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Book Review: Shoulder Pain?

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.


12 thoughts on “Book Review: Shoulder Pain?

  • Wow thanks for this review. I’ll check it out. Meanwhile a q? So if we do have rotator cuff injury or impingement, or tight muscles, is it better to do the hang straight vs KATy’s hang to the side method? And is it not then necessary to have super supple shoulders before hanging? I’ve been trying to do all the shoulder stretches, releases etc before even starting to hang, and I feel like I’ll never get to the point where I’m flexible enough to do so. But I can easily rotate my shoulders to the full hang position

  • The author of this book is hanging for the purpose to remodel the acromion so that there is more room for the tendons that run underneath it. In Restorative Exercise™ we hang to improve the health of the various shoulder tissues and range of motion of the joint itself, but also to restore strength-weight ratio; your arms should be able to organize your body weight. Thus, we start with a small percentage of body weight and gradually increase the weight and range of motion. Eventually you will end up with the arms overhead but the feet still on the floor and then some day, the full weight of your body. If you can easily rotate the arms to full overhead position, maybe you can start with a hang where the feet are still on the floor. Be mindful always of what your body can achieve. Maybe a new blog post!

  • thanks so very much for replying !! So I tried hanging with feet On ground. I can do it with muscles loose and get more of a stretch or else use muscles to “pull” me up /”hold” me up. So should I be hanging and letting things stretch or tighten / engage the muscles?
    Meanwhile if I hang with too much weight and let things stretch I can’t breathe !! What does that mean?

    Thanks again so much for your help

  • Two schools of thought – one is a complete hang with all the muscles getting long. That is good to reconfigure the brain/body weight computation. Then depression of the scapula so there is some stabilization (strength). Both are good, but you are the judge of how much. Don’t rush it! The breathing thing is really common – try some twists on the floor interspersed with hanging. Keep more weight on your feet for now and just take deep breaths with the arms overhead. The Restorative Exercise website has a list of certified RES – Maybe there is someone in your area? You have such good questions!

  • Thanks so much again!
    So I’ll listen to my body as far as how to hang. And do some rib stretches prior! Glad the breathing thing is common! Guess it’s because I raise my shoulders to breathe, and that movement is constricted when arms are overhead. Need more streeetchinggg. I feel like I could stretch all day and never be done!
    Thanks again!

  • Hi Carol. Thanks for the informative post. I recently had an MRI and found that my right labrum is partially torn. I tried hanging a few times with feet still on the floor and feel a little extra uncomfortable movement in the GH joint (I think) on the right side. Should I proceed with hanging with even less bodyweight, or regress to a more horizontal hanging? Should I avoid hanging at all with a partially torn labrum?

  • I hesitate (and am unqualified) to give medical advice. Your best bet is to see a Dr. Labrum tears can make a shoulder unstable so safe to say back off the hanging until you get some qualified advice. There is still a lot you can and should do to get your shoulder operating optimally without hanging. The post you commented on is about a book where the author’s intent is to make more room between the head of the humerus and the coracoacromial ligament. Thanks for your comment!

  • Thanks for the reply, Carol. I was really just curious how RES addresses torn or partially torn labrums, and how people with this type of instability could benefit from RES in terms of shoulder health. If you had a client like this would you just avoid anything to do with the unstable shoulder, or are there regressions in the RES system? (Not seeking medical advice – really just interested in how the system applies in this case).

    I’ve been reading a lot about natural movement lately and find it very interesting, but haven’t been able to find anything in relation to these questions. Thanks again!

  • RE™ addresses alignment, not any specific disease, but having said that, there is a reason the labrum tore and that reason is usually mechanical. You could make the argument that it was accidental (ie, falling on an outstretched arm) but the fact remains that that was the tissue that gave, so it was a weak link in the system (what biomechanists call a stress riser). I personally would not avoid the unstable shoulder, but try to stabilize/decompress it and get the humeral head in an optimal position on a neutral scapula/ribcage. A lot of what I would do would be working within your current ROM and working to expand that ROM safely. Personally I have a freakish ROM in my shoulders – I can gross people out by putting my arms in crazy positions, but there is no strength or stability. I have had two serious injuries to my shoulders that I rehabbed myself, but it’s only since I started RE™ that I understand the depth of that problem and how to address it. It helps to know that you don’t have a “shoulder problem” you have a “whole body alignment problem.” Shoulders are one of those structures that in our current state are so underused that people are shocked by their inability to hold a position when I put them in N and ask them to stabilize there. No one uses their shoulders in the way that would maximize their health, so it’s definitely worth working on. This sounds like a new blog post is in order!

  • Carol – great info about how you (or RE) would approach this general situation! Thanks so much. A blog post going more in depth would be of great interest to me, and I’m sure many of your other readers, too. Looking forward to it!

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