Located in Sterling, VA (703) 421-1200

"Shoulder Pain? The Solution and Prevention" - A Book Review

John M. Kirsch, M.D., has practiced medicine for over 40 years and is a board-certified orthopedic surgeon. He served as a flight surgeon in Vietnam, and also worked with the Louisville Hand Institute. After a few years of using conventional surgical and rehabilitative techniques to correct shoulder injuries, Dr. Kirsch (accidentally) found a very simple solution that helps restore joint function, reduces and often eliminates pain, and restores quality of life. He has used this technique for nearly 40 years on himself and his patients to often avoid the need for risky surgery. The third edition of this book was written by Dr. Kirsch in 2012; I believe it was updated in 2019, but this was the only copy of the book that I was able to locate. What you'll find is a book full of useful information that is easy to grasp, along with anatomical pictures and illustrations that help us to better understand a very complicated joint.

We learn that the shoulder joint is primarily a ball and socket joint, or what is more specifically known as the glenohumeral joint. This is where the head of the humerus (upper arm) connects to the glenoid fossa (indentation) of the scapula (shoulder blade). However, the shoulder also includes acromioclavicular (AC) joint, which is where the scapula and clavicle (collar bone) meet. When football quarterbacks get diagnosed with a separated shoulder as a result of a hit, this is usually where it occurs. The acromion process, a part of the scapula, is a component of what is called the coracoacromial arch (CA arch), which rises over the shoulder joint and sits just above the rotator cuff muscles and the coracoacromial ligament (CAL). The artists' renditions and computed tomography (CT) scans show this beautifully. Due to the effects of time and gravity, the space below the CA arch can narrow, causing impingement, pain, and fraying of the rotator cuff muscles and tendon, as well as the condition known as frozen shoulder.

Dr. Kirsch recommends hanging suspended from a straight bar with your palms facing forward. This helps to reverse the effects of aging and gravity by opening up the space below the CA arch, and now that we know more about shoulder anatomy this makes perfect sense. The author notes that when we were children we did things like climb trees, swing, and hang with our arms overhead, but that we do less of that as we get older. Regularly hanging suspended from a high bar can help to relieve many shoulder issues, even if you have a rotator cuff tear. As the author explains, "95 percent of rotator cuff tears are caused by the subacromial impingement syndrome (SIS). This condition is caused by tightness or contracture of the arch of ligament and bone that covers the upper arm and rotator cuff tendons that lift the arm. The tightness or contracture of the CA arch causes painful and destructive 'pinching' of the rotator cuff. The cause of the contracture of the CA arch is unknown, but most likely related to disuse and gravity." CT scans and illustrations in the book show the difference in the CA arch when at anatomically neutral and hanging positions.

How can we implement this hanging exercise into our routine? Any secure straight bar will work, even the portable ones that you can hang in a doorway. The Nautilus Multi-Exercise machine that we have at Total Results works perfectly, but there are several less cumbersome options you can use at home. Dr. Kirsch recommends starting off by hanging for about 30 seconds a few times a day, depending on the severity of your shoulder infirmity. I must warn you that you will experience shoulder discomfort as you perform the exercise, but that is not indicative of further injury. As improvement occurs, you can decrease frequency. It's a good idea to start out with part of your body weight supported, and then gradually work up to where you are hanging completely suspended. Getting safely loaded into and unloaded out of the exercise is absolutely critical. Never jump to reach the bar or load yourself abruptly - this will significantly increase the risk of injury. Depending upon the height of the bar, use a step stool or ladder to load and unload. Try to avoid excessive swinging, although a little rocking should pose no problem. If you have trouble maintaining your grip, I would advise investing in a set of lifting hooks. Finally, maintain proper neutral position of the head and neck during the exercise.

This book is written for the layman, not the professional, and Dr. Kirsch does a good job of keeping things simple and not getting overly technical. If you're not interested in the anatomical descriptions, you can simply skip ahead to how to perform the hanging technique. I am typically against stretching as a means to prevent injury, and I maintain that belief in most instances due to concerns over joint laxity, but as we see in the book many shoulder problems are a result of excessive tightness, so I believe the reasoning here is sound. Contraindications for performing this technique are if you have unstable or frequently dislocating shoulders, or are suffering from osteoporosis. Another thing I like about this book is that Dr. Kirsch goes to great lengths to avoid having to perform surgery, and that he is honest about its efficacy. That means a lot, considering he is a surgeon by trade. Where the author and I part company has to do with the strength exercises he has chosen. I am not a proponent of using dumbbells in most cases, since it is much more difficult to control independent movement arms and impossible to increase weight in small increments. Dr. Kirsch does not understand the exercise principle of inroad, instead recommending an arbitrary amount of repetitions. Furthermore, there is nothing discussed about speed of movement or the dangers of excessive force. This is the primary cause of injury during exercise, and it is ignored by the author. Aside from that, I agree with the basic premise of the book.

Whether your shoulder problems are recent and due to a singular event, or are chronic and a result of overuse, I believe that this hanging technique can make significant improvements in shoulder function, pain, and quality of life. This is a passive exercise that requires very little effort or time on your part, and can pay significant dividends in short order. It is certainly a more desirable alternative to surgery and lengthy rehabilitation.

Posted September 30, 2022 by Matthew Romans