I have a client who has been diagnosed with calcification of the shoulder joint. She is in her late 50s and has had surgery three times only for it to re-occur. Her primary goal is weight loss, and therefore, she requires a total body workout, but she finds most basic exercises painful. How can I help her get the most out of her workout, particularly her upper body?
Thank you for your question. Based on the information you provided, your client has been treated for a symptom not the cause of her problem. To get her to her goals, you will have to become a biomechanical detective helping her with her symptom BUT also searching for the possible cause and current compensation(s). Don’t get frustrated if all of these finding don’t “jump” out at you. Sometimes it takes time and “grunt” work on your behalf to create the right solution. There are no protocols, just principles of movement science that build strategies that lead to the right techniques for your client. To assist you in your detective work, I will list out some questions and things to think about:
Have you asked if the calcification (deposition of calcium salts) is bone or soft tissue related? Calcification is not restricted to bones; it may occur in a shapeless form in tendons, bursae and other tissues. If in fact it is within the soft tissue complex, I would refer your client to an ART Doctor/Therapist. They can be found on www.activerelease.com under Provider. They specialize in soft tissue treatment of this sort. In addition, you can start improving your client’s function immediately by following these principles:
- Assess your client’s necessary tasks. In other words, understand her essential (must do) movement patterns - tasks that must be performed. This will start your movement assessment.
- Once you know what movements to assess (i.e., squatting, lunging, stepping, reaching, shifting, bending, hopping, pulling, pressing, pushing, etc.), assess her ability to transform the movement from direction to the next. For example, can she lift her arm up and transition back efficiently? Or does the shoulder blade lag behind the speed of the humerus? NOTE: Most shoulder symptoms are not the cause – look around the symptom for the cause. In her case, take a close look at her scapula-thoracic joint, ensuring the scapula and thoracic spine are moving in sync with her humerus. Remember, the shoulder is the humerus and scapula connection.
- Next, appreciate the chain reaction linkages that HELP the shoulder. A great example is tennis. To properly hit the ball with your hand-arm-shoulder, you must have three dimensional hip mobility-stability. Have you tried using her hip motion to assist with shoulder movement?
- Last and most importantly, find where she is successful and focus on her success to allow her to move more and get a great workout. Remember the painful arcs of motion and use them as a re-assessment tool but never try to work through them. You want to stimulate the body, not aggravate it!
For a great reference on chain reaction shoulder rehabilitation, training and conditioning, please see Gary Gray’s Functional Video Digest The Mostability Shoulder V1.3 – its well worth your time!