Screwed up shoulder vs. F-progressions

Ok, as many of you will know by now, I've got a left shoulder that's been repaired for a labrum tear. Specifically it was a Bankart lesion. This is probably going to be a lengthy post, since I will try to be as precise as possible. I would appreciate it, if some of the PT's could chime in on this one.

 

I'm currently doing elements from F1,2,3 and H1, so I'm just going to post in F2, since my main problem is russian L-sit dips.

 

I had surgery seven years ago following a subluxation, and I've done a lot to rehab the shoulder, and have come a long way, from being unable to lift my arm above horizontal, to being able to have a fairly nice handstand, doing HeSPU, assisted one arm pullups, climbing, ice climbing etc. Most importantly, I have consistently been able to accomplish this virtually without pain.

 

Initially, in the first two-three years post-op, I'd have a low, droning background pain, but due to stretching, strengthening and re-establishing ROM, I am now pain free.

 

Enter the foundation series. Let me first state, that I love this course, and the following is no criticism of the course at all, because the exercises feel wonderful for my right shoulder, which is healthy. However, there's no escaping that I have a pathology in the left shoulder which it would be foolish to ignore.

 

Ok, so a pattern have begun to emerge. Extension and flexion of my left shoulder that takes place in the sagittal plane give me no trouble at all, even if the load is great. Things like chinups, muscleups, regular dips, HeSPU without flaring elbows etc. Xiaopengs are also fine, as are im1, 2, 3 & 4 in H1.

 

However, when a rotational torque element is introduced to the humerus, with the arm flaring out to the side, and in some cases also when the arm is flexed behind the back (think about the tightest spot in broomstick dislocates)  my shoulder gets irritated. Exercises that trigger this are the wide-grip pullups, russian dips, and weighted dislocates. Undergrip dislocates are better than overgrip, but I'll have to play more with them to know if the are painless when weighted.

 

I've mastered russian dips, and there actually wasn't any pain, but when I tried russian L-sit dips yesterday, there was an immediate, sharp pain response. Likewise, I've mastered the wide-grip pullups, except wide L-sit pullups, which also cause pain, albeit not as badly as russian L-dips. I am certain that the forward shifting of the centre of mass caused by performing russian dips and wide grip pullups in L-sit introduces more rotational torque on the humerus, because the torso shifts further back and away from the point where the hands grip the apparatus. Oddly enough, I assume that this would load the subscapularis harder, since internal rotation is occuring, but the pain I am feeling is on the backside of the humerus, radiating down the triceps as well as into the shoulderblade, mainly the infraspinatus.

 

I feel a relatively acute pain now if my arms are hanging down by my side, and I flex the elbow to 90 degrees and externally rotate. Any idea what's causing this?

 

Right now I will take a couple of weeks of from upper body training, because the left shoulder is quite sore right now (No biggie, I need to catch up in the MN and FL department), and see how I feel. To those of you who read my thread about my trouble with MN/PE6, that is actually no longer a problem in terms of pain. The big question remains, though: What do I do from here?

 

I am first and foremost doing this program for health, longevity and plain fun - I don't plan on being certified, but would certainly love to attend a seminar one day. I could be stubborn and push through, but that would just be too stupid. There is something odd going on with the rotator cuff and ligaments in my shoulder, which I can't exactly pinpoint - mostly because the diagnostic stuff online concerns pre-op shoulders; there's little information to be found about post-op symptoms. There's not anything wrong with it as such, but the joint capsule has been deliberately tightened by the surgeon, thereby reducing external rotation ROM to prevent future spontaneous dislocation, and I'm just not going to work against what the surgeon has done, by attempting to improve that ROM. This would also be futile anyway, because when I hit the end-ROM in external rotation, it's hard and doesn't budge unlike in my right shoulder. In day to day use, my ROM is as good as most peoples', the most obvious deficiency is that throwing a ball with the left hand feels very tight and restricted - No great loss, since I'm right-handed. I can live without being able to dislocate a lot of weight too.

 

The end goals of the foundation series all seem to be unaffected by my mobility deficiencies: I can already hold a side lever, I have the basic mobility to assume a manna shape in the weighted shoulder extension hang, and so forth. All the movements and static positions are within my painless ROM, so I see no reason to quit. My handstand line is not perfect, but it is improving rapidly, and I see no reason that I couldn't make it to the end of H1.

 

However, there are some progression that may just be, and it sickens me to say this, detrimental to my shoulder and its pathology. I know that the response will probably be to go back and properly prepare the left shoulder. Two things speak against this, though.

1: The pain is ROM-related. I will certainly do light rotator cuff work with bands to continue to strengthen weak spots. But my intution tells me that to deliberately target painful ROM spots in a reconstructed shoulder is asking for trouble. The shoulder is very stable now, but the price I pay is a bit of restriction on ROM, and that's ok.

2: My left shoulder has gone through exactly the same amount of preparation as the right one, and in most cases is just as strong. In those instances where it is not as strong, I suspect that it is due to surgical alterations to ligaments, not underdeveloped musculature - I think I am right to be a little anxious about messing with that.

 

Right... Sorry for making such a long post. Qualified input is more than welcome - Thanks!

It sounds like you have done remarkably well under the circumstances.

 

If there is an element that is causing pain due to a known pathology, of course the FIRST thing to do is back off! No course in the world can take into account everyone's particular issues. That's not a fault of courses, just a fact of life. So, don't feel like you are doing wrong by backing off.

 

If you really want to get a certain element that is causing pain, the only option is very low volume at first, just a single rep after the main workout. If it causes pain WAIT, see what happens next time. If it consistently causes pain then re-assess, is there a way to reduce load more, can you get an assist etc? For example what if you try a bent leg L?

 

In a case like yours (and ONLY in a case like yours for others who are reading) it may be best to skip a certain element. Perhaps testing with a single rep from time to time as you continue.

 

Coach Sommer has stated that for medical reasons, exceptions can be made, so if you are really interested in getting certified he will work with you. Perhaps also suggest some ways to move forward.

 

Also use the injury as guide to your mechanics, look at what you are doing, can you play with the mechanics in such a way as to reduce the pain.

 

I personally had elbow surgery for arthritis about a year and a half ago. I've had to start over on many skills and elements. It's an interesting process. I've had to move very, very patiently with many elements and slowly change, improvement comes. It's all good.

Thanks Cole, those are good suggestions. It's all about making do with what's available to us.

 

I think I have done well, my surgeon warned me that I shouldn't expect to be able to continue climbing. At that time, tree climbing / arborism was my profession, and I did manage to get back to doing that, which essentially paid for my university degree.

 

I think that because foundation teaches parallel tracks of progressions, there is an overlap of muscles used across the tracks, and therefore it can be difficult to sort out which exercise causes what. I think one of my issues is one of accumulated irritation - i.e. no acute injury, but possibly inflammation acquire by performing several exercise tracks that each contribute a little bit to causing inflammation or whatever it is. As mentioned, I'll rest my shoulders for a couple of weeks, see how it goes.

The Russian dip puts the Gleno-humeral joint in a high load internal rotation combined with extension. When our shoulder is in this position the humeral head wants to slide forward into the front of the labrum, which is where you had your injury. When the humeral head does not stay centred in the socket we compress structures that give us pain. Have you got a video of you doing a Russian dip and in the L sit? A side on view would be best. Can you also post a video of your shoulder in 90 deg abduction in supine. Let the the arm move into internal rotation with no active contraction by you. The movement is meant to be passive and since I cannot make it to Denmark to hold your arm try to relax the muscles as much as possible .

The fact you got the Russian dip is positive and it you should be able to get the Russian L-sit dip. There is just way more load. I am not sure of the exact increase in load. Coach would know more about this than me.

I like Cole's suggestion of doing a bent leg progression. I would then do a half L-Sit. You could call it HBP 11.33 and 11.66. You may also need to replicate the movement with a cable and weight really focusing on keeping the humeral head centred so that the correct position is integrated at a more complex neural level. Building some volume with the Russian Dip would also help.

Hi Mark

 

Thanks for the explanation, that really helps me understand what's going on. Given that the soreness in the shoulder is quite significant right now, I won't be able to post any dipping vids during the next couple of weeks, but I can do the supine test over the weekend. 

 

How do I tell if the humeral head is centred in the joint - Are we able to consciously control that? My first instinct would be retraction of the shoulder, but that just moves the scapula towards the centre of the back, right?

 

What I find odd right now is that when I externally rotate without load, it triggers pain, yet the irritation has been produced by internal rotation; and if I clasp my hands together and push there is no pain. Hmm 

Keeping the joint centred can be tricky, but with training it is possible. It usually depends on the exercise, but often it is retracting the scapula and externally rotating the humerus. This happens at the bottom of a push up and dip. the scapula retracts back and the humerus externally rotates so the elbows point back. This is most likely why good gymnastic Coaches teach push ups with the elbows back rather than out to the side. They probably found out you were stronger and got less injuries. It is also why power lifters try to break the bar when they bench press. It externally rotates the humeral head so it sits centered in glenoid fossa. Sometimes it involves protraction the scapula and externally rotating the humerus. This happens when we do the at the top of the push up and Planche progressions.

You may also need some soft tissue releases as well.

Don't be too concerned with the pain in external rotation. With your joint irritated it is too hard to tell what is causing the pain. The cause of pain is so complex that it may be a stiff lumbar joint causing the shoulder pain! I had a patient this week that has a supraspinatus tear and he has improved with treatment to the shoulder, but he had pain at end range flexion. Whatever I did to the shoulder did not improve the flexion. I then found a stiff lumbar joint that when released gave him full pain free shoulder movement. The body is amazing complex and the more I know the less I know. So if your shoulder does not respond as we expect look further through the whole body and you might find a sneaky culprit