Sore point

The poor, overworked rotator cuff

After stretching and warm-up, Connor Gilmore throws progressively longer tosses to Robert Staten (left) and Kevin Sheredy at Lamar Porter Field in Little Rock. A graduate of Catholic High School, Gilmore will attend the University of Central Arkansas in Conway.
After stretching and warm-up, Connor Gilmore throws progressively longer tosses to Robert Staten (left) and Kevin Sheredy at Lamar Porter Field in Little Rock. A graduate of Catholic High School, Gilmore will attend the University of Central Arkansas in Conway.

— Ellis Martin of Little Rock was skiing in Colorado on the day he turned 40 when he collided with a snowboarder.

Happy birthday, right rotator cuff tear.

Three weeks later Martin had surgery. Exactly a year later came his second rotator cuff surgery, on his left shoulder. No snowboarder this time, and yet there were two tears in his left rotator cuff.

Martin, 46, is a hairdresser.

“It was,” he said, “25 years of repetitive motion.”

Kevin Sheredy is 37 years old and a mortgage banker. But in a previous life he was a pitcher in high school, college and professional baseball, spending seven of his nine pro years in the minor league system of the St. Louis Cardinals. Along the way he had three of his own rotator cuff surgeries on his right, pitching, shoulder.

Both men are members in good standing of a club of Americans with worn-out, painful or bum rotator cuffs. It’s a mighty big club.

The American Academy of Orthopaedic Surgeons reports that between 1998 and 2004, more than 5 million visits to doctors were attributed to rotator cuff problems. In a report titled “Optimizing the Management of Rotator Cuff Problems,” the academy said that studies in cadavers and patient populations found the prevalence of rotator cuff tears could exceed 50 percent in people older than 65.

Ouch.

“Each year,” the report said, “approximately 300,000 Americans require shoulder surgery related to repair of the rotator cuff. An additional 400,000 Americans have surgery for related rotator cuff tendinitis or for partial tears.”

Let’s see, the 2010 Census said 14.4 percent of Arkansans are older than 65. With a 2010 population of 2,915,918, that’s right at 420,000 over-65 rotator cuffs waiting to pop. Double that, given the allotted two shoulders per person.

Dr. Shahryar Ahmadi, an orthopedic surgeon on the faculty at the University of Arkansas for Medical Sciences, gets to operate on some of those torn rotator cuffs. How many?

“A few a week.”

Let’s see ... a few a week ... over the course of a year. That’s a lot of rotator cuff surgery, an imprecise mathematical observation that elicited a smile from the doctor.

“It’s a very common problem,” Ahmadi said.

WHAT GIVES?

The rotator cuff is a group of muscles and tendons that attach to the bones of the shoulder joint, allowing the shoulder to move and keep stable. The rotator cuff goes awry in two ways, says the National Institutes of Health.

First, tendinitis, or irritation of the tendons and inflammation of the bursa - a normally smooth layer - lining the tendons.

Second, a tear of one of the tendons from overuse or injury.

Tendinitis can develop from the most mundane things, but those things keep the arm in the same position for long periods of time. Think computer work. Think sleeping on the same arm each night. Think hair styling.

Pained rotator cuffs come from sports, too, especially those in which the arm moves over the head repeatedly. Think tennis. Think pitching a baseball. Think lifting too much weight too many times over your head, Mr. Arnold Wannabe.

Work is tough on rotator cuffs, especially for painters, carpenters or anyone who works with arms overhead. Throw in poor posture over many years and the usual fraying of tendons that occurs with age.

Exact numbers of sufferers aren’t available; the orthopedic academy’s estimates range from 13 percent of people age 50 to 59 to 51 percent of those older than 80. Part of the uncertainty is that many people don’t exhibit the symptoms, specifically the pain, Ahmadi said.

Older people in particular may have one shoulder that’s weaker than the other, he said, and attribute that to normal aging.

Older people tend to have a chronic condition, younger people the trauma of a tear, often from sports. Not that sports is the only way to blow out a rotator cuff muscle. It could happen in a fall, or a car wreck, Ahmadi said.

And not every lingering pain in the shoulder is a bum rotator cuff. “There are many sorts of pain around the shoulder, so it would be difficult to differentiate,” he said. And “it depends on your age. If you’re 30 with no recent trauma, it’s unlikely to be a rotator cuff.”

Got any advice for the uncounted multitudes with a rotator cuff problem?

Play a sport properly, Ahmadi said. If your job requires a repetitive motion, take breaks. Stretch those shoulders. “And be active and exercise for the rest of your life.”

RECREATIONAL WRECKAGE

Active is an adjective that fits Ellis Martin. He’s a competitive tennis player - he and his mixed-doubles partner, Aimee Stringer Berry, have won all three of their tournaments thus far this year. He’s a 6-foot-4-inch athlete who plays tennis five days a week and lifts weights three.

He has given up skiing. “I’m so afraid of falling, it’s not fun anymore.”

The Colorado collision left him with a separated shoulder and that torn rotator cuff. Three weeks later he had surgery in Little Rock. Five days later he was back at work.

The experience was not pleasant.

“When you have a torn rotator cuff the constant aching keeps you awake at night. I’d reach up to grab something and - ow! I had to use my left arm to lift the right.”

After the surgery, his therapy was his work, with its constant movement. Martin also used weights as light as half a pound to make “teeny-tiny”movements to strengthen the shoulder muscles.

Once the surgically repaired right shoulder got better, Martin realized how much the left shoulder hurt. An MRI revealed two tears.

He went back to his surgeon and friend, Scott Bowen. Martin said his recovery from the second surgery was faster than the first. He’s confident in the future of his rotator cuffs.

“It took 40 years to hurt them, and I have about 20 years left to work, so I should be good.”

WHERE IT HURTS

Michael Switlik is the head athletic trainer at the University of Arkansas at Little Rock, and has been for a decade. One of his duties is to teach a class in athletic risk management.

How does an athlete know when that rotator cuff is wounded?

With a big anatomy chart, Switlik shows a tear. Usually the pain is in the front, “but it can radiate down to your elbow.”

For anyone, athlete or not, a bad rotator cuff would affect what Switlik calls ADLs - activities of daily living. A hurting rotator cuff would impinge on “brushing your teeth, turning the key in a door, washing your hair.”

The weekend warrior or weightlifter should use some common sense, Switlik said.

“Watch out with anything overhead. Anything above this horizontal plane” - he lifted his arms parallel to the ground - “and you open yourself up to potential injury. That doesn’t mean you don’t do it, but there are certain cautions. Make sure your mechanics are good, that you’re not lifting too much weight.”

This isn’t rocket science, Switlik said. Be careful with volume. Don’t practice your serve obsessively, don’t throw pitches for hours. Have the right mechanics. Make sure the body is ready. And rest.

“Our success relies more on how we rest than on how hard we work out.”

STARTING YOUNG

Kevin Sheredy’s shoulder still hurts him some. That’s not so bad for mortgage bankers with an office in Sherwood, which he is, but a painful shoulder is really bad for pitchers, which he was.

A Michigan native, Sheredy pitched for the University of Arkansas before his minor league career. He had four shoulder surgeries, three of them to repair one rotator cuff. He now uses those experiences to teach young people how to pitch at Diamond Sports in Bryant.

“Inevitably you put yourself in danger of shoulder injury by throwing a baseball,” he said. “It’s a completely unnatural motion.”

That means kids have to be taught to throw properly, Sheredy said.

To illustrate the wrong way, he described a toddler with a toy mallet. The motion of hitting a toy with a mallet - palm facing inward - is the wrong way to move the arm with a baseball. The right way - he picked up a koozie and pretended it was a can - is to empty the can by turning the arm the other way.

“The fat part of the palm should turn toward your [outer] leg,” he said.

Try it this way. Throw a football. To get a good spiral, the right-handed thrower turns the arm and hand a bit in the counter-clockwise direction. In fact, Tom House, a pitching coach for the Texas Rangers, advocated throwing a football to develop the right technique and arm strength.

“Pronate the arm over,” Sheredy said. “It’s not like reaching out to shake someone’s hand.”

WHOLE BODY PROGRAM

Sheredy also advocates a long toss program, which he calls an organized way to play catch. In long tossing, players gradually move farther away as they play catch and arch the ball as they throw rather than trying to throw the ball on a line.

A good long toss session, he said, includes stretching, throwing and cooling down.He said that long tossing is a given in professional baseball, the most important training for a pitcher. But training should also include strengthening the lower body and the core, because successful pitchers use the whole body to generate the power to throw.

Coaches and managers are greatly concerned about pitch count. Check the box scores in this newspaper to see how many pitches each major leaguer throws per game. Conventional wisdom says 100.

Youngsters, Sheredy said, should stay away from breaking pitches like the curve ball. Instead they should throw a two-seam fastball, which breaks down, and a four-seam fastball, which moves straight. And a change - a pitch thrown with a fastball motion but with a grip that causes the ball to approach the plate more slowly, to throw off the hitter’s timing.

At 15 or so, he said, young pitchers may learn a slider or a curve, generally the latter.

Parents and coaches have to watch those young arms, Sheredy said.

“Keep them healthy. Play catch correctly, play the game correctly, and see where it leads.”

ActiveStyle, Pages 25 on 08/06/2012

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