Video of prolo hip rehab

Ok, as promised here's a video of the exercises I did in Phase one of rehabbing the hip.  It's not sexy, but I notice how limited the range of motion is on this.  Gotta start somewhere:

My shoulder is the new Hip.

So when I saw Dr. Hauser for my shoulder pain he immediately thought the problem was with my C6-C7.  I thought he was crazy because I was certain that the issue was with my RC muscles, specifically the infraspinatus.  What would my spine have to do with my shoulder/neck pain??  Well, I’ve come to realize that he may be right in his diagnosis.  Sometimes when I wake up, maybe up to half the time, my left pinky and ring finger are numb.  It goes away on its own so I’ve never thought much about it, but I’ve realized that it could be connected to my shoulder/back/neck discomfort.

The symptoms of the numb pinky points to something impinging the C8 nerve.  This is the nerve between the C6 and T1, it’s just about where I constantly feel discomfort now.  I’m not sure what to do about this, but I figure I could see an orthopod for this, with my insurance it’s only $30.  I plan on making an appointment soon. The plan is to get a diagnosis and see what possible ways this can be fixed.  Dr. Hauser does seem to be able to help, but I want a name to this thing and see if there are other, cheaper options. 

Speaking of cheap ways to heal myself, since I’ve started hanging on a bar multiple of times a day, I have had days where I am basically symptom free *pumps fist*.  I saw Bobby on Monday and he was very impressed with how normal my pec and shoulder muscles felt.  Normally they are tight like I have a shoulder injury that they are trying to protect, but that doesn’t seem to be the case right now.  As opposed to taking maybe 30 minutes to release, my pec released in under five minutes.  I’d say that’s a win in my book.

I no longer have the pain and discomfort in my neck like around where the scalenes are, but I still have lingering discomfort lower, like between my shoulder blades.  I try to target the areas with a lacrosse ball and am somewhat successful. However, I have cracked my neck/back a couple of times doing this.  I’m worried that I am undoing what Dr. Hauser has done, so I am trying to stay away from it.  I’m not cracking my neck like I used to (where I would torque my neck with my hand), it’s just that when I apply pressure to my back, right between my left shoulder blade and my spine, I just naturally want to stretch out my neck muscles by lowering my right ear to my right shoulder.  And the result is a little click.  Not like the crunch I used to experience.  Still, I feel like I’m starting down a slippery slope going back to the way I used to be, and I don’t want that.

I am planning on seeing the Chiropractor this Friday to see what she finds, to see if she can help with my C6-C7.  I know almost every time I go to see her they are out of whack, but perhaps with this new info she can find out if something else is going on.  So much to figure out, so little time.

I’m so, so happy that I seem to have my hip licked, but now that it’s no longer hogging all the attention I’m starting to realize how much pain/discomfort I’ve been in thanks to my shoulder.  I’ve been addressing each issue as it presents itself, starting at tendinits to tight scalenes to something being wrong with in the C6-T1 region.  Hopefully I will get this figured out quickly, unlike my hip.

Prolotherapy rehab plan for the hip

So on my earlier post Pamela asked me where I’m getting my rehab program from, if I’m working with a physical therapist or just doing this through intuition.  She also asked how I know how much I can push things.

The short answer is that I am definitely not doing this alone, but I’m not exactly working with a physical therapist either.  I’m working with a “fitness specialist” at a gym who is working with my doctor to come up with an exercise routine for me to do on my own at the gym.

Now for the long answer.

I have a membership with a gym that has ties to a hospital, and one of the perks with membership is that I get a "fitness assessment", which is where I meet with a fantastic fellow named Mark who is comes up with the exercise routine for me.  I'm not sure of his actual credentials (He has many letters after his name, but I'm not sure what they all mean), but when I told him I had a torn labrum he knew exactly what I could and could not do, and explained why.  So that is where I get my rehab program from him.  I meet with him about every six weeks and we change up the program.  I plan on posting a video of the various exercises I do on each day for each phase.

With regards to how hard to push things, the first question that needs to be answered is “what are your goals?”  It’s difficult to know how hard to push when you’re not sure what you’re pushing for.  I know that isn’t really what Pamela is asking, but by addressing this issue I can write up a much more (hopefully) informative post.  With rehabbing my hip I am going to go through three different phases with four different goals: improve endurance, range of motion, strength and finally speed strength.

Endurance

When my hip was still in the early stages of healing I was kind of going bonkers because I felt that the restriction of “nothing more than 20 degrees of flexion and no external rotation” meant that I could do nothing.  But as my labrum was getting better I felt like I needed to engage the hip muscles somehow. Letting them go to waste felt like it would take me a couple of steps even further back.  So I needed to come up with something to do.  That’s when I learned of the fitness assessment my gym offered and I met with Mark.  After coordinating with Dr. Hauser, it was established the first thing with my rehab is to regain endurance/work the stabilizers.  I need to strengthen all those stabilizers that have withered under lack of use. This means I need to do low weight with high reps (3 sets of 12-15 reps).  Because I am trying to work the small stabilizers, what I am pushing for is absolutely perfect form.  I was allowed to increase the weight over time, but only after I could do 15 reps with EXCELLENT FORM ON EVERY REP FOR ALL THREE SETS.  This was perhaps the most boring/frustrating part, but it was much, much better than doing nothing.

Range of motion/strength

After about six weeks of this I’ve gone into this new phase where I will work on range of motion and strength.  This what I am working on now.  Because my hip is significantly better (hopefully my labrum is at 100% now), the doctor told me that I can do anything that doesn't cause my hip to click or snap.  The fact I can do squats, in any form, is quite the milestone. Now that my stabilizers should be strong enough to handle moderate loads I can do more functional exercises, like deadlifts and squats.  However, since my ROM is not 100% yet I have to modify both.  I am also continuing to do the exercises that I did in the first phase, but with greater ROM.

Besides the no-click rule, Dr. Hauser says that anything I do that results in residual pain for longer than two hours afterwards is too much.  Thankfully I’ve never done anything that has resulted in any residual pain, but this is another marker to see if I’ve pushed myself too far.

While I'm working on increasing my ROM, I am also increasing my strength.  I am now lowering my rep scheme to three sets of 8-12 reps.  Again, if I can do  the last rep perfectly I can go up in weight the next time.  Again, I plan on posting a video of the various exercises of this new phase.

Speed strength

After working on endurance, range of motion, and strength, there is only one last thing to cycle through: Speed strength.  The violent explosion of the hip in an Olympic lift, kettlebell swing, kipping pull-up, etc., all requires the hip to have everything working properly.  I do not know what Mark has in store for me with this phase, but I am very much looking forward to it.

Seventh treatment of hip

So after waiting it out for like a month, I can still feel that my hip is not 100%.  It is SO DAMN CLOSE to being absolutely perfect, but I can still tell that there is just the slightest problem with it, and I want to get this done.  I don't think it will set back my rehab other than a couple of days, and now that I'm spacing out the treatment I don't feel like I'm rushing it.

When Dr. Hauser examined my hip and felt it click he shook his head and I could've sworn that he commented that I might need "one more treatment".  I'm not too sure because it was a bit of a blur with the Vicodin and Xanax.  If he really did say that I feel like I have the right to be more than a little peeved.  I mean, I remember him saying he thought that I would be done after the fourth treatment.  Now it's been three more treatments, plus upping it to PRP injections.  I'm going to ask him if there is a discount after a while.

Instead of the usual Morrhuate Sodium solution for the non-PRP injections, he used Asclera, another, albeit different, fatty acid.  The nurse said that one difference between the two is that the Morrhuate tends to cause the muscles to tighten up, whereas the Asclera will not. ....For real?  Everytime I see Bobby after a treatment he always comments on how my psoas is rock-hard.  Perhaps my hip muscles were just sensitive to the Morrhuate?  My hip definitely feels different then after previous injections, and it feels better.  It feels more like there are less... side effects?  Like I feel the pressure from the injected liquid, but I don't really feel any referral pain or anything like that.  If the two solutions are about equally effective, then I much rather prefer the Asclera.

A few hours after the treatment, I was able to attend dance class and work on the tango as well as salsa.  This treatment allows me to do stuff like walk (or in this case, ballroom dance), but three days after the treatment I can't do anything like squat or run.  However, on the fourth day I plan on testing the hip out, and CAUTIOUSLY return to my workout.  If my hip even begins to hint at being pushed too hard. I'm shutting it down.  

Hopefully this one is the last one, I really really do.  To be able to say I've fixed this issue would make me happier than a dog loose in a butcher shop.  Again I'm playing it by ear, with the idea that if there is a problem I will see them six-eight weeks from now.  ...That could mean I see him the week after my wedding... wow...

Simple shoulder help

Ok, so I was still a little mystified (albeit amazed) at how effective simply hanging from a bar for like 20 seconds multiple times a day is for my shoulder/neck pain.  One thing I've realized is that I've never really had a diagnosis for what's wrong with my shoulder.  I mean. I keep figuring out what muscles are tight (Scalenes, Sternocleidomastoid, etc.) and figured out some great stretches for them thanks to Kstar.

[Update 9/11/13: I'm not the only one who has blogged about how great this stretch is for undoing tight shoulders and rendering surgery unnecessary.  Here is the post about him coming across Dr. Kirsch, and here is a detailed explanation of his protocol that worked for him.]

[Update 4/20/14: OK so that guy who wrote those posts has since shut down his blog.  I've changed the links to the wayback machine and just for the sake of keeping the good stuff I've tacked on his protocol here at the end of my post.]

At first I thought it was simply from laxity in the supraspinatus from injuring my shoulder and then years of sleeping on it.  However, it seems like it's a little more complicated then that, or my self-diagnosis is completely wrong (nothing new in either case).  There were definitely some instability issues in my neck, which I've fixed through prolotherapy and sleeping with a soft neck brace.  However, there are still some issues, and they feel like they come from near the center of my back, like right between the shoulder blades.

Well, since hanging from a bar seems to help, I decided to investigate: 1) what shoulder issues does it treat, and 2) why does it treat said issues.

Here is the short answer, according to one website:

1. Hanging from a bar helps with impingement syndrome and frozen shoulder.
2.  "This exercise does a marvelous job of stretching all of the ligaments, muscles, and tendons surrounding your shoulder joints, along with many of the soft tissues that cross your shoulder joints but that travel a good distance away from your shoulders, like your biceps tendons, triceps tendons, latissimus dorsi tendons, and even the tendons of your front chest muscles"

For a much longer, in depth look at this I found a thread that is started by someone asking about Subacromial Decompression surgery.  A certain Dr. John Kirsch is a huge fan of this whole "brachiating" (You should check out his website here), and here is what he thinks:

When you hang, you are bending the acromion and stretching the coracoacromial ligament (CA arch). Then, when you do the full side lift weight lifting, the RC tendon will become thicker, more robust and healthier. Most hardly ever use their rotator cuff muscles and the tendons become thin and fragile.
After remodelling your own CA arch, there will be more room beneath the arch for the rotator cuff, bursa, etc.

I've never heard about the coracoacromial ligament before, but it seems to be fairly important, at least to Dr. Kirsch:

The CA arch is responsible for most of our shoulder troubles. It presses on the subacromial structures (rotator cuff, bursa, biceps tendon) and when contracted due to time and disuse, produces degenerative damage in these structures. By hanging from an overhead bar or similar support; and then doing forward, side and extension dumbbell weight lifting (palms forward or down) you can restore the health of the rotator cuff tendon and muscles. Each time you stretch the CA arch by hanging, you are making more room for the RC. Over time, the deformity of the acromion will remodel (Wolff's law), and the coracoacromial ligament will stretch becoming more compliant.

Dr. Kirch actually has a book out on this, "Shoulder Pain? The Solution & Prevention, Revised & Expanded".  I plan on buying it and giving it a look over, I don't think it's too long of a read.

I'm very, very interested to see how this plays out, if I actually do have shoulder impingement and if remodeling my CA arch will help out.  So far so good, my shoulder is feeling markedly better, and I'm really, really surprised.

Here's the guy who wrote the fight4inches blog:

Brachiating  which is essentially hanging from a pull-up bar like a monkey. Not my idea (see Part 1 of this blog). I try to hang daily for 3x rounds of max duration from a pull-up bar. I often start off w/ a supported hang to warm up the joint because it is painful with a cold start. The purpose of this activity is primarily focused on re-shaping your acromion (or re-flatten it) to create space in your shoulder capsule per your original design. What happened over time is that your bone (acromion) literally got bent out of shape, so you have to straighten it out. 

Shoulder Capsule Mobility – to really understand this, you’ll have to purchase the ultimate guide to resolving pain, preventing injury, and optimizing athletic performance and look up how to specifically do this. I’m a fan of the band assisted approach (not the Kettlebell). Basically, this protocol entails pushing the ball joint of your humerus way back into the shoulder capsule to it’s designed position. I do this after I brachiate – open up the physical joint and then shove the joint back, deep where it belongs. You have to do this for over 2-minutes to get the best results. 

Strength Training – finally, do exercise elements to build up your upper back and anterior deltoids. If you buy the references I outlined in these two blogs, then you have all you need to know. An additional exercise I do that is not prescribed is elevated feet ring rows w/ knuckles up. You can do ring rows w/out elevating your feet – but you won’t juice up your back to the same extent. So where is my Prescribed Shoulder Mobility Recovery WOD (one day I’ll post a video blog on this if there is demand): 

Pre-game:
1. Warm-Up – Mobility – look up mobility WOD activities for your thoracic region of your back, lats, pecks, etc. You want to prep the muscles on your chest, back, sides that limit the full mobility of the shoulder joint. This takes about 10-mins to do properly. 

2. Warm-Up – literally Warm UP – do forward and backward small shoulder circles w/ arms fully extended to the side, palms up. I like to try to make my arms rotate behind my frontal plan. I do these in both directions until my shoulders are burning. Then do larger circles both direction until you feel your arms are ready to fall off. This is like 4-5 mins of work. Now your shoulder joint is properly juiced up for some good physical therapy. 

3. Shoulder Mobility Recovery WOD: 3 x Rounds for effort of:
Brachiate (max duration)
Shoulder Capsule Mobility (both Arms) – 2mins each arm
Strength Training Elements 

I recommend doing this a minimum of 4x a week. To date, I keep experience gradual improvements and went from not being able to do near anything upper body to now being able to row, deadlift (full effort), front squat (full effort), power cleans (lighter weights), OH Squat (lighter weights), etc. and continue to improve. I make a point of taking fish oil to help w/ the inflammation, but my shoulder continues to get healthy.  Once I’m 100% healthly – I’ll outline a detailed post on a very specific approach.  I feel comfortable that I’m on azimuth – we’ll see how it goes and I hope it helps any other weenie in pain.  Even if you aren’t in pain, assess your shoulders and make sure you have full mobility – otherwise, if you strength train, you are an injury waiting to happen.

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Rehab is slow going. Literally

Ok so I've been rehabbing the hip for a while now, and I thought I should share what I'm allowed to do and (more importantly) what I'm not allowed to do.  The important thing is for me to work on strengthening all the stabilizing muscles.  If I work them too hard too quickly I can undue some of the healing that has taken place.  Alright, here are the rules for my rehab currently:

• Begin SLOWLY AND GRADUALLY
• Begin with more reps at a lighter weight and slowly increase the weight. I need to gain endurance before I can increase how much I lift so that my hip will be stronger and less likely to become injured.
• When doing my lifting it has to be in click free range of motion. If I begin or continue to get pain or clicking/clunking during high activity it may mean that I need one more treatment.
• When I first begin lifting weights it has to be a slow smooth motion. Do not rush into the exercise. Slowly lift the bar and do more reps.
•  Do not do anything that causes a sharp pain
• Having a little pain during exercise is ok but the pain has to go away within 2 hours of my exercise.
• No triple extension of the hip yet.

So I have to start doing things slowly, gradually increase the ROM, and build up to high reps (like do sets of 15 reps) and then increase the weight.  It's a little annoying that I can't work on speed/explosion strength but all in due time I guess.

So here is my lifting routine right now. I'm only listing the leg workouts since that's what I'm rehabbing, but I'm also incorporating upper body exercises as well (want to look buff for the honeymoon). 

Day A

Quarter squats

Hip Adduction

Day B

Modified Deadlift

Hip Abduction

That's it for now.  I'm doing 3 sets of 8-12 reps, if I can do 12 reps then I up the weight.  It's not sexy I know, but for now it's all I can do in terms of strength training.  I've also been given the green light to use an elliptical machine, so now I can work a little on cardiovascular endurance.

Looking forward to being able to squat and sprint, really hope this happens within a couple of months.

Arm/Shoulder getting better

On my last visit to Dr. Hauser, I told him about the residual discomfort I experience in my shoulder/arm.  He did some manual tests on my range of motion and said all I need to do is to hang on a bar for at least 10 seconds a couple of times a day and the situation would resolve itself.  …I thought he was crazy, but I do trust him and so I’ve been doing it for a while now, and I have to say it is working.  I feel much, much better in the neck and shoulder area.  So simple, yet so effective.  I appreciate that Dr. Hauser’s first move is to tell me I can fix the situation on my own, rather than use his help.  That helps me feel like I can trust him, that he is looking out for my best interest, not trying to line his wallet with my money.