Well, now I've got something to distract me from my knee problems
I don't think running had anything to do with this new physical
challenge and fortunately, torn rotator cuffs haven't
affected my running, walking, and riding. They have
my sleeping, lifting, and doing any strenuous yard work or heavy
lifting the past
six or eight months, however.
The rotator cuff is comprised of four major muscles and the
tendons that hold them to the upper arm bone (humerus) and the
shoulder blade. You can see diagrams of the shoulder at
and other links. The rotator cuff also helps hold the ball of
your upper arm bone firmly in your shoulder socket. The
combination results in the greatest range of motion of any joint
in your body, according to the Mayo Clinic's website.
Rotator cuff injuries can be
caused in a number of ways:
normal wear and tear after the age of 40; poor
posture; falling; lifting or pulling something
improperly or that is too heavy; and repetitive overhead
movements (such as in sports like tennis, swimming, pitching
baseball or occupations like painting or carpentry).
I'm not sure how I hurt my shoulders but I can make an educated
guess: all of the above!
I think the main precipitating factor is all that heavy yard work
I did last summer: lifting and carrying fire wood around the property, digging and
tending the veggie garden, shoveling about a ton of mulch into
the bed of the pickup and distributing it in the perennial beds.
Etc, in adfinitum.
Gee, ya think?? I'm not 35 any more but I often try to do
as much at 60 as I used to twenty-five years ago. <sigh>
Just one of the piles of mulch I spread in
the garden last fall;
the departing Asplundh truck left several
trees down, too. (11-12-08)
I also built up to quite a lot
of weight and reps (for me) on the Life Fitness machines at the Y
last summer and fall. I
may have aggravated my shoulder problems by lifting too much
weight and/or inadvertently creating imbalances. I stopped using
the chest press, shoulder press, and military press machines
last summer because they hurt, even at low weights. I
concentrated on bicep curls, tricep press downs, lat pull downs,
and the seated row.
Two massage therapists have confirmed that I probably
strengthened those muscles too much in comparison to smaller
ones I was missing.
Maybe I wouldn't be in this fix if we'd gone on our summer trip
last year! I would have avoided some of that yard work and had
less opportunity to use weight machines when we were on the
road. Of course, that wouldn't have solved the pesky problems of
getting older and falling down too much when I run on gnarly
trails . . .
Some of the piles of mulch when into this
large perennial bed. (11-17-08)
In hindsight, I didn't notice anything more than general fatigue
and soreness during the summer and fall.
After we were in Texas and Arizona for a couple months in
November and December I began having problems sleeping on either
side, especially the left (my preference). I also began to wince
when I made certain motions, like lifting Cody's heavy water
bucket up into and out of the bed of the truck with my left arm.
Any motions where I raised my left arm straight overhead or bent
like a chicken wing (!) became very painful or just impossible.
I had to sleep on my back, modify my upper body lifting routine
at the fitness centers I was using, and stop lifting the water
bucket with that arm.
I dinked around with alternative remedies and therapies longer
than I should have -- electrical stimulation (below), massage,
chiropractic, hot and cold packs. I just had no clue they'd be virtually useless
for my particular problem.
While we were in the Huntsville, TX area for the month of
February I saw a massage therapist three times and my own
massage therapist in Roanoke a couple of times in March and
though they both did lots of deep tissue work around the
shoulder blades and upper arms, they still hurt. Both women told me
they thought I'd strengthened my biceps, triceps,
and lats too much in comparison with some of the smaller muscles
in my upper arms and shoulders. Both suggested a couple exercises
for me to strengthen the weak areas but they were ineffective.
Three of the four leads to the TENS unit;
the fourth is on the front of my arm.
I also saw my chiropractor when we got home. He thought the
problem might be "
shoulder blades. Manipulation and ultrasound in his office
brought some temporary relief. He also suggested I alternate hot
and cold packs and increase the
use of my TENS unit (above). I didn't notice any appreciable improvement after
doing those things, either. Electrical stimulation worked very
well on my sore hamstrings last fall, but it didn't alleviate
the pain or weakness in my shoulder.
I would soon find out why.
TIME TO FIND THE RIGHT ANSWERS
I finally got smart and contacted the orthopedic practice we use
in Roanoke. It takes several weeks to see an orthopedist there when we
have a new problem but we've learned how to get our foot in the
door within a few days: ask for a PA versed in the
body part with the current problem.
I was able to see a competent young lady named Andrea within two
days (March 27). She works with Dr. Larry Miller, one of the two
orthopedic surgeons in the practice who specialize in sports
medicine and knee/shoulder problems.
Andrea promptly diagnosed rotator cuff injuries in both
shoulders. That surprised me because the pain was different than
what I'd felt several years ago when I was diagnosed with a
minor rotator cuff problem in my right arm, most likely caused
by using the lat pull down machine incorrectly (bar in back
instead of in front).
That time I was referred for one session of physical therapy and
a home program that resolved the problem rather quickly. I
started doing the lat machine differently but I don't remember
anyone telling me at that time how important it was to continue
doing "maintenance" strength and stretching exercises as I got
The end result is worth all the hard work,
just as it is in ultra running.
This time the problem is in my other arm and it was very sore on the outside, halfway between the shoulder and
elbow -- not the shoulder itself. How could that be a rotator cuff problem?? It wasn't very
close to that joint.
Well, duh, I was about to learn a LOT about rotator cuff
problems in the next few days as I researched further beyond the
information Andrea gave me.
Referred pain lower down in the arm is one of the classic
symptoms of rotator cuff injuries that are caused by repetitive
stress, the most likely cause of my pain. I'm not aware of any
one traumatic incident that caused the problem. If that was the
case, it would more likely be my right arm that hurt because
that's the one I almost always fall on when I trip while
running. It's a wonder I've never broken it.
My symptoms, X-rays, and lack of strength in my left arm when
Andrea did resistance moves indicated one or more tears in my
left shoulder. She felt it was beyond cortisone treatment and
recommended an MRI as soon as possible to determine if the tears
were partial or complete.
My right rotator cuff is
probably not torn, at least not as badly as the left one. Andrea
didn't recommend an MRI or cortisone injection on it. She did
recommend that I begin physical therapy on both shoulders as
soon as I could get an appointment, even before finding out the
results of the MRI.
ZONING OUT IN AN UNLIKELY PLACE
I could have gotten an MRI on April 3, just one week later (try
THAT with "universal healthcare" or "socialized medicine!"),
but we had plans to be at Umstead that day. The next time I could get in was April 7. I
went to the same facility in Roanoke that I used for an MRI on
one of my knees in 2007.
This time a physician injected dye into my shoulder, standard
procedure for a rotator cuff injury. It was very cool watching
the screen overhead as the dye worked its way into the joint!
Wish I had a picture of that.
I was escorted to another large room for the MRI.
I was lying comfortably on my back for about thirty minutes
while the pictures were taken. I almost went to sleep despite the loud
'70s rock music in my ears, which was designed to drown out the even
louder jack hammer staccato of the MRI machine. It didn't, and I
was startled back to reality several times when the rat-a-tat resumed. I was so focused on the music,
however, that I was surprised when the
technician came in to turn off the machine. The time went by
The MRI center sent my results to my orthopedist, chiropractor,
and physical therapist, who I saw next (April 10). Wendy,
the owner of the PT practice I chose, gave me a copy of the
report and interpreted the results several days before I was
scheduled to see the orthopedist.
One of the eleven MRI films of my shoulder
The simple explanation is that I have three small tears in my
left rotator cuff (shoulder joint). The good news is that I
probably don't have arthritis there yet. Tears in this area are
common after age 40 as the rotator cuff loses elasticity.
Treatment is similar whether the tears are partial (as mine are)
or complete. They do not heal well over time on their own (no
The goal of treatment is to relieve the symptoms (pain and
weakness), not necessarily to heal the tears. In my case, the
best treatment is to strengthen the surrounding muscles so they
can support the joint properly and to stretch them so my range
of motion is increased back to normal.
And thus began a quickie course of physical therapy with the
intention of strengthening my shoulders as much as possible
before we head out of Dodge again.
Dr. Miller reiterated much of what Wendy told me (and what I'd
found on the internet) when I saw him on April 15. Even though I
had a list of questions about therapy and surgery I asked Jim to
accompany me so he'd better understand what was going on and pick up on things I might miss.
don't fully understand the orthopedist's explanation of
de-lamination of one of the muscles or tendons but we clearly understand that
surgery is not a viable option. As the other sports med and
shoulder/knee specialist in the practice, Dr. Brent Johnson (the
doctor I saw for my knee problem), likes to say, trying to
repair a torn rotator cuff is like trying to stitch together wet
That's pretty graphic and not very optimistic.
Using the biceps resistance machine at the
Y last summer (6-25-08)
We talked about what treatments are best for me (proper weight
work and at least six weeks of physical therapy for more strength, balance, and
flexibility), what treatments won't do me any good (cortisone
shots or a sling), and what therapies are neutral -- neither
harmful nor very helpful (massage, chiropractic adjustments,
ultrasound, electrical stimulation/TENS unit, or heat and cold). Ibuprofen is fine for
since I'm taking it for arthritis anyway.
Surgery is the last resort, and one I'm not anxious to try. I've
heard horror stories from my sister and friends who've had
shoulder surgery; it is described as one of the most
painful surgeries from which to recover. So
I've been working my butt (no, shoulders) off in PT at
one of Wendy's offices a couple times a week and at home every
day. I need more muscle strength and balance, better external
rotation of my arms, and better posture.
Mom was right:
stand up straight and keep your shoulders back!
My medical providers also confirmed one more probable cause for
my rotator cuff problems: sleeping mostly on my left side
for the last 50 or 60 years. By necessity I've learned over the
last six months to sleep mostly on my back.
I love my PT sessions. Problem is, since we're leaving town soon
I have less than four weeks to get in six weeks' worth of
Each time I go in for treatment one of the assistant
therapists puts a heated pack on my shoulder to warm it up
before Wendy comes in to evaluate my progress regarding
strength, resistance, and range of motion. After we talk she
formulates a revised, more advanced plan and gives it to one of
her assistant PTs, who shows me how to do the new exercises and puts me
through the paces of some of the older ones. Then I sit with a cold
pack on my shoulder for a few minutes while the new diagrams and
instructions (including weights and reps) are printed out for me
to take home. Each session lasts an hour or more.
After three weeks I'm up to twenty-one strength and stretching exercises a day! That's a
bunch. I can remember most but not all of them; I have to
refer to the diagrams so I don't miss any. Some use both
shoulders at the same time, like the tough alternating one-arm
version of a push-up that I do on the floor 40 times (I
switch arms every few seconds so only one at a time is
supporting my weight):
(Jim took those pictures in our camper on May 29, the day I
uploaded this entry.)
Most of the exercises
must be done separately for each shoulder. I'm concentrating on
the left (worse) side but doing the same ones most days on the
right side, too.
This has become very time-consuming, about 90
minutes for the whole routine. I usually break it up into two or
three sessions because my arms get too sore to do the moves
correctly with the weights, Thera-Bands, and/or body resistance against the wall
or floor. Breaking up the sessions also gives me time to do other things
around the house.
When I began therapy I assured Wendy that I was highly motivated
and would work very hard because 1) I knew I had a lot to do in
a very short time and 2) I was real tired of being in pain and
having limitations with that arm. I was wearing one of my
Leadville 100 shirts. I'm pretty sure that sent a signal that she could trust
my promise! Although she started me off slowly that first
session, she rapidly upped the ante each successive visit.
My diligence and compliance have paid off. Wendy is very pleased with my
progress. I have significantly more strength and range of motion
in both shoulders/arms in just three weeks.
Wendy's not real surprised at my tenacity. She's a
distance runner herself and knows the general mentality of athletes who
participate in extreme sports like ultra running. The same
personality traits that make us endurance athletes make us
strive purposefully toward other personal goals. Wendy and I
have had a
good professional relationship because we are like-minded and
working toward the same goal during treatment.
A 4x16-foot garden may be small, but
building it from scratch last summer
probably contributed to my rotator cuff
I have time for just one more PT session before we leave town.
Wendy will give a final assessment of my progress, forward that
information to Dr. Miller, and give me two plans: a
rigorous one for the next three weeks and a maintenance plan for
the remainder of the summer.
If I feel the need for more therapy before I return to Roanoke
in the fall, I can get a new prescription from Dr. Miller and
try to locate a physical therapist wherever we are camping at
the time. That's not real practical, so I'll do my best to
adhere to the program on my own.
Neither shoulder is 100% yet, but I'm already able to sleep much
more comfortably and don't have near the pain in my left arm
when I make the "wrong moves" as I did before beginning therapy.
That garden a month later; by July it was a
jungle but producing heavily. (5-31-08)
It's fun to be a successful patient! Progress is good. But from
everything I have read I will probably have to continue some of
these exercises for the rest of my life in order to prevent
recurrences, even if I avoid doing some of the strenuous things
I'm wont to do (yard work, moving furniture and heavy boxes,
These are the lessons I've learned from this experience:
- don't do so much heavy lifting, especially overhead
- don't do so much other strenuous work around the house and yard (a
big problem when we sell the house and have to move everything out)
- don't create muscle imbalances
- don't slouch
- don't sleep all night on either side, especially the left
- don't fall down so much when I'm running trails
- don't expect to do as much as I used to be able to do
- don't get old! (just kidding)
DON'T WANNA GO THERE
Two of the times I was in the large room where the PT's were
working with several other patients I got to watch a
well-dressed, sophisticated-looking woman in her 60s or 70s who
had double knee replacements several weeks ago at Duke
University. I forgot to ask her why she went to Duke but I did
get to ask a few other questions after our sessions.
One of the obvious ones was, "Why did you get them both done
at once?" She gave me the answer I expected:
"Because I never would have gone back for the second one if I'd
done just one the first time."
Maybe shoulder surgery
isn't the most painful from which to recover!
I know people who've had one knee replaced -- and then, miraculously,
the other bad knee doesn't feel so bad any more!
It's the same
rationale Jim used in 2003 when he had surgery on both
feet and calves at the same time for bunions, Morton's neuromas, and gastroc
releases (a total of SIX surgery sites!): he probably wouldn't have elected to go through
"da agony of da feet" a second time.
Jim's feet the day the bandages came off. (11-11-03)
Hope you aren't eating lunch while you read this entry!
If I do have to have my knees replaced (I'm hoping for some
scientific advancements before I'm forced to do it) my current
thoughts are that I'd do both at once, for the same reason this
woman did. She was in obvious pain each day I saw her at
therapy but she was working hard to gradually build back her
strength, stability, and flexibility. I saw quiet
determination through her gritted teeth and the tears she was
trying so hard to hold back.
I could visualize myself in her position. And this should come
surprise -- my knees feel better now!!
I learned something else that's important from this woman. She put off
getting treatment until surgery was her only option; she
had lost too much cartilage in her knees to even try injections of synthetic
materials. Now I know I need to get in to see Dr. Miller or Dr.
Johnson before it's too late for injections, which might delay
the need for surgery.
Next entry: what a drag it is getting old (hum along with
the Rolling Stones . . .)
"Runtrails & Company" - Sue Norwood, Jim O'Neil,
and Cody the Ultra Lab
© 2009 Sue Norwood and Jim O'Neil