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.
First of all, do you no longer have your ART specialist working for you? If not, that really sucks, bro.
Secondly, I'm glad to hear that the rotator cuff is good shape. That's certainly a blessing. Do you think, though, that with all the scar tissue built up that you might be suffering from a soft tissue impingement? Also, have you had any x-rays taken of your shoulder to see if there might be a problem with the acromial arch? A hooked acromion won't show up on an MRI, but will be pretty plain on an ordinary x-ray.
Just some random thoughts from the 3 shoulder surgeries I've endured. Good luck, JP. You shouldn't have to be any pain, especially if the shoulder joint "looks" healthy.
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Also, have you had any x-rays taken of your shoulder to see if there might be a problem with the acromial arch? A hooked acromion won't show up on an MRI, but will be pretty plain on an ordinary x-ray.
Actually, you will often be able to see a hooked acromion on an MRI.
My best answer is, I don't know for sure. How's that for specific. [img]tongue.gif[/img]
You're going to be the best one to tell what you need right now.
Determine any painful movements or positions. See if you can tolerate any contraction in those planes of movement starting with isometrics . Progressively increase intensity of contraction, but be sure to avoid pain. Keep durations about 8 sec for reps. Reps = quality and then rest and move on to another angle. If you can't perform a movement/position without pain or tolerate a low level contraction, move on to a movement or position you can tolerate.
The key is to reduce loads to levels that do not aggrevate symptoms.
For instance, bench press may be out but you may be able to load the same movement in a wall push-up. Then simply progress load (by moving body position closer to the floor), speed of movement (one thing that always seems to be avoided in rehab), and range of movement as you tolerate it. Keep in mind that the way you feel afterward and next day are also factors to determine training intensity.
You can do the same for pulls by using smith machine or power rack until you are horizontal.
Cables and bands may also be options at this time.
Depending on symptoms, multi-planar movements may be too much and then single plane shoulder rotations, flexion, and extension may be all you can hack at this point.
Keep good records of sets, reps, speed, frequencies, and subjective and objective findings as you go along. The more info you have the better we can guide you.
One word of advice...try strengthening at proximal musculature first. Give your cuff a foundation to work from.
Hmmmmm, not according to my orthopedist. My MRI's on both shoulders showed at the worst some torn cartilage, but no problems with the acromial arch.
The problem can be related to technique on MRI. The images have to be obtained in the correct plane in order to properly visualise the acromial arch. However, the same is true with plain x-rays----if the patient isn't positioned properly, it's very hard to evaluate the acromial arch correctly.
Plain x-rays and MRI are comparable in determining the acromial shape, but MRI obviously provides a great deal more info about the rotator cuff and glenoid labrum.
Acromial shapes and extension of rotator cuff tears: magnetic resonance imaging evaluation.
Hirano M, Ide J, Takagi K.
Department of Orthopaedic Surgery, Kumamoto National Hospital.
Magnetic resonance imaging makes it possible to inspect the status of the rotator cuff and the shape of the acromion. To clarify the relationship between acromial shapes and rotator cuff tears, we evaluated magnetic resonance images obtained in 192 shoulders. We classified the acromial shapes into 3 types: type I (flat), type II (curved), and type III (hooked). Among a group of 91 shoulders with rotator cuff tears, 33 (36.3%) were type I, 22 (24.2%) type II, and 36 (39.6%) type III. The size of rotator cuff tears in type III acromions was significantly larger than in type I or II acromions. Comparison of the incidence of each acromial shape between groups of specimens with and without rotator cuff tears revealed no significant differences. We suggest that whereas acromial shapes have a bearing on the extent of rotator cuff tears, the correlation between rotator cuff tears and a type III acromion is not as strong as has been suggested in the literature.
Originally posted by Quercus: Thought I'd try to use this shoulder thread for my question. I used to do the pec deck and had shoulder problems. I was told that this can cause shoulder problems, I stopped using it (along with some other things I changed) and I haven't had any shoulder problems for a while.
My question is, should the pec deck never be used or is this more an individual thing, i.e., if it hurts, don't do it. I thought there was a fundamental problem with the type of strain this machine puts on your shoulder and, if so, I'd like to pass on the info to this friend. Does anyone have any good info to pass on?
Q
Any piece of equipment used improperly can cause injury. I'm not particuarly aware of any inherent dangers in using a pec deck (apart from improper use, including improper fit). Technically, it's a constrained dumbbell flye. There could be, of course, information I'm not aware of.
Why do you (or the source of your information) think that it's inherently dangerous?
External rotation with horizontal abduction under load is the reason?
I don't get it. Yes, this is a potentially vulnerable position for your shoulder, but technically, so is any external rotation, with or without abduction.
I think the concern is the stretch to the anterior capsule and associated instabilities. This can obviously be avoided by limiting the degree of horizontal abduction (limit the stretch position) and/or not relaxing the pecs at end range.
It comes down to bad technique not necessarily a bad exercise. Some blame can go to muscle rags that tend to make it seem like maximum range of motion/max stretch has something to do with bigger, stronger muscles.
Just don't tell any baseball pitchers that abduction + external rotation is BAD for their shoulders
Okay Bill, here comes a whole new barrage of questions regarding my shoulder.
The main issue I have now is not anything actually torn, like my rotators, nor is anything truly impinged, since I have no parts that can actually touch in there, but there is still pain.
Does this mean that I can "tough it out" because the pain is not an actual tear? At this very moment, my shoulder doesn't even hurt. The cortizone shot I got a few days ago is in full effect, and I am pain free (for the time being). Does this mean it is safe to do motions that have hurt in the past, like overhead pressing, or bench press?
If there is no tear, what is the source of pain? If my joint tissue is "plump and healthy", the muscles are diagnosed as not being torn, and the joint has no possible way to impinge now, what is the harm of training hard on it again, other than the mind-numbing pain? If is not even an inflammation issue, it would follow that tylonol would be better for managing pain, since an anti-inflammatory won't be necessary. I am weak now, but that can change pretty quickly if I can jump back in.
Well, I can't just jump back in too quickly because of my wrist, which may legitimately be torn. I am wearing my splint constantly, not messing with it for the time being. I feel ready to start riding again, and I can ride with the splint (I did a short one to test it out). I would probably avoid trails for a while, at least until my wrist is better.
Originally posted by Bill Hartman: Weakness can result in impingement. You must remain as painfree as possible. Limited load, speed, etc. More later...
If your serratus anterior is weak or fatigued, the scapula won't be able to rotate upward as you elevate your arm. This can reduce the space beneath the acromion and result in impingement. Same goes for other scapular stabilizers and postural issues.
If the supraspinatus or superior fibers of subscapularis and infraspinatus are weak or fatigued, the humeral head won't depress in the glenoid as you elevate your arm resulting in impingement.
There are many other possibilities and most shoulder injuries are unique (as much as we'd like to think we know why).
The thing I'm getting at is that if your enthusiasm drives you to "work through" the pain, it's probably not a good idea with your history. That doesn't mean you shouldn't be motivated, just cautious.
Normal movement doesn't feel restricted or "funny". If it does you may still have an issue or five to deal with. Your injection reduced inflammation (and probably numbed it up a bit), but there was a reason for that inflammation. The injection doesn't "fix" it.
A good MRI doesn't necessarily mean you are 100% healthy in the shoulders (sorry...but you still have a promising MRI result). I have a 2cm tear that didn't show up on MRI (just an example).
Your basic rule is to proceed in a pain-free manner. Strength can start with low level isometrics, pain-free ROM, minimal loads, minimal volume, minimal speed, etc. and proceed from there.
If you want some ideas...
1. Scapular protraction/retraction/depress ion
2. Elevation in scaption with external rotation
Isometrics in flexion, extension, internal rotation, and external rotation keeping intensity below pain threshold. 8 second holds with reps to fatigue.
3. Frequent postural corrections.
4. No overhead activities
My apologies for not offering more. It's difficult. Have you had any PT yet?
I meet with a PT tomorrow. Being tight-of-budget at the moment though, I have only scheduled one visit whereupon I plan to get the rehab plan from him/her, and the proceed on my own. I like your list of exercises though. I may bug you later for some visual aids. Actually, I think I will print out part of this thread and bring it to my PT tomorrow. Thanks yet again!
I have experienced similar problems as the ones you have. As for as long as I can remember, when doing over head presses, I have had a small pop in my right shoulder. There has been no pain just an annoying sound.
Until August - I had really big pain and took a vacatio for three weeks. It didn't heal at all. Some days it's really good and I hardly notices it but some times I can't get my shirt on. Now it is mor of a POP instad of a pop. So this weekend I found a new friend through my girlfriend. This dude has been in the junior olymics and he have had similar problems like me. Right away when I told him he replied "That is the Supra spinatus - no doubt" I have been to doctors and kiropractors spending hundreds of dollars to make it heal. This guy solved it in ten minutes by stretching it. So find out how to strech you supra spinatus - it might be the solution to your problem! [img]smile.gif[/img]
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