
Study suggests surgery alternative for rotator cuff pain: push-ups, pull-ups - HillaryBriss
https://news.usc.edu/141175/shoulder-injury-left-a-woman-in-excruciating-pain-but-therapy-made-her-whole-again/
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steve_adams_86
This is anecdotal and people should be extremely cautious if they have RC
injuries. Talk to a pro, look into proper exercise progressions, and start
with baby steps even if you feel strong enough not to. But:

My right shoulder was a piece of trash for over 5 years. I couldn't use my
trackpad or mouse some days at work because it became incredibly hot and
excruciating. I couldn't throw rocks at the beach, ride my bike as far as I
wanted, drive in comfort, you name it. Just standing could be incredibly
painful if my shoulder needed rest. You don't know how awesome shoulders are
until they stop working.

One day I decided to try the exercise route after avoiding it for a very long
time. I did because someone shared an anecdote of exercise helping on reddit.
I started a pull up progression using elastic straps to assist at first. I did
push ups from my knees. I started doing stretches in door ways and on a big
inflatable ball. I rolled myself on a lacrosse ball like the cross fitters do.
If it fixes them it'll fix anything, right?

Within a year I was 'cured'. I was doing pull ups with a 45lb plate strapped
to my body and push ups with the same plate resting on my back. I began weight
lifting fairly seriously and made it up to a 400lb deadlift by the second
year. My shoulder was a limiter in my first year, but once I took up yoga as
well it never bothered me again.

Now, having said that, this all took a lot of time, energy, and will power.
It's not easy and it's not a silver bullet. Your body will strengthen though
and you can overcome biomechanical issues by working the system carefully,
methodically, consistently, and with good sleep and nutrition.

But again, don't jump into it and don't expect it to be easy. My experience
was positive in the end, but it's a total dog along the way. If you have the
money, find a trainer who understands injuries and recovery. Get on a program
and commit. The best thing you can do for your body is use it. But never go
too hard, and go as slow as you can handle at first. You can make it so much
worse in one little moment of overdoing it.

Hopefully someone is motivated by my anecdote because someone sharing theirs
on reddit ten years ago really did change my life.

~~~
ericmcer
I am a big believer in this, so far doing a form of trigger point therapy on
myself and exercise/stretching has relieved all my nagging pains (right
shoulder, right knee, both wrists).

It seems completely insane to me that you would have a painful wrist or knee
and start a regiment of ibuprofen for it. Why would you suppress your bodies
signals that something is wrong rather than trying to get your muscles, bones
and tendons to work correctly and healthily together. It's like fixing your
car by turning off the check engine light.

~~~
tomjen3
As an example, I would assume meds would start working noticably within hours
whereas exercise is more of a long term thing.

However I am extremely interested in where you got your exercises from as my
wrists have started to hurt and I want them to stop.

~~~
ericmcer
The internet is crazy full of resources for carpal tunnel relief. I just kept
trying stuff until i found what worked.

My problem was a ton of tension/tightness in my forearm muscles that was
leading to inflammation in the wrist making using mouse/keyboard pretty
unbearable, even for browsing the internet. If you do some basic forearm/wrist
stretching while probing the muscles for pain/tight feeling you will be able
to tell if something is wrong.

I fixed it by doing a combination of stretching, rubbing really hard on the
muscles, and pushing into the muscle while activating it. I would finish by
holding my wrists in ice water. The whole routine took 10-15 minutes and after
doing it for a weekish I was playing FPS games pain free.

------
ashelmire
Physical therapy is evidence-based health practice. This is sort of a "no
shit" piece. Doctors want to operate on you - it's what they are trained for,
it's how the make money. Hospitals make money off of surgery. Yet physical
therapy gets better results.

Lookup washout studies vs knee surgery with results like this [1].

1\. [https://www.scientificamerican.com/article/study-suggests-
co...](https://www.scientificamerican.com/article/study-suggests-common-kne/)

~~~
joshgel
Yes. I'm not sure this is so true for full thickness tears, but in general I
think your point stands.

That said, patients also want surgery. I can't tell you how many patients I
have referred to physical therapy for conditions which we _know_ are improved
by physical therapy (like routine lower back pain, minor muscle strains, etc)
and they look at me like I'm crazy. I've seen it work in my patients that
actually went and participated, but most go through the motions and stop going
after a session or two because 'it wasn't helping'. I think part of american
culture is that we want instant fixes, even for problems that have been
brewing for decades like heart disease and diabetes... /endRant

~~~
HatchedLake721
People want a magic pill to be healthy, pretty, famous and rich. It’s human
nature, we want everything right now.

~~~
Rapzid
It's interesting how relative it is too. For people who like to be active some
of these new rehab programs and findings are essentially "magic pills". "Wait,
you mean all I have to do is just 15 minutes of exercises only once every day
and my knee/wrist/elbow/shoulder might be 100% in 6 months?! Amazing!"

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dogma1138
Besides that proper face pulls, ideally a resistive band YTWL[1] (another
alternative is to do body weight YTWL by lying down [2]) exercise as well as
walking with your thumbs forced straight to the front (if your thumbs point
towards your hips when your hands are loose you have improper rotator position
in your shoulder) helps wonders with any shoulder issues.

[1] [https://www.youtube.com/watch?v=ELe4fATl-
Jg](https://www.youtube.com/watch?v=ELe4fATl-Jg) [2]
[https://www.youtube.com/watch?v=3MxHX9j15BU](https://www.youtube.com/watch?v=3MxHX9j15BU)

Another very good exercise is to stand straight against a wall keeping your
shoulder blades, mid back, butt, elbows and wrists touching the wall and doing
a shoulder press motion. The motion should be done without the elbows and the
wrists coming off the wall, even people in tip top shape find this exercise
extremely difficult to perform and most people would top out at just under a
90 degree bend in their elbow at first.

Unless there is actual damage to the joint (e.g. scar tissue that gets
inflamed and must be removed) surgery should be avoided at all costs, nearly
all orthopedics conditions can be resolved by strengthening under developed
muscles that would make the joints work as they should.

Shoulder issues tend to happen due to weak back/rear delts and overdeveloped
front delts and chest muscles this is the bane of the modern slouching life
style.

~~~
glangdale
"helps wonders with _any_ shoulder issues"? (emphasis mine)

That's a bold claim. There are a lot of different shoulder issues. I never
found that all that YTWL stuff did anything useful for my shoulder at all
(torn labrum from Judo), but doing stuff more like the article (closed chain)
and doing some of the flexibility stuff from a 'gymnastics for beginners' type
program ("Elements" from GMB - in the end I didn't like the program but I
still do the warmup/cooldown) also really helped.

Also not getting into impromptu bench pressing competitions with rugby players
at the gym was a pretty good idea too.

------
Stronico
I had a rotator cuff injury that went on for about two years before I went to
a doctor. Their medical advice consisted of "Check Youtube" and they handed me
two meters of resistance band.

I was skeptical, but two weeks of rather easy exercises and everything was
fixed. It's taken me significantly longer to train myself to remember to use
my left arm for anything overhead.

------
grizzles
A year ago I had golfer's elbow and it seemed like it wasn't ever going away.
After years of lifting very heavy I thought, this is it - I'm fucked. Well
fast forward to now and it's pretty much gone. All I did was knock down my
weights, did some physio and have slowly started building back up. I'm not
back on the big big weights yet but I'm at least on the big weights. Sometimes
things have a simple solution.

~~~
opportune
Just out of curiousity, did you deload on all your lifts or only one the ones
that affect golfer's elbow? Substitute things like bench press for those
machines that you make a "clapping" motion with?

~~~
grizzles
If I used my right arm I was feeling it. And I don't do much leg exercises so
I'd say I deloaded on everything except cardio/anaerobic.

------
SketchySeaBeast
Push-ups and pull-ups are exercises that get you above that "barely
acceptable" level of strength that physiotherapy seems to aim to get people to
- to perform those movements you need to actually have a level of strength
that you can't develop simply with bands. It makes absolute sense that the
solution to having a hurt joint is to make that joint significantly stronger.

~~~
jhayward
> _the solution to having a hurt joint is to make that joint significantly
> stronger_

This may seem like nit-picking, but I think it's important for people with
joint damage to understand: you aren't actually making the joint itself
stronger. The cartilage and ligaments, bones are not strengthening. Injuries
to those tissues are more or less forever.

What you are doing through therapeutic exercise is strengthening the
musculature around the joint. The muscles provide most of the support and
restraint to keep the joint intact relieving pain and preventing (further)
injury. The right muscles, strengthened in balanced form, are what make joints
strong.

~~~
fourseventy
Ligaments and bone density get stronger with strength training dude.. why even
make a comment like this with information that is completely wrong

~~~
jhayward
"Dude", we are speaking of injured tissue. A 50% torn ACL does not "get
stronger" through exercise. The muscles supporting the joint get stronger. The
ACL will always be 50% torn.

~~~
SketchySeaBeast
Apparently there's some evidence for the ACL regenerating itself.

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3293953/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3293953/)
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3293953/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3293953/)

~~~
jhayward
Those are interesting links, thanks.

ACL/MCL injuries, and knee/shoulder/elbow injuries in general, are a subject
where medical understanding is evolving and a lot of what used to pass as
standard care and generally accepted practice is not standing up to more
rigorous evidence-based studies. So I'm glad these are being done, but remain
very skeptical at this point.

My wife tore her ACL this winter so I had to read up / talk to folks about the
current state of care and my conclusion is as I said above: you can improve
the support of the joint muscularly, for certain.

In fact everyone involved in high-strain activities should probably be
screened for joint muscle strength _before_ they get injured - including folks
like military recruits, who have an abysmal knee injury rate that they then
suffer from for the rest of their lives.

Anything beyond muscle support improvement is an open question at the very
least, as far as my recent dive informed me.

------
Ididntdothis
I think the most important thing is to not think that one recipe will work for
everybody. There are a lot of different types of shoulder problems that are
all getting lumped into "rotator cuff". Try a few different things and see
what helps. Also keep watching your shoulders. It's really easy to mess them
up again.

------
rsync
Any discussion of shoulder injuries should include, somewhere, the PT exercise
known as "plate halos":

[https://www.youtube.com/watch?v=ZG0N6JKNUQU](https://www.youtube.com/watch?v=ZG0N6JKNUQU)

Very, very beneficial and also time efficient as it hits your shoulder from
all degrees of motion with a single exercise.

Further, the popularity of crossfit "bumper plates" means that a full diameter
plate can be very lightweight. The idea is to work up to a normal 45 pound
plate but if you are injured or a smaller female, you can find a 10 or 20
pound bumper plate that is the same diameter. (It's not very effective to use
a smaller diameter plate, such as a standard 25 pound plate.)

I would recommend plate halos as a core piece of any upper body strength
routine - I do them in my warmups every time I am in the gym.

------
sp332
A friend of mine is a personal trainer who put together an incredibly thorough
personalizable program for pull-ups. It's aimed at beginners and includes
instructions on building strength even if you can just support part of your
weight hanging from the bar. It covers warm-ups, stretches, injury prevention,
lots of technique (which is extra important if you're already injured), and
how to avoid tensing up and causing more soreness the next day.

The program is at
[https://thepullupsolution.com/](https://thepullupsolution.com/) (He doesn't
talk like a content marketer in real life.)

~~~
mistrial9
curiously similar name to the works of Jerry Robinson two decades ago, which
are still for sale

------
whytaka
My own anecdote is that for 7 months I didn't exercise. My shoulders hurt as I
slept on my side and rested my header on my pillow with my arm cradling it
underneath.

It went away just a week into me restarting my exercise regimen.

~~~
maybemabe
Cannot believe that you have described exactly the position that gives me pain
for the last 2 months. Both shoulders. Never had a shoulder problem before and
I am playing tennis every week for 15 years.

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simlevesque
I don't know if they ever tried that but I play with a yoyo, looping style
(2A) and it is a wonderful exercise for the shoulder area.

I broke my collarbone two years ago and couldn't use my right arm for almost
two months. After that I picked up yoyo and I'm certain that it helped me
recover my strength and flexibility.

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Fjolsvith
I experienced a period of forced inactivity which caused a calcium buildup in
my right knee. It was very painful to bend past 15 degrees with my weight on
it and would collapse under weight. A friend I had who was a big fitness buff
suggested I start walking stairs to fix it.

I started out with 5 minutes a day for the first week, then 10 for a week,
then 15. I climbed a single story flight of stairs and then turned around and
descended, repeating for the workout time.

After a month, the calcium buildup was gone. After three, my legs were so
strong I felt like I was bouncing on springs when I walked. I was taking the
steps two at a time when I climbed and didn't get winded at all. Great aerobic
workout!

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jeremyw
The trial registration:
[https://clinicaltrials.gov/ct2/show/study/NCT02750176?show_d...](https://clinicaltrials.gov/ct2/show/study/NCT02750176?show_desc=Y#desc)

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sunstone
I've had frozen shoulder in both shoulders in the recent past. Neither was
injured beforehand in any physical manner. I agree with the exercise
treatment. It worked for me both times. In the end I found that swimming,
breast stroke and then freestyle, worked best for me. For me the first couple
of lengths were searingly painful but after ten or fifteen minutes it was
really surprising how quickly the pain diminished. Each swimming session kind
of followed the same pattern, acute pain at first that slowly faded. After
maybe a dozen sessions over six weeks it was pretty much gone. One more
anecdote.

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camkego
Has anyone determined the exact six exercises used in the study? This article
mentions: "including push-ups, pull-ups, dips and reverse rows — while the end
of the limb is braced." But according to the trial registration, six exercises
were used.

Does anyone know where to find the exact exercise regimen used in the trial?
Why is this so tricky to find?

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joker3
The thing to keep in mind here is that studies can only compare the average
effects of any treatments they consider. You don't care about that. Instead,
you want to know what's going to work for your particular shoulder pain, which
might be helped by exercise, or might be something that generally requires
surgery.

