11 days out from my fifth Prolotherapy treatment

It's not yet two weeks out from the fifth treatment, but I'm really feeling better. I think a lot of the discomfort I was experiencing was stemming from the damage to my rib cage.  It's also pretty amazing how much my shoulder has changed after just one treatment to the shoulder capsule.

I don't know why, but Dr. Fullerton kind of ignored the shoulder capsule this time, even though I was pretty certain I could use another treatment.  He asked of I could hold a plank now, and I said something like, "Maybe??"  I didn't really know how to respond because I haven't tried doing a plank/push up since the last treatment.  ...I now realize that I should've simply said that, but for some reason I felt nervous and just didn't know what to say.

I'm still pretty impressed with how much more I can decompress my left ear now.  It's pretty much identical to the right ear.  Also I haven't felt as near as much need now to try to crack my neck, so that is obviously a good thing.

I still feel the need to try to roll out some areas in my upper back, like where the upper trap attaches to the shoulder blade, I think?   One of the hardest things about this whole process is that because it's my back, I can't easily point to it.  Like I can only approximate the location.  I think next time I will have to roll out and then turn around and show him where my skin is red.

I've really been tempted to go early this January and get a treatment just for my hips, but I think I will probably just wait it out for the next time.  ...if my shoulder/back is still giving my trouble I will book two sessions a week apart, and go from there.  So I guess I'm betting that I will need a sixth treatment on my back.  ...That's kind of sad, but I keep getting so much better after each session.

We will see;  we will see.

First Prolo Treatment with Dr. Fullerton

Fist off I have to say that I really like Dr. Fullerton. He's very professional and very thorough.  Heck even my wife likes him and now thinks that prolotherapy is a valid form of treatment.  The plan was to meet him on Thursday afternoon for an examination, and then friday morning for the treatment.  The first meeting went much longer than I expected. First, it took a long time to go over my medical history. It was fairly confusing for both the PA doing my intake and myself since I've seen four different doctors in VA and IL for the hip that I wasn't seeking treatment for, while having seen a PA in NC for the shoulder pain who gave the diagnosis of a torn labrum.  There's a lot of information there that can get jumbled up over the six years I've been seeking treatment.

So after my intake was complete Dr. Fullerton came in.  Like I said, he was very thorough.  He had me do a bunch of different functional tests to see what was wrong.  It was very similar to getting an assessment from a PT.  He then used the ultrasound machine to see what was going on.  He also did palpitations to see if any spot hurt.  Using these methods he pretty much pinpointed the exact areas of pain in my back.  The lavator, the rhomboid, the trap, and the supraspinatus.  He said these muscles all looked "frayed". That's not exactly what one likes to hear, but he said he's seen worse.  This fraying is all in addition to the torn labrum.  He also found some weakness in the spinal errectors on the right said of my back.  If they couldn't do anything, perhaps my left side has to overcompensate, which is why I've always had a tight QL and pain on the left side.  He also examined my left him, the one that now doesn't seem to move as well as my right, and said there was a pit in the capsule.  That doesn't sound good.  He also found out that when doing internal rotation with that him it caused pain on the inside of the hip joint, the part right next to my junk.  I'm not sure what all of the diagnosis were or meant, all I know is that he found a boatload of problems and he had his work cut out for him.

 

Then I saw him the next day for treatment.  He had me do all those tests that I failed again. Then he injected me with lidocaine to numb the relevant body part.  He waited for the numbing agent to take effect, and then injected the body part with dextrose under ultrasound guidance.  After that he then had me do the test again, and I passed!  It was very strange how immediate the effect was.  For example, he twisted my hip into internal rotation and it hurt on the inner part of the joint. He then injected some solution into the outer part of the capsule, did the motion again, and it no longer hurt!  After he went over everything with Dextrose, he then did the injections of the blood.  He had 180ml drawn to be spun out, so I imagine he had a lot of PRP to work with, so I think he injected everything with the PRP as well.

There was almost no pain during the treatment. None.  The lidocaine really worked at making the real injections painless.  The pain that I did experience came from the pressure of having so much solution

Lots of band-aids after the treatment.

injected into my body.  The pain immediately after the treatment got a little intense.  It's not that the pain is really that severe, is that you know you can't get away from it, nothing you can do will alleviate the pain, and that's hard to accept.  They put an ice-pack on my back for 10 minutes (That's the max you want to do, and only the day of since you don't want to reduce any of the acute inflammation it's suppose to cause.) and gave me some Tylenol and I was good to go.

The injection sites feel like hot water balloons underneath the skin.  My hip didn't feel anything for the first two hours, but my back felt it immediately.  I was able to sit in the car while we drove back home from Austin, and then I went out and ran some errands and then went to the museum with some friends. If I had the chance to do it all over again, I would've just stayed at home and slept, but I was able to do everything and anything I wanted to.

I really like that Dr. Fullerton was able to find so many things wrong.  Well, I don't mean to say that I'm happy I have so many things wrong with me, just that I feel that he was so complete that after these treatments I won't have anything unaddressed.  I won't have anything lingering.

I now definitely want him to examine my right hip once he has finished fixing the left hip, if the left hip proves not to be the source of the lingering pain in my right hip.

Given a choice between the two, I would rather go to Dr. Fullerton than Dr. Hauser. Dr. Fullerton's examination is much more complete. Dr. Hauser isn't really for diagnosing, just fixing.  So if there's something missed in the diagnosis, Dr. Hauser isn't going to find and address the problem.

Here's the part of my recordings the day of the treatment:

Danger of doing kipping pull ups without sufficient strength

(UPDATE: if you've hurt your shoulder I've found something that can really help out.  It's simple and cheap, and it's hanging from a bar multiple times a day. Won't heal the labrum, but it can help out with a lot of other shoulder ailments.)

If you peruse the injury threads on the crossfit.com board you'll find a lot of shoulder injuries, specifically SLAP tears (tears in the labrum). A lot of them seem to come from kipping pull ups, and I've come across a possible explanation. There is an article explaining what a SLAP tear is and how it comes about, most notably:

In theory, SLAP lesions most likely occur in overhead athletes from a combination of these 2 previously described forces. The eccentric biceps activity during deceleration may serve to weaken the biceps-labrum complex, while the torsional peel back force may result in the posterosuperior detachment of the labral anchor.

As some one else pointed out, when you look at the kipping pull up with this knowledge you'll see:

Eccentric bicep loading = the negative part of the pull-up, the arms straightening at the bottom

Arm deceleration = the swing into the kip

Abduction and external rotation = the position of the arms at the apex/reversal point of the kip

Just imagine the "peel-back" force in the shoulders when they are forcefully wrenched back at the apex/reversal point of the kip. If you really think about it, the head of the humerus is trying to push out the front of the glenohumeral (shoulder) joint, the kipper is trying to RELAX their muscles at the bottom to get the most out of their kip, leaving all the strain on the LABRUM (think of it as a suction cup on the scapula that holds the humerus on the body, with the greatest forces on the top/superior and the front/anterior parts), and the resultant forces--over time (repetition)--TEAR the TOP part of the labrum from the FRONT to the BACK...this is therefore a SUPERIOR LABRUM ANTERIOR-POSTERIOR injury mechanism, almost perfectly designed (as evidenced by the orthopedic doctors making a ton of money off of people who do them).

Steven Low, writer of an awesome exercise blog, has chimed in on this subject matter as well. I have much respect for the man. Not only do I have a link to his blog in the margins, but his posts have really helped me in the past with my injuries (led me to find a DO for my hip, helped realize massage would fix the tendonitis, etc.). Concerning SLAP tears, he says:

The reason why you don't seen the top CF athletes getting slap lesions is because their shoulder mobility sucks. If your shoulder mobility sucks when you relax your shoulder muscles at the bottom of the pullup you have your muscles contracting against opening the shoulder all the way thus mitigating any forces on the biceps long head tendon. In addition, the muscles do help bar forces from the shoulder.

However, when you get people who are weak (e.g. women in general, or those with good shoulder mobility) they're the ones getting the primary forces distributed through the muscles into the other soft tissues such as the long head of the biceps. This is especially the case with learning the kipping pullups where there's going to be a lot of jerking down into the motion while learning it.

I would never ever ever ever recommending learning kipping before you at least have 3+ deadhang pullups. It's not just not a good idea putting trauma on the shoulder especially when it's easy to not do it right and jerking down into the movement which is much more dangerous than a smooth movement.

Jerking down from toes to bar can do the same thing for reference.

There's also another article here by Whole 9 that basically sends the same message of do dead hangs before working on the kip. Crossfit Virtuosity also recently mentions how important it is to have strict pull ups before you start kipping (and provides a great program to get strict pull ups).

This kind of concerns me because my shoulder mobility is pretty darn good, however I have a very smooth swing, without a jerk. I also wonder if butterfly exposes the shoulder in the same way (don't think so). But from now I will definitely make sure I'm keeping my shoulders engaged at the bottom of a kip, I already have a tear in my hip labrum, and I really don't want to add a shoulder one to the mix.

...I should also point out that, as far as I know, no one at CFOT has suffered a SLAP tear. This is further testament to the training and programming that Jerry lays out for us. The man knows his stuff.

(UPDATE #2: Turns out I have a tear in the back of my shoulder's labrum, not a slap tear, but a tear nontheless. I've decided to forego surgery and try prolotherapy to repair the damage naturally. For more about prolotherapy check out these two videos here and here.  I've started a vlog where I document what recovering from prolo is like:



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