Shoulder clunking, easy fix on the left?, harder on the right...

[oversight]

Hi, First post, I have seen some excellent advice in this forum, so was hoping that you could help me.

Two shoulder problems... Easiest First.

Left Shoulder (my good shoulder) I am right handed, athletic, 40's, no specific sports played, but plenty of general exercise in the gym and outdoors. Desk jockey during the day.

I tend to sleep on my left shoulder because my right shoulder pains me a little, but more on the right shoulder later

My left shoulder is excellent in most regards, no clicks or pops. Recently I have started doing more chin ups, typically with the neutral grip (palms facing each other).

If I allow myself to descend to the bottom of the chin-up hang position (not even necessarily a dead hang but just down to the bottom still with some muscle tension) my left shoulder will clunk/pop substantially. It feels like the head of the Humerus has just turned a little in the socket and clunked/popped. There is no pain.

Obviously I try to avoid this by not descending completely, and deliberately tensing the shoulders at the bottom of the chin-up hang. This prevents the clunk. I have also notices this clunk occasionally during single arm overhead presses with the left arm.

Can you please provide any advice you might have on stretches or strengthening exercises that might specifically prevent this? Of course you might like to read about the right shoulder first as it might provide some additional information.

The Right Shoulder (problem shoulder)
This shoulder has improved a little recently..but previously 3 years ago? I wouldn't be able to sleep on this side, at all, now I can lie on this side a little. I had a pain in my right wrist, that in hindsight I believe was just a symptom of the shoulder and saw a surgeon over this, there was a dye contrast? scan and MRI done of the wrist but no tears were seen to the suspect bit of fibro-cartilidge, so I left it and have tried to rehab the shoulder off and on since then.

I am a little more determined now, and really want to focus on this shoulder until it is completely correct.

As long as 5-10 years ago I would have stopped bench pressing, due to pain around the front of the shoulder, around the AC joint. (Yes, I would have landed on it once years ago and nearly popped it out while diving for a frisbee[IMG]file:///C:\Users\Desktop\AppData\Local\Temp\msohtmlclip1\0 1\clip_image001.png[/IMG] and it might be a bit worn). I probably haven't been as diligent over the years at doing my pulling exercises as I should (but that's all changed now). I can do push ups, but too many might aggravate it.

The other day I jumped in and did a few sets of chins and pushups. There was only a straight bar available for the chins and I used the overhand grip, palms facing away, rather than my usual neutral grip. There was no pain at the time. But the next few days were hell. The right shoulder was sore around the A/C joint but also more generally around and behind that lump of bone that I can feel on the top of my shoulder.

Also more generally if I overhead reach, or behind the back reach, like when pulling a sweater/jersey on there will often be a pop in this shoulder, like a tendon/ligament snapping over bone. I don't like the feeling and I am always thankful that it did not happen under load.

I think my shoulder posture is a little forward slumped generally from working at a desk and mousing with the right hand. I have seen various physios for the injury, there is no specific diagnosis. I have great range of motion in this area, possibly a bit of weakness here and there in the rotator cuff otherwise general strength in the area is good, myself I would guess a little winging in the scapula. (I am also working on my desk bound lordosis which is coming along with some glute activation work and a return to deadlifting)

I have been a bit intermittent with my shoulder rehab exercises in the past, but have done plenty of stretches, push up plus's, external rotations, seated rows, etc... I have found that overall nothing has given me more relief that making the conscious effort to retract my scapula when seated, driving, or about to make a reaching movement. I would like this retraction to be a little less conscious and more natural however.

My best course forward would seem to be to knuckle down and really focus on building the strength around this joint. I have decided that I might also need to massacre the front of my shoulder, top of my right pec/deltoid area with a little self trigger point massage. I used to get a lot of DOMS in this area after bench pressing, and perhaps the area is a little chronically tight also pulling my shoulder forward. Perhaps I also need to focus on my serratus anterior work.

For your consideration and any advice.

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[kcho]

Since no one has answered, I think I would give it a go :P

When there isn't a clear diagnosis, and you've been to physiotherapy, I would think your problems are bought on by your postures.
At your age, your joints are probably starting to get stiffer, and maintaining the absolutely best posture is probably very difficult. I think you are heading the right direction, putting more attention on the posture. However, have you thought about the possibility that you may have done too much?? Of course, its kind of premature of me to suggest this before actually looking at your posture.

From the sound of it, I think you're probably doing too much rather than too little. Just take a minute to think about what you do when you correct your posture. Do u tense up your back muscles to keep your back straight? Have you ever checked that you could be arching your low back too much?? your winging scapular....why is it winging at all......is there a nerve palsy?? probably not.....my guess is that you keep you shoulders forward most of the time, not that you do it intentionally, but rather a result your increased thoracic kyphosis, so causing excessive stretching tension to the serratus anterior. No amount of strengthening would work for your winging, because no matter how strong it is, its endurance always has a limit. What about the head posture, have you read anything about "forward head posture" yet. Head, scapular, upper and lower back are all connected into one functional piece, and you cannot change any one thing alone. you need to consider all of them as a whole, change everything at once. Afterward, you can work on your hip position...but don't worry about that right now.........its getting too complicated at once already.....

Research on "Alexander technique". It is about finding the most efficient way to use your body, i.e. eliminate excessive tension. It has worked wonders for a lot of people, and after what it did for me, I've been recommending it to a lot of people. It is useful in more ways that you can comprehend, but its only good once you truly understand it. I would suggest read some books, watch videos (youtube), and maybe take lessons too, mind you they are expensive!! Its actually a difficult concept to learn initially, but if your are a "Determined Rehabilitator" you should have no problem. It took me ~2 months to start seeing progress....so keep at it.

Good Luck.

[neurospast]

Both your shoulders have the same problem, well I think, but at a different stage. Your right is the worsed of the 2 but don't be surpriced if left will catch up with right! What I read is that you are doing a lot of work in the gym. Personally I think gym work has a tendency to cause problems: 1 majority of exercise are focused on the front (mirror side of body) Big pecs, huge upper traps, even bigger Latissimus Dorsi. What the mirror doesn't show is the back where all the compensation can be seen for all the easy muscle pumping exercises which have enhanced the front. 2) every one goes to the gym, hardly anyone has a clue what they are doing, tendency to push more weight then reasonable (well gyms and competition goes together I suppose).
My point is that most likely you have created a disbalance between internal and external rotators, having a poor control of your scapula movements and none excisting Rotatorcuff function. All control being destroyed by the power muscles taking over functions regarding Scapula and Gleno-Humeral control and strength. Just to give you an example your clicking on the left is likely caused by tight internal rotators (check length of Pectoralis Major, Minor and Latissimus Dorsi (how to do you'll find likely on the net) Check weakness of external rotators.
By the way when you move your arms above your head with elbows straight, do you have to move on some directions your head forwards? Are you able to look at the ceiling or do you get some pain at your neck when doing it?
To be honoust you need to see a Sports- physiotherapist or a good sports therapist to get advice on these problems. That you had an MRI of your right shoulder? should give you a hint of how severe these problems might be (maybe not today but next year or the year after)
Hope to have scared you enough, good luck. I do not think it would be a good advice to give you exercises as so because shoulder problems tend to be more complicated and can respond very badly with the wrong advice on exercise.

[oversight]

Hi kcho,

Thanks for your advice, I think that you are right, age, and posture, has started to bring on my demise. I have certainly had too much time with the shoulders slumped forward and I am starting to correct this now by consciously pulling them back during those activities, like typing this reply Thoracic kyphosis... I had not thought about much until recently, when I returned to overhead lifting. I have started to stretch out the upper back by lying down and stretching back over and using the foam roller like a hinge. My head posture is generally good, I don't have any forward cant or thrust, and don't 'chicken neck' while I am exercising.

Thanks again for your advice and encouragement, I will have a look at the Alexander technique, as I think I do just need to notice and hold myself better at all times, but I will continue to try and strengthen the shoulder girdle and serratus anterior at the same time.

[oversight]

Hi neurospast,

Thanks for the advice. I think there are some tight internal rotator issues, I have done some stretching for them, and the standard external rotator exercises. I think now I will try to focus on some trigger point release around pec minor as this might have gotten a bit strained/stressed in the (distant) past with bench pressing type movements. I have stayed away from all the mirror muscle exercises for some years now focusing on the more functional movements, and now I am trying a little Olympic lifting.

Flexibility is good, I can stand arms straight overhead, or pulled back further, move them any which way, and look around with no pain. I am noticing perhaps a little tension at one point in some muscle that is around the front of my clavical (I think its more a connective tissue area than any muscle) so I will work with some pressure on that area as well.

I have started Chin ups with the neutral grip, I thought being a back exercise, these would be a good option? Or is it not so good to build the Lats with these, am I better with a rowing exercise. Also I thought I might now try doing some of these band pull-apart movements daily.

Your thoughts?

- - - Updated - - -

Also, why am I finding palm forward chin ups painful for the shoulder, but neutral grip not painful? I am assuming that its to do with the degree of rotation that the different grips put on my humeral head, but don't understand how this might relate to the underlying condition.

[kcho]

To Oversight,

I do not think it is possible to have "Thoracic kyphosis", and not have protracted neck at all. Maybe yours isn't significant, but there is usually some level of it. Look up "Deep Neck Flexor exercise" while you are at it, and also "cervical spine retraction extension exercise". Don't do too much of them.

The Thoracic spinal stretch exercise, you should have your arms relax and out to the side at 90degress, allow head to relax and drop down onto bed, don't use pillow unless you have more than mild pain in the neck/dizziness. Use the head and arms' weight to stretch the spine. Perform with the roller at T1, T2 and T3 (top 3 levels of thoracic spine), hold for 2 minutes each.

Neurospast stated a good point. Make sure after training your muscles, especially shoulders and back muscles, you also train them to fully relax. It actually takes effort in the beginning, because its not easy to notice those low level tension in the muscles when they are there most of the time. I have personal experience with this, and found the process of self hypnosis, really helps.

Have fun!