Shoulder Injured / In the middle of a cut- How to proceed?
- 07-03-2014, 10:49 PM
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!
- 07-03-2014, 10:51 PM
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
- 07-03-2014, 10:54 PM
07-04-2014, 08:48 AM
07-06-2014, 11:14 AM
07-06-2014, 11:25 AM
07-06-2014, 12:07 PM
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)
07-06-2014, 12:35 PM
07-06-2014, 12:37 PM
07-06-2014, 01:15 PM
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)
07-06-2014, 01:19 PM
07-06-2014, 01:31 PM
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)
07-06-2014, 01:45 PM
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
07-06-2014, 01:58 PM
Which comes from a misaligned resting scap postion (winged and abducted scap results in post shoulder tightness)
07-06-2014, 02:08 PM
07-06-2014, 02:09 PM
07-06-2014, 02:57 PM
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
07-06-2014, 04:04 PM
07-06-2014, 06:30 PM
Shoulder Injured / In the middle of a cut- How to proceed?
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
07-06-2014, 07:21 PM
07-06-2014, 08:39 PM
I can pull out a goniometer if needed to measure internal and external rotation if needed!
07-06-2014, 11:58 PM
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.
07-07-2014, 07:28 AM
Good points kt:
Make sure u do these properly with stabilization of coracoid on IR
Total arc of motion (ir plus er)
Passive er to end range for internal impingement
Horizontal abduction to end range then full passive er
Bear hug test in three positions, lift off
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
07-08-2014, 12:12 AM
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
07-08-2014, 01:21 AM
07-08-2014, 03:16 AM
07-08-2014, 05:16 AM
07-08-2014, 05:35 AM
07-15-2014, 01:44 PM
07-15-2014, 01:54 PM
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