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Walter & Group...
[GH] Our current topic of casting injuries blends into certain conditions which are either aggravated by problems caused by age, wear & tear, other sports, or work related injury. Most rotator cuff tears are the result of "all of the above" over the course of time even if the symptoms first appear during one particular effort .... such as fly casting.
As our discussions progress, you will hear from another subset of folks who are fly fishers and wish to continue their sport, but who have joint problems (including shoulders) which are badly damaged by osteoarthritis and other primary arthritic conditions. My experience as a lifetime fly fisher along with having performed over 5000 joint replacements over my many years as an orthopedic surgeon has taught me that these folks may best be handled with certain other precautions as they try to continue to fish and cast.
The best medical care includes a close working relationship between surgeon and rehabilitation experts. For best results, "It takes two to tango".
Master instructors will sooner or later run into these problems among their students. This is the reason Gary Eaton and I have spent so much time with these messages.
Gordy
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[GH] From Peter Morse (I changed the name of the fellow who wrote to him):
Gordy I received this inquiry from a guy, thought it might make an interesting topic of conversation.
"G'Day Peter, My name is John Doe, and as you have probably seen on
Forum both my shoulders are done now. I've not long had the left one done
and the Bicep had to be fixed up as well. Too much Butchering and
Landscaping the Surgeon said, Have you got any clues for me to be able to
get back into Casting a Fly?. I am so looking forward to getting back to
Flyfishing. I hope this email finds you fit and well.
Thanks Peter,
John "
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[GH] Peter,
By the term, "done" I'm sure he means that his shoulders have been operated upon. That doesn't tell us whether he had rotator cuff repairs, shoulder replacement, or other surgery. It can make a big difference.
The measures outlined by Gary Eaton, Peter Minnick and me are mainly for shoulders with rotator cuff problems and/or repairs. Protection and careful rehabilitation of the weakened and poor functioning muscles is most important.
After shoulder replacement surgery, one of the prime considerations is the avoidance of certain motions which might lead to dislocation or loosening of the prosthesis. SO... before you advise him, it would be well to ask him which condition he's experienced.
If he hasn't had shoulder replacements, then it's not a bad idea to help this chap by sending him some of the pertinent information we've received in our messages on shoulder problems during the past couple of days. Great if you could take the time to distill it down to plain and simple casting advice. MAKE CERTAIN HE CLEARS ALL THAT WITH HIS SURGEON AND REHAB. SPECIALISTS BEFORE GOING AHEAD .... Why? Because they are the experts who have been caring for him and best know the specifics of his current function and anatomy.
If you can help get him fly fishing again, I know he'll be forever grateful to you.
Perhaps some others in our Group who have had experiences getting back to fly fishing after having had serious shoulder problems can join Peter Minnick in sharing their stories.
Gordy
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[GH] From Gary Eaton. My brief comments and short answers in his text in red.
Gordy,
In conditioning for strength building, a caster should similarly limit resistance work where the elbow rises above the shoulder or goes behind the shoulder to avoid injury.
[GH] Agree !
I will rewrite a pre-habilitation exercise program for us next week that watches these issues as well as elbow, wrist and spine concerns. Here is some foundation material on exercise from my LOOP article (Winter 2010) -
"STRETCHING AFTER WARM-UP WITH FREQUENT BREAKS – The main purpose of proper stretching is injury prevention. Casting instructors are not to devise stretching regimens nor judge which direction or force of stretch appears optimal. Insist on health professional involvement to develop individualized exercise regimens. Generally, therapeutic stretching done after the connective tissues warm-up through low intensity use of the muscles provides more benefit than identical effort performed by ‘cold’ anatomic structures.
[GH] Yes ! Short answer: DON'T STRETCH COLD MUSCLES.
Warm weather, insulating clothing, and friction produced by rubbing or massage produce no effective metabolic warm-up to prepare for stretching or exertion. Longer duration of static stretch represents less hazard of injury than ‘bouncing’ stretches. No one but the affected individual should apply stretching forces. Stretches that place entire body weight through a non-weight bearing joint represent greater potential
for injurious overload.
[GH] Short answer: 1. Go slow with stretching. 2. Let the caster do it himself as directed.
Frequent rest periods allow tensed muscles to relax and restore energy nutrients through circulation. The more complete the physiologic rest, the greater benefit expected. Generally speaking, rest periods should be at least twice as long as activity periods that produced fatigue, burning, or discomfort. In no case should activity
resume while the affected area remains symptomatic."
[GH] Rest periods should be much longer than stretch and exercise intervals.
Peter Minnick's story is common to North America where baseball and all sort of throwing sports initiate youthful team competitions. Martial Arts, ice hockey, and others introduce us into similar biomechanics. His adaptations match my piece from The LOOP Summer 2010, excerpted below-
"LET THE ELBOW DESCEND
Avoiding high elbow, especially to the side, provides less biomechanical potential for shoulder pain from angling. Misguided casters may keep the elbow elevated attempting, incorrectly, to “stabilize” the elbow.
[GH] Agree.
SIDEARM DELIVERY - The sidearm cast carries less potential for injury if the elbow stays at or below shoulder height throughout the stroke. Sidearm casting plane utilizes more motion from the spine, hips and legs to generate the cast. Movement contribution from core body elements reduces the amount of isolated motion demanded solely of the shoulder. Low-elbow, sidearm plane might be inadvisable for those with spinal pain or leg problems.
Sidearm delivery often becomes a default adaptation for persons who suffered severe injury or did not fully rehabilitate after an episode of painful shoulder. Examples include tendon rupture, frozen shoulder, shoulder fracture or fusion, paralysis, polio, brachial plexus nerve damage, and failed rotator cuff surgery."
[GH] Yes. Body motion can substitute for some limb movement.
Gary Eaton
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