Shoulder questions/issue - Slizzardman, others?

[Guest GTJT]

I have registered on this forum after reading the very informative posts by Slizzardman and others on how to deal with shoulder issues. Very, very, good stuff!

I hope some of you will chime in and shed some light...

Generally speaking, during my years of weight training (no gymnastics) I have had few shoulder problems. They've "endured" a lot. Heavy, high volume workouts. And like so many others I neglected RC work, of course until I developed an issue - impingement in my right delt. This was in fact coupled with a nerve entrapment in C5 that a chiro fixed. I know this to be "fact" because after the chiro adjustment there was almost immediate relief and improvement - I am objective enough to judge this despite bias, etc. But the muscular shoulder impingement in the right delt was still there. Obviously that doesn't get fixed by neck adjustments.

In terms of training history, didn't get any shoulder probs until around summer. Then the right delt started gettin' "weird" as the impingement increased, and at some point the nerve was entrapped- probably due to "unfortunate" form on neck harness extensions. In terms of training I've generally done LOTS of back/posterior chain training, but it really wasn't until after my impingement that I got greater control of traps 3-4, rhomboids etc. Prior to that I was more of a "lat and trap 1-2 puller"....

I also for 2/3 of a year perhaps regularly did seated smith front presses. Now, these did NOT hurt to perform, but I understand they contribute or even cause impingement. I was doing 275 lbs for 10 reps or so on these, so lots of loading and lots of sets. Impingement increased, no rotator cuff training.

Fast forward 5 months or so, I have my problem diagnosed, I have my neck popped etc... I have implemented rotator cuff training in my workouts. There is less impingement in my right delt now, but still some. I have also gotten much better Trap 3-4 and rhomboid activation as well as strength and muscular development, and I am much more focused on keeping scapulae retracted and depressed when doing chest and shoulder training, etc. Also in every day activities. Say when I am sleeping on for example my left side I'll place a pillow in front of me to rest my right arm on to avoid the shoulder being internally rotated the whole night. I generally work with good posture and am more observant about my thoracic spine.

In terms of RC work I've done mostly arm abducted + the Poliquin variation with arm in front of body + some with arm adducted. However, I am much weaker with arm adducted - despite generally using good and tight form on ALL rc work. My strength on arm adducted is about 25 lbs for 8 reps. 20 lbs is a QUITE comfortable weight. I use slightly more weight on the Poliquin variation.

But bear in mind, I was doing 145 lbs on incline DB presses for 5 reps or so prior to my injury, so while my RC might be "strong" compared to others, it is pretty clear it is still weak relative to my other abilities.

My spine is generally normal. No one's ever mentioned it, but I believe my kyphosis might be sliightly more "significant" than the norm. But not by a great deal.

Ok..let's get more specific.

- BOTH my shoulders POP. Not when in the gym, but during every day activities. Pop pop pop. Pop pop pop. There is no pain or even discomfort associated with it, but the popping is quite audible and significant. And i'd like to get rid of it!! It came for both shoulders around the same time. Back in summer- Didn't think much of it at first, but...

- I have had Active release technique performed on particularly the impinged shoulder - it helped! IIRC he (the practictioner, that is) said the problem was mostly "AC related" (AC impingement...?). Also, at first there was too much movement in the GH-joint. But that was months ago.

- I've done lots and lots of lat and subscap stretching, but whatever stretching I do seems so temporary in nature! Give it a few days and the tightness will return! It feels HOPELESS! But my back training is VERY high volume. HIGH volume, and a siginificant amount of HEAVY sets. So, lots of lat work, and lots of subscap work.

- my right shoulder is as mentioned less impinged now than before. I can problem free train chest work, close grip bench etc, but the first few warm up sets of any (right arm) shoulder pressing "hurts". After a warm up it'll usually be gone.

Now to a more question by question outline:

- what does arm adducted RC external rotations do that arm abducted or arm in front of body don't? More infraspinatus involvement?

- other than SIGNIFICANTLY strengthening the ext. rotators of the cuff, strengthening traps 3 and 4 and rhomboideus, ensuring thoracic spine "integrity", maintaining good posture and form every day and when training, and stretching all muscles that perform internal rotation, WHAT can be done to fix impingement? Because I am DOING all those things with especially my right delt, but there is still some impingement, like mentioned. Is it simply the case that maybe I need to be a lot stronger on the external rotations so as to match my strength levels and balance in general?

- should the infraspinatus also be stretched?

- what do I do about this RIDICULOUS shoulder popping? All my ART practictioner could tell me specifically about that was maybe to refrain from ("over")stretching the shoulders (probably not the cause/solution), keep doing what I was doing otherwise, and also add a bit of subscap training as it is involved in caudal translation(?). Like I said, shoulders don't (or hardly) pop when training, and no pain associated. but I get the feeling that something isn't moving right.

- should targeted supraspinatus work also be done, or is it irrelevant to the problem of impingement?

- for pec major and minor and delt stretching I've done broomstick "dislocates". I've read an article by Eric Cressey about pec stretching up against the wall - think it was on T-nation and proper form on this, ie. scapula retracted, shoulder depressed etc, but I don't really "feel" it much. I do believe, however, my pecs are tight.

- Generally speaking...what the hell do I do?

Also, slizzardman..when will you get the remaining parts up of your "fix your shoulder pain!" series?

(I need to try those stretches again, tried them today, awkard.)

I really hope you guys will help. Please let me know if there is more info you need.

I need EXPERT council. If I go see some physical therapist in town they'll tell me what I already know.

My dedication to my training, and thus also to fixing this problem, is 100%.

[Guest GTJT]

Reading the "7 minute rotator cuff solution" I can't help but think how maybe I have "adaptively shortened internal rotators" and perhaps "fibrosis"...

(btw, regarding the Poliquin variation. He says you should be able to do 9% of your CG bench 1rm. I have only now resumed CG benching after 1½ years of not doing it, and back then I was doing 320 lbs for 4 reps. That means I should be doing 30-35 lbs on his variation of the movement...WHICH I CAN'T)

[Joshua Naterman]

One thing that helps a TON is to manually reposition the shoulder and keep it there. When you have shortened internal rotators, as I certainly do, I am finding that in addition to everything else, you have to keep the shoulder in the right position for long periods of time. If you do not, you will simply return to the "normal" dysfunctional position that you have "learned" to have.

http://www.return2fitness.net/Supports_and_braces/Shoulder_Supports

http://www.lp-support.com/product/detail.php?PID=901&PPID=109

The first link is better, but I put both up just in case. These have clavicle braces that basically help you keep the shoulder further back, where it belongs, for hours at a time. By itself this is nothing but a temporary fix but combined with what you are doing this should be a huge, huge help. I have not spent the $20 bucks because I don't have it ATM, but I am basically doing the same thing much less efficiently with bands and/or a canvas belt, depending on where I am and what I have. Even 30 minutes a few times a day makes a massive difference.

I personally will be ordering one of these as soon as I can, I mean seriously these are awesome. Just the relief I get from my ghetto-fied solution is great, but having the real thing should be much better.

This is important because it allows your body to slowly get rid of the inflammation in the injury! As you get the shoulder in a position where there is not so much constant stress on the front of the shoulder and the AC joint you will notice that everything gets better and stays better longer. Getting rid of the inflammation is important because it leads to tendon degeneration over time, and that is bad news!

I haven't done much external rotation work recently but I still have the strength to do 25 lbs pretty easily for 8 reps with Poliquin's version.

I don't like Smith machines for full ROM for a variety of reasons, but for strong range partials they are awesome. I still do my strong range partials in my power rack, just because I like the feeling of knowing I can actually hold the weight in real life and not just on linear bearings, but as additional strength work for the prime movers the smith machine is the bomb. It's all about the right tool for the right job! Fixed linear bearings = bad for full ROM.

The stretches in part 1 of the shoulder series are really important. They are more effective versions of what Cressey recommends. The problem with standing is that you have to support your weight, and that kills the stretch. On the floor you can let the muscles stretch because you are not going to fall over and you have much more control so you aren't afraid of messing up the shoulder! These stretches will feel weird and there is a small learning curve with them, but they will help.

As for infraspinatus and teres minor, EMG studies are pretty conflicted about which positions the particular muscles are most active in. I'd try to find a way to do them all, perhaps starting with a different position each time you do the exercises so that you make sure to emphasize the muscles in a slightly different order. That's just one idea, the most important thing is that you do them all. Adducted, abducted at 90-120 degrees both out to the side and in front (Poliquin's version is similar to this).

I don't know much about subscapularis flexibility issues, but the device I mentioned and linked to earlier should help a lot with pec minor, as will the stretches in my video.

It is usually not possible to perform heavy or high volume lat work without running into internal rotation. When your shoulders are healthy this isn't a big deal as long as it stays balanced with proper retraction, but when you already have a chronic issue this can perpetuate the problem. It may be possible to train with the devices I mentioned earlier on, and that may help you, but you may want to adjust your training so that you don't run into as much internal rotation until you have been symptom free for a few months. At that time it should be safe to slowly move back to a 50/50 split of heavier lat work that simply requires some internal rotation and somewhat more moderate lat work that you can use retraction without internal rotation.

That lat speculation in the previous paragraph is just a guess, but I see it EVERYWHERE so there is a good chance that if you set up a video camera off to the side while you do your sets you will see what I am talking about in the video. You won't see it from the front or back unless you are either really rotating the shoulders a lot or really know what you're looking for. It's worth checking into so that you can temporarily change your training to facilitate recovery if you decide it might help.

I think that for you the biggest thing will be getting rid of the chronic inflammation. Obviously an anti-inflammatory diet and fish oil along with short term ibuprofin will help manage the inflammation as you use that device or your own simulation of it to keep the shoulder in a better position so that the muscles can adjust to a new length and allow the inflammation to recede.

Believe or it not, using heat lamps can help a LOT. Just point them at your shoulders and hang out for 10-20 minutes at first. Protect your eyes with a cloth or something, too much exposure to infrared can cause the iris to lose color and possible cause some of the clear liquid under the lens to become somewhat opaque. This is not something that happens in any statistically significant percentage of people but it is a potential problem that I believe should be avoided from the get go. Kind of like wearing 1000v gloves when working on house electricity... you just avoid the problem right from the start instead of taking the chance that the slightly thinner gloves will get a pinhole and end up shocking you. Falling off of ladders is bad... it doesn't happen all that often, but when it does heads tend to crack open on concrete. Anyways, that's a cheap solution. 250w bulbs are 10 bucks each, and you can easily set up the heat therapy at home. Use a timer, preferably a timed outlet if you are prone to falling asleep. Those only cost a few bucks.

I have found that having the bulbs about 18-24 inches from my shoulders is fine for me, but you may need slightly more space. I have always been less affected by external energy sources than other people I have known, but that distance should be very pleasant. They heat the tissue directly, and are potently anti-inflammatory. There is a ton of literature out there on infrared light and healing. I feel like the LED versions that the therapists use just don't do much, but maybe they are better now. Regardless, this is massively cheap and effective. It is recommended to use porcelain lampholders when you use the heat lamps, but you should be fine with anything that doesn't have a shroud and is rated for 300W at least. Many are rated for 660W but double check to be safe.

[Guest GTJT]

Hey Lizzard.

Thank you for that quite lengthy post. I feel I've misrepresented myself though - in terms of the intensity of the problem. The ONLY exercise it affects now is overhead pressing. I say "only" because in the context of say very brutal impingement or acute shoulder injury, that would be a mild condition. But to me, it is NOT mild. Training is my life and everything. There can be no non-congenital, correctable condition that impairs my training. It would be total DEFEAT for me.

So, in that sense I "fear" your advice might be more directed towards someone with a more serious condition? And also people who are more clueless. People who complain of shoulder issues...but do not even fix their shoulder and scapula positioning!

Does this link work? http://www.nmrseminars.com/subscapularis_videogift.php

please view this video. It is NMR (which is kind of like ART), subscapularis release. See if you can find someone to perform it on you. I'll do the same. We'll compare results and experiences with it.

I am not making subscaps stretching a MAJOR priority. Stretching it every single day. Simple required, due to my high training volume. I am seriously talking 30-40 sets of back training on average, and I used to do 15-20 sets of presses for chest. No wonder my subscap got tight, and GETS tight!

I think Poliquin is right that the BTN press is a good indicator of shoulder health. If you can't perform it.. you have an issue. Tight subscap and/or tight infra.

Now, about my shoulder popping. What do you think? I mean, what the hell do I do? I really don't "understand" it. It is VERY consistent in its popping.

Fred Hatfield - please google this amazing sports legend and coach if you do not know him - recommends football tossing for shoulder health to break up adhesions and fibrosis etc. What do you think?

ANd not to be pushy, but when will you get parts 2-6 up?

A final inquiry in this post...for some reason I find it hard to keep my elbow down on the NON-IMPINGED shoulder when doing lying adducted ext. rotations..... umm..I don't get it? To add info to this comparison, I have had much more ART performed on my right one than the left one.

I appreciate very much your helpfulnes and intelligence.Thank you.

My dedication to fixing the issue is 100%. I DO NOT accept compromise.

[Joshua Naterman]

I'm pretty familiar with Dr. Hatfield, he's a beast! If you notice, low intensity shoulder movement through a full range of motion is what is used in many different protocols for health. From arm circles to football throws the basic premise is the same: repetitive functional movement will help lubricate the joints, minimize scar tissue adhesions, and help keep the joint capsule itself smooth with regular practice. Now, if you have DYSfunctional movement this repetitive motion will just cause more injury. What you are doing to correct dysfunctions is great, but there is one factor that can not influence directly: inflammation.

If you already have chronic inflammation, which it sounds like you do, movement can not help yet. You have to get rid of that inflammation. You will not like what I am about to say, so please talk to a plastic surgeon or other surgeon to confirm this. It can take up to six months for inflammation to clear up completely. This is why there is a before pic, a post surgical pic and a final results pic that is 4-6 months after surgery, sometimes a whole YEAR after surgery. IT takes that long to show the final results without inflammation masking them.

The inflammation in your shoulder is going to follow a similar time line, as is mine. Trust me, my shoulder issue is relatively minor as well, but I recognize that I am stuck in something of a negative feedback loop: Even a relatively small volume of work is enough to perpetuate the inflammation. Even though my movement is much less dysfunctional I still have inflammation, and that leads to friction which leads to more inflammation. It is very important to understand and believe that sometimes it takes a bit of time to correct an issue, but once things are done they are done. I still do not train anterior pressing hardly at all, because that is where MY problems are. I have no overhead issues to speak of. I am making very slow progress in my healing at this point, partially because as I said the inflammation takes a long time to go a way and partially because the combination of the small volume I do plus not taking anti-inflammatories OR having that device to allow the inflammation to reduce is helping to perpetuate my problem.

You have to understand that these are issues that even professional athletes wrestle with for years, often until their career is over and perhaps even after that, unless they simply take the time off. Yes, it sucks, but 6 months off from any aggravating activity and then a 6-8 month re-training period is much more preferable than several years of compromised competition culminating in catastrophic injury. It is usually the unwillingness to take this frustrating time off that leads to perpetual problems that keep popping back up! I am, for the most part, doing my part and my shoulder is SO much better than it was! I am tempted to do so much more work, but I am being smart and holding off. It may take me 6-12 more months to really be 100% better but after that my progress will be so much better and I will eclipse my previous bests. I am already approaching them despite my very low training volume! I don't know what else to tell you, there isn't a magic way to make this go away other than time off + muscular re-education + repositioning the joint to allow for actual healing + just enough maintenance work to avoid developing dysfunctional compensation patterns. That's a lengthy process, but it heals you.

Believe it or not, your condition is not mild. There is no such thing as a mild chronic condition. Degrees of pain are not representative of the accrual of injury. You are, most likely, dealing with supraspinatus impingement in the sub-acromial space. There could be other things going on, but based on what you are saying that is the problem. Try this: JUST do strong range shoulder work. If you do not feel it in the top 20-30 degrees of movement in a shoulder press but you do feel it lower, I am right. If you DO feel it up there as well then your condition is worse than you think. This will end up leading to a partial or full rupture of the supraspinatus tendon that attaches to the humerus if it goes unchecked and you continue training. It might be years and years in the future, but it will happen eventually. This is a common thing in sports and overhead lifting. There could be, as you suggest, quite a few things that lead to this situation and because of this I do believe that it is worthwhile to treat all possibilities instead of trying to narrow down one or two things. Sometimes there are synergistic results that do not happen with just one singular approach. I believe in taking a whole joint function approach and not trying to pinpoint things, because if something is already good there will not be problems with the small volume of rehab work in that area and if there IS a problem it is being effectively dealt with. Either way you do not lose.

This is all just my personal opinion, and it has worked well for me and people who have asked my advice so far, but you may have a different opinion and wish to do things differently. That is ok. There is almost always more than one way to get good results.

As for the next parts of my video, I will have to wait until I get back to Atlanta. I am currently iced in at my parents' mountain house! I do not know the exact schedule, but I will be working on getting at least two more done before the semester starts.

[Kyle Courville]

I know it sounds minor, but learning to release trigger points in the four rotator cuff can do miracles. I once had shoulder impingement that caused bicep "tendonitis." The same feeling popped up about two days ago, and a simple pressure to the trigger point on my infraspinatus cured my "Impingement" instantly. I was very relieved that the "Trigger Point Therapy Workbook" helped me as I am a pitcher. Remember, however, that trigger point therapy is just a small part of shoulder health. I suggest that you purchase the "Trigger Point Therapy" book if you are able. It is a great resource couple with correct posture. I hope you get better and return to training as soon as possible, GTJT.

[Guest GTJT]

Kyle,

Thank you. Do you have a link to where I can see where the relevant trigger points are? I'd like to get started "right away".

[Donar]

Hello GTJT,

I'm dealing with shoulder impingement and also with chronic pain.

This might help you with trigger points, although you have to buy it.

http://SaveYourself.ca/tutorials/trigger-points.php

This is a great website as well: http://triggerpoints.net/

In addition, how is your breathing? I have found breathing to be very helpful for my chronic pain, which is related to my impingement.

Read the following articles (you can find more articles about this on the web)

http://saveyourself.ca/articles/respira ... ection.php

http://boddickerperformance.com/?p=907

http://boddickerperformance.com/?p=630

http://boddickerperformance.com/?p=536

You can simply test your breathing by standing up and exhaling. If I do this and do not focus on my diaphragm, my left shoulder (the impinged one) comes forward and my scapula rotates downwards.

Furthermore, is one hip or one shoulder higher than the other? How's your thoracic spine mobility when you compare both sides?

[Joshua Naterman]

Yes, breathing with the upper body does perpetuate dysfunctions. That is one thing I am lucky to have instilled in myself years ago.

Like Donar says, having hips slightly off changes the curve of the spine, which in turn changes tension levels in various muscles of the shoulder girdle, and can easily cause and perpetuate dysfunctions of the shoulder. If you read Pain Free, this will all make sense to you. There are things that you simply will not be able to see until you are taught to look for them, and the book is pretty good about teaching you that skill. That book is the beginning of self education, not the end, so don't think it's the only thing you need to know.

I am reading through the trigger point link he posted and it is fabulous. It's the only other website besides what I am developing that I have ever seen with such a high standard of quality sourcing, which makes it the only site I have ever seen on the web that is so good! Check it out.

[Cole Dano]

saveyourself is a great site. I haven't bought the materials, but am planning to, i just want to get the whole pkg, which i can't spring for right now.

If anyone has any of the saveyourself materials, what do you think, was it a worthwhile purchase, can you give a short review?

[Kyle Courville]

Kyle,

Thank you. Do you have a link to where I can see where the relevant trigger points are? I'd like to get started "right away".

I am not a very articulate person. I will be glad to try and help you the best I can, but explaining how to do this over the internet is quite difficult. First off, I suggest that you buy the "Trigger Point Therapy Workbook" as soon as possible. It is a complete guide for many overuse pains and aches. Second, before you start I suggest you search around on this site and learn a little about trigger points: http://triggerpointbook.com/index.html. Third, have a tennis ball or another firm round object ready. Fourth, I do not have the book with me right now so I will try my best. Finally, this only works if trigger points are causing pain, and the specific muscles I am going to ask you to manipulate may not be the ones. Releasing trigger points is relatively simple and quite painful; just hold pressure (I use tiny circles) on the point of pain for about 10-20 seconds.

The four muscles of focus here are the rotator cuff muscles: infraspinatus, teres minor, subscapularis, and supraspinatus. I suggest you try and treat these four muscles in one session for best results.

The first two muscles of focus are the infraspinatus and teres minor. These two muscles will be treated together due to their close proximity. First get a good visualization of the muscles. This is made very simple with this helpful links: (drag to 10 for infraspinatus and 11 for teres minor) http://www.getbodysmart.com/ap/muscularsystem/armmuscles/posteriormuscles/infraspinatus/tutorial.html and

http://www.getbodysmart.com/ap/muscularsystem/armmuscles/posteriormuscles/teresminor/tutorial.html. You are lucky because a view of the trigger points on the infraspinatus have been provided here: http://triggerpointbook.com/shoulder.htm. As shown use a tennis ball pressed against the floor or wall to provide pressure for these trigger points. The same is done for the teres minor, which is right next to the infraspinatus. For me, these trigger points are the most painful and provide the most relief for popping and clicking in my shoulder. After treating these muscles my shoulder immediately feels much better.

The second muscle is the subscapularis. Again, get a visualization muscle on this link: (drag to 8 ) http://www.getbodysmart.com/ap/muscularsystem/armmuscles/anteriormuscles/subscapularis/tutorial.html. It is very easy to treat. Put your opposite hand under your desired arm (like arm farts). The best way, I feel, is to put your thumb in the middle of you armpit with spread fingers. Now lift your desired arm up overhead and touch your opposite shoulder. You will now have a handful of subscapularis. Feel around with your thumb and index finger for any tender spots. If you find one pinch it firmly until it releases. I usually have up to three trigger points in this muscle.

Finally, we have the suprasinatus muscle. I find this muscle hard to reach and provide relief due to its thicknesss and depth. Once again, visualize the muscle with the link: http://www.getbodysmart.com/ap/muscularsystem/armmuscles/posteriormuscles/supraspinatus/tutorial.html. You locate this muscle right above the spine of the scapula. You can get a visual of that here http://www.getbodysmart.com/ap/skeletalsystem/skeleton/appendicular/upperlimbs/scapula2/tutorial.html. There are three ways of treating this one. The most simple is to use a Thera Cane (http://www.theracane.com/) or a similarly shaped item. The second method is to lie face-down on your stomach and have someon apply the pressure with his/her thumb while leaning into you. The third is a way I made up. You will have to find a door frame and a tennis ball. You then bend at the hips and knees until your upper body is parallel to the ground. You will now jam the ball between your shoulder and the wall. I strongly suggest that while performing this method that you support yourself with you hands. Tennis balls do slip .

This pretty much concludes the tutorial . I hope it helps and feel free to ask questions, but I am currently limited as I do not currently have the "Trigger Point Therapy Workbook" with me. I hope you enjoy this post.

[Blairbob]

Very interesting. Something I definitely want to look over the next few days.

[Joshua Naterman]

All I can say is that those trigger point resources are amazing. Just working into the teres minor and infraspinatus has always helped me some, but digging into the supraspinatus made a big difference. It hurts, but the method with the lacrosse ball and the door jamb is the way to go. Lacrosse balls don't slip, I really like them. Got it two days ago and this is my first time using it.

So about 4 days ago I had my friend do Dr. Levy's subscapular release on me with only partial success, because it turns out that my entire armpit is one giant lump. That explains my absolutely horrendous shoulder mobility. So, I just spend about 45 minutes hitting the above trigger points and then my teres major and subscap, and while it is still a pretty big mess I then used a belt to do unilateral wall extensions while lying on the floor, just to make sure I was getting full range of motion. After a few reps and getting used to the increased range of motion I can touch my right bicep to my right ear. I have never done that in my entire LIFE. That trigger point work hurt like hell, but I'm going to stay on that for a good month along with anti-inflammatories and my new homemade infrared set up to make sure I am taking full advantage of what I can do. I seriously feel it all the way up to the outside of my right eyeball right now, it is super weird. Even the front of my shoulder is more pliable, and I haven't even touched that area. Crazy.

Anyways, it is definitely key that you IMMEDIATELY work on range of motion after trigger point work, so that you maximize the gains from each session. This is something that Dr Levy recommends and does in his practice, and it definitely works.

For those who don't know, Dr. Levy teaches NMR (Neuro-Muscular Re-education) and has DVDs available for home study. He is the guy in GTJT's linked subscapular video.

[Cole Dano]

Well you know the way Travell and Simmons actually recommend doing the TP treatments is Freezing Spray and then immediate stretch, so that's a great point you brought up with the stretching.

I don't know of anyone who actually does the spray and stretch though, i've always wondered why, as it was Travell and Simmons who did the groundbreaking research, and that's what they found to work best.

[Guest GTJT]

Hi guys.

Just getting back now to carefully re-read your replies. I will get back to you!

Slizzard, I am so happy that link works out for you. We need to help each other, friends with and in mutual interests.

Meanwhile I am wondering 2 things:

1- the subscap trigger point. I know there's a nerve that runs not far from there - that is how I understand it, atleast. The guy who did ART told me so. Dangerous performing the subscap (self)massage...?

2- for stretching the anterior shoulder, I'm doing broomstick "dislocates". One thing I've started doing is a one-arm stretch. It's simple, let me explain it. Standing up, and stretching my right side, I'll put my right arm behind my body and grab on to something in order to provide the resistance to the stretch. The arm is straight. Then I (hyper?)extend the shoulder by making absolutely sure the shoulder is "tucked back" as demonstrated in slizzardman's video about fixing shoulder pain. Shoulder BACK along with the elbow, and not just pullin' back on the arm and letting the shoulder roll forwards. So, the shoulder is extended, scapula depressed & retracted. Is this a relevant stretch to perform? And is it relevant to treat impingement? It "feels right".

[Cole Dano]

Nerves are actually tough, so there isn't really much risk of damage from even a strong massage. They don't do well under a constant pressure lasting many minutes, which is why your leg will fall asleep if you keep your legs crossed too long.

The stretch is another fine variation of what Slizz is demonstrating. Some people will find it better that way, some on the floor, both are good.

I personally have been doing something similar to what you describe but holding on to a stretch band attached to a wall hook, and its very powerfully coaxes the anterior shoulder muscles to release.

[Joshua Naterman]

I agree, nerves are really tough. It took like two hours under the log straight with no breaks to finally wreck whatever nerve(s) I screwed up in BUD/S. Short massages aren't a big deal. If anything, it is important to make sure the nerve is not adhered to the muscle! You can't do that without some temporary pain.

The stretch you mention should be fine, I mean anything that allows the anterior shoulder girdle to release will help. Just make sure you hit all your internal rotators as well (lats, pec minor/major, teres major, subscap, etc), both with manual release work(NMR, ART, TP, whatever) and with stretches right afterwards to help teach the body what it is actually capable of doing. Between that and using whatever you have available to accelerate your healing and make sure muscular strength balance is being improved you should be able to provide yourself with pretty much the highest possible quality of care you can get outside of pretty exclusive circles.

[Guest GTJT]

Will get back to a more elaborate reply. I do want to mention though, to slizzard, that doing quite vigorous subscap stretching (the exrx broomstick version) has - with high frequency - very quickly improved flexibility. BTN pressing is now an option for me. Due to my insane volume of chest pressing my subscap and int. rotators were seriously tight, but now, much better.

[Joshua Naterman]

It's weird; huh? Make sure you stretch RIGHT after the manual work so that you keep as much of the ROM gain as possible. There is a very small muscle on the inside of the biceps that was causing me trouble that I just found out about while reading last night. It's called the coracobrachialis and it hurts pretty bad to massage but it relieved a huge amount of pain. I also have a lot of tightness in my inner biceps head hear the elbow attachment and I am currently working on that. My entire right biceps head is just tight and non-pliable from top to bottom so that will be a project for tomorrow.

Each time I work through new things my shoulder gets better, and I am realizing that it is really a mistake to assume that there is much of any commonality in cause of injury or perpetuating factors. You really have to go after everything that can change shoulder position and tension levels, so making the soft tissue more pliable and then stretching for every muscle that connects to the shoulder is a powerful 1-2 combination. Making sure postural dysfunctions are not present and correcting them if they are is another mandatory step in true healing.

Anyhow, this all just reminds me that you really have to investigate every possibility and not leave anything unchecked when it comes to physical pain. Everybody has a slightly different lifestyle with different combinations of movement patterns, old injuries, postural dysfunctions, susceptibility to trigger points etc etc, and since this changes all the time there is no way to know what is wrong down to a T. You have to check everything and treat the problems as you find them, making sure to maintain the improvements and continually look for more problems until there are no more to be found.

[cccp22]

All I can say is that those trigger point resources are amazing. Just working into the teres minor and infraspinatus has always helped me some, but digging into the supraspinatus made a big difference. It hurts, but the method with the lacrosse ball and the door jamb is the way to go. Lacrosse balls don't slip, I really like them. Got it two days ago and this is my first time using it.

So about 4 days ago I had my friend do Dr. Levy's subscapular release on me with only partial success, because it turns out that my entire armpit is one giant lump. That explains my absolutely horrendous shoulder mobility. So, I just spend about 45 minutes hitting the above trigger points and then my teres major and subscap, and while it is still a pretty big mess I then used a belt to do unilateral wall extensions while lying on the floor, just to make sure I was getting full range of motion. After a few reps and getting used to the increased range of motion I can touch my right bicep to my right ear. I have never done that in my entire LIFE. That trigger point work hurt like hell, but I'm going to stay on that for a good month along with anti-inflammatories and my new homemade infrared set up to make sure I am taking full advantage of what I can do. I seriously feel it all the way up to the outside of my right eyeball right now, it is super weird. Even the front of my shoulder is more pliable, and I haven't even touched that area. Crazy

Anyways, it is definitely key that you IMMEDIATELY work on range of motion after trigger point work, so that you maximize the gains from each session. This is something that Dr Levy recommends and does in his practice, and it definitely works.

For those who don't know, Dr. Levy teaches NMR (Neuro-Muscular Re-education) and has DVDs available for home study. He is the guy in GTJT's linked subscapular video.

*************What anti inflammatories do you take? fish oil? If so what kind and how much. what about curcummin?are NSAID's that bad if you are taking a connective tissue supplement? Thank you in advance . Sorry about the multitude of questions.Just interested.

Brandon Green

[Olly]

Wow those supports look like a great aid!

I've found a site in the UK which offers a similair, possibly better support

http://www.jointsupports.co.uk/acatalog/OppO_Clavicle_Supports.html

Ordering one tonight after I measure myself - Will report back the results in a week or so

[Joshua Naterman]

NSAIDS are always THAT BAD. Don't use them unless you simply can not deal with the pain. They are pain meds, not healing meds.

The herbs with anti-inflammatory effects work very differently and are not a problem. Tumeric is pretty strong, as are most plants honestly.

Omega 3 is NOT anti-inflammatory. It simply causes a LESS inflammatory compound to be produced than Omega 6 does. I know that's semantic, but it is a big difference and needs to be understood.

[cccp22]

NSAIDS are always THAT BAD. Don't use them unless you simply can not deal with the pain. They are pain meds, not healing meds.

The herbs with anti-inflammatory effects work very differently and are not a problem. Tumeric is pretty strong, as are most plants honestly.

Omega 3 is NOT anti-inflammatory. It simply causes a LESS inflammatory compound to be produced than Omega 6 does. I know that's semantic, but it is a big difference and needs to be understood.

************* Thank you (as usual).

Brandon