pain in shoulder

[Kyle Courville]

I have a pain in my shoulder when lifting my arm forward.I first noticed it yeserday an hour after very low intensity baseball throwing. I performed all rotator cuff and scapula exercises in my basball conditioning books. The only ones that were painful were forward raises, external rotation, and scapular pushups. I ceased all exercises, took a fish oil capsule, and massaged area. What should i do next ? Should I wait, or see a proffesional as soon as possible? What professional would be best if I do need to see one?

[Kyle Courville]

I am going see an orthopedist as soon as possible. Around my area it takes forever to see one. My self-diagnosis is shoulder impingement of the supraspinatus. Hopefully I will be able to see an orthopedist before I start exercises, but my dad said it could take up to a month. :cry: We will make an appointment tommorrow. In the meantime, I am resting, icing, and massaging the shoulder for the first week. The second week I will restart my regular rotator cuff and scapula exercises. I will start extremely light and stop if there is any pain.

Any advice or insights will be much appreciated.

[Razz]

Well I'm not a physio therapist so I can't help with that, but you mentioned you took one fish oil capsule.. you might wanna try getting 10grams per day and see if it helps.

[Kyle Courville]

I found out through a little research that I just have tendonitis of the long head of the biceps. I'll rehab for a month, then work steady state cycles starting at square one until I get back to where I was. Due to the upcoming baseball season (starts in january)I'll leave out planches and handstands. I'll put more focus on mana, front lever, HLL, SLS, and GHR. I'll abandon all FSP during the season; then I start all over again during the off season with gymnastics for conditioning.

[Joshua Naterman]

That's perhaps not the most effective approach lol! But, do what you feel is best.

You should really put up some shirtless videos of you doing some basic exercises from the front and side so we can see how your shoulders and scaps look.

Just because you do all the exercises your book tells you to do does NOT mean you're keeping the shoulder girdle balanced. Baseball is nearly entirely anterior dominant, so even if your weight room activity is evenly split and based on maintaining strength and flexibility balance between anterior and posterior chains, you'll still be working the anterior more due to practice and games. It is very important to spend more time and energy on your scapular retractor strength and chest opening exercises like german hangs than you think you need, because that will be what helps minimize the dysfunctional patterns that can be unwittingly learned. High level male gymnasts have the same problem. The highest scoring skills are anterior chain, so many end up with shoulder problems because they do not put enough time into maintaining the strength balance they need.

I am willing to bet that your self-diagnosis is incomplete. I think you will find that your anterior capsule flexibility is lower than posterior, and that your scapular retractors are weak compared to your major internal rotators, which are the lats and the chest. Your rotator cuffs may well be strong enough on their own due to your conditioning, but that is only a part of shoulder health. It's an important part, and I'm glad to hear you take it seriously, but there is a lot more going on. What I've mentioned will help take care of what's going on with your shoulders and help you avoid future shoulder issues.

And, just so you know, supraspinatus impingement is usually indicated by pain in the lateral raises, not frontal raises. Bicep tendonitis could be all you are experiencing, but most likely it is being caused by improper shoulder position, probably with some dysfunctions in the AC area. That's caused primarily by the imbalance between anterior and posterior capsule flexibility and the imbalance between the scapular retractors and the internal rotators. All of that has to be addressed if you really want to put this behind you for good.

Good luck!

[Kyle Courville]

That's perhaps not the most effective approach lol! But, do what you feel is best.

You should really put up some shirtless videos of you doing some basic exercises from the front and side so we can see how your shoulders and scaps look.

Just because you do all the exercises your book tells you to do does NOT mean you're keeping the shoulder girdle balanced. Baseball is nearly entirely anterior dominant, so even if your weight room activity is evenly split and based on maintaining strength and flexibility balance between anterior and posterior chains, you'll still be working the anterior more due to practice and games. It is very important to spend more time and energy on your scapular retractor strength and chest opening exercises like german hangs than you think you need, because that will be what helps minimize the dysfunctional patterns that can be unwittingly learned. High level male gymnasts have the same problem. The highest scoring skills are anterior chain, so many end up with shoulder problems because they do not put enough time into maintaining the strength balance they need.

I am willing to bet that your self-diagnosis is incomplete. I think you will find that your anterior capsule flexibility is lower than posterior, and that your scapular retractors are weak compared to your major internal rotators, which are the lats and the chest. Your rotator cuffs may well be strong enough on their own due to your conditioning, but that is only a part of shoulder health. It's an important part, and I'm glad to hear you take it seriously, but there is a lot more going on. What I've mentioned will help take care of what's going on with your shoulders and help you avoid future shoulder issues.

And, just so you know, supraspinatus impingement is usually indicated by pain in the lateral raises, not frontal raises. Bicep tendonitis could be all you are experiencing, but most likely it is being caused by improper shoulder position, probably with some dysfunctions in the AC area. That's caused primarily by the imbalance between anterior and posterior capsule flexibility and the imbalance between the scapular retractors and the internal rotators. All of that has to be addressed if you really want to put this behind you for good.

Good luck!

Thanks for all of your generous help.

I will try and post a video in a couple of weeks after I do a little more rehab.(Wish I was doing prehab instead). What exercises would you prefer in the video? I probably do have disfunctional shoulders. I have been working on external rotation but I have been progressing slowly. What exercises would you suggest?Back levers, rows, pull ups, push ups, manna, german hang?

What do you think about this program?I will do one step a week.(Not sure how to post a link, didn't take any computer classes yet). http://www.sportnetdoc.com/retrain/14-07x1.htm

Do you have any recommendations for books or websites to read about shoulder health? Do you have any thoughts on Eric Cressey's "Optimal Shoulder Performance"?

Sorry for so many questions but my upper body is my life; I am a drummer, baseball player, like gymnastics as conditioning, and want to practice BJJ.

[Joshua Naterman]

No worries. I'm heading out to my place to do the WOD, and I will post more for you this evening. That website isn't a bad place to start.

As a drummer also, I am even less surprised! Most of what you do is in front of your body. There's nothing wrong with that, you'll just need to be diligent about working your upper back correctly. I suspect that what you have going on is relatively minor, and you're doing the right thing by tackling it immediately. A few months from now you should be getting back into your real training with no pain if you take the right steps now.

I haven't read Cressey's shoulder stuff, I'll have to see what I can dig up. Shoulders, despite being really complex, are pretty simple when you stop worrying about what specifically is wrong and you start worrying about how it is specifically SUPPOSED to be working. I know that is an unorthodox way of thinking in America, but that's how you get things working correctly. You go through how the shoulders SHOULD be working, and train for that, tossing out whatever was happening before. Trying to just fix what is wrong is nothing but symptom control unless you go all the way back to basics and conduct a full investigation, starting with basic posture.

As far as books go, Pete Egoscue's "Pain Free" is the best place to start. It is relatively short and an easy read, yet you will learn all of the basics concerning both how dysfunctions occur (some of which will surprise you but make perfect sense) as well as how to correct them. You will learn why many people have recurring injuries despite doing all the prescribed rehab, and by the end of the book you will be very dis-satisfied with American sports medicine as a whole, because you will have a good basic understanding of how the body works and how dysfunctions build up and cause both acute and chronic problems. This book should honestly be required reading in medical school, chiropractic school, etc. I'd go so far as to say it should be part of PE class in schools. I can't even imagine how many fewer people would be in the therapist waiting room... they'd learn how to avoid problems in the first place.

Aside from Pete's book, I can't think of anything that's going to be of direct help right this second.

[Kyle Courville]

I haven't read Cressey's shoulder stuff, I'll have to see what I can dig up. Shoulders, despite being really complex, are pretty simple when you stop worrying about what specifically is wrong and you start worrying about how it is specifically SUPPOSED to be working. I know that is an unorthodox way of thinking in America, but that's how you get things working correctly. You go through how the shoulders SHOULD be working, and train for that, tossing out whatever was happening before. Trying to just fix what is wrong is nothing but symptom control unless you go all the way back to basics and conduct a full investigation, starting with basic posture.

I don't think this way of thinking is unorthodox at all. In fact I am one who likes to prevent problems and get to the bottom of things. If I become a physical therapist my goal will be to never have a client return. 8)

[Joshua Naterman]

It's unorthodox in American medicine. It shouldn't be, but if you think about it this is the least profitable approach, and if you think doctors are in it just to help you, you'd better do some research on the adoption of hardware spinal fusions.

[Kyle Courville]

Any particular exercises in the video?

That's perhaps not the most effective approach lol! But, do what you feel is best.

What approach would you use if in my shoes?

[Joshua Naterman]

What video?

I would probably work planches at a lower intensity, which you should honestly be doing anyways. I'd construct a homemade version of the impulse trainer and watch the videos on youtube to learn how to use it. I'd scale back handstand work a little bit. I would absolutely keep working on all the FSP, definitely with more of a focus on Manna, L sit and Straddle L but still working the BL, PL, and FL properly. I'd just hit them a *little* bit lighter. I would follow the WODs for your conditioning, honestly. Baseball is a prime example of a sport where speed and the ability of the upper body to to handle fast acceleration without developing injuries, along with good plyometric lower body ability, is key. You will develop these with the WODs much more evenly than with whatever other conditioning you're using. I WOULD recommend that you slowly add weight to the standard pul up variations as you can, and use rings for your dips.My computer is crashing like crazy, I can't type any more. CHASIOFHSA:JK.

[Kyle Courville]

What video?

You should really put up some shirtless videos of you doing some basic exercises from the front and side so we can see how your shoulders and scaps look.

Thanks for the great advice, and I hope your computer lands safely.

[Kyle Courville]

Pain is finally going away. I can now perform shoulder flexion with up to five pounds pain free. Push ups are still causing pain only with elbows back and not to the sides, so i am still working up to that. I've been doing lots of curls, external rotation and upper back work. Looks like I'll resume training by the end of this month, or a little after.

[Kyle Courville]

Pain is finally going away. I can now perform shoulder flexion with up to five pounds pain free. Push ups are still causing pain only with elbows back and not to the sides, so i am still working up to that. I've been doing lots of curls, external rotation and upper back work. Looks like I'll resume training by the end of this month, or a little after.

[Cole Dano]

My shoulders are a disaster and one thing i've found that really helps with the push-ups it to use a push up board or a couple of blocks. This make engaging the packing muscles much more natural in the push up. I use a couple of handstand blocks for my push ups. And yes you're right keeping the elbows strictly to the sides is really important in the rehab stage.

[Tarun Suri]

Get familiar with this website and with Eric Cressey: http://ericcressey.com/

He is a master at coaching and specialises in baseball and talks a lot about elbows and shoulders. I highly recommend becoming familiar with him.

[Kyle Courville]

It seems funny that absolute rest is working the best for me. After one week of resting I could perform 5 full pushups with elbows back with absolutely no pain. Later that day, I went to a four hour car wash and it wrecked my shoulder for the day. I finally go to a orthopedist this friday.

[Joshua Naterman]

You didn't listen at all!

Don't test yourself. Don't work out, even a little bit. It is going to take an absolute minimum of 6 weeks before you're ready to even start gearing back up into training, and even then it will be at least another month after that before you're ready to even attempt a workout at what you were doing before you hurt so bad that you stopped. The first month should literally be nothing but light rehab and total focus on controlling inflammation.

I've been working on my shoulder for months (quite successfully, I might add) and I still wouldn't attempt something like that car wash. If you intend to get better, you need to stop making those decisions! The hardest thing to do is to remember to keep up the rehab work and turn it into a permanent part of your training.

[Kyle Courville]

Didn't have a choice with the carwash. I have been performing rehab since the injury, and I will still continue rehab. It wasn't a workout just a test of progress.(maybe not the smartest thing but didnt cause any harm) I have not worked out since the injury. The week of rest was from starting school. I didn't have the enrgy or time to do even rehab.

[Joshua Naterman]

You always have a choice. I felt like that too for a while when I was in the Navy, but I did in fact have the choice to take care of my shoulder, and I did not. That has led up to the problems I am now dealing with. In the grand scheme of things, a car wash is nothing. I know, I sound like a parent. Sorry.

Keep up the rehab, go nice and slow, and always do less than you think you should for the next few months. Don't do any more progress checks. That will drive you nuts, like it drives me nuts, but the only way for you to properly heal that shoulder is to really give it a few months of true rest and rehab. Even the occasional push up is going to work against you for the next 8 weeks, at least.

[Kyle Courville]

My shoulder is now at 60%-80%. Can't wait to start adding more volume, then eventually intensity.