Jan 29, 2015Getting a Lift
Shoulder replacement surgery is now common and its rehab is fairly straightforward. But how do you rehab a national record-holding power lifter who goes through the procedure?
Tom Hall’s shoulder replacement surgery was over 40 years in the making. Back in 1964, Hall was performing a two-handed overhead snatch during a power lifting competition when, “My left shoulder seemed to come out of it’s socket,” he says.
As painful as the injury sounds, it didn’t keep Hall from continuing to power lift competitively. But the discomfort never really went away, and by the time Hall reached his seventh decade of life, the shoulder had become progressively worse.
Hall began seeing shoulder specialists at the Cincinnati Sports Medicine and Orthopaedic Center in December of 2006. He received cortisone shots to allow him to compete in a competition early in 2007, and while the shots did their job, by summer, they weren’t enough.
“By that point, even though he could work out, there were problems with his rotator cuff and osteoarthritis had set in,” says Michael McCormack, PT, MHS, SCS, ATC, Director of Rehabilitation at the Cincinnati Sports Medicine. “When that happened, his only option was a total shoulder replacement.”
Physicians at the Center had done numerous replacements before, but the difficulty for McCormack would be getting the 71-year-old Hall back to lifting hundreds of pounds–a rehab McCormack wasn’t used to. “The objective with any shoulder replacement surgery is meeting the patient’s goals,” McCormack says. “For most of our older patients, that goal is pain relief. They have a limited ability to use their shoulders to do their daily routines, be it gardening or cleaning. But obviously, Tom wanted to do more than that.”
The first step was getting Hall’s range of motion (ROM) back. But that process wasn’t going to go quickly. “The first six weeks of his rehab focused on very gentle, passive motion in order to protect the healing tissue of the shoulder,” McCormack says. “In surgery, the doctor had to cut back the rotator cuff tendons in order to access the joint, and those tendons have to heal before we can do much rehab. So I had to be very cautious in the beginning.”
McCormack had Hall do numerous ROM exercises like overhead pulleys and table slides–where Hall would slide his hands forward on a table in front of him. As he progressed, McCormack introduced light strengthening exercises. But instead of using the heavy weights he was used to, Hall was doing triceps and bicep curls, shoulder shrugs, and scapular retraction with a piece of red Thera-Band. The whole time, the goal was to protect the shoulder muscles as much as possible.
“I kept the resistance light because I wanted Tom’s biceps and triceps to stay active while not utilizing the rotator cuff muscles that could pull on tendons that were trying to re-establish connections,” McCormack says. “We always tell patients that we can’t control everything that happens, so we protect things as much as possible.”
For the first six to seven weeks, the regimen remained mostly the same, with McCormack adding an external rotation exercise in which Hall rotated his arm while lying in a supine position and increased the Thera-Band resistance. But at the eight-week mark, McCormack ramped up the strength training by substituting the Thera-Band for a light dumbbell. It was at that point that Hall encountered his first–and only–difficult exercise.
“Raising and lowering a weight while I was on my side was a little tough, because I had no strength in my shoulder,” Hall says. “But I knew I would get it back if I kept working and adding weight.”
It was here that Hall’s weightlifting acumen began to help him. “Because he lifted, he knew the proper technique to use, which really minimized the stress on his shoulder,” McCormack says. “His motion was quick and easy, and it became obvious that he was doing well.”
Next, McCormack began giving Hall stabilization exercises. These would be important if Hall wanted to avoid his shoulder popping out of its socket again. “The shoulder joint relies on the strength of the musculature to hold the joint in the socket,” McCormack says. “We had to increase his shoulder strength and give him dynamic stability, where his rotator cuff muscles would create a locked base for him while he was holding things.”
Hall started with standing ball circle exercises, in which he would stand with his arm in front of him, hold a tennis ball, and move his arm in circles for 20 seconds. As he improved, the tennis ball was replaced with a one-pound medicine ball. Hall also did an exercise where he laid on his back and held his arm above his head while McCormack tried to push it down. Eventually, Hall was able to resist McCormack for 45 seconds. As his rotator cuff grew stronger in weeks eight to 12, McCormack felt comfortable enough to discharge Hall into the weightroom on his own, with instructions to continue the dynamic stabilization procedures as part of his traditional workout.
In roughly three months, Hall had recovered as well as one could hope, which isn’t always a given with a procedure of this magnitude. “I knew he was motivated enough to work hard, but with this surgery, you never know what the person can physically handle,” McCormack says. “The outcome can be different for everyone. Tom is, by far, the most extreme example of what you can do after this type of procedure. But a lot of that is because of his motivation. There were times I’d watch him and say, ‘Are you sure you want to do that?'”
The results have been amazing. Hall has set a dozen national and state power lifting records since the surgery, including a combined squat, bench, and deadlift of 1,130 pounds on July 10 at the All-Natural Physique and Power Confederation World Cup. And with his shoulder in top shape, he has no plans to slack off.
“I have no intention of slowing down,” Hall says. “I enjoy what I do. I’ve got a lot of records in my age group, but soon I’ll turn 75, and there will be a whole new set of records to try to break.”
Patrick Bohn is an Assistant Editor at Training & Conditioning.