Not long ago, I was teaching a patient with rotator cuff tendinopathy the principles of the rehab program we would be implementing for her physical therapy. After my rather dry presentation of how the rotator cuff tendon is likely degenerated, and how it has lost its tolerance to managing the loads required of it, and then describing how we’ll need to build up the strength and load tolerance of the tendon over time, she said the most peculiar thing.
“Oh, I get it! It’s sort of like Wesley in “The Princess Bride”, she said with a smile.
Now it was her turn to explain.
Here’s a little summary of the relevant details: The story opens with the beautiful Princess Buttercup ordering around her farm-boy, Wesley, who responds to all her requests with a loving and penetrating gaze and the short phrase, “As you wish”. The princess soon realizes she’s in love with him, and in time, he goes away to seek his fortune so they can marry. While away, through a series of events not relevant to our brief description, the princess is kidnapped. Wesley finally catches up with the three outlaws who kidnapped his true love, and bests the first two outlaws before meeting their leader, Vizzini. Wesley challenges the man to a battle of wits where Vizzini must figure out which goblet Wesley has poured poison into. After a hilarious scene where Vizzini uses his “supreme intellect” to deduce which goblet he should drink from, he finally chooses, they both sip from their own cup… and Vizzini falls down dead!
It turns out that Wesley had put poison in both goblets, only, as he reveals to Princess Buttercup, “I’ve been building my tolerance to the poison for the last 5 years.”
And there it is. That’s the part of the story my patient told me about. What she understood was that at this time, raising her arm overhead, or lifting a gallon of milk, for example, was like poison to her shoulder. The amount of contraction force required to do those tasks was like an “overdose”.
“Exactly!”, I said. So, the way healing occurs is to actually do the exact exercises that contract the rotator cuff in as painless a way as possible. Over time, this will build up the tissue’s tolerance to progressively stronger levels of tensioning. The program does require some effort, but mostly it’s boring, and requires a dedication of purpose equal to any cult classic hero trying to win the hand of a beautiful princess.
“Heck, all I want is to be able to throw a frisbee again,” my patient says.
“As you wish!”
If you could use some help recovering from pain or injury, or just want to talk about “The Princess Bride”, call to make an appointment at our office 🙂
458-210-2940
