point, I was up 40-15, served him wide in the deuce court, rushed the net, took his return and hit a sharp cross court volley for a clean winner. Man that felt good. I've been living off that match and shot for a few months now.

When I got home I iced the shoulder down, figured "well maybe I just tweaked it". When I was done icing it I couldn't lift it over my shoulder, was completely useless with what doctors call "the big sign that you have an issue" painful popping and a feeling of significant instability.

But I won, dammit!

[corbind]

I hear you on playing even know you should not. The drive to win or have fun exceeds the pain. That is until the pain becomes greater than the expected joy of playing.

[heycal]

Originally Posted by sixftlion

I love Pete Egoscue's stuff. I read his books long time ago, tried many exercises in my training and eventually adopted some of it into my style. The majority of my clients get great relief with some of the simple exercises, too.

PostureGuy is correct that a lot of the "born with" stuff is just something that was very mild sometimes long time ago and that with time and incorrect movement grew into something huge. It's never too late to start correcting things. It can take longer if the person has had the problem for long time, but any improvement is better than nothing. Patience and discipline to do the work is the key. Sometimes people give up way too early.

Originally Posted by Posture Guy

One piece of advice: if you're doing stuff from the book, do the exercises in order. Don't treat them as a 'buffet'. One sets you up for the next, etc... They're not just thrown together, but have a method to their madness, so to speak.

Are there a few key exercises you folks can recommend for a 50 year old guy suffering from low back pain for about a year? Any specific do's and dont's?

[Chas Tennis]

Originally Posted by heycal

Are there a few key exercises you folks can recommend for a 50 year old guy suffering from low back pain for about a year? Any specific do's and dont's?

Many years ago I played often with player who developed serious back pain. He was in his 30s. He went to see a Dr. The Dr treated him by having him do exercises. The exercises were painful and the general pain continued.

After about a year, he had imaging done on his back. The Dr then said that the exercises could not have helped his back problem and might even had made it worse.

He has not played since then.

If you have a slip-disc or other back problem doing exercises is risky. Find a well qualified Dr.

-------------------------
FYI - Link to back treatment for vertebrae osteoporosis. No personal experience but a player that I know says that his mother did very well with this procedure, kyphoplasty, performed on two different surgeries.

http://www.spine-health.com/video/ky...reatment-video

[Povl Carstensen]

Originally Posted by heycal

Are there a few key exercises you folks can recommend for a 50 year old guy suffering from low back pain for about a year? Any specific do's and dont's?

Here is a thread that might interest you: http://tt.tennis-warehouse.com/showthread.php?t=447310
I recommend doing exercises that bend the back backwards. Like lying on the floor and push your upper body up, so that you flex in the back. You can google McKenzie exercises.
(This is of course different than Egoscue, but pretty well credited I think).

[Posture Guy]

Originally Posted by Chas Tennis

Many years ago I played often with player who developed serious back pain. He was in his 30s. He went to see a Dr. The Dr treated him by having him do exercises. The exercises were painful and the general pain continued.

After about a year, he had imaging done on his back. The Dr then said that the exercises could not have helped his back problem and might even had made it worse.

He has not played since then.

If you have a slip-disc or other back problem doing exercises is risky. Find a well qualified Dr.

-------------------------
FYI - Link to back treatment for vertebrae osteoporosis. No personal experience but a player that I know says that his mother did very well with this procedure, kyphoplasty, performed on two different surgeries.

http://www.spine-health.com/video/ky...reatment-video

I have a different prespective. It's not that doing exercises is risky. Doing the wrong exercises is risky. That said, I'll bet that the person in question here got ample feedback from his body that the exercises he was doing were not constructive, and he most likely ignored that feedback thinking "well, the doctor told me to do it." Always trust your instincts. If something feels destructive instead of constructive, it probably is.

Working with people with bulging or herniated discs is the most common thing we do in our clinic and it's one of the easier things we deal with in terms of helping the client get symptom relief. The body NEEDS motion, but it needs complementary motion. Take the advice of doing McKenzie stuff above. It's mostly extension based. Well, if you have someone who has a bulging disc because their spine lacks extension, they might happen to do very well with that protocol. If they have a bulging disc because their spine has too much extension, that protocol will likely send them to the surgical table in screaming pain.

Where is the body out of balance, and what does it need to come back to balance? That's the question.

Bulging discs are not a big deal if you deal with them intelligently and listen to your body as you do so.

[Chas Tennis]

Originally Posted by Posture Guy

I have a different prespective. It's not that doing exercises is risky. Doing the wrong exercises is risky. That said, I'll bet that the person in question here got ample feedback from his body that the exercises he was doing were not constructive, and he most likely ignored that feedback thinking "well, the doctor told me to do it." Always trust your instincts. If something feels destructive instead of constructive, it probably is.

Working with people with bulging or herniated discs is the most common thing we do in our clinic and it's one of the easier things we deal with in terms of helping the client get symptom relief. The body NEEDS motion, but it needs complementary motion. Take the advice of doing McKenzie stuff above. It's mostly extension based. Well, if you have someone who has a bulging disc because their spine lacks extension, they might happen to do very well with that protocol. If they have a bulging disc because their spine has too much extension, that protocol will likely send them to the surgical table in screaming pain.

Where is the body out of balance, and what does it need to come back to balance? That's the question.

Bulging discs are not a big deal if you deal with them intelligently and listen to your body as you do so.

Those are good points after a firm diagnosis.

In my reply to heycal - asking for back exercises apparently without a diagnosis - I was pointing out the need for a Dr and imaging in a diagnosis. For example, if the bone itself of the vertebra is starting to deteriorate or is deteriorated how could that be known without imaging? I believe that a firm diagnosis for the back and other joints requires imaging such as MRI. I'm not sure what imaging technology was available at the time that my friend had his back injury or condition. He probably got an X ray.(?) Perhaps the other imaging of the spine available at that time was very invasive (?) so that imaging had considerable risk. ? My friend did complain to the Dr of the pain he experienced when doing the corrective exercises. As soon as he got the imaging the treatment changed.

[Posture Guy]

I have zero problem with a client getting imaging. I do think imaging diagnostics like MRIs are overused, especially in cases of minor to moderate pain. If a client is worried and fretting about the condition of their spine, I encourage them to get an MRI and find out.

But if they ask me if the results of the MRI will change my work with them, the answer is no. The MRI doesn't show the problem. It shows the RESULT of the problem. The problem is the spine has become fundamentally mispositioned. The discs wouldn't displace otherwise. So in case, I have two fundamental objectives:

1. Prescribe the appropriate corrective exercises to bring the body back to postural and functional balance.

2. Listen to the client's instincts and allow their wisdom to drive the process.

If I give a client an exercise that is posturally indicated but causes a mild increase in their symptom, that's their body telling me it's not ready to do that movement or position yet. We listen to that and find another way to get where we want to go.

My bottom line, if a client asks me if they think they should get an MRI, I tell them there are two fundamental circumstances in which I think that's absolutely appropriate:

1. Given the symptom presentation there is a distinct possibility of an issue that requires immediate medical or surgical intervention. When we're talking about mild to moderate back pain, that is beyond rare.

2. If the client is so mentally wrapped around the axle that they just "have to know". If it gives them peace of mind, great.

[Chas Tennis]

When it comes to diagnosing an injury or chronic condition I believe in imaging. Without imaging there is usually hardly any certain information on the damaged part of the body. I believe that the statistics of false positives and false negatives with imaging, when added to the other diagnostic information, gives the best probability for an accurate diagnosis.

[heycal]

Originally Posted by Posture Guy

I have zero problem with a client getting imaging. I do think imaging diagnostics like MRIs are overused, especially in cases of minor to moderate pain. If a client is worried and fretting about the condition of their spine, I encourage them to get an MRI and find out.

But if they ask me if the results of the MRI will change my work with them, the answer is no. The MRI doesn't show the problem. It shows the RESULT of the problem. The problem is the spine has become fundamentally mispositioned. The discs wouldn't displace otherwise. So in case, I have two fundamental objectives:

1. Prescribe the appropriate corrective exercises to bring the body back to postural and functional balance.

2. Listen to the client's instincts and allow their wisdom to drive the process.

If I give a client an exercise that is posturally indicated but causes a mild increase in their symptom, that's their body telling me it's not ready to do that movement or position yet. We listen to that and find another way to get where we want to go.

My bottom line, if a client asks me if they think they should get an MRI, I tell them there are two fundamental circumstances in which I think that's absolutely appropriate:

1. Given the symptom presentation there is a distinct possibility of an issue that requires immediate medical or surgical intervention. When we're talking about mild to moderate back pain, that is beyond rare.

2. If the client is so mentally wrapped around the axle that they just "have to know". If it gives them peace of mind, great.

Originally Posted by Chas Tennis

When it comes to diagnosing an injury or chronic condition I believe in imaging. Without imaging there is usually hardly any certain information on the damaged part of the body. I believe that the statistics of false positives and false negatives with imaging, when added to the other diagnostic information, gives the best probability for an accurate diagnosis.

I'm of the paranoid school, so I did get the imaging, which showed this:

MRI OF THE LUMBAR SPINE

Spondylitic changes L5-S1, with a left paracentral annular tear and small associated posterocentral disc herniation. Mild diffuse degenerative facet hypertrophy. No stenosis demonstrated.

I've tried McKenzie, doing it everyday for a month. While both the extension and flexion exercises felt good while doing them and for a very short time after, no real benefits long term.

Now I've got the Egoscue book. And the McKenzie book is still lying around. And two other books on back pain and a sheet of exercises recommended by a PT. There is TOO much information and too many exercies to choose from now, too many paths to try (some of them conflicting) leaving me confused and frustrated after a year of persistant back pain.

What to do? When? How often? Oh, how I wish there was one clear path to take, even if it was a hard one.

[tennis forlife]

Thanks for the reply about my shoulder and I apologize for being gone for so long. I was buried under with work. Anyway, the good news is the shoulder pain disappeard, thank goodness. Perhaps, it was due to my religiously performing the Egoscue e-cises.

However, I need help for my wife. She believes she has a ganglion at the top of the inner leg below the buttock. She is forever asking me to feel it, which I can't really. She visited a doctor who took an x-ray which revealed nothing wrong with the bone and no relief. Can anyone provide any advice, insight or help? Thanks in advance.

[Povl Carstensen]

Originally Posted by heycal

I've tried McKenzie, doing it everyday for a month. While both the extension and flexion exercises felt good while doing them and for a very short time after, no real benefits long term.

I think you should remember to only do extension untill the back feels good. Flexion is more for "maintenance" once the back is ok, imo. Too much or wrong flexion is often what causes the problem.

[heycal]

Originally Posted by Povl Carstensen

I think you should remember to only do extension untill the back feels good. Flexion is more for "maintenance" once the back is ok, imo. Too much or wrong flexion is often what causes the problem.

This seems somewhat at odds with most other back programs, yes? It seems to me that there are many, many exercises that include some form of flexion in various 'help your back' routines, including yoga.

Disregard all that in your opinion?