Scapular Dyskinesis and GIRD Rehab Advice

BReddy · January 7, 2012, 1:19am

[quote]Wawaweewa25 wrote:

[quote]BReddy wrote:Sorry it took me so long to reply. Been out of commission lately with ACL surgery.

How things been going?[/quote]

Damn that stinks! Hope your feeling better and I’m sure the fun is about to start with your rehab.

For the past two weeks I’ve been going back to the gym and doing my strengthening routine a couple times a week.

Push Up Plus
Prone T’s, Y’s W’s
Rows
Lats

However, when I go into therapy the day after I rehab at the gym he’s noticing that my posterior capsule feels tight again and that humerus will fall back into internal rotation?

After some thinking we both agreed that perhaps the Push Up Plus for serratus is some how aggravating me for some reason. Which ultimately worries me because there could be something else going on.

I’ve been extremely diligent with my rehab and might be asking my doctor for an MRI next week just to make sure I don’t have anything else going on. Lord knows its been a long harsh road and at times I get discouraged and feel like I’ll never get better. Then other times I feel like I’m getting there. I’m sure you know what I mean.

Infraspinatus is very tender when he works on it in general and then esp after rehab. I know my original MRI prior to my surgery mentioned partial cuff tears, but my previous surgeon said that those were simply an artifact of the MRI? He also said I have an abnormally larger space around my labrum which might be wear the clicking I get comes from.

I laid off rehab work yesterday and today and it feels decent to good. So something is aggravating it and when that happens, then the original elbow pain comes back a little bit since the bicep tendon is getting over-loaded and I get achy in my posterior shoulder/cuff area along with lats too.[/quote]

At this point I would highly suggest axing the rows and lat work. If you’re lats are still tight the last thing you need to do is any strengthening work for them. The lats are internal rotators and if they’re excessively strong in relation to other muscles, they will hold the humerus in internal rotation.

I know everyone goes nuts about “Just do a ton of pulling and your shoulder will feel better!” But it’s just not true. I have yet to see a single person who had “weak” lats. At least in comparison to their other muscles.

Also, a tight/tender infraspinatus is a typical symptom/cause of a tight posterior cuff. The rowing and lat work isn’t helping that either. When the shoulders flex the lats and infraspinatus both extend the humerus back into place. By doing those exercises you are potentially making the infraspinatus and lats tighter!

Also, I forget if I mentioned this but often times what people mistake as dominant upper traps is actually dominant rhomboids. The rhomboids will give the visual of a shrugging scapula and people go, “Oh, there you go, too much upper trap.” But if you watch closely, like in those videos I showed you, you can see the shoulder is actually elevating less than it should be. However, it is retracting wayyy more than it should be during upward rotation due to the tight rhomboids.

Your shoulder really needs work on strengthening the upward rotators and loosening up the downward rotators and posterior/inferior cuff. Right now you have:

Push up plus: An ok exercise for upward rotation. Because the arms can’t actually move upwards (they’re fixed by the ground) this isn’t the number 1 choice for upward rotation. Not bad, not great.

Ts, Ys, Ws: All work the infraspinatus. Which is already tight on you. Ts are also working the rhomboids = a no no. I like the Ys though.

Rows and lats: While these work the lower trap, if the form is STRICT, they are also working the rhomboids and lats. So while you may strengthen the lower trap, you aren’t balancing yourself out because whatever strength work is done for the lower traps here is also done by the rhomboids and lats. So you break even. What you want is to be doing exercises that are UNbalanced in favor of the lower traps and serratus. Exercises that work those muscles a lot but work the rhomboids and lats very little.

Your posterior capsule should be looser, not tighter, after your therapy. Do a bunch of sets of those shrugs I showed you and I guarantee your GIRD will diminish in just 15 minutes.

Best of luck!

Wawaweewa25 · January 9, 2012, 10:53pm

Hey Breddy:

Thx for the detailed reply, hope your post op rehab is coming along well.

A lot of what you say makes sense and my infraspinatus is VERY tender esp after I do some strengthening.

The push up plus was causing me to have a bit of fatigue and almost like a burning sensation in my bad shoulder; so my therapist told me to scratch those as well.

I guess that’s my problem right now, I want to strengthen, but I’m not sure which exercises I should do, that won’t aggravate my tight lats, infraspinatus etc. Form is VERY VERY STRICT on these. Even today, sitting in a desk for a couple hours and my posterior capsule is aching, arm feels a little tight from taking notes and shoulder feels like crap. Granted I haven’t had any therapy in a week.

I have completely eliminated my GIRD. My doctor tested me for it and several other tests last week. He said my rehab should focus on lat stretching, soft tissue stuff and then see how that goes.

However we will see what the MRI says. I’m at the point where I would be kinda shocked if there wasn’t anything going on in there, since I have been working on this for so long, and while its improved its still not close to 100%.

BReddy · January 10, 2012, 4:15pm

[quote]Wawaweewa25 wrote:
Hey Breddy:

Thx for the detailed reply, hope your post op rehab is coming along well.

A lot of what you say makes sense and my infraspinatus is VERY tender esp after I do some strengthening.

The push up plus was causing me to have a bit of fatigue and almost like a burning sensation in my bad shoulder; so my therapist told me to scratch those as well.

I guess that’s my problem right now, I want to strengthen, but I’m not sure which exercises I should do, that won’t aggravate my tight lats, infraspinatus etc. Form is VERY VERY STRICT on these. Even today, sitting in a desk for a couple hours and my posterior capsule is aching, arm feels a little tight from taking notes and shoulder feels like crap. Granted I haven’t had any therapy in a week.

I have completely eliminated my GIRD. My doctor tested me for it and several other tests last week. He said my rehab should focus on lat stretching, soft tissue stuff and then see how that goes.

However we will see what the MRI says. I’m at the point where I would be kinda shocked if there wasn’t anything going on in there, since I have been working on this for so long, and while its improved its still not close to 100%.

[/quote]

That’s one thing we haven’t talked about re: your daily life.

Do you take a lot of note? What position do you take them in?

I remember I used to lean on my elbow a fair amount. This isn’t good for the shoulder because the pressure from the desk or whatever you are taking notes on pushes the elbow, and then the shoulder, in a superior direction. Loosening up the shoulder in a superior direction but tightening up the posterior/inferior part of the capsule.

Just another idea.

Best of luck with the MRI. Keep in mind it’s very, very rare someone who is active will have a “normal” shoulder MRI. You’re pretty much guaranteed to have something going on in there regardless. Doesn’t always mean it’s the cause of your pain. Just me rambling :).

Wawaweewa25 · January 12, 2012, 3:20am

Yeah in reference to the MRI my doctor said the same thing esp considering I already had it scoped before.

I don’t do a lot of desk sitting at all. Just started up school again on Monday. Was in a desk for a couple of hours and posterior cuff area was aching. Interestingly enough, today no aching at all. I’m hyper aware of my posture at all times, although I am left handed which does cause me to flex my wrist when I write. I’m trying to adjust it and not do that.

What I did notice though is I feel tightness in my cervical spine at the base of my neck, into that left side. Upper trap isn’t very tight though? Perhaps scalenes?

Also I got transferred to our sister clinic and they have an awesome young therapist there. He poked around on me briefly and thinks that perhaps my issues are more cervical in their root and that I show signs of a some scoliosis, but nothing too drastic. He looked at my lumbar spine just for the heck of it, poked around a bit at I believe L5 on both sides. Right side felt nothing and fine, left side has been sore and hurting ever since!

He also said I’m a mess on the left side, almost no thoracic mobility and internally rotated.

Definitely feeling a bit depressed since I thought once i cleared up the GIRD the dyskinesis would be next. But this likely is a bump in the road and is showing that the strengthen I’m doing is setting me back rather than helping.

Thoughts on that and the fact that my lowe lumbar area is so tender on that same left side from simple poking around?

BReddy · January 13, 2012, 11:53pm

[quote]Wawaweewa25 wrote:
Yeah in reference to the MRI my doctor said the same thing esp considering I already had it scoped before.

I don’t do a lot of desk sitting at all. Just started up school again on Monday. Was in a desk for a couple of hours and posterior cuff area was aching. Interestingly enough, today no aching at all. I’m hyper aware of my posture at all times, although I am left handed which does cause me to flex my wrist when I write. I’m trying to adjust it and not do that.

What I did notice though is I feel tightness in my cervical spine at the base of my neck, into that left side. Upper trap isn’t very tight though? Perhaps scalenes?

Also I got transferred to our sister clinic and they have an awesome young therapist there. He poked around on me briefly and thinks that perhaps my issues are more cervical in their root and that I show signs of a some scoliosis, but nothing too drastic. He looked at my lumbar spine just for the heck of it, poked around a bit at I believe L5 on both sides. Right side felt nothing and fine, left side has been sore and hurting ever since!

He also said I’m a mess on the left side, almost no thoracic mobility and internally rotated.

Definitely feeling a bit depressed since I thought once i cleared up the GIRD the dyskinesis would be next. But this likely is a bump in the road and is showing that the strengthen I’m doing is setting me back rather than helping.

Thoughts on that and the fact that my lowe lumbar area is so tender on that same left side from simple poking around?
[/quote]

You may be rotated at the thoracic spine to the right. Pretty common thing. Although I see this much more in right handed people than left people. Hard to say without seeing you in person.

Regarding the tender upper trap: This is rrrrreally common in people with an overstretched / weak upper trap. Which I think you have. Think of it this way: A strained muscle is often times a muscle that was over stretched. We always think about that in the acute sense though. A muscle can be strained from being chronically stretched as well. Other than unique circumstances a depressed shoulder is a sign of an overstretched upper trap…which means it could be strained…strained muscles are often tender to the touch.

The tender left lumbar area could be around for a lot of reasons. The lat attaches down in that area and the lats are always overworked and tender in people. ESPECIALLY in people with shoulder issues. Remember your left shoulder is internally rotated. A movement done by the lats. This is why you see a lot of people excessively arch their lower back when they perform shoulder flexion. They are stretching the lats from the arms but the lats are tight. Thus the lats tighten from the other attachment site i.e. the lower back. So, they can perform shoulder flexion but only by arching the lower back. This way they are only stretching the rubber band (lats) from one end and not both.

Unless you truly have scoliosis, something I suspect you would already know by this point in your life, I think worrying much about your lumbar area for your shoulder issues is a bit silly though. And if you do have scoliosis but are just finding out now I’d bet a lot it’s muscular scoliosis and not congenital.

We all learn the hard way sometimes re: GIRD and the dyskinesis. After some experience you (me as well) realize attack the faulty movement and the GIRD clears up. Attack the GIRD first though and the faulty movement is still there.

Wawaweewa25 · January 17, 2012, 1:09am

Thanks for the reply as always bro, I’d be lost without you.

You mentioned I should work on strengthening the upward rotators and loosening the downward rotators and posterior cuff area.

Any thoughts on which exercises I can do for that which target the lower trap and serratus without recruiting all the other tight muscles?

I know you mentioned the wall slides and I’m going to start doing those, but I recall my therapist mention that I tend to sometimes hike that left shoulder/upper trap area up and presumably arch the lower back since i don’t have full range in flexion. How can I be more aware of my form on this since I can’t necessarily see myself while I do these?

My ortho told me to simply stretch the lats and get soft tissue work done, but my therapist was saying that’s fine and all, but its not going to take the weakness away. Which is I completely agree with. So that’s the tricky part I’m at right now, how to strengthen without aggravating.

Should I simply do the overhead wall shrugs, thoracic mobility work on the foam roller and lacrosse ball and stretch my lats?

Also another thing I wanted to ask you in relation to the exercises. My winging on the right side is badddd. Would doing the wall shrugs aggravate that? Or would it help? Is that something I should address first?

Thx

Wawaweewa25 · January 14, 2012, 4:51am

btw forgot to mention I got my MRI results back. All that they found was an abnormality in the posterior labrum that is suspicious for a non-displaced tear. However my ortho looked at the MRI pics from different angles and said it doesn’t look like anything at all to worry about. Not sure if having the posterior labrum tear would explain the tender infraspinatus and drooping shoulder??? I’m thinking it wouldn’t.

Wawaweewa25 · January 17, 2012, 1:10am

Other thing I have noticed is even though my GIRD has been completely resolved, I still get tight/achey like feeling in my posterior cuff area. Right around infraspinatus along with tight lats. This in turn coincides with the pain in inner crook of my medial elbow.

I know you had mentioned I might rotated to the right in my thoracic spine. Is there anyway to test for that?

Also seeing as I have tightness in the inner elbow along with an ache in the posterior cuff area, wouldn’t that be consistent with the possible posterior labrum tear that my MRI mentioned? With that I hear some slipping of the joint around the humerus and even scapula.

Just can’t shake the feeling that something is wrong which is causing this left side to sit in internal rotation and making my lats chronically tight.

My doctor wanted me to lay off strengthening and start stretching my lats. Even with no strengthening, my lats are chronically tight.

Also getting cervical tightness going down that left side as well.

BReddy · January 18, 2012, 2:46am

[quote]Wawaweewa25 wrote:
Thanks for the reply as always bro, I’d be lost without you.

You mentioned I should work on strengthening the upward rotators and loosening the downward rotators and posterior cuff area.

Any thoughts on which exercises I can do for that which target the lower trap and serratus without recruiting all the other tight muscles?

I know you mentioned the wall slides and I’m going to start doing those, but I recall my therapist mention that I tend to sometimes hike that left shoulder/upper trap area up and presumably arch the lower back since i don’t have full range in flexion. How can I be more aware of my form on this since I can’t necessarily see myself while I do these?

[/quote]

Ahh I got you covered.

Walls are your best friend.

First, definitely do the overhead shrugs like in the previous videos I showed you. Just make sure you stick your ass way out so you know you’re not arching your lower back. Other than people who are INSANELY tight this will solve that issue. I’m talking like 75 years old walking as if their first and last name was Hunch Back.

Next, stand with your back on the wall and perform shoulder flexion. In people with shoulder issues / tight lats it will look like this:

Notice how the lower back arches once the shoulders flex. This is a sign of tight lats. But, because you have the wall behind you, you know whether you’re lower back is arching since you’ll feel your lower back not touching the wall.

Also, notice how the neck hyperextends. This is from the levator scap, a downward rotator, being tight. Shoulder flexion / upward rotation stretches the levator scap. Something a tight lev. scap doesn’t like.

A lot of times when people say the upper traps are “tight” they say that because they see the shoulders shrug / elevate. You need to look at where this elevation is coming from though. The rhomboids and lev. scap are damn near always the culprits. I’ve never seen someone with shoulder issues who had overactive upper traps. The rhomboids are almost always to blame though.

So the proper way:

However, often once people can make their lower back stay flat they start doing this:

Notice how the elbows are turning outside of the wrists. Especially on her left arm. The lats are now tightening up to the point where they are medially rotating the shoulder. You want to try and keep everything in a nice straight line from the wrists to the elbows to the shoulder. With the palms facing each other. This will help insure the lats get stretched.

This can be HARD for a lot of people. A lot of times people have to start out only moving up a few inches or so and hopefully progress an inch or two each week or so. Eventually getting the arms completely straight so they can reach up and touch the wall. Don’t reach up all the way if you can’t keep everything straight. You’re only reinforcing poor movement.

Keeping your upper back against the wall will also help you feel a lot of work being done in the thoracic spine = a great thoracic spine stretch. But an active one.

BReddy · January 18, 2012, 2:49am

[quote]Wawaweewa25 wrote:
btw forgot to mention I got my MRI results back. All that they found was an abnormality in the posterior labrum that is suspicious for a non-displaced tear. However my ortho looked at the MRI pics from different angles and said it doesn’t look like anything at all to worry about. Not sure if having the posterior labrum tear would explain the tender infraspinatus and drooping shoulder??? I’m thinking it wouldn’t.[/quote]

I doubt it as well. A beat up labrum is a pretty common thing.

Do you carry anything regularly? How big are you?

Having heavy arms is a pretty common thing in those with low shoulders / winging scaps. It normally needs to be a pretty big guy though. Women get it more easily but that’s due to bra straps constantly pulling the shoulders down.

Wawaweewa25 · January 19, 2012, 5:10am

Thx for the reply Breddy.

Unfortunately for the next couple weeks I guess I’m under strict instruction from my ortho to not do any form of strengthening. His thinking is if my left lat and symptoms improve from simply stretching my lats and getting the soft tissue work from my therapist then its likely that its the exercises causing the issues.

If my lats continue to stay tight my therapist said there is a good chance my ortho will suggest exploratory surgery since this has been such a chronic issue.

My thinking is this. My left shoulder is STILL sitting drooped in relation to the right. From my basic understanding of anatomy and biomechanics, this shoulder sitting in internal rotation is the cause of my posterior area getting tight. However, the catch 22 I’m in is when I was strengthening I was obviously getting overly tight. I do believe these overhead wall shrugs might be the solution, but will have to wait a few weeks to see what my doc thinks.

Even stretching my left lat is difficult for that shoulder to maintain the position.

My therapist said my scapular control on the left side has improved a ton.

Right side still has worst winging, but completely asymptomatic, which i can’t figure out.

For now I’m stretching my lats 3-4x a week, doing some thoracic mobility on the foam roller and stretching my tight hammy’s and doing some bridges for my core.

My therapist worked on my infraspinatus on Tuesday and it was very painful! Extremely tender, I still can’t shake the feeling that something else is going on within that shoulder posterior cuff area since the shoulder just doesn’t feel right. I’ll let you know what happens.

Wawaweewa25 · January 20, 2012, 8:42pm

Potential good news. Went to therapy yesterday and my therapist said I was noticeably looser in my left lat, posterior cuff. Pec minor wasn’t tight etc. What we are both now thinking is that in my effort to be hyper aware of my posture, I have been OVER correcting. Meaning my shoulder being back and down is great, but too far back (behind my femoral line) and I’m likely exaggerating this movement without realizing.

He mentioned to me that usually the patients that are very passionate and wanting to get better are their worst enemy at times. He also checked me for scolosis since the therapist at my work is freaking me out since he’s trying to train a future new grad by pointing out every possible thing he might find wrong and surprise surprise, I def do not have scolosis. Which is a relief.

My therapist also showed me proper hip positing, I was using too much extension/flexion with my low back when I was trying to tilt my pelvis into neutral. He showed me how both the shoulders being back and down and the pelvic positioning are just subtle movements, not so exaggerated.

Hopefully this is all this bump in the road was and I can get back to strengthening and getting back to 100% soon.

Currently just working on lower body mobility by stretching my hip flexors, hammy’s, doing some bridging and foam roll work for thoracic mobility. The other thing I’m working on is lifting that rib cage area for good posture. I have excellent abs, but tend to sag a bit at the core when I forget about posture.

The one question I had is I’m getting conflicting info on proper sitting position. Some therapists tell me I use my low back extensors too much, so I started trying to feel my core as I sit. But I believe that leads to too much of a posterior tilt? So I’m’ slightly confused as to which way is proper. I know we are suppose to have a slight anterior tilt pin general to be at neutral.

I’m going to continue working on this since I know proper hip/pelvis positioning is key for proper upper body alignment.

Let me know what you think bro

BReddy · January 23, 2012, 10:56pm

[quote]Wawaweewa25 wrote:
Potential good news. Went to therapy yesterday and my therapist said I was noticeably looser in my left lat, posterior cuff. Pec minor wasn’t tight etc. What we are both now thinking is that in my effort to be hyper aware of my posture, I have been OVER correcting. Meaning my shoulder being back and down is great, but too far back (behind my femoral line) and I’m likely exaggerating this movement without realizing.

He mentioned to me that usually the patients that are very passionate and wanting to get better are their worst enemy at times. He also checked me for scolosis since the therapist at my work is freaking me out since he’s trying to train a future new grad by pointing out every possible thing he might find wrong and surprise surprise, I def do not have scolosis. Which is a relief.

My therapist also showed me proper hip positing, I was using too much extension/flexion with my low back when I was trying to tilt my pelvis into neutral. He showed me how both the shoulders being back and down and the pelvic positioning are just subtle movements, not so exaggerated.

Hopefully this is all this bump in the road was and I can get back to strengthening and getting back to 100% soon.

Currently just working on lower body mobility by stretching my hip flexors, hammy’s, doing some bridging and foam roll work for thoracic mobility. The other thing I’m working on is lifting that rib cage area for good posture. I have excellent abs, but tend to sag a bit at the core when I forget about posture.

The one question I had is I’m getting conflicting info on proper sitting position. Some therapists tell me I use my low back extensors too much, so I started trying to feel my core as I sit. But I believe that leads to too much of a posterior tilt? So I’m’ slightly confused as to which way is proper. I know we are suppose to have a slight anterior tilt pin general to be at neutral.

I’m going to continue working on this since I know proper hip/pelvis positioning is key for proper upper body alignment.

Let me know what you think bro[/quote]

Focusing too much on your shoulders being back and down can definitely be a bad thing. By making sure they are down especially, you are firing the downward rotators. The lat is a downward rotator. Plus, your left shoulder is already “down” enough. I’m much more concerned with your ability to put your arm up rather than your arm down.

The best position to sit is leaning back into something. The further back you are the less stress there is on the lower back. With shoulder issues my primary concern is always that the client is never sitting in a position where they are leaning on their arms in any fashion nor are there arms ever out to their side e.g. driving in the car and the left arm is resting on the window sill.

It’s tough to say without seeing you in person and knowing your case even better, but, unfortunately, to me it sounds like your therapist is playing too much of a trial and error game. If not a complete guessing game. Unless you aren’t being compliant, which doesn’t sound like you, there is no reason at this stage you should still have these tight muscles.

Furthermore, the fact you WERE able to loosen up those muscles indicates, well, those muscles are able to be loosened. As well as the posterior capsule. Thus, why is a surgeon going to cut you open to try and help loosen up those muscles / capsule when you can already do so?

Going along with that, again I haven’t seen you in person, but I think exploratory shoulder for a condition like yours is insane. You will come out of that surgery with your left shoulder still drooped. Nothing a surgeon can do will fix that. Even if they could, it will come back if you’re not able to recognize what’s causing the drooped shoulder.

If it were me, and there’s nothing on an MRI indicating I have a structural issue limiting movement (like a bone spur), I’m not coming close to a surgeon until my shoulder is moving perfectly AND I still have pain. A lot of pain.

The proper movement comes from the muscles. Surgery doesn’t teach muscles how to work properly again. I see people all the time who have a surgery and still have pain because the surgery didn’t treat the cause of their pain i.e. how their shoulder moves. It treated the symptom (tight capsule, labral fraying, etc.)

Wawaweewa25 · January 25, 2012, 7:26am

Thanks for the reply bro.

Def have notice a huge difference in the lat tightness ever since I completely stopped focusing on putting the shoulders back and down. My therapist told me to hold off on my appts til I see the doctor and hopefully I will get the clearance to start strengthening again. Looks like I’ve been my own worst enemy by trying to be too perfect in a sense. I’m realizing I can’t forcefully put the shoulder in a position where it shouldn’t be and since I have the weakness its going to aggravate those muscles.

Hopefully next week I’ll have good news and I fully agree with you on the surgery. My therapist feels the same way, it was just a little puzzling to him a couple weeks ago why i was still so tight after we cleared the GIRD and were making progress.

He’s a good guy, has my best interest in mind since he could have told me to keep coming in several more times to make money off me, but didn’t.

Perhaps once I’m through all this I can drive down to come see you at some point. I’ll keep you posted.

BReddy · January 30, 2012, 10:08pm

[quote]Wawaweewa25 wrote:
Thanks for the reply bro.

Def have notice a huge difference in the lat tightness ever since I completely stopped focusing on putting the shoulders back and down. My therapist told me to hold off on my appts til I see the doctor and hopefully I will get the clearance to start strengthening again. Looks like I’ve been my own worst enemy by trying to be too perfect in a sense. I’m realizing I can’t forcefully put the shoulder in a position where it shouldn’t be and since I have the weakness its going to aggravate those muscles.

Hopefully next week I’ll have good news and I fully agree with you on the surgery. My therapist feels the same way, it was just a little puzzling to him a couple weeks ago why i was still so tight after we cleared the GIRD and were making progress.

He’s a good guy, has my best interest in mind since he could have told me to keep coming in several more times to make money off me, but didn’t.

Perhaps once I’m through all this I can drive down to come see you at some point. I’ll keep you posted.
[/quote]

Glad to hear you’re making progress!

Definitely keep me posted / let me know if I can help you out in any other way.

I didn’t realize you were in California too. Where are you located?

Wawaweewa25 · January 31, 2012, 6:10pm

[quote]BReddy wrote:Glad to hear you’re making progress!

Definitely keep me posted / let me know if I can help you out in any other way.

I didn’t realize you were in California too. Where are you located?[/quote]

Hey bro,

So had my follow up appt this morning with my ortho. Left lat is STILL TIGGGGHT! I have completely laid off strengthening for the past couple weeks too. However, I did start school up again and have been sitting at a desk for several hours a day, which is surely contributing to the lat tightness.

My doc told me to stretch my lats a couple times a day and foam roll it as well. He said once I regain that mobility, I can start strengthening. He also agreed with you, saying lat pull downs etc are a terrible strengthening exercise for someone in my boat. So I’m starting to think twice about my therapist now. He’s great at soft tissue and a very nice guy, but perhaps maybe not the most knowledgeable on how to fix my situation.

Wanted your opinion on how I should go about stretching and loosening my left lat. What’s interesting is although I have winging in my right side, lats aren’t tight at all? Which makes me feel like the low shoulder on the left side is contributing to the tightness. I can’t really think of any other reason? Very frustrating!

I’ve been stretching my lats like this, except I’m only using one hand since the right side doesn’t need stretching. Do you have any preferences or a more effective way to stretch the lats? I remember also doing a “prayer” like stretch for my lats in my post op rehab.

Wanted your take on how to loosen up the lats. As mentioned I currently plan on stretching them twice a day (morning and night) and then foam rolling them 3-5x a week or as needed.

Edit: Forgot to mention, I’m in South Orange County

Wawaweewa25 · February 2, 2012, 6:21pm

Hey Breddy,

So went to my doc appt. He evaluated me, said I’m still pretty tight in my lats and instructed me to really focus on stretching my lats everyday, and foam rolling them 3-4x a week as well.

I hadn’t been doing much for the past 3 weeks, since they had instructed me to lay off focusing on keeping the shoulders back and down etc. No doubt, sitting in a desk again for several hours a day has started to rear its ugly head.

So my plan is as follows. Aggressively focus on stretching the lats daily, (like the video in my previous post), foam roll them as well. Work on core strength and get some soft tissue 1-2x a week. In a couple weeks I plan on starting to strengthen again, because simply put in my opinion, I’m not going to get better doing nothing. Don’t get me wrong, mobility before function, always, but I’m not SO TIGHT that I can’t strengthen in my opinion.

With that said, I still have the dykinesis, winging worse on the right side than left, but as you remember got the low shoulder on the left (bad) side.

My therapist told me when I start strengthening to focus on doing stuff below 90 degrees. I’m not so sure I agree with that, since we both know serratus and low trap are very weak on me. I was more in line with thinking what you had previously mentioned. To start doing those wall shrugs, get back to incorporating Y’s and T’s on a med ball and seeing if that can help get that low shoulder back to its proper position. My thinking is if I can get those two areas (serratus, low trap) to start firing properly, the tightness in my lats will subside.

I’d be interested in coming down to have you take a look at me. Where are you located? Was thinking seeing me in person would give you a much better picture of what’s going on with me and then maybe we could develop a solid game plan and finally get me better!

Also shoot me a PM to let me know your rates etc and maybe we can work something out bro.

thx

Wawaweewa25 · February 3, 2012, 2:02pm

Brian,

I don’t know if my eyes are playing tricks on me, but for the first time in 2 years, my left (drooped) shoulder seems to be looking like its not as drooped?!!! What did I change? Religiously been doing the lat stretch 2x a day (the one I provided in the link a couple posts above), foam roll the hell outta the lats, along with doing thoracic mobility and extension.

It was funny, I was at work last night, went to the bathroom, washing my hands and I look in the mirror and I was like WTF?! Because I haven’t seen that left shoulder anywhere close to normal shoulder height for so long. Don’t get me wrong, its still lower than my right, but its definitely made a noticeable improvement simply by stretching my lats.

Secondly, I also started incorporating the overhead wall shrugs you’ve been telling me to do for the past month. They feel great, esp for a good lat stretch as you mentioned. Couple questions on form.

How close should I be standing to the wall? I do them in the bathroom, so I’m standing perpendicular (laterally) to the mirror, so I can make sure I’m not arching my low back. Also should my palms be flat against the wall like the female client in your video link?

Lastly, how many sets, reps do you recommend me doing and how often a week?

Definitely want to come down and see you, have you assess me and make sure I’m doing these bad boys right.

Btw, checked out your Youtube channel and noticed there was a droid on there commenting about “tight upper traps and rhomboids being weak.” I couldn’t agree with your thoughts more! In my post op rehab, they had me stretch my rhomboids to death, never caught the GIRD and guess what? I didn’t’ get better.

Edit: Also I know you mentioned when sitting not to rest my arm on the window in the car, which I never do. What about general posture when sitting in a desk. Only sitting for about 3-4 hours a day, but I don’t know if I should let that left arm just hang down by my side or if I should put it on my belt buckle area? Lemme know what you think about that.

Alright, hope to hear from you soon, PM me with your rates, location etc and when we can set up a session.

Wawaweewa25 · February 5, 2012, 3:13am

Hey Brian,

Found this great video, wanted your thoughts on it. I’m starting to understand why I wasn’t really getting anywhere with my rehab with my therapist. I’ve got those over-active downward rotators and need to balance it out with the strengthen the upward rotators as you have mentioned.

http://www.fitnesseducationseminars.com/news/best-exercises-for-shoulder-impingement-syndrome

Alright I know I’ve posted a lot over the past couple days, so I’m going to continue stretching my lats and foam rolling; then doing those over-head shrugs and see what you think.

Really curious on your take on how often I should stretch my lats, my understanding is the lats are tight on the left side due to the weakness in the scapula upward rotators. Although the stretching has helped, since they don’t feel as tight.

BReddy · February 7, 2012, 12:19am

[quote]Wawaweewa25 wrote:
Brian,