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Old 10-08-2009, 12:01 PM   #1
Rafael Jimenez
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Need Help finding a good Physical Therapist in Atlanta, GA

Hey guys. I've been having some problems with my right shoulder. I went to Atlanta Sports Medicine and they had me going to PT, where I did rehab and stayed away from overhead movements. Now, I injured it again and I have multi-directional instability (MDI) in the same shoulder. I'm doing rehab for the MDI at Atlanta Sports Medicine, but they have told me, from the beginning that I should never, ever, ever, lift overhead again. Being a Crossfitter, I advised them that I have to lift overhead. I realize I will not be setting any overhead lifting records, but I want to continue doing the overhead lifts. For now, I'm doing the rehab exercises and doing band exercises to strengthen the rotator cuffs. I'm also staying away from overhead lifts until the pain subsides and tailoring CF WODS around the overheads. The PTs at Atlanta Sports Medicine believe CF to be dangerous, so I'm looking for a PT in the Atlanta area who would be more conducive to working with an injury-prone Crossfitter. Also, do you guys think I should completely stay away from overhead lifts for an extended period of time or should I start back with very light weight after a few weeks. Thanks.
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Old 07-09-2010, 03:38 AM   #2
Celeste Boyd
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Re: Need Help finding a good Physical Therapist in Atlanta, GA

Hey Rafael,

Just wondering how your multi-directional instability situation is going? Did the physical therapy help? Did you get surgery? I'm in the same boat... doing PT right now for it, and already have a torn labrum from it apparently... my physical therapist is trying to be as supportive as possible (since I went in there the first day and pretty much laid down the "I'm not quitting weightlifting so please don't try to make me" law), but she seems a little frustrated and not convinced that I'll be able to really go back to serious CF-ing. Just curious if, 9 months later, things have gotten better for you...?

-Celeste
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Old 07-10-2010, 08:28 PM   #3
Steven Low
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Re: Need Help finding a good Physical Therapist in Atlanta, GA

Look into trying to call around and see what sports teams use for their PTs/docs.

In general, they will try to get you back to your sports/exercise/etc. more than regular PTS who may even say squats are bad for your knees... heh.


I "learned" yesterday in PT school that valsalva was bad. -_-
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Old 07-11-2010, 05:32 AM   #4
Celeste Boyd
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Re: Need Help finding a good Physical Therapist in Atlanta, GA

Thanks, Steven. I'm definitely planning on trying to get a more sports medicine-oriented PT (although mine is actually pretty good...she's a serious competitive triathlete, so she understands the desire to get back to your sport). I was just curious about how likely it is that I'll be able to get over it with just PT, or whether I'm just going to have surgery, and if so, what the chances are with surgery that I'll fully recover.

I haven't seen many people on the forums talking about multi-directional instability issues, so I don't have a good sense of how common it is, or how successful surgery is in fixing it. Mine is pretty bad. My shoulder nearly subluxated the other day just lifting my arm to wipe my face on my sleeve, and it's subluxated a few times in recent years just by taking off a sports bra. So I'm starting to lose faith that I can "beat" it just by laying off of it and doing strictly PT for a few months.

Anyway, I'm definitely going to seek out a sports medicine doc (I'm near-ish to UNC in Chapel Hill, and I figure they have some good sports docs on staff for their teams). But in the meantime, if you have any thoughts on MDI, let me know!
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Old 07-11-2010, 09:58 AM   #5
Steven Low
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Re: Need Help finding a good Physical Therapist in Atlanta, GA

What are you currently doing for PT?

With loose glenohumeral ligaments and connective tissue MDI is pretty serious, especially if you're subluxing a lot. I mean, if any of hte ligaments were torn resulting in chronic dislocations (like inferior glenohumeral ligament -- aka bankart lesion) that would usually result in surgical intervention.

If you're at the point where you're almost chronically subluxing/dislocating it may be an option to look at surgery as much as I don't like saying that. Surgery is last option always, but when you're having chronic problems with everyday movements like that.... there's some serious issues that need to be addressed.

Was your shoulder MDI atraumatic or traumatic? Do you have naturally loose ligaments (can bend fingers back really far)?
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Old 07-11-2010, 10:20 AM   #6
Celeste Boyd
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Re: Need Help finding a good Physical Therapist in Atlanta, GA

I'm not subluxing (subluxating? what's the right word?) "a lot" exactly... it just sort of "threatens" to subluxate every once in a while...like maybe a couple of times a month? Although it seems to be happening with more frequency. But it hasn't *actually* subluxed more than a handful of times in the last 10 years. It's just that I can't do any serious lifting (or, increasingly, even minor lifting) without inflaming my shoulder (burning pain in that triangle between my clavicle and the head of scapula...I think... and at various other places...along my deltoids mostly).

I have naturally loose ligaments (can bend my fingers back far, can palm the floor pretty easily, have loose kneecaps, etc.), and the left shoulder was sort of injured about 10 years ago. It subluxed when I swung a heavy baseball bat and wasn't prepared for it not to make contact with pinata (stupid, I know... this was before I was athletic AT ALL). Anyway, the other shoulder is also painful, but the left one is much worse.

For PT, I'm doing a lot of stuff focusing on strengthening all the little muscles around my scapulas to try to pull the joint back and stabilize it (sorry, I don't know all the names of the muscles), as well as some rotator cuff exercises. Here's what I do 2x/day:
* "Wall washing" (?) - take two rags and press them into a wall, then focus on stabilizing the shoulders while I drag them up and down the wall.
* Scapular "pinches" - forearms to the wall and try to pull my scaps down and keep them from "winging."
* Planks - 30 sec. hold x 3
* Pushups - 2 x 10 (trying to be very very stable)
* Band work:
- External rotation x 10
- Internal rotation x 10
- Abduction x 10
- Scap rows 2x10
* External shoulder rotation while lying on my side x 10

So.... any suggestions? It sounded like from what you wrote before that if I'm not subluxing on a really regular basis, perhaps it's not serious enough for surgery? But if there's something else I need to be doing in terms of PT to get back to the point where I can lift again, I really want to figure it out so I'm not just stuck where I am now: unable to do any upper body exercises except a few highly-controlled (i.e., not kipping) pullups and pushups.

What do you think, oh master of CrossFit-specific injury advice?
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Old 07-11-2010, 08:29 PM   #7
Steven Low
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Re: Need Help finding a good Physical Therapist in Atlanta, GA

You should probably be doing more volume/intensity on the rehab work if you can handle it. That's like... light stuff....

Cut down to 4-5 days a week and start upping the weight in a controlled manner (depending on advice from your PT I guess).

Stronger is better for instability and if what you're doing isn't focused on making you stronger as fast then it's not going to be very helpful.

Still, if you feel it destabilize then that's not good at all. Have you talked with your PT/doc about surgery?
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Old 07-12-2010, 06:56 AM   #8
Celeste Boyd
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Re: Need Help finding a good Physical Therapist in Atlanta, GA

Increasing the weight seems reasonable, but I'm just trying to figure out what the appropriate level of pain is. Right now, I'm feeling a low-level (say, around a 3 on a 1-10 scale) burning pain in my shoulder pretty much constantly from even the light stuff that I'm doing. So I've been kind of waiting for my body to "adjust" to that light weight to where I don't feel that pain, and then I thought I'd increase the volume / weight accordingly. Do you think I should just increase it and work through that pain?

I haven't talked seriously about surgery yet, because I'd really like to get a new doc that's more sports-oriented. Right now I'm in the middle of studying for the bar exam, which is in two weeks. I'm planning on looking for a new doc after that, and then I'll probably start seriously discussing surgery.

Let me know what you think about upping the weight right now or waiting for the pain to subside, and then I'll just see where I'm at in a few weeks after the bar.
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Old 07-12-2010, 07:28 PM   #9
Steven Low
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Re: Need Help finding a good Physical Therapist in Atlanta, GA

What movements are you havin pain on?

That's generally not a good sign considering that most of the above is mobility. I didn't see you mention pain before.... just instability problems.

You should NOT be working through pain except in certain circumstances (gainin ROM is one of them but not really during exercise in general). It's counterproductive to therapy.

If you're having pain and it's not decreasing with therapy then surgery is definitely an option you may want to consider given your past history and loose joints.

Did you tell your PT about this?
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Old 07-13-2010, 03:54 AM   #10
Celeste Boyd
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Re: Need Help finding a good Physical Therapist in Atlanta, GA

I have the most pain on the abduction and external rotation movements. I didn't actually even think to mention it before because I've gotten so used to it. It's a burning pain while I'm working it that then turns into a dull ache the rest of the time.

I told my PT, and she didn't tell me to stop the PT, just the other lifting that I was doing (it's--perhaps obviously--worse when I do anything more major than that light PT). I think she's hoping that if I lay off the regular lifting, the inflammation will go down enough for me to keep doing the PT without pain, and eventually strengthen everything back up again.

I don't know, though... It's definitely sounding like I need to look into surgery... Ugh.

Thanks for your help, Steven. I really appreciate it.
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