T Nation

Mystery Shoulder Injury


#1

Hello, I have a shoulder issue and have no idea what is causing this pain, if you can't be bothered reading all of the text, read "The Issue" bit and skip to the end, please help if you can, thanks.

The Issue

I've had pain in both shoulders for around 2 years when doing any chest exercise and pull ups. It is inside the shoulder and gets progressively worse with each set, fatiguing if you will, before the targeted muscles. I also get this clicking in my rotator cuff area in both shoulders when lifting my arm above my head, when just above parallel. You can actually hear the clicking on the right side when doing overhead presses, and there is some pain and tightness during these, but not like pull ups and chest exercises.

The only exercises I can do with no pain is horizontal pulling exercises such as bent over rows, lower body and core. I could do tricep pulldowns at the end of last year but the shoulder issue caught up with that muscle group aswell, obviously I cant do overhead tricep extensions or any exercises lieing on the bench and so I am limited here to. I also get pain doing bicep curls. When lieing flat on my back I can actually let both arms hang parallel to side of me and cause pain as I let the humerus move 'fall' in the joint.

Action Taken So Far

I've been checked over by a General Practioner Doctor and multiple physical therapists testing for shoulder impingement and range of motion etc. and nothing is wrong there. I've been to multiple physical therapists for this issue, during this time period, I laid of weight lifting for my upper body all together for around a year to let my shoulder rest, this made no difference. I am now with a private physio who works with my countries' football team (Wales, UK) and charges £44 an hour and seems like he is good at what he does.

Firstly, he found my rotator cuffs were weak during external rotation and so prescribed me with a strong resistance band to do external rotations every night. I used my bodybuilding knowledge and progressively overloaded by wrapping my hand round the band more times to increase resistance. I had also incorporated push up plusses into my daily routine to increase my serratus anterior strength as i've read a lot about this muscle in regards to scapula instability and shoulder injuries. I had done this for a couple of months and found even with tape around my shoulder and scapula to increase stability, still had the pain in both shoulders when doing all of the mentioned exercises.

So, I went back to him, and he concluded that my rotator cuff strength is now good and so I suggested maybe it could be thoracic immobility causing this issue as I have had a tight neck and lower back for years. He done a few tests for thoracic mobility and found I was actually quite mobile and would categorise me as being a flexible person around my joints, and that this couldn't be the issue, this made sense as I have hypermobility in my ankles.

He then made me do press ups and recorded my back with my phone, and showed to me how much my shoulder blades were moving. This suggested to him that I have scapula instability and so told me to practice doing bodyweight exercises with as little shoulder blade movement as possible (of course there must be some movement). He also prescribed me one hand medicine ball push ups to target the muscles that stabilise the shoulder blades directly. So I've been doing these medicine ball push ups daily for around 8 weeks, and progressed to 2 medicine ball push ups after the first week.

I focus on keeping the medicine balls and shoulder blades as still as possible. I can now do sets of 15+ repetitions where the medicine balls barely move, my shoulder pain is what actually stops me from completing more repetitions. I can see how much my SA have actually grown from doing all this too. I also decided a few weeks ago to incorporate some direct lower trapezius work to see if this will give me any pain relief and increased scapula stability.

Now, I have tested the pain, and it is still pretty much the same during all of the exercises. So after a year's rest and all this work, if it is NOT the following shoulder issues, what could it be?

Shoulder Impingement
Rotator cuff weakness
Thoracic Immobility
Scapula Instability

Should I go back to the physiotherapist? If I go to a doctor again, the same range of motion and shoulder impingement tests will be done and can imagine i'll just be referred back to a physiotherapist again.

Can anyone help me please, all I want to do is bodybuild again and am starting to lose hope. Please reply and help if you have any advice or any idea on my issue, thanks.


#2

It sounds to me like it may be a labral tear although this is uncommon to have in both shoulders and your PTs should have diagnosed it. You definitely have some extreme shoulder instability (especially in the anterior part of your shoulder capsule). Are you hypermobile? Do you know your Beighton score (link below)?

http://www.shoulderdoc.co.uk/article.asp?article=645

Your anterior capsule is supported by the subscapularis muscle as well as your pectoralis major. Have you done any internal rotation work to strengthen these?

A good thing to do would be to raise your arm or do one of the movements that cause you pain while having someone stabilize your shoulder joint by pressing the ball into the socket. If this helps alleviate the pain, then you do need to work on shoulder stability and need to further narrow it down into what parts are unstable.


#3

If you can read french this author knows a lot Christophe Carrio (over 10 books, over 25 years training)
His website is written with a - between his name
A you tube search might help.
I had shoulder issue and it might be quite different.
Do you have any trigger point
Did any foam Rolling
Used a stick for self massage
Any pic including your elbows

What realy helped me was broomstick stretches and bands pull aparts (after 5 weeks of rest)
I never use a straight bar, i use neutral grip, for push ups i use 2 7 pounds hexagonal dumbells or you can test on your knockles on some carpet/folded towels or even better 2 free moving handles(like rings) for vertical pulls and pull backs/rowing
Pressings are dumbells or macines offering the neutral grip option

Last 7 months my 2 shoulders are fine
I am more flexible than average(my whole life) but i do not have hyperlax issues
Just ask if you want precisions
All the best !


#4

You have weak/poorly functioning glutes and tight IT Band and Rectus Femoris.


#5

Really? Although many people have this problem, it is not the ultimate cause of every musculoskeletal problem as you write on every injury post. In this case, the person is hypermobile (may even have Ehler's Danlos syndrome), which is strongly genetic and relates to improper collagen synthesis in the connective tissue.


#6

while weak/poorly functioning glutes and tight hip flexors are super common and can definitely contribute, I am with smallmike on this that it is unlikely to be a direct cause of the condition.

Never hurts to get glute strength up though...

smallmike, if you don't mind my asking, do you come from a medical background?


#7

Actually it is the cause of almost every musculoskeletal condition. Of course there are exceptions, but until you rule this out, don't bother looking anywhere else.

I see it ALL the time.

Something wrong with my shoulder, no like really it feels weird something is really wrong. Foam Roll do this glute work, does it feel better. Actually yes, its gone.

That is the easiest most common explanation for ANYTHING going wrong with the body. But people want to look for more exotic issues.


#8

Also, look around on the post's I'm posting on. Your right. I am posting the EXACT same thing on almost every injury post. Ockham's Razor dude. Everyone has imbalances at the hip. No one knows how to fix them. I have seen almost every injury being described here as a direct result of issues at the hip.

Could I be wrong? Sure! But the simplest explanation is usually the right one. Keep looking at the posts I'm making and watch how people realize I am telling them things about their body they didn't even realize. It's just because everyone has the same problem and no one knows how to fix it.


#9

Also, hypermobile or hypomobile, it's often the same root issue. Hypermobile can't create stability, hypomobile can't create mobility or stability in the correct position.

Not sure why that is, some bodies let things float free when they can't lock down shit, some bodies lock stuff down and don't allow things to happen it can't control. Very similar.