[Paddlewise] Rotator Cuff Impingement Syndrome; Scapular

Anne posted (snip):
>Anyone had rotator cuff impingement syndrome and/or scapular problems?<

Oh yeah! Your not a real paddler if you haven't experienced shoulder pain. 
Of course, really bad shoulder pain either means you are a really good, 
intense paddler (carrying my above logic forward) or, you are doing 
something terribly wrong. It can also mean you weren't gifted by nature for 
the level of activity causing the pain/problem.

My experience with rotator cuff started the first year paddling, and man, 
was it depressing -- to find an activity you really enjoy, and have to 
suffer so much. I did the ice thing, and the physical therapy, along with 
the exercises Jolie laid out. I also kept up weight lifting, concentrating 
on routines that built up general shoulder strength - avoiding heavy or 
repetitive lifting where the arms went above neck level. Lifting one's kayak 
on a vehicle can do damage too.

Ice is really all that brings me relief. On a long trip, there's been times 
I'd have killed for ice. After about a year of ice the first year of trouble 
(using the frozen Dixie-cup/rubbing around shoulder routine) I got to the 
point where after a long storm paddle, I'd melt half a cup in 5 or 6 
minutes. I always ice after a paddle, even if there is no pain. 25 years 
later, I can rub ice directly on either shoulder for 30 minutes without 
flinching. I don't think this length of exposure is recommended, but there 
are days when I even go 45 minutes. As I've been doing this for over two 
decades with no skin damage, it seems to work for me.

>Wondering what experience anyone else has had? Specific exercises? 
>Successful (or not) outcomes with PT?  Timeline?<

The only elasticband exercise that helped me was the one where you sit on a 
chair with the rubber-rope (etc) tied to a door knob to either side of you 
(depending on which shoulder you are working on). You keep your elbow tucked 
into your side, sitting straight up, then keeping your shoulder immobile 
with your elbow as a pivot, pull the resistance of the elastic away from the 
door, bringing your fist over to the other elbow. When rotating back, don't 
let your forearm go further than perpendicular. In other words, a 45 degree 
arc.

I underwent 5 years of physio (socialized medicine in Canada helped), to try 
and maintain a every-other day paddling schedule. I eventually had Cortisone 
shots, which were painful to have injected, but brought relief. One 
memorable weekend, after a Friday shot to the right shoulder, I was out 
storm paddling the next day, totally pain free, in my glory, until about 
half an hour into the 45 knot winds when my shoulder suddenly froze up. No 
pain, but no movement. Guess that's why they call it impingement. I'm glad I 
was a good swimmer. It hurt later, and did so for months, with no paddling 
possible. I underwent 3 shots each in total, in each shoulder, but the long 
term consequences of repeated shoulder injections isn't good in my opinion, 
as damage from the injectible agent takes its toll on cartilage and the 
bursa, etc. Of course, as a female paddler, I'm sure you will display more 
common sense with your body than I did and know when to back off.

I had one acromioplasty on the right shoulder (I wanted both done at the 
same time, but no way would the orthopod go for that. It didn't help for 
very long, so over the course of my 10th year paddling, I had two open 
shoulder surgeries, a few months apart, followed by physio. While the pain 
quickly returned (I continued to storm paddle, winter surf paddle, etc.), it 
would subside with rest, enough that I can still paddle, but not long 
distance. I suffer more in the summer than the winter. I can't swim using 
the forward stroke (I have to side-stroke, etc). I not throw ball, nor do I 
play tennis anymore. Church ball games are a killer.

For a first-time impingers, I'd say 3 to 9 months of ice, therapy, and 
physio to normalize again. Part of the trouble is after impingement takes 
route, even fairly benign activity like pulling the Cherrios out of the 
cupboard creates a vicious circle that's hard to circumvent, as normal 
duties tend to keep impingement active.

I know John Dowd suffers shoulder problems, and for a while was promoting 
the Greenland paddles. I'd recommend looking at a smaller, soft dihedral 
blade design. I picked up one from Aquabound one year a while back, for a 
trip around half of Vancouver Island, and it saw me through with less pain 
that normal. I'm used to a big-bladed, Lendal Nordkapp paddle that was used 
for most of my big-weather paddling, which probably contributed to some of 
my problems early on.

Joan mentioned sleep position. Be careful here too. I spent this past 
Christmas day with a very, very painful shoulder, unable to move it the 
whole day, after falling asleep with my arm above my head for a few hours. 
It took a whole day of ice and vitamin "I" just to stop wincing.

Here's a couple of links to some on-line articles:

http://www.nswseakayaker.asn.au/mag/21/shoulder.htm

http://www.nswseakayaker.asn.au/mag/31/shoulderpain.html

>Followup exercises or activities to insure being able to paddle?<

Don't get discouraged. Keep at it, good days will come. If you are serious 
about overcoming the hopefully temporary disability, it may take some effort 
and expenditure. I was told point black in 1981 to give up paddling Yeah 
right, like stop breathing?

Doug Lloyd
Victoria BC
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