How to Assess Shoulder Pain and Instability with The TAOFit Method

Assess Shoulder Pain and Instability

The 5 Primary Kinetic Chains
“The 5 Primary Kinetic Chains” by Dynamic Neuromuscular Assessment. On my list of “must-have” poster sets (link below). https://dna-assessment.com/product/applied-anatomy-set/

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.

Case Study:

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).

Returning Home

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.

Hypothesis

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

Gift Economy

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

Read the Rules of Pain

 

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Continue reading “How to Assess Shoulder Pain and Instability with The TAOFit Method”

The Rules of Pain

The “Rules of Pain” is the most important lesson that I teach.

Know the Rules of Pain

How do you move when pain is present? Follow the rules of pain 

Pain is a form of communication from within our bodies. Generally, when it comes to our movement, it means that something is not moving well.

Ignoring pain is kind of like sticking one’s fingers into their ears and yelling loudly. Except, the longer one ignores it, the louder it becomes–until it eventually gets their attention.

A big lesson in the Mobility Restoration program that I teach is to simply slow down, become a little more sensitive to the conversations within your body, listen to your physical pain, allow it to become a guide or a coach to help you move better. Below are the simple “rules of pain” that I follow to move better, even when I am feeling pain.

Moving when pain is present

Begin by acknowledging that pain is truly present. This surprisingly is one of the hardest things to learn for clients (as well as myself). My ego likes to go hard, and sometimes going hard is not what my body needs. When it comes to moving with physical pain, I don’t want to move my body from my ego’s point of view.

The Rules of Pain

Rule 1:  Is it Painful?
The pain scale

  • This is a very important question to answer.
  • The answer is either Yes or No.
  • If you get anything other than Yes! or No!, then keep asking the question until you get either a “YES” or a “NO”.
    • If the answer is No, then great. I suggest you keep reading and save this email for the next time you are in pain.
    • If your answer is “Yes!” Stop moving! Read the Rules of Pain (read it over again each time you’re in pain).

Rule 2: Do not move into pain, but do keep moving.

How to move when pain is present
Rate your pain on The Pain Scale of 1 – nonpainful to 10 – excruciating. (I consider slight discomfort to be between 1-3 on the pain scale).

A more accurate pain scale

  • If the pain is less than 3, Slow Down!
    • Enter your movement slowly, cautiously, safely, and non-forcefully.
    • Don’t take movement beyond a level 3 on the pain scale.
  • If the pain is greater than 3, Slow down, even more.
    • No matter how slow you go, you can always go slower).
    • Make your movement smaller and less painful.
    • Keep it below a level 3, and move slowly, cautiously, safely, and non-forcefully.
  • Super Important: Don’t move beyond level 3 on the pain scale!

Going slow and exploring the edges of your painful range of movement is a wonderful space to explore the depths of your breath and heart. Be spacious, playful, open, and generous with yourself.

Jesse James Retherford