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 read through several other shoulder pain related threads before starting this post, but none are quite what I'm experiencing, so here goes:
1. When did the pain begin?
About 1.5 months ago.
2. What were you doing at the time?Or did the pain come on gradually over time?
I was on the fourth and final set of a bench press routine called "Pectoral College" from Muscle & Fitness magazine. Basically you set up a power rack with a bench in it and the safety bar set up where you can only lift the bar a couple inches before the top of your ROM. Do that for 4 sets, then drop the safeties down a notch and do another 4 sets, drop, repeat, drop, repeat until the safeties are at the lowest setting (just above your chest). The concept behind this is that you can lift a LOT more weight than you would with a traditional bench press. I did this for 4 weeks total and had no problems until the very end on the last set. During the last set, I started to feel a "twinge" in my left shoulder, so I stopped, decreased the weight, and continued to finish up.
3. Where, anatomically, is the pain?
Several locations - The "big" pain is on the posterior right shoulder, right about where the teres minor attaches to the humerus (in that area). The pain also feels like it is "inside" the joint on both the left and right shoulders. Funny thing is, at the time I felt the first pain it was in my anterior left shoulder (which is gone now). I didn't notice the posterior right shoulder pain until much later.
4. What does the pain feel like? Sharp? Dull? Aching? Stabbing? Shooting?
The posterior right shoulder pain is very sharp. The "inside" pain in both shoulders feels achy/throbbing and increases if I lift.
5. Is the pain constant, or intermittent, or only on certain motions?
The posterior right shoulder pain only hurts if I do certain motions. The "inside" pain in both shoulders is semi-constant (not real bad) but increases if I lift through certain motions (see #6).
6. What motions make your pain worse?
Think of the YTLW (or whatever order the letters go in) -
If I use stretching motions or a stretching band:
Y does not hurt.
T does not hurt.
L twinges a little bit in the posterior right shoulder as the forearm rotates close to the shoulder.
W definitely hurts my posterior right shoulder when I bring my arms close to my shoulder (stretching or with bands).
Other motions don't seem to hurt. I can do back exercises, biceps/triceps exercises, etc. without any real pain (except sometimes feeling like my shoulder joints are going to "pop out" of their sockets on some motions).
7. What, if anything, makes your pain better?
Ice is nice.
8. Does your pain radiate to any other part of your body?
Nope.
9. What things could you do before, that you cannot do now because of your injury?
Lifting (around the home or in the gym) that involves the shoulder in the "W" position is not possible. I've greatly reduced the weights I use in the gym. I do bench presses on a machine now (to avoid rotating the shoulders through the "W" while getting in position). I also do the presses with my elbows "out" instead of closer to the body to avoid the "W" position. I only feel sharp pain if I'm in the "W" position (so I avoid it). But my shoulders do kinda feel like they want to "pop out" of their sockets sometimes with heavier weights.
10. What is your main concern regarding the pain and its consequences?
I hope I haven't done any damage to the joint or to the connective tissue. I'm just surprised that I was able to do the full "program" for 4 weeks with no problem at all until the last set, and since then have dealt with a lot of shoulder pain.
11. Have you ever injured that part of your body before? If so, how?
Both shoulders have been injured in the past on separate occasions. In each situation it was a "separation". These injuries were years ago (during my teen years).
12. Is your pain getting worse over time? And if so, how much worse over what time period?
Pain is about the same. No better, no worse. I figured that not lifting for a while would give my shoulders time to recoup, but after 4 weeks of no lifting, the pain is definitely still there.
I know I need to back off the "pressing" in the gym. But I don't want to stop it completely. So I've dropped the weights drastically (down to about 60% of what I usually lift with). It hurts a little, but if I'm careful it's not bad (I avoid the sharp pain in my posterior right shoulder). I just want to be sure I'm not causing more damage or preventing the shoulder(s) from getting better.
In the past I used dumbbells a lot for most of my pressing (inclines, flat, etc) but for now I completely avoid free weights for my pressing routine because rotating my arms to get the weights in position takes me through the "W" where it is extremely painful.
I completely stopped pressing for 4 weeks to see if that would help, but the pain level is about the same still. I just started pressing again last week.
My plan is to continue pressing on machines until the shoulder pain goes away. I also plan to listen carefully to my body and if it hurts too much (sharp pain) to stop.
Over the weekend I got some stretch bands so that I can work on my YTLW. Should I do this daily, or every other day? Should I do it with the strongest bands I can do it with to build the muscle, or should I do the lighter band to work on stretching/ROM? Or both?
I've been reading about how some people (like me) have an unnatural forward rotation of the shoulders because the front muscles are stronger than the back muscles. I know my back/shoulder muscles aren't where I'd like them to be - which is probably what allowed the injury to happen in the first place - and I've been working hard for a few months before the injury to increase my back/shoulder muscles. Now I'll be working even harder on that in an effort to bring my shoulders to a more natural position and avoid future injuries.
I've been hitting the gym regularly for 3 or 4 times a week for 2.5 years now and have made a lot of progress. This shoulder issue has really thrown a wrench into things and I'd like feedback on how to get back up to speed as soon as possible.
Reading your post I get the impression you know where you need the help. You really should get in to see a good physiotherapist/sports med doc with this info and work together to develop a program of combined correction/strengthening/stabi lization of the upper back and scapular structure. I.E. mobility and 2:1 ratio of pull to push.
From personal experience I can tell you that doing anything will be for not if you don't watch your posture and form ALL THE TIME. No sense in spending 1 hour in the gym and then practicing less than perfect posture for the remaining 23. Concentrating on my pulls has also been a great help (especially the pull up and inverted rows).
You really should get in to see a good physiotherapist/sports med doc with this info and work together to develop a program of combined correction/strengthening/stabi lization of the upper back and scapular structure.
I checked out the links you posted. When I saw the Mobility Test and the Active Impingement Test I cringed at the Mobility Test. I've always been "stiff jointed" for as long as I can remember. Touch my toes? Impossible. Scratch my back? Not without my bamboo back scratcher. *grin* Those are just things that I've never been able to do since .... forever.
Because I know that flexibility is an issue, I do stretches after my workouts (not after every workout, but after most of them - as time permits).
Anyways, did the Mobility Test and I figured I'd have a "you suck" score. Surprisingly, my hand is 8.75 inches and the distance between my fists was 12.5 inches. So, not perfect, but not incredibly bad either.
The Active Impingement Test - passed that one too. Left shoulder didn't hurt at all. Right shoulder (obviously) hurt, but only because of the shoulder injury.
coachdavidh (and tonester) -
I don't have much luck with doctors. Most of the time that I go to one it was basically a waste of my money. As for physiotherapists, I can't afford regular visits. I'm a teacher and teachers' salaries suck. Insurance isn't the best either. Thus, that's why I'm on this website (and doing searches on the Internet). I'm generally good at listening to my body and taking care of it. With feedback from experts (that's where you guys come in) I hope to get things back to normal.
So far I haven't had much luck figuring out which muscles are affected by the "W" motion in YTWL. In addition, on another site I was reading about a "self-test" that I did. Doing a front raise was painful (but only after I went above parallel) and a lateral raise was painful (but only as I approach and go above parallel). The first one says I should have anterior problems (I don't, because it hurts in the back, not the front) and the second one says I should have delt problems (which might be the case?)
Can you guys help me pinpoint which part of the joint is affected so that I can come up with a plan of attack for taking care of it?
I definitely plan to to place more effort on my back/shoulder routines. In the past I've done a one-bodypart-per-week routine:
If I have a particular area that I want to do extra work on, then I do two workouts that week for it. Obviously I'll be doing extra work for back and shoulders. I'm thinking (unless you guys recommend otherwise) that I'll also do my stretch band exercises for my shoulders/back on a daily basis.
Currently, most of my exercises for back and shoulders don't hurt my shoulder much. I have lowered the weights to be cautious, but I can do bent-over rows, seated cable rows, shoulder presses, even lat pull-downs (as long as I don't pull down to the "W" position). Basically I can do a modified workout with less weight with no major pain as long as I avoid:
The dreaded "W" position (OW!).
Lateral raises that approach parallel (shoulder height).
In either case the pain is generally in the posterior shoulder region although the lateral raises are felt more in the rear delt area (slightly different pain).
2. Arms straight overhead ... rear and side views.
3. Arms straight out to the side, like the letter T, and reaching back as far as you can (like you are trying to touch your hands together behind your back). Front and side views.
4. Same as above, but with elbows bent 90 degrees.
5. Start out in a position like the letter T, with elbows bent and parallel to the floor. Then rotate hands up toward the ceiling as far as you can. Front and side view.
Thanks.
PS: Are you in Utah? I have family in Smithfield ...
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Life's a Journey ... Enjoy the Ride!
Enjoying all that snow up north? *smile* Currently I'm living in Texas (been here for almost 2.5 years now). But, I've lived for several years in Utah. Smithfield eh? Cool. I've driven through there a couple/few times. Very small town.
To answer your question - I guess my shoulder flexibility is "ok". (Not sure what "normal" would be.) My pecs are not tight. I make sure to stretch them after all chest-related workouts.
Ok... be prepared - LOTS of pics to follow:
Keep in mind, none of these pictures really cause sharp pain (but maybe a little dull ache).
2. Arms straight overhead ... rear and side views.
3. Arms straight out to the side, like the letter T, and reaching back as far as you can (like you are trying to touch your hands together behind your back). Front and side views.
4. Same as above, but with elbows bent 90 degrees. [wasn't sure if you wanted this with forearms up or down...]
5. Start out in a position like the letter T, with elbows bent and parallel to the floor. Then rotate hands up toward the ceiling as far as you can. Front and side view. [I didn't quite know what you were asking here. This is my best guess...]
And then these are pictures that show what positions hurt (sharp pain):
And just where does it hurt (the sharp pain)? Right here.
Hurts right where my finger is at and also a little bit farther back (more towards the left of my finger in this pic).
One thing I've learned from these pics -
I still got a ways to go to achieve my goals. *grin* I'm at 15% BF in these pics but I still look way too soft. *sigh* Plus I have an overwhelming desire to retake the pics (and flex this time. Ha ha!)
Yes, Smithfield is small ... and my family is actually in Benson (a ward of Smithfield, which is even smaller!). I also have family in SLC and Provo.
Anyhoo ... I suspect you have an internal impingement from several causes ...
1. Too much pressing and not enough pulling.
2. Anteriorly and downwardly rotated scapulae.
3. Weak scapular stabilizers (winging of scapulae present).
4. Lack of thoracic extension.
How to fix it?
Well, fix the things above ...
1. Avoid any/all pressing movements for now.
2. Improve thoracic extension and rotation ... tennis ball drill, foam roller, t-spine reach and roll are all good things.
3. I suspect you need the sleeper stretch although I haven't seen your internal rotation ... how far up your back can you reach?
4. Improve scapular positioning ... this is tough to do on your own without a therapist ... generally you need tactile cueing. But picture tipping your shoulderblades backward and lifting the very tip of the shoulder up toward the ceiling (low effort movements, keep shoulderblades relaxed down back, no shrugging), then hold that position. Any time you find yourself out of this position, start at the beginning and reposition.
5. Focus on scapular stabilizer exercises ... especially once the pain has receded. YTWLs, face pulls, stick ups, etc.
6. Eliminate any trigger points in your shoulders and upper back. I highly recommend the Trigger Point Therapy Workbook by Clair Davies. (under $20 at Amazon).
7. Progress your rehab exercises, and when things are looking better, add back in pulling exercises only ... deadlifts, chins, rows, etc. After one month (and completely painfree), add back in pushup variations but keep pushup volume to 30% of pulling volume.
Keep me posted.
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Life's a Journey ... Enjoy the Ride!
Your right shoulder hangs much lower than the left when looking at the photo of your back. Do you tend to lift heavy stuff with the left arm more often than the right because it seems stronger? Do you lean on your left elbow, right arm extended to the mouse, while using a computer? Notice any other way you may favor one side over the other?
Try a push-up stretch in front of a mirror. Does the left shoulder stay locked in place while the right dives downwards?
The lower trap and possibly lat are shortened and/or knotted up which pulls the whole shoulder downward as the upper traps get lengthened and go inactive. You may also have some tightness in the Teres Major as it assists the lat in pulling the humerus downward/backward while internally rotating it.
Use your left hand/thumb to dig in hard underneath your armpit and along the underside of the arm, feel for any tight spots. When you hit the sweet spot you'll know it because the pain will reference instantly in your shoulder, possibly stronger than you've ever felt it before. The pain you feel at the back of the shoulder is likely the lower trap.
I would stop doing any overhead pulling motions and focus on aggressive massage, foam rolling and stretching of the lower trap, lat, teres major. Probably won't be able to hit the teres major with a foam roller too easily, but any kind of device that gives you leverage to put pressure on the area, like a Theracane, will help tremendously. Get those "lower" muscles loosened up so the upper trap can activate again.
LOL. I've never even heard of Benson. But then, there's small towns everywhere. I've also got family in the Wasatch front area (SLC, etc).
I definitely have an issue with not enough pulling (which is why I've been doing a lot more of it lately - but obviously need a lot more).
Thanks for the list of causes and fixes. I will follow them religiously!
There will be some issues with some of the stretches that require me to arch my back (with my head lower than my shoulders/back). I have a case of Meniere's (diagnosed 3 years ago) and tipping my head back like that is not a good thing. If the goal is to loosen and stretch the muscles can I work on doing them in modified versions for some? I have a nice percussion massager that can help loosen muscles and hit trigger points very well.
Scapular positioning. I'm trying to picture this... The way I understand you saying it would be like this -
Top portion of the shoulder blades tipping back and shoulder blades rotating (left) clockwise and (right) counter-clockwise.
Is that correct? I also feel an urge to bring the blades closer together as well. (Pulling my shoulders back.)
I'll definitely need to add the sleeper stretch. I have parts of my back that require the use of my back scratcher when I get the "itchies". *grin*
Pain really isn't an issue except if I put my arm in the position I showed in my pictures above. So I'll go ahead and start with the stabilizer exercises. Should I do them daily?
mpipes -
I am a VERY dominant left-hander. So I'm sure that is a factor. My right hand is the one I use for my mouse, but both arms/elbows hang free.
I was doing a tennis ball roll against the wall earlier and noticed that I have some heavy knotting on the upper half of my scapula. I don't know if it is part of the reason why I have the shoulder pain, or if it's a result of the shoulder pain (likely the latter). I didn't feel any knots/pain in the lat. Aside from the knots on my scapula, the only other "pain point" I've found is the one I am pointing at in the picture above. It hurts when I stretch my arm into those positions and it hurts when I push on it with my fingers.
I've looked at a few therapy-related pics on the Internet and I'm thinking to myself - wow... I seriously need to do some major shoulder/back development.
Rob, the pain I was referring to was the usual pain you feel in your shoulder where you were pointing in your photo. Oftentimes, the point where you feel the pain isn't actually where the problem is. You can feel the pain on the top of the shoulder but the source of the problem can actually be on the underside, because those muscles are tight, shortened and causing strain on the muscles/tendons directly opposite of them. Hence, you can find the tight spot underneath, and when you put pressure on it to get it to release, you may feel the pain up on top.
If you have knotting at the scapula, that's a tight/shortened trap. It very well can be a major contributor to the shoulder pain. The upper trap elevates the scap, the middle trap retracts it and the lower trap depresses the scap. If you have a tight middle and lower trap and a lengthened upper trap your scap is going to hang low. Look at the photo of your back again.
The LAST thing you need is more scapular retraction and depression work - at least temporarily on the right side, because it's already overworked or at the very least, imbalanced with the upper trap.
You need a break to give the inflammation in your shoulder time to heal and while doing that, get aggressive with the soft tissue work (as in several times per day, not beating yourself up to the point of bruising) to relieve that knotting. The soft tissue work will accelerate the decrease in inflammation as the tension subsides.
Just wanted to let ya'll know I'm still alive. *grin* Sorry I haven't replied - been swamped with school-related work (a teacher's job is never done).
Good news:
The pain in my shoulder appears to be gone. I have the ROM that I had before with no pain (and only a tiny twinge in the extreme "W" position). Obviously I still need to improve my ROM with continued stretches, etc.
I've been rolling a tennis ball on my back as often as I can. I still have a bit of a knot back there on my traps, but no pain at this point. Difficult to do it on the floor, so I do it against the wall.
I've also been doing YTLM's with stretch bands as often as I can too. The "W" position no longer hurts to do.
Last night I went to the gym and lifted for the first time in a long time (been doing nothing but cardio the past long while). I did squats and bent over rows and that felt fine. Out of curiosity I also did dumbbell presses at a reduced weight. Was doing fine until the 4th set. Rotating the dumbbells into position caused a twinge in my shoulder so I stopped. A tiny bit tender today. I'm thinking I probably would have been ok if I didn't have to rotate the dumbbells into position. So maybe either doing barbells or machine presses for a while.
Tonight I'll be doing squats, military presses, and deadlifts (basically I'm now doing Bill Starr's 5x5 program which focuses on overall strength). The main focus will be on building up back and shoulder strength to prevent this kind of injury from happening again.
My shoulders are still pretty much rotated forward. Maybe in the next couple days I'll take a pic and see if they're starting to rotate backwards more.
Question -
What is the correct neutral position for my shoulders to be in? If my back should be more or less "flat" then it looks like I have quite a ways to go. What can I do to get my shoulders where they need to be? Just keep going with the pulling exercises and the scapular positioning?
I seem to remember years ago a friend of mine wore something that pulled his shoulders back (improving his posture). Is that something I might look into?
Thanks to all of you for your help you've been giving me!
Stand as tall as you can.
Rotate your palms out as far as you can (with your arms relaxed down along your sides).
Hold that shoulderblade position, and let your arms relax.
External devices are worth crap IMO.
You can try tape (athletic) as a reminder cue to correct your posture.
Get into the posture you want to reinforce.
Have someone run athletic tape along both sides of your spine tailbone to tops of shoulders.
Clothes on top.
You'll be aware of it when you slouch.
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Life's a Journey ... Enjoy the Ride!
Keep doing soft tissue work and stretching on the chest - pecs major, pecs minor, anterior delt. If these muscles are locked up tight, you can work your upper back til the cows come home to pull the shoulders back, and all you'll end up with is even more pain/dysfunction.
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Mike Pipes
Massive fat loss survivor and aspiring trainer in training
Just wanted to give you a heads-up on my situation and also to thank all of you for your help you've given me.
After following all the advice, things finally started getting better for my right shoulder. Just when it's almost "back to normal" the LEFT shoulder flares up! Grrrr! I was determined not to let it take months and months like the right shoulder, so I went out and bought a theracane. LOVE the thing!
With the theracane I was able to probe and find that I had knotting all up and down my traps right along the shoulder blade. I hit the whole area hard with the theracane and it's feeling better. Knot isn't gone, but it it's no longer painful/tender. But now the right shoulder is flaring up again! Arg! Methinks I'm knot-prone in my traps. I do have another knot in my right traps in the upper shoulder blade area. I'm strongly inclined to believe that there's a direct correlation between the knots and the shoulder pain.
I've read on several reputable medical sites trying to find out the cause and prevention of the knots, but they all say the same thing - no real known cause and no real known prevention. They also say that stretching of the knotted muscles does nothing to get rid of the knots.
There's gotta be some known reason for the knots! I do think that massaging with the theracane has been a HUGE help. After several months, all the soft tissue work I did with the tennis balls and rollers helped my right shoulder, but the theracane worked MUCH faster on my left shoulder (I'm guessing because I could get pinpoint pressure on the effected areas). I also continue to do stretching of my back and shoulders as well as stretching my pecs too.
I do have to say I am very glad I'm not doing isolation exercises anymore. I'm doing a variation of Bill Starr's program (Olympic squats, deadlifts, bent-over rows, military presses, some pec deck [still can't do bench presses], and some ab and arm work) and the compound exercises are great! I can now do Olympic-style squats all the way in the hole and everything is working and feeling much better than it has in years (aside from this nagging shoulders/knots issue).
Any comments/suggestions/feedback? I'd greatly appreciate it (as always).
Oh, one other thing -
When I'm doing my squats, I have a bit of a pain directly above the top edge of my left knee. It doesn't affect my ability to do squats or my mobility, just hurts while squatting. It doesn't hurt when I poke or prod in the area, so I can't really pinpoint it exactly since I can't check it out while in the process of squatting with a barbell on my back. *grin* But if I were to venture a guess, it would be in the tendon area of where the vastus intermedius or the rectus femoris are attached above the knee. As I said, it doesn't affect my ability to squat (just hurts) and it isn't affecting my mobility. I did some pretty heavy squat work last night but my knee feels fine right now - no pain.
Any thoughts?
Again, thanks for all the help you all have given me!
You have lower cross syndrome. which means there is shortening of the lumbar erectors, iliopsoas, rectus femoris and tensor fascia latae with lengthening of the lower abdominal musculature, hamstrings, thoracic extensors and superficial cervical flexors. this posture is frequently seen in excercisers who spend a lot of time in the gyme exercising with imbalanced programs.
Hey rob take one more picture for me. i need one of you of your side shoulders relaxed from head to toe. i need your whole body in the picture. That way i can put a plum line down and see exactly which muscles are long and week and short and tight.
to start you need to do some lower abdominal exercise's, this will strengthen your lower abdominals and psoas which i can see on your body are long and weak. So on the floor leg lifts, BUT make sure you do not over arch your low back. so to do this you must do leg lifts with your knees bent at 90 degrees or so to start and progress by increasing the angle of your knee as your abdominals become stronger. also you probably have faulty transverabdominis activiation. the tva is a spinal extensor. and if this muscle does not turn on you will have problems. so activate this muscle while you are doing the leg lifts. to do that just draw in your belly buttom like your about to put on a tight pair of pants. that muscle is the tva.
~Matt
also another tip if you are using machines and bench's, you are shutting off your stabilizers. another tip that will help you is to make your workouts functional and train your stabilizers instead of machines use cables. for example machine bicepts curl to cable bicepts curl. If you use dumbells on bench's which shut your stabilizers off, use a swiss ball instead. if you work your postural muscles when your work out instead of shutting them off you will notice a very huge improvment and may even take your pain away completely
heres a good analogy of whats going on. If you hand a guitar to someone the first thing they do is tune it right. you cant play a guitar thats out of tune you just get noise. if the strings are to tight or to loose they do not produce good music. but when you tune the guitar you create music. the body works the same way if the are the phasic muscles are are weak and the tonic muscles are tight this creats imbalance and will lead to pain and limited range of motion. once the body is "tuned" you will move properly and will decrease pain
Just as an FYI - those pictures were taken 8 months ago. Since that time I've focused heavily on squats, bent-over rows, deadlifts, military presses, ab work, and some pectoral work using the pec deck. Curls and triceps are done once a week using barbells (curls) and pressdowns (triceps).
A quick glance in the mirror SEEMS to show that my pelvis isn't as tipped forward anymore and appears to be more level (I'll confirm that with a picture this weekend).
The real puzzle for me is why I seem to have so many knots in my traps? I don't know if I had them before, but they definitely weren't bothering me before. Now for the past year I've been struggling with shoulder issues (first the right, then the left, now back to the right). I've cut WAY back on any pectoral work and focusing a lot more on back and leg work.
another tip that will help you is to make your workouts functional and train your stabilizers instead of machines use cables. for example machine bicepts curl to cable bicepts curl.
oh look - is that credibility flying out the window?
I'm currently also experiencing shoulder pain now, i don' know what causes this, but many have told me that may be I'm bit stress, so i was thinking if stress should cause more body pain?
Shoulder pain
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