Q & A: Solutions for a bum shoulder on a seasoned weekend warrior
Q: How can a broken-down old man keep up with knee therapy, shoulder therapy, and a rounded fitness regiment, all at the same time? I’ve been noticing some weakness and discomfort in the shoulder I had surgically repaired a few years ago. It was great while I was able to tend to it with exercise, but now the knee has stolen center stage, along with all of my exercise time. What’s an old battleaxe to do?
If it ain’t broken, it ain’t me
A: (In the interest of full discloser, this old battleaxe is really a youthful early forties man, and patient of mine with a medical history that is likely responsible for paying the mortgage of a few orthopedists!)
As you know, assessing pain is best done through an examination to determine the source and nature of the problem, and identify associated impairments. Try the following suggestions, and if your pain doesn’t improve, we’ll need to examine it in person.
Your issue with addressing multiple injuries is quite common. Attack your concerns as you would your finances. Delving into debt and filing bankruptcy is never an ideal option. Instead, look at your goals, your assets, and liabilities, then implement a focused strategy. Not having a focused strategy is where most go wrong. As the saying goes, it’s hard to ride two horses with one saddle. Similarly, you can’t get in marathon shape, bodybuilder shape, hockey shape, and rehab a knee all at once. Focus on a few non-conflicting goals instead.
First your assets: you are relatively young, very hard working, health conscious, and have a low body fat. That last one is a big one: you need not concern yourself with the challenge of weight loss because you are already lean. And by addressing your liabilities, you will likely even lean out a bit more. You also heal well, having successfully avoided surgery on your left shoulder through PT and exercise in the past, and your current amazing progress after radical reconstructive surgery on your knee speaks to that.
Next, your liabilities: a severely degenerated and recently reconstructed left knee, your previously reconstructed and currently painful right shoulder, and your intermittently bothersome low back and left shoulder.
Finally, your goals: reduce pain, return to playing hockey, play sports with your young children, prevent future injury, and just be healthy!
So here’s the plan. You need to do corrective exercise, a dynamic warm-up, 3 resistance training workouts per week, 2 interval training sessions per week, and one sport-specific session. Aside from corrective exercises, the rest of these components can be completed in 3 hours of total training per week. Regarding your shoulder pain, you need to identify any postures or activities that reproduce pain, and avoid or modify them.
Focus on corrective exercises first. These are exercises designed to address muscle tightness, activate dysfunctional muscles, optimize joint mobility, improve posture, and improve joint health and nutrition. They don’t burn calories, make you stronger (directly), or improve cardiovascular function. They can be done almost anywhere, anytime, as often as possible, and definitely prior to working out.
Specifically, do the following corrective exercises (focusing on knee and common shoulder impairments):
- Knee AROM (just move it frequently, especially while sitting at your desk)
- Knee PROM – address extension and flexion deficits
- Scapula posterior tilts
- Thoracic mobilization over a foam roll
- Shoulder PROM: rotation and flexion are the most common deficits
Next, the warm-up. A dynamic warm-up involves moving your joints and muscles actively in multiple directions that simulate joint function. These differ for everyone, but some common examples are high knees, butt kicks, front kicks, heel-toe walks touchdowns, and back scratchers. Do this prior to exercise.
Resistance training will look something like this: Workout A: Squats, step-ups, balance and reach, pull downs, planks, rows, and scapula push-ups. Workout B: shuffles, hops, quick steps, lunges, balance and reach, 1 leg bridge, prone reverse flies, and external rotations. Alternate between these workouts.
Interval training will take place immediately after resistance training sessions. Intervals on the bike will be your only option until your knee is further along.
For sport specific training, get on the ice and skate around for fun with the kids (the little ones, not your hockey buddies!). Do this at least 1 time per week. No baseball until your pain is gone.
Being broke isn’t fun – physically, nor financially speaking. Both require planning and strategy. Give this strategy a shot, and we’ll adapt as needed.