Dull pain in shoulder?

[TheGreek]

Hello everyone,

I would like to draw on the wisdom all the nice people here on this forum to help me with a problem that I believe I am developping. I have been been following coach's steady state cycle program for rings on and off in the past with few problems. I had stopped for 6 months and have took to it again for the past 3 weeks. However, I have something that is concerning me...

The day after working out lately (and some times for several days) I've been experiencing some dull pain in my shoulder, which sometimes feels like a nerve is pinched and is accompanied by painful reduction in mobility. I was wondering if there was something I am doing wrong, and how I could correct it. I definetely do not want to develope any joint issues.

Here is a sample workout to give you an idea of what I am doing:

Warm up:

100 jumping jacks

3x10s ring support

3x5s L-sit

Joint loosening from head to waist (arm swinging, circles with head, wrists, etc)

Workout:

3x8s handstand hold

3x3 ring dips

3x10s tuck front levers

3x3 false grip pull-ups

3x5s back levers

3x3 skin-the-cats

Any help would be greately appreciated... if joint problems are inevitable... well.. I'd rather switch to a different modality of working out, although the rings do amazing things for my physical developpement.

P.S. I will definitley be implementing slizzardman's should routine.

[Joshua Naterman]

Everything you are doing is strength oriented, and that is almost certainly why you are developing impingement problems. That is what you have, by the way. It is impossible to say for sure where the impingement is, but what you are doing is developing and emphasizing internal rotation and protraction so far beyond external rotation and retraction that you are doomed to shoulder issues no matter if you use weights or bodyweight work, rings or floor. You must have balance.

As a general prescription, first you should take at least 2-3 weeks off and get on an anti-inflammatory diet. The ideal would be no wheat, 10g omega 3 per day, lots of veggies, milk, fruit, and lean meat. You will also benefit from 2-3 weeks of ibuprofin. As far as ibuprofin goes, doctors routinely prescribe 4 week regimens of 400-800 mg doses 3x per day. You should probably see how 400mg does, but if you are worried for some reason just stick with what the bottle says. This is NOT medical advice and should not be construed as such. Whatever you do is at your own risk. Having said that. do what you can and don't stress about what you are unable to do for whatever reason.

Work on the stretches I showed as well as scapular retraction. Don't bother with any external rotation over 2-3 lbs, it will most likely make things worse at this point. Right now it's all about teaching your body to work correctly. After at least a month of this rehab, with retraction at a minimum 2:1 ratio of external rotation (meaning at least 2 reps of retraction for every rep of external rotation, and probably more like 3 or 4:1) you may be ready to go up to 5 lbs of external rotation, and from there you may be able to add 1 lb per week. You may find that light isometrics will work better for you at first than actual movement, and that negatives will work better than concentrics once you can move without causing issues. Retraction can be done with as much resistance as you can perform correct repetitions with. It doesn't really matter what rep ranges you use, but at first sticking with somewhere around 15 reps at 3-4s per rep will probably be your best bet. ONLY do perfect reps. You are better off doing lots of small sets than you are doing lots of crappy reps. 1 minute rest should be fine. You will probably feel a very sharp soreness in a very small part of your rear deltoid part of the way through each workout for a while and that is ok if you do. That's your external rotators holding the shoulder in the socket as you retract. If the burning is just too much to handle, end the set and take your minute of rest on whatever rep that is. Set a goal of something like 30 reps per workout on the first week and 40 the second week, 50 the third week, and then add resistance to take you down to 30 if you are able to control it like that. Nice, slow progressions. Don't add more than 3% of the total load you are using when you add weight and don't add weight more than once every 2 weeks unless everything is PERFECT. In that case, once a week is ok as long as you follow the rules.

If you need more guidance than that then you need to go find a physical therapist. This is very basic and pretty much pushing the limits of what can be done over the internet. I highly recommend that you get a physical therapist immediately if you do not experience progressive relief over the next month or so once you start. The most important thing is that you not up the volume AT ALL when you stop taking ibuprofin! Stay steady state for a month to give your body a chance to adapt. Also, do not go cold turkey. If you're taking 400mg 3x per day for 3 weeks, take 200mg 3x per day for another week and if you still feel fine then drop that to 2x per day for 4-7 days and then 1x per day for a week. That will allow your body to learn to deal with normal inflammation on its own. This may not be necessary but it makes for a much more guaranteed healing process. If you start to notice discomfort as you drop the dose then you know you have not fixed the problem and you will need to seek professional help immediately.

[TheGreek]

Thank you for the great reply, slizzardman. I appreciate it very much.

I forgot to mention that I work out only 2 - 3 days per week. I have taken 4 days off with no Ibuprofin, and whatever little pain I had seems to have left the shoulder, and moved into the elbow! It isent painful, just annoying.

Could you please clarify what external rotation, internal rotation, and pounds of external rotation is, I don't understand

As for scalpular retraction, I do it throughout the day now after watching your videos. When I am on the rings, am I supposed to try to maintain scapular retraction throughout the set?

So you are recommending I completely stop working out for 3-4 weeks? Or take a week off and then just return to my steady state with some rehab everyday? Please forgive me, I am not very intelligent when it comes to thigns things.

I read Pain Free, and decided to do the elbow pain exercises as described, and then to the maintenance routine every morning. My concern is wether or not I will be able to keep working out and building mass! The prosepct of taking a month off is terrifying

Thank you very much again for such a well written and detailed reply. I cant begin to tell you how much you are helping me!

P.S. I am already on the diet you reccomend - I never eat red meats, and always lots of vegetables, chicken, nuts/seeds, and fish! Also, my other workouts consist of ring pushups, inverted pullups, and handstand progression pushups, and well as hollow body holds.

[Joshua Naterman]

Thank you for the great reply, slizzardman. I appreciate it very much.

I forgot to mention that I work out only 2 - 3 days per week. I have taken 4 days off with no Ibuprofin, and whatever little pain I had seems to have left the shoulder, and moved into the elbow! It isent painful, just annoying.

That means you are catching this just in time. That's like dodging a bullet, but only if you take this pain as the serious warning that it is. You COULD be like me. I am just now starting to feel normal in my elbows after I believe over a year of rehab efforts. I have not been able to train ideally for a year. That sucks. It's an option, though. Referred pain like that is not a good sign. That could mean several things, and I do not want to speculate further on that. Instead of trying to figure out what is wrong, I would concentrate my efforts on emphasizing the development of "perfect" joint integrity.

Could you please clarify what external rotation, internal rotation, and pounds of external rotation is, I don't understand

As for scalpular retraction, I do it throughout the day now after watching your videos. When I am on the rings, am I supposed to try to maintain scapular retraction throughout the set?

The only place you would want to retract is during front levers. If you notice, that is an automatic imbalance between retraction and not retraction. It is good that you are working on your retraction during the day, but try to make sure that you have strength sets during the week for retraction that match the volume of protraction both rep for rep AND time under tension. The resistance is pretty irrelevant, the important thing is to keep those neural patterns active and dominant under load. You DO need resistance, just standing around retracting is good but can not replace loaded retraction.

Internal rotation should be considered as any horizontal press, dips, pull ups, and for many HSPU. External rotation is something you need to google, it really isn't loaded in much of any sport or training movement except for specific external rotation exercises and decelerating the arm after a throw or punch. So, for every rep of those you do and for every second those reps take, you need to duplicate that with external rotation(at a minimum. If you do more that is ok). It does not have to be in the same workout but it DOES have to be in the same workout rotation. In other words, you should be performing that external rotation work before you train the internal rotation again. For loading the external rotation, I was literally talking about holding a 3 lb dumbbell!

Protraction is going to be any horizontal press. Push ups, bench, planche dips, whatever. Balance that with loaded retraction for AT LEAST the same total reps and TUT.

So you are recommending I completely stop working out for 3-4 weeks? Or take a week off and then just return to my steady state with some rehab everyday? Please forgive me, I am not very intelligent when it comes to thigns things.

It's cool, no one knows this stuff until they learn. Realistically, for best results you should not train for a month. You are way out of balance, and any gains you make right now will only be pulling you further out of balance. However, if you choose to do that I won't try and stop you. I will suggest that you only do one set, and that set be something you can do easily, and that you do that for two weeks. Then go to two sets, and do that for two weeks. THEN slowly increase the intensity back up to what you were doing. Take at least four 2-week progressive steps to do so. I do not recommend that you take this approach so soon, especially with pain, but if you want to that is your decision.

I am going to suggest that you either follow the WODS, mirror the WODs (do upper body when it does upper body, presses when it does presses, rows when it does rows, strength work on strength days, higher reps or tempo reps with lighter resistance on strength endurance and tempo days, etc) with your own idea of what sets/reps you need, or at the VERY least completely rewrite your program so that you are balanced between retraction and protraction, elevation and depression, internal and external rotation. Remember, balance means rep for rep and second for second, NOT pound for pound!

I read Pain Free, and decided to do the elbow pain exercises as described, and then to the maintenance routine every morning. My concern is wether or not I will be able to keep working out and building mass! The prosepct of taking a month off is terrifying

Don't worry, you won't lose too much, and what you lose will come back before you have safely worked back up to full intensity. That is why I would not worry. Yes, you will lose a little muscle. It will come back by the time that you are ready to work at full strength again safely. Therefore, it is not worth worrying about.

Thank you very much again for such a well written and detailed reply. I cant begin to tell you how much you are helping me!

P.S. I am already on the diet you reccomend - I never eat red meats, and always lots of vegetables, chicken, nuts/seeds, and fish!

Excellent!

[TheGreek]

Alright, this sounds very serious. I will definitely take yoru advice and take the 'slow and steady wins the race' route and completely stop my rings routine.

I will work on Pain Free for 2 weeks for elbow pain, and then once I start the daily maintenance routine, I will begin by doing retraction, external rotation exercises and abduction exercises with light (girly) free-weights and resistance bands combined with isometric holds of the same before the dynamic movement (alla coach) 4 times a week. I will steadily increase the weight over a period of 1 month. Afterwards, I will up the weight to training levels and start doing the WOD if I feel good.

I hope I am not being too ambitious with this. As for the workout of the day, it is very difficult to do with my current job (I work on a ship) due to limitations in space and equipment, which are both zero. I figured the rings here the be all end all solution to exercising under these conditions - guess I was terribly, terribly wrong!

Thank you for you help slizzardman, if this works out good you will have helped me to dodge the bullet!

Take care my friend,

TheGreek

[Blairbob]

http://www.irongarmx.net/Articles/7_minute_rotator_cuff_solution.pdf

This is a pretty good, quick and dirty guide to shoulders 101.

Basically, all the big pressing and pulling movements have to do with muscles that internally rotate. The external rotators are much smaller in comparison. Too much of the time they are left out. This all becomes fugly in due time.