Recovering from possible tendonitis around the supraspinatus

[liamg88]

I recently woke up with pain in my left shoulder, after a particularly strenuous day of activity (training in kickboxing in the morning, and weights in the evening)

I went to a physio a week after waking up with it, and then had a check-up a week later. He suspected tendonitis of the supraspinatus, or perhaps just a strain. After two weeks the pain was 99% gone, and the strength had returned. However, since then that 1% pain that I still had has remained.

When I circle my left arm I have full ROM, however, for a split second at a certain point, I feel a pain in the same spot as before. It's only for a second.

I have returned to my normal weights training, and am lifting my regular weights with no problems. I have not started boxing/kickboxing again yet however.


Does the presence of that second of pain when moving my shoulder mean the tendonitis will return if I resume full activities? What should I do to 'get rid' of that last remaining point of pain in the range of movement?


kind regards,
Liam

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[Musculoman]

Hay Liam.

Did your physiotherapist talk to you about exercises and your gym work etc.? or did he just treat the inflamed supraspinatus? Generally following even simple shoulder injuries to the shoulder a lot of complex things can happen!

The SS is part of a large stabilization system in your shoulder, when it loses its activation patterns you can lose the position of your humerus in its socket slightly. This prevents it from clearing a lip of bone when you roll your shoulder around as you mentioned, and can give pain / pinching / catches etc. Generally, in someone who trains regularly in the gym (and martial arts) increased muscle tone in your chest (pecs etc) will pull your glenohumeral head forward when you lose the aforementioned stability.

So, in all likelyhood the solution to your dramas will be in repositioning your humeral head to clear the acromion (small lip of bone @ the top of your shoulder). Below are some tips:

STRETCH your pecs every gym session. Put your arm against a door way @ 60/90/120 degrees and turn away from it (search pec stretches on google you should find some)

Focus on some back / posterior shoulder exercises i.e. bent over rows / seated row / etc. TECHNIQUE is VERY important with these, try and pull the head of your arm INTO the socket when you do them. Also try and keep your shoulder BACK (but don't exaggerate this). i.e. don't let your shoulder move forward when the weight is at its lowest point on bent over rows.

Simply practicing sucking the top of your arm into the socket and moving your shoulderblade down and in to the middle of your back about 100 times a day can also help, even without weights etc.


I have just thrown this together, there are a LOT of things you can do to improve your shoulder stability and strengthen it PROPERLY to ensure good results in the gym, painfree with decreased chance of reinjury. If you need any more tips just give me a hollar.

Take care , Musculoman!

[liamg88]

Thankyou so much for the detailed response. My physio recommended the very same back exercises, as well as bringing my shoulder blades together as you described for ten reps every hour or so.

One thing I may not have mentioned in the initial post, is that I only get this pain when I do the movement very slowly. When I raise my arms, thumb pointed up. When I move more fluently, like normal arm 'windmills' if you like, I don't notice/feel anything.


Given all of this, should I take time off bench pressing until the slight 'catch' and momentary instance of pain is gone? Or is this unecessary? I have not been doing much military press since it happened, though I did do 4x10 reps earlier last week. I do a strength routine in the gym - bench press, deadlift, squat, power cleans, bent over rows, and usually military press too.

[Musculoman]

Hmm, interesting that it only happens when you move your arm slowly. This could be due to a few reasons which would take a lot of explaining in this post.

My suggestions are to continue your gym program if it is really only 1% residual pain as you described. Focus on good shoulder position and technique, continue with the exercises the physio gave you, stop any aggravating activities as soon as you feel them (can try dropping weights if any of your gym exercises provoke pain, if pain continues cut the exercise), and if following a few more weeks you still have the 1% pain, go back to your physio. He can assess how things are coming along and give you further advice. I strongly reitterate not to continue with any aggravating activities however, even if it is only a slight discomfort, as the last thing you want is to be back at SQ1.

Hope it helps, if things get worse / pain is still an issue in 2 weeks. Let me know as well, I will try to help out!

[liamg88]

Thank-you so much for the response. In the meantime should I keep icing it after every workout? I am icing it 1-2 times per day, for 15-20 minutes at a time. Would heat creames such as 'deep heat' be suitable? Or neither of these things?

Thanks for all of your advice, I will definitely take it and see my physio in a few weeks time if it hasn't improved. But I am obviously hoping it will.

[Musculoman]

No problem Liam, glad to help.

Most reasearch shows us that ICE is only effective for acute swelling up to about 48 hours, and you are well past that. I know it sounds strange but iceing it is likely not doing anything at the moment. If you feel it is irritating / flaring up still try to avoid those aggravating activities more or possibly try some non-steroidal anti inflammatories i.e. voltaren. I suggest the topical cream over the tablets, but it is completely up t you (please if you have any medical conditions / taking any other medications consult with your doctor before taking any medication prescribed on the interweb! )

You might find that heat creams could help improve things, but from a mechanical point of view you will probably still find the same issue. However heat creams can give you afferent input / make the body more aware of a body area during a work out and therefore improve local stability etc. Give it a shot, only just before your workout however, and see if it makes any difference. If not, don't continue using it.

Other than that just continue with my advice from the previous post, keep on top of your technique and with everything you do have that shoulder sucked in and in line with your body, don't let it fall forwards or draw backwards

Good luck! Let me know how things go.

Regards,
Musculoman.

[roycar]

hey, where exactly do you feel this pain when you abduct your arm?

could be something simple as an infraspinatus trigger point that needs working out..

[liamg88]

hey, where exactly do you feel this pain when you abduct your arm?

could be something simple as an infraspinatus trigger point that needs working out..

Hi there. I feel the pain in the corner of my shoulder, perhaps ever so slightly more towards the front of the middle.

I'm starting to get very confused as to whether or not I have always had this pain.....or at least had it for a much longer time than the recent event.....

In any case, it seems to have become better since I posted. I haven't felt it or thought about it really. I also did some light sparring and that was fine, didn't feel anything the next day.


Would anyone recommend buying one of those 'posture' correcting type braces that loops around the shoulders? Or are those just a gimmick or something that could potentially make things worse?

[Musculoman]

Hay Liam,
Bracing can help protect a joint during competition or high impact/velocity situations, however I would recommend ONLY using it for these situations. If you are in the gym etc. work without it. The reason being you want your local support systems to have to work to stabilize your joint. If you constantly use a brace to do their job, they will waste away and leave you in a worse position.

By the way, those exercises and stretches etc. we talked about earlier, continue them at least 4 weeks into not feeling the injury any more, and always keep good shoulder position when working out etc. or you will likely repeat the same injury. The hardest thing to do in rehab is to keep the ideals/exercises going after all symptoms have disappeared but it is necessary.

Let us know how it goes!

Regards,
Musculoman.

Edit: Sorry didn't see you said "Posture" Brace, similar thing though, people become too reliant on posture braces and they end up in a bad place. Continue your exercises and shoulder stability work, be aware of your posture and not letting that shoulder draw forward too much.

[liamg88]

The following post is quite long, so I made the essential, 'summary' part bold in case you don't have much time:

I do have one issue: I sometimes experience a dull, very mild ache in my shoulder-blade and down my left arm. I think I've had this on and off for a long time, again, it sounds stupid, but I can't be sure. It might just be recent, or I might just be more...paranoid now....., whereas previously I would dismiss it and not even think about it. I experience it more at night, and it disappears when I rest with my arm behind my head.

Is this an indication that my tendonitis is lingering in the background waiting to re-surface if I resume full sporting activities? I'm really unsure. Or is it perhaps posture related? Perhaps, rather than being a symptom of the tendonitis, could it be caused by the same thing which caused my tendonitis?

It seems to follow long time spent at the computer (necessary for study), but it may also follow working out (not convinced about the latter, because when I do my weight workouts, I may have spent hours studying on that same day...)

My basic paradox is this: I am doing less activity (no boxing etc) in order to rest my shoulder. This inactivity could be resulting in my current problem (dull mild pain referred to my arm/shoulder-blade but not felt near the site of my tendonitis), or that problem may mean I am not resting enough....

Sorry, that is very long and convoluted. I am just trying to figure out if this pain may mean I am likely to experience tendonitis if I up things again. If you think this may be the case, I will more than likely go to my physio to see what can be done.

best wishes,
Liam


Also, I will most definitely continue doing back work, such as bent over rows, and the ones we discussed. They're an integral part of my weekly routine

[Musculoman]

Hay Liam,

There are a few reasons why you may be having the ache, and honestly I would probably need to really assess you to give it a good diagnosis. Could be a hypomobile shoulderblade? (hypo = tight). The shoulderblade accounts for a lot of the movement in your arm, especially when raised above your head, and sometimes following a shoulder injury, as you have not regularly been using this range, the body's use it or lose it policy kicks in, and your shoulderblade stiffens up. Doesn't make much sense as should likely be more uncomfortable when you bring your arm above your head, but maybe this is stretching it out and relieving your symptoms??? It does fit into your clinical picture of rest making things worse, as your not ranging your shoulderblade / gh joint. Also tight Scaps can also lead to tight Tx/Cx due to rhomboids, lev scap/few other local muscles dysfunctioning due to altered GH mechanics / activity, this could be referring pain to your shoulder/arm? Do you feel like you have a tight neck/middle back @ all?

Keep on the gym work keeping that shoulder technique, and pec stretches etc, can take > weeks to start to resolve!! Just have to be patient and consistent with those.

You could possibly have some further damage to your shoulder which is the cause of this however. An MRI would give you an exact picture of your shoulder, the labrum, local bursae, muscles, ligaments etc. If you got an MRI and posted the findings on here, we could definitely help you more! However I am not going to advise you to spend $300+ on an MRI without assessing you first.

If you have had it for a long time.. could be postural related? could be something to do with the martial arts too? It is murderous for shoulders sometimes

Sorry, would love to assess you to really give you an answer once and for all

Just to clarify, this is not the sharp pain you originally posted about right? That has resolved?

[liamg88]

The sharp pain has resolved - the 1% I spoke of has all but disappeared... sometimes I 'think' I detect something, but it's so ridiculously minor, I can't even be sure!

I actually do have a tight middle back and neck (the neck tightness is what a layman such as myself would call 'upper traps' and 'low' neck, or something...) I am even experiencing this right now. Silly of me not to think to mention it....