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-   -   Shoulder Pain following sleep (https://board.crossfit.com/showthread.php?t=27487)

Elliot Fuller 02-13-2008 11:23 AM

Shoulder Pain following sleep
 
1 Attachment(s)
I've read a few other shoulder pain threads, and most seem to be related to pain resulting from a workout or injury. My pain may simply be an overuse thing, or it may very well be a posture issue, as I spend most of my day (when not working out) at a computer (sigh...). After reading some of the other threads, I realize it could be a huge number of things, but mostly I'm trying to narrow down which muscles or tendons or ligaments are actually involved here.

I rarely have gotten shoulder pain during a workout. I row as a regular part of my warmup, along with OHS, pull-ups, Turkish getups, ring dips, shoulder dislocations, arm circles, among other things, which I figured should get my shoulders pretty limber and warmed up.

This is a somewhat recurrent pain which comes and goes at its leisure. It happens in both shoulders, sometimes at the same time, and sometimes at differing intensities. It's not quite debilitating, although it has come fairly close on a few occasions.

I most often get the pain after a night's rest -- e.g. it's not there when I go to bed, and somewhere in the middle of the night it just pops up, and I'll notice it while turning over in my sleep and having to swing my arm over the top.

I read another thread and found someone's description of their pain in the following picture (wfs): [URL="http://exrx.net/Graphics/DeltoidAnteriorFront.gif"]http://exrx.net/Graphics/DeltoidAnteriorFront.gif[/URL]

That seems to be the general area that I'm feeling the pain, however it doesn't really feel like a muscular pain that I would usually associate with a pulled muscle (like a pulled hammie, for example), although I could be mistaken. The pain isn't spread out over an area, but feels centralized to a specific region.

Attached is a picture which roughly pinpoints where I feel the pain (note: I don't actually feel pain at the X, but rather deeper underneath it). There is some very light tenderness felt if I push down pretty far on the "X" in the picture, although this tenderness is also felt on the opposing arm, but not to the same degree.

Using advanced computer technology, I have digitally reproduced one of the positions that causes the pain. Arm straight down at my side, I bend my elbow to raise my fist, as if getting ready to punch the sky. From there I rotate my elbow 90 degrees outward, and in that process feel the "pinch" or pain. I feel it when returning from that position as well, but not nearly as badly.

I've had this pain before, and it usually subsides after a day or two. I've always attributed it to just poor "sleeping mechanics." It has occurred in the past when I haven't been working out at all, as well as recently when I've introduced new things to my workout, like rowing and Turkish get-ups.

Does this sound like tendinitis maybe? It doesn't feel like I've pulled an entire muscle. And it doesn't feel like it's a joint problem. I just think it's strange that it shows up overnight without any real notice or indication during the day before.

I mentioned I spend a lot of time at a computer, most likely hunched over. I notice in the other threads that posture can be a big contributor. Would upper-body profiles help? I've never had superb flexibility in my shoulders, and doing full arm circles tends to yield a lot of clicks and pops from my clavicle area, but it's never been painful.

Hope that's enough information to get some ideas.

Elliot Fuller 02-13-2008 11:39 AM

Re: Shoulder Pain following sleep
 
4 Attachment(s)
Here are some profiles ... my God, you never realize how bad your posture is until you can see it in pictures like these...

I'm hoping there's a fix, and wouldn't be surprised if the posture is a major contributor.

The shoulder pain (this time, anyways) is predominantly in my left shoulder, by the way.

Elliot Fuller 02-13-2008 01:30 PM

Re: Shoulder Pain following sleep
 
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Sorry to keep bumping it... too late to edit the original posts:

Another movement that causes considerably more pain than the other one I described is holding the arm out straight in front of my body, shoulder-high, then bending the elbow at 90 degrees.

Then, starting with my bent arm out in front of me, I rotate it 90 degrees to the side (think of the arm gesture used to signal "stop"). At this position the pain and stiffness is significantly worse, and if I try to continue backwards into hyperextension it's even worse.

Here's another high-tech digital reproduction. I'm not an artist, but it's quicker to draw a picture than to take a picture, resize it and upload it :o

Blair Robert Lowe 02-14-2008 12:24 AM

Re: Shoulder Pain following sleep
 
Looking at your posture, it's out of whack obviously because you can see how far your head forward is.

Sleeping posture can really aggravate my shoulder problem. While I should sleep on my back, I sleep better often on my side with one arm above my head. This is a muscular pattern the chiro wants me to get rid of.


Sleeping on your front can put stress on the face of your shoulder if you have it above your head.

More than likely your shoulder problem is an alignment thing. Join the crowd.

Steven Low 02-14-2008 10:46 PM

Re: Shoulder Pain following sleep
 
It's not the sleeping that did you in. It's the bad posture and then the sleeping on it is what literally broke the camels back, heh.

Definitely is some type of impingement. Stretching it should help significantly. Try to massage it as need as you can. Fix the posture. Avoid things that hurt. You know.

Fix the posture (I'm sure you can find some of my posts on that) and that will help SIGNIFICANTLY. Basically things to look for are:

1. forward translated neck (pull neck back and engage neck flexors - will make you sore trying to hold it all the time)
2. rounded shoulders (retract scapulae -- will also make you sore)
3. slight thoracic rounding (stretch and foam roll)
4. poor posterior delt development compared to anterior (stretch out chest, lats, anterior delts -- unless causes pain; put more rowing into your workouts either bent over rows or whatever you want to do).

Elliot Fuller 02-15-2008 12:46 AM

Re: Shoulder Pain following sleep
 
Thanks Blair and Steven.

I know neither of you are MD's or anything, but would you advice getting x-rays and the whole shebang at this point, or does this seem like a pretty cut and dry case of terrible posture to you? I'll take whatever you advise into consideration, but don't want you to feel pressured into thinking you'll have the end-all, be-all decision on what I do from here :)

I don't want this to come back and haunt me down the road in the form of arthritis or severe rotator cuff damage, so I'm just curious whether you think this might be something I can fix with some physical therapy and personal exercises rather than yet another expensive doctor's visit, x-ray and MRI.

Steven, I've seen plenty of your posts regarding posture, so I'll look around and save you the trouble of having to beat a dead horse.

Just out of curiosity, then... any best guess as to what is actually being affected here? Just a nerve being pinched? A specific muscle? Maybe a joint?

Steven Low 02-15-2008 12:53 AM

Re: Shoulder Pain following sleep
 
Xrays probably wouldn't show anything because it's not problem with bony structure and soft tissue on X-rays is very hard to make out.

If you were going to see someone a PT is probably your best bet.

Sounds like impingement of a nerve. Probably one of the nerves that run from your cervical vertebrae through that region into the armpit/axilla and down the arm. wfs
[url]http://www.kiefersutherland24.net/6-01-BrachialPlexus.jpg[/url]

It could be joint related.. but I doubt that. If it's muscle related you should be able to feel adhesions or tightness/cramping of the muscle.

Elliot Fuller 02-15-2008 01:06 AM

Re: Shoulder Pain following sleep
 
Sorry, I'm dumb... wasn't sure what impingement meant in your first reply. Thanks for all the help!


Edit: For some reason I think it's hilarious that that picture is hosted at a site called kiefersutherland24.net

Steven Low 02-15-2008 01:40 AM

Re: Shoulder Pain following sleep
 
Well, impingement can refer to different things so you're right I wasn't that clear. Impingement of the RC tendons into the acromion is generally one type of impingement. Nerve impingement is another one which is related to herniated disks and such. You can also impinge muscles as well. Basically if you have it you can impinge it (generally speaking of course :p).

Elliot Fuller 02-15-2008 02:09 AM

Re: Shoulder Pain following sleep
 
I don't wanna take up too much attention from other posts that probably warrant it more than mine does, but I also meant to inquire:

Does it imply anything that this pain is not constant? As in: it will come on strong, as is the case this time, then after a day or two it will subside and not recur for anywhere between a week and a few months. Could that be more indicative of tendinitis flaring up (perhaps from a workout) than an impingement?

I'm not well-versed in anatomy and that sort of thing. But it seems to me that if it were my posture causing the issue, that the pain would have come on and stayed on until the posture corrected itself. I guess if it's the sleep that "compounds" everything and breaks the camel's back, as you said, then maybe it's just a game of chance based on my sleeping, as far a whether or not it actually hurts the next day.

On that same note, I've had some mild tendinitis in my elbow before and this doesn't feel quite the same. Just thought it might be a possibility since it's not a constant pain as many appear to experience.


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