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Hanging - January 19, 2005 9:59:00 PM   
Jon Newman

 

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What are people's opinion about hanging from a bar or door (ala brachiation) for general shoulder health?

Could this help in non-specific shoulder pain (impingement syndrome, etc)?

jon

And just for fun. If you stand in anatomic position (forearm supination), and fully abduct, then bring your arms back down to your sides staying in the sagittal plane (ie shoulder extension), note that your forearms are now pronated. When does that happen?

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Re: Hanging - January 19, 2005 10:26:00 PM   
FLOrthoPT

 

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when i had a small labra tear and impingement I felt as if someone could just pull my arm longitudinally some it would feel ,uch better. I am not so sure about hanging my whole body weight. I often use this distraction technique for acute conditions in the LE and the shoulder. in fact I was attempting to design a pulley and adjustable tripod system you could use to hook someone up to this old fashioned traction like device in a supine posiiton, but then i got busy and never did much with it. anyway, yes, I think it feels good, must be due to either joint positioning, neural stretch through plexus, or something else i am too tired to think of. I think in ortho 101 we talked about that phenomenom of the arm changing positions and i think it had to do with osteokinematics...i am too tired to type, good night

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Re: Hanging - January 20, 2005 7:39:00 AM   
Shill

 

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Well,
I have never seen a monkey with a shoulder problem, so it must be OK. No orangutans are complaining about impingement, so maybe there is some preventative good.
However, in the presence of a shoulder problem, this is typically quite painful, and whether it is good or bad pain is not known. I would GUESS that in the case of limited motion, the pain would feel bad, but as with anything, if overall there is improvement from day to day, then this could fall into the category of good, helpful in the long run pain.
As an aside, watch a child swing from the monkey bars. They hoist their bodyweight around with great ease. Other than gymnasts and folks who do pull ups regularly, most adults would injure themselves trying this. Why? Im going with lack of practice, lack of strength, and too many Big Macs. It is likely a very good way to place a high stabilizing demand on the GH supporters, RC, etc, but, it it safe? I dont know.
In regards to the automatic pronation back to neutral with the abduction to flexion maneuver, this is actually easy to explain. Its magic.

Im off to swing from trees and eat bananas.

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Steve Hill PT

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Re: Hanging - January 20, 2005 11:27:00 AM   
PTupdate.com


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Yes, I do it all the time with patients. I have seen many athletes and weight lifters that look as though they have 180 degrees of flexion, but when you lock their scapula, the pop up to 160. Stretching this manually and using the chin up bar has done wonders in those stubborn impingement cases.

John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]

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www.PTupdate.com

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Re: Hanging - January 20, 2005 11:38:00 AM   
Diane

 

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Has anyone considered that the axillary nerve and artery wind around the head of the humerus, and that traction on the arm or hanging will mobilize said structures and decrease biochemical irritation they might be reporting? I traction arms for "shoulder pain" too, but to oxygenate these physiologic structures, not to do anything even remotely "orthopaedic." Takes surprisingly small amounts of traction to do the job, patient supine, usually through the third (axis) finger, with a towel roll or something up under the axilla to hold the head of humerus anterior in the socket.

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Re: Hanging - January 20, 2005 1:10:00 PM   
chiroortho

 

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Whoa, just a minute here. This is completely counterintuitive to me, but I'm eager to learn. The first thing I do when I see a patient with impingement is advise them to avoid working with the involved arm above horizontal, with the intention being to avoid compression of the RC by the underside of the acromion. As you know, there is an area of relative hypovascularity just proximal to the insertion of the supraspinatus tendon onto the humerus. It seems to me that hanging from the arms would exacerbate the impingement.

I am very interested in your comments and perspective on this.

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Re: Hanging - January 20, 2005 3:27:00 PM   
nari

 

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Like Diane, I do not think orthopaedically when doing traction etc to a shoulder, but just physiologically, and particularly from a neural point of view. The Oz Hills hoist (clothes line) is very handy for this procedure, or a safe pergola beam.
Another trick for painful+ shoulder which seems to work well: figure of eight bandage as for #clavicle, and then elevation as tolerated, in tandem with the other arm. Easy to do at home, the fig 8 strap comes on and off easily. (Also serves as a useful rest for an hour or so, if pain is really bugging the owner of the shoulder).

I have no suggestion for jon's conundrum - but a monkey would probably give us the answer!! :cool:


Nari

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Re: Hanging - January 20, 2005 6:50:00 PM   
Jon Newman

 

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Hi Greg,

You've been quiet.

If I'm not mistaken, that zone of hypovascularity is said to be most compromised when the arm is hanging by one's side causing a "wringing out" of the tissue as it is stretched across the humeral head. Thus passive abduction would decrease this stretched over the humeral head situation allowing for full perfusion of the tissue.

I would think that for sure there is a difference between overhead work (lifting weight or at least the weight of one's arm) and passive hanging. What that difference is and whether it is advantageous or not is speculative.

jon

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Re: Hanging - January 20, 2005 7:27:00 PM   
Jon Newman

 

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Shill,

I think your question about saftey is well founded. I have many reasons I'm asking this question but mostly because my clinical experience has led me to ask this. It would be nice if there was something in the literature about this but there is not because I've checked. Thus, I thought I'd pick the brains of others regarding their experiences. Call me nuts.

My experience is this. I often have my patients use our "lat pull-down" bar in our gym. I use about 50 #'s for most folks. The 50# is quite easy for the patient to control (I hang on the bar also for the first sessions) and allows the patient an active assisted lift into humeral elevation. They only elevate as much as they feel they want to. It teaches them quickly that the only thing keeping them from going up any further is themselves (assuming there is no anatomic limitation). I make the exercise more difficult by decreasing the weight. Thus the patient has to use more and more of their own power to elevate their arms. I have had better success with this than pulleys. Some of my patients who really found it useful make a gizmo like this at home by buying a pulley and hanging something on one end of the rope.

jon

Here's a link describing my shoulder conundrum as Nari calls it. Scroll half way down the page to read "Codman's paradox".

http://www.orthop.washington.edu/shoulder_elbow/stiffness/mechanics/humerothoracic/02

jon

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Re: Hanging - January 20, 2005 8:36:00 PM   
FLOrthoPT

 

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I still think body weight will be overdoing it ala hanging, but something like the lat bar pulling up with force or supine manually pulling with some force and not specific to a joint mob, just a whole arm distract seems to work better.. or maybe I am just too heavy to be hanging?? And why can kids do pullups easier? Kid's center of gravity is very different than us adults, therefore our center of gravity tends to be lower and therefore the force multiplied by distance is greater on both ends, therefore much more relative force is required by our lats and biceps to pull up...e.g. 50 pound kid with 1 foot arms and 5 inches to center of gravity (disproportinally big head equals higher center of gravity)equals 17 inches X 50 pounds...no need to convert here to proper units...well compare that to 170 pounds 2 1/2 foot arms 17 inches to center of gravity...so 47 inches X 170 pounds...so disproportionally more effort for the muscles even takeing into account relativity of body size...

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Re: Hanging - January 21, 2005 7:38:00 AM   
Shill

 

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Jon,
Great idea with the gradual weight regression. Thanks for the info. These little suggestions are rather helpful, as there is so much we DONT know.
FlaORtho, I realize the physics behind the ease with which children whip themselves around. Nevertheless, the out of practice still theory still holds water with adults. We need to put jungle gyms in our living rooms,instad of couches, so we can hang around while watching TV.

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Re: Hanging - January 21, 2005 8:09:00 AM   
FLOrthoPT

 

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at the least it'll be more fun! until someone loses an eye

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The Importance of Hanging from an Overhead Support - May 14, 2010 2:57:15 PM   
Strider

 

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I believe I have solved your questions regarding the merits of hanging from an overhead support.

I have written a book titled: "Shoulder Pain? The Solution and Prevention"

This book is based on 25 yrs clinical research on healing and preventing the subacromial impingement syndrome and adhesive capsulitis (frozen shoulder) as well as decreasing the importance of small rotator cuff tears.

Included in the book are a variety of patients and their testimonials, Volume CT scans performed on subjects in the simulated hanging position (using traction weights to reproduce the hanging force in the horizontal position) to disclose the anatomy in this position and other types of arm elevation, and instructions for the hanging and accompanying weight lifting exercises. The exercises in the book are particularly helpful for athletes with overhead arm acitivity such all throwing, lap swimming, etc.

The book is being marketed by The Kirsch Institute for Shoulder Research LLC.

It is written for the common person, the difficult terminology of medicine simplified. It is available at Amazon.com, Barnes and Noble or the Kirsch Institute @ www.kirschshoulder.com

(in reply to FLOrthoPT)
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RE: The Importance of Hanging from an Overhead Support - May 14, 2010 6:55:42 PM   
Jon Newman

 

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Hello Dr. Kirsch,

This is quite a surprise. I believe I've heard and seen some of your preliminary work from a mutual friend but it's been a while and the details are sketchy. While mostly interesting as a side topic, the term brachiation (<--click for more info) is something I learned from a book titled The Hand (<--click for more info) by Frank Wilson.

From Wilson's book:

quote:

Brachiation itself may have begun simply as a biomechanical accommodation to increasing size and weight or to the advantages of suspended feeding (being able to reach for a meal not just from a sitting position but while hanging from a branch as well), or to both, as Napier proposed...The brain must have responded to this purely biomechanical change by increasing the complexity of its representation of the arm and hand in space, and there is no question that we have benefited from the overall change in very specific ways....In sum, we must infer that brachiation placed an enormous burden on the brain's kinesthetic monitoring and spatial computing power, since there were so many new places the hand could actually be while they were doing their job.


Anyway, I don't currently see this patient population but your book sounds informative. Over at SomaSimple.com, we often have book discussions and are always glad to have the author participate. Perhaps people here would be interested in the same. If not, I could see if there is any interest at SS.

Thanks for reviving an old thread I'd long forgotten about.

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RE: The Importance of Hanging from an Overhead Support - May 15, 2010 8:01:02 PM   
ginger

 

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I smell a "rat", or at least an interesting enough relationship between Jon's thread ( here and not SS ) and the "surprising" surfacing of the presumed "Dr. Kirsch", with three posts to his credit. A clever way to get around the usual bollicking an author would normaly get from shameless self promotion. (We let Duffy get away with this because he is , well, Duffy). Would like to hear more from Strider on the nature of his experiences with shoulders just the same.

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RE: The Importance of Hanging from an Overhead Support - May 15, 2010 8:06:52 PM   
TexasOrtho


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Duffy's also got a bit of credibility at the bar (RE is the "Cheers" of rehab internet forums after all). Mike Reinold as well. Where have those two been BTW? Strider, hang around a while and estblish some street cred and we'll probably take your pimping a little more seriously.

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RE: The Importance of Hanging from an Overhead Support - May 15, 2010 9:53:06 PM   
Jon Newman

 

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Hi Ginger,

I can understand why you think what you think but I was truly surprised. Dr. Kirsch had left a message at my home just recently requesting that I call him and I did. I was wondering "Well it's a local number but who is John Kirsch and why is he calling me?" I delayed a day because I don't even like talking to people I know on the phone. When I called he said he discovered this thread at RE when surfing around looking for info. about the topic and wanted me to know he had posted here.

I don't think I've ever met Dr. Kirsch but I may have had one of those quick introductions out on a ski trail one year. Regardless, a friend of mine and I used to train together quite a bit and conversations often centered on pain related issues, etc. and she mentioned this physician that thought hanging was a good idea for folks with shoulder pain. I'm not sure how those two know each other. Anyway, this all took place probably about the same time I had started this thread and likely served as my inspiration for starting the thread in the first place. When I hear people talk about something relatively unique related to therapy, I tend to post about it to see what others think.

Now five years later, he published a book about it and this, according to Dr. Kirsch, is the only place he found any discussion of people using some form of hanging for patients with shoulder problems. So he signed up and is here to tell you about it. You can choose to discuss things with him or not. It's his work and I get no credit and have nothing to gain from it. I already cautioned him that testimonials aren't likely to get him very far. Bollick away.

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RE: The Importance of Hanging from an Overhead Support - May 16, 2010 4:20:28 AM   
ginger

 

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Jon, as Rod has already posted , there are few places more welcoming of new faces than RE. Those that speak our language of science, discovery, method and comment are always welcome. I hope the good Doctor Kirsch has docked with a view to share.
I did parenthesise rat when alluding to the seeming too good to be true relationship between yourself and the promotional post by Strider. I would not like you to think I was levelling anything other than fair comment.
Strider, hoping you are willing to post further details of your shoulder problem solving. Always a treat to get fresh perspective , even if ultimately it is torn to tiny little bits and bleached, boiled and hung out to dry. ( just joshing)

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RE: The Importance of Hanging from an Overhead Support - May 16, 2010 9:21:55 AM   
Strider

 

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First of all, thanks to all of you for taking an interest in this idea concerning hanging from an overhead bar. As Jon has outlined, I spent months and years looking under every rock to find some mention of the idea. The only references that I could find that discuss what happens when the arm is raised are negative and most of these are recorded in two
heavy volumes of RockWood's book, "Shoulder Surgery." Previous experts in the field have stated that arm elevation is a problem in that the greater tuberosity of the humerus, when it contacts the acromion causes subacromial impingement. It seems that the acromion has been "demonized." Thus, parts of it need to be removed to stop the impingement process. Of course, the process that leads to this is "contracture of the CA arch." Various authors refer to the CA arch as "unyielding," (Neer) Hawkins, etc.

As for the causes of this contracture of the CA arch is a conspicuous absence of "disuse."





In Rockwood's book arm elevation receives quite a bit of discussion. Proper arm elevation is to be performed with the humerus in external rotation. The idea seems to have come from Saha who wrote a seminal paper published in Clinical Orthopedics a while ago. I have all the important references and will post them here when I wake up (lI'm on only the first of my three cups for today). So from that idea came this concept of "clearing the tuberosity." If you can look this up in Rockwood, you will find this nearly unintelligible drawing the is meant to depict this.

To shorten this post a bit, here is my story in a nutshell:
in1983 I cured my bilateral severe impingement and what I was sure was
small rotator cuff tear in one shoulder, the left. I wanted to avoid surgery.
It's a while back, so my recollection of my theory is a little unclear, but
I am pretty sure that my idea was that hanging from a bar would compress
the soft tissues in the SA space making more room for the rotator cuff. Now
I realized that that thinking was wrong. When one hangs, there is no "subacrom-
ial space" in the usual sense. When you hang fully, it is the antero-lateral hard
humeral cortex that contacts and presses on the acromion. The soft tissues be-
ween the two consist of the humeral periosteum, the bursa, and the CAL that
inserts on a broad area of the underside of the acromion and it is this ligament
that may serve as a sort of resilient cushion (replacing cartilage that is in most
joints). So there you have it: a part-time joint, the "acromiohumeral joint"
the other joint in the two part shoulder joint. Remember, this is just my theory
to try to expalin why nearly all who have used this exercise have either improved
or been completely cured with a few days or weeks.

I strongly urge all of you to check out what I have posted at the website

www.kirschshoulder.com

devoted to the teaching of this idea. Take a good look at the videos and
still images. The postings will be ongoing. Do feel free to write a blog at the
site, but to be fair, please read the book before posting.
Jon has prepared me that you will all discount testimonials, so I won't point
you to them only to mention that the response of those the who have used
the technique has been almost 100% for those with impingement, adhesive
capsulitis, or signs of small rotator cuff tears (some documented with
mri's).


There is much more to say about this idea, so we will continue.....
again, thanks for the interest. -JMK

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RE: The Importance of Hanging from an Overhead Support - May 16, 2010 9:51:50 AM   
Strider

 

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I forgot to mention a very important resource. E.A. Codman MD wrote a book titled
"The Shoulder" in 1934. (Codman EA. The Shoulder Boston: Thomas Dodd; 1934)
He, as Rockwood, discusses arm elevation and the confusion that
existed on the subject. He points out some of the confusion and is responsible for "Codman's Paradox." In the end, he says this: "Elevation is a good term for our special needs. When we raise an arm to point directly at the sky we certainly elevate it, whether we lift it in the coronal plane in abduction and external rotation or extend it according to the comparative anatomist, or flex it in the sagittal plane to please the anatomist,.....or....elevative as we may...."

Here is another quote taken directly from Rockwood's "The Shoulder" (Rockwood CA Jr, Matsen FA III, Wirth MA, Lippett SB. The Shoulder, 3rd edition Philadelphia: WB Saunders: 2004: pp 234-235
See if you can understand this (as I cannot); " Full arm elevation with maximal external rotation has also been shown to be a
position of greater stability of the shoulder than the elevated position."

(in reply to Strider)
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