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Old 12-21-2007, 06:24 PM   #1
Bryant Yee
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Prolotherapy for Recurrent Shoulder Dislocation?

Hi all,

First post here. This board is great, and I've been soaking up all the info I can.

My question is: has anybody used prolotherapy for recurrent anterior instability? I saw some old posts that briefly touched upon it, but I was wondering if there was any new information out there.

Brief Background: I'm 21 y.o. and will be attending USMC OCS in 5 months. A few years back I subluxed my shoulder a few times during grappling, and other sports. I was playing collegiate golf, and opted out of surgery, because it really never bothered me. Unfortunately, I also never did the rehab that I was supposed to. After this time, my shoulder felt fine, and I nearly forgot about it. I was accepted into OCS with a solid PFT (20PU, 100 Crunches, and a 21:00run.) Then once I was accepted, I tweaked my shoulder out playing tennis for the first time ever. Next thing you know, I'm freaking out. I can't get surgery. Shoulder still feels fine--solid ROM, little pain. Even if I had all the time in the world I'm not sure I'd opt for surgery. I can still do 20 dead hangs but they feel "wierd."

Anyways, I went to a Prolo doc for a consultation. Apparently, she's treating 3 other Marines, and a handful of wrestlers, so I know I'm in good hands. She's a professor at GTown, and a former Ortho surgeon too. She did the basic ortho tests on my shoulder, and said that the bad news is that she can literally "feel" a tear in my shoulder capsule, but that the good news is that my problem should respond well to prolo. I can feel the tear too, so I know she's not BSing me. It feels like really loose ligaments, and my shoulder slides around a little too freely for comfort. I remember an old MRI-arthrogram said the same thing about having a loose capsule.

Sorry for the long post. Has anybody used prolotherapy for this sort of laxity with any success? Not only is this a physical problem but it's time sensitive too--I need it healthy in 5 months. I hope that my doc will use the strongest formula possible. Needles don't bother me, and I'd like to say that I have a high pain tolerance, so I'm not worried about the pain that comes with the shots. I've also been doing the rehab I should've done a long time ago--cubans, and a bunch of other rotator stuff. In fact the prolo doc told me that the reason my shoulder stays in place through all the exercises is that I have good musculature and that's what's holding it in. I feel confident that this may help, as she can pinpoint the exact area of the problem, and she's treated quite a few athletes with the same problem. What do you guys think? Any other suggestions? I did do ART but that really didn't do anything for me, and it actually made my shoulder feel worse. Thanks for the help and Merry Christmas,

Bryant
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Old 12-22-2007, 12:34 PM   #2
Garrett Smith
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Re: Prolotherapy for Recurrent Shoulder Dislocation?

Go for it, with lax ligaments and a partial tear, prolo could absolutely be just what you need. Make sure to do at least 3-5 treatments, and the only exercise you should do during the treatment period is that which is totally pain-free.
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Old 12-22-2007, 06:50 PM   #3
Bryant Yee
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Re: Prolotherapy for Recurrent Shoulder Dislocation?

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Originally Posted by Garrett Smith View Post
Go for it, with lax ligaments and a partial tear, prolo could absolutely be just what you need. Make sure to do at least 3-5 treatments, and the only exercise you should do during the treatment period is that which is totally pain-free.
Thanks for the encouragement Garrett. I feel that Prolo makes the most sense, as I'd liken my shoulder to a tire with the lugnuts not screwed on tight enough--it works, it's painfree, but it just doesn't feel right and the performance is lacking. Hopefully, the prolo will just tighten things up inside.

The 26th DEC will be my first treatment. Should I ask for stronger proliferants or just let the doc do her thing? I don't want to seem like a pain in the a$$ to her, but I also don't want to waste my time with non results when I could've just used stronger treatments in the first place. Like I said my pain tolerance is high (knock on wood ) so I wouldn't mind the extra pain, if that makes my body react faster. I know my immune system is strong as I'm hardly sick, and when I am injured or sick, I heal fastly. As far as exercises go, I plan to avoid wide grip outboard pullups and some forms of overhead presses, as those are the only exercises that make my shoulders feel quite instable.

Again thanks, Merry Christmas, and I will keep you guys updated on how the injections go, in case any of y'all are unfortunate enough to have my injury.
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Old 12-22-2007, 08:50 PM   #4
Tim Donahey
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Re: Prolotherapy for Recurrent Shoulder Dislocation?

I too have shoulder subluxations... most from overhead squatting. What was your rehab? You mentioned Cuban pressed and external rotations, anything else?

Good luck with prolotherapy (i'll have to google that).
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Old 12-22-2007, 10:04 PM   #5
Bryant Yee
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Re: Prolotherapy for Recurrent Shoulder Dislocation?

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Originally Posted by Tim Donahey View Post
I too have shoulder subluxations... most from overhead squatting. What was your rehab? You mentioned Cuban pressed and external rotations, anything else?

Good luck with prolotherapy (i'll have to google that).
Unfortunately, I do not have a set routine. The exercises I do now are exercises that I've found through online research and from picking the minds of some therapists and trainers. I try to do 3 sets of 15 reps of at least one of the folowing exercises a day (all exercises done with 10lb weights):

1. Cubans
2. External Rotation
3. My own little creation where I mimic punching/throwing actions on a cable machine, or PT bands.
4. http://www.youtube.com/watch?v=k_NlwXBs37E *I really like this one
5. Pushups on gym ball/medicine ball
6. Front raises kettlebell style (I don't own kettlebells, but I love the exercises so I try to improvise with dumbells and weight plates).
7. Turkish Get-Ups...both full and partial

Has it helped? Like I said, I should have been doing this stuff from the very beginning, but I guess now is better than never. I've been doing these exercises for a month. I do feel more stable in comparison to the past where I had major apprehension in certain positions; however, being that my problem is ligamental in nature, there's only so much I can do. As of late, my shoulder always feels to be in a "awkward" state--never painful, but it never feels quite right. I suspect that doing the rehab work has made my shoulder more stable when my arm is in motion, but when I do not keep an active shoulder, it always feels suspect.

I notice a major problem when doing military presses and wide grip pull ups. When I try to lock out my arms on presses and I have my arms as far vertical as they go, my shoulder seems to slip (the feeling is very awkward, but it's not enough for me to drop the weight or anything.) Secondly, near the dead hang portion of a wide grip pullup, I feel this same sensation. When I undergo Prolo, I will eliminate these two exercises altogether for the time being. My point in mentioning this is that the rehab has not made me feel any more stable during these exercises. I think this is where the Prolo will help in stabilizing the ligaments.

Bottom line, I don't care how my shoulder feels, I simply don't want it to dislocate/sublex during OCS. I don't know if that's realistic, but perhaps it's possible to "hope" your way out of an injury !

Happy Holidays,

Bryant
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Old 12-23-2007, 09:10 AM   #6
Craig Van De Walker
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Re: Prolotherapy for Recurrent Shoulder Dislocation?

I had prolo for my triceps tendon (which was very bad for a long time prior) and wrist with good results.

I have loose shoulders from an ugly dislocation one one and a sublux on the other that are decades old. Let me know how your goes I may consider getting mine treated.
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Old 12-23-2007, 09:43 AM   #7
Corey Duvall
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Re: Prolotherapy for Recurrent Shoulder Dislocation?

Bryant, no matter what treatment you utilize, the rehabilitation of proper movement patterns will determine your success. I think you've got a great routine set up so far... I LOVE the turkish get-ups for shoulder rehab. Make sure you really push that shoulder blade through the weight at all angles. This will guide the shoulder blade to support your arm, allowing your rotator cuff to work properly. I also highly recommend the shoulder dislocate stretch for improving flexibility; this may seem strange for an "unstable" shoulder, but most shoulder instability is because the muscles do not allow the proper positioning FOR stability. This stretch, if done properly, is completely safe and VERY rehabilitative. Here is a link to a description of it: WFS http://www.board.crossfit.com/showth...der+dislocates

Read the fourth (second paragraph) and fifth posts.

Good luck, let us know how it goes.
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Old 12-23-2007, 03:34 PM   #8
Bryant Yee
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Re: Prolotherapy for Recurrent Shoulder Dislocation?

Corey:

Thanks for the rehab tips. That "dislocation" stretch is not easy. I can't even do it with my 45 inch driver (only thing I could find...) using straight arms. Nothing painful, but I certainly have to watch it with the hurt right shoulder. Perhaps my limited ROM is what caused my problems in the first place. My L shoulder is completely healthy (as far as I know) and the ROM on it is kinda crappy too. Could be why I was never a pitcher or QB!

Turkish Get-Up tips are great. Never thought of "driving my shoulder through the weight." I always thought to pull my shoulders down when I need the most stability....interesting.

Quick Question...should these light shoulder rehab exercises be done every day? I feel like I should--and I want to--but somehow I think that perhaps everyday isn't good? Not sure.

During some exercises...like Cubans...I get clicking. It's not painful, but it definately plays a mind game like there's something wrong. Should I still do them? Emphasis on zero pain. Ha, Sometimes I feel like a 60 yr old in a 20 yr old's body. All my joints click, but definately this right shoulder more than everything else.


Craig: Definately will let you know how it goes. Going in on Wednesday.
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Old 12-23-2007, 06:58 PM   #9
Garrett Smith
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Re: Prolotherapy for Recurrent Shoulder Dislocation?

Bryant,
I don't think you need to tell the doc to "go hard" on you, but you might definitely tell her that she doesn't have to "go easy". He/she likely has their standard solution and probably only changes it to make it less irritating.

Also googling Regenerative Injection Therapy or Proliferative (Injection) Therapy may come up with more results. Note that the treatment is very dependent on the solution used, proper technique, and the patient NOT taking anti-inflammatory meds after the treatment.
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Old 12-23-2007, 07:39 PM   #10
Corey Duvall
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Re: Prolotherapy for Recurrent Shoulder Dislocation?

I have a philosophy that all shoulders without proper ROM are dysfunctional, however they may not be painful right now.

The shoulder blade was meant to guide the humerus (arm bone) and essentially follow it around. As the arm is raised overhead, the shoulder blade rotates upward and forward, this places it more under the humerus to lend support, but more importantly places the rotator cuff muscles in position for all of them to function properly. Poor shoulder blade mobility and control puts the rotator cuff at a disadvantage, much like holding a bucket at arms length by your fingers, versus holding that same bucket close to your body with your whole hand... holding it with your fingers you have far less stability and the smallest nudge could make you drop the bucket. In close to you, using your whole hand, it is difficult to shake the bucket handle loose from your grip.

Posture also plays a large role. Forward rounded shoulders will tend to change the movement patterns of the shoulder blade, as well as stretching the anterior portion of the shoulder joint capsule... perhaps leading to chronic dislocations?

I would recommend doing light shoulder rehab exercises multiple times a day. Some like turkish get-ups and stretching of the warm tissues will be highly beneficial.

I'm not sure what "Cubans" are or at what point you get clicking. Could you explain your clicking a little further, and what the exercise is that creates it?
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