Assess Shoulder Pain and Instability
This class is an example of how the TAOFit Method can be used to assess shoulder pain and instability.
As an assessment, I am looking at gait mechanics through a neuro-muscular-fascial-structural lens. Assessing the relationships between the anterior and posterior core spirals of the wrist, arm, shoulder, and spine through the thoracolumbar fascia to the contralateral hip, knee, and foot.
Below is a case study (I am the subject). The class is 64 minutes followed by a brief Q&A. In the Q&A, I dive a bit more into the movement anatomy and theory of The TAOFit Method.
Two weeks ago, I participated in a men’s gathering in the rugged mountains of southern Oregon. It was a phenomenal weekend with an amazingly diverse group of masters. Over two days, we did a navigation challenge (maps and compasses). I hiked up and down steep gorges 10+ miles the first day and 15+ miles the second day. This was a significant increase in movement volume and intensity compared to my general conditioning program.
Afterward, I experienced minimal pain and noticeable swelling in the right knee joint (loss of about 10-20 degrees of deep knee flexion). Totally normal for me considering the circumstances and nothing unexpected. Overall, my body held up better than expected.
A brief and incomplete injury history:
Going back to 1998, I’ve had six total knee surgeries. Both knees experience true instability with the tendency for pain, inflammation and/or swelling after intense physical challenge.
The right knee has a full PCL rupture. Due to true PCL instability, there is a significant shifting of the femoral head on the tibial plateau with every step, lunge, and/or squat.
- Two PCL reconstructions with partial meniscectomy (1998 & 1999) – PCL reconstruction failure both surgeries
- Two surgeries to clear staph infection (1999 & @ 2002)
- One ACL reconstruction with partial meniscectomy (2006)
- Signs of degenerative arthritis via X-Ray over the years
The left knee has some medial meniscus removed (affecting tibiofemoral stability). The head of the femur has a tendency to slide off the tibial plateau when in a deep knee bend with tibial rotation
- A partial meniscectomy (2016 or 2017)
As well as multiple concussions, whiplash incidents, and other joint traumas from years as a competitive athlete (college basketball) and a self destructive lifestyle (not taking care of my body).
I drove back home from southern Oregon to Austin, Texas with my son. The drive was 32 hours. We completed it in 41 hours. Two days of hard-driving – i.e. sitting, and next to zero restorative movements (I’m a bit of a masochist 😊).
The first day back, a neighbor gave away a 4×8 foot piece of solid plywood (weighs between 60-85 lbs). I loaded it by myself into the truck, As I lifted the board, my nervous system spoke loudly. I felt my left shoulder become neurological unstable and mildly painful (3 to 4 on the pain scale of 10). Not terrible, but definitely “off”. As the day progressed, left shoulder stability continued to deteriorate, especially with stabilizing away from the midline of the body through the elbow and hand (example – getting up from the ground). Stability remained solid and non-painful with carrying and hanging. But active pull-ups felt unsafe.
As I took some quality time to self-assess movement, using the above template, I noticed significant core imbalances in the core relationships between the posterior left shoulder to the contralateral right hip, knee, and foot.
The current hypothesis that I’m working with is that the active inflammation and swelling caused neurological instability within the knee. This had a cascading affect to the complex relationships between the right foot, hip and spine (and from the spine it can spill out into anything and everything). As a secondary stability strategy, my left shoulder compensated by neurologically increasing the bracing patterns around the shoulder complex. (examples of bracing patterns – humeral compression within the glenoid fossa and humeral internal rotation to wind up the fascial spiral).
As a protective mechanism, this bracing strategy (i.e. compensation) generates greater structural stability within the contralateral hip and shoulder during the loading phase of gait mechanics (walking, running, crawling, climbing, swimming). This is a fantastic strategy for a wild human. It allows us to keep moving while preventing a more devastating injury.
Basically, with each step, my left shoulder was neurologically tasked to provide greater stability and tension to support an unstable right knee related to gait. When I lifted the bulky plywood, it blew out the neurological stability of the shoulder complex (analogous to blowing a circuit breaker).
Assess Shoulder Pain and Instability and Resetting the Circuit
Through the movement assessment, I am comparing the quality of movement at the edges of range of motion that are pain-free vs. pain-“yes”. I am using pain as a guide to building a highly sensitive movement map (i.e. where can I move safely, non-painfully, and with solid motor control).
At the same time, I am slowly exploring the edges of the map. The goal is to restore joint-by-joint neurological connection, integration, and stability. Slowly challenging each segment to connect into larger and larger multi-segment chains.
This doesn’t always happen in a single session. Depending upon the injury history, it can take days, weeks, or months to fully integrate. However, the results tend to be powerful. My shoulder isn’t 100%. But within the first 2-3 days, I’ve had 70-80% improvement in pain level, stability, strength, and function. Between 4-7 days, the shoulder is at 80-90% with the addition of light push-ups, pull-ups and climbing.
Findings of Interest from Assessment:
- Imbalance of core integration related to gait
- Anterior Spiral – right hip to left shoulder
- Posterior Spiral – left hip to right shoulder
- Lumbar spine
- Neurologically “stuck” in right lumber lateral flexion T12-L5 & Sacrum
- Thoracic spine
- Neurologically “stuck” in left lateral flexion
- Possible disc degeneration and/or spinal nerve impingement on the left between T6-T10
- Spinal compression C3-T1
- Neurologically “stuck” in left rotation and lateral flexion
- Possible vagal nerve impingement causing occasional heart arrhythmia (atrial fibrillation with tachycardia)
- Movement restriction in left rotation and left lateral flexion
- Left shoulder
- The humerus is “stuck” in compression (posterior capsule) and internal rotation
- Movement restriction and Pain with external rotation
- Right hip
- Neurologically “stuck” in compression
- Movement restriction with external rotation
- Left hip
- Neurologically “stuck” in anterior compression
My movement practice is something deeply Spiritual. This movement philosophy is a part of a daily practice. A method of movement that I have cultivated over decades of study with many amazing teachers. It requires consistency, something I occasionally fall short. But considering my long and well-earned injury history, the more consistent I am in this practice, the more I able to participate in cool adventures like hiking 10-15 miles through the mountains. Something, after the first knee surgery, the doctors told me I’d never be able to do again.
Structurally, at the age of almost 48, my body has the physical wear and tear of an 80-year-old, yet I experience less physical pain and greater overall freedom of movement, skill, and capacity than many 30-year-olds. Considering I’ve had six knee surgeries with true joint instability in both knees, I maintain a pretty solid level as a highly functional, Dysfunctional mover. My hope is to be able to play in the rugged mountains well into my 90’s. If successful, this video holds a few of the secrets that I’ve learned.
I hope you find value in this class. If so, I would love to hear your feedback. What did you discover? Please post a comment below. If it was a “super awesome” discovery, it would be super awesome if you liked, subscribed, and shared this video with your tribe. Tell us about your discovery and tag The Art of Fitness on the post. It helps us to grow The TAOFit tribe.
If you are
- Experiencing chronic physical pain
- Experience pain with any of these movements
- Find these movements to be extraordinarily challenging
- Are a Movement Coach/Teacher who wants to learn about movement assessment
- Or are simply interested and ready to change your life by developing a daily natural movement practice
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