T Nation

Shoulder Pain, Need Advice


#1

Hi,

Sorry for a 'help me' post but i'm at the end of my tether. If anyone is able to offer any advise I would be very grateful.

For a long time now there has been a dull ache at the front of my right shoulder, and it intefered with training during certain movements, eg:

  • Locking a weight overhead (eg overhead squat)
  • Bench press
  • Chest flyes
  • Rear delt flyes
  • Top portion of bicep curl
  • etc..

In addition, some day to day stuff would hurt, such as typing for a long time, or driving.

I saw a couple of physiotherapists and none were able to offer anything useful. One suggested I had weak serratus so I did a lot of scapula pushups etc. but this didn't help.

The problem didn't go away so I saw a shoulder surgeon who initially suggested a labrum tear. I had an MRI arthrogram to confirm/deny this, and found out I didn't have a labrum tear but rather had 'laxity in the front capsule of the shoulder'. He said he'd refer me to a physiotherapist to attempt to fix the problem over 3 months, and if it didn't get better he wanted to perform open shoulder surgery to tighten the capsule.

I have seen a physiotherapist (who has been provided with a full explanation of 'whats wrong' from the surgeon) who I must admit I have been absolutely disgusted with. He said I have weak rhomboids and serratus. He gave me the following exercises to do 'for 3 months':

  • External rotator cuff rotation with a band
  • Rear delt raises (lying on chest) with thumb pointing towards the ceiling
  • Some weird exercise where I lie on my front, hold my arm 'above my head' in an L shape, and raise a dumbell towards the ceiling.
  • 'Wall pushups', basically like the scapula pushup promoted on this site but leaning against a wall instead of the floor (These are ridiculous, i've been doing them on the floor instead)

I explained I was horrified with the suggestion I went away and treated the injury myself for 3 months with no guidance, and that weightlifting was important to me and I wished to get back to 100% asap, he said 'theres not much else I can do'.

I have done as instructed by the physiotherapist diligently, and no difference at all to my shoulder after a few weeks.

I'm at the point now where lots of stuff I do with my right shoulder hurts, and I can't train properly at all. It sucks. I have no idea what to do, I've seen 3 physiotherapists about this (all privately) and feel like I'm going nowhere.

I don't even know how this happened, it just started hurting one day, and it's only on the right side. The only give-away I have is that my lats seem to be less developed on the right hand side, especially towards the mid/lower back, but this may be effect rather than cause.

I have lost a considerable amount of muscle through not being able to train properly and feel like absolute crap (due to an unrelated injury I have also been unable to train my lower body properly for the last 12 months).

Does anyone have any words of wisdom, either regarding the injury, or what to do about the physiotherapist / surgeon?

Many thanks,
Jim


#2

Here are some words, if not some wisdom...

Do you have a bony bump at the top of your shoulder? Some people, myself included, have somewhat of a bony bump that protrudes. I think this is known as the acromion process (but I don't know much of anything about anatomy).

Anyway, it's quite easy for me to get to the point that touching or tapping on this produces pain. In fact, as mentioned in several articles, when I wake up after sleeping it is often more pronounced.

I believe rounding makes it worse... so while sleeping my shoulders are naturally pushed forward. I blame it on building thickness on the back... but who can say.

Generally, my right shoulder bugs me much more than the left. I believe it is because of "mousing" on the computer for years and years. My right shoulder appears to be far too willing to round because of extending the arm and "reaching" for the mouse over and over again.

If you aren't just overworking chest and underworking your back, then look for postural issues. Recently, when doing a lot of volume on the shoulders, I actually rolled up a small towel and slept with it under my spine to reduce forward pressure on my shoulders. I think it helped. Also, make sure you are getting your anti-inflammatories, such as Flameout.

A long term aggravation, if that is even what it is, could take a fair amount of time to settle down -- and much longer if you are doing something that continually aggravates it.

Anyway, again, I don't know much of anything about anatomy, particularly complex areas like shoulder and back, but maybe this will get some more people adding to your thread.


#3

If your PT sucks, get another one.


#4

hi

thanks for the reply

there is no lump - i believe the problem (as advised by surgeon) is 'laxity in the shoulder capsule', although i dont know if this is the cause of the problem, or the problem has caused the laxity, he didn't explain it very well tbh

in the past, before seeing surgeon, i have tried resting for 2-3 months and no good came of it.

also for around 3-4 months, again before seeing the surgeon, i reasoned the problem may be due to overworking chest and neglecting my back, so i attempted to work only back and shoulder girdle - lots of rowing (chest supported row, cable row, lat pulldown, dumbell row, etc etc), prone shrugs (both horizontal with dumbells, and also using a cable row), more rowing (mostly horizontal), rear delt work, straight arm pulldowns, scapula pushups, etc.. all high rep work.. made absolutely no difference :frowning: during this time i barely worked my chest at all, and all this seems to have done is massively reduced my pecs, it hasn't actually helped the shoulder at all.

i also did a lot of front delt and pec stretching, religiously, to try to stop my shoulders rounding forward

if it helps anyone at all i have scapular winging especially on the right but nothing seems to be stopping it

i know posting on an internet forum is no substitute for proper medical advice but in all honesty i feel i have explored the traditional avenues and haven't really got anywhere, other than slightly more in financial debt!!!

thanks for reading guys.
jim


#5

tweaker: i plan to, but as stated i've thus far seen 3 physiotherapists about this, and noone has been able to solve it yet.

every time i see a new physio it will take a couple of sessions before anything useful starts to happen, and i'm getting increasibly frustrated and despondent at the situation.

i thought it would be worthwhile posting here since there are some incredibly knowledgable folks here at T-Nation, and perhaps someone has had a similar problem and managed to fix it.

thanks,
jim


#6

Vroom,

re-reading your reply, i have given some thought to what you said about 'mousing'.

this may not be helping - i spend a LOT of time at a computer - i am a software developer - thus the mouse may be an issue

hmm. i may look into whether there are any articles about 'mouse shoulder' or similar!!


#7

If laxity is simply a looseness or relaxed forward position of that shoulder, and it coincides with reaching for your mouse (check it out), then we're probably talking about the same thing.

I believe, based on reading around here and such, that doing work with your shoulders rolled forward impinges things and so forth (well beyond my expertise here) and leads to shoulder pain.

EDIT

Oh what the heck, I don't have any credentials that stop me from climbing out on limbs when I feel like it...

I suspect that chronic "reaching" would cause laxity over time, but that not enough computer jockeys later jump into the gym in a serious enough way (long enough and/or causing enough development) for the medical community to realize there is a health risk issue here... such as mouse shoulder.


#8

Jim,

The dull ache you write of is most likely an anterior shoulder impingement (typically caused by decreased sub-acromial space). Essentially, due to the anterior capsule laxity (and possibly coupled with posterior capsule tightness-imagine squeezing a wet bar of soap in your hand, the soap tends to want to shoot out forward), you may be losing proprioceptive control of your glenohumeral joint (loss of control upward and possibly forward). When you use your right shoulder (gym, mousing, computer work etc.) your scapular/shoulder stabilizers are more than likely not working the way that they should. This causes an upward movement of the GH joint (this is the loss of control, whereas in proper biomechanics, the head of the humerus should be "compressed" in to the glenoid fossa). In turn, this causes structures to become impinged or squished underneath the acromion process (bony prominence coming anteriorly off the shoulder blade). Repeat the process often enough and you develop a tendonopathy of some sort. Thus commences the vicious circle of pain, altered biomechanics, irritation and back to pain.

To get a good handle on this sort of problem, you have to be willing to sacrifice the weight and work on form and body awareness. Retraining your scapular stability/GH stability should first focus on proprioception and control before moving heavier external loads. When doing your scap push ups and rotator cuff work, make sure that your scapula is truly stable before your limb moves. You will lose the benefit of the exercise if you do the movements with scapulae sliding all over the place. This is one of the hardest things to do. Having someone watch your shoulder blades while you complete those exercises can be invaluable to return TRUE scapular control/stability.

An excellent exercise that doesn't require a lot of equipment is to take a light ball (e.g. children's rubber ball) and hold it against a wall at arm's length. Keep your scapula retracted and depressed. Now make very small circles, almost like vibrating your arm. Don't lose control of your shoulder blade. Do these for about 5-10 seconds (or less if you lose scapular control) at a time.

Furthermore, soft tissue work to restore the integrity to certain tissues can be a huge benefit. The subscapularis should be one of those tissues targeted, along with teres major and the lats. As well, make sure pec minor is stretched out and in ideal length (this has implications for certain types of winging).

Serratus anterior work is also pretty important to control the scapular winging, especially if the winging takes place along the medial border. This too can also lead to various impingements syndromes. When working on serratus anterior, once again focus on controlling the tissue. Really get a sense of the muscle working.

As much work as you do, you will almost always lose the battle with head forward, rounded (protracted) shoulder postures. These postures are typically held when driving, at the computer, and watching tv. You may work out for an hour or so, but typically you hold these positions for much longer at a time, and more repetitively. Thus, you train your body to hold those positions, which leads to adaptive shortening/tightening/weakening of specific tissues.

Until you regain GH joint control, you will more than likely continue to impinge those structures and cause irritation. It will then take less activity to cause the same or greater amount of pain.

Once again, the advice of a trained medical professional who can assess you in person should yield the greatest benefit. That being said, unless the cause of the problem is being worked on, you will only receive temporary relief.

Hope that helps
dc


#9

Another thing to consider (in addition to shoulder stability work): even if you are right-handed, learn to mouse with your left hand. (I am right-handed and I work with a keyboard and mouse full time; I started mousing with my left hand several years ago after I started feeling numbness in my right wrist.)


#10

I would recommend getting a second opinion, preferably from an ortho who specializes in shoulder injuries. I can definitely appreciate your frustration with pt's; many seem to not know what they're talking about half the time.


#11

hi everyone,

thanks for the replies. especially dra - that was an astonishingly in-depth and informative post. i shall re-read this several times and google some of the bits i don't understand. you have been more helpful than anyone from the medical profession i have seen thus far :slight_smile:

i am at work so can't write too much, but am trying my mouse left-handed today, as after reading several articles about "mouse shoulder" and seeing this:

http://ergo.human.cornell.edu/AHProjects/EMGPaper1.pdf

(i seem to use posture closer to the last photo than the first)

.. i believe that the way i'm using my mouse probably isn't helping.

thanks again everyone, i'll keep this post going as and when i find out more information, hopefully i can get to the bottom of this. maybe others are having similar problems so this will be useful to them, too.

jim


#12

FWIW, I was desperate and in terrible pain when I stumbled on a thread about "shoulder dislocates".

http://www.T-Nation.com/readTopic.do?id=1224253

My pain disappeared after one session and now I do them a few times a week to keep pain free. I would say they are definitely worth a try. Just be careful to not push it at all and just take it slow. I moved my hands in over 2 feet on the rope from the first time.


#13

Have you been doing much barbell bench press by any chance?


#14

SXio: not really, no

I haven't trained BB bench press in the last 12 months in case it was causing problems, i have done a little dumbell benching in the last few months but not much barbell

did a fair bit of barbell overhead pressing but i havent done much of this recently due to the pain

Thanks,
Jim


#15

I only asked because I strained a rotator cuff over the summer, and I am seeing one now. What my PT suggested is working, but I have found that after PT, if I hit the gym and run for a half hour and stretch, I feel a whole lot better. The cardio is really helping.