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Old 05-10-2007, 06:28 AM   #1
Leon Robotham
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Hi Guys

Man i'm only 25 and im feeling like a beat up 40yr old. For months now I have had problems with my shoulder. rotator cuff and the acromion, when I press down and from front to back on the top of the shoulder it feels as though the muscle has torn into small fibers.

If I do pressups I get a pain on the front of the shoulder, if I kip then im ok but soon after the motion is completely restricted and the next day is mega painful. I've had physio but it's not helped. I've been using TGU's to help rehab it and while doing them I feel great, when I come to press i get terrible pains and it's all in the right shoulder.

seeing as tho the CF WODS contain a lot of P/Us Dips presses etc it's starting to annoy the hell out of me as it's just another problem to deal with. I tried about 3 weeks worth of light db abduction work and also adduction, with the adduction there once again seemed to be more pain.

What can I do to get round this while still prehabbing the shoulder problem.

I also think it has a lot to do with Muay Thai, if i throw right hooks or even heavy straights I get pain and the same with elbows. It makes sparring pretty interesting.

Any help is appreciated.

Thankyou.
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Old 05-10-2007, 07:30 PM   #2
Matthew McCarty
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Check out a book called "Inside Out Warm Up" by Mike Robertson and Bill Hartman.

Also T-nation has a lot of articles on shoulder health, etc. The site though may not be work safe. They like their scantily clad women.
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Old 05-11-2007, 10:49 AM   #3
Kelsie Scheeler
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I've got a similar problem with both shoulders. Too many push ups gets me, and sometimes the next day I can't lift my arm at all. Severe pain in the shoulder joint. I just saw a sports MD nd he thinks it could be postural related. My shoulders are a bit rounded, meaning they're not properly stabalized and this is due to tight pecs, weaker back and muscles that are shoulder stabalizer (rhomoids, anterior serratus, traps, delts etc). I'm waiting for an ultrasound to check for rotator cuff tears, but in the meantime I'm working on pulling back shoulder blades (to fix rounded shoulders) as well as posture strengthing exersises.
Also, just a note, I also box (for fitness, no fights) MD said boxing can aggravate the round shoulder problem, because the activity is a very forward shoulder movement. I would get to MD asap if possible, its not worth self-diagnosing and hurting yourself more. Hope this helps.
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Old 05-12-2007, 04:43 PM   #4
Wayne Nelson
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I see shoulder problems rather commonly with the people I work with. The cause very often is insufficient stabilization from the rotator cuff, ineffective shoulder blade positioning and control, or short and tight muscles. Stabilization includes both strength and, most important, reactivity (getting am muscle activation to occur at the right time). Over head lifts place a very high demand on the stabilizing elements of the shoulder. Quick movements challenge the reactivity of the stabilizers to respond appropriately. These are typical situations where problems begin to surface. Often stability is forgotten during training. Who wants to do shoulder rotation exercises or push-up pluses when there is more exciting things to do?

Rotator Cuff: There are four muscles tendons that make up the rotator cuff and they wrap around the shoulder joint. The stability function of the rotator cuff is two-fold: 1) To draw the top of your arm (head of the humerus) into the joint socket as you move your arm. 2) The rotator cuff also draws the head of the humerus down to keep the ceiling space (acromial arch) of the joint free. If this depression doesn’t occur things get jammed into the ceiling (acromion) and includes the supraspinatus tendon and a bursa. In movement the rotator cuff does as the name implies, rotates the arm, it also helps the deltoids in raising the arm.

When the rotator cuff muscles don’t perform correctly, that is respond too slowly or are weak, the head of the humerus moves all over the place overloading all sorts of stuff in your shoulder and causes pain. Not good, don’t go there! Often, however, the rotator cuff isn’t the only thing involved in shoulder problems. At least one of the other shoulder stabilizers (serratus ant, a scapular protractor and staabilizer; mid and low traps are scapular depressors and stabilizers; long head of the biceps, an anterior shoulder stabilizer) is often included in the problem. You might want to work on all areas of stabilization of the shoulder and shoulder blade in your work.

The solution (and prevention) to shoulder problems do not fall under the umbrella of CrossFit. This stuff stems from rehab and ends with specific performance training. At this stage I would recommend push-up +, a resisted scapular depression exercise like straight arm dips (using only your shoulder blades, and squeezing them together at the top), resisted shoulder internal and external rotation.

Push-up + is simply a push up on your elbows (push all the way up). There are many variations for this exercise that includes on your knees, toes, on one knee, one foot, on knees and one elbow, on feet one elbow, and one elbow and opposite knee or foot.

A Straight Arm Dip is just as the name implies, dips with straight arms, that is you don’t bend your elbows but use your shoulder blades entirely to develop the movement. This addresses the scapular depressors, mid and low traps, and helps get shoulders back to where they belong. At the end of the push up portion of the dip pull your shoulder blades together and really feel it low between your blades.

Shoulder Rotations: Begin the external rotation movement by setting your shoulder blade down and back (“In your back pocket.” “The opposite pocket!”) before pulling out to the side. Do these initially with elbow at your side (don’t pull away from your side). Start at 2.5#. Absolute maximum weight: 10 pounds. Fatigue occurs here when you feel pain, cannot perform correctly or don’t feel it in the back of your shoulder. We are training the movement here, not the muscle, so do a lot of reps (sets of 10-15/side), methodically separating the movements. After you have done 500 or so you can think of blending the two parts to flow together. When performing internal rotation (pushing across in front of you) set your shoulder when your arm goes back to the outside to start the rep again.

If you want picts let me know.

These exercises are great for developing strength but don’t do much for reactivity. You then need to move to unstable surfaces like a rocker board, wobble board, bosu, and ball. You also need to develop rotator cuff strength and reactivity in all ranges of motion for the shoulder in a paced and safe manner.

Strength is important but how quickly the muscles fire to create stability at the correct time is paramount to shoulder stability. Key elements to consider in rehab (or preventing problems) are strength, reactivating proper firing sequence of the stabilizers, then reprogramming these changes into the nervous system so they become automatic. Inadequate or inefficient stabilization of the shoulder are either the root causes or contributing factors of a large amount of shoulder problems.

I hope this helps and wasn’t too long winded.
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Old 05-13-2007, 09:38 PM   #5
James Hull
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Wow printing this now!

I have a horrible shoulder pain (right shoulder) it seems to be below the muscle, directly on the fartherest right part of the bone. It hurts when I move my elbow to shoulder height and above.

I think I'm going to see an MD. Its starting to really affect me. I haven't been able to do the WODs lately.

Thanks for the awesome post Wayne
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Old 05-14-2007, 07:23 AM   #6
Kelsie Scheeler
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Wow, thanks for the info Wayne!
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Old 05-14-2007, 12:24 PM   #7
Connie Morreale
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wayne,
if there is no tear, (my injury seems to be in the infancy stage..about 3 weeks now but getting worse if i try pressing movements), then what is your take on a cortisone shot and complete immobility for 3 weeks. then follow up w/internal and external resisted rotation and stabilizing exercises? i'm kind of an all or nothing girl; i back off a few days then try body wieght benches and here we go again.
-----------

dy try n
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Old 05-16-2007, 07:45 PM   #8
Corey Duvall
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I will first of all agreely largely with the postural problems in shoulder injuries. The placement of the shoulder blade with change the biomechanics of the shoulder joint and can cause problems.

I will not agree with immobilization. Immobilization causes reactive changes in the shoulder joint and surrounding musculature that cause even more problems. The phrase "use it or lose it" is ever pertinent. The fluid that lubricates the joint will diminish and the surrounding musculature will weaken, exactly what you DON'T want to happen for a rehabilitation. What you need to do is get some correct advice on shoulder posture and continue to move the shoulder in a pain free range of motion. The CFJ has a great article on shoulder rehab called "Shoulder Therapy" I believe. I highly suggest getting it and reading carefully. I used it to help rehabilitate my parents' shoulders after YEARS of neglect.

Good luck.
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Old 05-16-2007, 09:54 PM   #9
Wayne Nelson
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Definitely agree with Corey. Points well made. In addition, with movement, the scar tissue that always accompanies inflammation is created in a manner that more closely resembles the tissue it is replacing in strength and integrity.

Please keep in mind that when solving any problem, shoulders included, an accurate diagnosis is important to better understand the condition and how to solve it. The diagnosis should include both what tissues are involved and what dysfunctions are producing the overload on that tissue. Guesses don't help much, and accuracy cuts out the slack.
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Old 05-16-2007, 10:14 PM   #10
Wayne Nelson
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Interesting article on Shoulder Therapy. Looking at the just first page and the Tyler’s recommendation on his first exercise in his progression: to hang with the arms in full flexion and internal rotation, also known as a Kennedy-Hawkins test for shoulder impingement. That means that if there is impingement in the shoulder, there is pain. This occurs because the greater trochanter (the bump on the shoulder that limits raising you arm) compresses the tissues into the ceiling of the shoulder joint. Although this may be a good progression in some cases, it may not be good for all cases.

Am I missing something here?
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