T Nation

ART and PTs

Hi I’ve been having some shoulder problems on my left that keeps me from lifting heavy (more than 5 pounds)overhead or benching. I’ve seen 2 PTs and also been through 5 sessions of ART yet problem still persists. This might sound stupid but would it be worth a try to do ART and see a PT at the same time (ultrasound…etc) or would that obviously work against each other?

[quote]notafob wrote:
Hi I’ve been having some shoulder problems on my left that keeps me from lifting heavy (more than 5 pounds)overhead or benching. I’ve seen 2 PTs and also been through 5 sessions of ART yet problem still persists. This might sound stupid but would it be worth a try to do ART and see a PT at the same time (ultrasound…etc) or would that obviously work against each other?[/quote]

The first thing that I do whenever I get an injury is use ciopous amounts of ice!

Once the swelling is down I then go to my massage therapist who can usually determine the extent of the injury. I have also used Ultrasound at the same time. I think using both ART and PT at the same time can only help.

yah a bit passed the icing stage as its been over 3 months now…for those that have had success with ART, how many treatments did it take?? Right now after each treatment I can’t tell its improving, not sure if it means its not working or it should suddenly “work” after a few more treatments.

[quote]notafob wrote:
Hi I’ve been having some shoulder problems on my left that keeps me from lifting heavy (more than 5 pounds)overhead or benching. I’ve seen 2 PTs and also been through 5 sessions of ART yet problem still persists. This might sound stupid but would it be worth a try to do ART and see a PT at the same time (ultrasound…etc) or would that obviously work against each other?[/quote]

You might try an ATC.

PT/ATC = broad scope of training. ART is just a tool in the toolbox, same as ultrasound. ART is a continuing education program that ATs, PTs, Chiros, RMTS, etc can take. The don’t contraindicate each other’s use implicitly, but the goals of each are patient specific.

I you should have noticed improvement after 5 good sessions of ART.

AT would be a good option if your 2 PTs haven’t helped.

Are you right-handed or left? Do you use a computer mouse alot?

the injury is on the left shoulder but i’m right handed…

I’m having trouble finding what ATs are???

so based on you guys’ reply, both treatments simultaneously should by no means work against each other but will most likely help even more?

All ART is is a well used technique that involves trigger points and muscular movements that allow myofacial release. this has beed successfuly marketed as a brand, but is not a cure all.

As always, see a well skilled sports physio who works with trainers/athletes. he/she may have the skills that will help you, and save going to an ART practitioner, as they will more often than not do the same thing, but as Dr Ryan has said in the past i believe,…“may not be called that”.

I would just keep rehabing it, I have been dealing with my shoulder problem over a year and half now its much better than it was, I went through as many sessions of ART as well, i still deal with mine is posterior delt, on the back of the shoulder, using some of the rehab. exercises have helped me recover, I did have to go back for a few more sessions recently, but because I pushed mine a little too hard, so had to back for that.

[quote]miniross wrote:
All ART is is a well used technique that involves trigger points and muscular movements that allow myofacial release. this has beed successfuly marketed as a brand, but is not a cure all.

As always, see a well skilled sports physio who works with trainers/athletes. he/she may have the skills that will help you, and save going to an ART practitioner, as they will more often than not do the same thing, but as Dr Ryan has said in the past i believe,…“may not be called that”.[/quote]

Ross:

  1. for the love of god it’s not trigger points.
    We have this discussion with you every time it comes up.
    Trigger points are their own little therapy.

  2. It comes as close to being a cure-all as almost anything.
    I see a guy who does his own researched version of NMT and a chiroquackter who does ART, and between the two of them I’ve had improvements in things regl’ar doc/PT’s told me I’d just have to live with.

You need to have an MRI done so that they can see in there and see exactly what is going on in the shoulder joint. You could very well have a rotator cuff tear of some sort or a bone spur, or there might not be any real injury to the soft tissue, but the only way that can be determined for sure, especically since other avenues aren’t working, is to have an MRI done.

[quote]Damici wrote:
You need to have an MRI done so that they can see in there and see exactly what is going on in the shoulder joint. You could very well have a rotator cuff tear of some sort or a bone spur, or there might not be any real injury to the soft tissue, but the only way that can be determined for sure, especically since other avenues aren’t working, is to have an MRI done.[/quote]

good call. May very well be time to find a good orthopod.

Could also be some type of outlet syndrome

Check out Muscleactivation.com
These therapists really know their stuff.Hopefully there is one in your area.

Notafob, this is a very obvious question which noboby has thought to ask, WHAT THE HELL IS YOUR DIAGONSIS?

“Shoulder problem” could mean anything, rotator cuff tear, biciptial tendonitis, SLAP tear, arthisis, etc. I am an ATC, but I would never treat somebody without knowing what the hell I’m treating.

Go back to step one and see an orthopedic surgeon first then consult a rehab specialist (PT, ATC, ART).

[quote]notafob wrote:
the injury is on the left shoulder but i’m right handed…

I’m having trouble finding what ATs are???

so based on you guys’ reply, both treatments simultaneously should by no means work against each other but will most likely help even more?[/quote]

So my suggestions won’t work.

I saw a PT today(again after 2 other ones) and the diag was along the lines of “Shoulder Rotator Cuff Impingement”, I think most likely gonna go along with the PT treatments and the ART chiro simultaneously…getting desperate here, also try to get an MRI too.

What do they think caused the impingement? Usually the impingement is caused secondary to trauma (rotator cuff strain/tear/tendonitits, bicipital tendonitis, etc.) or bony involvement (i.e. hooked acromion). The initial treatment should consist of anti-inflammatory modalities. Later correcting/strengthening the injury.

notafob,

Other than the #of ART treatments and the reference to PT, you don’t really give a good idea of what treatment has been done and over what period of time (other than that the problem has been there for 3 months).

First of all, the ART/chiro should have done a complete neuro/ortho/musculoskeletal exam on you to come up with a working diagnosis prior to starting therapy.

In addition, they should have been able to do ultrasound in addition to the ART.

Also, you should have been given a home stretching and rotator cuff strengthening program. The scapulothoracic prime movers should have been addressed in this program as well.

A generally accepted treatment regimen would have been 3xwk for two weeks, followed by reassessment of your condition. If you made no improvement or got worse, then a shoulder MRI w/ contrast could have been ordered to assess the degree of injury present.

If you were making steady progress with the treatment, then the exercise could have been stepped up for two more weeks. At which time you again reassess. Typically if you still have significant symptoms at 4 wks then an MRI is warranted. Pending outcome, a referral to an orthopedist is necessary if any significant lesion is found. If no significant finding is present then a referral could be made for co-management or treatment continued based on doc/pt decision.

The chiro should be able to order an MRI, contrast is best for shoulders. They should also be able to refer you to an ortho as needed.

Obviously, if you continue to do the same activities that caused the problem initially, then progression with treatment will be slower.

If you have any questions, let me know.

Take care,

Ryan

Joe Weider wrote:


2. It comes as close to being a cure-all as almost anything.
I see a guy who does his own researched version of NMT and a chiroquackter who does ART, and between the two of them I’ve had improvements in things regl’ar doc/PT’s told me I’d just have to live with.

Nice chiro blast there JW, did you come up with that one all by yourself?

It’s funny how you say that he helped you and then you still feel it necessary to blast him. Now I obviously have no firsthand knowledge of this doc, maybe he deserves it. If not, how about a little respect. Maybe he should have just told you that it was something you would have to live with too. You know, kind of like your stupidity:)

Take care,

Ryan