Rotator cuff strain

[hypermobile_lifter]

Hi guys,

Hoping I can get some help with a shoulder problem. Read a few interesting threads here, nothing particularly specific to my problem though so thought I'd ask. Sorry if it's a bit of a read, I want to provide as much info as possible.

I've been weight lifting for about 6 years, for the most part ensuring with good form and a balanced routine accompanied by thorough warm ups and warm downs. I also tend to see a physio every couple of months to try and minimise stresses caused by the gym and the hours spent sitting at a computer in work. I try to do a lot of stretching, especially of the chest.

I'm hypermobile, not badly as I've never dislocated anything (or broken a bone for that matter), I just get cracking and popping in my fingers, left elbow and both knees. The last couple of years this has also spread to my shoulders, though no pains and no problems lifting. The cracking does get worse though the busier work is and the less I get to stretch as a result. I've found if left things start to get very tight and I get cramp in the shoulders. They've also always been fairly inflexible despite the stretching I do nowadays.

Anyway here is my problem: 2 weeks ago tomorrow (Fri 26th July) I tried lateral raises done with the thumbs down, using cable machines, the thumbs down part being new to me. I did 3 sets to failure, there was no pain, just what I thought was the feeling of the medial deltoid being worked at the time. After leaving the gym my shoulders felt very strained. I woke up the next morning with a loss of mobility and a fatigued feeling. I trained barbell back squats that day but had to alter my grip on the bar as it was causing a sharp pain in the shoulder.

A couple of days later this had seemingly all cleared up and I did my usual heavy chest session with no pain or loss of strength. However two days after this (last Weds) my right shoulder started to feel painful and cramped at random and was clicking more than usual. There was no pain with lifting so I trained shoulders and back as normal over the weekend.

This week my shoulder has gotten worse, I'm getting occasional sharp pains running down from around the end of the collar bone in to the bicep and a pinching sensation at random with movements. However no certain movement seems to cause this, I have full ROM with overall no pain and I've also tried tests such as the painful arc test with no positive result. My shoulder is also still cracking a lot more and I've found there is like a ticking noise when I abduct my elbow to about 30 degrees then rotate, though no pain and maybe this has been there a while?

I've spoken to two physios I trust, both which have said I've probably just strained some thing to do with the rotator cuff. They differ in advising how to deal with it though. One said keep training but go light for a few weeks. The other said do nothing for a week, then it should be fine! They both recommended hot/cold treatment, which I've tried with little difference.

I tried some light bench press last night, which felt hard and a little funny so it's definitely got worse the last week. I also squatted though and found no sharp pain!

I'm confident whatever I have done is due to the lateral raises, which had I not done I probably wouldn't be experiencing this problem now. I'm struggling to clarify what I may have done plus how to go about dealing with it though??

Again sorry for the long read, I'm really worried about this going chronic and becoming a real ongoing problem.

Any help is great appreciated.

Thanks in advance.

J

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[physiobob]

Hi Hypermobile_lifter,

First I'd like to comment on your comment 'I'm hypermobile'. The word on this in general is don't stretch as much as you need to develop stability through range of movement and not passively stretch. What often happens is muscles become overactive to compensate for the hyper mobility and the result is that they try to 'fix' your posture. Often I see people with poor posture who think they are stiff at a joint level when in fact they actually display underlying hyper mobility. In reality they need to train the muscles to develop strength throughout the available range of movement. If not they will just fix in one position, cause 'popping' and will leave the person prone to injury when things fatigue. From your description this sounds a little like you as well

Why would you do 'lateral raises done with the thumbs down'? This is an internally rotated humerus that is compressing the joint more anteriorly and is a most abnormal movement. It is also preventing the rotation posteriorly of the clavicle during shoulder elevation (not that might have upset the AC joint a little and a physio etc should mobilise that for you in various shoulder ranges of movement to check and free it if necessary). You could just do bent over bar bell or dumbbell rows, seated cable rows, reverse fly's etc to hit the rear delt's in a more normal fashion. One rule of thumb in the gym is ALWAYS see if you can find a real world example of your body moving in the way you are training it. I can't think of one for the little idea. Nor for that is the lat pull down behind the neck. No one does this for anything in real life. Pull in from of the head yes e.g. Lifting yourself up to look over a fence etc but behind just causes poor thoracic posture and neck compression. This is a common problem that will in the end result in shoulder issues as well.

Many of your symptoms seem to me like nerve issues. Compression of the neck or aggravation to the nerves that supply the lateral deltoid region can cause pain and also fatigue in that region. These are different to the nerves to the pecs and triceps which is probably why you bench pressing was OK.

For my two cents worth you have a mechanical issue. Hot/Cold will do nothing, nor will any tablets. You need some neck mobilisation, maybe some neural stretching and also checking of the AC joint and Sternoclavicular joint. I would put a rotator cuff strain a little lower on my list of culprits if the injury came from the exercise you mentioned as this is not likely to have caused trauma to the supraspinatus (but could have strained the posterior cuff I suppose).

Also ask the phsio to give you things to mobilise the upper thoracic spine into extension and the cervicothoracic junction segments as well e.g. ask them to show you how to do retraction and retraction/extension (later with rotation) of the lower cervical spine to make sure you aren't developing a thoracic kyphosis and pocked neck posture.

Let us know how you get on and thanks again for the detailed thread.

[hypermobile_lifter]

Thanks for the detailed response.


I've always found the stretching alleviates any cramps from long days of sitting down and limits the amount of popping from my shoulders. I've normally followed a balanced powerlifting routine but decided to change it up a bit recently.


Sorry I should have been more specific regarding the lat raises with the thumbs down, I didn't mean vertical to the floor, more of a slight angle, as in say pouring from a jug. The aim in this was to target the medial deltoid more, I read about it in a bodybuilding book, though after googling recently I wish I'd never tried it as the general online consensus is that it's a bad exercise.


Also though last week's heavy bench pressing was fine when I did it again yesterday a lot lighter my shoulder did not feel right.


Would these points perhaps change your train of thought on my injury?


Thanks again

[hypermobile_lifter]

Just to add my shoulder hasn't been feeling too bad this afternoon so I tried some light ROM with a resistant band to test it, I found that with this certain abductions would cause a pain.

Cheers

[physiobob]

The comments in general I think would still stand although if it was more just cable flys then you can impinge the supraspinatus tendon when doing it. It the rotation angle was a new one for you then it is very easy to strain the posterior cuff as they are relatively weak. It is more unlikely with a trained individual to strain the medial delts with this exercise unless there was a lot of cheating with the body involved? It does sound like things are resolving but perhaps look more towards some external cable arm rotations (elbow at 90 degrees), cable horizontal. Especially work/resist the eccentric action as the hand moves back across the body. That eccentric strength and control is an important once in balancing out the head of the humerus at it rotates on the scapula.

[hypermobile_lifter]

No wasn't cheating, was trying to keep the form strict.

It's feeling a lot worse today, think the ROM testing last night was a bad idea. Too much, too soon perhaps.

Have booked in with a physio, will post how i get on.

Cheers

[hypermobile_lifter]

Forgot to update this. The physio diagnosed it as shoulder tendonitis. He said he could feel some scar tissue and gave it some ultra sound, massage and finally some stretching. There was a big difference that was apparent immediately after the session. I was told the cause was probably just going too heavy too much as I had previously spent a few weeks of very heavy low rep training at the gym.

Since then I've varied the rep ranges a lot in the gym, I have however found I get a niggling in the shoulder from time to time which lasts a few days then disappears again. No activity in particular seems to cause this and it is no where near as bad as it was prior to physio. I'm planning to go back for a follow up though.

What does concern me is that I still seem to get a lot of popping and cracking from the shoulder, at least more so than the other side.

[toddchaney]

Hi Hypemobile, Your doctor is right. Too much gym seems like the cause of shoulder tendonitis. It may also occur due to sleeping on the same arm each night or working with the arm overhead for many hours or days. You should start physical therapy to learn exercises to stretch and strengthen the muscles.If the pain persists or if therapy is not possible because of severe pain, a steroid injection may reduce pain.Wish you a speedy recovery.