Sharp shoulder pain

[Svend]

Hey guys!

Yesterday I experienced a sharp pain i my right shoulder. The odd thing is that I was not active and had not been for several hours - I was sitting still. When I keep the shoulder joint calm I feel no pain after a short while however when I raise my upper arm as if I was doing a dumbbel lateral raise the pain usually comes right back. Any other motion with my shoulder joint does not hurt at all, only the lateral raise like movement.

Any clues to what I'm suffering from? I've been doing some golf ball massaging and it seems to relieve the tension a bit but does not fix the pain. Should I simply wait for this to go away or can I do something about it?

[Cole Dano]

Sounds like you've had some kind of a cramp. Sometimes they will come from no where.

Massage and time are the best medicine.

That said, though it doesn't always correspond, can you give a couple of details?

Where more exactly is the pain, and is it always sharp or just when it started?

[Svend]

The pain seems to be in the upper area of the lateral deltoid though I think it in the joint where the pain is actually coming from. The sharp pain is only present when I move my upper arm sideways about 35-40 degrees from my body - only in that area. Having my arm overhead doesn't cause pain but it hurts getting there since I have to pass that 35-40 degree area. I hope that makes sense! :|

[Cole Dano]

Yes that was actually the answer i was hoping for. I almost certainly a rotator cuff issue, supraspinatus.

Its a bit hard to self massage, and its not where you feel the pain which is confusing at first. Its the uppermost muscle on back of the shoulder-blade.

Since it happened at rest its most likely just a cramp. Take it easy until the pain subsides, if it lasts more than a week i'd look into it.

[Svend]

Thanks! That sound quite plausible - is this a product of muscular imbalances or can it happen to anyone? I'll continue to keep my shoulder calm and try massaging - I see how it's tricky to get to. I'll keep you updated

[Cole Dano]

At least for me cramps like that are from simple fatigue. (Or lack of magnesium....)

[Svend]

Ok, so now the pain is pretty much gone. If I'm doing aggresive arm swings I still feel something in the same area and I'm a little worried that the pain will emerge again so I've restrained from doing any sort of workout until now - I'm pretty sure I'll be able to workout again full scale very soon. Do you think there's anthing I can do to keep this from happening again?

[Joshua Naterman]

1) active release for supraspinatus.

2) active release and SMR for everything else that connects to the scapula. Biceps, triceps, lats, serratus anterior, subscap, infraspinatus, pec minor, teres minor and major, coracobrachialis, rhomboids and traps, levator scapula, etc. It will help to check some online anatomy pictures. Alternatively and at first preferably you could get a licensed ART practitioner to work on you so that you can feel how he or she does the technique. Once you understand it you can apply it to yourself easily. You will be bending muscles, not squishing them on the bone. It's a bit different than SMR and trigger point in that respect.

You still have inflammation in supraspinatus so don't try and get back into full ROM overhead lifting. Partials for the top 20 degrees of motion should be ok in a standing military press or a HSPU but that's it. You don't want to be in that middle range as you will be pinching the inflamed tissue and perpetuating the condition. Personally, I'd stay away from overhead stuff for a few weeks at least and do cryotherapy (ice alternated with heat) for the entire time at least twice a day. That's your ideal healing regimen but it probably won't do anything permanent for you if you don't get those muscles released.

[Svend]

I'm looking into active release and SMR this very moment. I'll experient with that! What do you think caused the inflamation?

I'll follow your advice and stay away from overhead movements. Would static handstands be okay, though?

Thanks

[Razz]

Unfortunately there's no ART practitioners in Denmark or anything similar.. Maybe I will be in a couple of years

[Svend]

Well, I just looked it up, and it seems there are 2. One in Copenhagen and one in Ã…rhus. I'm quite positive my economics won't be able to support a visit atm, though. :?

[Razz]

Ah that's cool, probably I didn't search enough last time as I also found them now

[Svend]

Maybe I will be in a couple of years

Have you looked into the possibilities of ART training?

[Razz]

Not really, but it's certainly something I plan to do in the future

[Svend]

Well, I'm sure there's a great market for it here.. Not a bad idea!

[Joshua Naterman]

I think it's a great idea, I'll be getting that while I'm in school.

[Cole Dano]

Now guys please keep in mind that ART, MFR etc are essentially brands with some extra hype and glitz attached to them. Hype and glitz have a very short half life in our society. Get a good basic education in manual therapy first, then go for the glitzy stuff.

[Blairbob]

Until then, get out your lacrosse ball, mobillitywod.com and get to work.

As well look into the shoulder material by Ido and Slizzardman.

[Svend]

Until then, get out your lacrosse ball, mobillitywod.com and get to work.

As well look into the shoulder material by Ido and Slizzardman.

I already do Ido's shoulder and scapula routines as well as Slizzardman's stretches. Not frequent enough I suppose Anyway, the mobillitywod I've heard of but never looked into. I'll do that now!

[Joshua Naterman]

ART does do things differently than MFR. They have similar goals but use different techniques and each is suited for certain situations. However, it does seem that ART is the most time efficient method to treat soft tissue restrictions. MFR is easier to do on your own but tends to rely on pressing the muscle against the bone which can create some bruising. ART bends the muscle, so to speak. You basically find a spot on the side of a muscle and maintain a constant position with whatever you are applying pressure with and then stretch the muscle around it. The motion is all internal, while with MFR the motion is largely external. There are some muscles where ART is just very hard to apply and MFR is sometimes more appropriate, like the smaller muscles of the hips.

I definitely think you need to have a very well rounded education in all this so that you don't become dogmatic, but ART is a very very good cert to get. They have a provider network that helps you drive traffic to your practice and they are becoming VERY well recognized. In short, they are just much more professional than most other organizations including Graston Technique.

[Blairbob]

Are you looking toward moving on to PT, Josh?

[Cole Dano]

They all do something 'different', that's why they are all brands. I understand ART is hot now, but that's always the case. For someone with your smarts getting a broad based education with a solid foundation is what's important now. I'm not saying ART isn't any good, but as you constantly bring up, there are any number of good programs. Start general than go specific, just my $0.02.

[Joshua Naterman]

I would say that I am far closer to being more like Poliquin, in the sense that I want to learn everything that works, learn why they work, and learn how to apply it to my trainees.

I am simply a bit more interested in distilling things down and helping to push this sort of thinking into mainstream training.

[Joshua Naterman]

The interesting thing about manual therapy is that there isn't much of anything central, each mode of therapy is like a side of a diamond. It's part of the whole and some are more similar than others. Some are better at certain things than others, but you never know what any particular patient will benefit most from until you make an assessment and start trying to treat the patient.

That's why I kind of take one at a time and learn them. My favorite thing about ART is their provider network. Why the other organizations don't copy that idea and set up networks of their own is beyond me!

In the end, you've got a number of things that could cause soft tissue restrictions, such as fibrosis(both between and within muscles and connective tissues) and trigger points, which can reinforce each other, and also hypertonicity. Then you've got neurological dysfunction, either from acute nerve damage or entrapment between bones or in soft tissue and then there's the possibility of learned dysfunction. Of course there could be actual physical damage to the muscle or connective tissues as well. In all likelihood this is not a complete list, but it's a good start. Right here we can already see that there's going to need to be a combination of rehab exercises, restriction removal, and possibly bone repositioning. There is no one modality that does all that.