Had my first official session of PT this morning specifically for the arm issue. However I was seen by a different therapist this morning since my normal therapist was away at a conference. Today was the only day he will be gone during my ensuing therapy, but the therapist today was also very knowledgeable and provided a lot more info to this case.
I walked in, as she was reviewing what my evaluation appt notes had said. I filled her in on the whole background (impingement in '09, one round of therapy, which resulted in clearance to return to the gym. Then immediately after the dull ache in the arm started, therapy 3 more times, negative MRI of elbow etc etc; surgery and here I am with arm pain still present though improved and posterior shoulder tightness and pain from time to time.
Instead of focusing on my arm, this therapist immediately wanted to look at shoulder function. Mentioned how shoulder dysfunction could be the source of all the pain, which I agree with....
Right off the bat, mentioned I display some scapular winging on my left side, which I was not surprised to hear since my previous therapist had mentioned this as well. However, also mentioned that I have a much more prominent winging on my right (good) side, which I was shocked to hear. Said it was most likely due to over-compensation and duration of time with this dysfunction.
Internal, external rotation and ROM were noted to be very good, so the focus is on the winging. Mentioned that the winging is the reason I'm getting major tightness in my sub-scapularis (armpit area) and pain in my posterior cuff (teres major , minor and sub-scap).
Gave me 5 exercises to work on at home, wanted me to do them 3x a day everyday and monitor my progress.
I have my next session on Tuesday.
Its hard for me to say when the winging occurred; I know I have always had an issue with poor posture, forward head and lifting hard has most likely magnified this issue with the rounded shoulders, likely muscle imbalance from front to back sides and then the impingement took it over the top.
The home exercises they want me to do are:
Prayer stretch type stance: I am on my knees, elbows locked; shoulders retracted. From this position I slowly go back with the use of only my arms, keeping my core tight and back flat until my butt touches my feet.
Wall Slides: Pretty much text book here, focusing on serratus activation by extending as far as I can at the top and concentrating on not being upper trap dominant on the way down.
Scap push-ups against wall: Protraction & Retraction
Prone Scapular Adduction: Very similar to the protraction/retraction; hands are bent by my head, focusing on squeezing the shoulder blades together, without using the low back or upper traps at all.
Supine Wall Slides: Keeping fingers against the wall, elbow tucked in and low back flat against the wall with knees slightly bent.
More or less what this means to me is my Serratus Anterior is completely shut down; which I guess is typical with shoulder dysfunction. Was told that my rhomboids are also weak, so these home exercises should address that.
Was also told to avoid doing anything in the gym for now until the winging is corrected; which sucks, but I totally understand and agree with.... I've been out of the gym for over 2 years now so I'm use to it.
Was also told to focus on posture, but not be so concerned with shoulders back and down; just to focus on keeping shoulders back.
Also mentioned I display some lower body posture issues which could be part of the reason for the upper body posture issues.
Overall I was very impressed with this therapist, focuses on not only PT but movement analysis and really liked his methodology since it helps get to the root cause of the issue, rather than just doing manual therapy and sending you on your way without any explanation.
Will keep everyone posted as I progress and would love to get feedback from those who have had similar issues and have had success correcting it.
I'm specifically interested in knowing the time frame for correcting winging, although I imagine it likely depends on whether its strictly due to poor posture or if its being caused by the long thoracic nerve being impinged or irritated.