Shoulders, Structural Imbalance?

Hello. I have had an ongoing problem with my left shoulder. I have hypermobility so I was referred to a Rheumatologist & then a Physiotherapist. My left shoulder is most of the time painful especially when I wake up in the morning. It feels tight & hurts when I reach behind my back. After 20 mins or so the pain subsided but it still doesn’t feel normal. The Physio said that I had mild impingement & rolled forward shoulders. She gave me some RC strengthening exercises to do then discharged me. I cannot do any overhead barbell work & the only thing that I can manage to do with little discomfort is seated smith machine OHP. Barbell bench press only gives me little discomfort afterwards. I have dropped lateral raises as these irritate me & any exercise that pulls down on my shoulder. Like I said the pain isn’t that bad & once I get moving it tends to disappear until I rest. The pain can be felt at the front & around to the back.

I now do lots back work, face pulls & dead hangs plus I warm up now before every session. The dead hangs really feel good & I get a good stretch. When I lay on a roller & put my arms up behind my head my left arm would never fall back as much as my right. After a few weeks of dead hangs this as now improved. It also feels like my lats & tricep on the bad side are really tight. I suspect I have tight pecs too?

The main reason I have posted here is because I am sure I have some kind of structural imbalance. I mentioned this to the PT who said it’s normal to have one side different to the other & didn’t really look at what I meant. I will try to explain what I mean. On my right side I can do a bicep pose & my arm is basically in line with my body & everything looks nice & in line. My left side which is the side that gives me issues is different. I cannot get my arm in to the same position without it feeling like something is stopping it. I cannot externally rotate it enough in the bicep pose & I cannot get my upper arm in line with my back in the bicep pose. My left anterior delt is almost none existent. I am sure something is not right here. I have attached some pics to illustrate what I mean.

Hi @BReddy I have noticed you have posted some good advice if you could take a look?

Front bicep pose: Imgur: The magic of the Internet
Right side: Imgur: The magic of the Internet
Left: Imgur: The magic of the Internet

I don’t know anything about fixing shoulders or what’s causing your problem.
My shoulders hurt until a got a set or rings and just basically started playing around with them. They helped mine a lot!

You need to see a doctor. Mild pain, shoulders rolling forward, weakness - all things you can attempt to manage without professional guidance, but you are describing what sounds like a serious problem that has gone undiagnosed and SHOULD NOT BE DIAGNOSED VIA CROWDSOURCING ON THE INTERNET. If you have not had an MRI run on your left shoulder, then you need to have one.

Hangs, face pulls, mobility work, and general rear delt attention are all great but if you are not exaggerating any of your symptoms here then this is simply not the place to gather information. Even if there were a sports physio on this forum, a reputable one wouldn’t diagnose you over the internet from a few pictures and a vague description. Please get the help you need, and if there are no tears or visible damage, come back and we can give you some suggestions.

Hey bflare,

Some general thoughts in how I approach clients-

-Issues when first waking up and I’m looking at how the person sleeps. Is there a sleep positioning change we can make so they wake up feeling better? Here is a simple one: do they lay on the shoulder that hurts? Easy change. Don’t lay on it :). There can be more to it than that, but it’s a surprisingly common one.

-When the elbow goes behind the shoulder and the person has pain, humeral anterior glide is a common culprit.

Think of the shoulder like a lever. If the bottom of the lever (elbow) goes back, the top will at some point start coming forward. This is why so many people have pain at the bottom of a bench press:

-Dead hangs are alright. I’m not a big fan of them because the person is going to be fighting the stretch to some degree.

It’s hard to completely relax when doing it, which means the muscles you’re trying to stretch are probably activating. After all, nobody wants to stretch so much they tear anything. So as you’re trying to let the arms get pulled up, you’re probably inadvertently pulling them down, if that makes sense. (If the feet are on the ground, not really a dead hang but same flavor, then that works better.)

I’m more in favor of actively working the arms up. You also get to work on how the arms move this way. Example:

-Some side to side differences are normal. If the person has a throwing background e.g. baseball, then you need to be even more ok with them.

That said, your left arm is lacking horizontal abduction ability quite a bit. Here is one way I work on that,

If the person can’t get the arms down to the floor comfortably, then I add a pillow or two under the elbow(s) so they can still stretch, but be relaxed. Over time, we lessen how much / big the pillows are.

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Thanks for taking the time to reply.

Issues when first waking up and I’m looking at how the person sleeps.

I used to sleep on my bad shoulder but I make the effort to sleep on my back now but I still found that difficult. I try to sleep on my good shoulder with my arm on my side but I think this allows my left shoulder to roll forward. I wake up every morning with a ache in my shoulder. It hurts to put my left arm behind my back, After around 15 mins the discomfort disappears but can come back as soon as I stop moving my arm.

Dead hangs are alright. I’m not a big fan of them because the person is going to be fighting the stretch to some degree.

Yep I understand & I find myself fighting the weight. If i let myself hang completely it gets pretty tight although it does feel amazing.

That said, your left arm is lacking horizontal abduction ability quite a bit. Here is one way I work on that,

What causes this? Is it a muscle tightness issue? What I noticed is that I started laying on a roller & putting my arms behind my back. My right arm would touch the floor but my left wouldn’t. I would feel tightness all down my left side, in my delts, lats, tricep etc. Just like this

I have started doing facepulls, external rotation on the cable machine before & after any lifting along with deadhangs after. I also do serratus anterior push ups, band pull aparts & this but with a band for my lower traps 9e58d31aaba085d3cc8e90f3b9b7d2a3
Things do appear to be improving & I can normally gauge by how my work outs feel & how much discomfort I feel when I wake. My arm doesn’t really hurt when I move it, its more of a pain that is just there. I have also dropped any lifts that hurt & I have split my benching between barbell & dumbbell to hopefully give my shoulders a rest from barbell benching twice a week like previous.

The lack of horizontal abduction can be from stiff pecs. Think of a person who has done a ton of benching, chest flys, pec deck. They’ve gotten really good at bringing the arms towards one another (adduction), but they might have lost some ability to bring the arms away from one another.

The foam roller position / laying with the arms directly overhead is usually more of a lat stiffness problem. (The person will commonly feel stiff underneath the shoulders.)

You don’t want to work on this with the lower back arched though. The lats connect all the way down to the lower back and play a role in lower back extension. So in order to properly stretch them, you want the lower back a little flat. This is one reason I like to have the person lay on the floor, or back against a wall.

The sleep is tough without looking at you more closely. But per that animation I sent in the last post, if you lay on your side but the elbow is behind the shoulder, that could be the problem.

Regardless, you want to keep playing with positions. If you are laying in a position for hours every night that’s causing problems. it’s hard to overcome that during the day with a few sets of exercises.