Weakness in shoulder after muscle injury of Levator Scapulae

Hi Guys! I am Kushal, 29 years of age. I have been doing gym workouts regularly for more than six years now. My workouts have always been moderate, not heavy (lift a maximum of 45 Kilograms on bench press and my workout lasts not more than 1 hour). I was working out regularly and stopped eight weeks back, after an injury happened. (I would add here that I had not made any sudden or abrupt change in my workouts just before the problem occurred.)

On June 9 2010, I had a suspected muscle injury in the left shoulder muscle which caused pain in left shoulder and nerve compression that resulted in referred pain in left arm and slight numbness in one finger. The pain didn’t start suddenly during my workout in the gym, rather it started in the middle of night while I was deep asleep.

The orthopaedic physician and physiotherapist to whom I went initially both diagnosed “cervical spondylosis” and prescribed me physiotherapy (a combination of diathermy (heat), cervical traction, IFT for initial few days only, TENS, Ultra Sound and some Isometric exercises at home). Another physiotherapist whom I consulted to get a second opinion said that “prolapsed disc” was causing pain and nerve compression.

After taking 17 continuous days of physiotherapy I realized that the pain and numbness had reduced considerably but was not going away entirely. So I consulted another physio. This guy listened to my case history and pain symptoms and diagnosed muscle injury (of Levator Scapulae muscle or some other shoulder muscle) as the cause of pain which was also resulting in the nerve pinch, which in turn, caused referred pain in left arm.

So as it turned out, the earlier diagnoses were all wrong. It was neither cervical spondylosis nor prolapsed disc, but was a muscle injury.

At present, I am doing the following stretching exercises 3 times a day, as advised by my latest physio (holding the position static for 10 seconds in the terminal positions of each movement and repeating each set ten times):

1. bending the head up and down (so that the chin touches the neck in down position),
2. bending the head sideways (laterally),
3. rolling the head clockwise and anticlockwise,
4. shrugging the shoulders,
5. stretching the chest keeping both arms folded at elbows (to exert pressure towards the spine in the back),
6. rolling the shoulders round and round in circles (both forward and backwards)

I have been doing the above exercises regularly for past 6 days and have experienced a lot of relief. The pain in shoulder (in levator scapulae muscle), referred pain in the left arm and numbness of the index finger have all disappeared completely. But there is something that still bothers me:

I tried doing a simple push-up (dip) yesterday and felt that I have lost strength in my left side- My left arm and shoulder together are not able to support and lift my body weight for long.

Should I be patient and continue with the exercises advised by the Physio at home and hope that complete recovery and restoration of strength would happen by itself? In how much time would that happen (at least an approximate estimate)?

I am worried about how long (how many weeks or months) would it still take me to resume my gym workouts, even if it is from light weights? Please give at least an approximate time period.

Its easier to diagnose and treat a condition after trials of therapy because you get an idea what works and what doesn’t for the history.
To sum up you treatment:
1. Electrotherapy works
2. Soft tissue release works better
3. There is residual weakness
But, is that the full story?
Have the joints been assessed and treated
Have the nerves been assessed and treated (neural mobilisation assessment)
Mobilisation with movement (MWM’s) are great way of identifying suspect arthrogenic issues because of the instantaneous response one gets from these techniques. If the pain increases with the technique (when done properly) and there are no neurogenic signs and symptoms this will identify whether myofascial assessment needs to be done. MWM’s are a great treatment direction test (TDT).
The myofascial assessment technique is based on the hard work from Italian physiotherapist luigi stecco and his wife Carla stecco an orthopaedic surgeon called myofascial manipulation. A recent study performed by Australian physiotherapist Julie ann day used this technique to treat shoulder pain: Application of fascial manipulation technique in chronic shoulder pain: anatomical basis and clinical implications.
The crux of the technique is assessment of the myofascia will direct treatment. The technique is based off the 12 meridian channels of tradition Chinese medicine. So go get a copy of the 12 meridians so you can follow the next part of this discussion:

The lung meridian is correlated with shoulder flexion
The small intestine meridian is correlated with shoulder extension
The heart meridian is correlated with adduction
The large intestine meridian is correlated with abduction
The pericardium meridian is correlated with internal rotation
The triple energizer meridian aka triple burner is correlated with external rotation

To assess perform shoulder active range of motion into flexion/ extension, abduction/ adduction and external / internal rotation. Then perform the diagonal which are a combination of the 3 cardinal planes ; saggittal, frontal and transverse planes.
Identify any limitation and painful responses in the planes of movement whether pure ; flexion or extension, abduction or adduction, internal or external rotation, or a combination of the two planes mentioned above. Identify the correlated meridian of the plane or planes and assess that meridian along the arm line. Break up the sequence into shoulder arm foream and wrist/hand and palapate each segment to identify lesions along the myofascial meridian. Identify the active trigger points and latent trigger points and treat accordingly to resolve these lesions.

For example :
Levator scapulae is where you feel pain when you move your arm into abduction which will correlate with the large intestine meridian. Palpate the large intestine and its opposite meridian the heart meridian in the shoulder segment only to identify lesions; trigger points, treat the active trigger point if there is no active assess the arm to identify the active trigger point and so on until you find the active trigger point along the myofascial meridian.
If a combination identifies the limitation the treatment focuses on the local retinaculum of each joint and the division between the two myofascial planes.
Try before you buy and let us know how you go. cheers

Hi

You can resume your workouts but you need modify it.I assume after two weeks should be much better.
take care
Jarek
Fizjomanual I Fizjosport - Start

Hi dude,
From what you told us, I suggest you can resume your gym training, but start from lighter weight at the beginning. This would stimulate the muscle to grow and get back to your pre-injury stage as you train up gradually. It's just like those athletes doing. No worry,

Take care