A patient once called me in a panic in mid-April. He had been outside practicing his cast with his fly rod when, on the fourth or fifth cast he began experiencing pain in his mid back. This pain turned into a severely limited range of motion in his shoulder. He arrived in the office dejected. He had a western fly fishing trip for Cutthroat Trout in two weeks (a dream trip for many anglers). He had already begun the process of backing out of the fishing trip but his final stop was seeing if there was anything I could do for him.

For anyone who knows what fly fishing is like (anyone who doesn’t can look up one of many videos on YouTube to see for yourself), you know that the casting is a delicate procedure. It can be extremely tiring throughout the course of a day as you make many more casts and false-casts than other types of fishing. This makes fly fishing an extremely athletic pursuit for the upper body.

This patient worked in a warehouse, moving boxes all day using mostly his right arm and shoulder to lift and twist. This immediately brings the term “repetitive use injury” to any provider’s mind. I checked his range of motion and immediately could see that he was operating with approximately 50% of normal range of motion in the shoulder. He could not raise his rod high enough or bring it back enough during the back cast and reaching forward for his true cast, he was stopping short which meant his accuracy had diminished. The muscle examination showed spasm and multiple trigger points in the rhomboid muscle group (between the shoulder blades), the latissimus dorsi (commonly referred to as “lats”) and the deltoid group (the muscles that are on the shoulder and upper arm). He had no examination findings that would indicate serious nerve entrapment or other pathology.

I immediately started performing a trial course of intense myofascial release using Graston tools on the muscle groups above coupled with adjustments of his shoulder and thoracic spine (midback). After one 15 minute treatment, all ranges of motion in his shoulder were restored to 80%. He was amazed and immediately left the office to practice casting under my restriction that he perform his practice casts at 50% speed and limit the number of practice casts to 15-20 per day until I saw him again. He also was required to use a foam roller to stretch out after each training session.

Early the following week he returned and his range of motion was slightly restricted but he reported that he could still cast just fine but he was worried that it would be aggravated on the trip and he wanted to go into the trip with a shot at his best possible performance. I performed the same therapy on two visits that week and had him back to a reported 100% functionality. The following week he left for the trip, appreciative and promising to call to let me know how it went on his return. Two weeks later I received a call from him. He had not only fished comfortably every day for over 6 hours but caught a personal best fish in the process!