(… that we know of…)
So a couple of years ago I was part of a group of fitness entrepreneurs and I met this Canadian guy who was just nuts about injury rehab, which was weird, cause he wasn’t a physical therapist. His specialty is helping two groups of people:
- People who are in pain or have discomfort who, like myself, would rather be subjected to a 36-hour marathon “chick flicks” (sorry ladies) than go to the doctor’s, and
- People who have been discharged from acute clinical care of doctors, PTs, and Chiros but haven’t made a full recovery to get back to their sports or their lives
Rick Kaselj is an Injury Specialist. And like me two years ago, you’ve probably never heard of him. Too bad for us cause a lot of other people have. And not just “average” people either. Strong guys seek Rick’s expertise – guys like Jedd Johnson, RKC, of the Diesel Crew, a world champion grip athlete and Mike Westerdahl, a powerlifter with a legit 600+ pound Bench Press.
So when strong guys like these tell me that this guy knows his stuff, I wanted to see what that stuff was so it could help you out with any shoulder issues you might be having.
So I contacted Rick and he kindly agreed to do an interview for us.
You’ll learn some very surprising info about how to self-treat and self-manage your own shoulder issues, including the importance of breathing, why chimpanzees don’t get shoulder pain (and you do), and the three areas you need to address to get out of and stay out of pain.
So let’s get to it!
Geoff: Thanks for agreeing to do this interview, Rick. I appreciate it and I’m sure my readers will too. They’re always interested in getting cutting edge information from fresh sources. Why don’t you tell us a little about yourself, your background, and more specifically, your passion for injury prevention and rehab.
Rick: My name is Rick Kaselj and I am a exercise physiologist and exercise therapist from Vancouver, BC, Canada. What I specialize in is designing exercise programs for people recovering from pain and injury.
I help clients to transition from their doctor, physical therapist, chiropractor, massage therapist, etc into a gym or home exercise program.
Geoff: Cool, so like “post-rehabilitation” – that fine line between acute care and performance. Done that myself. Ok, Rick – hot seat time right off the bat. The obvious question is why did you choose this route – why a Master’s in Kinesiology instead of a Master’s or Doctorate in Physical Therapy?
Rick: While I was in high school I wanted to become a physical therapist. In Canada the common route that people take is they will get their Bachelor’s Degree in Kinesiology and then move onto their Masters’ of Physical Therapy.
That was my initial plan.
I then got to university and did some work terms/internships in a physical therapy clinic. While I was working in the clinic, I got to do the exercise prescription for those that were seeing the physical therapist. Looking at everything the physical therapist did, the part that interested me the most was the exercises for injuries.
After university and the internships, I decided to pass on physical therapy and work on getting more experience with exercise and injuries.
I began to work in all kinds of settings where I could focus in on exercises for injuries. I worked in a physical therapy clinic, chiropractic clinic, large rehab centers, in recreation centers, in the community, and even at people’s homes.
I began to focus on helping those people that were leaving the medical model (doctor, physical therapist, chiropractor, etc.) and transitioning back into the fitness setting. I would work with their doctor or therapist and build on the program they had and integrate them into the gym or into a home program. I would make sure exercises helped them and did not hurt them.
Now I continue to see clients, I share what I have learned with thousands of fitness and health professionals all over north America and share my injury workouts with people around the world at my website, http://ExercisesForInjuries.com
Geoff: How did you get interested in the shoulder and helping people rehab from shoulders?
Rick: When I graduated from university, I was thrown into work and had to learn on the job.
There were great resources when it came to the back. Researchers like Dr. Stu McGill have provided great insight and guidelines on what to do for the back but there was very little when it came to the shoulder.
What you could find, many times related to an athletic population, which does not always trickle down into all populations.
I decided to focus more on the shoulder and better understand it since it was the second most common injury that I was coming across. Of course, I most often saw back issues.
The complexity of the shoulder both challenged and interested me.
Geoff: Now most of my readers, Rick, come from traditional workout backgrounds, machines, free weights, sports, etc. and have either transitioned totally or partially to kettlebell training. This has allowed people to overcome many of their injuries they sustained from traditional weight training exercises. But one of the most common injuries is still the shoulder, despite some of the cutting edge joint stabilization techniques we teach, like “packing the shoulder.”
Why do you think that is?
Rick: As I worked with more and more people, I could see something different between people that had shoulder pain and those that did not.
What I could see is the joints looked different. You could see that someone with shoulder pain had a different looking shoulder blade and position of the shoulder.
When you looked at the shoulder blade, with many people it was tilted forward. This forward tilted scapula would change the shape of the shoulder joint leading to a decrease in space in the shoulder joint and in many cases leading to pinching of structures in the shoulder joint.
The second thing I would see is a shoulder tuck. We can call this rounded shoulders but it is the shoulder joint is anterior and towards the midline of the body. This shoulder tuck affects the centration of the shoulder joint which moves the upper arm (humeral head) out of optimal and ideal alignment with the shoulder joint (glenoid fossa). This decreases the space in the shoulder joint and leads to greater stress on structures in the shoulder joint like the rotator cuff.
One other thing I saw was even with clients that I worked with for a while, they may have not had a shoulder pain but with time they ended up with it. At first, I thought it might have been the exercises they were doing but I checked that and that was fine.
I would check their technique and that was fine.
So it had to be something else.
A while back I came across an orthopedic surgeon called Dr. John M Kirsch. He started to decrease the surgeries he did and encourage his clients to stretch out their shoulders by hanging like a monkey on tree.
I thought it was very weird and strange.
He talked about the fact that with time, gravity has an effect on the shoulder. Gravity pulling on our arm, which weighs about 10lbs, leads to the shoulder joint changing shape. What ends up happening is the coracoacromial ligament (CAL) would shorten up and we need to stretch the ligament in order to re-shape the shoulder.
It was the missing piece that I was looking for.
With all of this, shoulder pain is often time a result of our shoulder joint reshaping into a painful shoulder joint because our shoulder blade has tilted anterior, the glenohumeral joint has lost ideal centration and the structures in the shoulder joint has changed, for example the CAL.
Geoff: Ok, wow – I did not know that. So the ligaments actually shorten causing the joint to deform. That explains a lot of things. And I’d never heard about the hanging thing, but it makes perfect sense now that I think about it. I guess that’s why chimpanzees don’t get shoulder problems. 🙂
So even though “packing the shoulder” is a technique meant to centrate the joint, you’re saying it’s physically impossible for some people because of the deformation of the joint structures. Very, very interesting… Again, makes perfect sense… Ok, moving on, what are some of the most common shoulder injuries you’ve seen with your clients? How do people get them? And what strategies did you use to correct or overcome them?
Rick: The most common shoulder issues that I see are: shoulder tendonitis, rotator cuff tear, shoulder impingement and shoulder subluxations.
Most common reasons for injuries are overuse or trauma (accident or fall).
How I end up approaching things is with something that I call the “SR3 Method.”
Like I mentioned above, the SR3 Method came from just looking at a lot of shoulders. Then the next step was how can I organize everything so my clients and other professionals could understand.
My approach to training is I want to educate and empower the client to a point that they don’t need me. If they are given the tools, good feedback and progression, in many cases they are good on their own for a while.
In order educate and empower, I organized it into 3-parts and 10-steps wich I called SR3.
SR3 stands for:
“Shoulder Reshaping 3-Part Method”
What I do is an assessment and based on that assessment people will need to do one or all of the parts of the method.
The SR3 Method focuses on the things we talked about above – centration, scapular tilt and ligament shortening.
Geoff: So “reshaping” is just layman’s terms for “tissue remodeling” which is not something people typically address or consider when doing rehab / post-rehab. We just talk about getting stronger and restoring function. I like it. Ok, typically how long does the healing process take – or the adaptation to pain-free lifting – take based on using some of your strategies?
Rick: For some, full healing never occurs because if you work out and you do not make sure you are doing perfect technique, you shoulder joint will always be in a pain cycle.
The first step people have to do is work on hammering their technique, especially if their shoulder aches a little or have full-blown shoulder pain.
To be honest, if people commit to the SR3 Method they will see an improvement in their shoulder in 7 days. It won’t be gone but there will be an improvement.
I find if people stick with the program for a month, they will have a substantial decrease in shoulder pain.
After the program, I recommend they continue some of the exercise as maintenance and include them in their warm-up, cool-down or recovery segments.
Geoff: When would you tell someone to go see his/her doctor?
Rick: If your injury reaches a point where it impedes you from doing what you do, get it looked at.
You might not like the advice you get. The advice might not be helpful but the most important thing is mental satisfaction.
You have gone to someone, they have looked at it and they have told you what you have. What they recommend to you might be weak but now you know what you got and you can focus on getting better.
In very, very rare cases, shoulder pain can be something else that is serious or life threatening. The doctor shoulder rule this out and then you can have a calm mind and focus on getting better.
Geoff: I agree. Peace of mind is important. We know that anxiety alters your breathing patterns and that’s no good if you’re having shoulder pain – more on that in a minute. But first, you’re a big fan of stretching when addressing an injury. I have typically moved away from stretching. Maybe that’s cause of my personality – not the world’s most patient person. However, I noticed that you are a big fan of “Fascial Stretching,” which I’ve never used before. It intrigues me, especially now that I know more about fascia than I did earlier in my career. How does Fascial Stretching differ from traditional forms of stretching and I’m assuming there’s a bigger payoff, since you’re using it? What’s the payoff?
Rick: I have been doing more and more fascial stretching and I like the results I am getting.
How I look at it is, static stretching is safe isolation stretching. There is very low risk of injury and it generally targets one muscle, or at least it’s intended to.
Like you said, we are starting to learn and accept that muscles are all connected and groups of muscles tend to be connected with a connective tissue called fascia.
With most of us the fascia ends up shortening or thickening due to poor posture, injury, muscle imbalances, activity, etc. This ends up affecting movement and the shoulder.
The fascial stretching is a lot more complex to perform, there is greater risk of injury if you over due but the results are better.
That’s because it takes into account how groups of muscles are connected with fascia, works on lengthening it in the stretch and then you can modulate the stretch by moving parts of your body.
It is very cool stuff.
I had a client where we focused on the static stretching of pectoralis major and we were seeing a decrease in tension in the pec and range of motion. I then began reading about fascial stretching to this client as she had good body awareness and had a good feel for her body. We added corocobrachialis, biceps, pectoralis major and pectoralis minor fascial stretching. The improvement in tension and movement was significant so I continued to use it with other clients when it was right for them.
Geoff: Good stuff. Now, back to breathing: I also noticed you’re a big fan of breathing for restoring shoulder function. Me too. Can you tell us why it’s such a big deal? Because it’s something that very few people know about and from my vantage point, very few therapists address. Why do you think that is?
Rick: Poor breathing leads to tense muscles. In the shoulder, tense muscles lead to shoulder pain and changes the position of the shoulder which increases the risk of shoulder injury and pain.
Breathing helps set the ribs in an ideal position, which helps the shoulder out.
I am not talking about taking 60 minutes to focus on breathing but rather when you are recovering, stretching or sitting. Take 5 or 10 good breaths in order to decrease the tension in your shoulder muscles and help put your rib cage in a good position.
Details matter in professional sport and they matter in every day life as well.
Geoff: You’ve got a new project you’ve been passionately working on over the last couple of months. Can you tell us a little bit about that? Specifically who it’s for? And how it’s different from traditional approaches? And more importantly, when it’s available?
Rick: I have a product called “Fix My Shoulder Pain,” which came out this past Tuesday.
It is targeted to people that have achy shoulders or full blown shoulder pain and want to get back to pain-free workouts.
In more traditional approaches to shoulder pain recovery, the focus has been stretching and strengthening. What I have found is it this is a temporary solution so it helps with the symptoms for a short period of time. You need to focus on the problem. The problem is your shoulder has been reshaped into a painful shoulder joint and we need to reshape it into a pain-free shoulder joint.
Geoff: I noticed when reviewing FMSP, you chose not to address the relationships between the shoulder and the midsection (core) and the shoulder and the hip. Any particular reason?
Rick: Yes, there is a link between the upper body, core and lower body. When it comes to “Fix My Shoulder Pain,” I had to draw the line somewhere.
I wanted to put together the best program that I could for the masses with achey shoulders and shoulder pain. This program does just that. And you’re absolutely right, the core plays a role in shoulder health, recovery and prevention.
When it comes to designing my clients’ specific programs, I include core work as it helps the shoulder integrate with the rest of the body. [Editor’s Note: There is some torso work in FMSP.]
Geoff: My readers are a savvy lot. I’m sure they’ll have questions after reading your wisdom. Is it ok if they reach out and contact you? And if so, what’s the best way to get ahold of you?
Rick: For sure, they can see what I do at http://ExercisesForInjuries.com , which is where I write about all kinds of stuff when it relates to injuries. They can always leave a comment or email me at support@ExercisesForInjuries.com .
Geoff: Rick, thanks so much for taking the time out of your busy schedule to help my readers out – I’m sure they not only learned as much as I did, but appreciated it as much too!
Rick: Geoff, thank you for the opportunity to share this with your readers. All the best and we will talk to you soon. – Rick Kaselj, MS
If you’ve been suffering from shoulder issues, grab a copy of “Fix My Shoulder Pain” today for half price during Rick’s special launch celebration. (It’s ridiculously cheap – less than $20.)
When you get your copy through my link, I’ll send you my Exclusive Bonus – the exact rotator cuff rehab program I’ve been doing with one of my clients that I’ve been telling you about lately in my emails. In it you’ll learn the specific exercises I’ve been using, the rationale for using them, and how to perform them safely, all in an easy to view video format. I’ll also throw in a PDF with the exact sets and reps you should use for this program as well.
(It’s designed around using a kettlebell as the main tool, but if you had to you could use a dumbbell. And interestingly enough, I use some of the very same methodologies as Rick does in his SR3 Program and I wrote it before I reviewed his material.)
All you have to do is send me a copy of your receipt to firstname.lastname@example.org when you buy your copy of “Fix My Shoulder Pain.”