Shoulder Pain

Training Injuries
1

So my left shoulder has been bothering me since mid-june. I tried to max my bench press, failed, and experienced the pain the next day. I went to 3 different PTs, but that really didn’t help much. Maybe I just had bad luck, but it seemed like they didn’t have a clue about what they were talking about. (One of them said swimming for 2 weeks would miraculously cure the shoulder, another one used Radial Shockwave Therapy with no effect, obviously.)

After these unsuccessful visits, I went to another PT a friend of mine recommended. He examined the shoulder and said that it was most likely an impingement syndrome or a supraspinatus strain. He recommended an MRI scan to check for impingement. This came back negative. But it is my understanding that the MRI was ‘set’ to only check for impingement. But wouldn’t they see if my RC was damaged anyway? Should I try another one of these?

I’ve been told that my shoulders are too much rotated forward, so I’ve been doing various exercises to bring them back (seated rows, face pulls). I’ve also been doing a lot of RC exercises as well as stretching my lats.

The shoulder pops when I’m rotating it backwards, but every PT said that was normal and probably didn’t have anything to do with my injury. I sometimes experience a sharp pain in front of the shoulder when I hold my palm against the back of my head and rotate, in addition to a light but constant pain in the shoulder in general.

The shoulder feels stiff, but the funny thing is that this varies. The sensation is close to the feeling of muscle soreness, especially when I stretch the shoulder.

When I do overhead presses with just my arms it feels like a tendon is grinding a bone or something.

Basically, all pushing exercises hurt. Rowing exercises are OK with the exception of pull ups, but can’t go too heavy on the rows either without feeling pain.

Anyways, this is just some kind of last attempt to resolve my shoulder problems without undergoing surgery. So if anyone has any suggestions it would be very appreciated…

2

Can you post a picture of a shoulder and mark where exactly the pain is? Did you ever see a physician or just the physical therapists?

As far as the MRI, the machine doesn’t get “set” to scan for a specific injury. It just takes multiple pictures of a body part of area at different depths and angles to get a full picture of the body part. They will usually write the script for the MRI to rule out a specific injury but that doesn’t mean that is all that will be seen. Did they inject a dye into your shoulder before the MRI? Most shoulder MRIs that the doctors I have worked with order arthrogram dye MRIs to help get a better imaging. Also, I’m not surprised that they didn’t find the impingement in the MRI, especially if your shoulder wasn’t in the position of impingement when the MRI was taken. Did the MRI report state that they found any other abnormalities?

What does your current training look like and what did your previous rehab look like?

3

Thank you for your response.

The person who said it was most likely an impingement was a Senior Consultant. English is not my first language so I don’t know if that translation says you anything. An experienced doctor, kinda.

They didn’t inject anything in my shoulder. Maybe I should get another scan with dye injected?

I will try to translate the MRI report, but as it is written with medical terms in Norwegian it might be confusing: “RC looks normal. Labrum looks normal. Bicep tendon is placed in the sulcus. AC joint OK. Good spacing below the acromioclavicular joint. Impingement is however a clinical diagnosis.”

Haven’t really been following a strict routine, as I don’t know what I’m dealing with thus what to do. Been working out around 3x a week with light RC exercises, seated rows, low weight deadlifts etc. I’ve recently been trying out part I of this 8 Weeks to Monster Shoulders this program. Foam rolling has gotten rid of the soreness I used to have around the scapulae.

The X on the picture attached views the sharp pain which I sometimes experience. This typically happens when I hold the back of my head with my hand and rotate the shoulder back and forth.

Oh, and the constant pain is varying in degree and I never wake up at night because of it.

4

Yeah my shoulder’s in pretty much the same state…sore in exactly the same internal area. Been to a couple of PTs but they didnt seem sure, but ive been strengthening the traps and internal rotators and it seems to be really helping. Hurts when i sleep on that side though. Damn, shoulders are so complicated!

5

OP, if I were you I would stick to part I for quite a while, and even when you get to part II, I would replace the upright rows with another exercise. I have found that those with impingement symptoms generally do not do well with upright rows.

6

Take a look at this thread soma, post a picture of yourself in those same positions (the lying positions) I bet you are seriously internally rotated and have very poor flexion/abduction rom of the humerus. Alot of people are familiar with the whole weak on one side tight on the other idea, but most times the tightness on one side is causing the bigger problem and attempting to strengthen the ‘weak’ side cannot take place effectively until you can gain some rom on the tight side. so all those face pulls your doing I would say are never going to help anything until you free up some rom on the other side.

Its like having a tight psoas and weak glutes. Both are big problems, but its virtually impossible to strengthen your glutes with a tight psoas so you need to fix that issue first. Same thing here. You need some ART or something to free up some external rotation and flexion. But post a picture so we can be sure.

7

Sorry this is the thread What the Hell is Wrong w/ My Shoulder? - Injuries and Rehab - Forums - T Nation

8

The pain you talk about seems to occur when you are attempting external rotation, indicating tight internal rotators, but dont think pec or lat, subscapularis is more of an issue here I bet.

9

Buying some bands and making band pull aparts one of your favorite exercises would seem like a good idea

10

The idea of the band pull-aparts is a great idea. One thing, though, and it sounds kinda whacked, but the ileum(pelvic region) on the right side may be rotated back, more than the left. This can cause the spine to rotate and send the same rotation up the food chain. The opposite-side shoulder ends up being forward. Not even many PT’s will check for this, in my own experience. Fairly easy to correct. Restore the lumbar curve, pelvic alignment, etc., and it is easier to fix shoulder stuff. See, told you it may sound far-fetched.

11

sounds like a partial labrum tear

12

It’s really too bad that you didn’t have an arthrographic MRI (with dye). It’s my understanding that the contrast that is injected is what allows a tear to show by virtue of dye seeping into areas where it shouldn’t.

13

[quote]Shadowzz4 wrote:
Take a look at this thread soma, post a picture of yourself in those same positions (the lying positions) I bet you are seriously internally rotated and have very poor flexion/abduction rom of the humerus. Alot of people are familiar with the whole weak on one side tight on the other idea, but most times the tightness on one side is causing the bigger problem and attempting to strengthen the ‘weak’ side cannot take place effectively until you can gain some rom on the tight side. so all those face pulls your doing I would say are never going to help anything until you free up some rom on the other side.

Its like having a tight psoas and weak glutes. Both are big problems, but its virtually impossible to strengthen your glutes with a tight psoas so you need to fix that issue first. Same thing here. You need some ART or something to free up some external rotation and flexion. But post a picture so we can be sure. [/quote]

I don’t have access to a camera right now, but I will post the pictures asap. Please check back in a few days.

14

[quote]colt44 wrote:
sounds like a partial labrum tear[/quote]

Why do you think that? Will an MRI with dye reveal such a tear?

16

To start I would defiantly scrap any overhead pressing, your shoulder is in no shape to be handling the sheer and compressive force demands at this point in your training.
I think your third PT was correct but possibly bushidobadboy might be right as well…although if you failed at overhead pressing that then does not give us a definite answer to your problem as the bicept tendon isnt in a position to be really involved in overhead pressing since its more of a tricept dominant exercise.
I dont think you have a major problem here OP… You just need to rest and recover. Its obviously irritated so you need to pick the most shoulder friendly exercises and stick to them while you do mobility and light scapula/external and internal rotation work at a ratio of 2:1 and you will be back to lifting in 4-8 weeks depending on how bad it is, I cant tell from my computer screen so just need to stick with it till you feel no pain doing pushups and latpulldowns and more demanding exercises.

Im gunna throw you a bone here because im bored and tell you exactly what to do here so you cant fuck up somehow. First cut your training time to 3 times a week full body. Make sure you warmup properly. Keep up your foam rolling, get your lats, back (try it with your arms overhead) Start doing shoulder mobility work DAILY (vids below) and stick to shoulder friendly exercises like single arm rows seated rows, reverse incline bench DB rhomboid shrug, reverse DB fly, external/internal band rotations…remember your not trying to impress anyone you want to rehab that shoulder so keep it reasonabily high reps around 8-20. Take advantage of this time and focus on your lowerbody and core, its good your doing deadlifts but defiantly stepup your goblet squat, hip thrust and plank game if you dont wanna rot your gains away.
So ya, warmup properly, do your mobility homework until things settle down. Let me know if you have any questions or anything.

Warmup Vids:

Scapula Mobilization Routine - YouTube (pick exercises wisely)
The TRUTH about the Shoulder Sleeper Stretch and Posterior Capsule Tightness - YouTube
Thoracic Spine Mobility - New Joint Mobility exercise - YouTube

Give it a try! Let me know how it goes.

Lift string and prosper

Paul

17

[quote]bushidobadboy wrote:
The area you marked is just next to the biceps tendon.

The biceps tendon is commonly the first structure to be inflamed in a shoulder pain scenario with gym lifters, not sportspersons.

The biceps tendon is irritated by subacromial impingment.

The mechanism of injury (failed bench) would fit the symptoms of bicep tendonitis.

Honestly with the amount of bro-knowledge being thrown around in this thread, I’m suprised the OP hasn’t given up.

And yet with all the outre suggestions people have been making, I didn’t see anyone proposing the most common, most likely issue; simple biceps tendonitis.

OP, there are simple tests for the condition (which I’m shocked and surprised the PTs didn’t do) that can almost 100% accurately diagnose it. Look them up on youtube and do them yourself/with a friend.

Sort out your scapular positioning/internal rotation (if you have it and lots of gym rats do), hence removing the cause of the irritation. Apply cross-friction massage and ibuprofen gel to the area and if you’re not significantly better in 3 weeks, I’ll be surprised.

Surgery indeed! Bah.

BBB[/quote]

Dude your a cocky fuck. You come on another thread talking about how bad ass you are and that I have no idea what I am talking about. Then on this thread, you come around talking about all the bro-knowledge and how your surprised the OP hasn’t given up and start going on and on about biceps tendonitis. Big deal so thats the injury. Any jackass knows that. Then what did you recommend to fix it? Exactly what I recommended. Fixing the source of the problem which is most likely and internal rotation issue. Believe it or not your not the only one who knows what he is talking about. No need to get all pissy because other people have something intelligent to say you cocky James Bond wannabe prick.

19

[quote]bushidobadboy wrote:
The area you marked is just next to the biceps tendon.

The biceps tendon is commonly the first structure to be inflamed in a shoulder pain scenario with gym lifters, not sportspersons.

The biceps tendon is irritated by subacromial impingment.

The mechanism of injury (failed bench) would fit the symptoms of bicep tendonitis.

Honestly with the amount of bro-knowledge being thrown around in this thread, I’m suprised the OP hasn’t given up.

And yet with all the outre suggestions people have been making, I didn’t see anyone proposing the most common, most likely issue; simple biceps tendonitis.

OP, there are simple tests for the condition (which I’m shocked and surprised the PTs didn’t do) that can almost 100% accurately diagnose it. Look them up on youtube and do them yourself/with a friend.

Sort out your scapular positioning/internal rotation (if you have it and lots of gym rats do), hence removing the cause of the irritation. Apply cross-friction massage and ibuprofen gel to the area and if you’re not significantly better in 3 weeks, I’ll be surprised.

Surgery indeed! Bah.

BBB[/quote]

Thanks for your reply BBB

I tried the dig your thumb into the bicipital groove like you suggested in this thread: Supraspinatus Tendonitis - Injuries and Rehab - Forums - T Nation , and the tendon is definitely sore. I think you’re spot on with your diagnosis, but I have a few questions regarding how to resolve it:

  1. In order to not waste your time, should I just follow the advices you gave in the above-mentioned thread?
  2. Crossfriction. As I understand this involves pressing the tendon horizontal with your fingers. Correct? Should I apply the ibuprofen gel after or during this massage?
  3. When you say that I should sort out my scapular positioning/internal rotation, what exactly do you mean? I can provide pics if required.
  4. When I’m doing heavy squats, my shoulder gets a little uncomfortable. It’s not a big thing, but would it be wise to stay off them if they hurt?
  5. As it’s impossible to get a hold of a foam roller here in Norway, I’ve made my own of a broomstick and some isolation. It’s quite uncomfortable using, but can this be a problem?

Regarding my SS, I haven’t been able to do any of the tests yet, but will write back in this thread as soon as I have.

Anyways, I’ve come up with the following routine, and I would appreciate if you cold give me some feedback here :slight_smile:

Full body mon/wed/fri:
Warmup: Foam rolling, exercises suggested by Paulster56 (thx btw) what’s your take on these vids BBB?

Squats 3x5 (DLs 3x10 on wed)
Seated rows 3x15 (alternate between different variations)
Facepulls 3x15
DB rhomboid shrug 3x12
Reverse DB fly 3x12
External/internal band rotations
YWNTLs
Stretching: Pecs and lats. 2x60 secs. Pecs first then alternate. Should I add broomstick stretches or anything like that?
Cross-friction massage, mobility work and foam rolling on every resting day.

What do you think?

Last questions. You said that “the biceps tendon is irritated by subacromial impingment”. How can this be when the MRI scan came back negative? Wouldn’t the PT see if the acromion is type II or III from the scan? Also, isn’t it strange that seated rows are pain-free, seeing how much biceps involvement there are?

Thanks again, BBB. I’m sorry if some (all?) of these questions are pretty elementary, but I would really appreciate it if you could answer them.