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Walter & Group....
[GH] Syd Smith is a physician with valuable insight into his own personal experiences with shoulder problems:
Gordy
I felt I should add something on the shoulder injury question. The main point of this is to emphasize the importance of a loose shoulder joint denuded of cartilage from osteoarthritis as a cause of pain and what can be done about it. Gary and others have beautifully emphasized the methods of keeping the shoulder healthy and remedy when there is a problem with an otherwise intact shoulder.
I am a physician and have been plagued by osteoarthritis for years leading to two knee replacements and a left shoulder replacement. The Osteoarthritis has denuded the right shoulder joint of cartilage so there is just bone on bone. I did not replace my right major casting shoulder (which was worse Xray-wise than the replaced left) as I wanted to retain casting as well as possible.
Casting low elbow I was able to do most anything I wanted to do fortunately including distance casts and large saltwater rod casts. In retrospect I was strengthening the muscles of the shoulder involved in those casts, thus maintaining the shoulder joint in good, stable anatomical position. It was not rattling around bone against bone.
In training for the Masters exam I have run into the off shoulder distance accuracy cast (now 50 ft) without haul, requiring 2-3 ft back cast loops. The absence of the ability to haul on this test required a longer stroke length and more strength in the casting arm which required the rod to be over my head. It also took away the stabilizing influence of two arms performing the cast. The stabilizing muscles in that position had become weak and the shoulder rattled around and I began to experience a great deal of pain as the joint moved bone against bone. Since I was not willing to have the shoulder replaced this close to a try at the Masters, my orthopedist suggested physical therapy. I had been through that with the left shoulder replacement and remembered the attendant pain well, and was not anxious to further inflame the casting shoulder with the rigorous therapy required. BUT I decided it was the best alternative. The first few weeks were predictably quite painful, but as the muscles strengthened and the joint became stronger and more stable in all positions the pain has subsided to a measurable degree. My physical therapist mentioned that only a few millimeters of misalignment could provoke a lot of pain. The jury is not in but I am convinced that I will be able to operate the off shoulder cast with adequate strength and low pain given a few months of therapy. Something to consider.
I'm sure Gordy and Gary can comment more.
Syd Smith, FFFCCI
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[GH] Syd,
You are probably doing the right thing by not going ahead with shoulder replacement surgery on your dominant right side for a variety of reasons not the least of which is that certain arm casting positions including elbow raised and casting literally overhead could place the prosthetic joint at risk for dislocation or set the stage for eventual loosening.
As you doubtless recall, weight bearing pain when walking or climbing is what drives many to total knee and total hip replacement. Pain, limited motion and weakness can lead to shoulder surgery as well.... but one major difference is that the shoulder is not required to bear the weight of the body. It is usually pain with certain motions and attendant weakness which combine to reach the eventual indication for shoulder replacement.
One reason I have always advised my patients to wait as long as they can before having a joint replacement is that as time passes surgeons get better and better at performing these operations. At the same time, new advances in materials and prosthesis design are rapidly emerging. In the case of the shoulder joint, one example is the development of the "Reverse Shoulder Prosthesis" which gives surgeons and patients another option:
Of course, in the real World of fly fishing, you can avoid those painful arm positions such as casting overhead with rod tip over the opposite shoulder and an elbow elevated out to the side. Even if you wanted to do it, you could alleviate some of the strain on the casting arm with a haul. As you've already pointed out, that isn't allowed for this task on the casting exam.
This boils down to your training and eventual ability to make one cast on the Master's exam: Task 14: The 45 foot (13.7m) accuracy cast made over the opposite shoulder.
So there is no misunderstanding, I placed the task description in an attachment.
Gordy
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[GH] From Jim Gill :
Gordy,
This series has really provoked me into some serious thought on my approach to game -angling coaching. I've spent many years working in radiology and have seen some really awful musculo-skeletal conditions - as no doubt you and Dr Eaton have. Prior to any course I carry out a risk assessment on the location that includes identifying any medical conditions that may impact on the activity (only if the client/student wishes to disclose and even then only in private - all records being kept strictly medical-in-confidence) and obviously I need to be more cautious about "minor" MSK injuries/conditions that may have not manifested any cause of concern for the client/student - I would not enjoy being accused of exacerbating any such condition! *
My colleagues and I attend many Countryside Shows and Game Fairs and organise "have-a-go sessions" and again our risk assessment must reflect any possibility of MSK conditions. Also we must ensure we have a range of suitable equipment to suit the students physicality - especially with youngsters by appreciating the variations in age and MSK development.
The reference articles have provided good literature research on what is an important subject in coaching. In the UK it is Olympic Year - within the games legacy angling is regarded as a recognised sport (although not an Olympic sport) and has to have structured coaching stratagems. Therefore as in other sports coaching programs health & fitness being is a subject in our angling, coaching qualifications - but probably needs to be expanded as our sports administrators do not always recognise angling as having a considerable amount of physical activity.
Regards, Jim.
[GH] - * MSK = Musculoskeletal.
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[GH] Jim,
Well said. I often think of this as I am called upon to teach fly fishers accustomed to light trout tackle to learn salt water techniques with rods, reels, lines, leaders and flies much heavier than they've ever used previously. Even the act of initiating the "stop sequence" with the momentum of a heavy counterweight (a large tarpon reel with 400 yds. of backing and a SW fly line) can pose a problem.
Gordy
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[GH] From John Bilotta:
This discussion is very helpful. I like that we are reviewing and creating a few easy to use and remember concepts.
Maybe the top three or five recommendations should get posted on the main website as an instructor resource.
Thanks
John
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Attachment:
Accuracy casts for the Masters Exam.pdf
Description: Adobe PDF document