Number of Problems - Hoping for some input, to help out my physio!

Hey everyone, new guy here, finally, ive found somewhere, where i hope i can gain some advice and knowledge on some problems that have really been bothering me as of late.

I am currently seeing a physiotherapist, and am seeing her again tomorrow, not to disrespect her or anything like that, but where i can only see her every 2-3 weeks which isn't that often seeing as my problems affect me in everyday life, i was hoping to gain some knowledge and some suggestions from you guys here.

Ok, well, to start off, this isn't just one problem unfortunately, there's several, which is the way with me, everything happens at once, whether it be bills, work, you name it, so that's just the way things happen with me :p

I am really passionate and into fitness and lifting weights, i run, lift weights, and hope to get into some form of kick boxing soon when im 100% functional. If it helps, im just 19 years old, around 5'10-5'11 and about 165lbs.

I'll try not to keep you guys bored with an essay, and try to list the problems which are most bothering me as of late first incase i end up boring you guys, ok here goes:

- Shoulder pain/Lack of mobility:
This, i think is the right name to call the problem, it's not a lack of flexibility as my shoulders are quite flexible, however, ive noticed during certain activities that ive been getting pain in my shoulders, and it's yet another problem i'll have to bother my physio with tomorrow! She must hate seeing me ;)

Anyway, I used to do a lot of skipping/jump rope as i enjoyed it a lot and found it a good way to train, shortly however, i noticed i couldn't do it, as after anything from 2-5mins my shoulders would feel so fatigued and exhausted along with some boney pain, so this messed things up here. I also notice during certain weight exercises like Overhead Barbell Press, Wide grip upright rows, Dips, and in cardio sometimes for example - running. Im being kinda brief on this i know, but im not sure what the actual cause is, it seems as though my collarbone could be linked to the problem as that sometimes hurts, also if there's a chance it could be connected, my shoulder blades sometimes hurt and seem to flare out quite a bit, my physio says i have some bad posture in my neck, which i can understand would affect the shoulders, but i wouldn't of guessed it to be to this extent so im wondering if there's more to it:

- Neck Weakness:
Thought it would be ideal to carry on here after just linking this part to the above, the physio says i have some bad posture in my head, so im guessing forward head posture of some sort, i personally don't feel it's that bad right now, and i have made many changes to my daily lifestyle, like sleeping with 1 pillow, having the computer screen at eye level so im not looking downwards on it, using a pillow as a chair back support etc. It's been coming and going the pain, although it does bother me on most day to day basis, ive been doing some exercises to counter the problem which ive researched myself, such as lying flat on the floor and bringing my neck and shoulders up as much as i can for 3 seconds, repeating 15 times, so sort of like an upper back extension.

Boney/Muscular Pain just below low back:
Ok, for this problem, my physio believes it is more muscular than anything else, basically i was noticing that everyday that around my lower back was hurting just from sitting down, if i woke up, i would have to walk about and do stuff so that i didn't have to sit through the pain. The pain comes mostly from what feels my pelvis, the Ilium part, and some part of my tailbone at times, she says i am very tense around my stomach and this is putting more pressure on my back and causing the pain, i have since then been working on breathing through my abdominals much more and it has helped reduce the problem although it's still there, i have bad and worse days with this problem, i was initially worried that i was messing up my back with the weights - deadlifts, but i have been checked on numerous occasions by coaches on my technique and they all say it is fine and i never really experience pain doing them so i wouldn't link weight lifting to the problem of most of my problems, although it seems to get the blame a lot of the time from my parents!


Knees! Ligaments at back of knee?
For these, i noticed it a good couple of years back, occasionally it would feel as though some ligaments were twisted, and caused pain, but this happened only very occasionally, then more often i noticed they were becoming a problem, i did some research and thought it to be some sprains to either my MCL or LCL's, it's on both knees by the way. The ligaments just feel so weak, as they cause pain cycling so im limited to just light cycling, as i feel the pain from the back of the knees affects the overall knee and causes pain, it also affects me squatting and running from time to time and i would like to get the pain completely diminished. I think the physio again said it's more muscular and that she will try working on the problem in the upcoming sessions. I also looked into Osgoods schlatter disease but where im 19 and it's both knees, i would of thought that it wouldn't be likely to be that. For around the past month or so ive been finding it hard to walk on my right knee, and have been limping at times just to walk, trying heat, pain killers, ice, rest, everything, nothing seemed to work, i bought a foam roller the other week and started rolling my IT band and i haven't been limping as much, although the ligament weakness is still there.


Just my own concern here:
I don't want to add yet another problem for my physio as im worried she'll end up thinking im messing her about, they are most of the problems above, although i have a concern here that im worried about and may not be as hard to identify as those above:
My elbows feel kinda weak, and my left one clicks/cracks all the time, i used to do an exercise called french press a while back when i just started out lifting and not knowing what i was doing, like an idiot i was getting some pain in my elbows but didn't realize i should of stopped, so it could be from that, but at times my elbows just feel so tender, my left one more weak than my right, after dips, pull ups, anything like that, they can feel weak and tender, i was wondering if i have some form of tendinitis, even so, ive rested for long periods on numerous occasions and the problem still persists.


If you are STILL reading, then you truly are a saint, i hate to write essays like this as it must be so much hassle just to read them, which is why i listed the problems in bold as i wouldn't expect one person to know everything! I hope you guys understand my concerns, im someone who likes to be active and have a lot of goals i would like to meet, but of course to stay healthy and meet those goals, i have to be 100% functional and able to train, i have taken a good couple of months off and am starting to do some exercises occasionally to help stimulate some of the muscle i have built, along with keeping up some of my strength.

Thank you all so much for reading this, i can't say how much i appreciate it, as it may take a while for my physio to solve just one problem, let alone at least 4 others! Thank you again so much in advance, and i will update after tomorrows physio appointment if anything changes there, thank you and god bless :)

Hey everyone, i just thought id update my situation as i have seen the physio.

She said that my hamstring tendon which is connected to my knees are really tight and that it's prevent especially my right knee from fully straightening, and that the knee is then placed in a non anatomical position which can cause pain. She gave me a few stretches to do which i will stretch a lot for the next 4 days until i see her again, i then brought up about my shoulder pain but she said to avoid exercising like skipping and running as it may shorten my tendon which im stretching.

This is kinda what i don't understand though, surely exercise is good, running in particular, when im limping to walk, after running i feel better and can walk much more easier, perhaps if i stretch and still run it may help?

For my neck she said the bone and all is fine but she feels it's muscular weakness, so she suggested a neck strengthening exercise.

Bump, would like to get some opinions and thoughts :)

Anyone have some input to help me out?

Hello I am a senior physio and we see problems like yours everyday.
Whilst it would appear you have a number of problems it is likely they are linked.
I think that the primary problem is to do with the sacroilliac joints it would fit in with the symptoms you are describing and can cause referred problems to knees and also thoracic/cervical spine. Sometimes small biomechanical problems can cause an array of symptoms also these would not show on xray, you cannot see anything other than bone on xray. Obviously I cannot diagnose without examining but if you were my patient that is where I would start. I hope this has been helpful.

Hi JBL.

You've listed quite a few issues here, which sound like they are all related. Before I come onto any of these, I must stress that your physio is dealing with them, and it would be wrong for any of us to butt in and possible negatively impact her treatment programme. Having said that, I will offer a little of my insight using the information you have given. Please note though, that without examining you myself I am not getting the whole picture...

You sound like a very active young man, which is not a bad thing considering most people of a similar age are fairly sedentary. However, you do sound like you're overdoing it, and probably have been for a while. Without meaning to sound patronising, you are only 19 years old, and as such you are still developing and growing. Let me explain what I'm getting at: your bones can often grow quicker than the soft tissues (eg. muscles, tendons, ligaments, etc), and often this leads to an imbalance between these soft tissues and your bones. This means that when you are exercising, your muscles and tendons are working in a shortened position and have trouble working at those lengths. This is especially true for what we call "two joint muscles", eg. your hamstrings. Without going into too much detail, these muscles will be working at a mechanical disadvantage, and with repeated loading over a length of time will become more prone to "failure", thus causing a range of possible symptoms. Now your body works as a unit, meaning that all the tissues are connected, so imbalances in one area will cause problems in another. So starting with your hamstrings (I like to start from the ground up), these are connected to your pelvis by not only tendons, but also a sheet of tissue called fascia. This fascia is a link between your hamstrings and your lower back (have a look at Anatomy Trains | KMI | Welcome! for some more info, and especially http://www.anatomytrains.com/uploads...nsOverview.pdf). This tightness is likely to be pulling on the "myofascia" in your lower back, as well as causing your pelvis to rest in a position of "posterior tilt", which means the back part (the arse side) is lower than the front side, which amongst other things also results in tension in your lower back muscles. If you think of how gravity acts on you, this means that in effect you are falling backwards. So how does the body react to this? Well obviously it tries to compensate by activating the muscles on the front of your body to regain some kind of equilibrium. This includes your abdominal muscles, especially your six pack ones, which can tighten and shorten as a result. Now let me catch my breath before I continue...

The reason your knees feel better after running is because running warms up the soft tissues and therefore makes them more stretchy. Stretching before running is unlikely to help (it may make things worse in fact), and when you have cooled down the problem returns. If you insist on running, then I would suggest stretching as part of the warm down (you do a warm up and a warm down don't you?). You have said that exercise is surely good, but this always depends on what the exercise is, and how you are doing it. Just bear in mind that your knee problems return when you stop exercising, so the underlying problem is, as your physio has said, likely to be the shortness of the hamstrings. You must also remember that symptoms often do not start when you are actually doing the aggravating exercise, but there is often a delayed reaction.

As an additional point, you have said that rolling your ITB helps the limping. This suggests that you have some ITB trigger points, which will affect the biomechanics of the kneecap on that side. This problem may be caused by some weakness in your gluteals, which seems even more likely when considering that you have probably been compensating for this by using your hamstrings, for example when doing dead lifts. The gluteal weakness may also be causing the sacroiliac problem that dibrace has suggested, or vice versa. As she has said though, this is only a possibility!

I would also like to make a point about weights too. I will stick my neck on the line here and say that they probably are a major contributing factor to your problems. Whether your technique is correct or not, the actual amount of weight you are lifting, the frequency, reps, etc, play a big role here. As I have said before, symptoms often occur afterwards, not during the exercise itself. Muscle fatigue and spasm can set in hours or even days after lifting, and if you are doing weights frequently then it has a cumulative effect. I would like to stress again that I think you are probably overtraining, and also not giving your body enough of a chance to recover either. It would be really useful to get some more insight into what the goals you have mentioned are, as well as your specific training regime.

Now moving on to your upper body, again these are likely to be linked to the problems in the lower half. Doing some of the exercises you have listed is likely to be overdeveloping some of the powerful muscles in your back, such as your lats (lattissimus dorsi) and you upper trapezius, at the expense of the stabilising muscles in your shoulder. Let me explain what I mean: the shoulder joint is very mobile, but this mobility comes at the expense of stability. While most joints are stabilised by powerful ligaments (eg. the hip joint), the shoulder has weak ligaments, and as such is kept stable by the muscles. These muscles are the rotator cuff in the shoulder joint, and other muscles (eg. serratus anterior), which stabilise the shoulder blade (scapula). These muscles are often weak, especially in weight lifters. This may come as a surprise to you, considering all the training you do, but please realise that when you are training, you are unlikely to be working these muscles. Instead you are using other muscles (eg. lats and upper trapezius) to do the work of stabilising the shoulder. Unfortunately, these powerful muscles are meant for powerful activity, such as climbing, and in short bursts (they contain fast twitch muscle fibres), but are not very good at slow sustained contractions, which the rotator cuff muscles are (they contain slow twitch muscle fibres). When you are doing weights, the power muscles are working overtime trying to stabilise the shoulder and lift the weights! They therefore fatigue very quickly and cause pain and instability. To relate that to your symptoms, the lats are connected to your shoulder blades. The collar bone is attached to your upper traps, plus you are probably overworking your pectoral muscles, a sign that you may again be overdoing the weights (think amount, reps, frequency, etc).

Onto the neck: stick to the strengthening exercises your physio has given you. These are likely to be strengthening the right muscles (ie. stabilising muscles in your neck), rather than just working on the power ones. Doing the exercises that you researched (they sound like prone neck extensions - lying on your front and lifting your head) will just develop muscles such as your upper traps, which don't sound like they need any more help! Overworking the power muscles will actually make your neck posture worse, not better.

Regarding your elbow problem - TELL YOUR PHYSIO ABOUT THIS! Please always try and give health professional the whole story, and not just fragments of it. Telling us about everything gives us a fuller picture, and as I have said, problems are often connected. If your elbow is clicking, then I would be very wary of doing weights. It might be worth getting your elbow scanned just to check that you have not injured the cartilage, which can be a problem for people (especially male) of your age.

I hope that what I have said makes sense. I do understand you have many goals, and you sound like a very driven individual, but sometimes you can be your own worst enemy. The important lesson is always to listen to your body. Although you have no problems in your back and neck on X-ray, these problems do develop over time, and can cause you some nasty symptoms when you get older. Training and exercise should be at the right pace, and if you overdo it you are taking one step forward but two steps back. If you train too hard ("just five more minutes", "just 0.5kg more"), then you can trigger an injury that can take months to heal, meaning that you can't train at all. Do tell me your thoughts on this, and keep us up to date on your progress. I'm sure that other physios will add their thoughts on the subject too.

I hope I haven't discouraged you in any way. Like I said, just remember to train right and listen to your body. Give yourself time to recover and vary your training programme. Pain is usually a warning sign when it starts, and often means you are doing something wrong and need to correct it.

Anyway, take care and stay healthy!

Mike (musculoskeletal/rheumatological physio)

Sorry I meant KJB, not JBL!