Shoulder Pain? The Solution & Prevention, Fourth Edition, The Kauai Study
by John M. Kirsch, MD
As a Restorative Exercise Specialist™, hanging is part of my prescription protocol; everybody who comes to see me starts to hang right away. I generally don’t see people who are candidates for immediate surgery, so I feel fine getting people to hang right away, regardless if they have shoulder discomfort or not. And after reading this book, I feel quite comfortable with that decision.
Dr. Kirsch, 74, the author of this book, is an orthopedic surgeon who was in practice for 33 years. Kudos to a surgeon who has performed clinical research on shoulder function and written an affordable book designed for people to avoid surgery. The book is subtitled “The Kauai Study” because Dr. Kirsch first presented the results of his academic study at the meeting of the hand and upper extremity surgery societies in Kauai, Hawaii. The book is a slim volume at 95 pages, easy to digest in one sitting.
Katy Bowman is one of the few people that I know who advocates hanging, and indeed, has a whole hanging protocol designed to develop a better strength:weight ratio for the upper body. I was very interested to see what a surgeon had to say about hanging and the reasons he had for prescribing it to patients.
In Bowman’s Restorative Exercise™ method, the reasons for hanging are many. Dr. Kirsch hangs for basically one reason: to re-model or re-shape the coracoacromial arch to increase the space for the rotator cuff tendons, reducing or completely eradicating SIS, frozen shoulder, osteoarthritis of the glenohumeral joint. Unlike Bowman’s method, Kirsch also prescribes weight lifting with light weights for the purpose of strengthening the muscles of the rotator cuff.
The Kauai study consisted of a sample of 92 subjects, 90 of whom finished the study, (two left for personal reasons). Over the entire study (lasting as long as 28 years with some subjects), all 90 returned to comfortable activities of daily living. Two that had scheduled surgeries were able to cancel those surgeries.
What caught my eye was how Dr. Kirsch outlined the standard procedures for shoulder pain patients, which includes rest, ice, anti-inflammatories, and safe exercises designed not to increase pain. Other therapies might be recommended, such as massage, but any stretching or exercising is limited to what can be achieved without increase in pain. After several weeks, patients may find it necessary to return for more tests, scans or MRI’s, therapy, and eventually possible cortisone shots and even surgery! This standard medical routine and others like it for bone and joint health (shoulder pain is third most common) costs the U.S. $849 BILLION a year (2008 numbers – they are even higher now!). The method for re-surfacing the shoulder joint removes 5-8mm of bone and tissue to make more room for the rotator cuff.
So is Dr. Kirsch (like Katy Bowman) really saying that hanging is a viable alternative to this standard procedure – and can something as simple as hanging from a bar daily be an alternative to damaging and costly surgery? Incredibly, the answer is yes, and this is why: we know that bone is capable of remodelling. Dr. Kirsch’s example is orthodontics; remodelling the teeth and jaw. Another example of bone remodelling is a bunion. It’s not a desirable addition but one that develops in response to the forces on the bones over time. Similarly, the process of hanging remodels the acromion as the force of the humeral head in the position of 180 degrees vertical acts upon it. These forces are not generated by simply raising the arm overhead, the full 180 degrees is only achieved though passive hanging. In fact, according to many of Dr. Kirsch’s patients, relief was felt in only a few days.
The hanging can be initially uncomfortable or even painful, but it’s important to note that if you have already been diagnosed with a tear of the rotator cuff tissues, hanging will not exacerbate or damage the tissues further. In fact, they are out of the way in the full hang position. As long as you can get the arm past horizontal on your own, you can begin to hang.
Dr. Kirsch’s book has many images of CT scans, artist renderings and xray images of the structures mentioned for further understanding and they are well labelled for the layman. As well, plans for hanging bars and web links to buy bars are included. Partial hanging, for those with limited strength or weight issues, is addressed, as is a page on the mechanics of swinging.
On page 91, there is a thorough list of the many other structures of the arm and trunk that benefit from a hanging protocol. Dr. Kirsch laments the lack of hanging bars in public places, and suggests they be made available in airport lounges (such a good idea!), parks and playgrounds.
Dr. Kirsch’s website can be accessed here: www.kirschshoulder.com
The book can be ordered from Amazon here.
But please don’t wait until you are a surgical candidate before ordering this book! Hanging is an excellent prevention and everyone (and their kids and their grandmothers) should be hanging on a daily basis. If you are ready to learn how to add hanging to your daily practice, I suggest reading this book and/or finding a Restorative Exercise Specialist™ in your area.