T Nation

Shoulder Impingement

Turns out I have shoulder impingement on my left side. I have started to rehabilitate it over the past few weeks. I have cut my chest workouts in half and I am trying to add more back as well. I also have started to do more rotator cuff work. I was also advised to do very low weight (3-5lbs) high rep posterior delt work to hopefully pull my shoulders back. Curious if anyone out there has anymore advice or has gone through this themselves and had something that worked well. Thanks for the help!!

Quite a few people here, including myself, have had shoulder issues. One thing I would say is that I see no need to use light weight when doing rear delt work. I try to go as heavy as possible on rear delt raises, rear delt machines, and facepulls. I add in band pull aparts to most workouts, and I do them on off days.

Cuban presses are a good rehab exercise, try them out. The Diesel crew shoulder rehab/prehab stuff has a lot of good ideas in it too. Broomstick stretches haven’t done much for me, but they’re usually recommended.

Try and get hold of some bands. If you can do shoulder traction and other band work, you should find it helps. Dave Tate came up with an excellent exercise I try and do every day: you put a light band around your wrists, then walk your hands up and down a wall (and side to side) like you’re spiderman. This really is one of the best warmup/rehab exercises I’ve found.

The key thing though is to program good shoulder health habits in your daily routine. That means not slouching if you have a desk job, keeping your scapulae retracted etc.

YMMV, but I found that broomstick stretches and simply hanging at the bottom of the pull up position worked me through 85% of my impingement.

From Doggcrapp:

HOW TO CURE SHOULDER PROBLEMS (Trust me this will do it 90% of the time)
With a large towel or broomstick I want you to hold it with straight arms for the entire time of what i describe in the following movement–a large “rolled up like a rope” beach towel works good but honestly a longer broomstick (without the bristles) works best in my opinion. Start out with it with a really wide grip (with straight arms) in front of you (on your quads) and with straight arms bring it up and overhead and then down and back to the middle of your back–STRAIGHT ARMS ALL THE WAY–this is going to be very difficult and hard the first couple times out and then will be “old hat” with time----and its going to be painful in a stretching pump kind of way—i want 50 reps each time you do this–one repetition is from in front of your face (all with straight arms) to up overhead and back, and then down all the way to the middle of your back and then back up overhead to in front of your face again (again all with straight arms)–the important part of the movement is the area overhead that is really tight–do all of this carefully/slowly—dont just whip it over and back—if your hand is slipping off the broomstick even with the widest grip, or you cant bring your arms over straight and the start bending on you, you have some serious shoulder inflexibility and need to work this hard and get up to speed (or you could just need a longer broomstick too)–again do all of these revolutions controlled and carefully–push into the stretch as you go along toward the 50 revolutions, your chest will be pushing outward and your shoulders rolling back–your shoulders are going to blow up with so much blood its going to be incredibly painfull pumpwise–Do this once a day at nite as many times a week as you can—sometimes I have people do it every single day—but every time you do it try to move your grip inward (thats the key)----its going to be very hard to do but try your best to move your grip inward for the next 2-4 weeks and your range of motion with shoulders will increase dramatically and any impingement and the majority of other problems should be gone in 2 weeks–also try to move your grip in as you are doing the 50 revolutions–start off with a stretching but relatively easy 10 to warm up some, then try to move your grip in even by a centimeter if you can for the next 20 revolutions and then at 30 try to move the grip in another centimeter–really try to push what you can do stretchwise once your warmed up here–trust me this sounds easy but your going to be muttering “fuck you dante” after you get to your 25th revolution–Ive cured too many shoulder problems with this simple movement now its pretty ridiculous, and this and a menthol rub applied liberally daily and before sleep has cured alot of shoulder/bicepital tendonitis in trainees —Heres a pic attached to this post so you can get an idea (thanks to a trainee of mine who cured his shoulders with this)–but remember the broomstick goes overhead and all the way back to the middle of the back (he just drew the start of the movement when you begin)

What kind of stretches do you recommend if it´s not possible to get the arms behind the head in the first place. It´s my right shoulder that is the problematic one. I can grip the broomstick and get it to a position over my head but not any further.

go wider. If you are already as wide as possible then try using a rolled up bed sheet.

still can’t do it, go see a physical therapist

Do you have any other shoulder pathologies going on? Any capsular laxity? If you can’t answer those questions, then you should go see an orthopedic physician to be evaluated. Also, how did you find out that you had impingement? Did a physician tell you that or did you come to that conclusion yourself?

I am torn about the broom stick dislocations as a proper exercise. In an otherwise completely healthy shoulder, I think they are fine to perform. But with a shoulder with any kind of labral pathology or anterior laxity issues, I am very against it. Also, if there are any elbow issues (such as UCL laxity or ulnar nerve subluxations), I am very much against them as well. Even in an otherwise healthy shoulder, I feel there are better options than the broomstick dislocations due to the added stresses it places on the shoulder/upper extremity.

I’m not sure what capsular laxity stands for so I don’t know. I’m working on my kinesiology degree so I know a lot of people in the industry. I’m just getting in to the degree so I don’t know enough about it now but I asked one of my teachers, two of my personal trainers, and my buddy who is a physical therapist. Basically how it started was I started bodybuilding and lifting chest almost as much as back.

Since I was lifting chest so much and you only have your couple pectoral muscles that they started to become so tight that they are pulling my shoulders forward. So now I know that I need to lift back 3 to 1 to chest but I’m just looking for ways to to help rehabilitate it faster so some of the pain goes away. Thanks for some of the advice and I’m going to start to apply it. Anymore comments or recommendations would be appreciated.

Capsular laxity means that you have instability in your shoulder joint. If you have capsular laxity, especially anterior capsular laxity, broomstick dislocations is a big no-no.

Check out this article: http://www.T-Nation.com/free_online_article/sports_body_training_performance_repair/pushups_face_pulls_and_shrugs

And research the neaderthol no more series on here as well. Should be a good start.

[quote]LevelHeaded wrote:
Do you have any other shoulder pathologies going on? Any capsular laxity? If you can’t answer those questions, then you should go see an orthopedic physician to be evaluated. Also, how did you find out that you had impingement? Did a physician tell you that or did you come to that conclusion yourself?

I am torn about the broom stick dislocations as a proper exercise. In an otherwise completely healthy shoulder, I think they are fine to perform. But with a shoulder with any kind of labral pathology or anterior laxity issues, I am very against it. Also, if there are any elbow issues (such as UCL laxity or ulnar nerve subluxations), I am very much against them as well. Even in an otherwise healthy shoulder, I feel there are better options than the broomstick dislocations due to the added stresses it places on the shoulder/upper extremity.[/quote]

How about for a broken greater tuberosity of the humerus? I fractured mine 6 weeks ago. Looking into really taking care of my shoulders from here on out, and was going to start with this broomstick method. I still can’t fully extend my arms upward yet, but in about 2 weeks or so I should be good to go. Would you recommend against this exercise with this sort of injury?

I also have a very minor tear of my labrum in that shoulder, but it hasn’t produced any pain for about 6 months now.

Thanks!

Let me preface my response by saying you should always follow the advice of your doctor. They are able to see exactly what all is going on with your shoulder and can give the best insight.

If the fracture is not healed, I would be very cautious of any activity. When you say you can’t fully extend your arms, is it due to physical limitations or that a doctor told you not to yet? Also, did u have any procedures/surgery done? What caused the fracture/injury? Any other damage done along with the fracture? Is the labral tear from the same incident? Where is your labral tear located, anteriorly, posteriorly, etc? What type of activities are you involved in (sports, etc)? How are things at your elbows?

For the rotator cuff impingement exacerbated by bench pressing, make sure you retract your shoulders and keep them that way during your bench press. I.e. pull your shoulder blades back together. This will promote more of an arched posture and posteriorly tilting the superior scapula and keeping the subacromial space open. I.e. giving your supraspinatus plenty of room to move during your bench press.

beef

[quote]LevelHeaded wrote:
Let me preface my response by saying you should always follow the advice of your doctor. They are able to see exactly what all is going on with your shoulder and can give the best insight.

If the fracture is not healed, I would be very cautious of any activity. When you say you can’t fully extend your arms, is it due to physical limitations or that a doctor told you not to yet? Also, did u have any procedures/surgery done? What caused the fracture/injury? Any other damage done along with the fracture? Is the labral tear from the same incident? Where is your labral tear located, anteriorly, posteriorly, etc? What type of activities are you involved in (sports, etc)? How are things at your elbows?[/quote]

Well, I can’t get a follow up X-ray very easily as I live in a third world country at the moment. My orthopedist from the USA told me to wait 8 weeks before any physical activity, and that when I started, to start slow. Pretty standard advice which I fully intend on following. I can lift it all the way up in front of me to where my humerus would be 180 degrees from the anatomical position, but in so doing I get a little bit of pain, so I don’t. That sentence sounds retarded now that I’ve read it, but yeah, I know I still have full range of motion of this point, and I can move it without serious pain, but I’m going to wait for the 8 week deadline before trying anything and I’m certainly not going to do anything that produces pain.

I broke the arm playing football. Fell on to my outstretched arm while diving to make a play. Apparently, your bones don’t like 200 lbs coming crashing down on them, go figure. The break was a non-displaced (or minimally) fracture of my greater tuberosity. As such it didn’t require any surgical intervention, just immobilization. I was in a sling for 4 weeks that also secured around the waist, the idea being to keep the humerus internally rotated and preventing the shoulder from abducting. Not sure about soft tissue damage. Oftentimes with these breaks the tendons of the SITS muscles are damaged, but that tends to be with displacement, and again, I had none. An MRI is out of the question because they simply don’t have those kinds of resources readily available here. That will wait until December.

As far as the labrum goes, that was in the spring of 2009 playing intramural softball with my work team. I did not get an MRI to assess the degree of the tear, but my ortho diagnosed it as a minor SLAP tear of my right labrum. It was incredibly painful for a few weeks, but most of that subsided after 2 hydrocortisone injections. The last time it bothered me was probably 5 months ago when I was attempting a really heavy set of military presses and I refused to quit (dumb idea).

Elbows are fine. I play sports recreationally when I have time, but for the most part my only activity pre-fracture was running and lifting. Was running a pretty balanced program from a Thibs article that I found.

I appreciate the help. I am of course going to follow the doc’s orders regarding the time frame, and even after that, not do anything that hurts. I know that the SITS muscles all insert on the greater tuberosity, and I have no interest in losing most of my shoulder stability for the rest of my life due to a little bit of impatience. As part of slowly working myself back into things, I’ve been looking at a lot of the posture/shoulder strengthening articles on T-Nation, and everyone seems to recommend this broomstick exercise. Thought I’d get an opinion on if you thought it may be contraindicated, and if so, why and what else I could do.

Thanks again, and OP, sorry for the semi-hijack. Really.

I would say that with a SLAP tear, to be very cautious with broomstick dislocations.

I could recommend the following drills in the two linked videos:
http://www.youtube.com/watch?v=pdjwnjtBoxg

Jerome or Rational Gaze (or anyone),

did you guys feel pain from the rear delt all the way down ur upper arm to your elbow? I was doing weighted pull-ups and my left elbow, bicep, tricep and shoulder just started throbbing. It seems anytime I grip something tightly, the pain begins. I feel some relief when I stretch my pec and do some foam rolling on my left trap/lat.

The pain also comes up when I play basketball/football…sometimes even when I’m running. I shoot/throw right handed, so I’m not sure why my left side is hurting. Could it be tendonitis as well as impingement? The pain is really annoying and I lose all motivation to finish my workout. It started hurting when I was squatting today :S

Any ideas?

I did not feel that much pain or at least it going down my arm. My shoulder has been doing a lot better now though. I basically cut pack on heavy pressing shoulder movements. If your a big lifter your probably getting a lot of shoulder activation in your chest and back days as is. I would keep things pretty light. Then to help rehabilitate my shoulder impingement I started doing more back, less chest, and Y, L, T, W’s.

I would personally do these about 4 days a week at an incline. You can do no weight to start and 30 reps each. I then started with about 1 set per day until my strength was up and then started to add sets to 3 and then slowly started to add weight. I would not recommend going over 3lbs. Then once you have built your strength up you can start to do them lying face down. The Y, L, T, W’s will help with pulling your shoulders back if you have an impingement. I’m not a doctor so I can’t say what’s wrong with you but if you get checked out and you do have an impingement this should definitely help.

Impingement… I’d probably stop with all the pressing for a while. How’s your posture? I’d fix that first. If you have forward shoulders and a rounded t-spine, those would be the things to fix. Pressing isn’t going to do that. Stretch whats in front. Also foam roll your t-spine. Strengthen the upper back.

Also, you could probably use some work on scapular upward rotation. My guess is that you have dominant upper traps and need some lower trap and serratus work. So fix that force couple as well with some wall slides and push-up +