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    Registered User Prophylaxis's Avatar
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    BodyBuilding Physiotherapy/PT Thread

    Throughout my time lurking this forum I've noticed many questions regarding pains and aches. There are also plenty of misconceptions floating around, especially in the weight-lifting scene. "Take X Vitamin, and it will resolve Y condition".

    I'm a trained physiotherapist who works closely with elite sports teams. I have seen many young men injure themselves while working out - backs and shoulders especially! Personally I have dislocated my shoulder several times (able to avoid surgery thankfully), so I know how frustrating it can be when injuries get in the way of your progress.

    I've created this thread with the intent of answering any questions you may have about any aches or pains you experience.

    If you could I'd like responses in:

    Body Chart: (Where exactly does it hurt?) - try to be as specific as possible
    Age: (How old are you?)
    Mechanism of injury: Did the pain occur during ONE particular event? Or can you think of nothing that brought it on?
    Aggravating factors: What makes the pain worse?
    Easing factors: What relieves the pain?

    Based on this I will then give you my provisional diagnosis with appropriate exercises. I may need a couple follow-up questions before I arrive at my provisional diagnosis. I'm sure I don't need to tell you, that my advice should not substitute seeing a REAL LIFE health care professional.

    Feel free to also ask questions about physiotherapy in general. Other PT's or doctors feel free to contribute.

    Prophylaxis
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    Registered User adoamd's Avatar
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    Body Chart: Anterior shoulder near AC joint Also near the inferior angle of the scap. Left shoulder
    Age: 21
    Mechanism of injury: Was shoulder pressing ages ago and joint started to hurt (thought it was a muscle DOMS), felt like a ligament stretch, hurts to sleep on. Went to do a wide grip bench press, pain got worse.
    Aggravating factors: Shoulder flexion with the arm abducted, Also lateral raises bring about the same pain. When i come to stretch out my lat,(holding onto a pole with my arm parallel to the ground and just pulling my body backwards, i get the Inferior angle of scap. pain. feels sharp and localised.
    Easing factors: resting. pain at rest 2/10. pain when pressing with the arm abducted 7/10

    how long have you been experiencing this pain? about 6 months.
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    Registered User Prophylaxis's Avatar
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    Originally Posted by adoamd View Post
    Body Chart: Anterior shoulder near AC joint Also near the inferior angle of the scap. Left shoulder
    Age: 21
    Mechanism of injury: Was shoulder pressing ages ago and joint started to hurt (thought it was a muscle DOMS), felt like a ligament stretch, hurts to sleep on. Went to do a wide grip bench press, pain got worse.
    Aggravating factors: Shoulder flexion with the arm abducted, Also lateral raises bring about the same pain. When i come to stretch out my lat,(holding onto a pole with my arm parallel to the ground and just pulling my body backwards, i get the Inferior angle of scap. pain. feels sharp and localised.
    Easing factors: resting. pain at rest 2/10. pain when pressing with the arm abducted 7/10

    how long have you been experiencing this pain? about 6 months.
    Hey adoamd,

    Just a few follow-up questions:

    Initially did the anterior shoulder pain start first, and THEN the scap pain follow?
    Has your shoulder every popped out/or felt unstable?
    Do you wake up with pins and needles/numbness in the morning? (or does it feel like you have a 'dead' arm sometimes?)
    Do you have any neck pain (or traps) pain associated with the shoulder pain?
    What is your current upper body workout?
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    Originally Posted by Prophylaxis View Post
    Hey adoamd,

    Just a few follow-up questions:

    Initially did the anterior shoulder pain start first, and THEN the scap pain follow?
    Has your shoulder every popped out/or felt unstable?
    Do you wake up with pins and needles/numbness in the morning? (or does it feel like you have a 'dead' arm sometimes?)
    Do you have any neck pain (or traps) pain associated with the shoulder pain?
    What is your current upper body workout?
    yeah, it was the shoulder then the scap. Feels stable, just painful. I get a nice click in my shoulder when I abduct to 90 degrees then externally rotate. Yeah, i get some neck pain on my left side (same side) as well. It's pretty much at like C3-4 and that's only brought about when i try to crack my back. yes i do get numbness pretty quickly, but it goes away when i roll over

    upper body used to be shoulder presses, bench with barbell and freeweights, seated rows, bent over rows, lat pull downs, tricep pushdowns and biceps curls.
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    Registered User flipzag's Avatar
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    Originally Posted by adoamd View Post
    yeah, it was the shoulder then the scap. Feels stable, just painful. I get a nice click in my shoulder when I abduct to 90 degrees then externally rotate. Yeah, i get some neck pain on my left side (same side) as well. It's pretty much at like C3-4 and that's only brought about when i try to crack my back. yes i do get numbness pretty quickly, but it goes away when i roll over

    upper body used to be shoulder presses, bench with barbell and freeweights, seated rows, bent over rows, lat pull downs, tricep pushdowns and biceps curls.
    (NB - Didn't realise that I can't post links or images until I have 50 posts - mods- feel free to check the images - these are NOT spam and are carefully selected by myself (perhaps other PT's will know the names of the tests below - if the images get removed) -. Replace the (DOT) for the following tests.


    Hmm, there very well may be a neck component to your pain then (often the lower neck joints (C6-T1) can refer pain to the scapular region. Is the numbness down your arm? (if so what region) - sorry for being so particular, but this is an important detail.

    1) Neck Active Movements Can you perform all active movements of the neck in all directions- do any of these bring on your shoulder or scap pain?

    massagetoday.com/content/images/flexion1_40658_1_1_9945(DOT)jpg


    Now I'll do a couple of tests on the shoulder.

    As the other PT's will know - basically every shoulder test (except for the apprehension/relocation test) has poor validity, and it is impossible to tell clinically exactly what is happening inside someone's shoulder - BUT we can still get an idea of what MAY be causing your pain with the following tests.

    Now a few shoulder tests I would like you to perform:

    1) (Ext Rot STRENGTH) Is there any pain or weakness on resisted external rotation (in 0 degrees abduction?) Can resist with your good arm. (If so, don't perform the following tests, otherwise carry on)

    2) Do you have full shoulder flexion range? (if there is pain, can I get you to slightly squeeze your shoulder blade 'up and back' and re-perform the movement - did this reduce the pain?

    3) (Active Impingement Test) With your sore arm - I want you touch your other shoulder and lift up your elbow (below) Does this elicit the anterior shoulder pain? (can try on your good side for comparison)


    t-nation.com/img/photos/2009/09-135-training/05b(DOT)jpg


    4) (Empty Can Test) Pretend like you emptying a can - I want you to have your arm in scaption (halfway between flexion and abduction - at 90-degs) - then I want you to keep your arm still while pushing down/resisting your sore arm with the good arm. Is there any pain associated with this? (If so, can you repeat this while squeezing the shoulder blades back) - does this reduce the pain?

    classconnection.s3.amazonaws.com/522/flashcards/1066522/jpg/empty_can1330050970924(DOT)jpg


    5) (Speeds Test) With a straight arm, palms facing up at 90 deg shoulder flexion - resist the sore arm with the good arm. Does this bring on any pain?

    i1.ytimg.com/vi/N00gA4Pvsbw/hqdefault(DOT)jpg


    Let me know how you go!
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    Interdasting, LPTA brah checking in.


    inb4 APTA and FSBPT


    Also OP your use of physiotherapy instead of physical therapy leads me to believe you are not in the U.S. correct? How long was your schooling?
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    sub acromial bursitis checking in, what can i do to help make it better? i can do all exercises fine bar anything shoulder isolation, cant overhead without making it so much worse the next day
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    Body Chart: Right in between groin and inner thigh?
    Age: 21
    Mechanism of injury: Occurred earlier in HS, flares up when I run only on the right side. Hurts a lot
    Aggravating factors: Running when it flares up, long duration runs and sprints after it flares
    Easing factors: Not running, resting for a while

    Body Chart: Uppers Spine/Back of Neck
    Age: 21
    Mechanism of injury: No clue
    Aggravating factors: Hurts when I lean head back and put the weight of my head on it. Not sure how to explain it
    Easing factors: Holding head anywhere but that position.
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    Body Chart: (Where exactly does it hurt?) - My right wrist pinky side.

    Age: 27 years old

    Mechanism of injury:It started after using a flat curl bar. I always used an ez bar before but decided to mix it up and used a flat curl bar. Started to hurt, stopped and started using dumbbells instead. Continued and it started to hurt even more. Have since stopped using such heavy weights for curls and have had to drop down the weight and do higher reps to prevent pain.

    Aggravating factors: Doing any type of bicep exercise that doesn't involve dumbbells.

    Easing factors: Hammer curls currently the only bicep curl that doesn't hurt my wrist as I can move it so my wrist is tilted in an angle that keeps pressure off of it.

    Advice?
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    Body Chart: abbductors/glutes area
    Age: 20
    Mechanism of injury: Squatting
    Aggravating factors: Squatting, sitting down, both make it start cramping up/tightening up badly
    Easing factors: Laying down

    Body Chart: Lower back
    Age: 20
    Mechanism of injury: Can't think of anything specific, my sports therapist said really tight hams and illio something
    Aggravating factors: Sitting down, bending over, sitting upright too long
    Easing factors: Laying down



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    Body Chart: (Where exactly does it hurt?) - Right shoulder, feels like the pain is from the tendons.
    Age: (How old are you?) 24
    Mechanism of injury: Was trying to get into position for a shoulder dumbbell press, grip slipped on the dumbbell while I was getting in position and swung back, I felt like my shoulder was being torn apart (40Kg dumbbell) instead of just dropping it I pushed it up.
    Aggravating factors: Nothing really makes it feel worse, I just feel it on press movements at the gym during chest and shoulder workouts
    Easing factors: I don't feel it unless there's stress on the muscle.

    Medicine like Brufen helped a bit.
    December 2013 stats / March 2013 stats
    Bodyweight: 174lb (79kg) / 274lb (124kg)
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    Deadlift: 375lb (170kg) / 132lb (60kg)

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    In for wisdom. What do you think is the most useful treatment? Eg exercise vs stretching vs rest.
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    Hey OP, appreciate any input. I also have lower back pain (but thats harder to describe / symptoms are harder to predict, so ill stick with this one)

    Body Chart: (Where exactly does it hurt?) - Between my shoulder blades, mostly to the left of my spine
    Age: (How old are you?) - 21
    Mechanism of injury: Whenever I maintain good posture for a while, especially when I'm sitting cross-legged with a straight back for a long period of time.
    Aggravating factors: What makes the pain worse? Sitting up straight, pushing my shoulders back.
    Easing factors: What relieves the pain? Sitting with bad posture / hunching over
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    history on my pain and (failed) treatment.

    pain. muscular pain under the scapula w/ tightness and some pain in the trap and lat on the left side.

    can be made worse by anything, especially high intensity cardio. nothing seems to bring much relief.

    it's been going on sense june, nothing seemed to cause it.

    I've scene several chiros, a orthopedic surgeon and a dr who recommended physical therapy. after two sessions of pt, which was not helpful at all. went back to the doc and she wanted to give me cortisone (no thanks jeff).

    one chiro I was seeing, everytime I'd go in, he'd say the first 5 ribs on the left were out of place, he'd adjust and I'd get instant relief that would last for a day or two.

    so after looking online, I've diagnosed myself w/ slipping rib syndrome, and from what I've read the only thing that helps is prolotherapy.

    if you have any suggestions that would be great. the pain is ruining my life atm.
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    First-year physiotherapy student here. Subbed.
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    Originally Posted by Eric_Edge View Post

    Also OP your use of physiotherapy instead of physical therapy leads me to believe you are not in the U.S. correct? How long was your schooling?
    Hey man, that's correct - I'm from Australia. Fortunately I was lucky to get straight into an undergraduate school which was only 4 years! (Then the real learning begun..)

    Originally Posted by Jakegreentree View Post
    sub acromial bursitis checking in, what can i do to help make it better? i can do all exercises fine bar anything shoulder isolation, cant overhead without making it so much worse the next day
    Sub acromial bursitis is inflammation of the bursa (fluid-filled sac) under the acromion (front part of the scapula). This serves to minimise friction between bone and tendon (rotator cuff). In the shoulder this inflammation be caused by a number of factors:

    1) Rotator Cuff Tendinopathy - where microtears occur in the rotator cuff (often the supraspinatus) due to overload of the rotator cuff- this can cause irritation around the bursa (where the supraspinatus tendon runs)
    2) Poor scapular control/positioning - If your scap is protracted and laterally rotated (v common) and positioned properly during workouts - you minimise the 'sub-acromial space' which also puts pressure on the bursa
    3) Overuse - Rotator cuff becomes overloaded (after a while, this can lead to tendinopathies) - can happen in swimmers.
    4) Muscle imbalance - often in young men, I see the deltoids overpower the rotator cuff, which causes a superior shift of the humeral head, which can minimise subacromial space and cause subsequent inflammation of the bursa
    5) Thoracic spine stiffness --> rib stiffness - if you have a stiff back - it will force your scap to be protracted and laterally rotated.
    6) Posterior cuff tightness - When muscles at the back of the shoulder seize up - they can put extra pressure on the shoulder.

    The best exercises would therefore be identifying which one (or more) of these factors are causing the bursitis.

    Generally speaking - the most common reasons for young men working out to have this bursitis (often clinically diagnosed as 'Impingement') - is due to poor scapular positioning and weak rotator cuff muscles (compared to delts).

    My 2 cents:

    Stick to decline only until your shoulder settles down and avoid heavy shoulder press or incline/flat bench.

    Begin strengthening your posterior cuff gently - this means gently shoulder ADDUCTION (pulleys are great for this) - avoid any ABDUCTION strengthening as this is all deltoids!

    Gentle stretch the posterior cuff (elbow across body - but making sure it doesn't go ABOVE shoulder height.

    Start scapular stabilisation exercises and scap setting exercises (MOST CRUCIAL STEP IMO) - basically you want to begin with early range shoulder flexion while keep the shoulder blade squeezed back slightly (don't lift the hand up ABOVE the belly button when doing this in standing). You want to SMASH these every few hours try to squeeze in at least 30 reps.

    After you stick with this and symptoms settle - THEN start training rotator cuff strength.


    All this should be PAIN FREE.

    Can't wait til I have 50 posts under my belt so I can post pics haha - will be MUCH easier for both of us!

    Let me know if you have any further questions:
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    Originally Posted by Prophylaxis View Post
    Hey man, that's correct - I'm from Australia. Fortunately I was lucky to get straight into an undergraduate school which was only 4 years! (Then the real learning begun..)
    That's sweet, that's about how long PTA school is here with pre recs in the states. PT is now a doctorate in the states so its a good chunk of schooling.

    Had a physiotherapist come over from Europe in our upper class and the education he had was deemed inadequate to practice in the states so he just went ahead and did PTA school. It makes me curious how different the education really is here in the states vs the rest of the world

    How long have you been licensed and practicing? Do you have your own clinic?

    Also @jakegreentree, did you have an X-ray taken? Sometimes they will find sub-acromial bone spurs on the inferior aspect of the acromion process which can contribute to this and cause impingment and eventually cause a supraspinatus (rotator cuff muscle) tear. Might wanna have it looked at.

    Alot of times they can give you a shot of cortisone or a corticosteroid and that clears it up.
    Last edited by Eric_Edge; 01-29-2014 at 01:55 AM.
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    In on thread.

    Body Chart: (Where exactly does it hurt?) - Left arm. Pain feels like it is radiating away from the elbows.
    Age: (How old are you?) - 29
    Mechanism of injury: Felt is first during my last 1RM Deadlift. Now it comes back whenever i work out back / chest two days in a row.
    Aggravating factors: Continuing to work chest / upper body. Also feel it slightly as i go about my day.
    Easing factors: Rest. With enough rest i feel that i have recovered fully. NSAIDs sometimes to relieve the pain. Read that fish oil can benefit so i take that also (not sure if its effective though).

    I'm not sure at all, but i feel it could be a flexibility issue. Will be adding some yoga to see if that benefits.
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    Originally Posted by Z93 View Post
    Hey OP, appreciate any input. I also have lower back pain (but thats harder to describe / symptoms are harder to predict, so ill stick with this one)

    Body Chart: (Where exactly does it hurt?) - Between my shoulder blades, mostly to the left of my spine
    Age: (How old are you?) - 21
    Mechanism of injury: Whenever I maintain good posture for a while, especially when I'm sitting cross-legged with a straight back for a long period of time.
    Aggravating factors: What makes the pain worse? Sitting up straight, pushing my shoulders back.
    Easing factors: What relieves the pain? Sitting with bad posture / hunching over
    Hey,

    Quick questions, if you sit up 'straight' cross-legged, does you pain come on immediately, or does it take a few mins/ hours to start?

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    Originally Posted by Prophylaxis View Post
    (NB - Didn't realise that I can't post links or images until I have 50 posts - mods- feel free to check the images - these are NOT spam and are carefully selected by myself (perhaps other PT's will know the names of the tests below - if the images get removed) -. Replace the (DOT) for the following tests.


    Hmm, there very well may be a neck component to your pain then (often the lower neck joints (C6-T1) can refer pain to the scapular region. Is the numbness down your arm? (if so what region) - sorry for being so particular, but this is an important detail.

    1) Neck Active Movements Can you perform all active movements of the neck in all directions- do any of these bring on your shoulder or scap pain?

    massagetoday.com/content/images/flexion1_40658_1_1_9945(DOT)jpg


    Now I'll do a couple of tests on the shoulder.

    As the other PT's will know - basically every shoulder test (except for the apprehension/relocation test) has poor validity, and it is impossible to tell clinically exactly what is happening inside someone's shoulder - BUT we can still get an idea of what MAY be causing your pain with the following tests.

    Now a few shoulder tests I would like you to perform:

    1) (Ext Rot STRENGTH) Is there any pain or weakness on resisted external rotation (in 0 degrees abduction?) Can resist with your good arm. (If so, don't perform the following tests, otherwise carry on)

    2) Do you have full shoulder flexion range? (if there is pain, can I get you to slightly squeeze your shoulder blade 'up and back' and re-perform the movement - did this reduce the pain?

    3) (Active Impingement Test) With your sore arm - I want you touch your other shoulder and lift up your elbow (below) Does this elicit the anterior shoulder pain? (can try on your good side for comparison)


    t-nation.com/img/photos/2009/09-135-training/05b(DOT)jpg


    4) (Empty Can Test) Pretend like you emptying a can - I want you to have your arm in scaption (halfway between flexion and abduction - at 90-degs) - then I want you to keep your arm still while pushing down/resisting your sore arm with the good arm. Is there any pain associated with this? (If so, can you repeat this while squeezing the shoulder blades back) - does this reduce the pain?

    classconnection.s3.amazonaws.com/522/flashcards/1066522/jpg/empty_can1330050970924(DOT)jpg


    5) (Speeds Test) With a straight arm, palms facing up at 90 deg shoulder flexion - resist the sore arm with the good arm. Does this bring on any pain?

    i1.ytimg.com/vi/N00gA4Pvsbw/hqdefault(DOT)jpg


    Let me know how you go!
    Number 2 helped! pain when i'm like 80 degres of shoulder flex.
    No loss of ext strength.
    4. Pain is reduced when shoulders are retracted
    5. yes, pain in the anterior delt. Look at the picture to see where I get the pain and i get that lat/inferior angle of scap pain.
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    Originally Posted by adoamd View Post
    Number 2 helped! pain when i'm like 80 degres of shoulder flex.
    No loss of ext strength.
    4. Pain is reduced when shoulders are retracted
    5. yes, pain in the anterior delt. Look at the picture to see where I get the pain and i get that lat/inferior angle of scap pain.
    Great - finally before I give you my provisional diagnosis and exercises - Did number 3 (active impingement test) reproduce any pain? - where you touch your opposite shoulder and lift the elbow up?

    I will answer the rest of the posts on this thread over the next 12 hours!
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    Originally Posted by Poolee32 View Post
    Body Chart: Right in between groin and inner thigh?
    Age: 21
    Mechanism of injury: Occurred earlier in HS, flares up when I run only on the right side. Hurts a lot
    Aggravating factors: Running when it flares up, long duration runs and sprints after it flares
    Easing factors: Not running, resting for a while
    Hey man,

    I'll just focus on this one for now. Then we'll move onto the neck.

    Click on this image (of the right groin!) - change the (DOT) zerotoboston.com/wp-content/uploads/2009/04/grointriangle(DOT)jpg- and tell me EXACTLY whether your groin pain is inside or medial to the triangle, outside or lateral to the triangle or above the triangle. It may seem pedantic but depending on where the pain is, can mean totally different things.

    Any pins and needles or numbness going down the leg?
    Do you have any lumbar pain as well? - Does doing lumbar active movements bring on the groin pain? spinesurgeon.com.au/Neurological_Conditions/images/movements(DOT)jpg
    Did you have any hip problems as a kid? (Were you unable to cross your legs as a child, or do you find it difficult or painful to sit on a low chair?)
    Is the groin pain worse AFTER, DURING OR BEFORE you run?
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    i have a standard patella injury/jumpers knee

    so far ive been
    - stretching hips, groin, quads
    - rolling hips, it band, quads

    what else can i do to help it heal faster
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    Body Chart: Left Shoulder. The pain tends to 'feel' as if it is in the front/anterior (or sort of in between the front and middle) deltoid. I think the pain is 'deeper' into the deltoid. The pain tends to be a 'tearing' dull ache (sounds weird).
    Age: 21
    Mechanism of injury: Cannot remember an event that caused this pain to occur. As far as i'm aware, ever since i have lifted i have always had this 'pain' in the left shoulder.
    Aggravating factors: If i do the pec dec for chest flies, i get pain when performing the exercise. Another exercise where i get this pain, is when i'm doing front/anterior deltoid raises, with dumbells. The pain tends to hurt 'more' on the negative part of the movement. As a result of this pain, i have trouble doing rear delt exercises. When i perform the movement (eg reverse flies on pec dec), when i move my left arm from the starting position (arm in front of me) to the end of the movement (arm out to the side), i get this achey pain in my front delt. As a result, i cannot focus on activating my rear delt, as i have this annoying pain in my front shoulder.
    Easing factors: Not doing front deltoid/rear deltoid exercises.



    I need some help with this, cos i just can't seem to activate me left rear delt, because i'm certain something is up with my shoulder. Repping anyone who can offer me some legit advice!

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    Originally Posted by prudz View Post
    Body Chart: (Where exactly does it hurt?) - My right wrist pinky side.

    Age: 27 years old

    Mechanism of injury:It started after using a flat curl bar. I always used an ez bar before but decided to mix it up and used a flat curl bar. Started to hurt, stopped and started using dumbbells instead. Continued and it started to hurt even more. Have since stopped using such heavy weights for curls and have had to drop down the weight and do higher reps to prevent pain.

    Aggravating factors: Doing any type of bicep exercise that doesn't involve dumbbells.

    Easing factors: Hammer curls currently the only bicep curl that doesn't hurt my wrist as I can move it so my wrist is tilted in an angle that keeps pressure off of it.

    Advice?
    hey prudz,

    Heads up - sorry for all the questions!! - want to be as thorough as possible.

    A few questions:

    How long have you had the pain for, and how long have you allowed it to rest?
    Have you had any previous traumas of the wrist? (fell onto hand etc)
    Is there any swelling, or look like there is a bulge around the wrist?
    Are you 'double-jointed'?
    Any pins and needles or numbness in the hand? (along the ring finger or pinky?)
    If you do an exaggerated 'wave' with your wrist, does that hurt?
    If you try to lift up a table by placing your hands underneath it - does that hurt? (pic) -i1.ytimg.com/vi/OxFjjo-9Ydo/hqdefault(DOT)jpg
    Does it hurt when you put any weight through your wrists, e.g. trying to lift up own body weight while sitting?
    If you press just above (distal to the ulnar styloid (bumpy part of your wrist) - is that tender at all?
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    Fellow PTA brah here. I work in geriatric care, though. I didn't like the out patient scene.
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    Originally Posted by Dawlphinracer View Post
    Body Chart: abbductors/glutes area
    Age: 20
    Mechanism of injury: Squatting
    Aggravating factors: Squatting, sitting down, both make it start cramping up/tightening up badly
    Easing factors: Laying down
    Hey man,

    Given that you have lumbar pain AS WELL AS glut pain, i'd say there is a good chance these are related.

    Is your back pain on the same side as the glut pain?
    If you go through all lumbar active range of motion spinesurgeon.com.au/Neurological_Conditions/images/movements(DOT)jpg - which one of these movements specifically brings on the glut pain or lumbar pain?
    Any pins and needles or numbness down the leg?
    Does the pain travel past the gluts - into the legs?
    What exercises did the PT give you? Which one of these relieved the pain?
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