[Vickie]

Hi Jim,

The good news is that your MRI gave you the go ahead to rehab. Even though you shared your rehab protocols, and they helped, I can't be sure they were executed with enough precision to bring the joint back into it maximal capacity; as opposed to being an exercise in temporary pain relief.

Rotator Cuff problems are always and forever an indication that your shoulders are out of alignment. This includes the position of the shoulder blades which indicates inappropriate application of the rhomboid, latissimus, and pectoralis muscles on the primary level and many smaller muscles on the secondary level; as you can imaagine that is where the evaluation comes into play.

Since I have worked in a physical therapy facility, in gyms with 'professional' trainers, and witnessed the 'experts' on TV (yes that includes the golf channel) I must tell you that more often than not I have seen perfectly effective rehabilitative movements applied without the benefit of alignment. This translates into limited positive outcome and an opportunity to strengthen in the disfunction.

Your goal in your training should focus on creating a balance of tension in the shoulder girdle. If one primary system is faulty then the whole system functions poorly.

First things first. Overuse of your dominant arm is inherent in every sport. The only solution to avoiding eventual damage (whether it is pain or just loss of full use of funtion that translates into loss of accuracy or strength) is to re-establish balance at the end of 'play'. If you continually realign your structure then you avoid the residual deterioration of the soft tissue. This actually holds true for even non athletic endeavors. I will tell you that the aches and pains we call old age are nothing more than loosing our alignment over time and suffering the slow deterioration (as opposed the the more rapid deterioration we see in overuse for sport endeavors) of a perfectly designed frame we call the skeleton due completely to mismanagement of the muscular system. The bones go where the muscles take them. Period.

So what do you do?

1. Realize that the muscle has two functions: contract for power and elongate with proper counter tension to keep the joints from collapsing into the contraction. This includes the spine which is nothing more than a series of intricately connected joints.

2. For the above reason you must have a flexability program and a strength program. You must bring at least as much intention and concentration in your stretch positions as to pushing against resistance for strength. In fact possibly more since we like to measure our workouts in distance, quantity of weight and range of motion. Flexibility is measured, literally, in millimeters so most of us feel impatient with the process. Maybe this will help; there is only a 3 degree range of motion between the spinal joints. Accomplishing (over time) a 1 degree increase means a 33 percent increase in function. Weights force you to breath but the same amount of oxygen must be created within your cells to give you the energy to create the work of stretching muscle fibers, so you have to think about it. The reason most people have more success in yoga than traditional stretching is simply because breathing is emphasized from day one.

3. Learn to perfectly execute the exercises that address the core muscles of your body. This is not, as is popularly misunderstood, just the abdominal wall but includes the neck and thigh muscles. You don't have to become a body builder but must use a level of resistance that challenges your natural strength threshhold (level). You don't have to be in the gym an hour or do 'so many' sets but address the primary muscles in their entirety and with complete focus on execution of the movements.

4. Since your bicep and tricep and a secondary pec muscle all connect the shoulder blades make sure you can create full extension with absolute alignment.

5. I don't often suggest other peoples material because it still requires learning to set your body in proper alignment before you apply even the best effort but . . . this is a very useful book. The 7-minute Rotator Cuff Solution by Joseph Horrigan, D.C. & Jerry Robinson. There is a lot of information about the function of the joint and I think their illustrations are pretty close albiet not as refined as I instruct.

Would be easier to be more specific with an evaluation in real time but alas . . . In closing just remember, as long as you play gold, or any athletic activity, you must bring your body back to balance so it will not suffer from the necessary adjustments you make to load-up maximal power for your drive.

Best of luck, Vik

P.S. It will also help in refining your short game