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Shoulder Dislocation

Hey Dr. Jen, I'm hoping you can answer this question. About 3 years ago I dislocated my left shoulder. It was a fast dislocation and the joint popped right back into it's normal position. After a month it felt normal again. I have not dislocated it since that time and when I met with an orthopedic surgeon he did the tests and was surprised that I even had the dislocation saying that I had no shoulder instability at all.

I have a chance to get hired with an awesome department and I wanted to know what to do when I go through the medical. Should I have the doc write a letter for me saying it won't be a problem? Is there anything else I should consider? Thanks.

I am not the one who put my hands on your shoudler, so I can't vouch for what the orthopedist felt. But, I'll answer this as best I can without that bit of information.
I dislocated my shoudler at 16 diving for a lacrosse ball. It was re-set. Ouch. It has never been quite the same. It makes lots of noise- called crepidis. Crepidis can be harmless, but if the grinding and popping causes pain, then there is a problem. Be it great or small, the pain is a problem. So, if you have pain and popping, then I would ask the doc for a letter just to cover yourself. It didn't sound like you were in pain, though, so I'm betting that's not the case, eh?

Further, your humeral head may have felt like it moved/popped, then returned to it's normal place. It often does that without causing any damage to the genoid labrum or the stretching the joint capsule or ligaments. I pop joints for a living, and let me tell you, it is very often very safe. It's when it's beyond a certain point that it's a problem. Even if there was a slight change in those tissues at the time, you likely healed well, as the body does amazing things.

If you feel better about it, go to the dr's office, ask to read your file. See if the doc wrote in the file that your shoudler was stable. If he didn't write it, maybe you could persuade him to do so. But, then, once it's done, you should leave it, and your worries there.

I am not the expert on the hiring process for the departments you might be interested in. BUT, I have done plenty of pre-employment physicals, and sports physicals. And an injury that has no residuals does not, in my opinion, have any bearing on your ability to do the job. I would not offer it up. If they ask specifically, I would NOT lie. Then you could get the doc's notes and show them to them.

I would also train very carefully with your shoulders in the future, matter who you are. Low back and shoulderinjuries are common in FFs. Train the rotator cuff muscles specifically with light weight as a warm up on your chest and shoulder days at the gym. (The sits muscles: supraspinatus, Infraspinatous, subscapularis, and teres minor). There are specific exercises for each. If you can not find those exercises, let me know, as my next product is specifically about that. You should protect your future with just a few extra minutes a day even if you don't have anything wrong....
Oh, and avoid the 3 exercises that I see causing the most injuries: behind the neck lat pulls and military press, and straight bar bench. For more info on that, see my web site/FAQ's... look in the tabel of contents at the top of the page: "Regarding Bench Press".

Hope that helps! Best wishes!
Dr. Jen Milus, DC
Author of Fire it Up CPAT Training System

Wow, I just finished reading the bench topic, I had no idea those exercises could be harmful like that. During training we used to do stand-up push ups, push ups, and dips. Are exercises like that harmful as well? I can now tell I'm very fortunate that my shoulder seems to have healed well. I don't have any pain, lifting or not.

After looking at that, I'm thinking I should re-evaluate my workout. Is there a specific balanced workout you recommend? Or any books, any other websites? I'd also definitely be interested in those other smaller exercises you recommended. Thank you very much for the advice.

I have not had the same high percentage of injuries with dips or push ups as I have with straight bar bench. Try pec flies (watch form) along with the ones you are doing.

For posterior delts, back flies and upright rows are safer than behind the neck military press. And lat pulls in front are safer than in back.

For the most part, remember that people tend to train their push muscles more than their pull muscles. They over train chest/pecs, and don't do as much lats/rhomboids. This leads to overly short muscles on the front, and internal rotation of the shoulder joint. Posture changes, to a forward lean... and palms face back when standing straight up. (They should face in). Try to do equal reps, sets (and edge for)weights with the front of your body as you do your back. It might take a while to even out!

Think about this for your legs and abs. Do you work your hams as much as your quads? Hams are usually only about 60-70% as strong and quads, but: think about how much you work each. AND: abs: We do alot of crunches, right? What about lateral flexion on the hyperextension bench? And extensions on there? And Good morning exercises? And stiff legged dead lifts?
Just a few ideas...

Now for the shoulder stuff:

If anything listed below hurts you, stop, try lowering your weight. IF it still hurts, then or after, ice it for 20 minutes, and write me back. These are small muscle, with very specific actions. Be precise with your form. Form is everything here, weight is nothing.

Here are the exercises I would recommend:

1. Supraspinatus/Empty can:
Weight: 3-8 lb. dumbbell. Don?t push this- it?s a tiny muscle
Reps: 2 sets of 12
Form: Stand with a dumbbell in each hand. Do one arm at a time. Raise your stiff arm in front, up away from your body to shoulder height, no further.. Rotate the hand inward until you are in a thumb down position. In that thumb down position, lower the weight until your thumb hits your thigh. Raise it, never above the shoulder level. Move slowly. Do 12 reps. Do the other arm, and repeat both.

2. Subscapularis:
Weight: 10-30 lbs. Form is important here, so try it light first. I do 20 lbs. with a ?healthy? shoulder.
Reps: 2 sets of 12
Machine: Set a cable pulley machine so the handle is at shoulder level. Use a D ring handle.
Form: Your back is to the machine. Grab the handle with a stiff arm. Raise the stiff arm out in front of you. The cable should run under your arm pit. The arm should be in the up position of the previous exercise, only palm down. Elbow locked, hand out at shoulder level. Hold your body and trunk stiff. Now translate ONLY your shoulder forward. Of course the arm and hand will move to, but it?s just a shift forward, leaving the rest of your body still. Your scapula will track along your ribcage, and your humeral head will push forward.You should feel this only lightly in under your armpit, actually in the front (anterior surface) of your scapula (shoulder blade).

3. External rotators: teres minor and infraspinatus:
Note: This is described for the right shoulder. You should do all of these on both shoulders anyway. But, this is only going to be described this way. You can then do the same thing on the other shoulder.
Weight: 10-20 lbs. I use 15 when my shoulder feels good, less when it doesn?t.
Reps: 2 sets of 12. Do Right arm, then left, and repeat.
Machine: Set cable pulley machine so the pulley and handle is at elbow height. Set your weight. This exercise can irritate, so better to err on the light side then the heavy. D ring handle.
Form: Stand with your left shoulder to the machine, your right shoulder away. Hold the handle in your right hand with palm facing the machine, elbow bent to 90*. Glue your elbow to your ribcage. Keep your shoulder down and away from your ear. The inside of your forearm should be on your belly to start with. Move away from the machine until the slack is taken out. Now externally rotate your right upper arm, lifting the weight until your knuckles point straight ahead, now go a little further. Don?t force it into external rotation, it will hurt you. Lower the weight. Do 12 and go do the other arm, and repeat both.

4. Internal Rotators: pec. minor and subscapularis:
Note: This too is described for the right shoulder. You should do all of these on both shoulders also. But, this is only going to be described this way. You can then do the same thing on the other shoulder.
Reps: 2 sets of 12
Weight: internal rotators are stronger and less vulnerable than externals, so I go a little heavier? 20-30 lbs. for a guy? I use 20 when I feel good, and less when I don?t. Know yourself.
Machine: Leave machine in the same position as last exercise. Turn around so your right shoulder is to the machine. Glue your elbow to your ribcage. Keep your shoulder down away from your ear. Bend your elbow to 90*, knuckles pointing forward, and palm facing away from the machine. Step away from the machine to take the slack out of the cable. Rotate upper arm in to lift weight until the inside of the forearm is on your belly. Return the weight to almost touching the stack. Again, do not allow external rotation to the point of discomfort. Repeat 12 times. Do the other arm. Do both again.

There, I am out of breath. Read this again, sitting in front of the computer, do the exercises in the air. Do it a couple of times. Then when you go to the gym, you should be able to duplicate them.
Does this make sense? I hope it helps.

Oh, by the way, anyone else to reads this: this is a great warm up before any upper body workout. It takes only 3-5 minutes once you get the hang of it, and it can save you problems later. IF, however, you already have a problem, try to get help from a good Physical therapist or ortho and an okay before you go at this. You could even go as far as to print this out for them and ask if it's okay for you...

Dr. Jen Milus, DC
This message was edited by DrJen on 4-9-06 @ 5:39 PM

Hey Dr. Jen, just wanted to say I've been doing those exercises for a few weeks now and they work very well. Thanks.

You are more than welcome. Don't stop. It will serve you later!!!
Dr. Jen Milus, DC