Injuries and RehabTell us where it hurts! Do a quick search before asking about your shoulder injury to make sure your question hasn't already been answered (about 50 times), and read the sticky post first.
I've finally decided to stop lurking over here and actually become a member, it's a shame though that my first post is in the Injury/Rehab section but I've exhausted all the resources I can think of (like my friends at Training Anarchy). So what the hell...
1. When did the pain begin?
About three weeks ago, I've since been to the miitary doctor we have on base (I'm in Iraq right now), and have received three different prognosis'. Which is why I'm here.
2. What were you doing at the time? Or did the pain come on gradually over time?
A 1RM on BP, I originally felt a sharp pain in my anterior deltoid, but thought nothing more of it since it went away intially. The pain came again after doing heavy shoulder presses. My shoulder completely gave out on me and I almost dropped the weight on my head.
3. Where, anatomically, is the pain?
It felt like DOMS at first and was sore in my anterior delt, then progressively moved into my rear delt over two days. There is also some pain in my AC joint if I extend my straight on in front of me or directly overhead and contract my shoulder muscles.
4. What does the pain feel like? Sharp? Dull? Aching? Stabbing? Shooting?
At first it was dull and achy like DOMS, but after some RICE it has slowly gone away and just feels fatigued. And there is some sharp pain in my AC joint, mentioned above.
5. Is the pain constant, or intermittent, or only on certain motions?
It's only if I contract my shoulder muscles and hold my arm straight on in front of me or overhead, every day movements don't hurt but the muscles become fatigued faster than my left shoulder. I can tell that my left shoulder has more mobility than my right as well and if I do any heavy horizontal or vertical pushing/pulling I feel pain in my rear deltoid afterwards that resembles DOMS.
6. What motions make your pain worse?
The above motions, and I can also feel some popping of the joint when I internally rotate my arm and my ROM in my right shoulder when internally/externally rotated isn't as great as my left shoulder.
7. What, if anything, makes your pain better?
RICE and wall stretches or door stretches. And so does rolling on the trigger points of my infraspinatus with a tennis ball.
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?
Any heavy horizontal or vertical pushing/and pulling.
10. What is your main concern regarding the pain and its consequences?
That I could possibly have a torn or injured rotator cuff or strained AC joint that I need to rehab properly. I'm also concerned with the lack of mobility in my right shoulder compared to my left.
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 not any worse, but my shoulder doesn't feel like it's getting any better at all and constanly feels fatigued.
Thank you in advance to anyone that can help me with this, I appreciate it greatly! If you guys need to know anything else, please let me know.
Julie, thanks, but you really don't have to thank me, I was involuntarily recalled so I have to be here. I got outta the Marines in June of 2005 and had to come back in Oct of 2007, and I should be getting out again around Sept or Oct of this year.
Anyways...the first diagnonsis was a Grade II strain of my AC joint, the second was a torn rear delt, and the third was an injured rotator cuff. They took an x-ray and an MRI, the x-ray was clean and the MRI was inclusive (meaning the Dr couldn't tell if I had any damage to my AC joint at all). I was also given some mobility tests, mainly the Empty Can Test, and I've done the Apley Scratch Test with myself as well. I've also laid down with my elbow bent at a 90 degree angle and my arms rotated externally and internally and my left forearm can touch the ground, but my right is about an inch shy.
Hope this helps your diagnosis a little more. If things start to improve in the next couple of weeks I was hoping to do some PNF rehab exercises for my shoulders. If they don't, then I'll make an appointment with a PT or Ortho when I get out and get another opinion.
Well, voluntary or involuntary ... I still thank you!
Really, it doesn't matter if it is an AC strain or a RTC strain ... let's go with symptoms.
Can you lie on it (ie to sleep) or does it hurt?
If you poke around with your finger, can you find any sore spots in the shoulder? Like anteriorly or laterally or wherever?
Did the doc say that the Empty Can test was positive or negative?
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Julie, thanks for the quick repsonse, I'm in transit back to the States right now so I apologize for not trying to respond sooner.
I can sleep on it, but it is becoming more and more uncomfortable and my shoulder feels pretty stiff the past two mornings. I'm not sure if that's because I've had to use my shoulder(s) in the last week doing a lot of packing and throwing around seabags, so it could just be me aggravating my injury.
I poked around yesterday and found some sore spots: 1) laterally in my shoulder there is some soreness and pain that could be associated with inflammation, I'm not really sure where the inflammation could be coming from though, it feels like it's my middle deltoid though, it's not really sore to the touch, just achy; 2) I have a tender spot that is in the rear of my shoulder but it's kinda hard to explain without a picture, so I'll try my best, it feels like it's at the top right portion of my infraspinatus where it begins to cover my rotator cuff. As of right now the former is what is mostly a dull pain, but if I dig my fingers into the area in the back of my shoulder it hurts a lot.
As for the Empty Can test, it was positive, I had some pain and weakness when first doing it. I performed it again and still have the same pain and weakness.
1. Ice it. 10-15 minutes at a clip, several times per day if you can.
2. Avoid all provoking movements if at all possible (I understand that certain "life activities" may make this difficult right now). i.e. no benching, no overhead pressing.
3. Avoid lying on it at night, and avoid lying with it up overhead at night.
4. Tennis ball rolling to the infraspinatus trigger point.
Give it two weeks and report back with results. Then once the inflammation and irritation are reduced, we will look at some rehab exercises to get it back functioning properly. You don't want to end up with a chronic impingement.
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When doing the posterior stretch I can feel some accute pain in my AC joint, is this a classic sign of impingement? Just curious really, I'm only asking to satisfy my curiousity.
And I will probably take three weeks to report back to you, as of right now I don't have access to an ice pack, so I'll have to wait and just keep taking NSAID's for now. I just wanted to thank you for your help and patience, I appreciate it. I'll be doing this as prescribed and hopefully reporting back with good news soon. Thanks again!
Fair enough...I can't imagine doing all that damage from just bench pressing though, looking back I can remember having some pain in my shoulder for months when I raised it overhead, but I always thought nothing much of it. That combined with repeated use and 40 pounds of equipment probably didn't help. Oh well...rest it is. Thanks again.
Julie....I actually had a question about overhead lifts. It seems that some people support the implementation of OH lifts in workout programs, but some are against them as well. I remembered reading some article before stating that correcting scapular dysfunction (tightness, imbalances) will allow a person to have OH lifts in their program without causing any harm. I also remembered coming across something by Cressey talking about how only 1/3 of the population have the acromion structure that is suitable for OH lifts....so that's something to consider in addition to the scapular dysfunction that may already be present. I'm debating on whether to use them when creating workout routines.
Any good reading or viewing material on scapular functioning that you suggest?
There are some good shoulder books out there ... Donatelli is the most "common" ... but his older print didn't have a whole lot on scapular function ... Jenny McConnell has a shoulder course, but not sure if she has a book out on it. Shirley Sahrmann's Movement Impairment Syndromes has some stuff on scapular function.
As for overhead lifts ... there is no reason not to if the shoulder is healthy and painfree. After all, are you going to tell your clients not to get things from the top shelf in their closet?
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You can download the pdf of the article. I found it to be of interest.
I have tried the suggested form to clear the acromion, and I found that I have a better time of it No more sitting shoulder presses for me. All done standing seems to be the ticket. I also find it interesting that doing wall handstands don't bother me!!! Wierd.
Fair enough...I can't imagine doing all that damage from just bench pressing though, looking back I can remember having some pain in my shoulder for months when I raised it overhead, but I always thought nothing much of it. That combined with repeated use and 40 pounds of equipment probably didn't help. Oh well...rest it is. Thanks again.
Ron
You'd be surprised. Benching + not enough scapular strength and/or shoulder mobility can wreck you in a hurry.
Both of my shoulders will attest to that
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You can download the pdf of the article. I found it to be of interest.
I have tried the suggested form to clear the acromion, and I found that I have a better time of it No more sitting shoulder presses for me. All done standing seems to be the ticket. I also find it interesting that doing wall handstands don't bother me!!! Wierd.
Anyways, hope this adds to your research.
Thanks for the article! I'll probably read it soon and see how it is.
The pain shoulder has almost completely gone away, my AC joint is still a little sore from time to time. I have horrible HORRIBLE knos in my shoulders and scapula though. I've gotten better mobility, but I can't seem to get rid of the knots at all.
I've also noticed that I have some postural issues (my shoulders are rolling forward and I've done the pencil test and I'm 10 and 2). I was contemplating doing Neanderthal No More. I talked to Fass about it via PM on TA and he recommended it as long as it didn't cause any pain. Should I do that or do you have a recommendation?
Well, you aren't going to have luck getting your periscapular muscles working properly if you don't address the knots.
Get a lacrosse ball and a tube sock. Use the sock to assist with positioning the ball and do some rolling against a wall (ie hang the ball down your back with the sock). Roll all sore spots. You might feel bruised there for a good long while as you work the knots out.
Do some upper trap stretching (let me know if you need pictures).
Pectoral stretching too.
Be tall (ie postural improvement).
Foam roll the t-spine to improve extension.
T-spine Reach and Roll.
Prone TYWLs (with light weight or bodyweight and lots of reps).
No pain with anything.
That would be my recommendation right now. Still lay off benching and overhead pressing. But you can add in push up variations as long as they are painfree.
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Actually let me clarify, can you send me pictures or links for:
trap stretches
t-spine reach and roll (I think I have an idea, but I'm not sure) prone ytwl (never mind, I found something on youtube, how often should I be doing this though, 3 x week?)
Roll daily if you can tolerate it. Every other day if you can't.
Upper Trap Stretch
T-Spine Reach and Roll
*do on the floor and roll (in this picture) the left arm back, then reach up along the right arm which reaches continually toward the ceiling
*This is in I/O if you have it.
I would do the exercises 3-5 times per week, light to no weight (2-3# max), 2 sets of 15-20 reps each.
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Julie, Julie, Julie...well you'll be happy to know that my right shoulder has fully recovered, but my left shoulder is now giving me fits...
Went to the doctor and was diagnosed with Shoulder Impingement, I was schedulded to have an MRI and arthogram, but alas I can't afford the 1200.00 it will require. Basically my insurance sucks! So I humbley come to you for advice again.
I did the Empty Can test, Apley Scratch Test, Passive Shoulder Internal Rotation (pain in rear of shoulder), Medial Rotation (Internal rotation) was about 60 degrees in left shoulder and about 75 to 80 degrees in my right shoulder. Also when I hold my left arm straight out to the side and try to rotate my elbow towards the sky I have a butt load of pain in the rear of my shoulder. All signs point to an impingement according to the Doctor. No RCT's that he could see from the x-rays, I do have a type-III acromion on my right shoulder and between a type-II or III acromion on my left shoulder. Not really sure if that makes a difference if I have an impingement though.
So...should I proceed with the same routine as before? Or do you have something else in mind? Also, what the hell can I do to prevent this, someone that I think it pretty knowledgeable told me that impingement's can be caused from my scapular not functioning correctly and that I should focus on correcting my scapular and strengthen my RC. I have been working hard on my posture, but I still believe I have downward sloping shoulders.
Thanks alot for any advice you can provide, once again, I am in your debt!
Arrggghhhh ... Eric Cressey is updating his website/blog and now I can't find the newsletter where he talks about posterior shoulder impingement ... that is likely what this is and he had some really good points about what to do ... I'll keep searching.
The type III acromion sucks. You will be predisposed to impingement. And fixing your scapulothoracic issues will help.
Let me get back to you ...
In the meantime ... what we did before would be helpful to start. Work out the trigger points. Avoid painful positions to decrease irritation/inflammation.
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I've been doing some posterior stretches and tricep stretches, also making a point to walk talk and squeeze my shoulder blades together and sit tall since I'm doing a lot of sitting on my butt now.
Not a lot of pain in the trigger points really, but I'll start using my trusty tennis ball in a sock again, can't hurt anything, that's for sure!
Lingering Shoulder Problems...
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