TweetUse of Active Release Technique to Treat Shoulder Pain
By Dr. Keith Bartley


[This is an article by Glenn Buechlein’s doctor. The patient in question is Glenn (no surprise there). This will give you an idea as to how a doctor diagnoses and treats a patient. My thanks go to Dr. Bartley for taking the time to write this article. —Jim Wendler]

History and presenting symptoms

The patient is a 39-year-old male who teaches at Vincennes Lincoln High School. He is a powerlifter, specializing in bench pressing, and has several national and international bench press records. He experienced a severe incident in July of 2005 when he “exploded his right shoulder” during a lifting competition. His past history also includes low back surgery for an L5 ruptured disc in 1989. The patient has experienced bilateral shoulder pain off and on for years. His pain occurs on a daily basis and occasionally at night, and he has taken NSAIDS, Celebrix, and Lodine. His pain is reoccurring and has slowed his ability to workout.

Exam findings

This very active man is in excellent physical condition, weighs 235 lbs, and is 70 ½” tall. He denies smoking and rarely consumes alcohol. His family history is unremarkable.

Chiropractic evaluation of posture and gait

A standing postural evaluation finds generally good alignment with intact spinal curves and no lateral listing of his pelvis or spine. He demonstrates excessive bilateral shoulder protraction, causing a mild increase in his thoracic kyphosis. He has excessive muscular hypertrophy throughout his bicep, tricep, deltoid, and upper trap region. A lateral view reveals mild forward head posture. His gait pattern reveals no obvious abnormalities. He also has excessive muscular hypertrophy in his quadriceps, hamstring, and lower leg region.

A shoulder exam reveals limited motion in all planes, with a forward elevation to 120 degrees, bilateral, and an external rotation to 0 degrees, bilateral. He has internal rotation to L2 and abduction to 120 bilateral. He exhibits no weakness to internal rotation or abduction. The patient noted mild tenderness around the AC joint, R > L, and he is tender over the posterior joint line and posterior glenohumeral capsule. A mild glenohumeral crepitus is noted bilateral as well. His rotator cuff strength is intact, and his neurovascular exam is intact.

Imaging

The patient’s x-rays reveal moderately severe, advanced degenerative changes of the glenohumeral joints bilaterally. A mild spurring is noted, and lateral tilting of the distal acromion and hypertrophic changes are noted at the AC joint.

An MRI of the right shoulder with arthrogram revealed a small focal defect seen in the cartilage of the mid glenoid area.
There was fluid evident within the biceps tendon sheath.
There were marked edematous changes seen in the region of the supraspinatus muscle and adjacent fascial planes, raising concern for intramuscular tear/strain.
Degenerative spurring was seen inferiorly at the AC joint facing the underlying supraspinatus muscle/tendon.
Multiple degenerative cystic changes were seen in the humeral head.
Clinical impression
The patient has a right shoulder, intramuscular tear/strain associated with defects in the glenoid cartilage as well as moderate degenerative spurring in and around the AC joint. Also, there is impingement of the supraspinatus tendon in the subacromial space.

Treatment plan
A conservative approach was taken, which included the use of joint manipulation, soft tissue management, active release technique (ART), and supraspinatus rehab exercises as well as the avoidance of provocative lifting procedures and proprioceptive neuromuscular facilitation (PNF) of the shoulder rotator cuff musculature.
The patient was treated 1–2 times a week for 4–6 weeks.
Ice was recommended for 25 minutes, three times daily, and initially the patient was to avoid abduction past 90 degrees with progress to full ROM exercises and specific rotator cuff strengthening exercises.
The patient was advised on taking glucosamine and chondroiten sulfate and MSN as well as omega-3 fatty acid, which he was already taking.
Response to care
The patient’s response was excellent to manipulation, soft tissue management, and rehabilitation exercises. Following six weeks of therapy, the patient had build back up to almost 100 percent of his pre-injury workout weight. He will continue to have limitations in abduction and external rotation due to the degenerative changes and hypertrophy of his musculature.

Discussion
Rotator cuff tears or strains are very common in powerlifters, especially those who specialize in the bench press. It has been my experience that heavy bench pressing does lead to premature degenerative changes in most shoulders, and this is a perfect example of that category. Conservative care can be used to manage these types of injuries if one can coordinate with a qualified practitioner.

Active release technique (ART) is a patented, state-of-the-art soft tissue system/movement based on a massage technique that treats problems with muscles, tendons, ligaments, fascia, and nerves. These conditions all have one important thing in common—they are a result of overused muscles. This can lead to acute conditions such as a supraspinatus strain or the accumulation of small tears due to repetitive microtrauma. This in turn will cause the tissue to undergo hypoxia, which means that the tissue is not getting enough oxygen. These factors can cause the body to produce tough, dense, scar tissue in the effected area. This is very common in weight lifters. This scar tissue binds up and ties down tissues that need to move freely. As this scar tissue builds up, muscles become shorter and weaker, tension on tendons can cause tendonitis, and nerves can become trapped. This can cause reduced ROM, loss of strength, and pain. If a nerve is trapped, the patient may also feel tingling, numbness, and weakness.

The ART provider uses his or her hands to evaluate the texture, tightness, and movement of the muscles, fascia, tendons, ligaments, and nerves. Abnormal tissues are treated by combining precisely directed tension with very specific patient movements. The practitioner uses over 500 specific protocols that are unique to ART, which allows them to identify and correct the specific problems affecting each individual patient.

ART has been developed, refined, and patented by P. Michael Leahy, DC, CCSP. Dr. Leahy now teaches and certifies healthcare providers all over the world to use ART. For more information, visit the ART web sight at www.activerelease.com.

TweetART is the shit! If you haven't tried it yet, go get it done. It's pretty intese, kinda like deep tissue massage but works wonders!