The View from Sports Center

Shoulder Pain: The Problem is Dem Bones

During his first season in the big leagues in 1998, the strong, young kid with the monster fastball noticed a nagging pain in his right elbow. He thought it would go away but it didn't. He played in pain through the remainder of the season. In the spring of 1999, he tore a ligament in his right elbow and had a Tommy John surgery. He missed the entire 1999 season spending much of it in rehab for his elbow.

After playing the first part of 2000 in the minor leagues, the Chicago Cubs added him to the roster in May. His debut with Cubs was promising but a new warning sign appeared: right shoulder pain. He was out for a month with a diagnosis of tendinitis and followed this with a triceps strain. He was on and off the disabled list about as often as Paris Hilton buys a new purse. In August 2005, he was headed for yet another surgery, this time on his right shoulder. He then spent several months in rehab.

Following the surgery, Kerry Wood spent four months in rehab for his shoulder to prepare for the 2006 season.  Then, in March of 2006, he had a "minor" arthroscopic procedure - a "cleaning up of his meniscus" -  on his right knee. He made it back to the mound May 18, 2006.

By early July 2006, it appeared that Kerry Wood's career as a professional baseball pitcher might be over. The Chicago Cub's once promising star pitcher tore the infraspinatus muscle, one of the rotator cuff muscles in the right shoulder. According to an article in the Chicago Tribune, Wood will go through more rehab and is debating about surgery. Again.

Do you see a trend? Is there somthing missing in his repeated bouts of rehab or is Kerry just an extremely unlucky guy?

If Kerry attempts a come back, he has a lot of work ahead of him. The obvious problems are in his shoulder but slinking around in the shadows is his right knee. His "minor" surgery in March was on one of the primary stabilizers of the knee - the meniscus - a crescent-moon shaped piece of cartilage tacked onto the top of your shin bone, the tibia.  The meniscus helps absorb shock in the knee and keeps the thigh bone (femur) and shin bone (tibia) from moving too much especially during a twisting action like baseball pitching.

Baseball pitchers need rock solid legs. It's where all the power comes from and when you don't have it in the legs, you steal it from the shoulder. Small changes in stability of the knee, like what happens when a portion of the meniscus is removed, rarely cause problems at low speeds and forces like tossing a baseball to your son in the back yard or even a slow jog around the neighborhood. But, pitching requires a lot of force over a short period of time. You need all you can get from your legs.

On the outer rim of the meniscus is a small bed of nerves. These nerves are now thought to play an important role in telling your brain how to coordinate muscles during complex tasks like pitching. Signals from the ankle, knee, and hip converge in the brain influencing how and when the various muscles contract. Think of a conference call with people giving their opinion of what you should do and imagine that you could actually listen and analyze everyone at once. This is what your brain does. It's listening to the advice from the joints. When a part of the meniscus is removed, some of the nerves may be damaged or removed as well. It's like someone hung up on your conference call. You don't have all the advice you need so, your brain does the best that it can. In most cases, the shoulder or elbow works harder to generate more force. The harder you try to throw with your arm, the easier it is to hurt your arm. This leads to periodic shoulder or elbow injuries. Anytime you have a repeated injury of the shoulder, you will usually find an unresolved problem in the hip, knee or ankle.

We are a society that likes to compartmentalize, reduce, isolate problems and then fix them. If you have shoulder pain, you see a shoulder specialist, maybe have shoulder surgery, go through shoulder rehab and move on. But, unfortunately, that's not how the body works. Your shoulder needs the "advice" of your hip, knee and ankle; your lower back depends on your butt muscles; your knee needs your ankle; your neck thrives from your upper back. You know the old song, Dem Dry Bones - "the ankle bone's connected to the knee bone, the knee bone's connected to the thigh bone...."? It's true. The body's joints and muscles work together. When it comes to rehab, joints and muscles that work together, win together.

If you're struggling with persistent shoulder pain and recurring injuries, like Kerry Wood is, make sure you have any nagging hip, knee or ankle problem addressed as part of your shoulder rehab. It could be the one thing that truly "fixes" your shoulder.

Make today count.

Doug Kelsey

PS - For those of you with shoulder pain, check out our next free seminar, Shoulder Pain: Why it Still Hurts to Throw, Swim, or Serve. Seating is limited - call 512-206-0433 to reserve your spot.

I Repeat - Repetition is Good.

Somedays, I just don't feel like climbing out of bed and onto an elliptical trainer for 30 or 40 minutes. I'd rather sip coffee. I'd rather read. So, I have a short dialogue with myself - just a reminder that the feeling of not wanting to to do what I need to do will pass. I focus on what I want - to be healthy, active, have a vibrant life - not on how I feel at the moment. The more I repeat the process, the more success I have in overcoming the inertia of inactivity and get off my butt, the easier it becomes. Repetition breeds success.

When I was in grade school, my math teacher stood at the front of the class, and occasionally called out my name and  quizzed me on things like multiplication tables. If I missed it, she would hand me a piece of chalk, show me a chalkboard the size of Texas on which I would write, over and over, the multiplication tables starting with 1 x 1 = 1.

In music class, where I studied trumpet, I played the twelve chromatic scales until each scale was perfectly played. If I missed a note, I started over, from the beginning.

At the end of basketball practice, I shot free throws until I made 20 in a row. If missed, I started over.

See a pattern?

Repetition, of the right thing, done the right way, transforms flimsy knowledge, fragile understanding, and inconsistent performance into something dependable and solid. All teachers know that through repetition, you learn.

The same principle is at work in the body when you overcome an injury. Through repetition of training, you learn what to do and how to do it. Through repetition of movement, your body grows stronger, more flexible; you develop power and endurance. Your heart and lungs learn how to deliver the much needed oxygen. Through repetition of thought, your mind finds solutions; finds the positive alternatives to negative situations - ways to win.

I grumbled about having to go to the chalk board and write the formulas, repeat the scales on my trumpet, shoot the free throws just as you may grumble from time to time about having to change your daily routine because of an injury or surgery and work on drills until you master them. But, if you want to not just feel better but really be better, that's what you have to do. You have to show up and practice even when you don't feel like it. Your body makes you earn your health. Otherwise, everyone would be healthy.

Winning is built on repetition of the right thing done the right way. Is that what you're doing?

Make today count.
Doug Kelsey

Bull Riding in My Future?

I'm thinking about riding a bull.  You know, the sport where you take a thick rope, wrap it around a bull's testicles, climb on his back, yank on the rope and hold on for 8 seconds? Maybe it's a mid-life urge to prove myself - to find the cowboy within. After all,  I live in Texas. I own some black leather cowboy boots, a big brass buckle with my name on it, a hat or two. Finding a tight pair of jeans won't be hard. Maybe I'll start with one of those mechanical bulls like you find in an urban cowboy bar. Ease into it. Just to make sure my body can take the pummeling of a 2000 lb. steer as it does its best to shake me off its back.

I know what my wife will say. "I see stitches and x-rays in your future."

All professional bull riders get hurt and about half of the time, it's their head. According to a 20 year study by the Justin Sports Medicine, 48% of injuries are concussions and many riders have sustained multiple concussions.

If you bang your head hard enough that the next day you don't know what town you're in, there's a very good chance you'll also have some neck pain. Your neck must control the weight of your head which, for most people, is about 10% of their body weight. So, if you weigh 150 lbs., your head weighs about 15 lbs - a nice size bowling ball periliously perched on top of your shoudlers. When a bull rider smacks his head on the ground, the sudden acceleration-deceleration of his head can sprain ligaments, strain muscles and bruise the bone. Sometimes the injuries can be severe - fractures, concussions, spinal cord injuries. But, many bull riders have an injury that the average, non-bull riding person also gets: "whiplash" - primarily a ligament injury of the neck. The "whiplash" injury from a car accident is similar to a bull rider striking his head on the ground - the head rapidly snaps forward and backward. The symptoms often show up several days to weeks later. Your neck will be stiff, sore and may ache. Headaches, especially in the back of the head, are common.

And, the most common treatment for this kind of injury? Stretching.

Why you stretch tissues that have already been overstretched is just a real puzzle to me. Of course, one of the reasons you stretch your neck is because it feels tight or stiff and you can't turn it much. And, if you're not injured, stretching may help you (yoga exercises for example). But, for the average person with neck pain who thinks, "Maybe if I stretch it, that will help. Maybe then I can move it," it doesn't work so well. Can you imagine stretching a sprained ankle? A sprained wrist? So, why do people stretch a sprained neck?

Maybe it's because they don't know any better or because everyone else does it. I think it's because they don't understand how the tissue heals.

Helping the tissues heal after a "whiplash" injury starts the same way as other ligament injuries: gentle, easy motion through a limited range of motion, under low levels of force. In some cases, you may need a brace, for a short period of time, to protect the area and keep it from moving too much. As symptoms subside and the motion improves, special forms of exercise help your muscles regain the strength and endurance you need (ask your health care provider about spinal stabilization exercises).

Here's the take home point: when you sprain a ligament, regardless of where it is in your body, don't stretch it. It's already been stretched - too much.

I think I'll leave the boots, belt and hat in the closet and just stick to an elliptical machine. But, now that I think about it, I've fallen off that thing too.

Make today count.
Doug Kelsey

For those of you who want to learn more, sign up for our free lecture, Neckonomics: Solve Your Neck Pain Without Breaking The Bank.

The Back Pain Boomerang

It's back.

Freddie wishes it would just go away.

The back pain boomerang circled around about one year later to knock Freddie Couples out of the Scottish Open on July 13, 2006.  "I couldn't have even walked down the first fairway, let alone play," Couples said. "Every time I get up I feel like I'm going to fall down. It's not very good." (source: USA Today).  Not very good? I'd say it's awful.

Back pain is a problem best fixed by understanding it first. All back pain is not created equal. The pain can come from a herniated disc, sprained or torn ligaments, irritated tendons, or overloaded bone (not to mention a number of other reasons for back pain that require medical attention like tumors, kidney disease or a dissecting aorta), or a combination of all of these things. This is why many clinicians throw up their hands in frustration, treat the symptoms and pray; why many clients throw in the towel and quit.

Solving back pain is never just one thing. It's never a quick fix, a jiggle here, a stretch there, a pill, a rub, a needle or two, some heat or some cold. A quick fix is how you launch the boomerang.  Solving back pain requires you to look closely at all the elements and address each one.

I have written about this problem before. The elements to solving back pain are the same:

• heal the tissue
• re-establish motion
• improve balance and reaction time
• maximize strength

All golfers know the numbers of their game. Freddie can tell you exactly how far he hits a 7 iron, a 3 wood and his average putts per round. But, I'll bet he cannot tell you the strength of his hips or the key core muscles of his trunk, or his flexibility, or his endurance, or his balance. I'll bet Freddie has been playing back pain roulette - feels good after a bit and gives golf a go. Maybe he thinks to himself, "Well, I feel pretty good and I seem stronger so I think I'll play 18 holes today." This what most people with back pain do. When they feel good to go, they think they are good to go. Not true. Not unless you know your numbers.

Numbers, measurements of key functions of the body, tell you if what you're feeling matches up against what your body can actually do. For example, let's assume Freddie's back feels good one day after some type of treatment. We measure his hip strength and find it's low. Since your back and your hips work together to control and distribute the forces of the golf swing, having strong hips is a must. Golfers with weak hips and trunk muscles tend to have back trouble partly due to the inability to handle the force of the swing*. So, if we let Freddie play before his numbers indicate he's ready, what do you suppose will happen? Right. The back pain boomerang knocks him out of a tournament.

When you feel better is the time to find out if you really are better. Otherwise, duck. The boomerang is on its way.

Doug Kelsey
Former Member, Backpain Boomerang Society

* The University of Pittsburgh Medical Center