ExRx.net

You'd be more likely to know than me, actually. As a trainer you see way more people who train their shoulders than I do. People come to me because they have malaria or typhoid, or because members of a neighboring tribe have shot them or amputated one (or more) of their limbs. I was tempted to post a photo of someone with a huge bush-knife gash across their shoulder, and label it "rotator cuff dysfunction", but I thought that not everyone would appreciate gallows humor or blood and gore.

Ken, how did your wife get to the subscap with the caster? I should have wondered that before.

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Our greatest fear should not be of failure, but of succeeding at things in life that don't really matter.--Francis Chan

I dunno, I've met some seriously impressive MDs whose command of orthopedic testing has completely blown me out of the water. I'm really only beginning to understand some of the relationships at play here in such an amazingly complex area. I was in the right place at the right time when I started my career — working in a gym with an osteopath, an RMT and a chiropractor — so I have had the luxury of being able to work directly with a paramedical practitioner.

In 100% of cases, if a client has even moderate shoulder pain, I send them to the doctor.

For future reference, I would completely appreciate it.

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don't you know there ain't no devil
that's just god when he's drunk

That one I know, having gotten within 30 credits of an IE degree.

Here's the plan I came up with before seeing the trainer later this morning. We'll see if he modifies it.


Ibuprofen
As anti-inflammatory

4x/day, morning, lunch, dinner, bedtime. For 1 week. Stay hydrated.

Soft Tissue Work
Daily, especially rear delt, lat delt, and scapular region. This has helped a lot in just two days.

Good-To-Go Exercises
These exercises either cause no discomfort or actually make my shoulder feel better.

All lower body exercises – regular 5/3/1
Pendlay rows, volume
Any isolated triceps move
Face pulls
External Rotations

Gray Area Exercises
These cause mild discomfort. I will work these back in after waiting at least one week.

Lateral Raises
Curls and Concentration Curls
Dumbbell bench press, pronated or neutral (may wait on this one, not sure)

Definite Problem Exercises
These cause noticeable discomfort before and after the movement. No definite plan for putting these back in, things have to feel much better first

Front Raises
Dumbbell flyes (I don't normally do these, but they make a good diagnostic, they produce an awful pull in left bicep with even light weight)
Seated Dumbbell press, neutral grip
Seated Dumbbell press, pronated. These were the “big winner”, horrible lock-up and sudden loss of strength as if I were going to drop the dumbbell.

I'm going to make a couple other suggestions here. Don't think of the shoulder as a single joint, because it isn't; it's got an absolutely absurd number of articulations between it's three joints and the scapulothoracic pseudojoint*.

In order for the humerus to move, the scapulothoracic joint also has to move, roughly ~1° for every ~2° of humeral movement through flexion and after the first 30° of abduction. I say roughly because I don't understand it super well, and the relationships here are vast and terrifying, like the dark horrors of R'lyeh. If the scapula doesn't "move out of the way," the humeral head can't rotate or move smoothly within the glenoid fossa and it can press down on all kinds of soft tissue structures — like the tendons of your rotator cuff — even if the range of motion of the joint seems full. A good indication of scapulothoracic dysfunction is if there's a sensation of clicking, pinching or rolling, or if the scapula itself wings or protrudes and doesn't sit flat against the thoracic cage.

That said, think about trying to free up the movement of your scapula so that it can get out of the way and let the humerus slide around like a pig in poop. The five muscles that stabilize the scapula are: Lats, rhomboids, levator scapulae, lower traps and serratus anterior. Try foam rolling your lats, and try doing exercises to strengthen your lower traps and serratus like ATYW, trap 3 raises, and scapular wall slides. Additionally the pec minor pulls the humeral head anteriorly, so try releasing that as well with a tennis ball.

And, y'know, go see a doctor. Bicipital tendonitis, shoulder impingement and full on soft tissue tears to your labrum all present with a good degree of symmetry. Two of those get you a couple weeks of physio and RICE, and one of those lands you in a surgeon's chair.
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*It's technically not a joint, but it is a joint at the same time? I don't know the word for this.

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don't you know there ain't no devil
that's just god when he's drunk

@Jason, it's going to take me a little while to digest your reply, so I'll get back to that.

In the meantime, here is what the trainer said about form. He wanted to evaluate my form on the major lifts. Here they are from best to worst.

Deadlift: good form, remember to scrape my shins. He said my build favors deadlift over squat and bench because I have relatively long arms and legs compared to torso.

Overhead Press: empty bar only due to shoulder issue, said it was almost perfect, but I should try to end up with the bar about 1" further forward at the top.

Squat: Said I carried the bar "illegally low" (guess I'd get a red light on the platform) and to raise it up a bit. Also said I was going way down below parallel and that's why I was losing my lower back arch, aka butt wink. Also corrected my breathing, said I needed to take a full breath between reps and really fill my belly. Thought I was, but I guess not.

Bench: Not sure I did anything right. He explained "spreading the bar" in a way that finally snapped, and showed me how to set up by beginning with my feet on the bench, going into a bridge, and then putting my feet down. Told me I wasn't hitting the same spot in my chest twice at all, going both forward and back, made me use a narrower grip and said I was tucking elbows too much, leading to lost stability. Was not "stacking" wrist over elbow. Well, you get the idea. Bench is what we'll be working on next week.

He endorsed the general plan to stick with squat, deadlift, face-pulls, etc., and showed me variations of the pull, and corrected some form issues on those. Overall a great first experience.

cool
may I ask the price you pay?

Oscar, $35.00/half hour

@jason, the wall slides I think I can daily. Found a youtube video on Trap 3 raises, those I can add in as well.

Do not know what a ATYW exercise is.

Sounds like a variation of YTWL.

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Let thy food be thy medicine, and thy medicine be thy food.~Hippocrates
Strength is the adaptation that leads to all other adaptations that you really care about - Charles Staley
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Thanks TimD

Don't forget to try and prevent your thoracic cage from tipping. You need scapulothoracic movement, not lumbar extension.

Yeah my chiro gives out what he calls ATYWs (also known as YTAs or YTIs, +w), same concept; external rotation and lower trap strength.

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don't you know there ain't no devil
that's just god when he's drunk

Can anyone describe how to do these YTWL's?

From what I gather, it's just a case of:

Lying prone on a bench
Lift arms to Y position
Move arms to T position
Move arms to W position
Move arms to L position
thats 1 rep

I have also heard it described with various rotations and what-not...

This is a good article on them -

http://nicktumminello.com/2009/07/a-new ... oved-ytwl/

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What if the Hokey Cokey really IS what it's all about?

Doc, your question, "how did your wife get to the subscapularis". She actually said, "that's the area of..." but did not claim to be hitting it.

Can she still trigger the numbness in your fingers with pressure in that some place?

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Our greatest fear should not be of failure, but of succeeding at things in life that don't really matter.--Francis Chan