StandApart - Shoulder injury question ...

[rookie]

I saw in another thread where you have some experience with shoulder surgeries, injuries and what not. I have a great personal experience cop story to share with the board sometime but for now a quick summary. After being struck by a vehicle during a foot pursuit I reached to grab ahold of the first object I could whilst in the air. As my luck would have it, it turned out to be the bumper of a moving vehicle in the next lane. The good news - I successfully latched on. The bad news - ..see previous sentence and pay attention to the word moving....! Any way, My right arm and shoulder could not succesfully stop the momentum my flying carcas had gained. However, my fear of death and my grip held strong. Resulting in a dislocation and tears I never even fully understood. I had one small surgery and weeks of recovery. But that was 11 years ago. This shoulder overall causes no problems for me. However when lifting it gives out before anything else. It has not held me back much but there are times I rack the weights and move on. It can best be described as a feeling of lactic acid buildup so severe it causes sharp pain.
So with all that, do you have any thoughts or suggestions that could help out?

[rookie]

I had to add after reading my post the following: Don't picture a flying through the air guy grabbing a passing bumper. Not nearly that Hollywood. More like rolling and flailing and being hit by a 2nd car.
And yes I had other injuries to boot but this is the only lingering one, if it is even realted.
And lastly, please anyone offer your opinion if you have one. I just directed it to Standapart based on a reply in another post.

[John Izzo]

Were you a cop or stunt man?

All kidding aside. Thank you for entrusting me with your concern. First, based on my own experience with shoulder surgery adnd intensive rehab, I would guess that your rotator cuff is fatigued. I woudl also assume that you have some dysfunction in that shoulder in the form of:
1.) Subscapularis is shortened (tight)
2.) Tendonitis has formed
3.) Supraspinatus is weak (probably due to tendonitis)
4.) Asymmetrical scapular elevation: look in the mirror relaxed. Is one shoulder "higher" that the other?
5.) Protracted shoulder girdle

It can be a host of other reasons, but I would concentrate on a MOBILITY program to get your shoulder back on track. Chances are teh burning sensation you are feeling is due to joint ROM alteration and their is some compensation going on. It is really hard to see without visually seeing what is going on.

[Eric Cressey]

I will wager every penny that I have that he does not have tendinitis.

[John Izzo]

Yeah...I don't think its neccessarily tendonitis. If it was...he wouldn't be able to lift. I do understand the burning sensation he gets though, and that can also be painful. I am willing to bet everything that he has some sort of scapular-humeral dysfunction.

Your best bet, is to see a therpaist familiar with sports/weight-training.

[Eric Cressey]

Originally Posted by standAPART

Yeah...I don't think its neccessarily tendonitis. If it was...he wouldn't be able to lift. I do understand the burning sensation he gets though, and that can also be painful. I am willing to bet everything that he has some sort of scapular-humeral dysfunction.

Your best bet, is to see a therpaist familiar with sports/weight-training.

Oh, he'd be able to lift if it was tendinitis. Not to stir the pot or get off-topic, but I don't think you're catching what I'm throwing.

What does the suffix "itis" indicate?

Most shoulder injuries originate at the scapula; we're in agreement on that.

[John Izzo]

Eric, If he has i"nflammation of the tendon", particulalry the suprapinatus or subscaularis, he will have altered or painful ROM. I agee he may not have tendonitis if he is still able to lift.

No mattter what, he has dysfunction. Period.

[Eric Cressey]

Originally Posted by standAPART

Eric, If he has i"nflammation of the tendon", particulalry the suprapinatus or subscaularis, he will have altered or painful ROM. I agee he may not have tendonitis if he is still able to lift.

No mattter what, he has dysfunction. Period.

Tendinitis is extremely rare; these are almost ALWAYS tendinosis. It might seem like wordplay, but the difference between the two is actually more significant than one might think. Tendinitis can literally resolve within 3-5 days with anti-inflammatory medications. Anyone here with chronic pain in this regard can vouch that these things are stubborn SOBs that don't resolve so easily. As strength and conditioning professionals, I think it's imperative that we hold ourselves to a high standard and recognize the difference between the two, as the doctors simply don't seem to care enough to even take the time.

With degeneration, the reason he's in pain is because the activities he's doing exceed the regeneration capacity of the tissues in question. He needs to progress that tissue with exercises that actually PROMOTE inflammation on a small scale, as it's the first phase of the tissue remodeling phase. This is where eccentric exercise has proved to be the most valuable, although it's shown a lot more promise in the patellar and Achilles tendons.

All that said, as we both agree, the single-most important thing he can do is correct the altered scapulohumeral rhythm, which should remove the offending stimulus (in this case, the exceeding of the tissue's capacity for loading is largely due to the fact that all his movements are irritating that tissue because of poor biomechanics). However, tell something that they have tendinitis, and the first thing they're going to run out and buy is NSAIDs, which actually impair the healing process and make you weaker (along with a host of other negative side effects).

[Brian A.]

I have to agree with Eric on the point that the term tendonitis is thrown around way too much, especially by doctors who are looking the simply write a prescription rather than understand the pathology of the problem.

With all that said, the one good thing that most doctors do is to send the patient to a physical thearapist. Unfortunately for rookie physical thearapy 11 years ago is definely not what it is today. So, the million dollar questions to rookie are what type of therapy did you under go, what exercises did they have you do to repair the shoulder, did they give you post rehab exercises to continue to strengthen the shoulder, and most importantly did you continue to do them or simply stop after it felt better?

[John Izzo]

I agree that tendonitis is thrown around also.

I didn't suspect tendinosis because of the lack of information in rookie's original post: age, strength training frequency, volumn, intensity used, history of injury, and exercise program. With any degenerative condition, I think these factors play a huge role.

I agree that in some cases with stubborn shoulder injuries, "you have to make it hurt, to heal it". That is a blanket statement and one that shouldn't be used with anything. but it illustrates how physcial therapy has evolved in the last 10-15 years. Years ago if you were injured, the recommended solution was rest. Nowadays, we understand the healing properties of the human body much better and promote movement and ROM (even if it discomforting). Geez, does this mean if it HURTS, IGNORE it? Absolutely not. It means see a qualified professional and undergo a rehablitative program. And don't be afraid to ask questions!

[Eric Cressey]

Here's a good read, fellas:

Lian OB, Engebretsen L, Bahr R. Prevalence of jumper's knee among elite athletes from different sports: a cross-sectional study. Am J Sports Med. 2005 Apr;33(4):561-7.

http://www.ncbi.nlm.nih.gov/entrez/q...arch&DB=pubmed

-87 of 613 (14.2%) athletes assessed presented had clinical signs of jumper’s knee (tendinosis)

-51 other athletes (8%) reported a previous history of patellar tendon symptoms.

-Mean duration of symptoms was 32 months

-Sure, this is an at-risk population, but remember that patellar tendon is just one of several tendons commonly affected - and this is just as much a problem occupationally as it is athletically. This is widespread.

And, as a little aside...

Cook JL, Khan KM, Kiss ZA, Griffiths L. Patellar tendinopathy in junior basketball players: a controlled clinical and ultrasonographic study of 268 patellar tendons in players aged 14-18 years. Scand J Med Sci Sports. 2000 Aug;10(4):216-20.


-Just because you have a tendinopathy does not mean that you'll present with symptoms right away.

-In 134 elite junior basketball players (268 tendons), only 19 (7%) presented clinically with symptoms.

-With ultrasonographic examination, 26% of all tendons could be classified as tendinopathies based on degenerative changes.

-For every athlete that suffers from clinically diagnosed tendinopathy, it's safe to say that roughly three other athletes are undiagnosed at the very least.


Your risk increases with age, so this is going to be even more problematic than these studies of teenagers and athletes in their 20s and 30s shows. Most people are just waiting to break "the threshold" to symptoms, and doctors and fitness professionals aren't grasping how serious a problem this is.

I'm more than comfortable with wagering that this is what he's dealing with.

Good discussion, guys.

[Eric Cressey]

Originally Posted by standAPART

I agree that tendonitis is thrown around also.

I didn't suspect tendinosis because of the lack of information in rookie's original post: age, strength training frequency, volumn, intensity used, history of injury, and exercise program. With any degenerative condition, I think these factors play a huge role.

How can you venture a guess on inflammation then? You're more likely to have degenerative changes than inflammation regardless of the training background. I'm not being confrontational at all; I'm just curious as to your rationale. Maybe you're seeing something I don't.

[John Izzo]

Eric,

I agree this is a fun discussion and a great article you posted. I read another one: http://www.physsportsmed.com/issues/2000/05_00/khan.htm and echoed many of the things you said.

In light of our discussion, I lean towards your assumption that it could be tendonosis just based on the findings in the artcicle and the details provided by rookie. However, and I know you will agree with me, that neither of us are qualified enough to make a prognosis.

Great discussion. Thats why I like this board!

[Eric Cressey]

Khan has written several great reviews on this subject.

You're correct about making a prognosis for a traumatic injury; it can go either way. On one hand, you might have hypermobility as a result of the nature of the injury. On the other hand, given how long ago it was, there's a good chance that you've got some accumulated scar tissue binding up the area. Either way, you'll have some sort of scapular dyskinesis. I'd get it checked out and see what they say.

[67Cutlass]

Actually, I think you are both wrong.
I say Professor Plum, in the Library, with a candlestick...

(Sometimes, I crack myself up!)

[rookie]

Don't worry Cutlass, The rest of us laugh at you too!


And thanks for all the discussion guys. I have not been back to the ortho clinic in a while. But am due back next month. Thanks again for all the discussion.