By Nick Nathan in
HealthThis is for anyone who feels like they’re too young to be dealing with recurring aches and pains, anyone suffering from frequent "flare ups” and anyone who has a “bad” shoulder, knee, ankle, hip etc. but hasn’t even hit 40.
This is also for those of you who were college athletes, whether at the intramural, club, or NCAA level, who used to feel invincible, but have started to notice that it gets harder to recover from training and longer to rehab from an injury as the years go by.
This is for anyone who continues to work out and train to maintain your fitness, takes classes, maybe even competes, but is starting to suffer from recurring injuries, aches and pains.
Sound like you?
I am not a medical professional and I don’t pretend to be.
That said, I have spent a lot of time working with medical professionals of various types over the past two years in an attempt to deal with various musculoskeletal issues of my own. My experiences on this journey inspired me to start Tether Health through which I have met and interviewed dozens of patients and medical practitioners.
While I may not have medical credentials, I can speak from a wealth of personal and professional experience. Hopefully my story will be useful to you.
I was a multi-sport high school athlete and collegiate rugby player. While in college I separated my right acromioclavicular (AC) joint which connects my collarbone to the wing of my shoulder. After the injury I received very poor medical care and did very minimal rehab as a result.
Since then I always had a “bad” shoulder. After the initial recovery things were mostly ok in the sense that the pain was gone, but it pretty much ended my rugby “career”. Eventually I was able to get back in the gym and train as before but always with some amount of caution doing overhead presses or lateral shoulder raises i.e. anything that specifically worked my shoulder.
After graduating from school I continued to train for general fitness and health. Every once in awhile my shoulder would “flare up” and become sore for a period of time. Given my athletic background, I usually just pushed through the pain but rarely ever stopped training all together. It was more of an inconvenience.
Fast forward a few years and the frequency of the flare ups increased, the severity increased as well, and it started to take longer and longer to recover. Eventually things got so bad that during flare ups I couldn't raise my arm at all and I would have to wait weeks before I could train like normal.
During these long training gaps while I waited for my shoulder to recover my training progress slowed, I lost a lot of muscle mass, my diet got worse, lack of exercise started to impact my sleep and my mood suffered as a result. It felt unfair. I was still young but things were quickly changing for the worse.
If elements of this story sound familiar then I want to reassure you that this situation is actually very common. Everyone understands that as you get older your body starts to degrade physically but no one ever talks about what this means or what to do about it. If you find yourself in non-specific physical pain i.e. not from a recent, acute injury or trauma, and you’re still fairly young, it can be really confusing and scary.
As a result, a large number of people in this situation do not do anything about their pain. Why not?
Looking back on my own behavior I can see how resistant I was to seeking out clinical support. But then again, I didn’t know much about the medical system. I wasn’t really sure which doctor to go to and I had this vague idea that maybe I would need surgery. The idea of surgery not only scared me but the whole process seemed so daunting and expensive.
As a result, I avoided dealing with my shoulder issues for years. Eventually though, things got bad enough that I couldn’t ignore them anymore.
What do you do if you’re in pain and suffer from frequent flare ups? There are many options but each one comes with a different financial and time cost. It’s hard to know what is best or where to start.
At the start of this journey I was pretty naive. I went down the winding “traditional” path loosely prescribed by the medical system. Here’s what I tried:
I tried this approach first. It worked ok in the beginning but eventually became less and less effective. Most importantly, it didn’t really solve my core problem. I wanted to be able to train, consistently, without pain. Simply stopping altogether was fine for a bit but wasn't a real solution.
I had the idea that maybe consistently icing my shoulder after workouts would help. Unsurprisingly while it helped relieve my symptoms in the short term it didn’t really do much when I wasn’t icing. Non steroid anti inflammatory drugs (NSAIDs) e.g. ibuprofen or aspirin worked ok but they also had the effect of making me feel better than I was. As a result I ended up pushing my shoulder too hard thus compounding the issue. Plus I didn’t want to be dependent on pills just to exercise.
Once I finally acknowledged that my shoulder issues weren’t just going to just go away I took the next least effort step. I googled “shoulder pain” online. After searching around, doing a fair amount of research, and trying to diagnose myself I found a few YouTube video tutorials with shoulder exercises.
I tried doing these exercises for about 2 weeks without any real results. The main problems with online rehab exercise programs are:
Next I figured that if I could only identify the problematic tissues I could look up better programs online. While I was able to identify all the muscles in nicely drawn anatomical diagrams, learn how they worked at a high level, and approximate which movements roughly corresponded to which muscles, I was unable to map my pain to specific tissues.
I would later discover that because I was mostly only looking at bones and muscles and l was missing a lot of important nuance, no surprise there …
Once I finally convinced myself I was going to need to see a doctor the question became, "which doctor”? I wasn’t sure so I defaulted to visiting my primary care doctor. My primary care doctor concluded that everything looked mostly fine: I had basic motor control, my muscles weren’t wasting away, no bones were broken. He recommended I rest and go easy for a bit, use ice and take some aspirin ... completely useless advice.
So I continued to suffer for probably another 6 months until I went to see a different primary care doctor for a different reason. I asked him about my shoulder and this time got a different perspective. This doctor said that I had poor posture. My shoulders were rolled too far forward and I had to sit up straighter and pull my shoulders back.
Seemed like sensible advice until I tried actually applying it. Turns out remembering to fix your posture constantly is a nightmare. I already used a standing desk, I knew my posture wasn’t great, but I had no clue what to do to actually fix it.
Fortunately for me there happened to be an orthopedic specialist in the same clinic. After explaining my situation again and going through a series of manual tests the doctor concluded that my shoulder blades were not moving correctly. They were “winging” i.e. moving too far off of the ribcage.
This was all very fine and interesting but I left that conversation with, yet again, no practical strategy to resolve my pain. I was instead referred to a physical therapist.
It wasn’t until I started working with a physical therapist that I got the first real clue that eventually helped me to fix my shoulder. Interestingly, the physical therapist did almost the exact same set of diagnostic exercises as the orthopedic doctor and some additional ones as well.
After going through her evaluation she explained that the soft tissue surrounding my shoulder, the joint capsule, had been stretched, potentially from the initial injury. As a result the head of my upper arm bone, the humerus, was sliding forward in the joint. This forward shift was causing the end of my bicep tendon to catch the bone as it passed over in certain movements. Add some load to those movements and the wear on the tendon increased. She believed that this obstruction was causing the tendon and musculature to become inflamed.
She then recommended a few exercises to help pull the humeral head back in the joint capsule and strengthen the muscles on the back of my shoulder.
Unfortunately these exercises didn’t really do much at first. I diligently repeated them for a few weeks before going back to the physical therapist, somewhat frustrated.
After watching me attempt the exercises she quickly identified that I was doing them wrong, not because I didn’t know what to do but because I didn’t know how the movement should feel. Specifically, when moving under load I need to roll my shoulders back and out while pulling my shoulder blades back and down. As you may have noticed, just explaining these movements is confusing. They had to be felt to be understood.
After learning how it felt to move correctly everything changed. I soon learned how to mobilize the correct muscles to pull my shoulder into the right position for a whole category of exercises and movements.
A few weeks later, now back in the gym, I was able to perform pain free lifts like I hadn’t been able to do in years. It felt like magic.
What I didn’t really understand at the time but have learned since is that I needed to rewire my nervous system to allow me to move my muscles in a way that previously felt unnatural. In addition to rewiring my neural circuitry, I had to build strength in muscle groups that were previously weak because my brain underutilized them.
Exasperating the problem was that I spent many years working on my chest, benching heavy, and siting hunched over at a desk. These habits resulted in tight pecks and rotator cuffs pulling my shoulders forward.
In order to unconsciously deploy these new movement patterns I had to practice them over and over again. The existing patterns were deeply engrained and it took many hours of repetition to feel natural moving in the new way.
I then had to find another, specialist physical therapist, who could help me find ways to progress the simple exercises I started with and incorporate them into my regular training.
I still have occasional soreness but I haven’t missed a single training day as a result of shoulder problems. I feel stronger than ever and I’m still improving!
If you get only one thing out of my story I hope it’s this
If you struggle with recurring pain and bad flare-ups your FIRST step should be to find a qualified physical therapist.
I have been shocked at how many people don’t know what a physical therapist is, what they do, and how they can help younger, active people, and athletes. I was one of those people. As a result I spent years in pain, because I was worried about surgery and because I didn’t know how to get the right help.
While theoretically you could have a serious problem unrelated to your musculoskeletal system, the reality is that if your physical therapist is halfway decent they will know to send you back to an MD if necessary. In fact, I have spoken to many physical therapists who have caught serious complications that all of their referring MDs missed.
If you do end up needing surgery after all you will inevitably end up back in the care of a physical therapist anyway. Might as well start there and see if you can’t save yourself a ton of time, money, and pain.
Do yourself a favor, keep yourself young longer, and go work with an expert. I know how hard it can be to find a good physical therapist (I’ll be writing a post on that soon) but in the meantime feel free to shoot me an email and maybe I can point you in the right direction :)
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