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Marco Levati

Pain in the shoulder when doing handstand

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Marco Levati

Hi all, looking for some advice on troubleshooting what I have.

I feel a discomfort when doing handstand in the shoulder. I have it since months now.

I can do everything, but I feel the discomfort.

A physiotherapist told me that it is the connection of the bicep to the clavicle. However I also feel the discomfort when lifting the arm keeping the thumb and the index finger and the back on the wall. That is the anterior deltoid.

1) Is there some exercise to understand what is the body part affected?

2) since it is already 6 months, what should I do to make the pain go away? 

thanks!

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Alessandro Mainente

Hi Marco, the problem is already chronic and you MUST avoid the painful movements. Also when the problem is felt in the bicep, then the problem is not bicep. the problem is usually the rotator cuff, that pinches the bursa that pinches the long head bicep insertion. without changing the correct positioning of the scapulae the problem cannot be solved.

EXTREMELY IMPORTANT: i'm making a suggestion now that should be confirmed face to face. a good PT should give you the tools (like exercises) for solving the problem. now..personal opinion, change the PT.

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Marco Levati

Thanks Alessandro. I found a good PT in Raleigh, NC and he told me my symptoms are the ones of the rotator cuff impingement.

I did a first dry needling session that helped my neck, sholder, scaps, lats to release and I am now doing every day 30 reps laying on the side with a 2lbs weight externally rotating the sholder to activate the rotator cuff. I will keep you posted how long will it take  and how it goes. Started on the 21 of December 2018.

 

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Alessandro Mainente

If the problem is a suffering rotator cuff probably you tend to have rounded shoulders.

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Marco Levati

I had for many years. 2 years ago I started to be more straight. 

Do you know how long can take to restore a rotator cuff? Exercise is everyday as a ritual?

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Alessandro Mainente

The problem occurs on the rotator cuff because the shoulders are rounded, but the rotator cuff is not the first cause. the first cause is an abnormal scapular positioning. how much can it take? it depends on the state of the process. I mean that if the correcting exercises require a painful range of motion, you need first to get some massages by  PT to restore the tissues flexibility then work on those exercises. impossible to say how much time it requires.

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Marco Levati

I want to give an update which might be useful for other people.

After the PT 1 meeting, some dry needling, I have been doing every morning the classic rotator cuff exercise laying on the side with 1lbs weight. Also I have been catching myself in rounded shoulder positions during car rides, sleeping on the side, etc.. and I have tried to push back and down the shoulder.

After 12 days, I had no pain at all lifting the arm straight over my shoulder.

After 2 weeks, my range of motion has been restored with no pain.

I still have pain when I try to reach for my opposite scapula (eg: putting sunscreen on the back), or when I extend my arm behind my back all the way straight. Other than these 2 extreme positions, the shoulder feels ok without load.

My plan for the future (suggested by the PT) is:

  • Not use the shoulder overhead (I will have to adapt the thoracic bridge stretch exercises)
  • Everyday: 30 reps on each side of rotator cuff exercise with band (maybe the new band series?)
  • Ever other day:
    • A1 - Shoulder press with inverted kettle bell (to simulate instability) from a table top body position 3x10reps;
    • A2 - Shoulder press with inverted kettle bell from lounging position 3x10reps;

I plan to have a acupuncture session soon too.

Any feedback is also appreciated on my plan.

 

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Alessandro Mainente

HI Marco, pain attention that if you perform the only strengthening exercise for the rotator cuff you will end with a tight posterior capsule and, possibly, the increased problem in your shoulders.

did you PT tell you what is the cause of the problem?

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Marco Levati

The problem was that due to a lot of hours on the computer, staying with the mouse too far away. So the rotator cuff which was pulling back the scapula and creating the space under the shoulder bone wasn’t doing completely the job. 

I have been doing the exercise above and now I can straight the arms overhead, however I don’t feel I can load yet, and try for instance a handstand. 

Should I integrate the exercise above with the new band series?

Even in the side core workout I feel some uncomfort in the side plank position. 

Any comment in the form?

https://youtu.be/YoNCs_wO5W0

thanks!

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Alessandro Mainente

HOnestly, is impossible for me to make a diagnosis, these type of shoulder problems must be evaluated and solved face to face. Any type of suggestion can be potentially good but also potentially worse. I cannot take this responsibility. for the side lever work please use the proper foundation's section.

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Petra Dvorak

Ciao Marco

I had a look at your video and it seems that you have poor stabilisation of the scapulae (both sides)

I would recommend doing the exercises muuuch more slowly and paying attention to "glueing" your scapula to the ribs, starting already with a strong protraction like in the exercises of "stradle planche"

Saluti Petra

200485987_Bildschirmfoto2019-01-16um07_55_07.png.3dfc8da239ac04ee993fce38aaa75dd8.png

 

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Marco Levati

Good feedback. I paid more attention to my scaps position and even when holding a simple plank, I noticed that my right scap had a “bump”. Not the left. 

Looks like it is loose. I will book another appointment to a PT, but do you know which series I can use to stabilize my right scapula and make it less loose?

 

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Marco Levati

Another update on my quest for having injury free shoulders.

I have been very diligent in my movement practice since a year now, and I have to say my shoulder impingement that I had in December is feeling much better after the rotator cuff exercises.

However I was not seeing any improvement after 1 month of the same exercise. I can feel if my body is on the right track and I realized there is something wrong.

So I did more research and I found that there are 2 possible injuries of the shoulder:

1) shoulder impingement

2) AC shoulder pain

I tried to diagnose with the tools available in the internet and I have to say I have all of these 3 symptoms:

https://www.youtube.com/watch?v=npHPXrV6_JI

that are for the AC shoulder pain. I think I had shoulder impingement but now that I am treating it since a month, I don't see any improvement in my full extended range of motion.

 

I actually started to have problems when:

- I used a heavy kung fu sword, and I was holding the sword behind my back

- my clavicle started to pop when lifting extremely the shoulder

- when I do handstand (shoulder and scapula protracted)

- even when I do plank, my body is in extreme hollow position, accentuating the round shoulder.

- when I dance tango, by right scap is protacted forward to hold my follower

- when I was hanging passively for 2-3 min from a bar

- I noticed also that my right scapula doesn't stay glued to the rib-cage during certain exercises.

- I do table top presses and I feel the stretch, but I am not sure if it is a good stretch.

 

If I really have the AC shoulder issue, then I think my scapula is always tense because is trying to protect the shoulder misplacement. 

I believe I need to let it heal first, keeping my shoulder "in place", and not relaxing.

Am I on the right track?

I went already to 3 physiotherapist  however I don't feel I can trust anyone yet because I am not sure my issue is understood. And I see that from being stuck in my healing recovery.

I just want to find the right person to work with and reach high level performance in gymnastics.. at 35.

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Alessandro Mainente

The shoulder impingement usually occurs because the upper arm is not correctly positioned in the socket and the problem can be:

-muscle pulling from the sternum like chest or muscle pulling by the back like lats 

-muscle pulling from the scapulae like pec minor, teres major and subscapularis.

said that, if there is a combination of these 2 factors,a good PT should be able to tell you what muscles are shorted and what muscles are weak and you will act by making the shorted longer and the weak stronger. this is the solution.

By making the external rotator stronger and shorted you can potentially be making the situation worse and this is why external rotation are not always the solution and they should be planned carefully if the situation needs it. 

now, from my point of view, is the time for a diagnostic tool like MRI.

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Marco Levati

Update of March: MRI done.

You can see the images here: https://photos.app.goo.gl/A1HRUcTy44Q6Z8Ht8

The results are that my shoulder is totally fine. Tendons, bones, muscles. The orthpedic told me there is nothing to do.

They did confirm that my clavicula right is out a little bit, but also that this does not affect the shoulder mobility at all.

Now, I have been doing regular massage and that helped me a lot to relax my pectorals and my rotator cuff.

Every morning I do very gentle exercises like hands circles laying down, external rotation with band on the door, weight lifting at 45 degree up to the shoulder.

I have no pain at all when doing those exercises.

Every time I try even a gentle stretch of my chest, I feel inflamation the day after. Or also any type of armpit opening exercise.

 

However, as soon as I start to do the Foundation 1 exercises for upper body or handstand or movement, I feel the pain and discomfort.

At this point it must be that my right shoulder tendons are fine and maybe just loose. Or that I am doing the wrong movements when doing the series.

 

Since my structure is fine, I want to start very slow to rebuild day by day my shoulder. Which series should I start with?

I have been doing the exercises from 4 different PT and after 3 months of doing it every morning like they told me, I don't see any result.

 

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Alessandro Mainente

Are you performing their exercise with a progressively more demanding load?

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Marco Levati

no. I am stuck with the current loads, I am afraid to do too much, which I believe was the cause of all of this. Should I try to increase?

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Alessandro Mainente

If you do not reach a level in the correcting exercises that leads to superior joint stabilization you have lo chances to reduce the problem. is like having a problem with shoulder external rotation that requires to stretch more than 90° of external rotation...if you stretch only to 50° you cannot reduce the problem.

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Marco Levati

Coach, can you recommend a series to follow that would help me to start slowly to reinforce 100% of the aspects of the shoulder but in a gentle way?

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Alessandro Mainente

Rehab takes place in function of the problem. if you were my clients probably i would be able to give you something specific.

but this is not the situation.

use the current correcting exercises, improves the load, work with your normal GB schedule in a pain-free range.

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Marco Levati

Will do. I may try to come to Italy to visit you for a day. 

 

In the meanwhile, what series would you recommend instead of the thoracic bridge stretch series but that addresses the same shoulder and back mobility?

that series is great bu a little too much for me now. 

 

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Alessandro Mainente

Well Marco if you have pain you are out of my competency.

The restore series for the shoulder is more appropriate.

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Marco Levati

Keeping you posted with the exercises from my PT. 

I avoid the pain during the execution.

I do them once a week, 4x10 reps. 

 

 

 

 

 

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