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View Full Version : Avoiding shoulder injuries, and fixing them - What's the best course of action?


Nicolas Castonguay
01-05-2008, 11:22 AM
This is in relation to my old post: http://www.board.crossfit.com/showthread.php?t=25082 (wfs)

Although when I keep my shoulder blades pulled back when doing Shoulder Press, I still feel some pain, even if it's not as sharp as before. Because of this, I have decided to undergo a rehabilitation course for my shoulders to better improve them.

Question: I have two different options. Either completely cut off any WODs that directly demand heavy use of shoulders (any kind of cleans / presses / bench press), and do some RC strengthening exercises, OR keep doing the WODs, maybe at a lighter weight, but also making sure to stretch a lot before and also making sure to do the RC strengthening exercises. Since right now I am not injured, but only feel some pain, from light to mild, which option would be best?

Here are the stretches, at the bottom of the page: http://www.bodybuilding.com/fun/likness22.htm (wfs)
I will also do Doggcrapp's broomstick's stretch: http://www.intensemuscle.com/6997-how-cure-shoulder-problems-trust-me-will-do-90-time.html?pp=25 (wfs)
Here are some RC strengthening exercises that a member here suggested to me: http://forum.bodybuilding.com/showpost.php?p=98554231&postcount=74 (wfs). I will also add internal and external rotations with light weight and high reps (10-15lbs, 30-40 reps)

Once I have decided what to do (stop shoulder WODs or not), how should I do it? This is where I'm quite clueless. Should I do the RC strengthening exercises every day? How should I know when to stop doing one and switch to the next one? How should I know when I can start doing the WODs again (if I decide to stop doing them). Any info on this would be greatly appreciated :)

Steven Low
01-05-2008, 07:41 PM
RC exercises are not the answer to all shoulder problems nor is quitting exercises or even going light. First you have to determine what the actual problem is.. mostly due to what hurts on what exercises and where.

Again, in the other thread we didn't really determine what's cause the problem. From the description of where it hurts it does NOT seem like an issue of RC imbalance (which doing RC exercises would correct) although scapular work does seem to help relieve the pain it may or may not be directly related. Retracting the shoulder blades can, for example, create a bit of space in front of the shoulder relieving impingement if that is/was indeed the cause of the problem. In effect, if you start doing stuff without determining a cause you can make it worse.

I would like to see a couple pictures of your posture (lateral, front and back view if possible) and you can highlight where it hurts on the pictures.

Nicolas Castonguay
01-06-2008, 03:09 PM
Alright I'll get some pictures really soon and I'll try to pinpoint where it hurts. Problem is, it's hard to tell exactly where the pain is :/ do you have any pointers to help me figure out where the pain could be? Or any kind of exercise/stretch that could trigger the pain and then tell me where it is?

Steven Low
01-06-2008, 04:17 PM
Generally, you can somewhat tell what it is by what exercises are hurting it... but sometimes it's a bit harder than that which is why it is good to know locations.

Is yours more of a multi-area pain or one that spreads or something?

Yong Tang
01-07-2008, 07:00 PM
dieselcrew has a great video on youtube for shoulder rehab protocol. there are many exercises on there i didn' konw of that are important for the shoulder, and are often overlooked. take a look.

http://www.youtube.com/watch?v=A0ONHZmsFec (wfs)

Steven Low
01-07-2008, 07:55 PM
dieselcrew has a great video on youtube for shoulder rehab protocol. there are many exercises on there i didn' konw of that are important for the shoulder, and are often overlooked. take a look.

http://www.youtube.com/watch?v=A0ONHZmsFec (wfs)
That's actually a very good video. I would recommend it to anyone with shoulder problems. All of the exercises have intended targets whether it be the RC or scapulae or whatnot.

The only thing they don't target is thoracic mobility which does affect the shoulder though so add in some overhead squats and/or SOTS presses along with some stretching and you're good to go.

Bryant Yee
01-07-2008, 10:23 PM
Although when I keep my shoulder blades pulled back when doing Shoulder Press...

Aren't you supposed to elevate your shoulder blades when doing shoulder presses (the shove your shoulders to your ears technique) rather than pulling them back? And then depress/retract them when doing the opposite motion (ie. pullups)? I thought the idea on both being that the shoulder blade supports the weight better/more naturally. Please correct if wrong.

Steven Low
01-07-2008, 11:52 PM
Strict presses, HSPUs and maybe thrusters should more or less have the active shoulders you're talking about where you shove them as high as you can to keep them active (aka push them as far away from the socket as possible.

As far as push presses, push jerks, split jerks, snatches, overhead squats and any of the more violent ones or stabilizing heavy weights above you will retract and elevate them because it provides a much more stable base to support the weight from. You're not so much using your arms in this case to elevate the weight which is why it's not the same as the brute strength strict press or HSPUs and other things of that nature.

Good question though Bryant. I had to think about it for a little bit. :)

Nicolas Castonguay
01-09-2008, 07:45 AM
Alright well I got some minor update. I've pretty much figured where it hurts in my shoulder, and tonight, I will take the pictures you asked and pinpoint on them where it is painful. As for the type of pain, I've realized yesterday that it's the same type of pain that I feel in my elbows (although not as sharp) when I do too heavy skullcrushers... I'm guessing that would be AC pain? Because I already injured my RC once at work (according to the doctor, not to me) and I'm pretty sure the kind of pain was different then what I'm feeling when I do presses or other shoulder exercises.

Steven Low
01-09-2008, 10:25 AM
Uhm, well, elbows and shoulders are totally different joints.. so it can't be similar, lol.

Nicolas Castonguay
01-09-2008, 11:23 AM
What I meant is the pain is more similar to the one I felt in my elbows to the one I felt when I injured my RC... I don't know if that can be any indicator. Anyways, tonight I will post pictures of my posture, this might help a lot more

Nicolas Castonguay
01-10-2008, 03:11 PM
Alright I got the pictures and I circled where it hurts, and I also just realized my shoulders are very uneven (yes I was standing straight in my front picture). Could that be a factor explaining it? Also where I circled is where I feel the most pain, but it hurts pretty much in my whole shoulder. I wasn't flexing at all in the pictures, it's all relaxed. I couldn't really circle in the back picture though...

Steven Low
01-10-2008, 04:19 PM
In your first post you said...

Although when I keep my shoulder blades pulled back when doing Shoulder Press, I still feel some pain, even if it's not as sharp as before.

Which, when combined with these pictures suggests most likely some sort of tendonitis with the supraspinatus (as it is in that area and the most often injured RC muscle) and when you overhead press the swelling there probably helps impinge the tendon against the acromion. (Reading back through the other thread I think this is the case as well).

Pic 3 shows poor thoracic mobility (rounded back) coupled the rounded/hunched shoulders. In addition, pic #1 you can see your scapulae are slightly protracted at rest rather than fully retracted. The thoracic mobility and rounded shoulders contribute to a lack in overhead mobility of the shoulder joint which, when exacerbate with swelling, will probably impinge the tendon against the acromion.

Treatment for that is generally massage to try to get blood flowing to the area and push the swelling away as well as ice after very light exercises (non-painful exercise). Some anti-inflammatories directly to the site.. although I don't know if you can get any. Also, work with the scapular retractors (aka rhomboids) like rows to help fix up your posture which is probably the most important part to keep it from happening again.

If you saw the youtube video in this thread like 5 posts earlier I would suggest doing that as your shoulder rehab work except eliminate any of the exercises that would hurt your shoulder. Ice after. Self massage or get someone to do it for you. Again, as much as you want to work out you can.. but don't do anything to aggravate it.

Cal Jones
01-11-2008, 05:56 AM
Nicolas, do you work on a computer all day? Because I have the same issue.

Justin Algera
01-11-2008, 09:57 AM
I have the same pain in the same place on my right shoulder as well... It mainly comes during presses, OHS, and HSPU, but sometimes with back squats when the weight gets heavy, or Ive done the other exercises before. With the presses it comes usually on my 3rd or 4th set of 5X5. I also have pain in the elbows (tendonitis from pull-ups being a pretty big guy) as well. Both these (althought my elbows not so much anymore) have really hampered my gains in both these exercises. Used to be able to do a few HSPU anyways, and now I can't, and cant do more than 145lbs on strict presses in my total or ME.

Steven Low
01-11-2008, 11:11 AM
Seriously.. I don't know what is up with you guys and not resting or at least avoiding the exercises if you're starting to get pain. You're just hindering yourself maybe weeks if not months or more by aggravating painful stuff over and over and over again. Pain = sign that you shouldn't be doing something or that something needs fixing before you repeat it.

Lenora Galitz-Pfeffer
01-11-2008, 01:19 PM
Seriously.. I don't know what is up with you guys and not resting or at least avoiding the exercises if you're starting to get pain. You're just hindering yourself maybe weeks if not months or more by aggravating painful stuff over and over and over again. Pain = sign that you shouldn't be doing something or that something needs fixing before you repeat it.

Steven, as much as it may be a repetition of previous posts on injury threads, your message bears repeating. Thanks for posting this in plain english.

Ian Kovtunovich
01-13-2008, 11:40 AM
It's sort of funny reading these injury threads...Steven Low is right; if doing something puts you in pain...stop doing it! I learned this valuable lesson from a physical therapist, unfortunately after I had surgery (see below). And any climbers out there who read Rock & Ice may have come across articles recently by Dr. Julian Saunders, who is fond of noting that if you just stop ****ing your condition off, it will usually resolve itself (typically in reference to tendonitis).

Admitting that, yes, you are injured can be hard, especially when you realize that it means scaling back or even stopping training, but continuing to do the activity that injured you in the first place will not heal you. Having rock climbed for 15 years, it has become almost routine for me to have to sit out a couple months for a finger or elbow injury, and I had to sit out almost a year after shoulder surgery (torn biceps tendon). The latter was my first (so far only) surgical injury, and it got to that point because I kept training harder and harder and ignoring first the pain, then the grinding, popping, and clicking noises coming from my shoulder.

Surgery is a lousy and expensive, but very effective, way of making you rest. Obviously, some injuries are surgical regardless of how much you rest, but many start out minor, and get aggravated from overuse, to the point that they become much more severe.

The more positive thing I've learned is that, in the context of my biceps tendon injury, muscle imbalance was a big contributing factor, and a lot of more minor nagging injuries can be held at bay by working opposing muscle groups, as opposed to, say, only working the pulling muscles and never pushing.:shrug: So CrossFit can be a great way to stay out of that kind of trouble...provided you don't get hurt CrossFitting, that is!:D

Best of luck on staying injury-free.

Nicolas Castonguay
01-15-2008, 10:56 AM
In your first post you said...



Which, when combined with these pictures suggests most likely some sort of tendonitis with the supraspinatus (as it is in that area and the most often injured RC muscle) and when you overhead press the swelling there probably helps impinge the tendon against the acromion. (Reading back through the other thread I think this is the case as well).

Pic 3 shows poor thoracic mobility (rounded back) coupled the rounded/hunched shoulders. In addition, pic #1 you can see your scapulae are slightly protracted at rest rather than fully retracted. The thoracic mobility and rounded shoulders contribute to a lack in overhead mobility of the shoulder joint which, when exacerbate with swelling, will probably impinge the tendon against the acromion.

Treatment for that is generally massage to try to get blood flowing to the area and push the swelling away as well as ice after very light exercises (non-painful exercise). Some anti-inflammatories directly to the site.. although I don't know if you can get any. Also, work with the scapular retractors (aka rhomboids) like rows to help fix up your posture which is probably the most important part to keep it from happening again.

If you saw the youtube video in this thread like 5 posts earlier I would suggest doing that as your shoulder rehab work except eliminate any of the exercises that would hurt your shoulder. Ice after. Self massage or get someone to do it for you. Again, as much as you want to work out you can.. but don't do anything to aggravate it.

Ok thanks a lot for your post I really appreciate it. Now I just want to make sure I'll do the right course of action. What's written in bold is what I need most help with.

First of all, I can keep working out as long as I don't feel any pain. So I'll keep doing all the WODs, and stop it immediately if I feel the slightest pain (however for now I will probably skip most shoulder working WODs, or go very light, since working lightly doesn't hurt). Example today is the Filthy Fifty, I will probably do all of it, except scale down the burpees and the press movements, which last time caused me pain.

Second, I will do RC strengthening exercises that are showed on the youtube video (that do not hurt) and others that were prescribed to me on my bodybuilding.com Crossfit journal. However, how often should I do these, and when? Every day before I do my WOD? Every other day? 2-3 times a day? Any recommended amount of sets / reps? (obviously it's going to be very light weight)

Third, after every workout, I will ice/heat my shoulders (my dad was told by a physiotherapist to do a mix of ice/heat to prevent and help heal swelling, so I will do that).

Fourth, I must fix my posture. However, this is the part where I still need help. I know I need to work on my Rhomboids, but I do not know exactly what to do. What exercises other than Rows, how often, how many sets, light weight or heavy weight, etc?

Once again, thanks a lot.


And to Ian, surgery is free for me :D Quebec might have a lousy health system, but at least it's free of charge. :D Thanks for your input by the way.

Nicolas Castonguay
01-19-2008, 10:56 AM
Last post I need help with please :), after that I should be good to go to fix my shoulder problems.

Steven Low
01-19-2008, 11:39 AM
However, how often should I do these, and when? Every day before I do my WOD? Every other day? 2-3 times a day? Any recommended amount of sets / reps? (obviously it's going to be very light weight)

Usually 2-3 times a week after your workouts.

If they are fairly weak when you're starting out I would go about 3 sets of about 15 or so. Basically gotta get them working first with higher reps and then you can switch to strength work for them later with lower reps heavier weight if you want. After a couple weeks at 15 go heavier and drop down to about 8-12 reps. Then if you want after a couple more you can go a bit heavier with about 5-6 reps or so.


Fourth, I must fix my posture. However, this is the part where I still need help. I know I need to work on my Rhomboids, but I do not know exactly what to do. What exercises other than Rows, how often, how many sets, light weight or heavy weight, etc?

Squeeze them together even when you are just going about your daily activities. Make sticky notes at the computer telling you to do this. Whatever. I virtually fixed my own rounded shoulders within a week instead of having to do PT or whatnot by just focusing on doing it ALL the time. I was mega sore at first especially in the back but now my body is used to it, and I do it without thinking.

Anything that has scapular retraction works... rows, front lever pullups work, the top part of pullups, squats (ironically), bench press (the correct way). Same thing if they're weak like the RC. Start with higher reps and then work your way into the strength range.

In my opinion if you can do deadhang muscle ups (or even muscle up negatives) for high reps these are the BEST exercise for both external rotators and rhomboids. It's specifically the transition that hits it so kipping through the whole thing won't help you much.

Lenora Galitz-Pfeffer
01-19-2008, 02:31 PM
This seems the best place for this post. I read every thread on shoulders and try to learn from everyone. This includes the injured, and the experts alike. I've completed 7 weeks, and usually my shoulders recover well. I've been paying attention to my posture, and avoiding most risks. But - I've overdone it on Bench Press. I did them twice in the same week, the second one being on Lynne. I have a history of rc issues with impingement. This time, I've got clicking in my left shoulder and deeper pain than in the past. Sometimes it throbs. I'm getting an appointment with the doc and a referral to a pt. She really needs to do a full diagnostic testing on me. I hope I'm not off upperbody for a spell. Maybe I just have to get off bench press for a few weeks. Pushups have been great, and shoulder presses have been fine also. I admit I've been experimenting with pullups on a straight bar with an under handed grip. Rings seem safer. Oops. I read all your advice, Steven. Sometimes my brain gets more rest than the rest of me. :ranting2:

Lenora Galitz-Pfeffer
01-19-2008, 02:33 PM
To clarify. Steven, it's a "You told me/us so" moment. Thanks for your good posts. Without them, I may have caused more trouble.

Steven Low
01-19-2008, 07:24 PM
There's some critical stuff deep in the shoulder like the labrum and long head of the biceps so deep ache is generally not good. Clicking is usually associated with the labrum or bursas rubbing against something.. the fact that there's the deep pain may possibly indicate a labrum tear or something insidious like that.

Anyway, yeah. Hopefully it's nothing bad. How were you doing the bench? Flared elbows or elbows tucked at like 45 degrees (aka the correct way to bench)? If I were you I'd sub rings anytime bench comes up. Bench is generally not that great...

Lenora Galitz-Pfeffer
01-20-2008, 11:18 AM
There's some critical stuff deep in the shoulder like the labrum and long head of the biceps so deep ache is generally not good. Clicking is usually associated with the labrum or bursas rubbing against something.. the fact that there's the deep pain may possibly indicate a labrum tear or something insidious like that.

Anyway, yeah. Hopefully it's nothing bad. How were you doing the bench? Flared elbows or elbows tucked at like 45 degrees (aka the correct way to bench)? If I were you I'd sub rings anytime bench comes up. Bench is generally not that great...
I really need to check on that angle. I may have messed up there. No wonder ring push-ups are safer. I can't flare my elbows and keep stable on them. Clicking seems gone this morning. Maybe it's just a warning shot. I'm trying to sleep on my back as much as possible. I'm usually worry when I wake up to find I'm on a shoulder. Both tell me immediately "fowl". I gently stretched in a doorway this morning. It's one of my personal tests. Each shoulder has a different problem. I'm taking an extra day off to see how it is healing. Your previous post about there being more "underrecovery" than overtraining is particularly important here. I've suddenly gone from 2 days of weight training only to 5/2 with cf. 2 of those days are a modified SS. I'll probably switch to 2 days on, 1 day off, 2 days on, 2 days off. Thanks again for your advice.

Steven Low
01-20-2008, 11:26 AM
Yeah, that's definitely too much too quickly. Your new schedule looks better at least until you adapt fairly well to that.

George Holder
01-20-2008, 01:05 PM
dieselcrew has a great video on youtube for shoulder rehab protocol. there are many exercises on there i didn't know of that are important for the shoulder, and are often overlooked. take a look. http://www.youtube.com/watch?v=A0ONHZmsFec (wfs)

That is a great video but for proper rehab, the injured party needs to make a slight but significant addition to all of dieselcrews' internal/external rotation demos. The target arm needs to be stabilized in order to not require recruitment of the deltoids.

Place a rolled towel between your arm and the side of your chest to stabilize the humerus. This will focus the activity on the small muscles of the shoulder. The way that the guy in the video is performing the exercises requires the deltoids to stabilize the shoulder and renders the exercise another large muscle exercise and thus, pointless for RC rehab.

Also with those exercises where the humerus is oriented 90 degrees from the chest place your elbow on a towel resting on a table or stability ball, also for stabilization.

It is my understanding that external and internal rotations are considered mandatory exercises for everyone, not just people that are rehabbing. And always stabilized so that the proper muscles get worked.

Lenora Galitz-Pfeffer
01-21-2008, 12:01 PM
Went to my chiropractor today for ultrasound and other light adjustments on both shoulders and upper back. Bursitis is very likely, and can't really tell if there's a small tear. I'll be back for another treatment on wednesday. Probably do just low body stuff that I need to work on tomorrow. Rest shoulders short time now or long time later. :shrug: I hope I'm not off upper-body work to long. I miss my rings.

Theresa Meyer
01-21-2008, 01:01 PM
I've never been to a chiropractor before, but a friend of mine has a friend who is one and has been treating his shoulder and ankle for awhile now. How much does the treatment cost typically, and do you think this is the best move for impingement/tendinitis? I've had a couple of steroid injections in my left shoulder, and now the right one is doing the same thing. I realize I need some rhomboid work to offset anterior deltoid/pectoral development I have.

Lenora Galitz-Pfeffer
01-21-2008, 02:58 PM
I've never been to a chiropractor before, but a friend of mine has a friend who is one and has been treating his shoulder and ankle for awhile now. How much does the treatment cost typically, and do you think this is the best move for impingement/tendinitis? I've had a couple of steroid injections in my left shoulder, and now the right one is doing the same thing. I realize I need some rhomboid work to offset anterior deltoid/pectoral development I have.
Today's visit cost me $50. Do you have a physical therapist who would also give you treatments like ultra sound, electro-simulation, and specific exercizes for your unique shoulder concerns. Impingement is (in a way) a symptom of something like uneven strength. Strengthening your rhomboids is one important part. Tendinitis may require some rest and other treatments. Sometimes people post a diagram of where exactly the problem is on your shoulder. Where is the impingement/tendinitis? How is your posture? Do you sleep on your shoulders? Our experts here can give you some good info. My "expertist" is experiential. I do rhomboid work and still have an overuse issue.
Good luck.

Theresa Meyer
01-21-2008, 03:06 PM
I can pinpoint the pain to the anterior deltoid. It's the same spot where I had trouble with the left shoulder. Yes, I sleep on my shoulder; I used to sleep on the left, so I switched to the other side. I imagine this has a lot to do with my current right shoulder problems, so I'm trying to learn to sleep on my back. That's easier said than done.

I'm in the Air Force, so I can go see a physical therapist once I'm referred. I didn't have much luck with PT with my left shoulder, but I wasn't very good about doing the exercises either. I was convinced that it couldn't be a muscular development issue. Now I realize it's probably a big part of it. I also typically have right rhomboid pain--adjacent to my spine.

Lenora Galitz-Pfeffer
01-21-2008, 03:20 PM
Sleeping on your back is worth it, but, it's hard to train yourself to do it. It will take the pressure off the shoulder and possibly ease up on the rhomboid. Sounds like pt would be helpful. A chiropracter would help you also with an initial ultra sound and general easing up of the area. Is your other shoulder feeling normal?

Theresa Meyer
01-21-2008, 03:34 PM
Yes, the left shoulder feels surprisingly good. The right one cracks and pops and it's difficult to lift overhead.

Lenora Galitz-Pfeffer
01-21-2008, 03:38 PM
The cracking and popping are a sign of some trouble. I believe Steven Low has posted some ideas on this thread and other shoulder injury threads. They may also shed some light.

Steven Low
01-21-2008, 07:54 PM
To be honest you don't need a PT.. but you have to be diligent with fixing your posture, strengthening your rhomboids and external rotators and loosing up your thoracic spine + getting your scapular mobility back.

If you can a front/back/side picture I can help you out.. but without knowing what's really going on it's hard to make a diagnosis.

For example wfs
http://www.board.crossfit.com/showthread.php?t=26091

Lenora Galitz-Pfeffer
01-22-2008, 05:43 PM
Chiropractor thinks it's bursitis. Not sure if there's a small tear. Getting a second ultra sound tomorrow. Both are better today than yesterday, but I don't think I'm out of the woods yet. Worked lower body today and will do so thurs and fri. It may have been dicey holding the bar for back squats today, but, I just used thd 45# bar, and was very dilligent about my scapula and a low bar position. Maybe all I'll need is chiropractic and my rarer commodity - common sense. I also try to sleep on my back. Hard to do but it's the only shoulder friendly position.

Dan Hollingsworth
01-24-2008, 01:32 PM
To be honest, what you don't need is an internet diagnosis. Sorry, but even the most educated and well intended internet "friends" are significantly limited in their ability to perform a proper assessment over the internet. I would never do it (I have a masters degree in physical therapy). It is just too easy to miss something, plus you just never know what the credentials or background are of the person giving you the advice. I don't say this to slight or offend anyone in this forum, nor is this directed at anyone specifically.

I would recommend that you go to physical therapy. If all they want to do is treat you with ultrasound, or electrical stimulation or some other machine plugged into the wall, my recommendation would be to ask to see another therapist. Study after study has shown that those are ineffective modalities.

The Air Force has some extremely talented physical therapists, honestly some of the best and brightest in the field. Some of them are located just down the road in San Antonio.

If you are hell bent on seeing a chiropractor see if there is one on your base. I'm pretty sure the Air Force has contract chiropractors, but they aren't on every base. The Navy and Army have had them for several years. Their contracts only allow them to treat active duty personnel, and if they are good their schedule is usually rather full, but at least it's free.

Best of luck with your shoulder.

Lenora Galitz-Pfeffer
01-24-2008, 03:34 PM
Did a little upper body work today. 3 rounds of cfwu. Feel a little pain in the back on the right. Possibly a little soon, but, did some good stretching and ice. Did the heat a couple of hours later. My Chiro and PT are both very good. Both do a full gamut of treatments. PT has been better about teaching proper exercizes and long term care of the shoulders. Not all Chiros and PT's are alike. It's good to be in touch with how your body feels. It is also good to get a reliable diagnosis. The experts in our discussion groups(like Steven)state in their posts that they are not diagnosing. Glad to get your input also.:)

Steven Low
01-24-2008, 03:44 PM
True Dan.

But it's also true that a lot of the 'problems' that people have basically have very simple answers.

Internet "diagnosing" is quite fun for me actually and I'm fairly decent at it (although like Lenora said I am not here to offer real medical advice or anything). It's always a good idea to get a [real] second opinion. Although most pain on an exercise forum is just from overuse so rest is always a a fairly good answer.


It seems like there's more PTs and MDs on here now so maybe I can learn something more hopefully.

Joe Waguespack
01-24-2008, 04:14 PM
.

I would recommend that you go to physical therapy. If all they want to do is treat you with ultrasound, or electrical stimulation or some other machine plugged into the wall, my recommendation would be to ask to see another therapist. Study after study has shown that those are ineffective modalities.





I am wondering about that because a few years ago i was dealing with horrible tendonitis in my elbows and biceps I tried cortisone injections, when that didn't work my doctor sent me to a PT who ran me through a bunch of different things ( massage of the area, exercises, ect.) and that only seemed to make the pain worse. After I finally gave up and figured it was just a pain I would have to deal with if I wanted to continue training my Chiro. suggested using the muscle stim. and ultra sound on my problems and within two weeks the pain was gone and never returned. I am just wondering why these would be considered ineffective modalities? They were very effective on me when nothing else worked.

Lenora Galitz-Pfeffer
01-24-2008, 04:24 PM
I am wondering about that because a few years ago i was dealing with horrible tendonitis in my elbows and biceps I tried cortisone injections, when that didn't work my doctor sent me to a PT who ran me through a bunch of different things ( massage of the area, exercises, ect.) and that only seemed to make the pain worse. After I finally gave up and figured it was just a pain I would have to deal with if I wanted to continue training my Chiro. suggested using the muscle stim. and ultra sound on my problems and within two weeks the pain was gone and never returned. I am just wondering why these would be considered ineffective modalities? They were very effective on me when nothing else worked.

My chiro used electro stim and ultra sound on my back, and my pt used them on my back and shoulders. It may be a matter of selecting that treatment after assessing what's needed. The body is very complex, so, sometimes we have to make a few visits with different practitioners. Cortisone has also made my rc worse, and so did massage. That was from an orthopedic physician, and massage(by my chiro). Sometimes the practitioners have to try a few things in their little black bag. I'm glad you found relief within two weeks with muscle stim and ultra sound. They make a big difference.

Dan Hollingsworth
01-24-2008, 04:52 PM
There are plenty of anecdotal reports of ultrasound, e-stim and the plethora of other modalities that are utilized by physical therapists, occupational therapists and now chiropractors are helpful. However, when these modalities are truly put to the test in double-blind, randomized, controlled clinical studies, they just don't cut it. Plain and simple. Several studies have been done and essentially all of the well done studies have come up with the same conclusion, these are not efficacious modalities. They have also been meta-analyses (the gold standard of clinical research) that have come up with the same conclusions.

Now, am I saying that after your ultrasound or e-stim treatment that you did not feel better? No, like I said plenty of people report that it "helps" them. The placebo effect is a real effect. As a physical therapist if a patient comes to me and says "I had this problem a few years ago and the only thing that helped was ultrasound." Well, guess what, they're likely going to get ultrasound, in addition to a lot of education and therapeutic exercises to hopefully provide them long-term benefit.

If you would like references to the studies I can get them for you.

Dan Hollingsworth
01-24-2008, 04:59 PM
[QUOTE=Steven Low;247069]



Internet "diagnosing" is quite fun for me actually and I'm fairly decent at it


QUOTE]

Steven,

Please know that I am not trying to pick a fight with you or bash you on this forum. I'm still new to the forum, so i certainly don't want to **** anyone off, not yet at least :)

At any rate, what may be "fun" for you could be potentially harmful for the person on the receiving end. I read your posts on this thread, and in all likelihood you are on the spot with your assessment, but the simple truth is that you don't have enough information to make a truly informed assessment. I think it is always important to make certain to post on these types of threads the important caveat that assessment, IN PERSON, by a physician, therapist, chiropractor, or some other trained professional is always the best first choice.

Theresa Meyer
01-24-2008, 05:47 PM
I had x-rays and an MRI on Tuesday and will follow up with orthopedics in another week. In the meantime, I've already started working on strengthening my rhomboids with resistance bands and by squeezing my shoulder blades together while working at my desk.

Tom Rawls
01-24-2008, 05:52 PM
Dan--

I'd be interested in a reference or two.

You've got me wondering why I'm paying for treatments. I feel better, but that may be because, first, I stopped doing the things that cause pain (its amazing how stupid and stubborn I--we--can be in avoiding this simple step), and second, started rehab exercises.

Dan Hollingsworth
01-24-2008, 06:50 PM
Tom,

Here's a few to start with. I know there is a meta-analysis out there somewhere, just can't find. I'm running back and forth between cooking dinner, searching for articles and getting mentally prepared for my CF workout tonight. PM me if you need more info.

Dan

prospective double blind placebo-controlled randomized trial of ultrasound in the physiotherapy treatment of shoulder pain.
Ainsworth R, Dziedzic K, Hiller L, Daniels J, Bruton A, Broadfield J.
Rheumatology (Oxford) 2007; 46(5): 815-820
School of Health Sciences, University of Birmingham, UK. roberta.ainsworth@nhs.net

OBJECTIVE: To compare the effectiveness of manual therapy and ultrasound (US) with manual therapy and placebo ultrasound (placebo US) in the treatment of new episodes of unilateral shoulder pain referred for physiotherapy. METHODS: In a multicentre, double blind, placebo-controlled randomized trial, participants were recruited with a clinical diagnosis of unilateral shoulder pain from nine primary care physiotherapy departments in Birmingham, UK. Recruitment took place from January 1999 to September 2001. Participants were 18 yrs old and above. Participants all received advice and home exercises and were randomized to additionally receive manual therapy plus US or manual therapy plus placebo US. The primary outcome measure was the Shoulder Disability Questionnaire (SDQ-UK). Outcomes were assessed at baseline, 2 weeks, 6 weeks and 6 months. Analysis was by intention to treat. RESULTS: A total of 221 participants (mean age 56 yrs) were recruited. 113 participants were randomized to US and 108 to placebo US. There was 76% follow up at 6 weeks and 71% at 6 months. The mean (95% CI) reduction in SDQ scores at 6 weeks was 17 points (13-26) for US and 13 points (9-17) for placebo US (P = 0.06). There were no statistically significant differences at the 5% level in mean changes between groups at any of the time points. CONCLUSIONS: The addition of US was not superior to placebo US when used as part of a package of physiotherapy in the short-term management of shoulder pain. This has important implications for physiotherapy practice.

PMID: 17218327 [PubMed - indexed for MEDLINE]


Pulsed ultrasound treatment of the painful shoulder a randomized, double-blind, placebo-controlled study.
Nykänen M.
Scand J Rehabil Med 1995; 27(2): 105-108
Punkaharju Rehabilitation Hospital, Finland.

To study the effect of pulsed ultrasound in shoulder pains, 35 patients were treated with pulsed ultrasound and 37 patients with placebo ultrasound in a double-blind design. The therapy was given during inpatient rehabilitation, 10-12 treatments over 3-4 weeks. Treatment time was 10 minutes, frequency 1.0mHz, on-off ratio 1:4 and intensity 1.0w/cm2. Follow-ups were done after 4-12 months. No differences (p < 0.05) in outcomes were found between the groups after the treatment period or at follow-ups. These results discourage the adding of pulsed ultrasound therapy with the variables used to the conservative treatment of the painful shoulder.

PMID: 7569819 [PubMed - indexed for MEDLINE]



No effect of bipolar interferential electrotherapy and pulsed ultrasound for soft tissue shoulder disorders: a randomised controlled trial.
Van Der Heijden GJ, Leffers P, Wolters PJ, Verheijden JJ, van Mameren H, Houben JP, Bouter LM, Knipschild PG.
Ann Rheum Dis 1999; 58(9): 530-540
Institute for Rehabilitation Research, Hoensbroek, The Netherlands.

OBJECTIVE: To assess the efficacy of bipolar interferential electrotherapy (ET) and pulsed ultrasound (US) as adjuvants to exercise therapy for soft tissue shoulder disorders (SD). METHODS: Randomised placebo controlled trial with a two by two factorial design plus an additional control group in 17 primary care physiotherapy practices in the south of the Netherlands. Patients with shoulder pain and/or restricted shoulder mobility, because of a soft tissue impairment without underlying specific or generalised condition, were enrolled if they had not recovered after six sessions of exercise therapy in two weeks. They were randomised to receive (1) active ET plus active US; (2) active ET plus dummy US; (3) dummy ET plus active US; (4) dummy ET plus dummy US; or (5) no adjuvants. Additionally, they received a maximum of 12 sessions of exercise therapy in six weeks. Measurements at baseline, 6 weeks and 3, 6, 9, and 12 months later were blinded for treatment. Outcome measures: recovery, functional status, chief complaint, pain, clinical status, and range of motion. RESULTS: After written informed consent 180 patients were randomised: both the active treatments were given to 73 patients, both the dummy treatments to 72 patients, and 35 patients received no adjuvants. Prognosis of groups appeared similar at baseline. Blinding was successfully maintained. At six weeks seven patients (20%) without adjuvants reported very large improvement (including complete recovery), 17 (23%) and 16 (22%) with active and dummy ET, and 19 (26%) and 14 (19%) with active and dummy US. These proportions increased to about 40% at three months, but remained virtually stable thereafter. Up to 12 months follow up the 95% CI for differences between groups for all outcomes include zero. CONCLUSION: Neither ET nor US prove to be effective as adjuvants to exercise therapy for soft tissue SD.

PMID: 10460185 [PubMed - indexed for MEDLINE]

Steven Low
01-24-2008, 07:55 PM
If it makes ya happy I'll add a disclaimer. :)

Tom Rawls
01-24-2008, 07:56 PM
Thanks, Dan. Generous of you to track those citations.

Lenora Galitz-Pfeffer
01-25-2008, 07:13 AM
I had x-rays and an MRI on Tuesday and will follow up with orthopedics in another week. In the meantime, I've already started working on strengthening my rhomboids with resistance bands and by squeezing my shoulder blades together while working at my desk.
Glad you are strengthening your rhomboids. Good idea to have the x rays and MRI. You'll get some good info there. Good luck.

Lenora Galitz-Pfeffer
01-25-2008, 07:17 AM
Dan, that's for posting the studies, and welcome to the forum.

Theresa Meyer
02-07-2008, 04:49 PM
I just got back from my ortho appointment. As it turns out, I have a small supraspinatus tendon tear, and because I'm about to deploy for a year, the doctor wants to repair it. He also considered my level of activity and the likelihood of it worsening while in a location where I won't be able to receive definitive treatment and/or the possibility of having to be sent home if it does worsen, so he thinks it's best to fix it surgically.

I'm in good shape but I'm interested in others' experiences with this type of surgery.

Lenora Galitz-Pfeffer
02-07-2008, 05:07 PM
Theresa, I was thinking about you and wondering how you were doing. I don't know if it's the same healing time, with or without surgery. Do what you have to do, but, if you can get another medical opinion, it might be a good idea. Find out all you can about the surgery. Is it laproscopic? What is the usual rehab schedule, etc?

Theresa Meyer
02-08-2008, 07:50 AM
Thanks for thinking of me, Lenora!

I've seen this doctor for problems with my other shoulder and a knee that I had surgery on years ago when I was still a teenager. He doesn't seem to be one whose first option is to cut people open; however, I know I will continue to CrossFit at the pace I have been, and the potential for more damage is undoubtedly there. I really don't want them to send me home from my deployment because of a torn up shoulder! So, leaving it alone doesn't appear to be an option, and it is hindering my performance--in CrossFit and in my everyday activities. I had to do some field training recently, and I was guarding it the entire time--lugging body armor around for two days didn't help much either. Besides, I haven't gotten good sleep in a long time because of it!:mad:

Lenora Galitz-Pfeffer
02-08-2008, 02:29 PM
Theresa, I understand you wanting to be in the best condition when you are deployed. I had to scale cf and on some days do only low body work. If you get the surgery, I'm sure you'll get rehab and physical therapy to regain your range of motion and strength. Find out all you can before you have the surgery so you can plan your recovery. Some procedures are not that invasive. Keep us posted, and best of luck.

David Wood
02-08-2008, 03:49 PM
I just got back from my ortho appointment. As it turns out, I have a small supraspinatus tendon tear, and because I'm about to deploy for a year, the doctor wants to repair it. He also considered my level of activity and the likelihood of it worsening while in a location where I won't be able to receive definitive treatment and/or the possibility of having to be sent home if it does worsen, so he thinks it's best to fix it surgically.

I'm in good shape but I'm interested in others' experiences with this type of surgery.


Do it. I struggled for 12 months trying to rehab a tear in this exact tendon without surgery. Very frustrating . . . a lot of different modalities (RICE, ART, anti-inflammatories, etc.) "helped" . . . but nothing cured it like going under the knife. Very successful surgery . . . 8 months later, I'm at 99%.

Theresa Meyer
02-09-2008, 07:33 AM
Thanks for the advice, David. Last night was probably my most uncomfortable night with this shoulder problem, but it was nice to have it happen at my parents' house because my mom took good care of me. :)

Anyway, how much time went by before you were really able to continue regular activies? I'm scheduled to have the surgery 19 February, but I'm supposed to go to 2 months of training with the Army (I'm Air Force), which begins 31 March. I really don't want this to interfere with my deployment, but at the same time, I know I cannot deploy with it feeling this way.