Physio ineffective/wrong, confused as to what to do now.

[EdChap]

I went to see a physio regarding a small pain in my right shoulder. She said that I didn’t have a rotator cuff impingement and that the pain only came in the ‘extreme’ ROM’s in the tests she did. She noted I have very mobile scapulae and that my shoulders are slightly rounded forward. Her suggestions were to avoid Cuban presses for 2-3 weeks and limit my ROM on external rotations but that was it. 3 weeks later and my shoulder is still not better.

1. When did the pain begin? 5 or so weeks ago.
2. What were you doing at the time? Or did the pain come on gradually over time? Elbow supported external rotations.
3. Where, anatomically, is the pain? Within the middle of my right shoulder.
4. What does the pain feel like? Sharp? Dull? Aching? Stabbing? Shooting? Relatively sharp, sometimes a dull, prolonged ache.
5. Is the pain constant, or intermittent, or only on certain motions? Certain motions but can remain after those.
6. What motions make your pain worse? I don't have pain just sitting around, however I get twinges when I do the Apley scratch test and with random reaching.
7. What, if anything, makes your pain better? Avoiding painful ROM's.
8. Does your pain radiate to any other part of your body? No.
9. What things could you do before, that you cannot do now because of your injury? Nothing in particular, it's just a pain that has me worried that I'm on the cusp of something more serious.
10. What is your main concern regarding the pain and its consequences? That it will get worse, right now it isn't really a problem unless I move it in certain directions.
11. Have you ever injured that part of your body before? If so, how? No.
12. Is your pain getting worse over time? And if so, how much worse over what time period? It's remained pretty similar.

I took a week off and I’ve started NROL Strength I, 4 times a week. I'm going to remove all pressing movements; barbell/DB bench, barbell/DB overhead pressing etc and replace them with;

Scap pushups, 1-arm DB protractions, face pulls, prone trap raises, push-up Iso hold and external/internal rotations.

Is this an acceptable plan of action?

Thanks in advance for any help.

[bryanc]

So, basically, you're staying that you've had about a 6 week history of a minor sharp, sometimes aching pain in the middle of your right shoulder (could you be a little more specific?) that occurs at the extremes of external rotation that doesn't affect what you do now, but that you're worried will turn into something more serious later. You have no pain during rest, or during most of your shoulder movements.

This is going to sound like a typical doctor response, but unless pressing movements specifically cause you pain, I don't see a reason why you should eliminate them. You should probably avoid doing movements at those extremes of ROM. I don't know what you look like when you're doing external rotations, but you don't necessarily have to do the rotation exercise much beyond what your non-weighted ROM will allow. So, if you're doing elbow supported external rotations, don't allow the weight to change your natural ROM (since after you pass the perpendicular angle, gravity acts on the weight to potentially artificially increase your ROM, which may act as a possible mechanism of injury).

Basically, in this case, I would suggest allowing discomfort (as opposed to frank pain) to be your guide. As with any return-to-activity scenario, you should start off lighter and gradually work your way back to your original loading.

[EdChap]

Originally Posted by bryanc

So, basically, you're staying that you've had about a 6 week history of a minor sharp, sometimes aching pain in the middle of your right shoulder (could you be a little more specific?) that occurs at the extremes of external rotation that doesn't affect what you do now, but that you're worried will turn into something more serious later. You have no pain during rest, or during most of your shoulder movements.

The pain is located in the middle of the shoulder (if you look at it from side on) and quite close to the surface/top. Sorry, I'm finding it hard to be more specific.

If I don't aggravate it by moving it in certain directions I don't have any pain, but if I do move it in a painful direction then the ache can linger a while and be fairly uncomfortable.

I did bent-over rows yesterday and that somewhat aggravated it, there was a bit of discomfort straight afterwards when I was doing face pulls and then pain later in the day, both an ache and when moving the shoulder.

This is going to sound like a typical doctor response, but unless pressing movements specifically cause you pain, I don't see a reason why you should eliminate them. You should probably avoid doing movements at those extremes of ROM. I don't know what you look like when you're doing external rotations, but you don't necessarily have to do the rotation exercise much beyond what your non-weighted ROM will allow. So, if you're doing elbow supported external rotations, don't allow the weight to change your natural ROM (since after you pass the perpendicular angle, gravity acts on the weight to potentially artificially increase your ROM, which may act as a possible mechanism of injury).

Perhaps extreme was the wrong wording, what I meant was that at either end of the ROM, both the top and the bottom of the rotation, there's discomfort.

Thank you for your help, I really appreciate it!