Nicholas A. Dinubile - FrameWork for the Shoulder A 6-Step Plan for Preventing Injury and Ending Pain

N O D OUBT ABOUT I T, FrameWork is an important book that I know you will enjoy and find helpful on your road to optimal health, conditioning, and achievement. Its a must-read for anyone who cares about his or her body and wants it to last.

Governor Arnold Schwarzenegger

During my 21-year major-league career, it was amazing to see the advances in training and medicine from the time I first made it to the big leagues in 1981 to the time I retired in 2001. Dr. DiNubiles book is a striking example of that and how a firm understanding of your body and how best to keep it in shape can enhance every part of your life. Having gone through my share of injuries, from bumps and bruises to a herniated disk, I wish that resources like FrameWork were available to me throughout my career.

Cal Ripken Jr.,
baseballs all-time Iron Man, two-time AL MVP, perennial All-Star

Dr. Nick has the uncanny ability to understand the language of the human body. He knows how it speaks. In the movie industry and in sports, the body is invaluable as an instrument. Dr. Nick is invaluable at keeping that instrument tuned to perfection. He is a healer of the highest order.

M. Night Shyamalan,
director, The Sixth Sense, Unbreakable,
The Last Airbender

FrameWork is an indispensable text that gives individuals essential advice and information on how to protect and enhance arguably our most valuable assetthe health and function of our musculoskeletal systems. Renowned orthopedic surgeon Dr. Nicholas DiNubile offers a wide variety of useful tips and practical guidance such as how to conduct a simple self-assessment of the condition of our muscles, bones, and joints, and, more importantly, how to properly exercise to safely improve our functional movement capabilities. At the American Council on Exercise, we were so impressed with the content in FrameWork that it is used as the core foundation of a continuing education course for our more than 50,000 fitness professionals. This book is a must-read for anyone interested in experiencing the joys of leading a physically active lifestyle and developing a body thats built to last a lifetime.

Cedric X. Bryant, PhD, FACSM,
chief science officer, American Council on Exercise

I have known Dr. DiNubile for many years, and his reputation as a specialist in sports medicine is legendary. Now he has compiled into book form knowledge accumulated from many years of working with athletes, which should enable even the nonathlete to achieve total fitness.

Kenneth H. Cooper, MD, MPH,
founder, president, and CEO, The Cooper Aerobics Center

This is the owners manual that should have come with your body.

Dr. Neil Liebman,
team chiropractor, Philadelphia 76ers

Dr. Nick is a great doctor. Hes not only an excellent surgeon but also an understanding, feeling practitioner in all musculoskeletal-related concerns. As he says, since we are living longer, this aspect of health care has surpassed the common cold for frequency of treatment. I am fortunate enough to have had Dr. Nick repair one of my knees. Being a good example of just the kind of extended-wear person Dr. Nick is talking about, now I am even more grateful to get advice from one of the brightest (and nicest) guys in the field on how to keep my frame working for me. I, like a lot of us who have borrowed time from science, can only very strongly recommend his words to anyone and everyone interested in keeping their bones working to their best potential as we gracefully glide, run, skip, bat, pole-vault, hike, or bike into our happiest days.

William Hurt,
Academy Award-winning actor

Dr. DiNubile is the master of preventative medicine for the musculoskeletal system.

Wayne L. Westcott, PhD, CSCS,
fitness research director, South Shore YMCA, Quincy, MA

FrameWork teaches you how to take optimal care of your body so you can enjoy both life and leisure more. For athletes, its essential for a long, healthy career.

Jay Sigel,
US PGA and US amateur golf champion

Dr. DiNubiles FrameWork provides cutting-edge information not only from a health and wellness standpoint but from an athletic performance aspect as well.

Gary Vitti,
head trainer, LA Lakers

I was quite young when a knee injury changed my life. Dr. Nick helped me then, and he can help you now.

David Boreanaz,
actor, Bones, Angel, and Buffy the Vampire Slayer

To my dream team:
Marybeth, Emily, and Dylan

Every book in this series has been special to me, and this one is no exception. Ive long held the belief that the shoulder is one of the last frontiers of orthopaedic knowledge. Were crossing that frontier now, and Im thrilled to tell you all about it.

Until recently, the shoulder had been poorly understood. The way my colleagues and I saw things, doctors hadnt come very far from our orthopaedic residency days decades ago, when we had a pretty good knowledge base of common conditions like fractures but didnt fully understand the true functional anatomy of the shoulder or its bio-mechanics. The arthroscope, the miracle operating tool that enabled us to do delicate, noninvasive repairs, was just being introduced when I was a resident; it exploded onto the scene shortly afterward and was used big-time to advance our knowledge of knees and then elbows, but the shoulder remained a bit of a puzzle.

Three things happened that changed the orthopaedic playing field. First, the arthroscope kept advancing, and the shoulder was the next big joint that it went to. Being able to look closely into every part of it provided firsthand knowledge of how it works, what goes wrong with it, and whats really going on when theres pain. Its a whole lot better than the early years, when all we had to go on was a physical exam and some x-rays.

Second, MRI scanners enabled doctors to see soft tissues, the rotator cuff, the labrum, and other stabilizing structures and begin to understand how they change with age. We can see all sorts of things in the shoulder now that we never fully appreciated before when it comes to both health and injury.

Last, I think we got really good at biome-chanical analysis, which is made possible by high-speed video studies being done by trailblazers like Dr. James Andrews and his head therapist, Kevin Wilk.

Thanks to these advances, we now know how the shoulder works, and, more important, how and why it fails.

The knowledge from recent advances is evolving, and more and more orthopaedic surgeons are opting for a shoulder specialty, adding to the army of shoulder gurus that has sprung up around the land.

No question about it: Were learning more and more about the shoulder, much as were still learning about the knee. Arthroscopic techniques and tools specifically for the shoulders structure and components have gotten fairly sophisticated in a very short period of time, and it seems as though every month brings another breakthrough. Patients are getting better results for shoulder complaints because we doctors understand shoulder-disease processes and breakdowns better. Were better at fixing them, better at managing them, and better at