Wednesday, September 12, 2012

Three patients comparing notes on ream and run recovery.

Dear Readers

Here’s an interesting exchange between three “ream and runners”, the first, “TF”, is a year out from his ream and run, has full motion, great looking x-rays (below) and minimal discomfort, but he desires even more. The second, “EK”, is over two years out and has achieved a very high level of function and the third "SC" who just had his second side done. I thought this was very interesting, especially in that it shows the dedication of these two individuals to full and unlimited shoulder function after the ream and run and their willingness to support one another.

Best wishes


Dear Dr Matsen,
Thank you for seeing me last week for my 1 year Ream and Run 'anniversary'. As always, it was nice to visit with both you. I appreciate your very kind words of encouragement.

The recovery is coming along fine, just very slowly. Since the visit last week, I've been careful to follow your advice of following an every other day routine of light throwing exercises. Patient compliance has not really been an issue. Since the surgery I have strived to be 100% compliant with complete devotion to a maximum recovery outcome. To help me for instance, the rope/pulley assembly is always centrally located, ready for multiple daily use. Then, next to my floor mat (for further stretching), I keep my Internet radio to listen to. I believe the time spent rehabilitating my shoulder is an invaluable investment toward future personal happiness. Motivation hasn't been an problem. Patience......that comes with time.

As I mentioned, even after 12 months my shoulder is still a bit of 'a work in progress'. That said, I am still able to do most things I wish, including gym activities, swimming, play basketball, tennis, jog, and occasionally work around the yard with a full wheelbarrow. Also as needed, I now am able to manage a loaded wheelchair up and down steps for my 95-year-old mother. As you are aware though, I have a rather lofty goal. Similar to fellow patient JR, I hope to someday resume playing competitive age-bracket handball. Perhaps, that may be raising the bar a bit but that's been my goal all along.

Importantly, I was blessed to work with a very competent and experienced physical therapist, well versed with shoulder replacement rehabilitation. For this purpose, I have a number of assorted weights and therapy bands at home. I visited the PT periodically all year to assess my progress and continually tailor my home routine. Sometimes, even I would suggest a new exercise or two to add to the program! It wasn't until a year post op that he was finally satisfied that I was flexible and strong enough not to return.

Currently, the determining factor for a good and strong throwing motion appears to be the glenoid. Osseous healing though, isn't exactly an overnight success. The motion itself whether overhand or sidearm thankfully, feels quite natural. The recovery is very gradual, little by little every week. The goal is to be able to strike a ball overhead, accurately, and pain free. I have to remind myself that I've come a long way but I'm still only 12 months out....and it's a 2+year recovery. There's still a lot of work to do but it's well worth the effort and wait. That's for sure.

As a result of my recent visit at UW , you helped remind me that I'm headed in the right direction. I can't thank you enough for the new shoulder as well as your continued invaluable support.

In appreciation,



Dear TF
I’m taking the liberty of sharing with you the most thoughtful response from EK to your one year report. You may have seen the post that he generously enabled me to share:
It is surely inspirational as are the stories of others. What is gratifying is the mutually supporting community developing around this procedure.

Rick Matsen
Dear Dr. Matsen,
I’ll be glad to give you my opinion. It seems TF is highly motivated, like the others I met through you. Thank you for that also.

Assuming TK has achieved good ROM and a stable shoulder, there are, in fact, a few suggestions I can provide.

(1) It may be that he is overtraining. The overtraining syndrome is a common occurrence with Olympic-level athletes, but could also be the case here. Physiological improvement in sports only occurs during the rest period following hard training. The goal in muscle training is to increase capillaries in the muscles, and increasing glycogen stores and mitochondrial enzyme systems within the muscle cells. During recovery periods these systems build to greater levels to compensate for the stress that was applied. The result is a higher level of performance. Of course, nutrition also plays into this. If sufficient rest is not included in a training program then regeneration cannot occur and performance plateaus. After the first eight months of rehab following ream and run, I went back to doing only stretching and passive range of motion exercises for three to four days every other week, to give the tissue a chance to recover. If overtraining is the cause, 3-5 days rest should do a lot good. Overtraining is a grave condition, that has to be recognized and treated. In most cases, athletes are unable to recognize the condition themselves.

(2) As a martial arts athlete I know of another phenomenon that I’ve seen working on a number of people, including myself. I will try to explain this one. If, for instance, my right elbow and wrist were sprained during a particular move, I would not necessarily take off and rest, but instead work the other side. So, we execute the move on the left, which may still affect the right side, but not as much and quite differently. There may still be some pain, but this helps the athlete to overcome the situation psychologically much better than a complete layoff. The different load does not keep the injury from healing. It is said to actually help the injury to heal faster. In the case at hand, the patient may benefit from working the other arm as if he was going to play like this in competition. Shifting the focus to the other arm may improve the condition of the recovering joint. Just as a preventative measure, I always do the rehab exercises on both arms anyway.

(3) It may also be beneficial to try a completely different approach. I can recommend kettlebell swings to strengthen the rotator cuff muscles and to improve other aspects of the joint. I would start with very light weight (maybe 3lbs) and start swinging the kettlebells using mostly momentum from the thighs and centrifugal force. 30 reps each arm every other day (not every day).

(4) In reference to the glenoid healing process, I must say that at 12 weeks post-op for me the pain was entirely gone. But, if Tom thinks that this area needs more attention, I would try isometric exercises in the position the pain occurs. Start with very light resistance, 5 seconds on, 5 seconds off, 10x. Use a pillow, bands or exercise ball.

(5) This may sound weird, but another exercise that helped me, was never designed as an exercise. You may remember that I ride horses and rope cattle. Swinging the rope and throwing it over a dummy steer is a great shoulder exercise. I do that once a week for about 30 minutes, to improve my roping skills, but my shoulder always feels even better afterwards. I asked a few older cowboys from out west, if throwing the rope caused them any shoulder problems. They said no, and confirmed that It helps them keep their arms limber.

That’s all that comes to mind. I wish TF good luck and I’ll be glad to talk with him, if you like.

Best regards,

Dear All
I had my first R&R December 1, 2010 on my dominant, left shoulder. My local orthopedic surgeon referred me to Dr. Matsen and after meeting with Alex and Dr. Matsen, I was confident they would return my shoulder to 100%. 

At the time, I was a very active 58 year old 'CrossFitter' ( <> ),a CrossFit kettlebell, gymnastics and olympic weightlifting coach and owner of a CrossFit gym.  ( <> ). I am also a USAW Sport Performance Coach, American Kettlebell Club Kettlebell Lifting Coach, World Kettlebell Club Master Trainer and Commando Krav Maga Instructor. 

Below is a link to a video from, I believe is the middle of August, 2011, about 8 1/s months following my R&R. I performed my 1st 'muscle-up' following surgery. A muscle-up is a gymnastics movement beginning with a pullup on the rings and continuing into a dip, extending the elbows to a static hold.

During my rehab I followed the instructions I received from Dr. Matsen's team. Later,  I added a few of my own creations.

Kettlebells and a piece of PVC were my primary rehab tools. Later today, with the help of my wife, I will video some of the exercises I used to help me achieve 100% recovery.  I will continue using these techniques on my right shoulder in a few months.  I am currently at week 3, following R&R surgery on the right side.

I am looking forward to the same results thanks to Dr. Matsen and his team.  I look forward to hearing your suggestions, also.

Thank you,

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