T Nation

Modified Programming for Injury?


#1

Hey everyone,

I have been running 5-3-1 for a few months and love it. Before I started the program I agitated a nerve and have been trying to fix it for some time now. The issue is being considered TOS or Thoracic outlet syndrome. It sounds like I need to strength some areas in my back and correct some over due posture issues. I am working on it but the issue I run into is OHP. Every time I try it it ends up in pain that night or for a few days.

My question is should I not OHP in the program or replace OHP day with different exercises to strengthen my shoulders and back?


#2

Hi!
I’m a physio and see these issues quite a bit. Usually strength isn’t the issue, especially if you have been doing the 5-3-1 program. If your symptoms are aggravated with OHP I can assume you have some mobility issues with regards to shoulder flexion and/or thoracic spine. I can assume you are trying to improve t-spine extension by way of extension based mobility drills. Quite often t-spine rotation is not thought of and this in fact is the way the thoracic spine posture improves and functions. So perhaps target rotation of your t-spine. Secondly work on improving shoulder flexion. The lat dorsi is usually the culprit here. It’s a massive muscle and so strong, and given its anatomy it can be a key component in decreasing t-spine AND shoulder mobility (particularly flexion and external rotation - both needed for OHP)
Hope this helps. I cant give you specific exercises or mobility drills as everyone is completely different. But just some advice…clear t-spine rotation and shoulder extension and external rotation (by way of the lat dorsi)
Good luck. Following to see how you go!


#3

Thanks for the reply. I was given some exercises like a door stretch and lying on a foam roller to open the shoulders up. As for the back muscles they have me doing mid trap raises and a y raise similar to the mid trap raise, some neck stretches but as I’ve found they appear to be doing little to improve my issue. I have tried OHP with dumbbells and with low weight, 10 lbs, I can keep my back tight and do the reps but still causes the injury\condition to come back in some form. I had noticed when doing the OHP with the barbell that my lower back appeared weak and at times noticed that by trying to keep my chest up that I flex my spine pretty badly. It might a sign but might not be.


#4

So it seems like the focus of your rehab has been to release the pec/anterior shoulder and strengthen the mind back. If this hasn’t provided relief after 3-4 times of performing it then my personal opinion would be to change tactics.

So If we think about the anatomy of the lat, it travels from the anterior shoulder to the lumbar spine. If we try and lengthen it at one end (I.e. at the shoulder during OHP) it will try and shorten at the other end (the lumbar spine) to feed you some slack. This will create and overextended lumbar spine during shoulder flexion (OHP). When at rest, this can also cause rounded shoulders and kyphosis as the anterior is being pulled down and forward to again create more slack in the system.

So give yourself a good banded lat stretch like this picture. But notice in the picture his palm is facing down, the stretch is more effective with palm facing up. During the stretch dont let your lumbar spine compensate by extending, you want to maintain neutral to flexion in the lumbar spine.

Accumulate a few minutes on each shoulder then re test a light OHP.

Prior to the stretch do a couple of OHP in the mirror and get a friend to take photos, then compare after the stretch.

We are looking for full external rotation of the shoulder and no lumbar spine extension after you have done the stretch.

Good luck.

Cheers

Adam


#5