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.
Note: I apologize if this is something that has been answered in the past. I searched but didn't find an answer that I could apply to my situation....not saying that it's not out there...just didn't see it. Also, I posted this same question on the Fitcast Forums as well, but this site seems to have more traffic. I was hoping to get an answer that might point me in the right direction......
Now, on to the question.
I've been having some issues with my left shoulder recently. It isn't in agonizing pain. But, it is a bit tender when I make certain movements.
Here is a little history. I injured my shoulder years ago during a collision from playing Rugby. It was the third injury that I'd had that year. After that I stopped playing sports, stopped working out, and basically stopped being concerned about my fitness. At the time I didn't have health insurance and it didn't immediately hurt worse than any other strain, or pull that I'd had in the past. So, I didn't go see a doctor. But, it never seemed to get better. Months later I couldn't lift my arm to parallel to the ground. That was the same time that I started playing a lot of guitar; three to four hours per day, every day. I'm not sure that the guitar playing has anything to do with this, but it does put your left shoulder in a weird position as you drop your elbow to your side and outwardly rotate your upper arm. I played like this for several years.
Now, about 12 years later, I'm back in the gym and I'm noticing some issues with that same shoulder. It hasn't caused any real difficulties yet, but I want to try to catch it and be proactive rather than waiting for an injury to cause me a serious setback. I've talked to a couple of doctors about this and have had an x-ray. There is no bone damage. The doctor didn't think that it was significant enough to warrant seeing a PT and told me to come back if it continued to get worse.
So, whats the issue? Two things. Upward rows hurt. Of course, as soon as I realized that I stopped doing them. But, even holding my left arm (with no weight) in that position that you see at the top of an upward row hurts. The pain is somewhere near the shoulder blade. There is also a bit of clicking in my shoulder, but it is pretty minor. Second, I do a lot of leg raises at the dip station/knee raise machine. I have real trouble supporting my weight while suspended in the air. My shoulders, specifically the left one, seems to give out before my abs do. I can't make progress there because I can't stay up there long enough to really stress my abs. At first I thought that I was just weak and that it would improve with time. But, 12 weeks later I find that I am much stronger in everything else, but still can't seem to support my body weight in that hanging knee raise position on the dip station.
Any ideas what my particular brand of dysfunction is?
The doctors didn't note any kind of tears anywhere?
The deltoid and the smaller supraspinatus both work to raise the arm in the fashion you described, and both have attachments to the spine on the shoulder blade. If doctors havent found any tears then inflamation could be due to strain caused by tightness and muscle imbalances.
The weakness with hanging leg raises is a separate issue, but as it involves muscles such as the lower trapezius, rhomboids and pectoralis minor, all which attach to the shoulder blade and work to retract, depress and stabilize it, if those muscles can't do their jobs you will feel the affects of it where you have you recurring pain as the shoulder blade will be pushed out of position.
For starters, to work your abs like this without killing your shoulders, do reverse crunches where you lay on your back and attach a pulley cable to your feet. Bend your knees and bring them to your chest. Same movement as the hanging raise without involving shoulders (at 230lbs, I know what you mean about shoulders not liking hanging leg raises) These are killer, I freakin LOVE them.
For the shoulder it's hard to say without getting hands-on or seeing detailed pics for assessment, but it could be as simple as improper bench press technique or posture where you tend to roll the shoulders forward which causes the anterior (front) portion of the deltoid and the pectoralis minor to shorten drastically, which places strain on the posterior (rear) portion of the delt and rhomboids as they get continually stretched. This stretching also causes them to go inactive, where they won't work properly. Some vigorous massage and other soft tissue work to loosen up the whole area would be a good place to start. Then if you can see any signs of muscle imbalances like tight chest/shoulders or arms rolling forward you can work on a training program to balance those issues out.
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Mike Pipes
Massive fat loss survivor and aspiring trainer in training
The doctors didn't note any kind of tears anywhere?
Well, they didn't say anything about any tears. But all they did was take an x-ray and pull, push, and prod the shoulder area. No real diagnosis. He just said come back if it gets worse. It's starting to get worse. Not much worse, but little by little it gets more and more sore.
I'm a bit concerned that these situations are getting better as I get stronger overall. I'm doing a lot of military presses with dumbbells, chest presses with dumbbells, rows, dips, and close grip pull downs. I've gotten stronger on each of those exercises over the past 12 weeks, but the dysfunction doesn't seem to be getting any better. I guess I thought that if I was stronger the issues would lessen. Instead they seem to be the same or slightly worse. Perhaps I'm just furthering an existing imbalance? Do I stop training that area?
I guess I'm going to have to pony up the dough to see a physical therapist. Hopefully their answer to me won't be, "stop lifting weights."
I'm a bit concerned that these situations are getting better as I get stronger overall. I'm doing a lot of military presses with dumbbells, chest presses with dumbbells, rows, dips, and close grip pull downs. I've gotten stronger on each of those exercises over the past 12 weeks, but the dysfunction doesn't seem to be getting any better. I guess I thought that if I was stronger the issues would lessen. Instead they seem to be the same or slightly worse. Perhaps I'm just furthering an existing imbalance? Do I stop training that area?
This is why Julie asked about your detailed routine. Going strictly by the exercises you listed, you have 3 pressing movements and 2 pulling movements, and that can cause an imbalance which will pull your shoulders forward, especially if you're going for a big bench. But there may be other things in your routine furthering the issue.
Some brief rest and vigorous recovery work will help tremendously. Stretching out the front, get some relief on the back, let any inflammation subside. You don't have to stop training, you just need to bring training into balance, and maybe change a few things around like volume and intensity.
Julie here is a PT and if you provide the info she asked about, she can give you some extra insight to what's going on.
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Mike Pipes
Massive fat loss survivor and aspiring trainer in training
Monday:
Warmup with Leg Swings, Glute Bridge, Band Pull Downs behind the neck
RDL's 6x4
Squats 6x4
Close Grip Lat Pull Downs 6x4 (Hands Pronated)
Seated Overhead Dumbbell Press 6x4
Also some work on one legged squats
Tuesday and Thursday:
Bird Dogs, Clams, Band Pull Downs, Reverse Flys with Band,
Plank Holds
Hanging Leg Raises
Calf Raises
Cardio
Wednesday:
Warmup with Glute Bridge, Leg Swings, Band Pull Downs
RDL's 4x8
Squats 4x8
Dips 4x8
Cable Row 4x8
Also some work on single leg squats, and deadlifts
Friday:
Warmup with Glute Bridge, Leg Swings, Band Pull Downs
Box Step Ups 3x12 each side
Cable Pull Throughs 3x12
Dumbbell Chest Press 3x12
Face Pulls w/ Neutral Grip 3x12
Also some work on single leg squats, and deadlifts
2. I do outside sales. I spend most of my day driving from account to account. I spend a significant amount of time in front of a computer.
3. My posture is improving. It's actually not too bad when driving, but when sitting at a desk I have to constantly remind myself not to hunch forward.
4. I'm technologically illiterate. I can't post a photo. I'll just say that it hurt on the inside of the shoulder blade; the area between the shoulder blade and the spine. When holding my shoulder up (Like in an upward row) it hurts more towards the top of the shoulder blade. When depressing the shoulder it hurts more towards the center of the shoulder blade.
Hmm ... okay, so you are actually saying that the pain is not in your "shoulder" but in your "upper back"?
I guess so. I just kind of thought of it all as the shoulder area. But, I guess your right. It feels like its right at the inside of the shoulder blade.
Any pain with any neck movements (ie look all the way up, all the way down, all the way left, all the way right, tip your ear toward your right shoulder, then tip your left ear toward your left shoulder)?
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Life's a Journey ... Enjoy the Ride!
Any pain with any neck movements (ie look all the way up, all the way down, all the way left, all the way right, tip your ear toward your right shoulder, then tip your left ear toward your left shoulder)?
Not really. If I tilt my head to the right (right ear towards right shoulder) I feel a bit of tightness. But, I wouldn't call it pain. Feels more like a good stretch.
I've been thinking about it and its actually difficult to tell exactly where the pain is. It's all throughout the trap, and shoulder blade.
What exactly did they tell you about the old shoulder injury when you did it?
Was it a shoulder separation? Or something else?
I didn't go to the doctors. I didn't have health insurance at the time, and it really didn't seem all that bad when it happened. What happened was that I was running on the field and went to tackle someone and lowered my shoulder and I must have hit shoulder or head right on the outside of my left shoulder. It was painful, but it wasn't all that painful. I had only just recovered from injuring my right shoulder. When I hurt my right shoulder it was excruciating, swollen, and throbbing. It hurt for a few weeks and then was better. When I came back was when I injured the left shoulder, and it really didn't seem as bad. So, I wasn't too concerned. But, unlike the injury with the right shoulder, the one with the left never seemed to get better. My range of motion didn't get better for a couple of years.
Later when I did have health insurance I had an x-ray on the shoulder and was told that it was clear. The doctor stated that it was possible that there was a slight separation that wasn't picked up on the x-ray, but it was entirely speculation.
I hope that this gives you some info that you can use.
Earlier you asked whether it was really the shoulder or the back. The reason why I've always thought that it was the shoulder is because of the initial injury, and the fact that the pain only occurs when I move my arm or shoulder. It does hurt a tiny bit when I tilt my head but I'd never really noticed it until you said something. I don't notice pain when I turn my head, turn my torso, bend my spine, etc.
Last edited by chaddukes : 02-14-2009 at 04:32 PM.
Yeah, but it's all interrelated ... and the injury history tells me what muscles may or may not be working ...
1. I'd bet dollars to dimes that you have scapular winging and lower trap weakness.
2. You probably also have forward head.
I bet you're right! But, I still don't have a photo to put up. I'm going to be setting an appointment with an orthopedist (sp?) soon. Any tips on the kind of Ortho/PT to look for?
Just following up for anyone else who might read this in the future. Perhaps it will help someone.
My pain in my shoulder has subsided a great deal. I've focused recently on doing more pulling than pushing exercises, and have focused on the lower traps, rhomboids, etc. I've taken dumbbell presses out and focused more on push ups, and one arm push ups. I'm doing more pulling than pressing motions now. I do lots of rows, pull ups, deadlifts, etc. Also, I've been working the area with a couple of tennis/lacrosse balls in a sock, and trying to incorporate more thoracic mobility/stretching.
But, I think the biggest help came when the strap on my workbag/breifcase broke. I used to carry that thing on my left shoulder all the time. When the strap broke I had to carry it in my hand instead of having it hang on my shoulder. About two weeks afterwards the pain was noticeably less. Goes to show that the answer may not have anything to do with what you're doing in the gym!
I still have some limited motion in the shoulder, but the pain is almost non-existant. Carrying the bag seemed to have the biggest impact from a pain point of view. But, I'm sure the work on the muscles of the upper back has helped as well. I really don't think about it much anymore.
What is this shoulder issue?
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