I have a client that is getting a re-occurance of scapular-region pain. Not when she does any particular lift, but just moving the arm in a bench press motion or across the chest. She says it clicks or pops at times also. I’m decent at knowing what’s going on with the large, marjor muscle groups, but need some help when it comes to small stabalizers.
I have her on a strength/hypertrophy routine. She doesn’t respond well to heavy weight/low reps, so she is working sets of 8-12, all compound exercises, total body, twice per week. I do my best to design her program in antagonist fashion, being sure extensors get as much work as flexors.
Any insite to what may be going on? Any particular movements, re-hab/pre-hab, or stretches that might help?
I’ve experienced the same problem myself over the last 8 months. I find the only thing that helps me is to stop doing barbell and dumbbell benches of any kind. I’ve resorted to hammer strength machines with very little irritation of the area and still get a pretty good chest workout. Before this I never had any problems at all with the scapula area. It initially started on my left side and within the last 4 months now affects my right side too. I used to sleep on my side at night (i don’t know if that had anything to do with it) but because of the pain I now have to sleep on my back and I hate that.
I’m stubborn and after the pain has subsided for a few weeks I’ve tried to return to free weights for chest and after about 1 or 2 training sessions the pain is back.
I’ve seen an orthopedist and had x-rays and an MRI with no explainable reason for the pain. The doc told me the old joke of if it hurts to do those lifts then don’t do them. (I didn’t enjoy the attempt at humor either).
I know my post doesn’t exactly answer your question but may offer your client some relief. I hope it helps.
I’ll also monitor this thread to see if anyone else has anything to offer.
What’s up ass! Just thought I’d lighten the mood… anywho… thanks for the feedback. I appreciate it, even if its not PT speak.
My situation is that I don’t own “commercial” equipment where I have a dozen different ways to work the chest. I have a 4-post power rack with a cable pulley, a couple benches, dumbbells, and plates. That’s it. At this point I don’t think its necessary to get fancy with my studio, as I have found many ways to get variety out of the bread and butter lifts. Long story short, its either barbell/dumbbell pressing or flyes for chest for my clients.
I would really like to know (as I’m sure you would as well) what is going on with the body back there so I don’t have to abondon the bench press. In my 15 years of training I have yet to see this specific injury. Yet, you are the third person lately who has had this pain that I know of. So, I’d love to have some advanced knowledge on the subject as it seems its a bigger problem than previously thought.
The scapula is a very large bone; it’s tough to tell what’s going without knowing the exact location of the pain.
Also, you mentioned “chest exercises.” I’ll guarantee you that your clients’ injury rates will go down appreciably once you start training movements and not muscles.
I had the same problem (I think) 6 yrs ago when I was lifting on and off (mostly off). When I first start lifting, everything was fine. Then I stopped for like half a year and went back. That’s when my shoulder area (I know you said scapula, but like Eric said it’s a large bone and it is connected with the arms) feel some pain, but after 2 months of getting-use-to workouts. It felt all better, no pain at all. The only thing left was the poping. I can make the poping noise whenever I want, but no pain. And couple months later, I stopped working out again and went back, the pain came back. I have no idea what is it, so I did the same thing, I kept on lifting until the pain go away(light to heavy). And this happen quite a FEW times. So, maybe just have her build those muscle around the area for support(?).
[quote]Eric Cressey wrote:
The scapula is a very large bone; it’s tough to tell what’s going without knowing the exact location of the pain.
Also, you mentioned “chest exercises.” I’ll guarantee you that your clients’ injury rates will go down appreciably once you start training movements and not muscles.[/quote]
Hi Eric,
Maybe I’m a big dummy and I probably am, LOL… But could you please elaborate on what you meant by “injury rates will go down appreciably once you start training movements and not muscles.”?
[quote]Eric Cressey wrote:
The scapula is a very large bone; it’s tough to tell what’s going without knowing the exact location of the pain.
Also, you mentioned “chest exercises.” I’ll guarantee you that your clients’ injury rates will go down appreciably once you start training movements and not muscles.[/quote]
I’ll try NOT to take that suggestion about “training movements and not muscles” personally, as I you don’t know me very well. Out of the dozens of clients that I train/ed this is the first injury actually and a very mild one at that. I refer to my lifts as upper/lower body pushing/pulling and core movements. And of course some rotator and specific muscle group work where needed.
I don’t know of anyone that can have 100% perfect biomechnically efficient technique on every single rep over the course of their life-time while at 100% effort. There will always be contraindictions anytime a person pushes themselves.
Further, I appreciate your response, but it doesn’t matter if I call the bench press an upper body horizontal press or a chest movement (which is the primary mover as you know) my clients will still be performing them. I teach 98% compound lifts, working in all planes with both barbells and dumbbells. Honestly, I don’t know if I could design more comprehensive programs if you paid me 1 million bucks!
Moving on… her pain is just about in between where the rhomboid major and minor attach to the interior fascia of the scapula.
[quote]getbig wrote:
I had the same problem (I think) 6 yrs ago when I was lifting on and off (mostly off). When I first start lifting, everything was fine. Then I stopped for like half a year and went back. That’s when my shoulder area (I know you said scapula, but like Eric said it’s a large bone and it is connected with the arms) feel some pain, but after 2 months of getting-use-to workouts. It felt all better, no pain at all. The only thing left was the poping. I can make the poping noise whenever I want, but no pain. And couple months later, I stopped working out again and went back, the pain came back. I have no idea what is it, so I did the same thing, I kept on lifting until the pain go away(light to heavy). And this happen quite a FEW times. So, maybe just have her build those muscle around the area for support(?).
GB[/quote]
GB, as you can tell from my post to Eric, all my clients are quite well rounded in their programs. Yet, I’m all for learning as much as possible to become a better trainer - this is why I started this discussion. I have their scapula depressing, retracting, protracting, elevating, etc., by working several planes of motion, which would build the associated muscle tissue. I’m wondering if there are some unique movements/exercises that I can teach to either pre-hab or re-hab my clients. As the bread and butter basics (compound lifts) are obviously not enough, at least for one client.
As an addition to my post to Eric, and for general purposes, not all trainees come into a trainers care in perfect balance. Most likely, almost all have some impingements or problems that must be addressed. This is what makes our job as a trainer or self-trainer challenging. If this client performed a certain job in which her scapula tracts out of position due to a weakness in one the scapular movers, this would pre-dispose her to inury, no matter how flawless the design of her program. This could be said about nearly all trainees, in any area of their body.
For instance, I have 6, instead of 5 lumbar vertebrae and a psuedo-joint into my pelvis off my L6. Therefore, I cannot tolerate extreme torso flexion as the pressure on my lumbar disc’s is greatly increased. Just one example of how I must make a few very unique changes in my training to avoid injury to my back.
[quote]TopSirloin wrote:
getbig wrote:
I had the same problem (I think) 6 yrs ago when I was lifting on and off (mostly off). When I first start lifting, everything was fine. Then I stopped for like half a year and went back. That’s when my shoulder area (I know you said scapula, but like Eric said it’s a large bone and it is connected with the arms) feel some pain, but after 2 months of getting-use-to workouts. It felt all better, no pain at all. The only thing left was the poping. I can make the poping noise whenever I want, but no pain. And couple months later, I stopped working out again and went back, the pain came back. I have no idea what is it, so I did the same thing, I kept on lifting until the pain go away(light to heavy). And this happen quite a FEW times. So, maybe just have her build those muscle around the area for support(?).
GB
GB, as you can tell from my post to Eric, all my clients are quite well rounded in their programs. Yet, I’m all for learning as much as possible to become a better trainer - this is why I started this discussion. I have their scapula depressing, retracting, protracting, elevating, etc., by working several planes of motion, which would build the associated muscle tissue. I’m wondering if there are some unique movements/exercises that I can teach to either pre-hab or re-hab my clients. As the bread and butter basics (compound lifts) are obviously not enough, at least for one client.
Sincerely,
TopSirloin[/quote]
Hey TopSirloin, what I used was just basic isolated exercisers like shoulder raise(front, side, and back) and Arnold military press. It did not do upright row cause I can feel that my joints is keeping the weight up (too much stress on the joints). I haven’t done that in like 6 months at least just because I didn’t like the feeling. I should be doing it (power upright row) again soon when I start CT’s Shoulder Overhaul. Hope that help!
I have a client that is getting a re-occurance of scapular-region pain. Not when she does any particular lift, but just moving the arm in a bench press motion or across the chest. She says it clicks or pops at times also. I’m decent at knowing what’s going on with the large, marjor muscle groups, but need some help when it comes to small stabalizers.
I have her on a strength/hypertrophy routine. She doesn’t respond well to heavy weight/low reps, so she is working sets of 8-12, all compound exercises, total body, twice per week. I do my best to design her program in antagonist fashion, being sure extensors get as much work as flexors.
Any insite to what may be going on? Any particular movements, re-hab/pre-hab, or stretches that might help?
Greatly appreciative,
TopSirloin[/quote]
I mean if the pain is severe enough, and it’s very reoccuring, and there is a popping sensation, if she can’t do strength exercises in the region (i.e. shoulder flexion etc…) maybe you should refer to an orthopedic surgeon. At the very least she could get some X-rays, as it’s possible there could be some damage there (or on another level, scar tissue from past occurences) did you client ever play a ball throwing sport?
Have you checked out the “Booming Biceps” articles by Don Alessi? It sounds like she may be suffering from Scapular Winging. I am experiencing the same thing - pain in pressing movements (certain types) and at one time, it was painful to execute any type of curl other than the hammer curl. I, too, experience pain when reaching across my chest.
I saw a chiropractor who was also an ART practicioner. He thought is was muscle imbalance at first - chest pulling the shoulder out of alighment. He did some work on me which relieved the pain somewhat. I can press at relatively low weight levels (below 225), but anything greater causes pain.
Anyway, Don has some recommended exercises to try to get everything back in place - push press, incline front raise with DB, and “L” side lat raise.
Well, I hope this helped. If you find out anything else, let me know as I’m still trying different ideas to overcome this.
If you haven’t read the 7 minute rotator cuff solution by health for life you should. They really explain the biomechanics of the shoulder and what can go wrong with it. You might find somethings in there that can help.
I’d recommend ART or another form of deep tissue. More than likely there are some adhesions in that area.
I’ve had good success using Iron Woody and Jump stretch bands…just hold the band with the ends in each hand at shoulder level and pull apart until the hands are pulled back as far as they’ll go and the scapula are completely retracted. Keep the arms straight and at shoulder level throughout the movement.
This is what makes this site phenomenal!!! Thank you everyone for the responses. I will look into all the previously mentioned articles and I can recommend an ART treatment to her. And, the resistance band pulls sound helpful as well.
She is anti-chiropractic unfortunately, so she might be a little leary of the ART technique (even though its not chiro). Also, her pain is quite mild so an ortho is a bit pre-mature at this point. I definitely think its correctable with working the associated musculature. If not, I’ll be back!!
[quote]Sifu wrote:
If you haven’t read the 7 minute rotator cuff solution by health for life you should. They really explain the biomechanics of the shoulder and what can go wrong with it. You might find somethings in there that can help.[/quote]
I mean if the pain is severe enough, and it’s very reoccuring, and there is a popping sensation, if she can’t do strength exercises in the region (i.e. shoulder flexion etc…) maybe you should refer to an orthopedic surgeon. At the very least she could get some X-rays, as it’s possible there could be some damage there (or on another level, scar tissue from past occurences) did you client ever play a ball throwing sport?
[/quote]
She did some cheerleading, so there might be some shoulder/upper back issues from the gymnastic aspect of her sport. She also has hypermobile joints so that can sometimes pose a problem as things can tract out of place.
Hey TopSirloin, what I used was just basic isolated exercisers like shoulder raise(front, side, and back) and Arnold military press. It did not do upright row cause I can feel that my joints is keeping the weight up (too much stress on the joints). I haven’t done that in like 6 months at least just because I didn’t like the feeling. I should be doing it (power upright row) again soon when I start CT’s Shoulder Overhaul. Hope that help!
GB[/quote]
Thanks for the suggestions. I work her shoulder girdle from many angles and lifts, using the ones you mentioned and others. I do have her avoid over-head pressing because of some complaint of pain. I will also cut out any upright rowing, unless using dumbells pulling the elbow toward the body and up (versus a strict vertical pull with a shoulers externally rotating).
As I mentioned elsewhere, she has hypermobile joints which I believe are causing some problems. I will likely reduce the loading on her upper body and work a variety of small pre-hab moves in.
Smart to address the hypermobility issue and back off on the upper body intensity. If she can’t stabilize her shoulder girdle, she’s definitely gonna run into problems in the future.
good luck!
[quote]TopSirloin wrote:
getbig wrote:
Hey TopSirloin, what I used was just basic isolated exercisers like shoulder raise(front, side, and back) and Arnold military press. It did not do upright row cause I can feel that my joints is keeping the weight up (too much stress on the joints). I haven’t done that in like 6 months at least just because I didn’t like the feeling. I should be doing it (power upright row) again soon when I start CT’s Shoulder Overhaul. Hope that help!
GB
Thanks for the suggestions. I work her shoulder girdle from many angles and lifts, using the ones you mentioned and others. I do have her avoid over-head pressing because of some complaint of pain. I will also cut out any upright rowing, unless using dumbells pulling the elbow toward the body and up (versus a strict vertical pull with a shoulers externally rotating).
As I mentioned elsewhere, she has hypermobile joints which I believe are causing some problems. I will likely reduce the loading on her upper body and work a variety of small pre-hab moves in.
You mentioned she was doing bench presses - I’d recommend stopping this immediately if she has pain in the scapular region. Since they’re pinned down against the bench under load, it could be causing the problem to become worse. If you’ve already done that, well, kudos. I actually wouldn’t recommend benching at any time for someone who isn’t a competitive strength athlete, but I’m a little on the conservative side.
You also mentioned she has pain in overhead pressing - obviously this is not normal, as it’s a normal ROM for all joints involved. What has assessment of this shown? Just the pain in the scapular region, or are there weaknesses elsewhere in the rotator cuff (outside of the laxity)?
I know you said she has joint laxity, but it could simply be tightness in the region. Her program may be well rounded, but if she isn’t putting much into stretching the musculature in this area, it could have tightened up while her shoulders remained hypermobile due to laxity in connective structures or other musculature. The scar tissure treatment mentioned previously may help if it’s simply adhesions causing tightness, too.
Best of luck, but remember not to take on the whole responsibility yourself - if ART and a few corrective exercises don’t work, tell her she’s not allowed to lift until she sees an ortho. Be firm.