The Complete Shoulder and RC Injury Article

[bigman334]

It's probably tendonitis somewhere in your shoulder, where the shoulder attaches to the bicep, or in your rotator cuff. Those symptoms are pretty similar to mine.

where it attaches to the bicep huh.. that would explain why it feels funky with pulling motions. even heavy hammer curls feel weird. at least i'm getting somewhere now.

[Blindead]

where it attaches to the bicep huh.. that would explain why it feels funky with pulling motions. even heavy hammer curls feel weird. at least i'm getting somewhere now.

well, rather, where the bicep attaches to the shoulder. the tendon there. you could also be impinged...have bursitis. the treatment for bursitis is about the same as tendonitis though. you could possibly have a type 2 acromiom which would cause irritation and inflammation too, but that's just a hypothetical and probably isn't the case.

[bigman334]

well, rather, where the bicep attaches to the shoulder. the tendon there. you could also be impinged...have bursitis. the treatment for bursitis is about the same as tendonitis though. you could possibly have a type 2 acromiom which would cause irritation and inflammation too, but that's just a hypothetical and probably isn't the case.

now that you mention that. if i stand up and mimic an incline type pressing movement with my bum shoulder i can feel the pain. but when i take my other hand and press down really hard right in the middle where you see the separation of the shoulder and the front long part of the bicep i dont feel the pain. interesting. thats a pretty big find in determining my problem it seems.

[manONfire]

thx great thread

[Blindead]

now that you mention that. if i stand up and mimic an incline type pressing movement with my bum shoulder i can feel the pain. but when i take my other hand and press down really hard right in the middle where you see the separation of the shoulder and the front long part of the bicep i dont feel the pain. interesting. thats a pretty big find in determining my problem it seems.

Try pushing it around in the middle of your medial deltoid. That's where most of my pain is.

[shou]

First at all, i would like to thank you Bernie for the time you took to write this very rich and interesting topic on shoulder and RC injury/rehab.

Furthermore, since i had a bankart surgery on my shoulder 3 years ago (and my infraspinatus is still a bit sensible), i would like to know if i should train specifically my infraspinatus (which is sane according to IRM and echography exam) with external rotation exercise in spite the fact it becomes quickly relatively painful (my physician told me i must train it even it is a bit painful) ?

I ask the question because i've heard infraspinatus is very important to work for preventing other RC injurys but so i don't know really what to do (work it or not ?).

Thank you by advance for all your advices and experience !

Sorry for my poor english (i'm a french guy).

Greeting

P.S : on the advice of my physician, i've started back light weight lifting (non painful exercises such lateral raises up to 70-80?, front raise to 70-80?, bent over rows, chest exercises with cables....)

[shou]

First at all, i would like to thank you Bernie for the time you took to write this very rich and interesting topic on shoulder and RC injury/rehab.

Furthermore, since i had a bankart surgery on my shoulder 3 years ago (and my infraspinatus is still a bit sensible), i would like to know if i should train specifically my infraspinatus (which is sane according to IRM and echography exam) with external rotation exercise in spite the fact it becomes quickly relatively painful (my physician told me i must train it even it is a bit painful) ?

I ask the question because i've heard infraspinatus is very important to work for preventing other RC injurys but so i don't know really what to do (work it or not ?).

Thank you by advance for all your advices and experience !

Sorry for my poor english (i'm a french guy).

Greeting

P.S : on the advice of my physician, i've started back light weight lifting (non painful exercises such lateral raises up to 70-80?, front raise to 70-80?, bent over rows, chest exercises with cables....)

Any opinion on my infraspinatus's problem ?

[Staxed1989]

First at all, i would like to thank you Bernie for the time you took to write this very rich and interesting topic on shoulder and RC injury/rehab.

Furthermore, since i had a bankart surgery on my shoulder 3 years ago (and my infraspinatus is still a bit sensible), i would like to know if i should train specifically my infraspinatus (which is sane according to IRM and echography exam) with external rotation exercise in spite the fact it becomes quickly relatively painful (my physician told me i must train it even it is a bit painful) ?

I ask the question because i've heard infraspinatus is very important to work for preventing other RC injurys but so i don't know really what to do (work it or not ?).

Thank you by advance for all your advices and experience !

Sorry for my poor english (i'm a french guy).

Greeting

P.S : on the advice of my physician, i've started back light weight lifting (non painful exercises such lateral raises up to 70-80?, front raise to 70-80?, bent over rows, chest exercises with cables....)

I fit hurts then just try different movements e.g. if you can't do the basic DB external rotations, try doing cable or thera band rotations, or even face pulls with external rotation towards the end, or even cuban rotations. There are always ways around these problems.

Good luck!

[low blow]

http://billhartman.blogspot.com/2006...u-at-risk.html

The reason that experienced weight lifters hurt their shouldnt isn't because of weak external rotators IMO, it's probably more related to have an imbalance between the medial scapula rotators (ie the rhomboids and levatore scapulae) vs. the lateral scapula rotators (serratus anterior, upper trapezisu).

as the serratus/subscap is an extremely important muscle for any overhead or pressing movements, i think they're worth a mention in the "rehab" guide.

http://www.bertec.com/publications/r...-AJSM-2003.pdf

outlines some great subscapularis exericses

IMO the push up plus should be a mainstay in any weight lifters routine for its serratus and subscap activation

I'm actually going to go out on a limb and say that the subscap is more of a stabiliser of the anterior part of the shoulder capsule then it is an internal rotator - the above article mentions traditional IR's as being the worst for activating the subscap.

but of course everybody has an individual case that needs to be anaylsed. Making broad assumptions never helps anybody

[blast00]

what is the website guys that is asterixed out? can someone please PM it to me for reps.

[blast00]

when doing these:


Cable Seated Shoulder Internal Rotation

do you rotate from your shoulder or from your elbow? its hard for me to rotate from my shoulder, rotating from my elbow feels much more natural and i guess my shoulder rotates too when doing this?

but which way is it supposed to be done?

[jared07]

Thanks for the great write up/info...After having shoulder surgery 2 months ago, this will defiantly help me get back into the swing of things



-jared

[Blindead]

when doing these:


Cable Seated Shoulder Internal Rotation

do you rotate from your shoulder or from your elbow? its hard for me to rotate from my shoulder, rotating from my elbow feels much more natural and i guess my shoulder rotates too when doing this?

but which way is it supposed to be done?

you rotate at your elbow. it also rotates your RC, you just cant see it. put your hand on your back where your RC can be felt and you'll feel it move during rotations.

[Mnx4]

Hey, first off, thanks for this thread. I've had some shoulder discomfort for the past couple of weeks and didn't even think about strengthening my rotator cuff.
So a few weeks ago, I was in the middle of doing tricep rope pull downs when there was a sharp pain in my left shoulder. I was pulling the rope down, rope braids together, and when I reached the bottom, pulled the braids outward. It was during that outward movement when I had the pain. Since then, I've reduced weight a little and let my arms naturally pull the strands apart rather than actively pulling them apart and it's been alright. However, the discomfort still remains. It's a very, very dull ache which seems to resurface after flexion or tension. I had noted in my last shoulder exercise log that my left arm could not lift a dumbbell as high as my right arm of equal weight (towards the end of each set). I don't remember there being much of a problem with chest exercises, but I'll find out when I go tomorrow.
Anyway, I know it's not a lot of information, but does this sound like I'm leading myself towards a rotator cuff injury? Is there any way to pin it on whether it's a muscle, joint or a nerve issue? Thanks.

[GluteStrength]

I've had some minor impingement before in my past and aches, I finally saw a physical therapist about it who claimed that my traps and pec (where it connects to the front part of the shoulder) were overactive and somehow putting stress on my shoulder. After 4 weeks of Physical therapy, one day a week, she said since I could do reps and a few sets there was no injury and discharged me from physical therapy. So here I am happy to be back in the gym starting out slow again, when the pain and tightness and fatigue is STILL there several months after being let go from PT (and the amount of weight I'm using is nowhere near what it used to be). What should I do? Get an MRI? Does this PT know what she's talking about?

[Blindead]

Hey, first off, thanks for this thread. I've had some shoulder discomfort for the past couple of weeks and didn't even think about strengthening my rotator cuff.
So a few weeks ago, I was in the middle of doing tricep rope pull downs when there was a sharp pain in my left shoulder. I was pulling the rope down, rope braids together, and when I reached the bottom, pulled the braids outward. It was during that outward movement when I had the pain. Since then, I've reduced weight a little and let my arms naturally pull the strands apart rather than actively pulling them apart and it's been alright. However, the discomfort still remains. It's a very, very dull ache which seems to resurface after flexion or tension. I had noted in my last shoulder exercise log that my left arm could not lift a dumbbell as high as my right arm of equal weight (towards the end of each set). I don't remember there being much of a problem with chest exercises, but I'll find out when I go tomorrow.
Anyway, I know it's not a lot of information, but does this sound like I'm leading myself towards a rotator cuff injury? Is there any way to pin it on whether it's a muscle, joint or a nerve issue? Thanks.

It sounds like the pains occuring during external rotation of the rotator cuff, which yes, would be a rotator injury. Try keeping off of your shoulders completely for a few weeks and then do rotator cuff exercises.

[josephinedalton]

OUTSTANDING

Had surgery June of 2008 (decompression, bone spur removal, clean out, AC ligament release) and my overall pain has decreases but I am left with reduced performance in other exercises, although I am able to perform most deltoid exercises with lower weights and higher reps.

I plan to incorporate this into my RC program ! !
THANK YOU

[OneBetter]

I've had some minor impingement before in my past and aches, I finally saw a physical therapist about it who claimed that my traps and pec (where it connects to the front part of the shoulder) were overactive and somehow putting stress on my shoulder. After 4 weeks of Physical therapy, one day a week, she said since I could do reps and a few sets there was no injury and discharged me from physical therapy. So here I am happy to be back in the gym starting out slow again, when the pain and tightness and fatigue is STILL there several months after being let go from PT (and the amount of weight I'm using is nowhere near what it used to be). What should I do? Get an MRI? Does this PT know what she's talking about?

first, stress on your shoulder is very vague.

second, yes it is possible. in basic terms - pec major essentially originates from your sternum up and around to your clavicle and inserts into your humerus. pec minor essentially runs from your 3rd, 4th, and 5th ribs to upper part of the scapula. it may help to think about their orientation in the body when asking your question. think about how they could stress your shoulder if they were pulling on the bones they insert into.

third, it could be a muscular imbalance. meaning one set of muscles is overpowering another set, causing discomfort. i would also add that one day a week seems a little light on the therapy. what did she recommend you do for exercises, and did you do them as she said?

[nick1990]

i injured my shoulder throwing a baseball a week ago today.

I feel pretty bad pain while doing a "cuban press" movement so i believe its the RC.
hurts mainly on the part when i begin to rotate my arms upward btw.
The pain also shoots to my rear delt as well.

cuban press:



I would always just let it heal by itself and when it did i would just go back to training, but after reading this article i want to try to strengthen it to prevent future injury.

I actually wanted to know when it would be best to begin strengthening it?

any help would be appreciated

[jckedup616]

My shoulder gets extremely sore when I do any type of press exercise on chest day. The soreness is so bad that I cannot do any chest exercises. It is also slightly effected when I do pull movements for my back and biceps.

The soreness is coming from the large muscle that runs from the bicep to the collar bone. There is no pain just extreme soreness.

I followed your rehab guide for about a month and I saw no improvement. In fact, it seems worse now. I did not do any chest stuff during that month and I did not strain myself on other exercises.

So am I out of luck??

[Mr.Leather]

yup

[Thedss]

I have been lifting seriously for around 2 years now. Over this time, I continued to participate in varsity basketball for my school team. Sometime over this summer after playing pickup, I noticed an odd shooting type pain in my upper left arm, which i could not quite locate. I did not think much of it and kept lifting/playing basketball and it didnt get worse at all. I took an advil before working out as precaution, and began to warm up and cool down as well. However, a couple of months ago, I noticed that after chest day, my shoulders would be more sore than normal, and would take a couple more days to recover. Also, after playing basketball, my shoulders would get a bit more pain than before. I began to read things on the internet, and self diagnosed myself with rotator cuff tendonitis,
although a mild form, as my ROM and pain was not TOO bad.

Around this time I decided to go to my family doctor for proper diagnosis. My Doc is not very good with sports injuries and said I had milf shoulder tendonitis and just do RICE. A waste of time, except for that i got a referal to physical therapy. The physical therapist said the same thing, and said i should lay off my shoulder for a month and go to therapy, and it will be better. The problem is, I cant lay off my shoulder because I am in the middle of basketball season, and am into lifting too much. By the way, I was still making gains during this time. I encountered a major problem however. My shoulders, and body in general, was staying sore for too long, so i had to change my workout plan. I switched from a 5 day split, to a split in which i worked my upper body twice a week and legs once. My goal in this split is to give my body more rest so I can still lift.

This is where I am at now. A major problem so far in this program has been that after 3x benchpress lets say, my whole upperbody is fatigued for some reason. I can lift effectively for a couple excercises, but after that my strength goes down significantly. I am also warming up for 10 mins before and 10 mins after, doing special stretches and movements for the tators. Also, I am going to physical therapy twice a week, taking MSM/Glucosamine/Chondritin, and doing rotator excersises on my off days AND playing basketball. My shoulders are not getting better, and i am worried and frustratetd. I see my friends at the gym doing what they are doing and I am afraid I will get left behind.

NOTE: I feel the pain most after a set when I put the weight down, and I have completely eliminated barbell incline press and direct shoulder work. I stretch everyday, and have a good ROM, but the shoulders are stiff.

Thank you for reading this long post, and i look forward to getting help. Cheers

[Finnegan Bell]

My pain goes away with Broomstick stretch ,but returns again after a couple of hours. I also bought a dumbbell to do rotations at home. Still have this pain near the biceps when I fly my arms back.

[Sauce-head]

Hey Guys,

I've become extremely frustrated with my shoulder/bicep pain. Got diagonosed with Impingement of my left shoulder about 5 months ago. Immediately started seeing a PT who told me the common thing: strength your RC and you'll be fine. Started doing internal/external rotations about 3x a week and the pain definitely subsided significantly.

However if I didn't do my RC exercises for even a week after going a couple months strong, the pain would return.

I now noticed that while the pain in my shoulder was still there on pressing movements, it was much more tolerable, however my bicep was causing more pain than anything else.

I started seeing a specialist who introduced me to Active Release Therapy. It definitely made a difference, but he asked me to not go to the gym during this time (about 6 weeks). Figured the rest would do me good anyway. He used Granston on me (a tool to release inflammation for those not familiar, hurts like a byatch btw) and said I have A LOT of scar tissue build up in my left bicep.

After about 6 weeks of stability and core rehab with him, I started going to the gym again. However after a few weeks, the bicep tendonitis is STILL present. When I lift my shoulder over-head I clearly hear a cracking sound.

I went to the gym a couple days ago and did light bicep work and there was some pain and it basically feels like very little if any blood is going to the arm.

I've started the recommending rehab here again: Broomstick, internal/external rotations, but I'm wondering if I should be doing some type of specific rehab for my bicep that's killing me.

BTW the pain is at the inner bend of my elbow, the tendon that runs up to my shoulder. I've also been icing, but I'm starting to wonder if my impingement is under control and my issue is now strictly bicep tendonitis???

Any thoughts of advice?? Would an MRI be necessary?? I'm hoping I don't have a tear???


Thanks for the help,



SH

[Blindead]

My pain goes away with Broomstick stretch ,but returns again after a couple of hours. I also bought a dumbbell to do rotations at home. Still have this pain near the biceps when I fly my arms back.

I think I know the bicep "pain" you refer to. I get it when stretching my sub-scapularis. It just means you have tight biceps, since they don't get stretched much. Try loosening them up a little bit, but don't go overboard.

[Deet.er]

Great article BernieD! Its nice to see all this info gathered in one nice spot. I had a question, 3 weeks ago I was doing military presses behind my head (stupid yes, now I know but its too late) with the heaviest weight I had ever done on military presses (115lb), I was lifting the weight fine and was about to finish my last rep of my last until until my shoulder gave out and felt like something popped out and back in - I've never had any sort of feeling remotely close to what I felt then. Luckily I had a spotter who caught the bar. But anyways, it sounds like I have an AC injury since it happened while lifting over my head. Now, 3 weeks later, I have full ROM with little to no pain. I did dumbbell presses with 50lb's and my shoulder hurt a bit the next day. I'm incorporating internal and external rotations into my workout plan so that I do them 3 times per week. I'm obviously going to have to do lighter weight for a bit but how long do you suspect I will have to lay off barbell benching with complete reps for?

[weegee]

great work

[low blow]

Hey Guys,

I've become extremely frustrated with my shoulder/bicep pain. Got diagonosed with Impingement of my left shoulder about 5 months ago. Immediately started seeing a PT who told me the common thing: strength your RC and you'll be fine. Started doing internal/external rotations about 3x a week and the pain definitely subsided significantly.

However if I didn't do my RC exercises for even a week after going a couple months strong, the pain would return.

I now noticed that while the pain in my shoulder was still there on pressing movements, it was much more tolerable, however my bicep was causing more pain than anything else.

I started seeing a specialist who introduced me to Active Release Therapy. It definitely made a difference, but he asked me to not go to the gym during this time (about 6 weeks). Figured the rest would do me good anyway. He used Granston on me (a tool to release inflammation for those not familiar, hurts like a byatch btw) and said I have A LOT of scar tissue build up in my left bicep.

After about 6 weeks of stability and core rehab with him, I started going to the gym again. However after a few weeks, the bicep tendonitis is STILL present. When I lift my shoulder over-head I clearly hear a cracking sound.

I went to the gym a couple days ago and did light bicep work and there was some pain and it basically feels like very little if any blood is going to the arm.

I've started the recommending rehab here again: Broomstick, internal/external rotations, but I'm wondering if I should be doing some type of specific rehab for my bicep that's killing me.

BTW the pain is at the inner bend of my elbow, the tendon that runs up to my shoulder. I've also been icing, but I'm starting to wonder if my impingement is under control and my issue is now strictly bicep tendonitis???

Any thoughts of advice?? Would an MRI be necessary?? I'm hoping I don't have a tear???


Thanks for the help,



SH

great sauce head

it sounds like your getting pain in the front of the shoulder ?

http://shoulderpaininfo.com/shoulderBicepsTend.html

basically this tendon indicates a dysfunctional shoulder since it plays a role in stability of the shoulder - or more specifically anterior stability + reinforcing the glenoid labrum (the ring of tissue that helps keep your humerus, the arm bone, inside its place on the scapula). Constant inflammation of this tendon can mean a couple things such as anterior instability, a rotator cuff tear or dysfunction or a SLAP lesion.

so yes, to rule out 2 of the above 3 you will need an MRI

sounds like tendinosis also, which should come up on the MRI - this is irregular collagen in the tendon that isnt as strong as normal tissue.

So firstly

1) find a good shoulder specialist who can manage your shoulder
2) get MRI
3) report back

[Sauce-head]

great sauce head

it sounds like your getting pain in the front of the shoulder ?

http://shoulderpaininfo.com/shoulderBicepsTend.html

basically this tendon indicates a dysfunctional shoulder since it plays a role in stability of the shoulder - or more specifically anterior stability + reinforcing the glenoid labrum (the ring of tissue that helps keep your humerus, the arm bone, inside its place on the scapula). Constant inflammation of this tendon can mean a couple things such as anterior instability, a rotator cuff tear or dysfunction or a SLAP lesion.

so yes, to rule out 2 of the above 3 you will need an MRI

sounds like tendinosis also, which should come up on the MRI - this is irregular collagen in the tendon that isnt as strong as normal tissue.

So firstly

1) find a good shoulder specialist who can manage your shoulder
2) get MRI
3) report back

Thanks for the reply bro. I think your definitely right on a few things here. I've got some posture/shoulder instability (cracking) and definitely have bicep tendonosis.

I've been doing massage therapy (cross fiber) for the past 6 weeks and it seems to have helped some, but I still feel the discomfort at the inner bend of my elbow.

I just started eccentrics tonight and can feel something happening! haha I'll keep this up for at least 6-8 weeks and see how it responds.

I don't have any inflammation, but I do feel dull pain in belly of the bicep from time to time and also have pain when I sleep on that side.

Do you have any tips on a good eccentric routine for my bicep?

I'm kinda a noob on eccentrics....


Thanks bro, I'll keep you posted and look forward to your reply.



SH

[dancingduck]

Thank you so much.. I just posted a question you answered in this write up.. and am suffering from this type of injury.