Physical therapy help

[atbarr]

Back in '06 I had my right shoulder replaced. Absolutely no problems,...until I started shooting IDPA and USPSA last year.

I have a real problem when I'm drawing my pistol. It's really hard on my shoulder to pull my pistol out of my holster. Can anyone suggest an exercise that will help me draw my pistol a little faster?

Thanks,

A.T.

[Jake Di Vita]

How much overhead pressing have you done to rehabilitate it?

Hows your flexibility? Range of motion? Strength? Age? Other chronic injuries? Overweight?

[atbarr]

How much overhead pressing have you done to rehabilitate it?

Hows your flexibility? Range of motion? Strength? Age? Other chronic injuries? Overweight?

<How much overhead pressing have you done to rehabilitate it?>

Not much, too painful.

<Hows your flexibility? Range of motion?>

To be honest, I was very pleased when I could actually comb my hair with my right hand. If I had to do it all over again, I would not have the operation. The only range of motion problem I'm having is getting my pistol out of the holster.

<Age?>

64 in October.

<Other chronic injuries?>

No, thankfully.

<Overweight?>

Back in '02, I was almost 290 lbs (6' tall). I looked around and didn't see any 80 yr. old obese men. So I've lost down to 205 lbs. +-.

A.T.

[Boats]

There is no easy answer to your question. Being a sport of one sort or another for all my life have had a number of injuries that needed to be repaired then rehabilitated. At age 62 more frequently too. Have had good and bad results with Therapist, Chiropractors and even the guys at my gym. What you need is someone who can analyse whats going on then recommend a good routine . Injury's can set things in place and cause permanent shifts in body movement and flexibility. Most all can be corrected with patience and steady application of exercises.

Problem is finding someone good that knows your sport. Two examples. We have a Optometrist in our club that will prescribe glasses exactly like a shooter needs, even let you bring the the gun into his office to see what optically is the best solution. On the other hand I will often take the Yoga classes in our gym, great for balance and flexibility. One day the girl teaching the class asked me if they were helping. I made the mistake of telling her how important position and neutral holds were to shooting. That was the end of that !

I would ask around your gun club to see if anybody knows someone who is a semi professional, gym instructor, personal trainer, coach etc that has some experience with rehabilitation and knows the shooting sports. Guy in our club had two knee replacements and is now shooting IDPA very well. he worked with a guy at the YMCA that got him back on track.

Boats

[FranDoc]

Call around to the local physical therapy offices and ask if anyone has done graduate work in shoulder rehab. Ohio State University offers post-graduate training specifically in shoulder rehab, and I suspect that there are at least a few in KY who have attended that. UK may do similar courses, my first-hand experience is with Ohio-trained therapists. In OH, patients can refer themselves to a therapist without getting a physician's order first. I do not know if that's the case in KY. The therapist will be able to tell you; the office will advise you on your insurance coverage.

It is impossible for anyone on this Forum to prescribe treatment for you without taking a full history of your original injury, and without knowing specifically what surgical procedure was performed and what, if any, post-surgical rehab has already been done.

Also, shoulder exercises are extremely specific with regard to form. A slight shift in neck, thoracic spine, shoulder, shoulder blade or arm position can worsen all of your symptoms. It is absolutely essential that someone examine you and coach you through a rehab program in person. I've seen 'curbside consults' from well-meaning friends turn 'shoulder pain' into a numb hand that drops coffee cups (don't go there).

[badchad]

I’m a physical therapist and here’s what I think.

As you probably know shoulder replacements are a last ditch effort to regain function for a FUBAR shoulder. Because of the small joint and the instability in comparison to a hip or a knee they don’t return near the same amount of function. Being able to comb your hair is a good outcome, and I don’t think overhead presses will ever be in the cards after that type of procedure. Overhead presses aren’t a bad exercise in general but after a shoulder replacement they would almost certainly be too much even if you could do them.

As for lessening the pain with your draw you could talk to a PT in your area (preferably recommended by yours or another shoulder surgeon) to see if there is anything more they could do with regards to relatively light rotator cuff and scapular stabilization strengthening, maybe some mild stretching. I don’t think this would be a no pain no gain type of scenario, as the last thing you would want to do is aggravate it. Even with this I think you would likely still have troubles.

I think maybe the best idea for your draw would be to use a race holster (Ghost lets go pretty easy) holding the gun kind of low, maybe placed more forward on the belt, then you won’t have to draw your arm up so much or so hard to free the gun. Of course this would only work for USPSA. For IDPA you might be out of luck.

The last option I can think of would be to start drawing and shooting with your weak hand, and using your strong arm for support only.

[Jadeslade]

I agree with badchad-no weights. Try walking your hand up the wall-start at the waist and go as high as you can without pain. Pencil it. Try 5 reps. Now go watch TV or read the forum-use weak hand on mouse. Do it again tomorrow. Go to 2-3 times a day or more if you can. Stop if it hurts. If, after a week there is no change or increased pain-need to see the surgeon and get his recommendation about your activity. Guys who do shoulders are usually at the high end of the spectrum and are usually very specific about rehab. It's been 3 years for you and you have had no problems, so it is likely that your draw is the problem. Take your holster and belt in when you go-worth a thousand words. I agree with chad-it may be time to go with weak hand draw-think how good you will be on weak hand classifiers! Shoulders are a huge operation! I am amazed you have been able to do so well. If your MD says ok-here's some rehab instructions-you might want to move where chad is for a couple of months. Good PT and the like are rare and more valuable than gold. I wish you well and good luck.

[Jake Di Vita]

I definitely think it would be a horrible idea to just give up and use your "weak" hand instead.

If you were a client of mine, I'd likely recommend starting with a big movement the shoulder was designed to do, and that is the press. It wouldn't matter if you were just starting with PVC - just start getting accustomed to the range of motion in small increments as best as you can. The press is a incredibly safe movement that the shoulder was literally designed to do, but doing it correctly is an absolute must. When done correctly, there is remarkable gain in function for people with severe shoulder injuries.

If you are interested, I can link you to information explaining the movement in detail and possibly places for personal coaching.

Remember, rehabilitation stops when the joint/muscle is as strong or stronger than before the injury.

The bottom line is, the human body is best rehabilitated by doing the movements it was originally designed to do.

[badchad]

Remember, rehabilitation stops when the joint/muscle is as strong or stronger than before the injury.

That never, ever happens with a total shoulder replacement.

[Jadeslade]

Jake I admire your enthusiasm, but you are giving really bad advice. Don't make it worse. Primum non nocere. A draw is a extremely complex movement involving hundreds of small, medium, and large muscles. All of the nerves surrounding the shoulder girdle are cut or damaged in a total shoulder artroplasty, often leading to the patient having no proprioception or sensation in that area. Hence no ability to tell when the joint may come apart. And no ability to quantify the muscles being recruited to move the arm. Gentle guidance by an experienced hand here is warranted. It may be the best for AT to switch hands. Certainly he needs to stop and get assessed.

[ahudson]

I've had shoulder surgery I had problems with just shrugging my shoulder for the longest time. Does this cause any problems or pain?

[SteveU]

AT:

I tried to draw and paid close attention to how my shoulder functions during the draw. Starting with the fundamentals, you need to put your hand on the grip, which requires shoulder extension (and internal rotation). This in itself is difficult post shoulder replacement. A big issue with shoulder replacements is stiffness postop, and extension is not a motion that is focused on very much by surgeons, or tested much. But in order to draw, you not only need your shoulder to extend to reach the grip, you need to extend it even further while flexing your elbow, which allows your arm to compress in a zig-zag like a spring and draw the handgun from the holster.

Things that make this difficult:

1) Weakness in front of shoulder: Subscapularis and Supraspinatus muscles. They can be strengthened with therapy to a point. Subscap is typically a little weaker because it's cut and repaired to put the implant in in most cases. It may be as strong as it will ever be.

2) Weakness of the deltoid/latissimus muscles (these can be strengthened)

3) Stiffness of the joint capsule (stretch and focus on shoulder extension)

4) Position of the shoulder implant components making this position unstable and painful. There is nothing you can do about this one.

You should have your therapist work on those particular items. (1-3) It would be helpful to bring your unloaded handgun/holster to therapy and demonstrate the specific positions you are having difficulty with. There may be a work around or there may be a factor not noticed by the above that is contributing to the problem.

If you doctor doesn't think bench press is contra-indicated (he might) then the weight of the bar helps with shoulder extension and puts your arm where you need it when the bar is across your chest. Wall pushups may help too. Your therapist should have a list of shoulder extension exercises.

Other thoughts:

As Chad said, using a holster that is as forward, offset, and low as is division legal will assist by decreasing the requirement on a full ROM. One that has a significant cut out at the ejection port or a race holster will allow it to release without pulling up as far. Consider risks/benefits about race holsters regarding your ability to retain the gun while moving or standing from a seated position.

Finally, the work around that is probably most energy intensive and what you are probably doing is to lean away from your holster when you draw. By using your trunk muscles and your somewhat stiff arm to increase the distance from handgun to holster, you can get it out that way. This is maladaptive, may be a balance problem, and may cause back pain, but can help you get the gun out of the holster. This will help get the handgun from the holster for sure, but is bad overall and if you can obtain better ROM of the shoulder you shouldn't need to do it.

<Edited to add: Trainer or Therapist. Either can help>

Edited August 11, 2009 by Surge

[Jake Di Vita]

In this case it is very possible that it cannot be rehabbed fully. But it should be done to at least get everyday function of out it.

I know what could happen if he tried rehabbing it.

I also know what will happen if he doesn't.

Also notice, I said nothing about a bench press. I recommended a press.

[Boats]

I am not against professional therapist, my latest sports injury was "fixed" by a sports medicine doctor that x rayed and analysed then a good therapist that set up a routine of exercises to regain full movement. All this in the normal fashion through insurance providers and paid for.

However had bad luck with the same route and a previous injury and a therapist that just went through the motions and collected the payment from the insurance company. I am afraid the "system" is not built for regaining your ability to participate in a particular sport. Same with a doctor and Arthroscopic Knee job that did not turn out well. He would not admit the surgery was not a success and had to change doctors to get it fixed right.

I think I would go the professional route first, analyze the problem then look for a good trainer that can follow up sports specific. I don't have any faith in the regular doctor - therapist-insurance system to spend that sort of specific time.

On the firearm part. You can use a dumbbell about pistol weight to duplicate the action that's giving problems. Trainer at my gym worked with me on the El Prez movement looking for balance and wasted motion when I first started shooting IDPA. All with a 2 # dumbbell

Boats

Edited August 11, 2009 by Boats

[John Dunn]

Go see your surgeon. Pain after an arthroplasty could be a lot of things, infection, prosthetic loosening, instability, cuff tear, etc.

First make the diagnosis, then make the plan.