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

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  1. 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!


  2. 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
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  3. 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!

  4. 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.

  5. 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

  6. 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!

  7. 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/

  8. 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!

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

  10. 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)
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  11. 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?

  12. 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)

  13. 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

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

  15. 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!

  16. 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!?

  17. 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

  18. 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.
  19. 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 02:27 AM. Reason: typos

  20. good info mate!

  21. Quote Originally Posted by kjetil1234 View Post
    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 GH, 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 GH. 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 regulating the synergists and antagonists to create stability is usually the culprit of chronic tightness in the shoulder.
    Quote Originally Posted by braskibra View Post
    good info mate!
    I know yall cant diagnose me cause you cant evaluate me in person, but is there any test, exercise, stretch, etc that i can perform and let yall know the results that can diagnose my problem? Im heck bent on figuring this out, and between the 3 of us i think we can diagnose my problem and then come up with a plan to fix it!

    I can pull out a goniometer if needed to measure internal and external rotation if needed!

  22. The IR is almost definitely a subscap problem. However the scapula may be contributing the dysfunction. You already got good advice from braski regarding training the rtc and leveling scapula. Put a pic that shows your posture and it will be easier to give a better diagnosis. Also a pic showing position of your shoulder blades when relaxed.

  23. Good points kt:

    Id measure:
    Both arms
    Make sure u do these properly with stabilization of coracoid on IR
    IR
    ER
    Total arc of motion (ir plus er)
    Flexion

    Hawkins kennedy
    Neers impingement
    Passive er to end range for internal impingement
    Horizontal abduction to end range then full passive er
    Full can
    Bear hug test in three positions, lift off
    Apleys scratch
    Full can

    Labral testing
    O briens
    Jerk test
    Clunk test
    Anterior/post apprehensions
    Etc

    All in magee orthopedics pull up book perform tests report results, there are more you can add in

    Suspicion is an articular sided rtc pathology either rubbing or fraying on post humerus/labrum with or without concomitant posterior labral issue

  24. I have to say after the first half of this thread I had to start using Google to understand what anyone is saying here but very good info. What field do you guys work in if you don't mind me asking? I'm ready to post a pic of my posture to be diagnosed myself. Lol

  25. Quote Originally Posted by goodvibes View Post
    I have to say after the first half of this thread I had to start using Google to understand what anyone is saying here but very good info. What field do you guys work in if you don't mind me asking? I'm ready to post a pic of my posture to be diagnosed myself. Lol
    Im in school for physical therapy.

  26. Quote Originally Posted by goodvibes View Post
    I have to say after the first half of this thread I had to start using Google to understand what anyone is saying here but very good info. What field do you guys work in if you don't mind me asking? I'm ready to post a pic of my posture to be diagnosed myself. Lol
    Educating yourself is incredibly important for staying healthy. So keep googling buddy!

  27. Quote Originally Posted by NattyForLife View Post
    Im in school for physical therapy.
    Aaahh that explains it. Good luck on your shoulder bro, mine is feeling better lately. I did a 4 day workout week last week and just skipped doing tris/bis to lessen the work load.

    Quote Originally Posted by kjetil1234 View Post
    Educating yourself is incredibly important for staying healthy. So keep googling buddy!
    It is I agree but these type of injuries you're not fully aware until it really happens. That's why I'm starting to learn the functionality of our shoulders in depth so I can avoid it in the future.

  28. Quote Originally Posted by goodvibes View Post
    It is I agree but these type of injuries you're not fully aware until it really happens. That's why I'm starting to learn the functionality of our shoulders in depth so I can avoid it in the future.
    Spot on, mate!

  29. 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
    Quote Originally Posted by kjetil1234 View Post
    Spot on, mate!
    It may be hard to believe, but my shoulder is lots better in like a week in a half! Just want to thank yall for that! Ive been stretching, working my subscap, infra, and supra, also im doing the sleeper stretch and it has helped tons! Also been strengthening serratus and doing some soft tissue massage with a tennis ball! Thanks again guys! Just curious, do yall think the subscap work or the sleeper stretch has helped the most?

  30. Impossible to determine! Great to hear the news!
  

  
 

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