In the February issue of our newsletter, Mike O’Hara discusses ways to improve hip mobility and strength. Read Jeff Tirrell’s article on why dairy products may actually be good for you. Having back pain doesn’t mean you can’t have a fitness program.
The Coldest of Shoulders
Understanding and Not Understanding Adhesive Capsulitis
Marilyn first noticed the right shoulder pain when she was sleeping on her right side. Over the next month, the pain became more frequent and more intense. Her shoulder ached in the morning and after any repetitive activity. Marilyn tried medications and ice, but the pain persisted. After eight weeks, the pain decreased, but her shoulder movement had become restricted. Her shoulder became so tight that she developed difficulty with activities of daily living such as fixing her hair, dressing, and bathing. Marilyn had developed a “frozen shoulder” and the frustrating thing was that she had no idea why it had happened.
No one fully understands why a frozen shoulder develops. For some reason, the envelope of tissue that surrounds the glenohumeral joint–the joint capsule, shortens and develops thickened adhesions or scar tissue. The medical term is “Adhesive Capsulitis”. This tissue restriction limits the ability of the humeral head (upper arm bone) to rotate and glide properly so your shoulder becomes tight and painful.
Most of the time, a frozen shoulder occurs with no associated injury or activity. Frozen shoulder most commonly affects patients between the ages of 40 and 60 years old. It is far more common in women than men. Individuals with diabetes are at far greater risk. If you have undergone a surgery or sustained a trauma to the shoulder, you can develop a frozen shoulder. This is especially true if you have held the joint immobile for a period of time. Several studies have linked Parkinson’s disease, thyroid problems, and heart disease to a greater incidence of frozen shoulder. Patients that develop a frozen shoulder are more prone to getting it in the opposite shoulder. Despite all of this knowledge, we continue to see many frozen shoulder patients that have none of these predisposing factors.
I would add another condition to the commonly mentioned predisposing risk factors for frozen shoulder. In my career as a physical therapist, it has been a rarity to find a frozen shoulder patient who was strong. From grip strength in the hand to the muscles that hold the shoulder blade on the rib cage, these patients are usually weaker than their same age and sex peers. The strength in the unaffected arm is often as limited as the arm with the frozen shoulder. My belief is that the most common risk factor for developing a frozen shoulder is upper body weakness. The glenohumeral joint is a fairly unstable joint that relies on the integrity of the muscles to kept it free from trauma. If the shoulder muscles are unable to properly control the joint, then excessive stress is transmitted to the joint capsule and an inflammatory response ensues that scars and tightens the capsule.
Physical therapy for a frozen shoulder consists of manual therapy to stretch out the shortened joint capsule and a program of exercise to restores shoulder range of motion, coordination, and strength. Most of the time, we get the patient when the shoulder is at its tightest point and recovery takes six to ten weeks. As with so many conditions, the patients that get to therapy earlier or before the shoulder is fully frozen do better with therapy.
In many ways, Marilyn is the typical frozen shoulder patient. She is the correct, age, sex, and fitness level. Further medical work up revealed that she was prediabetic and in need of some ongoing medical attention. Marilyn was a model physical therapy patient and her shoulder function was restored with six weeks of physical therapy.
Michael S. O’Hara, PT, OCS, CSCS
In the January 2018 issue, Mike O’Hara focuses on strengthening your hamstrings. Exercises to make your hamstrings stronger, not longer are given along with video demonstration. Jeff Tirrell tells us how to make incremental changes in our diets to see positive changes, and the spotlight is on Fenton Fitness member, Robin Forstat–a nationally ranked power lifter.
Advice From The Experts At Fenton Fitness/Fenton Physical Therapy
Tara Parker-Pope wrote a great article in the October 17, 2016 edition of The New York Times entitled “The 8 Health Habits Experts Say You Need in Your 20s.” While I agree with some of these recommendations, we at Fenton Fitness and Fenton Physical Therapy have some suggestions of our own.
#1—Don’t do dumb stuff
The cumulative injuries you suffer in your twenties echo through a lifetime. My long and busy career as a physical therapist has taught me that this is true. The 20 year old with a knee arthroscopy returns as a 32 year old with a ligament reconstruction and then again as a 50 year old knee replacement patient. Surgery and rehab can only do so much. Resist participation in the “hold my beer” events that inevitably present themselves in the social lives of 20 year olds. Think twice before you enter that Gladiator Challenge Race, swing from that rope suspended over a river, or text and drive. Your sixty-year old self will thank you.
-Mike O’Hara, Physical Therapist for the last 32 years. Fitness coach and board certified orthopedic specialist
To read the article, click on the link below:
Listen to Mike’s advice: https://youtu.be/8JCtFzj539M
Everyone needs to read the two part New York Times article on falls (see links below). As a physical therapist who has worked with fall related injuries and fall prevention for the last thirty years, I applaud Katie Hafner. For the last ten years, the number of emergency room visits and the number of deaths from fall related injuries has been climbing at an alarming rate. Most people are unaware of how dramatically a fall can change their life. The news we are not getting is that programs designed to prevent falls are very effective. A properly designed fitness program can improve your balance, enhance your reaction skills, and make you less likely to fall.
Please Stand Up
If you want to improve your balance you must stand up. There is specificity to exercise. You will not get better at tennis with an exercise program of swimming. Seated, supine, or prone exercise activities will not improve your balance, reaction time, or proprioception.
The Feeble Fall
Make strength training and the maintenance of muscle mass a priority in your fitness program. The loss of muscle mass and strength is directly correlated to a higher incidence of falls. It is good to improve flexibility and cardiovascular capacity, but they will not reduce your risk of falling.
If fall prevention is your goal, then your fitness training must make you move at quicker tempos. Most of the training in fitness facilities is of the slow and controlled variety: Slow seated knee extensions, slow down dogs, slow seated physioball leg lifts. In life, much of what comes at you is fast and uncontrolled. The time you spend training must focus on activities that make you move quickly. Throwing a medicine ball, foot work on an agility ladder, or low hurdles and reactive resistance tubing drills are good examples of faster paced exercises.
Become a Better Shock Absorber
Your fitness program should make you impact resilient. Fall events often occur because of an impact. You get bumped or jostled and are unable to maintain your equilibrium. The force of the impact causes just enough movement disruption that you topple over. Just like any other physical attribute, impact resilience can be improved with proper training.
Getting up and down off the ground enhances all aspects of balance, coordination, and positional awareness. The capacity to transfer gracefully and safely from the floor to standing maintains independence. Getting down on the ground and developing this skill should be part of your fitness program.
Fall prevention programs work, and they work better than most other disease preventative programs. Most people start fall prevention training after they have tumbled over several times. Whether it is heart disease, diabetes, or falls, it is far better to start prevention programs before problems develop. My suggestion is that if you are over forty, you need to make fall preventative activities part of your exercise program. Fear, denial, and the “old dog–new tricks” dilemma are the obstacles we keep tripping over.
To read Part I, click on the link below:
To read Part II, click on the link below:
-Michael O’Hara, PT, OCS, CSCS