sever pain

[anoodyPT]

hello happy new year everybody

I just started in gym 2 weeks ago, last thursday's morning I felt sever pain ( deep pain but ican not determine its nature) at inferior border of right scapula ( insertion of remboid muscle)

pain is increased with antigravity position ( sitting and standing) and with expiration also and decresed so much with lying supine or compression ...what's this i am afraid I have serious problem

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• sever spastic patient

[gcoe]

Can you tell us. Bit more:

Did it come on suddenly or di it build up over time. What ere you doing at the time or just before
What did your gym program me consist of
Describe what the pain feels like
Can you make the pain worse by certain movements of the trunk or neck -if so what movements
Is the pain always there or is it intermittent?

[taiger111]

when in standing or sitting positions, muscles to stabilize shoulder(rotator cuffs and rhomboids major minor and lower traps are in demand more than
in spine or prone. Anoodypt you need to provide more information to rule out any significant pathology(rupture, fracture, etc)

Anoobypt, skills of taking history is the probably most important skill in your careers.

I wrote down the following that might benefit your careers later.

in my minds followings are structures that might be involved. (after GCOE's history, and do ortho to rule out rupture, fracture, etc)

problems are around infraspinatus, teres major, minor, rhomboids, lower trap, lattisimus dorsi erector spinae. and if inhalation and exhalation causes more pains, might be serrthiatus posterior inferior.
I need to gather more information to narrow downs. so I would do active range of motion and passive range of motion
I would let the pt lie down in prone, and do shoulder internal and external rotation, aduction and abduction, actively and possibly and reduce possible causes of dysfunctions and then palpate those suspected structures.I choose this position because you feel less pain, and i can treat in this position for most of structures involved in this case. because treating those kinds of painful structure might get uncalled reflex response by stimulating too much receptors, I stay away from local pain site. I would start treating spots that are dysfunctional after palpations and away from the site of pain. i would do treatment on local pain site toward the end of treatment. this is from my experience of treating soft tissues on patients that some patients respond greatly after treating local pain site first then i neglected parts that are causing pain. Pt reports that pain comes back in days or worse case in 25 min. Reflex response can last 25 min to days and i do not want to have reflex response in my treatment. I do manipulations but I use the same strategy when using manipulations.


I would treat structures most of time by Active Release technique(pin stretch soft tissue treatment) and avoid graston(instrument assisted soft tissue mobilization) or sliding ofascia release technique unless it is called for(tendons, ligaments superficial treatment)

by the way, did you do excessive lat exercises, anoobypt?