This video details how Dr. Eron Horchik helped a patient, Matthew, overcome severe shoulder pain that 20 doctors and four physical therapists could not fix. Dr. Horchik explains his diagnostic process, identifies the root cause of Matthew's pain as shoulder instability and a weak posterior rotator cuff, and then demonstrates the targeted exercises he prescribed. The video emphasizes how these specific exercises led to Matthew's full recovery and ability to press heavy weights pain-free.
Patient's Initial Condition #
- Matthew experienced extreme shoulder pain when pressing light weights overhead.
- His pain was unresolved despite consultations with 20 doctors and four physical therapists.
Diagnostic Evaluation #
- Scapular Observation:
- Matthew's left (painful) shoulder blade rotated upwards much faster than his non-painful side during overhead movement.
- This indicates instability; the scapula moves faster to keep the shoulder blade under the humerus bone.
- Shoulder Mechanics Explanation:
- The shoulder complex operates with "force couples" where opposing muscles stabilize the joint and create movement.
- The deltoid generates an upward and outward force on the humerus.
- The rotator cuff muscles counter this with a downward and inward force, keeping the joint secure.
- Impaired rotator cuff function can lead to excessive upward humeral motion and increased injury risk.
- External Rotation Stability Test:
- Tested with arms out to the side at 90 degrees (similar to his pain-inducing pressing position).
- His right side was strong.
- His left arm dropped instantly due to pain when pressure was applied.
- This indicated his posterior rotator cuff was not working in balance, causing excessive joint movement and pain.
Initial Exercise Attempt and Adjustment #
- Banded 90-degree External Rotation Drill:
- Described as an excellent drill for building stability for overhead pressing issues.
- Cues: Pull elbow back to 80 degrees of retraction, keep elbow from dropping, rotate shoulder into external rotation, hold for a few seconds.
- Matthew experienced discomfort with this exercise, indicating it was not yet suitable for him.
- The concept: Every exercise is also a test; exercises need to be progressed or regressed to find the right stimulus.
Effective Exercises Prescribed #
- Prone External Rotation (Gravity Resistance):
- Patient lay flat on stomach with arms at 90 degrees.
- Lifted hands (moving shoulders into external rotation) against gravity.
- Held for 3-5 seconds, performed 10 reps.
- This exercise was pain-free and effectively engaged the back of his shoulder.
- Upside-Down Kettlebell Front Rack to Side Movement:
- Patient held a light kettlebell upside down in a front rack position.
- Moved arm out to the side into his position of instability.
- Held for a few seconds, then returned to the front, repeating several times.
- Benefit: The instability of the upside-down kettlebell enhances demand on shoulder stability, making rotator cuff muscles work harder.
- Superior to a dumbbell due to increased instability.
Immediate and Long-Term Results #
- Immediate Improvement:
- After performing the two new exercises, Matthew was able to press 95 lbs (the initial painful weight) 100% pain-free later that day.
- This indicated the exercises provided the necessary stimulus for adaptation and stability.
- Progression for Home Exercises:
- Prone External Rotation: Gradually increase weight.
- Banded External Rotation: Eventually return to this drill.
- Upside-Down Kettlebell: Progress to heavier weights, and eventually add a press movement while maintaining stability.
- Long-Term Success:
- Two months later, Matthew was pressing 190 lbs (a new personal record) 100% pain-free.
Additional Information #
- Dr. Horchik's book, "Rebuilding Milo," is recommended for further injury-fixing tips.
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