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PostPosted: Tue Dec 06, 2011 7:28 pm 
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Hey guys. I'm almost positive i have a protracted shoulder girdle as well as a winging scapula. I also suspect shoulder impingement, bilaterally but more on the right side (same as the winged scap).

Here's the cause for my suspicion:

My shoulders have always "clicked" during overhead reaching. I'd never really thought about it much, as my joints are kind of crappy all over. However, when i first began working out earlier this year, i experienced a peculiar burning sensation and loud snap/crackle/pop when attempting to do my shoulder presses like this http://www.exrx.net/WeightExercises/Del ... Press.html . Needless to say, i stopped doing them like that. I found that if i tucked my elbows and squeezed my shoulder blades together, i experienced no pain and only an almost imperceptible "click" in my right shoulder. I began doing my dumbbell floor presses in a very similar manner. I've since seen these techniques validated by several sources.

I've read the NMN series, the Shoulder Savers series, and several other related articles on T Nation, as well as the pertinent resources on the main ExRx website. Based upon these sources, my shoulder pre-hab routine consists of the following:
1) resistance band exercises/stretches (external & internal rotations, pec minor stretch, facepulls, behind the neck pulldowns, and basically this http://www.exrx.net/WeightExercises/Del ... aises.html )
2) scapular push-ups & dip shrugs
3) various rows, including rear delt rows
4) some other modifications to my normal routine, including an increased emphasis on pulling and a decreased emphasis on pushing. I've only been doing my dumbbell floor presses once every few weeks, for maintenance purposes. I continue to do a healthy amount of pulls/chins.

My question for you is this: do i need to be doing anything like supraspinatus strengthening to specifically address the impingement? I do experience a small amount of crepitus in my right shoulder when i do regular lateral raises, and the "empty can" variety gives me pain and is definitely a no-go.

What do you make of this? http://www.ncbi.nlm.nih.gov/pubmed/19812522

It would seem to suggest that one can exercise the supraspinatus adequately with only external rotations, but i thought the supraspinatus was an internal rotator. The abstract states that the recordings were taken during isometric contractions rather than throughout the range of motion -- is that perhaps relevant?

For reference, here's the equipment at my disposal:
1) dumbbells + EZ curl bar + weight plates
2) a couple resistance bands
3) a pull-up bar, and some olympic rings which i hang from it


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PostPosted: Tue Dec 06, 2011 10:20 pm 
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Row more and military press. Since I've started focusing on military presses on a regular day, I haven't had really any impingment problems.

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PostPosted: Tue Dec 06, 2011 10:40 pm 
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I do dumbbell shoulder presses in the manner described above two or three times per week. I haven't been maxing out, however, as i've noticed that i have a tendency to lean back excessively, thus placing undue stress on the lower back. So i'm working on that.

As for rows, i do those also. I just got some olympic rings, and i really like doing inverted rows with those. I much prefer it to using dumbbells or a bar, although i think i'll still do db rows sometimes. I'm working on getting the form down at the moment, but will probably be doing feet elevated/weighted rows soon. In general, for regular inverted rows (not the rear delt ones), should i be using a shoulder-width grip to target the lats, or a wider grip to target the lower traps and rhomboids? Or some of both?


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PostPosted: Wed Dec 07, 2011 8:58 am 
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commodiusvicus wrote:
My question for you is this: do i need to be doing anything like supraspinatus strengthening to specifically address the impingement? I do experience a small amount of crepitus in my right shoulder when i do regular lateral raises, and the "empty can" variety gives me pain and is definitely a no-go.

What do you make of this? http://www.ncbi.nlm.nih.gov/pubmed/19812522

It would seem to suggest that one can exercise the supraspinatus adequately with only external rotations, but i thought the supraspinatus was an internal rotator. The abstract states that the recordings were taken during isometric contractions rather than throughout the range of motion -- is that perhaps relevant?


I don't think you should over think it. The supraspinatus in the case of "impingement" is just a victim poor shoulder blade stability/strength and thoracic spine mobility. It's more an abductor if you were to give it one function but it's also important to realise that the rotator cuff muscles primarily stabilise the humeral head and any mind of motion or load will fire them up i.e. holding something heavy in your hands, even by your side (farmers walks are also a great rotator cuff exercise!).

The best thing you can do for supraspinatus is give it a break. The abuse it suffers is due to too much contact with the acromion as you raise your arms upwards. Too much contact comes from limited space, and limited space comes from elevated and/or winged shoulder blades. By getting your middle, lower traps, and serratus anterior stronger, the shoulder blades sit in better alignment and depress the humeral head, giving more clearance room for the RC tendons to pass through without getting crushed.

Strengthening the rotator cuff will help this too but, the root of the issue is the shoulder blades as this is what jams up the the shoulder joint in the first place. Thoracic spine mobility comes into it because your shoulder blades sit on your rib cage and if your rib cage (and therefore, Tspine) is hunched forward, the shoulder blades can't glide as they should and will always be slightly elevated or winged out until Tspine/rib cage position is fixed.

Also, don't do the empty can raises. This is honestly a provocative tests used by therapists to determine which RC muscle is pi$$ed off. Not something you want to do often and especially with load.

So, yeah - more rows, and don't walk/sit around with a hunched posture.

KPj

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PostPosted: Wed Dec 07, 2011 10:42 am 
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If overhead pressing gives you troubles, you might want to switch to (high) incline bench pressing.
It works basically the same muscles, but without putting your shoulders in a vulnerable position.


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PostPosted: Wed Dec 07, 2011 12:23 pm 
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KPj wrote:
commodiusvicus wrote:
My question for you is this: do i need to be doing anything like supraspinatus strengthening to specifically address the impingement? I do experience a small amount of crepitus in my right shoulder when i do regular lateral raises, and the "empty can" variety gives me pain and is definitely a no-go.

What do you make of this? http://www.ncbi.nlm.nih.gov/pubmed/19812522

It would seem to suggest that one can exercise the supraspinatus adequately with only external rotations, but i thought the supraspinatus was an internal rotator. The abstract states that the recordings were taken during isometric contractions rather than throughout the range of motion -- is that perhaps relevant?


I don't think you should over think it. The supraspinatus in the case of "impingement" is just a victim poor shoulder blade stability/strength and thoracic spine mobility. It's more an abductor if you were to give it one function but it's also important to realise that the rotator cuff muscles primarily stabilise the humeral head and any mind of motion or load will fire them up i.e. holding something heavy in your hands, even by your side (farmers walks are also a great rotator cuff exercise!).

The best thing you can do for supraspinatus is give it a break. The abuse it suffers is due to too much contact with the acromion as you raise your arms upwards. Too much contact comes from limited space, and limited space comes from elevated and/or winged shoulder blades. By getting your middle, lower traps, and serratus anterior stronger, the shoulder blades sit in better alignment and depress the humeral head, giving more clearance room for the RC tendons to pass through without getting crushed.

Strengthening the rotator cuff will help this too but, the root of the issue is the shoulder blades as this is what jams up the the shoulder joint in the first place. Thoracic spine mobility comes into it because your shoulder blades sit on your rib cage and if your rib cage (and therefore, Tspine) is hunched forward, the shoulder blades can't glide as they should and will always be slightly elevated or winged out until Tspine/rib cage position is fixed.

Also, don't do the empty can raises. This is honestly a provocative tests used by therapists to determine which RC muscle is pi$$ed off. Not something you want to do often and especially with load.

So, yeah - more rows, and don't walk/sit around with a hunched posture.

KPj


Sounds reasonable to me. Thanks.


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