Category: Newsletter Library

Many avid golfers contort their bodies into oddly twisted postures, generating a great deal of torque. Couple this motion with a bent-over stance, repeat 120 times over three or four hours, add the fatigue that comes with several miles of walking, and you’ve got a good workout-and a recipe for potential lower-back trouble.

As America’s love affair with the game continues to grow, the American Chiropractic Association (ACA) has advice on how to take a proactive approach that will prepare your body for many years of pain-free play.

“Most golfers go until they get hurt, then look for help,” says Dr. David Stude, member of the ACA Sports Council and founding fellow of the National Golf Fitness Society. “Back pain is a warning sign that there is an underlying problem responsible for a symptom that will likely get worse. Doctors of chiropractic look for the cause of the symptom and help reduce the likelihood of future injury.”

If you take the chiropractic approach, you’re in good company. According to Dr. Stude, Tiger Woods says that lifting weights and visiting his chiropractor regularly have made him a better golfer. Dr. Stude and the ACA suggest these simple measures to help you avoid back pain or injury and improve your game:

• Purchase equipment that fits. Don’t try to adapt your swing to the wrong clubs: A six-footer playing with irons designed for someone five inches shorter is begging for back trouble.
• For the women in golf: If you have “inherited” your husband’s or significant other’s golf clubs, they might be difficult for you to use. Not only are the clubs often too long, but the shaft is often not flexible enough for a woman’s grip. Women typically play better with clubs that are composed of lighter, more flexible material, such as graphite.
• For the men in golf: It is a good idea to spend some extra time performing quality stretches-before and after your game-to increase your trunk flexibility. While men are traditionally stronger than women, they usually aren’t as flexible. Men need to improve their flexibility to maintain a more even and consistent swing plane and thus improve the likelihood of more consistent performance.
• For senior golfers: If you show some signs of arthritis in the hands, consider a larger, more specialized grip for added safety and performance.
• For all golfers: For some, scores may not be as important as enjoying the social benefits of the game. Having clubs that are comfortable will increase the chances of playing for a long time without significant physical limitations.
• Take lessons. Learning proper swing technique is critical. At the end of the swing, you want to be standing up straight; the back should not be twisted.
• Wear orthotics. These custom-made shoe inserts support the arch, absorb shock, and increase coordination. “Studies show custom-made, flexible orthotics can improve the entire body’s balance, stability and coordination, which translates into a smoother swing and reduced fatigue,” Dr. Stude says. While the upper part of a shoe may score style points, what the foot rests on affects your game.
• Avoid metal spikes. They tear up greens and can increase stress on the back. Soft shoes or soft spikes allow for greater motion.
• Warm up before each round. “Stretching before and after 18 holes is the best way to reduce post-game stiffness and soreness,” says Dr. Stude. Take a brisk walk to get blood flowing to the muscles; then do a set of stretches. To set up a stretching and/or exercise routine, see a doctor of chiropractic or golf pro who can evaluate your areas of tension and flexibility.
• Pull, don’t carry, your golf bag. Carrying a heavy bag for 18 holes can cause the spine to shrink, leading to disk problems and nerve irritation. If you prefer to ride in a cart, alternate riding and walking every other hole— bouncing around in a cart can also be hard on the spine.
• Keep your entire body involved. Every third hole, take a few practice swings with the opposite hand to keep your muscles balanced and even out stress on the back.
• Drink lots of water. Dehydration causes early fatigue, leading you to compensate by adjusting your swing, thus increasing the risk of injury. Don’t smoke or drink alcoholic beverages while golfing, as both cause loss of fluid
• Take the “drop.” One bad swing-striking a root or a rock with your club-can damage a wrist. If unsure whether you can get a clean swing, take the drop

A critical mass of recent surveys and studies document the fact that the public, and conventional health care providers and payers, have come to recognize that traditional medicine can’t answer all of consumers’ health care needs. In particular, more people are turning to chiropractic services.

• A study published in the July 1, 1998 issue of the Annals of Internal Medicine shows that chiropractic treatment is appropriate for low-back pain in a considerable number of cases. This study by the Rand Corporation found that 46 percent of a sample of low-back pain patients received appropriate care from doctors of chiropractic – an appropriateness rating similar to that of common medical procedures.
• Poll results released in January 1998 by Landmark Healthcare, Inc., showed that one in every five adults ages 55 to 64 has used chiropractic care.
• A December 1997 report from the Federal Agency for Health Policy and Research (AHCPR) notes that the chiropractic profession is now the third largest group of doctoral-level providers in the United States (after medical doctors and dentists).
• That same AHCPR report shows that fully 80 percent of American workers in conventional insurance plans, preferred providers organizations (PPOs), and point-of-service plans now have coverage that pays at least part of the cost of chiropractic care.

As the recent AHCPR report states, “In the areas of training, practice and research, chiropractic has emerged from the periphery of the health care system and is playing an increasingly important role in discussions of health care policy.” And, notes a March 1998 article in Business and Health magazine, “Many companies say chiropractic coverage has lowered their medical and workers’ comp costs, while raising overall health and productivity. ‘It’s one of the best benefits possible from a quality, quantity and pricing perspective,’ says George McGregor, president of [a firm that is a third-party administrator].” The article also cites an Oregon study, which found that median work time lost for employees with back injuries who used chiropractic care was only 9 days as compared with 34.5 days for workers who used medical care.

Quick relief of symptoms and sustained effectiveness have long attracted consumers to chiropractic care. In fact, in just one year — 1997 — more than 20 million adults used chiropractic services. The 1994 AHCPR guidelines for low-back pain concluded that spinal manipulation, chiropractic’s primary treatment technique, is one of only three treatments whose effectiveness is substantiated by rigorous research. According to a 1992 RAND Corp. study, patients see a chiropractor primarily for low back pain and neck pain, though many seek chiropractic care for mid-back pain, extremity problems, headaches and other symptoms as well.

Because back pain is so pervasive in our society, a recent study published in the British Medical Journal pointing out that back pain doesn’t go away that easily confirmed what chiropractors have always known. Only 25 percent of low back pain sufferers had fully recovered 12 months after their first visit to a general practitioner, the study said. This low number is in conflict with the commonly-held notion that low back pain episodes go away by themselves after a month. “This hardly comes as a surprise to low back pain sufferers who have been told by their medical doctors not to worry – the pain will go away on its own,” said Dr. Michael Pedigo, president of the American Chiropractic Association. “In many cases, further treatment is necessary.”

Doctors of chiropractic have long understood the cyclic nature of low back pain, and perhaps this is one of the reasons they consistently rate higher than MDs in patient satisfaction in this area. In a recent Gallup poll, 90 percent of all people who visited a chiropractor agreed that their care was effective.

Successful outcomes in both effectiveness and patient satisfaction, have paved the way for chiropractors to enter the mainstream of health care services. Some have even begun to collaborate with medical doctors in integrated health care practices. As reported in the May/June 1998 issue of Health magazine, the prestigious Texas Back Institute (TBI) at one time included only surgeons and other M.D.s. Then, about ten years ago, when TBI’s medical doctors discovered chiropractic’s success with lower back pain, they hired their first chiropractor. Now, according to one administrator quoted in the article, about 50 percent of the Institute’s patients see a chiropractor first when beginning their treatment. Also, the Washington Post recently reported on the success of the 5-year-old company, American WholeHealth, whose clinics incorporate a consumer-driven mix of traditional medical and alternative health care including chiropractic.

Due to years of criticism — and even an illegal boycott by the American Medical Association — chiropractic training was sometimes called into question. However, the fact remains, chiropractors must complete a minimum of 6 and, on average, 7 years of college and post-graduate study to earn their degrees. Their education includes at least 4,200 hours of classroom, laboratory and clinical experience, and as much — and sometimes more than — course work in anatomy and physiology as most medical doctors. After they receive their degrees from one of the nation’s 17 accredited chiropractic colleges, they have to pass rigorous exams and be licensed by the state before they can open a practice. The practice of chiropractic is licensed in all 50 states, and in 1994 there were approximately 50,000 chiropractors licensed in the United States. This number is expected to double by the year 2010, according to the 1997 AHCPR report.

“These recent surveys and reports finally vindicate the chiropractic profession after years of enduring doubt, questions and criticism about our training and practices,” said Dr. Pedigo. “What the health care and medical communities are just beginning to accept is what our patients have known all along — that our treatment is safe, effective and highly successful at improving their quality of life.”

A person with an exercise- or sports-related injury has many questions: When can I start exercising? When can I get back to my sport? What can I do to prevent this from happening again? The answers to these questions are relatively straightforward. But for some, injuries continue to happen. Which leads to the key question: Why did this happen to me?^1,2

This is the hardest to answer. Some injuries may occur even when you’re doing the things you’re supposed to be doing. Sometimes you just have to shrug your shoulders and move on. But it’s also very important to continue to try to discover the underlying causes.

If we dig deeper, we’ll find that there are three main sources of training injuries: (1) under-preparation, (2) over-training, and (3) lack of focus or not paying attention.

Under-preparation means doing things you’re not ready to do. People who have never done aerobic exercise go out and try to run five miles. People who have never done strength training go to the gym and try to lift weights that are too heavy. People who have never taken a yoga class go to one, like it, and then go every day for a week.

These exercise patterns can be dangerous, physically, and may directly lead to injury. A 16-year-old teenager has some leeway and can get away with making a variety of training errors. This may even be true for those who are in their mid-20s. But persons who are older need to train on a trajectory. Good principles to follow include starting slowly, starting with the basics, and making sure to include rest days in your training program. Build up your strength and stamina. Doing more than you’re ready to do will send you straight to your chiropractor’s office or even to the hospital.

Over-training means doing too much. Most of us are guilty of this. For example, you love to run, you build up your weekly mileage to a good level, but then you keep piling on distance. All of a sudden you’ve got a stress fracture in your leg or a bad strain of a calf muscle.

How do you know when you’re over-training? The key is to train smart, and to be aware of the possibility of over-training. The temptation to do more is always there, but the result is never good. The short-term gratification is completely outweighed by the frustration and loss of conditioning resulting from injury-enforced down-time.

What about focus and paying attention? Many injuries happen during normal training because the person’s mind wandered off. People pay more attention to the TV or to their incoming text messages than they do to the equipment they’re using or the weight they’re lifting. The result is an injury, sometimes a bad one. In fact, you’re very unlikely to sustain an injury during normal training if you’re completely focused. Maintaining focus is part of the discipline of training.

But even if a person is doing all the right things, aren’t there underlying issues that may predispose that person to injury? The easy answer is “yes”. The hard part is to accurately assess and possibly diagnose such issues.³

A big part of the assessment process is the acquisition of knowledge. In the realm of exercise and fitness, some personal knowledge of biomechanics can go a very long way toward preventing injuries. Your chiropractor can help you learn more about human biomechanics and physical performance.

¹Chow JW, Knudsen DV: Use of deterministic models in sports and exercise biomechanics research. Sports Biomech 10(3):219-233, 2011

²Stergiou N, Decker LM: Human movement variability, nonlinear dynamics, and pathology: is there a connection? Hum Mov Sci 30(5):869-888, 2011

³Carter CW, Micheli LJ: Training the child athlete: physical fitness, health and injury. Br J Sports Med 45(11):880-885, 2011

Eat more vegetables. Stress less. Take the kids out to the park more often. You may already have a long list of resolutions for the new year. This year, honor your spine, too. With the help of your doctor of chiropractic, these simple steps can promote a healthier back for the new year.

Consider replacing your pillow or mattress.

Do you wake up with aches and pains? It could be time to purchase a new mattress or pillow. The American Chiropractic Association (ACA) recommends finding a mattress that evenly supports your whole body. There should be no gaps between you and the mattress when you lie down. When choosing a pillow, select one that supports your head and neck in alignment with the rest of the spine, whether you sleep on your side or back. Keep in mind that what works for your partner may not work for you- there isn’t one mattress or pillow that fits everyone. Simple adjustments, such as adding foam padding, can help tremendously.

Re-evaluate your posture at work.

Americans spend an average of 44 hours at work every week- often behind a desk. To avoid poor posture that can lead to tension, back pain, and joint problems such as carpal tunnel syndrome, check that your chair is the right size and adjusted correctly, says the ACA. Do your feet rest comfortably on the ground? Does the chair offer lumbar support? Are you able to tilt or swivel easily while performing tasks at your desk? Also, be sure you have adequate light (so that you aren’t straining to see documents or a computer screen), adjust your computer monitor so that it is at eye level, and wear a headset for longer telephone conversations. And don’t forget to take frequent breaks and stretch throughout the day.

Learn how to lift correctly.

Many back injuries are caused by improper lifting of items such as luggage, backpacks or briefcases, storage boxes, or even groceries. But knowing how to lift properly can prevent serious injury. First and foremost, don’t bend from the waist. Keep your back straight, and squat to reach the item. Then, keep it close to your body as you lift, and avoid twisting motions. When traveling, check all bags that weigh more than 10 percent of your body weight.

Eat right and exercise well.

Eating a balanced diet and getting regular exercise helps your body stay toned and tension-free- and promotes a healthy weight and a happier spine. Smart exercise and a good diet can also prevent osteoporosis, which affects over 20 million American women. To start, the ACA recommends eating out at restaurants less (to reduce the amount of unhealthful fats and sugars you consume) and adding more fresh fruits, vegetables, and whole grains to your diet. Aim for a minimum of 20 to 30 minutes of exercise, three or four days a week.

We all know someone who has suffered a serious driving-related injury that had nothing to do with being involved in a motor vehicle accident. For example, turning your head suddenly and swiftly for a last minute check of your “blind spot” before changing lanes on the interstate could result in a painful neck sprain. Getting out your car in a crowded shopping center parking lot can often be awkward and may even result in a low back injury. Bending over to lift a grocery bag out of your back seat or trunk can even cause a herniated lumbar disc with very painful consequences. Thus, driving can be dangerous, even without taking account of your innumerable fellow drivers who are talking on their cell phones, texting, combing their hair, putting on makeup, or even shaving when they should be 100% focused on the road. Even if you’re a highly skilled, appropriately defensive driver, doing driving-related things can cause real physical injury.

Why do such injuries happen? The cause is the same as for the person who, while getting dressed in the morning, bends over to put on his or her socks, stockings, or tights and experiences a sudden, sharp pain in the low back. Later on, that pain may worsen and radiate down one leg, and a likely diagnosis of a herniated disc may ensue. “But I wasn’t doing anything wrong,” the person exclaims to his chiropractor. “All I was doing was putting on my socks.” But the chiropractor knows that the movement that apparently caused the injury was merely the last physical insult in a long chain of musculoskeletal and biomechanical deficiencies.

As with the person who injures his or her neck or back at home while engaged in innocuous activities of daily living such as housecleaning or taking out the trash, driving-related injuries that are not the result of an actual accident are caused by being deconditioned or out-of-shape. If your neck and back muscles, ligaments, and joints are not used to doing physical work while engaged in a full range of motion, suddenly putting them in mechanically stressful situations will very likely lead to injury. For such persons, the primary missing fitness factor involves the core muscles, the body’s group of central, deep, sheath-like muscles that provide the base for almost all movement and motion.

Lack of core fitness is the culprit for most neck and back injuries that happen when you “weren’t doing anything”. The good news is that core training is readily available. You are training your core muscles whenever you do strength training or yoga. You are doing core training when you walk, run, bike, or swim, provided you are doing these activities effectively and efficiently. You don’t need special equipment. All that is required is the willingness and persistence to engage in regular vigorous exercise. The many benefits are broad and longlasting, including getting more enjoyment out of the time you spend in your car.

¹Rietveld AB: Dancers’ and musicians’ injuries. Clin Rheumatol 32(4):425-434, 2013

²Micheo W, et al: Basic principles regarding strength, flexibility, and stability exercises. PM R 4(11):805-811, 2012

³Steele J, et al: A review of the specificity of exercises designed for conditioning the lumbar extensors. Br J Sports Med October 2013: doi: 10.1136/bjsports-2013-092197. [Epub ahead of print]

All of us who’ve experienced a back injury of one sort or another have been told at some point to “avoid heavy lifting.” That type of advice appears to be a no-brainer or at least redundant, as no one whose back is hurting is going to try to pick up an air conditioner or even a 100-foot reel of garden hose. In this context, it’s important to remember the words of Shakespeare’s Cassius: “The fault, dear Brutus, is not in our stars, but in ourselves”. The problem isn’t the heavy lifting, as such. The real problem is in us, that is, in our overall level of conditioning or physical fitness.

Most back injuries don’t occur as a result of heavy lifting, but rather are caused by a seemingly innocuous event such as bending over in the shower to retrieve a bar of soap that has fallen to the floor. Other likely pain-producing scenarios are bending over to place a bag of groceries in the trunk of a car bending over to tie a loose shoelace. None of these circumstances involved lifting extraordinary weight. Rather, the common elements are lack of flexibility and lack of appropriate muscle tone and strength to support the weight of your body in a forward flexed position.

The problem isn’t lack of big muscles. Picking up a bar of soap or positioning a 15-pound grocery bag doesn’t require bulging biceps or massive lats. The problem is lack of conditioning. Most of us no longer do actual physical work on a regular basis. We spend the large majority of our day sitting, either working, reading, or watching entertainment on television or other devices. The result of such lack of activity is twofold. Muscles lose strength and muscle fibers are replaced by fat. Additionally, tendons and ligaments contract and become tight, losing their necessary composition of elastic fibers. The functional loss associated with these physiological changes is profound. We experience these change every time we feel a twinge, or worse, in our backs.

The fix is easy and primarily focuses on building up core muscle strength.^1,2 Core training is directed toward your deep abdominal muscles. The main such muscle is the transverses abdominis, which surrounds your entire waist, protecting and supporting your lower back. You can think of this critically important structure as your internal weight belt. Activation of the core muscles is required for all effective physical activity.³ Without this essential foundation, any minor attempt at work, even bending over to pick up a pencil, can lead to disaster in the form of excruciating back pain.

Core training includes exercises such as the scorpion, lying windmill with bent legs, pushups, squats, and the plank. Many good books and numerous online videos are available to provide instruction in the performance of core exercises. Your chiropractor is experienced in rehabilitative exercise and will help guide you to the training methods that are best for you.

¹Inani SB, Selkar SP: Effect of core stabilization exercises versus conventional exercises on pain and functional status in patients with non-specific low back pain: a randomized clinical trial. J Back Musculoskel Rehabil 26(1):37-43, 2014

²Brumitt J, et al: Core stabilization exercise prescription, part 2: a systematic review of motor control and general (global) exercise rehabilitation approaches for patients with low back pain. Sports Health 5(6):510-3, 2013

³Wang XQ, et al: A meta-analysis of core stability exercise versus general exercise for chronic low back pain. PLoS One 2012;7(12):e52082. doi: 10.1371/journal.pone.0052082. Epub 2012 Dec 17

As springtime approaches, weather warms up and leaves turn green, many people will spend more time outside planting bulbs, mowing the lawn and pulling weeds. Gardening can provide a great workout, but with all the bending, twisting, reaching and pulling, your body may not be ready for exercise of the garden variety.

Gardening can be enjoyable, but it is important to stretch your muscles before reaching for your gardening tools. The back, upper legs, shoulders, and wrists are all major muscle groups affected when using your green thumb.

A warm-up and cool-down period is as important in gardening as it is for any other physical activity,” said Dr. Scott Bautch of the American Chiropractic Association’s (ACA) Council on Occupational Health. “Performing simple stretches during these periods will help alleviate injuries, pain and stiffness.”

To make gardening as fun and enjoyable as possible, it is important to prepare your body for this type of physical activity. The following stretches will help to alleviate muscle pain after a day spent in your garden.

Garden Fitness Stretches

• Before stretching for any activity, breathe in and out, slowly and rhythmically; do not bounce or jerk your body, and stretch as far and as comfortably as you can. Do not follow the no pain, no gain rule. Stretching should not be painful.
• While sitting, prop your heel on a stool or step, keeping the knees straight. Lean forward until you feel a stretch in the back of the thigh, or the hamstring muscle. Hold this position for 15 seconds. Do this once more and repeat with the other leg.
• Stand up, balance yourself, and grab the front of your ankle from behind. Pull your heel towards your buttocks and hold the position for 15 seconds. Do this again and repeat with the other leg.
• While standing, weave your fingers together above your head with the palms up. Lean to one side for 10 seconds, then to the other. Repeat this stretch three times.
• Do the “Hug your best friend.” Wrap your arms around yourself and rotate to one side, stretching as far as you can comfortably go. Hold for 10 seconds and reverse. Repeat two or three times.

Finally, be aware of your body technique, body form and correct posture while gardening. Kneel, don’t bend, and alternate your stance and movements as often as possible to keep the muscles and body balanced.

When the Bulbs Are Planted…

If you already feel muscle aches and pains and did not complete the warm-up and cool-down stretches, there are ways to alleviate the discomfort. Apply a cold pack on the area of pain for the first 48 hours or apply a heat pack after 48 hours, and consider chiropractic care.

Prevention is Key!

The best way to fight the pain, emotional stress, and missed work that may accompany a spinal problem is to prevent it from happening in the first place. The following tips will help you identify and eliminate “spinal stressors” and incorporate spinal health into your daily routine.

As we get older, rotator cuff injuries become more common, a result of the natural aging process. A similar mechanism operates in the discs separating the vertebras in your lower back. These cartilaginous structures lose water over time, becoming less flexible and more brittle as the decades roll by. In the case of the shoulder, the rotator cuff tendon is pulleyed to and fro as the arm swings forward and back and up and down. As the years pass, this constant motion may cause fraying in the rotator cuff tendon and inflammation in the muscles that comprise the rotator cuff. Eventually, partial or full thickness tears may develop in one or more of these musculotendinous units, causing pain and some loss of function. Importantly, conservative care may be all that’s needed to reduce pain and restore needed motion.

The shoulder joint is beautifully designed and a marvel of engineering. Its construction makes possible a full 360-degree arc of motion in both the sagittal and frontal planes. In other words, you can swing your arm in a complete circle from front-to-back and to-the-side-and-up-and-around. In the third, horizontal, plane, 180 degrees of motion is available. The overall combination of movements in three-dimensional space makes the shoulder joint the most freely movable joint in your body. However, as with all freedoms we enjoy in this life, there is a price. The shoulder joint’s great mobility is countered by its very limited stability.

The shoulder’s lack of stability needn’t concern us in our average day-to-day tasks. Protection to the joint is built-in by way of the rotator cuff muscles, which form a strong hood that envelops the intersection of the arm bone and shoulder blade. Falling on an outstretched arm may result in a dislocated shoulder, so we need to have some care in this regard.

If you’re a young athlete and have suffered a rotator cuff tear, surgery may be an appropriate option.¹ But for the vast majority of people, especially for those over age 40, most rotator cuff injuries are chronic rather than acute and can be treated with rest and rehabilitative exercise. Again, if you’re a 60-year-old skier who has torn his or her rotator cuff in a downhill accident, surgery could be indicated. For the rest of us, rehabilitative exercise is the key.^2,3

Four or five primary strength training exercises are involved in shoulder or rotator cuff rehabilitation. The three basic shoulder exercises are (1) seated overhead press, which trains all the shoulder girdle muscles simultaneously; (2) standing side [lateral] raise; and (3) seated or standing bent-over raise. The lateral raise specifically trains the middle deltoid muscle and the bent-over raise specifically trains the posterior deltoid muscle. Specific rotator cuff strength training exercises include internal rotation and external rotation on a flat bench using very light dumbbells. More painful injuries with greater loss of mobility may require (1) Codman pendulum exercises and (2) finger-walking (up a wall) to the front and to the side.

The goals of rotator cuff rehabilitation, as for any mechanical injury, include decreased inflammation, decreased pain, return to more full active range of motion, return to more full muscular strength, and restoration of function.

¹ Plate JF, et al: Rotator cuff injuries in professional and recreational athletes. J Surg Orthop Adv 22(2):134-142, 2013

² Escalmilla RF, et al: Optimal management of shoulder impingement syndrome. Open Access J Sports Med 5:13-24, 2014

³ McMahon PJ, et al: What Is the Prevalence of Senior-athlete Rotator Cuff Injuries and Are They Associated With Pain and Dysfunction? Clin Orthop Relat Res 2014 Mar 12. [Epub ahead of print]

The great TV classic ER helps teach armchair physicians to become amateur diagnosticians. He’s in shock! She’s got kidney stones! Rule-out pheochromocytoma!

But sometimes a little knowledge can be a dangerous thing.

You’ve learned somewhere – on the network news, in the Science section of The New York Times, or in a CPR class at your job – that shoulder pain can mean you’re having a heart attack. Now, seemingly out of the blue, your shoulder begins to ache and throb. Very concerned, you rush to the local emergency room.

The resident’s first question, of course, is “where does it hurt”? You point to your right shoulder and blurt out, “Am I having a heart attack?” The resident smiles, gently reassuring. “A heart attack might give you pain in your left shoulder,” she says. “Have you been to the gym lately? This might be a rotator cuff strain.”

The resident knows that heart attack symptoms usually involve chest pain (in two-thirds of cases), and may include faintness, shortness of breath, sweating, and a feeling of impending doom.¹ Chest pain may spread to the back, jaw, and arms. Left arm pain may radiate to the inside of the forearm and the ring and little fingers. So, shoulder pain by itself probably doesn’t suggest a heart attack.

She orders an MRI which shows mild damage to the right rotator cuff. What’s going on? What exactly is the rotator cuff?

The rotator cuff is a muscular sheath that surrounds the head of the arm bone (the humerus) and the entire shoulder joint (really, two joints – the acromioclavicular and glenohumeral joints). The four muscles that comprise the rotator cuff help raise the arm to the front and the side and help turn the shoulder inward and outward.

If you’re a sports fan, you know that rotator cuff injuries affect baseball pitchers, tennis players, swimmers, and football players. Such injuries are due to repetitive motion, and may also result from falling on the shoulder or arm or lifting heavy weights.

Rotator cuff injuries may also be slowly developing and chronic, related to arthritic and degenerative changes in the rotator cuff tendon and the two shoulder joints. Low-grade pain may develop, and the pain may become aching, throbbing, and chronic. Raising the arm may cause pain, and there may be loss of mobility.²

In the above-40 population, lack of exercise and chronically poor posture may contribute to rotator cuff problems. Sitting at a desk all day, with the neck jutting forward and slumped shoulders, places long-term mechanical stress on the rotator cuff.

Chiropractic treatment may be very useful in helping to rehabilitate chronic rotator cuff injuries. The chiropractic physician is expert in evaluating postural problems and associated spinal conditions. By providing effective treatment, postural corrections, and rehabilitative exercise, chiropractors offer a comprehensive therapeutic program to reduce pain, improve shoulder mobility, and regain function.

¹Source: Cedars-Sinai www.cedars-sinai.edu
²Baring T, et al: Management of rotator cuff disease. Best Pract Res Clin Rheumatol 21(2):279-294, 2007

As with much in life that we take for granted, we are not usually concerned with the mechanisms of how our bodies work and how they do what they do. Such knowledge is not required for use of these magnificent machines that have been freely given to us. But just as a wise consumer will care for her or his car in terms of regular scheduled maintenance, our bodies require ongoing attention in order to maintain proper function. The shoulder joint, in particular, requires such proper care.

The shoulder has the greatest range of motion of any joint in the human body. The shoulder is capable of 360º of mobility from front to back (the sagittal plane), 360º of mobility in the frontal plane, and 180º of mobility to the right and the left (horizontal plane). Taken together, these optimal ranges are termed circumduction. But the shoulder’s remarkable capabilities come at a price. The shoulder girdle is the least stable joint structure and is readily subject to sprains (of the acromioclavicular joint) and dislocation injuries (of the glenohumeral joint). Additionally, the rotator cuff, the group of muscles that protect the shoulder girdle and move the shoulder joints through three-dimensional space, is commonly injured, owing to the substantial mechanical stresses involved in such extensive motion.1

We can help prevent such injuries by engaging in regular physical exercise such as yoga and strength training. These activities place weightbearing loads on the shoulder, progressively training the muscles, tendons, and nerves that supply the shoulder joint structures to handle mechanical stresses.2,3 As a result of such training, when called upon to manage the shock of an unusual mechanical force, the shoulder will be able to respond effectively while likely preventing injury.

The choice of yoga versus strength training is not mutually exclusive. Many people will enjoy taking one yoga class per week and doing two strength training sessions per week. For persons taking yoga class, the two strength training sessions could focus on (1) the chest and back and (2) the shoulders and arms. Almost every yoga exercise involves weightbearing loads on the arms. Regarding strength training, a representative shoulder program includes seated dumbbell or barbell press (for the entire shoulder girdle), standing lateral raise (for the middle deltoids), and seated bent-over raise (for the rear deltoids). If you’re doing yoga, strength training sessions for the legs may not be necessary. Of course, a complete exercise program includes specific cardiovascular exercise such as walking, swimming, bicycling, or running.

It may not be possible to prevent every shoulder injury. Engaging in a regular program of vigorous exercise, including yoga, strength training, and cardiovascular exercise, is the best means of ensuring optimal biomechanical health and wellness and the best overall method for preventing injury.

Sources

1Camargo PR, et al: Eccentric training as a new approach for rotator cuff tendinopathy: Review and perspectives. World J Orthop 5(5):634-644, 2014
2Miller RM, et al: Effects of exercise therapy for the treatment of symptomatic full-thickness supraspinatus tears on in vivo glenohumeral kinematics. J Shoulder Elbow Surg 2015 Nov 24. pii: S1058-2746(15)00485-1
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