3 Months Post Shoulder Op Nagging Bicep Issue

[quote]Wawaweewa25 wrote:
Posted a reply this morning but I guess it didn’t go through for some reason.

Def not trying to set PR’s in any rehab or conditioning exercise, I was more curious on what I can do to get better at them considering I’ve got winging I’m working on and this inner elbow pain.

Here’s the reason this not knowing exactly what is going on is killing me; because it creates some self doubt in all the treatment I have received from all the other therapists I have seen thus far in regards to my inner elbow. Don’t get me wrong I have been lucky to have some great therapists work on my shoulder, help me realize how it works, what to strengthen, the importance of proper posture, the effects of sitting at a desk all day on the kinetic chain etc.

But at the same time many of them, just like any other industry are in it simply to make money and their bed side manner and communication skills are very poor. I realize that the average joe is not going to know what pronator teres syndrome is or thoracic outlet etc, but at least explain what you are thinking and what your plan of treatment is… alright rant off.

I think I am starting to get closer to solving this mystery.

I started keeping a log and also had the head therapist at the clinic I work at take a look at it. He evaluated me, assessed my history and feels very strong that I have median nerve entrapment . My symptoms based on my log over the past couple days tend to agree with that. The pain as I mentioned before is concentrated primarily in the inner elbow right where the median nerve runs through.

Well since I started doing this log I realized I get a “heart beat” like pain in my hand just below my middle finger and sometimes it goes closer to my thumb as well. I looked t some median nerve anatomy and see that it runs through the middle, ring fingers as well as the thumb.

I will communicate all this to my therapist and the next step for me is to figure out where the nerve is entrapped and possibly get an EMG of the area. I had an EMG of my shoulder last year which came back negative, but feel like a closer look at the thoracic outlet & brachial plex area might show something.

This would also run consistent with the reduced grip strength I have in the hand, weakness when doing an sort of arm flexion and intermittent pain I feel there.

Let me know what you think 56. [/quote]

Glad to hear you’re taking my advice about the journal. Amazing how certain things surface when you put pen to paper.

Now that you suspect it could be the nerve, explore that. Determine if it’s the main cause. Based on your findings, you will now know what the next step will be.

It absolutely is torture not knowing. But you need to focus on the task at hand rather than dwelling on the negative. No one smiles when obsessed with the worst-case scenarios.

Yet another reason I suggested keeping a journal is that when you bring this with you to the PT sessions, they’ll recognize how motivated you are to get to the bottom of this. This, in turn, should give your PT enough motivation to bring their A game. Furthermore, it subtly suggests that you are not afraid to escalate this matter to the supervisor. Obviously, don’t make such statements outright; no one reacts well to threats. If the PT has half a brain (and it sounds like they do), they’ll know they are dealing with someone who won’t settle for mediocre treatment. When you show them your journal, casually show that you are mentioning their name in the treatment procedure.

If this doesn’t work, address the matter with someone in charge and document the grievance. Again, don’t make outright threats. However, anyone who made it to upper management will know to treat the matter seriously once they know you are documenting.

Thx for the reply 56.

Had another session of PT on Saturday; this time with the other therapist that works on assessing posture. We went over the serratus exercises and she noted that although I still have the winging its starting to look a bit better. She also told me that my natural posture is more of a “sway back” at the moment, along with the fact that my left shoulder is anteriorly rotated. She was mentioning how this postural distortions could and likely are the cause of the referred arm pain I am feeling… noting that pain if you have arm pain it usually comes from higher up.

Not sure if I mentioned this to you, but about two months ago I started having trouble swallowing; at the time I didn’t think anything of it, but more recently I have started having tinnitus or ringing in my left ear only. Some of these symptoms seem to be consistent with thoracic outlet syndrome. Any thoughts on this 56? As I type this my left ear is almost completely plugged up and ringing LOUDDD, there is some pain as well.

Do you think I should go to a doctor and get all this check out and give him my injury history? Or should I continue with PT and see what happens? I’m starting to think I should maybe go see a neurologist or even a thoracic outlet physician but don’t want to jump the gun and assume I have something simply based off a symptom list.

Thx for your help

[quote]Wawaweewa25 wrote:
Thx for the reply 56.

Had another session of PT on Saturday; this time with the other therapist that works on assessing posture. We went over the serratus exercises and she noted that although I still have the winging its starting to look a bit better. She also told me that my natural posture is more of a “sway back” at the moment, along with the fact that my left shoulder is anteriorly rotated. She was mentioning how this postural distortions could and likely are the cause of the referred arm pain I am feeling… noting that pain if you have arm pain it usually comes from higher up.

Not sure if I mentioned this to you, but about two months ago I started having trouble swallowing; at the time I didn’t think anything of it, but more recently I have started having tinnitus or ringing in my left ear only. Some of these symptoms seem to be consistent with thoracic outlet syndrome. Any thoughts on this 56? As I type this my left ear is almost completely plugged up and ringing LOUDDD, there is some pain as well.

Do you think I should go to a doctor and get all this check out and give him my injury history? Or should I continue with PT and see what happens? I’m starting to think I should maybe go see a neurologist or even a thoracic outlet physician but don’t want to jump the gun and assume I have something simply based off a symptom list.

Thx for your help[/quote]

No, you never mentioned anything about your left ear in your previous posts. And, yes, if the pain persists, you should see a specialist.

I am not accusing you of this. Let me be absolutely clear about that. However, I had this one client that came up with a different ailment every month. It was as if she found enjoyment in constantly being ill. To this day, I cannot help but wonder if there wasn’t a deeper set of issues she needed to resolve. She couldn’t control the many unpleasant factors in life but she could control the fact that she hurt, for no reason, on a given day. It was my hope to replace that with the empowerment one can achieve in getting stronger and healthier. Unfortunately, some battles cannot be won. I eventually asked her to find someone else.

The theory that there is an emotional component to chronic pain has been around for quite some time. Of course, if someone breaks a bone, tears a muscle, etc. they MUST get the appropriate care. However, those who often suffer from phantom pain can, IMO, stand to benefit from a careful examination of things outside the weight room.

Thx for the reply bro; only reason I’m mentioning these odd ball symptoms now is because initially I never would have thought they could be linked together. My therapist encouraged me to keep the journal and right down anything that I think might be related. I’ll admit I have my bad days with this whole situation since its been so damn long, at times I wonder if I will ever be back to 100%, especially since I’m still young. But I agree, there’s a bigger picture and I have to keep that in mind.

Additionally I mentioned the posture from the other therapist because she feels that the sway back posture I display, anteriorly rotated shoulder etc is what is causing the issue down my arm.

I’m going to stay the course with my current therapy, see what happens and if I improve; i think setting smaller goals will keep me focused and prevent me from having mini meltdowns.

So my first goal is to correct my winging; which I understand is fairly common after a shoulder surgery and usually resolves within a couple months. After the winging is corrected I will set a new goal.

Also keep in mind that due to the whole “not knowing exactly what I have” yet is where a lot of the panic starts to set in from as far as theories on what I have; nerve entrapment; thoracic outlet, scar tissue; etc etc. I don’t like doing that either, but obviously this is a somewhat complex situation.

[quote]Wawaweewa25 wrote:
Thx for the reply bro; only reason I’m mentioning these odd ball symptoms now is because initially I never would have thought they could be linked together. My therapist encouraged me to keep the journal and right down anything that I think might be related. I’ll admit I have my bad days with this whole situation since its been so damn long, at times I wonder if I will ever be back to 100%, especially since I’m still young. But I agree, there’s a bigger picture and I have to keep that in mind.

Additionally I mentioned the posture from the other therapist because she feels that the sway back posture I display, anteriorly rotated shoulder etc is what is causing the issue down my arm.

I’m going to stay the course with my current therapy, see what happens and if I improve; i think setting smaller goals will keep me focused and prevent me from having mini meltdowns.

So my first goal is to correct my winging; which I understand is fairly common after a shoulder surgery and usually resolves within a couple months. After the winging is corrected I will set a new goal.

Also keep in mind that due to the whole “not knowing exactly what I have” yet is where a lot of the panic starts to set in from as far as theories on what I have; nerve entrapment; thoracic outlet, scar tissue; etc etc. I don’t like doing that either, but obviously this is a somewhat complex situation.

[/quote]

No worries at all. Keep utilizing the journal. Think of this situation as a puzzle. Every time you get that one piece, take comfort in the fact that you are that much closer to a resolution.

Make nice with your therapists. As a strength/conditioning coach, I can attest that clients who bring a positive mindset, strong work ethic, and friendly demeanor automatically get the red carpet treatment. Of course, I do my best to treat all clients well, but we are all human and the law of reciprocity never sleeps. In other words, the more you are liked and respected, the better the attention they should give you. That said, if you’re unlucky enough to get an industry whore who will exploit that to just give you a base-level amount of service, find another - pronto - and discreetly make your grievance known to the proper personnel.

Yo 56, little update:

So as mentioned the current therapist I’m with has decided to focus his efforts on using ART on the inner elbow (lateral aspect I believe?) and to be honest, I feel good at times and in pain at others. So through I recommendation of a good friend in the industry I made an appt to go get another opinion from a very well known, respected orthopedic doc since my previous doc keeps telling me my inner elbow pain is unrelated to my impingement; which has we both know is def not the case.

From the minute I got there I got incredible treatment, prompt service and a very thorough examination by the doctor. He examined me in all 3 planes of motion, I mentioned the issues I was aware of (winging in both sides, right side worse than the left and the ulnar nerve irritation).

When I was on the table laying down he tested my internal rotation with my arm out to my side and attempting to rotate down. The left side barely had 20 degrees of rotation, which I believe is suppose to be around 60? In either case, he exclaims “that’s your problem right there.” You can’t rotate your arms due to scapular dyskinesis. He tested my ulnar nerve and noted that I do show a bit of irritation since a slight tap on the nerve was immediately felt in my hand, but said the main issue is the dyskinesis.

He recommended that I go to a different therapist and focus entirely on this issue; which is soft tissue mobilization of the lats, subscap and pec minor. Continue with the postural stuff I’m working on and that I should respond really well to therapy.

The most telling test was I had my arms out in extension abducted about 45 degrees and he pressed down to test serratus function and my left arm just went down like a twig. Right side was weak as well, but the left was much worse.

So now I’m in a weird position; I had scheduled out with my current CSCS until the end of November, but either need to tell him to focus on this issue (without sounded like I’m doubting his treatment) OR, tell him I got referred to another therapist. The other reason this is a big dilemma for me is because I’m going to be applying to PT school next year and I’m good friends with my current therapist, so I don’t want to burn that relationship.

Would love to hear your take on the latest developments and how I should go about talking to my current therapist.

Once again, thx you so much 56, you have been hitting the nail on the head from the get go.

[quote]Wawaweewa25 wrote:
Yo 56, little update:

So as mentioned the current therapist I’m with has decided to focus his efforts on using ART on the inner elbow (lateral aspect I believe?) and to be honest, I feel good at times and in pain at others. So through I recommendation of a good friend in the industry I made an appt to go get another opinion from a very well known, respected orthopedic doc since my previous doc keeps telling me my inner elbow pain is unrelated to my impingement; which has we both know is def not the case.[/quote]

I honestly lost count of the times I told someone, “Get another opinion because your doc is an overpaid imbecile.” And that’s the G-rated version. Furthermore, I honestly lost count of the times the person, upon seeing other clinicians, told me I was right.

The truth of the matter is most medical doctors are not that intelligent. They’re very very good at remembering things (which is how they got through med school). However, the ability to take in all relevant information and distinguish what is important from what is not, is a skill they truly lack.

[quote]Wawaweewa25 wrote:
From the minute I got there I got incredible treatment, prompt service and a very thorough examination by the doctor. He examined me in all 3 planes of motion, I mentioned the issues I was aware of (winging in both sides, right side worse than the left and the ulnar nerve irritation).

When I was on the table laying down he tested my internal rotation with my arm out to my side and attempting to rotate down. The left side barely had 20 degrees of rotation, which I believe is suppose to be around 60? In either case, he exclaims “that’s your problem right there.” You can’t rotate your arms due to scapular dyskinesis. He tested my ulnar nerve and noted that I do show a bit of irritation since a slight tap on the nerve was immediately felt in my hand, but said the main issue is the dyskinesis.

He recommended that I go to a different therapist and focus entirely on this issue; which is soft tissue mobilization of the lats, subscap and pec minor. Continue with the postural stuff I’m working on and that I should respond really well to therapy.

The most telling test was I had my arms out in extension abducted about 45 degrees and he pressed down to test serratus function and my left arm just went down like a twig. Right side was weak as well, but the left was much worse.
[/quote]

This is what I meant when I said in my 10/3 post. Each piece you find gets you that much closer to completing the puzzle.

[quote]Wawaweewa25 wrote:
So now I’m in a weird position; I had scheduled out with my current CSCS until the end of November, but either need to tell him to focus on this issue (without sounded like I’m doubting his treatment) OR, tell him I got referred to another therapist.
[/quote]

The end of November is 6 weeks. That’s too much time to waste. Hell, 6 seconds is too much time to waste on what’s NOT working.

If your current PT is a true professional, he should be open to new information - even if it contradicts his current line of thought.

On one hand, the other PT recommended by your current doc may not be any better. It could simply be a case of that doc referring patients to that particular individual. This sort of network happens all the time.

(I actually knew an ortho who referred patients to his brother in-law. There’s some integrity right there.)

On the other hand, if this other PT has a close working relationship with your current doc, this can benefit you AS LONG AS this PT doesn’t just blindly follow the doc’s orders but can objectively make modifications and give positive input.

I would at the very least talk to the other PT and more or less interview him. Ask for references and follow up.

[quote]Wawaweewa25 wrote:
The other reason this is a big dilemma for me is because I’m going to be applying to PT school next year and I’m good friends with my current therapist, so I don’t want to burn that relationship.

Would love to hear your take on the latest developments and how I should go about talking to my current therapist.
[/quote]

After you visit with the new PT, call your current one and tell him the situation. If he’s an adult, he’ll appreciate candor much much more than passive-aggressive behavior. IF he genuinely says that he’ll take this new information and apply it AND you believe him, your relationship and therefore your treatments will be that much more effective. In other words, you have now created an emotional bond. You are no longer just a name on a file.

Unless, of course, the new PT impresses the hell out of you. Then you have to go where the best treatment is. This is, after all, your health we’re talking about.

[quote]Wawaweewa25 wrote:
Once again, thx you so much 56, you have been hitting the nail on the head from the get go.

[/quote]

And that’s why over 90 percent of my clients re-sign every month.

I rather envy you in your chosen profession. The curse of being a Strength and Conditioning Coach/Personal Trainer is that, quite often, people that can and should be helped don’t want it because they, as they thump their bible (be it cross fit, squat every day, bilateral movements rule, if-you’re-not-doing-the-big-three-you’re-lame, etc. etc. etc.), will smugly tell me, “Thanks bro, but I got it alllllll figured out.”

Well, as you’ll soon learn when you become a PT, a great majority of these dunces WILL have to see you and others like you when the inevitable occurs. That, my friend, is job security.

Solid advice and def something I will take into consideration. I tend to agree with you, I should at the very least check out the other therapist and get a map of how he plans to treat me and get me put back together.

Both my friend and the PT I was referred to were trained by the new ortho I saw. But again as mentioned he def cares about his patients and to say the difference was night and day would be an understatement from visits to previous orthos. The PT he wants me to see is the owner of his own clinic and has nearly 20 years experience, he also specializes in scapular dysfunction, so I really do want to check him out.

I’ll take your advice and talk to my current PT and figure it all out.

One thing I want to ask you about is my left shoulder is anteriorly rotated. Because of this it sits forward and lower than my right shoulder. I’ve been told that because of this lower position the nerves around the neck (brachili plex??) are getting compressed and is likely the source of the muscle tightness I feel in my scalenes. My therapist has recommended that when I’m sitting (very rarely) that I rest my right hand underneath my left elbow in an effort to get that left shoulder up a little bit, where it should be. Wanted your thoughts on this? And what I could do to get it back into place. I know a big part of this is a very weak serratus and rhomboids. But in my 4 month post op therapy stint, I they focused quiet a bit on strengthening the mid/lower traps and rhomboids. Stretching the pec minor and doing manual therapy on the lats. I believe my subscap didn’t get the attention it needed because its very tight as well. Was told that external rotation strengthen was solid.

For now I plan on continuing with my at home serratus exercises and then waiting to talk and potentially see the new therapist.

Would like your input on the questions above and also I know everyone is different and it truly depends, but do you have a ballpark idea of how long I’m looking at in rehab before I’m better? In my head I’m thinking 3-6 months, but I hope its less than that! haha

^^^

The anterior tilt of your left scap and the sub-acromial decompression surgery you had back in May are most likely related. Remember - anterior tilt of the scap will cause a host of problems, one of which is SAIS (subacromial impingement syndrome).

Starting to add up now, isn’t it…?

This could be a chicken or the egg scenario. Did you always have anterior tilt of the scap as well as a type 2 or even 3 acromion? Or was it a case of too much pushing and not enough prehab i.e. scap retraction/depression work that caused the imbalance? Or possibly a combination of the two scenarios. The bottom line is you now know first hand that strength training in the absence of resolving any underlying dysfunction is a losing bet.

No one in his right mind will think of building a house on an earth quake fault line. Yet that’s exactly what so many do. And with the human body, the metaphorical fault line is ever shifting.

As I stated in my very first post, you will need to become very very good friends with exercises that retract as well as depress the scaps. You say that your external rotation is good. Well…that could just mean your teres minor/infraspinatus are firing reasonably well. I caution not to make the mistake so many do and think that just because they passed some assessments, they have carte blanche to ignore prehab, constantly work on refining technique, taking deload weeks, and throwing down on their pet lifts (just read some of the threads in the Injury section to see how faulty this logic is).

As for rehab time, I’ve stated before that your ortho and pt (whomever you decide) will be able to give a realistic time line.

As always, a positive mindset is greatly beneficial.

[quote]56x11 wrote:
^^^

The anterior tilt of your left scap and the sub-acromial decompression surgery you had back in May are most likely related. Remember - anterior tilt of the scap will cause a host of problems, one of which is SAIS (subacromial impingement syndrome).

Definitely starting to add up, BIG TIME!! Realizing what I’ve learned over the past week about my condition, its really a surprise that I only have a slight ache in my arm, considering how out of whack I am.

Starting to add up now, isn’t it…?

This could be a chicken or the egg scenario. Did you always have anterior tilt of the scap as well as a type 2 or even 3 acromion?

No, never had an anteriorly rotated shoulder until I hurt myself pressing, the day all this madness started; but apparently I’ve always had a type 2 acromion.

Or was it a case of too much pushing and not enough prehab i.e. scap retraction/depression work that caused the imbalance?

I’m sure this is a large contributing factor to it; prior to the past 2 years, I was the typical ego lifter, who did the typical 5 day split, without a clear understanding of length tension relationships, muscle imbalances etc etc. Also I NEVER use to pull my scap back and down when getting pressing… pains me to look back at how wrong I was lifting.

Or possibly a combination of the two scenarios. The bottom line is you now know first hand that strength training in the absence of resolving any underlying dysfunction is a losing bet.

Exactly and this is the biggest reason I educate all the patients I see at the clinic I work at on these very facts.

No one in his right mind will think of building a house on an earth quake fault line. Yet that’s exactly what so many do. And with the human body, the metaphorical fault line is ever shifting.

I’m sure you see it first hand, I know I do, even in rehab you see the terrible form and wonder “how in the world did they not get injured sooner?”

As I stated in my very first post, you will need to become very very good friends with exercises that retract as well as depress the scaps. You say that your external rotation is good. Well…that could just mean your teres minor/infraspinatus are firing reasonably well. I caution not to make the mistake so many do and think that just because they passed some assessments, they have carte blanche to ignore prehab, constantly work on refining technique, taking deload weeks, and throwing down on their pet lifts (just read some of the threads in the Injury section to see how faulty this logic is).

Your absolutely right; I’m weak all around right now, and while external rotation is better than internal, both need A LOT of work. Actually had the owner of the clinic I work at take a look today and he manually stretched my posterior capsule and showed me how much internal rotation I gained just from that; probably about 30-40 degrees. I’m actually going to start working with him on my rehab because the other place hasn’t even called me back yet if you can believe that. He mentioned that I display GIRD; glenohumeral internal rotation deficit, which is easy to see with the tight posterior capsule.

As for rehab time, I’ve stated before that your ortho and pt (whomever you decide) will be able to give a realistic time line.

I agree, just got excited to FINALLY have some sort of clue as to what is going on with me; not knowing was driving me crazy.

As always, a positive mindset is greatly beneficial.

I think reading this thread you can see the wave of emotion I have been going through for the past several months. I FINALLY feel like I’m on the right track and I owe a big part of that to you. Will keep you in the loop.

[/quote]

Hey 56, some updates and thoughts.

So finally had the new PT place I was recommended to call me back and schedule me in for my eval. Therapist was very nice and knowledgeable, explained my whole story (impingement, surgery, ache in arm, anteriorly rotated shoulder, winging etc) and he gave me some really good advice and rehab stuff.

He said my lats and subscap although tight were not that tight compared to teres minor. He showed me how to dig into that while lying on my back with my hand straight up internally rotated. One thing that I’m worried about is there is a possibility I might have labral issues. Apparently my therapist told me that the doc who did my surgery often misses labral tears unless they are huge. Futhermore at the time of my post op appt my ortho told me that I had an “abnormally large space around my labrum.” He called it some medical word, which I don’t recall. Not sure if labral issues would further help to explain the anteriorly rotated shoulder or if its simply all serratus.

It was also noted that when I abduct my arms overhead either in front or out to the side that my shoulder lifts with it as soon as I get past parallel, instead of depressing as it should. Not sure if the internally rotated humerus is causing this??

Next he showed me a few different ways to stretch the pec minor instead of the common pec wall stretch. Then we worked on a few exercises to do at home, mainly all targeted at learning how to retract the scap before pulling and strengthen my external rotators.

Lastly we worked on pelvic positioning since I do display an anteriorly tilted pelvis as mentioned before. Been working on this with a home program consisting of hip flexor stretching, bridges, planks and some thoracic mobility work on the foam roller.

Now for the bad news… I’ve had over 30 visits of PT this year so far, and so far my insurance is still covering it since it looks like with my surgery they see that its medically necessary. However this new placed warned me at any point they could decide that they will not cover me anymore and then I’d be stuck with the full bill, which is not something I can afford right now.

I do have a friend who actually use to work at the same PT place with the guy who treated me last week, so I’m hoping I can work something out with her since she now runs her own home practice.

My other option is to apply to get a job at the this PT place since I’m going to be applying to PT school next year, then I could get his advice and care as I go through the rehab.

Or I could take all of what I have learned over the past year and work on my own rehab program at home until the start of the new year. Would likely focus on core strengthening, serratus work, digging into teres minor manually and then also using a lacrosse ball to get in there, my subscap and my lats along with stretching my pecs. Then once the new year hits, start going back to PT.

Let me know what your think

[quote]Wawaweewa25 wrote:
I’ve had over 30 visits of PT this year so far, and so far my insurance is still covering it since it looks like with my surgery they see that its medically necessary. However this new placed warned me at any point they could decide that they will not cover me anymore and then I’d be stuck with the full bill, which is not something I can afford right now.

I do have a friend who actually use to work at the same PT place with the guy who treated me last week, so I’m hoping I can work something out with her since she now runs her own home practice.

My other option is to apply to get a job at the this PT place since I’m going to be applying to PT school next year, then I could get his advice and care as I go through the rehab.

Or I could take all of what I have learned over the past year and work on my own rehab program at home until the start of the new year. Would likely focus on core strengthening, serratus work, digging into teres minor manually and then also using a lacrosse ball to get in there, my subscap and my lats along with stretching my pecs. Then once the new year hits, start going back to PT.

Let me know what your think[/quote]

Go with Option B: get a job at the PT place. You will have a steady paycheck (again, think of ALL the knuckleheads who think they know what proper training is and end up hurting themselves = job security). You will make valuable contacts in the field. You will gain experience in your field. And, quite possibly the most important, you will get treatment.

As for your friend who now runs her home practice, unless she can offer the same benefits as the other pt, the odds are not in your favor if you take this route.

It’s all about increasing the margin of success in your favor while decreasing the margin of failure. Doesn’t matter whether it’s career, training, crossing the street.

The third choice is not what I advise. You need an objective view point. You simply do not have that right now.

The best weight lifters have coaches.

The best body builders have full time coaches or at least contest prep coaches. Look at Phil Heath.

The best athletes have coaches. Both the Cardinals and Rangers have hitting and pitching coaches.

The wealthiest people have financial advisers and accountants.

You’re at a point now where every mistake will be costly. You need someone who cares about your well being yet is distant just enough to provide objectivity.

Alright, finally got everything cleared up with my insurance and turns out I’m completely in the clear to continue with my PT. Won’t get into the details except to say the front desk receptionist at this clinic is a complete beeyatch! But the therapist is excellent; so its all good.

I had my re-eval with the doctor today; noted that my GIRD was still pretty prominent and understood that I only had one session of PT since I initially saw him. He had my abduct my arms horizontally and straight in front (sagittal plane) and said that I do show some improvement in scapular control. Also my left shoulder isn’t drooping as much as it was previously, but still needs some improvement.

At home, I’ve been doing some soft tissue work with a lacrosse ball for my pec minor and started using Mike Renold’s approach for posterior capsule tightness by doing the cross body stretch against the wall.

Also foam rolling my lats and digging into the area just outside my armpit, i think where teres minor meets the humerus?

Also found some good exercises by searching the net; variations on prone exercises aimed at strengthening the mid/lower traps, rhomboids, and external rotators.

I’ve laid off the serratus work i was doing with my previous therapist, but think I might bring back some wall slides.

These guys all swear by the sleeper stretch at 70, 90 and 110 degrees, but like you know, after reading Renoid’s piece I’m thinking of sticking with the cross body stretch.

I notice that when I do the sleeper stretch (might be due to pushing down too hard), I feel it in the side of my arm as well as my posterior capsule; where as with the cross body against the wall I only feel it in the back of my shoulder as intended.

The doctor said that with 6-8 weeks of consistent therapy I should see tremendous improvement and I’m hoping be clear to be able to get back in the gym CAREFULLY and being smart with program design and avoiding OH movement for now and likely forever.