Fix your shoulder pain!

[Joshua Naterman]

Sorry everyone! The end of the semester is busy. My last final is next friday and after that I'm off for a few weeks. I'll try to get some stuff done during the break.

[Guest kevinrohrbach]

Hey Slizzardman. I only just stumbled across this thread. Thanks for putting in the effort!

Since I'm beginning to study physiotherapy next year (that thing you guys in the US call physical therapy) I'm really interested in this kind of topic. Tell me, how did you become so knowledgeable in these things. Just out of interest. I hope that question's not intruding.

Personally, the past couple of months have been really interesting. After the road trip I was on in the past summer I haven't been able to find temporary work to keep me occupied until my stint as a kayak instructor begins next May with the studies following after that. Because of that I've had a lost of time for self experimentation. I tweaked my diet and promptly lost around 10% body fat, I started doing regular workouts and have been improving at a steady rate.

Among other things I noticed that the past decade spent rock climbing and kayaking has lead to a seriously unbalanced physique. Yes, I was one of those athletes that always eschewed stretching and prehab exercises. So, suffice to say that I was rather shocked at my performance in some exercises, external rotation of the shoulders and wrist extension to name two.

Specifically, I've noticed that I'm massively weaker in movements targeting the Teres Major and/or Teres Minor and Infraspinatus in one of my shoulders. Ironically this is my "normal" left shoulder (I was born without any pectorals on my right side).

I'm thinking that this has something to do with reciprocal inhibition due to a relatively overdeveloped and tight pectoral on that side. This assumption seems to be supported by the fact that I've been seeing some improvement after incorporating Ido's routines and wall extensions into my regular training. I'll definitely be shifting to your stretches in future. Stupidly, I've never applied my PNF stretching knowledge to pectoral stretches (duh!)

What's your take on this? If you don't mind me asking.

Anyway.

After all that rambling I'd like to include my voice in hoping that in future a more holistic approach to health and increased focus on underlying problems instead of symptoms gain popularity. I for one will be aiming to work in that way and it's one of the reasons I've chosen Dutch physio training over Swiss.

P.S: I wish you the best of luck in your finals!

[Joshua Naterman]

Thanks Kevin! You know, I have always been one of those people that is not satisfied until I have an answer that makes sense. Over the years I have had many injuries, most of which were from my own stupidity as a youth and were acute in nature, and I used to go to the library and research with books to find the answers when doctors couldn't help. When I was training for BUDS I ran into my first experiences with chronic injuries, and that along with my regular involvement at the now-defunct getfitnow forums led me to an accidental discovery of Pain Free, which fundamentally changed the way I viewed exercise and injury. From there I just wanted to learn more and more, and I have seriously read a very large total percentage of the books available on these subjects. I can't even remember them all, and a lot is repeat information with a lot of incorrect stuff and/or incomplete information as well, but I tend to remember everything that works. When I don't understand WHY something works I start researching into the nature of whatever it is I do not understand, and from there I usually end up learning a lot about this one small subject, which then sparks some sort of new understanding of something completely unrelated (at least on the surface) and I look back into that, read some more, and this process just goes on and on on a daily basis. There is never a day when I'm not reading up on things for at least an hour.

I was raised to find my own solutions and to not take anything on faith just because someone is supposed to be an expert, but instead to educate myself on the subject as well as I can and interpret information through the most objective and informed perspective I am capable of developing. This will never be perfect, but I try. This causes trouble in the classroom every so often, but I have always been ok with that. I will always be ok being ostracized for being correct and disliked rather than being liked for conforming to something that I know and can prove is incorrect.

[Tarun Suri]

I was raised to find my own solutions and to not take anything on faith just because someone is supposed to be an expert, but instead to educate myself on the subject as well as I can and interpret information through the most objective and informed perspective I am capable of developing. This will never be perfect, but I try. This causes trouble in the classroom every so often, but I have always been ok with that. I will always be ok being ostracized for being correct and disliked rather than being liked for conforming to something that I know and can prove is incorrect.

Any examples of these classroom experiences? I took one exercise science class and hated it, because I could find at least 1 error or over-generalization per page in the text book. Most of them were aerobic related, but I saw my fair share of "bad" things like the valsalva maneuver being dangerous and all :roll:

[Joshua Naterman]

The first one I remember was way back in 2nd or 3rd grade. The teacher was saying something about the moon and I knew she was wrong because I have always loved science and grew up reading Science News, which was pretty much a physical science and astronomy oriented version of PubMed. Anyhow, I told her she was wrong. She then proceeds to tell me that I am a child and she is the teacher and she is not going to be talked back to. I then told her I would be right back, that I was going to the library to get an encyclopedia and SHOW her she was wrong. I did so, and found myself in the principal's office. They didn't know what to do, because I technically didn't do anything wrong and I was reasonably polite. I think they sent me home early just to make the teacher happy, but It could be that nothing happened.

There have been several times where I have had problems marked wrong on math tests and I have had to show teachers how I did things just because the method I used was not something they had seen before. Some of it I just figured out on the fly, you know? I did most of my learning in math during the tests. I have no idea how that works, but I still do a lot of that with statistics and I still get A's on the tests.

Then there was the Science Olympiad debacle... So I was going to Kittredge Magnet School for High Achievers. That sounds really silly when I type it. Anyways, it was a really fun school and a pilot program in Georgia. you had to be in the top 1% on placement testing to be eligible, and there was a drawing if more than one person at an elementary school was eligible. If no one was, no one got the slot for that school and another school would end up with two slots. Anyhow, there were 3 of us at my school and I got picked. The very first year, 4th grade, I remember that we could do Atlas but not Science Olympiad because THAT was for 6&7th grades only. Well, our principal announces to the school that we could sign up. I knew better, because I could read. This was like telling a normal group of kids that Santa was going to come to school and give everyone their favorite toys, a week off of school AND a free trip to Disneyland. Everyone was so excited, there were long lines for sign up. I know, weird place. Well, of course the principal was forced at some point to call an assembly and tell us all that there was a mistake and we could not sign up because we were too young. I stood up, fairly angry, and asked quite loudly: "Why did you lie to us? I'm only 9 but I can read the rules sheet well enough to see that only 6th and 7th graders can do this. I pointed this out and I was ignored, but how could you not see that?" As you can imagine, that was not the start of a beautiful friendship.

I actually earned his respect in 6th grade though, when I opened my teacher's door by bending a paper clip into the shape of a key and adjusting it based on what I felt inside the lock until it worked. I had left some project materials inside the room and had to have them to finish my project, which was due THAT morning at 7:55 am. Well, the custodian saw me coming OUT of the room. A few hours later I was called to the principal's office and he just wanted to know how I did it, so I showed him. Being a kid was fun.

[Longshanks]

Good video thanks Slizz. I've actually been doing a similar stretch to this by just gripping the inside of the door frame behind me and just bend my knees to what height felt comfortable. As you mentioned though, elbow strength is a limiting factor if the elbow isn't supported, so I really liked this version. Will implement this from now on.

I also have to agree with you about the incompetence of the majority of PT's. That's not to say that they're all idiots but I saw absolutely loads of physio's over the years over my shoulder problem. Three of them actually gave me neck exercises due to the refereed pain shooting up to my head. It was only the final one which was private and cost a fortune (the 6th) that even diagnosed the correct problem; and even he gave me rubbish exercises which actually made it a hell of a lot worse (lateral raises until my hands meet above my head multiple times a day to failure). It's only from what I've gleaned from this site that has caused slow improvements in my shoulder health.

Slizz, although I'm sure you'll go into it in your next video (and should probably be self explanatory to most forum members by now), be sure to mention that volume of shoulder work is a very subjective from person to person. I've found that half of your max reps for 2-3 sets in a controlled manner 2-3 times a week to be perfect for me. Even when I found the right muscle group and exercise to use to rehab it I did find it early on to overdo it and actually make it worse before I cut the volume and intensity down a lot. Half max reps of controlled negatives and heat treatment every day were the golden rules for me. Hope this information complements your own findings.

[Joshua Naterman]

Excellent! Thanks longshanks!

[Jonas Jonzen]

Im looking forward to your next video Slizzardman! Lots of good information out here. Me like.

[Andrew Browne]

I suppose being a "side-sleeper" doesn't help shoulder posture either. It's difficult trying to transition to being a "back-sleeper."

[Tarun Suri]

Why is that a bad thing? I consider the fetal position to be practically a genetically intuitive position to sleep in. However, I do keep a pillow between my knees/thighs when I sleep.

[Alexander Moreen]

Why is that a bad thing? I consider the fetal position to be practically a genetically intuitive position to sleep in. However, I do keep a pillow between my knees/thighs when I sleep.

Because if your shoulders are already rounded forward and your humerus is already at the front of the socket then spending 8 hours a night in a position that rounds your shoulders and pushes your humerus forward is probably not beneficial.

[sean.albo]

Birth is the first exposure to multiple spine curvatures, and from that moment, your posture is adapts to the demands of gravity and movement. Fetal position is super cozy, but I wouldn't rely on it for postural health

[Tarun Suri]

Actually i tried this last night. I slept on my back with my arms diagonally downwards at 45 degrees. I always had a problem where my right hand would never touch the bed/ground (palms facing up). I guess that's a combination of glenoid head not in the back of the socket and internal rotation. Anyways, by the time I woke up, the hand was touching quite easily.

[MCem222]

Hey Slizzardman, I've been doing these for a few weeks and I have some questions. When I hold these positions, occasionally I feel tingling and, if I haven't stopped, numbness in my arm. What does this mean?

Also, just to clarify, elbow pain would be from putting weight on the hand, not the shoulder? The first time I tried this I pressed hard onto my hand and immediately felt it in my elbow. I've been focusing on pivoting about the shoulder and making the stretch active, and as a result don't usually feel anything in my elbow. I still have to actively reach my hand toward the ceiling to avoid pressure being put on it

Also, sort of related on the issue of shoulder health, on one of braindx articles on eatmoveimprove he talks about the need for shoulder extension, and how everybody should start a manna progression to include shoulder extension. Someone recently suggested crab walks as an alternative (i.e. moving in the tablemaker position). I've been doing a lot of those and straight bridges (like coach sommer's "ag walks"), would these extension exercises help keep my shoulder from rolling forward?

Thanks

[Joshua Naterman]

As far as crab walks go, it depends on how you do them. Manna progressions like reverse push up are better, because you are actually pressing your chest UP. Crab walks are very good, don't get me wrong! They are, however, harder to perform in a helpful way. If you can do that, then absolutely! You may need to start with the reverse push ups, but I don't know.

As for the shoulder tingling/numbness, there are a few things that could be happening. You could be reflexively contracting the muscles in your shoulder, thereby putting pressure on the supplying blood vessels as well as the nerves. You could also be putting pressure directly on one or both of the above. Using a soft yoga mat will help if direct pressure is the problem. A less likely but still possible cause is that one or more of the nerves in your arms/shoulders is adhered to tissue. Nerve glides and massage usually help with that.

What is the timeframe for the tingling and numbness? Is it immediate or is it a gradual build up, and about how long does it take to show up and then to change from tingling to numbness, and then how quickly does the numbness go away?

[MCem222]

I occasionally do reverse pushups. I'm not quite flexible to achieve a full bridge, i can press my head a few inches off the ground from a neck bridge but not high enough to straighten my arms (not sure if the problem is in my shoulder or back flexibility)

I only vaguely remember the numbness happening once, I realized I was getting numb, got up, and it went away quickly

The tingling is different. Its been happening once or twice between the 12 positions (6 stretches, 2 arms) most often when my arm is out above 90 degrees, sometimes also at 90 degrees. It's a gradual build up, only happening when I go through various positions in succession. When I notice it I usually sit up, shake out my arms, and go back into it.

I've been doing it on an exercise mat (stiffer than a yoga mat, softer than the floor). I do notice that after all the stretches the fronts of my shoulders are red from the pressure that is being put on them. I do focus my energy on leaning in on my shoulder- maybe I should distribute more weight through my legs? I'm also fairly skinny, maybe its just my boniness putting pressure

[Joshua Naterman]

Ok, that sounds fine. I feel something similar when my arm is in the high position, and it's not anything to worry about. Over time, as mobility and flexibility get better that should fade away. It has started to for me.

Today I did something different that I really liked. For one thing, I had my head resting on my foam roller. It is around 6.5" thick. I also pressed my arm just like I do in reverse push up, and I straddled my legs with my top leg somewhat behind me and my bottom leg around 30-45 degrees in front of me. This made the stretch much more comfortable and I didn't have to focus so much on the shoulder. One other thing I do is intentionally relax my pecs, especially pec minor.

[Mikkel H.L.]

Hey Slizz.

Loved your description on scapula movement during pullups (definitely needs more focus :oops: ), I was wondering if you could tell me how to move my scapula for dips? Atm. I do the following:

At the top i depress and no protract or retract, bottom is totally retracted (very deep dips) and shrugged. Is this right?

[Joshua Naterman]

Usually at the top of the dip there will be slight protraction as well, but not anything crazy like if you were at the top of a push up.

Keep in mind that this stuff is BEST concentrated on separately, you don't need to emphasize this to the T when you are working on the prime movers as long as you are maintaining proper scapular motion. In other words, you don't have to try to depress as hard as you can at the top of a dip since you should be doing some kind of similar scapular work on a separate basis, but you can if you want. The important thing is to make sure your scaps do depress as you rise during the dip.

[Mikkel H.L.]

Usually at the top of the dip there will be slight protraction as well, but not anything crazy like if you were at the top of a push up.

Keep in mind that this stuff is BEST concentrated on separately, you don't need to emphasize this to the T when you are working on the prime movers as long as you are maintaining proper scapular motion. In other words, you don't have to try to depress as hard as you can at the top of a dip since you should be doing some kind of similar scapular work on a separate basis, but you can if you want. The important thing is to make sure your scaps do depress as you rise during the dip.

Okay thanks man didn't want to miss out something on my dips, as i did with pullups, I just found out that I can't even do one pullup "bar to chest", tried doing it on the pulldown machine, and got mean soreness in lower traps, so that'll be my focus now.. but seems like I do the dips correctly then

[Mikael Kristiansen]

Great video! Usefull information for athletes on all levels. I do have some questions to you Slizzardman since you seem to know quite a lot about this subject. I saw you commented on my handbalancing video, so you probably understand the amount of training my shoulders undergo. Because of all my shoulder training, I have become more and more interested in learning the more in-depth anatomy and issues concerning the shoulders. I have never had any shoulder issues which hasnt fixed itself within a week(I am also taking measures to make it stay that way), even while still training, but then again my work capacity on the shoulders is very high, and I try never to go beyond technical failure.

What I wonder is basically, how do you look upon handstands when it comes to shoulder health? Of course a good shoulder ROM is a requirement to do a well aligned handstand, but most people will have to go through a progression of both strethcing and specific training to get there. As said, I am no expert at the field, but my impression is that it is quite a healthy exercise for the shoulder girdle, at least as long as you dont have any serious shoulder issues from before. The activation of the scapula in an extended ROM as well as heavy trapezius work and constant stabilization seem to do a lot of good for people I have seen.

Of course, other re/prehab and exercises, depending on the individual training schedule might be needed. I do straps, so I get a heavy share of pulling work(both lateral and horizontal), which I believe very healthy to balance the extreme amount of overhead pushing, but I know many handbalancers who do next to no pulling exercise, and they seem to be very well off. Of course they all have very good shoulder flex though.

Now this became a little bit of a rambling, but would be very interesting to hear what you think about some of this!

[Razz]

Handbalancer if I may give my two cents:

Press HS are very good for shoulder health.

Work manna and/or MSH in order to balance your planche and other pushing work.

[Cole Dano]

I have to agree, at least regarding HS on two hands i don't have nearly enough one had experience to comment.

HS is a strange beast as the shoulders seem to love them. Even when i have had my worst issues, being in HS has always seemed almost therapeutic. But then i don't really think of 2H HS as a strength element as much of as a skill. So in that regard its not so hard on the shoulders anyway.

[Joshua Naterman]

Great video! Usefull information for athletes on all levels. I do have some questions to you Slizzardman since you seem to know quite a lot about this subject. I saw you commented on my handbalancing video, so you probably understand the amount of training my shoulders undergo. Because of all my shoulder training, I have become more and more interested in learning the more in-depth anatomy and issues concerning the shoulders. I have never had any shoulder issues which hasnt fixed itself within a week(I am also taking measures to make it stay that way), even while still training, but then again my work capacity on the shoulders is very high, and I try never to go beyond technical failure.

What I wonder is basically, how do you look upon handstands when it comes to shoulder health? Of course a good shoulder ROM is a requirement to do a well aligned handstand, but most people will have to go through a progression of both strethcing and specific training to get there. As said, I am no expert at the field, but my impression is that it is quite a healthy exercise for the shoulder girdle, at least as long as you dont have any serious shoulder issues from before. The activation of the scapula in an extended ROM as well as heavy trapezius work and constant stabilization seem to do a lot of good for people I have seen.

Of course, other re/prehab and exercises, depending on the individual training schedule might be needed. I do straps, so I get a heavy share of pulling work(both lateral and horizontal), which I believe very healthy to balance the extreme amount of overhead pushing, but I know many handbalancers who do next to no pulling exercise, and they seem to be very well off. Of course they all have very good shoulder flex though.

Now this became a little bit of a rambling, but would be very interesting to hear what you think about some of this!

I think that with 'static' HS work, whether one hand or two, you are activating the entire shoulder girdle to such an extent that you really would have a hard time developing unhealthy shoulder movement. I mean, everything has to be working to maintain balance, and that should be keeping dysfunctional compensation patterns at a minimum. There is also a very small ROM with the HS work, and even during a press you are spending very little time with the shoulders rounded forward compared to the time that you are spending in an inverted position with full scapular activation. I would think, though I am not sure of this, that because you are spending much more time doing what would be considered "shoulder balancing" work compared to "shoulder unbalancing" work that you would be doing a pretty good job of protecting the shoulders from injury and helping to restore good activation patterns in those who are slightly off.

Obviously if you can't do any of this without dysfunctional movement then that has to be fixed first, but the great thing about isometrics like a two or one armed handstand is that there is very little movement in the joint, and even if you are not exactly using ideal muscle recruitment there is very little motion. Motion is where friction comes from , and friction is where inflammation comes from, and inflammation is what leads to tears. If there is little to no motion, you can't really develop too much of a chronic inflammatory injury.

This brings up the concept of holds vs lifts, which is something I think should be looked at during shoulder rehab. I am doing some single subject self experimentation right now with different protocols. It is nowhere near controlled enough to ever reference, but it is good for brainstorming and developing ideas for possible ways to maximize strength in individuals already prone to shoulder re-injury or maintain strength in those who are able to perform isometric holds without pain during rehab. Strength without motion is something that gymnasts and handbalancers are reasonably familiar with but it is not something people think of when training for team sports. Anyways, that was a bit rambly.

The interesting thing about press handstands is that unlike using external loads the shoulder joint is always directly over the point of loading and in line with gravity the whole time. Because of the form used, you avoid putting very much unhealthy stress on the shoulder capsule. Think about it: Your center of gravity has to stay close to the point of contact on the ground, otherwise you fall, and good form involves the body being compressed so that the shoulder can stay more or less directly above the hand(s). This creates lines of force that are not trying to shear the ball out of the socket. That is a stark contrast with dumbbell raises, for example. Perhaps that is why that tends to aggravate problems while the presses perhaps provide some relief?

Cole, even in a two armed HS you are holding 80% to 90% of your body's weight with your shoulders! That's no joke. The difference is that you can be so strong in that position that you can hold 4x or more of your bw there. There are guys who can walk across the yard with 1000 lbs overhead. Hence the one handed HS being totally attainable by anyone willing to put the time in.

[Longshanks]

I've actually been refereed to a decent shoulder specialist these last few weeks and I've actually noticed a bit of a difference these last few weeks finally.I've been told a lot of stuff that overlaps with what you've said with a few additions. For one apparently I've a moderate inflexibility in the anterior shoulder girdle compared to the external rotators causing some winging of the shoulder blades. I've just spent the last few weeks doing nothing but flexibility work similar to your own. The only only difference is they are all bent arm stretches so I've found it a lot easier to put more stretch onto the shoulder without putting stress on the elbow. He also showed me one like the bottom of the dip but with feet supported to stretch the anterior delts. Feels a lot like the german hang without the straight arm aspect. I've also been shown a brilliant stretch where you lye on your back with your elbow at 90 degrees to your body on the floor. You then push your hand down to the floor with your opposite hand and once level with the floor start rotating your body in towards your stretched arm. This one has been by far the hardest one for me and I think caused the most relief when it started becoming easier.

I've been told to stop any pushing exercises until the strength and flexibility imbalance is remedied and I've just started doing easy angle ring rows, something close to a cuban press with therabands, and some type of shoulder push-up just keeping the arm straight and pushing the shoulders forward and back within the girdle. All done at tempo of course for about 5 seconds per rep, 2s up 3s down.

If anyone's interested I'll do a video of the few extra stretch variations and exercises although I think they seem to just be easier variations of the one's slizzardman has already shown.