PDA

View Full Version : Shoulder subluxations, RC weakness, and joint clicking, OH MY!


Tim Donahey
08-08-2007, 06:28 PM
So my shoulders have been pretty good, today is the first I've had problems in awhile, but I managed to slightly subluxate my left shoulder during a snatch balance and now that shoulder is popping and crackling and clicking like rice crispies.

I can OH press 135 lbs, but I can scarcely OH squat the bar and I know the source of these problems lies therein that weakness.

How can I make my rotator cuff stronger?

Eric Allen Kerr
08-08-2007, 07:25 PM
Tim,

Sounds about the same symptoms I have. But in my case the subluxation occurred while doing pull-ups. So, I have had to do some research in this area.

A pretty good book on the topic is

http://www.amazon.com/Treat-Your-Own-Rotator-Cuff/dp/1598582062/ref=pd_bbs_sr_1/ 105-2520413-5368441?ie=UTF8&s=books&qid=1186625526&sr=8-1 (http://www.amazon.com/Treat-Your-Own-Rotator-Cuff/dp/1598582062/ref=pd_bbs_sr_1/105-2520413-5368441?ie=UTF8&s=books&qid=1186625526&sr=8-1)

It agrees pretty well with other information I've dug up on the topic, plus has quite a bit of info that I hadn't found anywhere else.

Drop the overhead lifts while your are rehabbing your RC.

Stretch your shoulders daily.

Strengthening exercies for:

External Rotation
Internal Rotation
Abduction (no more than 45°)
Also shoulder strenghtening exercies like Dumbell rows are good.

If you've got someone that can assess your injury accurately, you can decide to place more emphasis on the weaker muscles rather than a general RC strengthening program.

Start with the little pink dumbells and work your way up.

Tubing or cables weight machines can also be used.

Keep the number of sets low and the number of reps high.

I've seen some info recommending doing more ballistic activitives (throwing and catching medicine ball type activities) after you've got range of motion and strength back to a decent level. But haven't necessarily seen sufficient research to back it up.

Joshua Marcum
08-09-2007, 06:41 AM
Hey buddy the best way I have found to rehab a shoulder al around is the kip. I had a really bad dis location a while back and the whole thing was drifting around. I practiced the kips for about amonth really focussing on being able to hold the retracted position and before I knew I was back to full strength and a much more stable joint. Don't know if that helps but I hope it does.

Corey Duvall
08-10-2007, 08:15 AM
Turkish get ups are a phenomenal exercise for the shoulder. A common misconception is that you must rehab the rotator cuff, but more important is rehabbing the scapulohumeral rhythm. Your shoulder blade is what your arm actually forms a joint with and as your arms move around their range of motion the scapula rotates in order to support the head of the humerus. When this rotation is dysfunctional it puts the rotator cuff at a disadvantage, the muscles don't have the pull or strength that they should and can't maintain shoulder stability. Neglecting the scapula is a major error in shoulder rehabilitation.

Once you have a full, pain-free range of motion I highly suggest learning and utilizing the turkish get-up. Focus on pushing your whole shoulder and arm thru the weight at all times, this will help engage the proper shoulder blade stabilizers and will develop your shoulder rhythm through a large range of motion. Also, you must always engage your shoulders to push against the forces when doing any exercise. You'll hear Coach Rippetoe talk about the "shoulders to the ears" when doing a shoulder press, push press, or jerk. That means actively pushing your shoulders into the weight, this again engages the proper shoulder musculature and support. Joshua recommended keeping the shoulders in the retracted position for a pullup, this is perfect. Again, the shoulders actively resist the forces. You should do this for dips as well, keep them in a retracted, forced down and back, position.

Cheers

David Wells
08-11-2007, 02:33 PM
I used to have the same problem. My left shoulder would sublux but it would have problems going back into place because of a bolt I have from a surgery a long time ago.

Any way I have found holding handstands with active shoulders, handstand pushups, pushups with hands placed on a medicine ball, ring dips, and the overhead presses have stabilized things. Actually basic crossfit exercises have helped me. I still have to watch and make sure I don't get to heavy on overhead push presses and jerks. That is what has helped me.

Tim Donahey
08-13-2007, 08:41 AM
Wow, thanks for all the great suggestion. It sounds like a mixture of isolated exercises, and static holds/stabilization movements should really strengthen and stabilize the region.

Going along with the crossfit schedule I've worked out a shoulder rehab program:

Day 1:
Towel Stretch, Broomstick Stretch
Horizontal Rotation, External Rotation, Side Lying Abduction
Snatch Grip Overhead Barbell Hold, Headstands, L-Sits
Turkish Get-Ups, HSPU

Day 2:
Chest Stretch, Doorway Stretch, Towel Stretch, Abduction Stretch
Levers, Headstands, L-Sits
Medicine Ball Push-Ups

Day 3:
Towel Stretch, Broomstick Stretch
Horizontal Rotation, External Rotation, Side Lying Abduction
Snatch Grip Overhead Barbell Hold, Headstands, L-Sits
Turkish Get-Ups, Ring Dips

Day 4:
Rest

I'd be swapping out some of the exercise from the CSFU and adding others, but how does this look for a plan of attack?

Bonnie Kirkpatrick
08-15-2007, 07:31 AM
I second Corey's observation that the shoulder blade is probably the culprit. I've had issues with my right shoulder for years, and only began making significant progress a year ago when focusing on the shoulder blade. I have to patiently teach my shoulder-blade muscles how to be in the active position. My weight-training coach used to think that my shoulders were active when they really weren't, because my injured shoulder is so good at being mis-active in a very wrong way.

For me the most significant progress comes when I identify an exercise where my shoulder is not properly active. After identifying the correct movement pattern, then I put together a routine involving stretches and exercises to promote activation of the lazy muscles, to stretch of the tight muscles, and to encourage my shoulder to get the feel of being active. I usually see significant progress after performing a good routine for a week at high reps. The frustrating part is that it takes months for me to really identify a specific problem with my shoulder.

The point is that I have found that the exercises must be carefully targeted for my particular issues of shoulder-blade mis-movement. If they are not, I can do exercises forever and either not make progress or make negative progress.

A good physical therapist can help you with this process, but only if they have a lot of experience with this sort of thing.

Good luck,
Bonnie

Corey Duvall
08-15-2007, 08:06 AM
Yup, PT's with experience can help a lot. A good quality chiropractor who deals with these issues (there's a select few, I offer caution if taking this route) can help as well. Bonnie hit the nail on the head. It is a series of stretching the short muscles, activating the lazy ones, and starting out with high repetitions for a perfection of your technique. Do not be afraid to progress to heavier weights, but do so at a conservative rate; you'll see progress if you do it all correctly.

Tim: I like your approach to the rehab. Do a broad range of functional exercises while focusing on active shoulder stabilization. Keep the rehab varied and you'll enjoy it just like crossfit.

Good luck man.

Tim Donahey
08-15-2007, 08:21 AM
I suspect that the shoulder blade plays a role... but I'm fairly certain it's the RC because doing things like opening sliding/spring loaded doors (internal/external rotation) are sometimes more of a struggle than they should be. I have a strong bentover row (180#, last I checked) and I can do 10-12 pull-ups from a dead hang, so I have pretty good upper back strength.

Corey Duvall
08-15-2007, 08:43 AM
I'm not saying your rotator cuff muscles aren't dysfunctional... but the most common cause of RC dysfunction is shoulder blade dysfunction. When the shoulder blade isn't where it should be for a given action, this puts the rotator cuff muscles at a disadvantage and they lose their lever-arm and ability to create torque, leading to imbalance and thus instability. But really we're talking oranges and oranges. When dealing with shoulder dysfunction, the entire shoulder girdle must be taken into account, this includes rotator cuff and shoulder blade function. Your rehab includes all areas and I think you'll be successful.