Video of poor scapular mobility, would appreciate advice from phsyio knowledgeable on shoulder mechanics

Hi guys, 

             To cut a long story short, I boxed for years with no shoulder issues, then got into olympic weightlifting/powerlifting and injured my shoulders. Partial proximal bicep tear, supraspinatus impingement/minor tear, no surgery was performed on this injuries, instead I rehabbed and often training around injuries. Finding ways to perform exercises without pain ingrained some very poor motor functions leading to very poor scapular mobility particulary in my right side where I still suffer inpingement to this day. 

I have been offered coaching work at a local boxing club and at a mma gym, to get back into this and coach people I need my full ROM back, full scapular mobility and be able to throw hooks without pain. I know I can do this with the help of those with good knowledge of shoulder mechanics. I also want to incorporate gymnastics routines into my routines and stop barbell training for overall shoulder health.

I was shocked when I seen the video of myself. Right shoulder sits lower (this is the one I suffer impingerment in)

I find it near impossible to even activate the lat on my right side (noticed this earlier when playing around with a thera band but the left side activates with ease, this side of my shoulder gives me very little issues. Its the right side which I find hard to activate my lat, this is the side I suffer impingement on.

I tried to do an exercise to activate the serratus anterior (where you pull a band around your back), it activates on the left, but yet again, I feel nothing on the right side, the very side that I trained around while injured.

I noticed even my body looks twisted when I try to stand up straight with good posture, I once had a over 3 times bodyweight deadlift, a 2 and a half times squat and for this reason I am very stiff, I aim to increase mobility in my hips, hamstrings and spine over the next few months - I have no injuries in this area and I am relatively pain free.

Video to come shortly, thank you very much for listening.

So here we are, as you can see I am a bit twisted, I have also lost a lot of muscle this past year or two since ceasing training. I think I push my right shoulder down and don't realise im doing it.

To recap

• Struggle to activate lat and serratus anterior on my right side, suffer supraspinatus impigement here.
• I have stopped barbell training and want to specifically focus on gaining scapular mobility and shoulder strength.
• All advice would be so very much appreciated.

That looks like a scoliosis of the spine. I would get x-rays of the pelvis and whole spine. That way you can determine if the problem is structural or not. If it is structural you won't be able to change the curves. The shoulder imbalance is due to the poor pelvic and spinal position.

Damn that looks nasty...

30 minutes ago, Mark Collins said:

That looks like a scoliosis of the spine. I would get x-rays of the pelvis and whole spine. That way you can determine if the problem is structural or not. If it is structural you won't be able to change the curves. The shoulder imbalance is due to the poor pelvic and spinal position.

Hi mark, thanks for your reply! I can confirm I don't have scoliosis, I have had an x ray of the spine before for another reason which came back normal, I do however have an extremely tight pelvis which I am going to start working on.

I will post another video tomorrow with side on angles and after a good stretch! I've spent the last week stuck in seat studying for an exam

any my advice on the scapula shoulders themselves? Specific spinal or pelvic stretches or exercises? I appreciate your input.

i am going to post a journal on the forum of my recovery.

thanks for your time

Well, you know an explanation like this over the internet is difficult, as much more information is needed, but worthy of discussion. 

A physical therapist would screen any possible other injuries above or below your area of concern, but this seems to be minimal from what you have described.  So looking at the picture, it appears there is atrophy of Right Upper Traps, Lats, and Serratus Anterior.  Digging deeper, we would ask about the origin of these muscles, the nerves:  C3,4 nerve roots of Accessory nerve into the Upper traps, C5,6,7 via Long Thoracic nerve into the serratus anterior, and C6,7,8 on the thoracodorsal nerve into the lats.  Don't quote me, this is off the top of my head.  Because of the combined nerve roots involved in these muscle groups, we would question cervical involvement. That's not a surgical incision on your neck is it?

We would dig further and test deep tendon reflexes, and assure no deep motor neuron involvement or blows to the left side of your head due to your sport.  Also, because of the multiple muscles and the C3-C7 nerve root involvement, we would want to now if a brachial plexus (the nerve root bundles coming out of your neck, to the rest of your Right upper limb) injury has occurred. And, of course, once medically cleared, we would discuss mobility options.

That is good to hear. You really need to be working with a good health professional as your imbalances are significant. Without a thorough assessment where I can feel the muscles, joints and nerves I am just shooting in the dark. 

The good news is you can be helped and will improve alot quicker when you get these imbalances sorted out.

On 05/03/2016 at 1:12 AM, Ryan Bailey said:

Well, you know an explanation like this over the internet is difficult, as much more information is needed, but worthy of discussion. 

A physical therapist would screen any possible other injuries above or below your area of concern, but this seems to be minimal from what you have described.  So looking at the picture, it appears there is atrophy of Right Upper Traps, Lats, and Serratus Anterior.  Digging deeper, we would ask about the origin of these muscles, the nerves:  C3,4 nerve roots of Accessory nerve into the Upper traps, C5,6,7 via Long Thoracic nerve into the serratus anterior, and C6,7,8 on the thoracodorsal nerve into the lats.  Don't quote me, this is off the top of my head.  Because of the combined nerve roots involved in these muscle groups, we would question cervical involvement. That's not a surgical incision on your neck is it?

We would dig further and test deep tendon reflexes, and assure no deep motor neuron involvement or blows to the left side of your head due to your sport.  Also, because of the multiple muscles and the C3-C7 nerve root involvement, we would want to now if a brachial plexus (the nerve root bundles coming out of your neck, to the rest of your Right upper limb) injury has occurred. And, of course, once medically cleared, we would discuss mobility options.

 

I appreciate your reply and fully understand to diagnose or treat anything over the internet is guess work. Sadly I live in rural ireland and a  goood physiotherapist is difficult to find, so I really do appreciate anyone with knowledge of shoulder mechanics taking their time to watch my videos.

To answer your question

• No surgical incision on neck
• I believe I pull my own right shoulder down to try to activate my lat/scapula to pinch my shoulder blades together, thats what makes my posture look so odd.

I have had MRI's done on both shoulders when these injuries occoured. They showed.

• Small proximal bicep tear, small labrium tear
• bursitis, supraspinatus tendonitis
• the dreaded type 3 hooked acromiums

I was assessed by 3 different shoulder surgeons, they never mentioned nerve damage or spinal issues, however even then they mentioned my posture was poor....

I know the muscle imbalance was created from training around injuries, so I found a favourable position for pullups with no pain, favourable position for bent over rows etc and I know this how I developed poor motor functions.

I feel like I can't activate my right lat or serratus anterior on the right side, I also find it difficult to to pinch my scapula together.

I am going to get more videos tonight and post them here.

I know of a physio who specialises in active release therapy, would this be worth while?

55 minutes ago, dun08032863 said:

I know of a physio who specialises in active release therapy, would this be worth while?

Yes, this could be worth a try.  Glad to hear you had the medical work up.

Where are you up to with Foundation, Handstand and Stretch series?

18 hours ago, Mark Collins said:

Where are you up to with Foundation, Handstand and Stretch series?

Hi mark I never purchased the series due to financial issues, I am a student.

I have been stretching my back and pelvis out for the last couple of days, I am going to take a video shortly and posted it in.

I am booked in with the physio for ART, but the appointment is 3 weeks away, I am hoping from watching the video you may be able to get me some pointers on stretches and exercises which may help.

I am currently doing some straight arm pull downs with thera band, to try to activate my right lat.

Video coming soon, thanks

So after a few days stretching, I think I look a bit straighter, perhaps not. I noticed when stretching there is a loss of mobility in my right hip, extremely tight, so will be working on that.

At the moment I am doing straight arm pulldowns with therabands, trying to activate my right lat and I am hoping in time I will be able to activate my serratus anterior (I cant feel it at all) but can feel it on my left.....any advice?

I forgot to say I also suffer from tricept tendonitis on my left side where it attaches at the elbow but reckon thats very likely due to my left tricep compensating from my right side when pressing, I think when the muscle imbalance is sorted out that this will stop flaring up.

Personally I believe this whole imbalance was caused by doing overhand pullups in a way which stopped activating my right lat (injured shoulder side) to avoid pain, from this is there any stretches or exercises you guys would reccomend to try to reverse this.

Your problem is too complex to offer any specific advice over the internet. Wait until your consult with the physio. They will be able to get you on track.

Then I recommend you get started on Foundation and H1.

100% agree with Mark.

I used to snowboard a lot, every day during the winter. And I developed similar issues due to the nature of how you carry yourself with a twist in the body on a snowboard. 

I'm no expert on boxing, but I can easily imagine it having a similar effect due to it's asymmetric posture.

Also if you transitioned from boxing to overhead lifting, you most likely went in with a large mobility deficit which could easily explain the resultant shoulder injuries.

First step is consultation with a live professional. Once you have the OK, the GB programs will work syergiysticaly with whatever your therapist prescribes.

Ok thanks guys,

                            I am considering purchasing some rings (getting ahead of myself I know) but I am considering dropping weights for good and focusing on bodyweight.

Any reccomendations on whats needed for rings and where to get them in the uk.

My appointment is three weeks from now, so fingers crossed I can fix this.

Also

You will be tempted to get the rings, but you are putting the cart before the horse. You really need to finish Foundation and H1/2 to get the benefit of rings training.

Ok Mark I will go for the foundation and H1/2 once I can sort some of my issues out.

I feel like I cannot activate my serratus anterior or lat, its two weeks until I see a physio so I have been trying an serratus anterior activation exercise......doing nothing is killing me. I know nobody wants to give out specific advice, however going from this video I would be interested if someone could comment on if it looks like I am activating my serratus anterior properly. I must say I feel like I am in comparision to when I first tried this a few days ago.

I have been using a rubber ball to roll about on and have realised just how tight my shoulder are and how free they feel after working them with the ball.

Things to note are my right hip is extremely tight in comparison to the left which I am working on.

So I will see a physio in about 10 days time, until then I have been focusing on serratus anterior work and trying to activate my lat.....I think I can see a difference after videoing myself.

What is everyones opinions on the change thus far?

Better. You are still side-bent to the Right. Are you able to over correct? 

I will give it a try ryan, what I have noticed is my rightshoulder has gained some ROM with serratus anterior exercises. I also feel that if I could get greater activation of my lat on my right side, then everything will come together nicely.

I have also been trying to activate my serratus anterior doing ab wheel roll outs.

Opinions?

If it were me, I would address alignment and long duration holds prior to dynamic movement such as ab roll outs. Once cleared by your physio, I would look into Foundation 1 and Handstand 1 to address these specifics. Plus you will get much more specific feedback in the forum. 

Ok ryan thanks