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

[doggy_dog]

Looking for some advice/input.

I've been cutting for the last 4-5 weeks but I've recently started having problems with my shoulder.
It's bad enough that I can't really do much upper body work (pushing or pulling).
I can kind of do curls and I'm ok with deadlifts.

Any suggestions on how to proceed?
I was planning on cutting for another 3-4 weeks, but I'm not sure if this is the best option if I can barely do any upper work.

Do I just keep going and just avoid the exercises which aggravate it or make some sort of change?

 

[NattyForLife]

Looking for some advice/input. I've been cutting for the last 4-5 weeks but I've recently started having problems with my shoulder. It's bad enough that I can't really do much upper body work (pushing or pulling). I can kind of do curls and I'm ok with deadlifts. Any suggestions on how to proceed? I was planning on cutting for another 3-4 weeks, but I'm not sure if this is the best option if I can barely do any upper work. Do I just keep going and just avoid the exercises which aggravate it or make some sort of change?

Go to the doctor.

 

[doggy_dog]

Go to the doctor.

lol
I don't mean how to proceed in relation to the injury. I'm already seeing a therapist.

I'm trying to decide what to do with the cut.

 

[amarula]

If I were you I'd enter in maintenace mode till you solve the problema: lower body and the upper body exercises you can handle, but not forcing. Up cals a little bit too, cause the body will need the extra energy to cure himself

 

[nicksox15]

As the above poster stated, I'd go into maintenance mode. I had a shoulder injury that kept me from doing upper body for quite awhile, so I just would do legs and cardio to stay active while eating at maintenance. I was pleasantly surprised how quickly I got back into the swing of things. What is your therapist giving you for an ETA on returning back to regular activity?

 

[doggy_dog]

If I were you I'd enter in maintenace mode till you solve the problema: lower body and the upper body exercises you can handle, but not forcing. Up cals a little bit too, cause the body will need the extra energy to cure himself

As the above poster stated, I'd go into maintenance mode. I had a shoulder injury that kept me from doing upper body for quite awhile, so I just would do legs and cardio to stay active while eating at maintenance. I was pleasantly surprised how quickly I got back into the swing of things. What is your therapist giving you for an ETA on returning back to regular activity?

Yeah, what you guys suggest makes sense.
I was hoping to work around this and continue my cut before I take off for vacation in a few weeks.

Therapist said a couple of weeks. Although I've been battling this for a while off and on, so I'm not so confident.
And what really sucks is that I wont have gym access while away so I was hoping to put in some work before leaving.

Thanks for the input.

 

[NattyForLife]

Yeah, what you guys suggest makes sense. I was hoping to work around this and continue my cut before I take off for vacation in a few weeks. Therapist said a couple of weeks. Although I've been battling this for a while off and on, so I'm not so confident. And what really sucks is that I wont have gym access while away so I was hoping to put in some work before leaving. Thanks for the input.

Just curious, what was your diagnosis?

 

[goodvibes]

Yeah, what you guys suggest makes sense.
I was hoping to work around this and continue my cut before I take off for vacation in a few weeks.

Therapist said a couple of weeks. Although I've been battling this for a while off and on, so I'm not so confident.
And what really sucks is that I wont have gym access while away so I was hoping to put in some work before leaving.

Thanks for the input.

I feel you brotha, I have a bursitis on my right shoulder that has gotten worse so I'm just hitting a ton of pulls and leg workouts. My back isn't 100% but I just try to work as hard as I can to compensate. Have another appt to the docs this coming week.

 

[doggy_dog]

Just curious, what was your diagnosis?

Infraspinatus strain and inflamation.
Tweaked once before, got over it, but messed it up again.

I feel you brotha, I have a bursitis on my right shoulder that has gotten worse so I'm just hitting a ton of pulls and leg workouts. My back isn't 100% but I just try to work as hard as I can to compensate. Have another appt to the docs this coming week.

Totally sucks, man.
Having the desire, the dedication, and the time to train hard but not being able to because of injuries.

 

[NattyForLife]

Infraspinatus strain and inflamation. Tweaked once before, got over it, but messed it up again. Totally sucks, man. Having the desire, the dedication, and the time to train hard but not being able to because of injuries.

Thats exactly what i think is wrong with my left shoulder! It hurts whenever you have resistance while trying to external rotate doesnt it? Are you having therapy or anything like that?

 

[goodvibes]

Totally sucks, man.
Having the desire, the dedication, and the time to train hard but not being able to because of injuries.

Yup goin crazy with all this drive. I normally don't do cardio but now I am because I just have too much energy lol

 

[doggy_dog]

Thats exactly what i think is wrong with my left shoulder! It hurts whenever you have resistance while trying to external rotate doesnt it? Are you having therapy or anything like that?

Yup. External rotation is not good.

I am getting treatments with by an athletic therapist. I get some massage and "active release therapy". Definitely helps.

 

[NattyForLife]

Yup. External rotation is not good. I am getting treatments with by an athletic therapist. I get some massage and "active release therapy". Definitely helps.

Exactly what is wrong with mine! If you dont mind me asking, what is the therapist getting you to do treatment and exercise wise and rest wise?

 

[doggy_dog]

Exactly what is wrong with mine! If you dont mind me asking, what is the therapist getting you to do treatment and exercise wise and rest wise?

For exercises he basically recommended external rotations using light DB's, to strengthen those rotator cuff muscles.
He also recommended this infraspinatus stretch where I lie on my side, arm around a 90 degree angle and gently push my hand inwards (using the other arm) until I feel the stretch in that area.

Kinda like this:

He's also recommended using a tennis/lacrosse/golf ball to jam into that area to hit any scar tissue.
For example, take the ball and put on that spot, lean back into a wall, and move around the arm.
Hurts like hell but helps in the long run.

For rest he tells me to stay way from rows, pulls ups, and that sort of stuff until it feels better. Same with benching, etc.
I never listen and that's why I'm always hurt.


EDIT
His treament is a real treat.
He basically digs his thumb into various areas of the muscle and then does a lot ROM type movements. Makes me want to cry, but it loosens things up and helps with scar tissue. (same idea as doing it yourself using a ball)

 

[NattyForLife]

For exercises he basically recommended external rotations using light DB's, to strengthen those rotator cuff muscles. He also recommended this infraspinatus stretch where I lie on my side, arm around a 90 degree angle and gently push my hand inwards (using the other arm) until I feel the stretch in that area. Kinda like this: He's also recommended using a tennis/lacrosse/golf ball to jam into that area to hit any scar tissue. For example, take the ball and put on that spot, lean back into a wall, and move around the arm. Hurts like hell but helps in the long run. For rest he tells me to stay way from rows, pulls ups, and that sort of stuff until it feels better. Same with benching, etc. I never listen and that's why I'm always hurt. EDIT His treament is a real treat. He basically digs his thumb into various areas of the muscle and then does a lot ROM type movements. Makes me want to cry, but it loosens things up and helps with scar tissue. (same idea as doing it yourself using a ball)

Thanks a lot bro! Maybe i will only be out for about 2-3 weeks!

Edit: i have also went to maintenance calories to help the healing take place in my body. Im still working legs, abs and cardio!

 

[kjetil1234]

Looking for some advice/input.

I've been cutting for the last 4-5 weeks but I've recently started having problems with my shoulder.
It's bad enough that I can't really do much upper body work (pushing or pulling).
I can kind of do curls and I'm ok with deadlifts.

Any suggestions on how to proceed?
I was planning on cutting for another 3-4 weeks, but I'm not sure if this is the best option if I can barely do any upper work.

Do I just keep going and just avoid the exercises which aggravate it or make some sort of change?

Well, your description is very vague. Anterior deltoid is where the pain is?

Most like you have two issues. One is lack of scapular stabilization (strengthen your serratus anterior and learn to posteriorly tilt your scapula during exercise) and two: your rotator cuff is likely malfunctioning. Work both internal and external rotation, and easy abductions like lateral raises.

Muscles you'll want to strengthen and learn to include in movement:

Serratus anterior (scapular push ups)
Subscapularis (internal rotation)
Teres minor & infraspinatus (external rotation)
Lower trapz (shrugs while slightly bent over)
Supraspinatus (lateral raises)

These are common issues and will likely help you.

 

[NattyForLife]

Well, your description is very vague. Anterior deltoid is where the pain is? Most like you have two issues. One is lack of scapular stabilization (strengthen your serratus anterior and learn to posteriorly tilt your scapula during exercise) and two: your rotator cuff is likely malfunctioning. Work both internal and external rotation, and easy abductions like lateral raises. Muscles you'll want to strengthen and learn to include in movement: Serratus anterior (scapular push ups) Subscapularis (internal rotation) Teres minor & infraspinatus (external rotation) Lower trapz (shrugs while slightly bent over) Supraspinatus (lateral raises) These are common issues and will likely help you.

Most people dont need to work internal rotation because most have internally rotated humeri. That would make matters worse! Also a good lower trap exercise is reverse shrugs! (Hang from pullup bar or lat pulldown and just use your lower traps to shrug downward!

 

[kjetil1234]

Most people dont need to work internal rotation because most have internally rotated humeri. That would make matters worse! Also a good lower trap exercise is reverse shrugs! (Hang from pullup bar or lat pulldown and just use your lower traps to shrug downward!

And why are they internally rotated? Because the teres major, pecs and lats are compensated due to inhibition in subscap. Result is chronic tightness, poor mobility in the rotator cuff and some times humeral anterior glide.

It's easy to make that assessment though. Usually there is plenty of external rotation available and very little internal rotation of the humerus when you're dealing with subscap inhibition. I agree that it's not too common, but I do see it frequently. The OP also says he has inflammation in his infraspinatus which points to poor stabilization as I mentioned.

The infraspinatus tends to overcompensate when there is not proper humeral centration.

 

[NattyForLife]

And why are they internally rotated? Because the teres major, pecs and lats are compensated due to inhibition in subscap. Result is chronic tightness, poor mobility in the rotator cuff and some times humeral anterior glide.

I know! The subscapularis performs internal rotation, so if you already have internally rotated humeri than you dont want them shortened anymore! You want to stretch it!

 

[kjetil1234]

I know! The subscapularis performs internal rotation, so if you already have internally rotated humeri than you dont want them shortened anymore! You want to stretch it!

Well that depends what is causing the internal rotation. Look at my modified post please, I added some clarifications.

 

[NattyForLife]

Well that depends what is causing the internal rotation. Look at my modified post please, I added some clarifications.

Yes, could be pecs, lats, teres major, front delt, and subscapularis that could be causing internally rotated humeri!

 

[kjetil1234]

Yes, could be pecs, lats, teres major, front delt, and subscapularis that could be causing internally rotated humeri!

Exactly. So enabling the subscap will be key. And humeral rotations primarily activate the subscap, and that will help the compensators relax and chronic tightness will disappear.

 

[NattyForLife]

Exactly. So enabling the subscap will be key. And humeral rotations primarily activate the subscap, and that will help the compensators relax and chronic tightness will disappear.

Just curious are you in the PT or chiro?

 

[kjetil1234]

Just curious are you in the PT or chiro?

Personal trainer. I work with plenty of PT cases though. Yourself mate?

 

[NattyForLife]

Personal trainer. I work with plenty of PT cases though. Yourself mate?

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!

 

[kjetil1234]

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

 

[kjetil1234]

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.

 

[NattyForLife]

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!

 

[NattyForLife]

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?

 

[kjetil1234]

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!

 

[NattyForLife]

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!

 

[kjetil1234]

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

 

[NattyForLife]

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!

 

[doggy_dog]

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.

 

[braskibra]

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

 

[NattyForLife]

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!

 

[braskibra]

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/

 

[NattyForLife]

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!

 

[NattyForLife]

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

 

[braskibra]

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)

 

[NattyForLife]

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?

 

[braskibra]

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)

 

[braskibra]

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

 

[braskibra]

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

 

[NattyForLife]

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!

 

[NattyForLife]

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!?

 

[braskibra]

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

 

[NattyForLife]

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.

 

[kjetil1234]

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.

 

[braskibra]

good info mate!