Posts Tagged ‘subluxation’

Gentle Shoulder Rehab: Just A Suggestion

October 31st, 2009

There is an old saying that suggests that there are many ways to skin a cat. Just so, and there are also many ways to stretch and rehab any joint, including the shoulder.

I sometimes feel that there is a gap in the way that we as therapists and trainers handle the recovery and rehabilitation phase of shoulder injury; that the categories are sub-divided too starkly into black and white, passive and active, low-stress mobilising and strength building. It seems to me that we should more often look at what the individual needs and build in an intermediate phase, where act as guide but let the injured individual be inventive and therefore participatory in their own recovery. They improve faster as a result. Encourage them to clean windows, polish floors, bounce balls against a wall – all low, (or at least controllable), effort activities that help to distract from the discomfort but also gives a sense of achievement.

This is not revolutionary thinking by any means as business management techniques are always telling us that if the employee ‘buys in’, then productivity and contentment rise! Why should patients and sports people be any different?

Each individual is just that, individual, and has different physical structure, varying levels of physical activity, abilities, age, expectations and needs. It seems intuitive, therefore, that while those who are professionals endeavour to tailor recovery regimes, that they should, in part at least, be led by the recipient.

I am a great fan of The Rotater and, increasingly, of Kettlebell workouts, but they have very different ‘points of entry’ in the timeline of recovery – the Rotater can be used fairly early in the recovery phase – gently at first, ramping up the intensity as pain reduces and range of motion increases and until it becomes an integral part of any workout, prehab or sporting event. Kettlebell is fantastic as a total body workout that is low impact and wonderful as shoulder mobiliser, BUT is only appropriate rather further down the recovery road!

The following video tries to outline a fairly ‘loose’ approach to mobilising the shoulder – be inventive, work within your means to start with, gradually increasing range and intensity, trust your therapist or trainer, but trust yourself as well.

As with all advice on medical conditions, check with your doctor, osteopath, physiotherapist, chiropractor or trainer before embarking on any new regime.

Shoulder Dislocation

October 15th, 2009

What is a dislocation? Everyone knows, right? A true dislocation of a joint requires the complete separation of the two sides of a joint. What is often called a dislocation is actually a sub-luxation, or partial separation – they still hurt and do damage, but tend to recover faster.

This is an example of a shoulder dislocation. It is of a rare type, inferior, (or downwards into the armpit), and is caused by hyperabduction and makes up only 1% to 2% of all dislocations. This is a Luxatio erecta type.

1_16.12.08 A&E

So, if it is so rare, why does it matter? Well, it is rare overall, but is relatively common in sporting people who fall!  Mountain biking, moto-X, soccer goalkeeping, equestrian sports and skateboarding.

If YOU end up in the emergency room with your arm stuck above your head, the chances are that they will not have seen it. The key to relocating this joint is to dislocate it again first…..FORWARD, creating an ANTERIOR dislocation, then a more normal reduction to its proper position.

As well as the usual problems associated with dislocations, (AC joint, nerve and blood vessel damage), the inferior type causes damage to the floor of the armpit and can lead to  concurrent fractures of the upper arm, AC joint, as well as injury to the nerves, (brachial plexus), or specifically to the axillary artery.

Recovery can be slow, even with conventional physical therapies, medication and exercises. You will probably have to start with PASSIVE movements, such as pendulum swinging which you can see if you run the video. Remember that passive means just that – let someone else make the movements for you, (physio,osteopath), or use the weight of a tin of beans or can of coke and your body movements to generate the impetus.

Repeat these exercises several times a day and at every opportunity. If you don’t use the range of motion, you may well lose it! Repeat each direction on movement about 30 to 40 times. ie, 30-40 clockwise, anticlockwise, front-to-back, etc.

Good luck with your rehab and make use of all the tools available to you; information, professional advice, devices like the Rotater and, most of all, use your imagination.