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-   -   Shoulder Impingement (https://board.crossfit.com/showthread.php?t=51561)

Brian Gee 09-28-2009 08:27 AM

Shoulder Impingement
 
Hey Guys I need a bit of advice regarding shoulder impingement.

I just completed a cycle of Starting Strength, gains were great. I am 5'7", 170 lbs., 13% BF (up from 10%), DL 330 BS 305 OHP 175.

Now I am back to my original routine, which is Oly lifting (with Crossfit Metcons), and after the first week (5 workouts) I have some pretty bad shoulder pain. Had it looked at by a friend of mine who is an Atheltic Trainer and after a quick examination, he said I clearly have some shoulder impingement issues. He gave me some stretches and some boooorrriiinnngg exercises.

Now my question is this, what would you guys suggest is the best way to stay on track while nursing this problem. Im not suppossed to do "anything" overhead, most rotational stuff hurts and my shoulder feels weak on everything from pull ups to the C2. Anyone have any good workouts for the upper body impaired? Thanks in advance...

Mike Mallory 09-28-2009 09:33 AM

Re: Shoulder Impingement
 
If you're jones'n to get back into it, then be aggressive with your rehab.....I don't mean pile the weight onto the exercises your friend gave you, just use more tools;

Ice
Bodywork (Rolfing, NMT, self release)
Stretching
chiropractor
PT
Sleep (10:30-6:30)
anti-inflammatory diet
etc.

If you've pushed your shoulder too far then you've got to take the responsibility to back off a little bit.......Step back and get your form real tight on everything

Frank E Morel 09-28-2009 10:12 AM

Re: Shoulder Impingement
 
brian . go see kelly Starett at san francisco crossfit for an evalute. Book the appoint thru the website. He will assess you properly, teach you the best exercises for your problem. Plus the dude holds a doctorate of PT and is a level 3 crossfit since the early days. So you getting the best of both world thinking and experience.

Steven Low 09-28-2009 12:34 PM

Re: Shoulder Impingement
 
Ice, massage, REST... then probaly RC work and mobility work. MAYBE posture as well.

Brian Gee 09-28-2009 03:25 PM

Re: Shoulder Impingement
 
Thanks Guys!

Frank, thanks for the heads up about Kelly, I had no idea. That sounds like a great plan!

Steven, I actually just started some posture exercises. Retracting the scapula and depressing the shoulders and holding that position. I've never considered myself having "bad posture" but it certainly is not as good as it could be.

So I guess I will back off and really focus on the rehab. What are your guys opinions on anti-inflamatories so I can atleast get through some sets of high bar back squats. Or should I not even push the squats?

Steven Low 09-28-2009 03:45 PM

Re: Shoulder Impingement
 
Don't do anything that hurts it. (Besides rehab work obviously..)

I personally don't like anti-inflams that much except natural stuff like fish-oil. But yeah..

Sean Murray 10-29-2009 04:20 PM

Re: Shoulder Impingement
 
Just going to tag my questions on to this. Recovering from a long term shoulder impingement injury. Referred to physiotherapy dept at my local hospital after a lot of treatment by private physio did not stop symptoms coming back (deep pain near the AC over head- akin to someone pushing back down on the area/tightness at top of pecs under clavicle/tightness along side of neck to where muscles attach to clavicle/ severe clipping inside left shoulder as elevated). There was no testing or checking of the mechanics though by this physio of what i did at the gym to give a real picture of the root cause. She wanted me to get an MRI to rule out labrum tear she suspected. Pain was in overhead pressing movements- at first just pressing movements were a problem then got so bad as to causing pain on kipping pull ups/ KB swings/ wall ball.

Hospital physio ruled out need for MRI with pre assessment but did spot some dysfunction in the scapula and so proceeded with just rehab for abduction.
Guys at the gym who had shoulder issues intro'd me to some great rehab exercises and posted them up on our CF board (scap push ups/scarecrows/lateral rotation/external rotation and few others). After doing some work on lateral rotation with a light resistance band I had massive weakness in that movement and could feel the fatigue in the working muscles there (infraspinatus/teres minor??) Something the hospital physio or private one didn't bother to assess with me.

I've basically got on with my own rehab as the UK hospital physio's are only concerned with basic function. As my symptoms diminished (more down to removal of aggravating movements and rest) they're happy to sign me off.
Gradually brought back in all the movements and up to now no reaction. I do feel the fatigue in the (infraspinatus/teres minor area) though on any workouts with a lot of pull ups or pressing. Also, I've noticed a feeling of fatigue/weakness in what i think is my left rhomboid or could it be where infraspinatus/teres minor attaches near the mid back region??? Just a bit inwards from the point of the shoulder blade I'm not sure how to identify which it is. I can feel a little trigger point in there and am wondering if that is what is causing this feeling or if its a deeper issue?

I've got a sports massage booked in for Monday so will get her to look at that for me. I do get a lot of trigger points though in that left shoulder area actually.

Steven Low 10-29-2009 06:50 PM

Re: Shoulder Impingement
 
Sean,

It sounds like you have anterior instability (poor posture coupled with weak and tight upper back and external rotators) rather than shoulder impingement.

Check out the shoulder articles in this thread especially the ones I posted. The DC shoulder rehab protocol should help you a lot along with Ido's scapular mobilization work:

wfs
[url]http://www.performancemenu.com/forum/showthread.php?t=4761[/url]

Ice the areas with pain. Do proper rehab.

Sean Murray 10-30-2009 03:14 AM

Re: Shoulder Impingement
 
[QUOTE=Steven Low;688076]Sean,

It sounds like you have anterior instability (poor posture coupled with weak and tight upper back and external rotators) rather than shoulder impingement.

Check out the shoulder articles in this thread especially the ones I posted. The DC shoulder rehab protocol should help you a lot along with Ido's scapular mobilization work:

wfs
[url]http://www.performancemenu.com/forum/showthread.php?t=4761[/url]

Ice the areas with pain. Do proper rehab.[/QUOTE]

Steven- yep the DC crew rehab is what was posted up on our board by one of the guys so I'll adopt that fully. I've not had any pain in the original problem spots, just the tired achey feeling around the bottom of the scap (teres minor/infraspinatus). My coaches have said my overhead position is looking better since coming back to pressing. I've always had a problem with tight shoulders and a struggle to get arms by your ears overhead. Mid thoracic has had loads of work to loosen that area and I keep on top of that with the foam roller.
I've just remembered that in some of my physio sessions before hospital referral, one of the best exercises that seemed to remove the popping and clipping in the shoulder and gave me a better range of motion in elevation to overhead was using a resistance band tied in a loop > arms out in front with thumbs up > push arms outwards against the band whilst elevating straight arms to overhead position.

Matthew Apostol 10-30-2009 09:50 AM

Re: Shoulder Impingement
 
I've suffered from impingement for over a year in my left shoulder. Done a lot of digging, and the two big causes of impingement seem to be:

1) Underlying glenohumeral instability. That pretty much means that the joint where the humeral head (ball) and glenoid fossa of the shouler blade (socket) is naturally unstable and as a result there is a lot of movement...hence the supraspinatus impinging on the acromium.

2) AC joint degeneration which may promote growth of bone spurs underneath the acromium. Spurs impinge on the supraspinatus.

3) Scapula sublaxation. Basically means that the scapula is moving too much (or not moving how it is supposed to, or it's not being "active"). I noticed that my left shoulder blade (bad shoulder) travelled way higher than my right one (my good one) when i did certain movements such as placing my arm behind my back. This puts a lot of the work burden on the RC cuffs, which in turn get weak, and then that leads to glenohumeral instability.

Recently, in the past month, I have been able to get a substantial amount of relief from scapular mobility/shoulder stability exercises such as Turksih Get-ups, overhead barbell shoulder shrugs, pull up retractions etc. Start light, focus on proper form (elbow locked, head to shoulder, pushing through weight etc) and then slowly add weight as you get stronger. I can really feel the difference now. My shoulders seem tighter (but in a good way) and stronger.

Concurrently, I have been doing the Diesel Crew Shouler rehab routine that Steven had prescribed. This works the RC muscles well while being low impact. Coupled with the stability and scapula work, my RC strength and overall range of motion has improved drastically.

One exercise that I am experimenting with is grasping a 5lb DB, placing it behind my back at the sacrum (lower back) and lifting it slowly up my spine about six inches (almost like you are being put in a hammer lock that cops like to use to control suspects). Just six inches and no further, at least at first. This focuses on strengthening the muscles that are supposed to keep the scapula down and "active" instead of riding up and causing strain on the RC muscles. So far it seems to be working in restoring range of motion and keeping that shoulder blade down.

Hope this helps.

Sean Murray 03-11-2010 08:57 AM

Re: Shoulder Impingement
 
[QUOTE=Sean Murray;688005]Just going to tag my questions on to this. Recovering from a long term shoulder impingement injury. Referred to physiotherapy dept at my local hospital after a lot of treatment by private physio did not stop symptoms coming back (deep pain near the AC over head- akin to someone pushing back down on the area/tightness at top of pecs under clavicle/tightness along side of neck to where muscles attach to clavicle/ severe clipping inside left shoulder as elevated). There was no testing or checking of the mechanics though by this physio of what i did at the gym to give a real picture of the root cause. She wanted me to get an MRI to rule out labrum tear she suspected. Pain was in overhead pressing movements- at first just pressing movements were a problem then got so bad as to causing pain on kipping pull ups/ KB swings/ wall ball.

Hospital physio ruled out need for MRI with pre assessment but did spot some dysfunction in the scapula and so proceeded with just rehab for abduction.
Guys at the gym who had shoulder issues intro'd me to some great rehab exercises and posted them up on our CF board (scap push ups/scarecrows/lateral rotation/external rotation and few others). After doing some work on lateral rotation with a light resistance band I had massive weakness in that movement and could feel the fatigue in the working muscles there (infraspinatus/teres minor??) Something the hospital physio or private one didn't bother to assess with me.

I've basically got on with my own rehab as the UK hospital physio's are only concerned with basic function. As my symptoms diminished (more down to removal of aggravating movements and rest) they're happy to sign me off.
Gradually brought back in all the movements and up to now no reaction. I do feel the fatigue in the (infraspinatus/teres minor area) though on any workouts with a lot of pull ups or pressing. Also, I've noticed a feeling of fatigue/weakness in what i think is my left rhomboid or could it be where infraspinatus/teres minor attaches near the mid back region??? Just a bit inwards from the point of the shoulder blade I'm not sure how to identify which it is. I can feel a little trigger point in there and am wondering if that is what is causing this feeling or if its a deeper issue?

I've got a sports massage booked in for Monday so will get her to look at that for me. I do get a lot of trigger points though in that left shoulder area actually.[/QUOTE]

Finally got to see a top notch guy about my shoulder. Allegedly this guys website is the most visited site on the web for shoulder info..how true???
[url]http://www.shoulderdoc.co.uk/[/url]

Quick exam and got my history with it and he's 99% sure its AC joint osteolysis (stress fracture from heavy loading where bone erodes faster than can be repaired). MRI scan to be sure to come. Been told to stay off all overhead movements for a month to allow it to settle down. Apparently common with weightlifters and people involved in power sports involving maximal loads of shoulder.

Brad Davis 03-11-2010 12:31 PM

Re: Shoulder Impingement
 
Quick tack-on question. Sorry, it's been done once in this thread and I can't resist the temptation, LOL.

I'm wondering if I have impingement also. If I put my left arm forward, bend my elbow so that my finger is pointing up, then internally rotate, I can feel some pain (3-4 on a scale of 1-10) near my max ROM, which is same both arms, probably 30 deg below horiz. It's about under my posterior deltoid head when in the rotated position. Also, if I put my arm down to my side, internally rotate to max ROM, and then raise my arm forward like a front DB raise, I feel pain in the same place when my arm gets to about horizontal. During exercise, feel no pain during pullups or chinups, little or no pain during presses, 3-4 scale pain during bench press warmups, then nothing on the heavier sets.

This started about 2 months ago. I had just done a workout with bench, dips, and pullups. Felt fine. Went to my car and the one next to it was jammed in tight. I didn't think about what I was doing and wedged myself in there and externally rotated my left arm to get the key in the door. Felt a quick and sharp pain in the same area mentioned above. It hasn't improved in 2 months. Might be degrading ever so slowly. Dropped dips a month or so ago. Dropped bench 2 weeks ago until the problem is resolved. Currently am just doing very light presses like the Starr Rehab plan, and ice.

Sound like impingement? Something else?

Advice appreciated as always.
DBD

Steven Low 03-11-2010 06:59 PM

Re: Shoulder Impingement
 
Sounds like internal impingement to me....

Strengthen your RC muscles, do posterior capsule stretch, and sleeper stretch, and do LYTPs. Ice afterwards if needed.

wfs
[url]http://davedraper.com/blog/2009/07/22/shoulder-ytwls-become-lytps/[/url]

Brad Davis 03-15-2010 10:04 PM

Re: Shoulder Impingement
 
Thanks Steven. Looking into it.

Sean Murray 05-16-2011 04:20 AM

Re: Shoulder Impingement
 
Have just been signed off with my shoulder issue. MRI with dye in showed no SLAP tear. Consultant decided there was no need for surgery and that the issue was mechanics. Had a physio check me over before discharging me and he believes the impingement overhead is due to an anterior tilt in my left scapula which decreases the subacromial space. Had me on my front and pressed down on the scapula to show me the lack of movement in there compared to the right. Suggested I get it mobilized as pretty tight, as well as strengthening the area.

I'm guessing this is part of the reason I get so many severe trigger points around my left scapula. Just not so happy its taken so long to come to this conclusion. :ranting2:


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