Do you recall hanging from monkey bars on the school playground? Remember how compelling it was to swing from bar to bar until the bell rang? Sure it was fun to dangle your feet, but perhaps it was also a latent urge from an arboreal past. From the popularity of monkey bars when I was a kid, I suspect there is still some monkey in most of us.
To be sure, human anatomy, especially shoulder joints, share features with orangutans, apes, and tree-dwelling monkeys. While the human shoulder has distinct characteristics, the most significant difference is our ability to also throw things (balls, darts, rocks, spears).
Today, few adults get the kind of exercise monkey bars offer and as for throwing things overhand, that’s become a spectator event. This lack of use leads to a weakening of ligaments, tendons, muscles, bones, and other tissues. The cumulative effects eventually lead to a wide range of problems that include osteoarthritis, rotator cuff tears, and more. For more about this evolutionary connection read, “Ancient Shoulders Show Signs of Humanity’s Ape-Like Past.”
While I’m not recommending that anyone rush to the playground to swing on monkey bars after a 20+ year hiatus, it is important to know that all joints need to be exercised regularly over their full range of motion if we want to retain their ability to serve us. For many, extending their arms high over their head to support their weight is a motion that rarely happens again after their last school gym class. On the plus side, the cumulative effects of not using the full range of motion over 20+ years is a big part of what keeps orthopedic surgeons fully employed in America.
Of course, range of motion exercise is necessary for good health in all joints. What’s different about the shoulder is that in most of the body, bones are surrounded by muscles. In the shoulder it’s different, muscles and tendons are surrounded by bone. Under that bone is soft tissue that includes ligaments, tendons, and muscles. Without stretches that help maintain space between the bones, blood flow is reduced, compression of tissues begins, and swelling occurs. As this happens, tendon tissue begins to fray like an old rope. Soon it becomes uncomfortable to extend the arms in almost any direction except for motions that don’t add to the compression. When the pain becomes intolerable, it’s often an indication of irritation from bone compression, or a small tear, or a hole in a tendon. That’s when you’re likely to be diagnosed as having a rotator cuff tear. But Doc, you say, “I didn’t lift anything that heavy.” The reality is, you don’t have to do anything extreme to get shoulder pain. You can get shoulder pain as a result of nothing more than the gradual decrease in space between bones caused by lack of stretching activity that pulls the bones away from each other.
Rotator cuff problems are just one aspect of what is often diagnosed more generally as shoulder impingement syndrome. The symptoms may include difficulty reaching up behind the back, pain when the arms are extended above the head, or shoulder weakness. Fortunately, most discover they have only partial tears that can heal without surgery. Physical therapy is often the best answer, along with an understanding that there may be some pain with every gain until normal ranges of motion are restored.
As you may have suspected, I brought you to this point to encourage you to remember the importance of conditioning exercises and incidentally to share a personal story. It’s a story that began with an odd little book by an orthopedic surgeon named Dr. John M. Kirsch. The gist of the book was a recommendation to hang by your hands from an overhead bar as a way of avoiding shoulder impingement syndrome. From MRI scans of the shoulder joint, with the arms in tension from the weight of the body, Dr. Kirsch demonstrated that the forces pulling on the shoulder bones pull them out of their compressed position. Of course, this takes time. Some respond well in a few months with others taking a full year. The typical routine involves gradually adding weight by progressively relaxing the legs until you can support yourself for a minute a couple of times a day.
When I refer to Kirsch’s book as odd, it’s not to diminish the value of his book. I’m glad I found it and that it reminded me to monkey around more. What’s odd about the book is that by the time you finish page one of the Forward to the book, you can forget the rest of the book. The remainder of the book describes research supporting the therapy along with many anatomical diagrams of shoulder joints. As a bonus, the book suggests the hanging bar therapy for sleep apnea. For many, their sleep problems are aggravated by an inability to sleep on their side due to sore shoulders. Eliminate the sore shoulder caused by bone compression, and a better night’s sleep becomes possible.
I found humorous the contrasting reviews of the book on Amazon. In a backhanded way, the one-star reviews were more complementary than the five-star reviews. In essence, the one-star reviews often said, “Just hang from a bar, you don’t need to buy the book.”
Granted, there is some truth to the one-star review comments. To address this complaint, Dr. Kirsch makes the observation, “The exercises in this book are simple. The book is not.” Indeed, the shoulder is an amazingly complex structure which defies a one therapy solution for the many problems that can occur. What Dr. Kirsch’s research did reveal was that for the most common shoulder problems that did not involve a total tear, his therapy was usually successful. In his last published study, he reported success with 90 out of 92 patients.
As for the five-star Amazon reviews, I recommend reading them to see if you feel they apply to you. If you have been reluctant about beginning a comprehensive exercise conditioning program, the stories shared may provide the inspiration needed. The book also included motivation stories that should give most pause to ask their orthopedist about trying the method for a few months before committing to surgery.
On a personal note, the book was given to me by my sister-in-law, the same lady that for many years raised spring garden plants for my patients. In recent years her joints had limited her activities and hence no more vegetable plants to give away. On her quest for health, at age 78 she came to better appreciate that as we age, we use it or lose it. Having recently taken up a plant-based whole food diet and balance classes, there is now hope for vegetable plants next Spring.
The book she found is, “Shoulder Pain? The Solution & Prevention,” by John M. Kirsch, MD. As you may have guessed, the book found its way from her home to mine by way of my husband. This led to my husband asking, “Do you suppose we need a hanging bar?” To me, Dr. Kirsch’s research findings made a compelling argument and we now have a hanging bar in the breezeway between the house and garage. On the way out to the garage or the garden, it’s easy to take a swing and for a moment feel like a kid again.
Perhaps it’s time for you to monkey around. My advice is to take it slow. Even better invest in a few hours from a personal trainer to help round out your regimen. As for using a monkey bar, begin with only a small amount of bodyweight on the bar until you feel confident you can do more without overdoing it. Muscles, tendons, and ligaments can restore their strength but only gradually. Overdo it, and you might end up in worse condition than when you started.
When it comes to other exercises like walking, the same advice holds. Begin slowly and build up as you gain confidence. That’s one of the best features of a walk around the lakes on Saturday mornings. Whether you walk slow or fast, we walk in a circle, and everyone eventually meets. Hope to see you there.
Nancy Neighbors, MD