Shoulder Injured / In the middle of a cut- How to proceed?

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  1. Quote Originally Posted by NattyForLife View Post
    In school for physical therapy! Im also having slight infraspinatus strain! I can produce pain when having resistance while externally rotating with humerus at 90 degrees! Its honestly not that bad, hopefully it will heal up pretty good in the next few weeks! Ive never thought about working my subscapularis to relieve stress off my lats, pecs, front delts, and teres major. Im currently resting right now, just working legs, abs and cardio!
    Alright man, cool

    Look into Evan Osar. Chiro, author, masseur and personal trainer. I learned SO SO SO much from his book and his videos on YouTube and it has drastically changed my confidence while treating clients.

    I recommend you do a manual muscle test on all your rotator cuff muscles to make sure they're strong enough and activates during movement. If they're not, compensations will occur and they can cause a myriad of troubles! Anterior glide and impingement are common symptoms of this muscular dysfunction.

    Also make sure that your scapula is moving correctly to the pattern you're performing. I see dysfunction in scapular stabilization ALL the time.

    If you have chronic tightness in your infra it's likely due to inhibited subscap. Giveaway will be plenty of available external rotation while the elbow is adducted.

    Hope this helps your pains bro


  2. Ps these type of pains are usually a symptom of dysfunction and rarely heal up by themselves. That's why a patient will feel relatively fine for a short time after rest, and then the injury will return.
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  3. Quote Originally Posted by kjetil1234 View Post
    Ps these type of pains are usually a symptom of dysfunction and rarely heal up by themselves. That's why a patient will feel relatively fine for a short time after rest, and then the injury will return.
    Yea ive started doing lower trap exercises, serratus anterior exercises, also stretching lats and pecs quite a lot!

  4. Also before school let out in may, all my classmates had to do a posture/gait analysis on one another. Looking back at that just know, i measured normal in external rotation in both arms, but internal rotation measured 55 degrees in right arm and 44 degrees in left arm! Left shoulder is the one in having problems with! What do you suggest about this?

  5. Quote Originally Posted by NattyForLife View Post
    Also before school let out in may, all my classmates had to do a posture/gait analysis on one another. Looking back at that just know, i measured normal in external rotation in both arms, but internal rotation measured 55 degrees in right arm and 44 degrees in left arm! Left shoulder is the one in having problems with! What do you suggest about this?
    10 degrees difference is considered significant, says Dr Osar in his book.

    Can you lift your arms (both?) off your back when internally rotated? The higher dysfunction in a stabiliser the higher the up regulation on the other side to "create" stability. Definitely sounds like subscap inhibition to me mate.

    Palpate your humerus and feel if more than 1/3 of it is anterior to the AC while extending the shoulder joint. That's a sign of anterior glide and definitely another sign of inhibitor of subscap. Bursitis and trouble with abduction may also be a problem because the subscap also keeps the humerus depressed in the glenoid fossa.

    I'm writing on my phone, hope this wasn't too messy!
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  6. Quote Originally Posted by kjetil1234 View Post
    10 degrees difference is considered significant, says Dr Osar in his book. Can you lift your arms (both?) off your back when internally rotated? The higher dysfunction in a stabiliser the higher the up regulation on the other side to "create" stability. Definitely sounds like subscap inhibition to me mate. Palpate your humerus and feel if more than 1/3 of it is anterior to the AC while extending the shoulder joint. That's a sign of anterior glide and definitely another sign of inhibitor of subscap. Bursitis and trouble with abduction may also be a problem because the subscap also keeps the humerus depressed in the glenoid fossa. I'm writing on my phone, hope this wasn't too messy!
    Yes i could lift both my arms off my back. Cant really measure but i can sort of feel my left one(bad one) doesnt come as far off as my right. And yea i would say my humeral head is anterior to my AC joint!

    And also note, my right serratus anterior is more developed than my left one. Im sure a tad of winging doesnt help this matter either!

  7. There you go buddy, clear sign if compensation. You got a lot of knowledge, so it will be no problem for you to follow up on this when you know about the cause of your symptoms

  8. Quote Originally Posted by kjetil1234 View Post
    There you go buddy, clear sign if compensation. You got a lot of knowledge, so it will be no problem for you to follow up on this when you know about the cause of your symptoms
    Thanks a lot bro! And welcome to Anabolic Minds!

  9. Quote Originally Posted by kjetil1234 View Post
    Ps these type of pains are usually a symptom of dysfunction and rarely heal up by themselves. That's why a patient will feel relatively fine for a short time after rest, and then the injury will return.
    I know this pretty well, unfortunately.


    Thanks for all the input.

  10. Quote Originally Posted by NattyForLife View Post
    In school for physical therapy! Im also having slight infraspinatus strain! I can produce pain when having resistance while externally rotating with humerus at 90 degrees! Its honestly not that bad, hopefully it will heal up pretty good in the next few weeks! Ive never thought about working my subscapularis to relieve stress off my lats, pecs, front delts, and teres major. Im currently resting right now, just working legs, abs and cardio!

    are you sure your not experiencing internal impingement with the ER at 90

  11. Quote Originally Posted by braskibra View Post
    are you sure your not experiencing internal impingement with the ER at 90
    That was my first thought because my left shoulder(bad one) is more internally rotated than my right. But im not sure now!

  12. seems like you have a reverse capsular pattern: loss of IR, then ab, and finally ER least restricted, very similar to an overhead athletes shoulder.


    I agree with kjetil that you do not need to shy away from subscap strengthening, I think all RTC strengthening is warranted especially in dynamic movement patterns.

    I would recommend re-evaluating all movements in the gym etc that elicit pain and figure out what biomechanically you can change. For example in many throwers whom present with impingement issues if you evaluate their mechanics you typically can find a mechanical issue which if fixed (usually too much horizontal abduction[hyperangulation], will reduce and eliminate the cause of symptoms. This is easily missed as on examine they most likely present with many of the above issues (weakness, scapular dyskinesis, instability) which you may feel are the cause, but in actuality are resulting from pain etc from poor movement pattern.

    This approach is usually successful for many active lifters etc. Regardless of how strong you make the cuff etc it will never eliminate these issues until you find the source. The source can be an imbalanced cuff etc mentioned above, but in more cases then not the imbalance is resulting from injury, pain, inflammation, etc from a biomechanical issue.

    Another tip is to not only perform standard RTC exercises for strength, but incorporate RTC exercises into similar movement patterns that you perform. For example in throwers you may toss a weighted ball over their shoulder as an eccentric movement pattern for the cuff. Remember specificity of training is very important once you come close to maxing out physiological gains such as hypertrophy and energy systems.


    may be a good read for you (and free although im sure you have access to many database as a student)

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3945046/

  13. Quote Originally Posted by braskibra View Post
    seems like you have a reverse capsular pattern: loss of IR, then ab, and finally ER least restricted, very similar to an overhead athletes shoulder. I agree with kjetil that you do not need to shy away from subscap strengthening, I think all RTC strengthening is warranted especially in dynamic movement patterns. I would recommend re-evaluating all movements in the gym etc that elicit pain and figure out what biomechanically you can change. For example in many throwers whom present with impingement issues if you evaluate their mechanics you typically can find a mechanical issue which if fixed (usually too much horizontal abduction[hyperangulation], will reduce and eliminate the cause of symptoms. This is easily missed as on examine they most likely present with many of the above issues (weakness, scapular dyskinesis, instability) which you may feel are the cause, but in actuality are resulting from pain etc from poor movement pattern. This approach is usually successful for many active lifters etc. Regardless of how strong you make the cuff etc it will never eliminate these issues until you find the source. The source can be an imbalanced cuff etc mentioned above, but in more cases then not the imbalance is resulting from injury, pain, inflammation, etc from a biomechanical issue. Another tip is to not only perform standard RTC exercises for strength, but incorporate RTC exercises into similar movement patterns that you perform. For example in throwers you may toss a weighted ball over their shoulder as an eccentric movement pattern for the cuff. Remember specificity of training is very important once you come close to maxing out physiological gains such as hypertrophy and energy systems. may be a good read for you (and free although im sure you have access to many database as a student) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3945046/
    Yea, the reason i was skipping the subscap work is because my shoulder is already internally rotated! And that would make it more internally rotated by working my subscap! Once i stretch out my lats, pecs, and front delts maybe i will get it out of internal rotation and that will fix my issue....hopefully!

  14. I really never injured my shoulder! The pain sort of came on slowly!

  15. That's a typical report with impingement, strengthening the subscap will not result in loss of motion, its usually neglect of full AROM that results in motion loss. (Guy who squats/lifts a ton but never runs loses hip extension) as long as ur taking care of stretching and working thru full rom with prime movers u will be fine (pec, lat etc) the pec contributes little to IR strength above 90(minus some contribution from clavicular head)

  16. Quote Originally Posted by braskibra View Post
    That's a typical report with impingement, strengthening the subscap will not result in loss of motion, its usually neglect of full AROM that results in motion loss. (Guy who squats/lifts a ton but never runs loses hip extension) as long as ur taking care of stretching and working thru full rom with prime movers u will be fine (pec, lat etc) the pec contributes little to IR strength above 90(minus some contribution from clavicular head)
    So my pec isnt most likely causing my increased internal rotation in my humerus?

  17. No it could, ull be eliminating it by working at 90 degrees abduction, better isolating the subscap u just have to watch pinching in that position (hawkins kennedy etc all test at 90 degrees elevation)

  18. And by the way, if ur subscap was tight, you wouldn't lose internal rotation, you would lose external rotation ( your not going to lose the motion the muscle produces, tight quad does not result in loss of hip flexion, u lose hip ext) the loss in IR comes from posterior shoulder tightness

  19. Which comes from a misaligned resting scap postion (winged and abducted scap results in post shoulder tightness)

  20. Quote Originally Posted by braskibra View Post
    And by the way, if ur subscap was tight, you wouldn't lose internal rotation, you would lose external rotation ( your not going to lose the motion the muscle produces, tight quad does not result in loss of hip flexion, u lose hip ext) the loss in IR comes from posterior shoulder tightness
    Yes i know. Thats why i neglected subscap work because my shoulder is already internally rotated!

  21. Quote Originally Posted by braskibra View Post
    Which comes from a misaligned resting scap postion (winged and abducted scap results in post shoulder tightness)
    So pretty much stretch lats, pecs, front delts and strengthen serratus and rhomboids and middle an lower traps!?

  22. Yes, id recommend following

    Modified sleeper: 60,90,120 for posterior shoulder tightness (post shoulder tightness leads to post/supero humeral translation and resulting anterior laxity)

    Pec minor stretch: 30. Degrees abduction

    Long head of triceps stretch

    Neuromuscular re ed of scap stabilization: this must take place before strengthening to ensure proper muscle firing sequence:
    Pushups with plus, horizontal abduction,scap retraction, close grip rowing

    Rtc strengthening: strengthening infra and supra and sub

    Incorporation into movement patterns: work firing sequence into common patterns you perform

  23. Quote Originally Posted by braskibra View Post
    Yes, id recommend following Modified sleeper: 60,90,120 for posterior shoulder tightness (post shoulder tightness leads to post/supero humeral translation and resulting anterior laxity) Pec minor stretch: 30. Degrees abduction Long head of triceps stretch Neuromuscular re ed of scap stabilization: this must take place before strengthening to ensure proper muscle firing sequence: Pushups with plus, horizontal abduction,scap retraction, close grip rowing Rtc strengthening: strengthening infra and supra and sub Incorporation into movement patterns: work firing sequence into common patterns you perform
    Thanks a lot bro! Rep points for you when i get home to my computer.
  24. Shoulder Injured / In the middle of a cut- How to proceed?


    Quote Originally Posted by NattyForLife View Post
    Yes i know. Thats why i neglected subscap work because my shoulder is already internally rotated!
    That's what most do. Yet the give away is great ER and poor IR(often), because all surrounding syngerists and antagonist will be upregulated.

    The rotator cuff muscles are the only ones perfectly attached for pulling the humerus without potentially pulling it out of the GF, so when, for example, the lats, teres major and pecs are up regulated (especially the first two), (or there's serious restrictions in mobility) it may force the humeral head out of centration in the Glenoid fossa.

    Poor scapular articulation may do the same. A common impingement problem is when the scapula is elevated during OHP, rather than bracing around the thorax.

    Up regulation of the synergists and antagonists to create stability is usually the culprit of chronic tightness in the shoulder.
    Last edited by kjetil1234; 07-07-2014 at 01:27 AM. Reason: typos

  25. good info mate!
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