Shoulder/Neck and Bodybuilding

[Feelgood.MD]

Hi everybody,

would need some help on the following case.
I´m treating some bodybuilders from time to time, a lot of them complain about a shoulder instab. during workout and a strange felling of loss of grip due to Nerval failure

On testing them, each of them! The following occurs:
M.Supraspinatus - painful/positive
Infraspin. - slightly painful
Long tendin of Biceps - Painful

coracobrachialis - painful
the other Muskles show NO sign of overuse or an infiammation - sine pain

but then, Clowards Zone 5 Positive
ULNT 1 - nothing
The complete cervical spine is noticeable, of course all of them have very little rotation and lateral flektion, some flektion...
It seems to recidivate, surely due to mis-and overuse, but what exacly is it those guys have?

So far I`m treating them on Cx and Tx, I´m trying to get the Scap. moving on the Tx again, give them stretch exercises and some friktion on the Supraspin.
anybody know, what else I could do?

Thanx in advance

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[karen.hankey]

You could try looking for any muscle imbalance. Most bodybuilders tend to have very active Pecs but very little use of the posterior stabilisers. The over training of the pecs could lead to an anterior displacement of the shoulder because there is nothing at the back to hold it central. This would mean that as they move the shoulder doesn't move as it noramlly should and would possibly give the feeling that it might dislocate.

So if you strengthen their posterior shoulder muscles it should relocate the head of the humerus back to a more stable position. The problem that you may get from the patients is compliance to complete the exercises.

[Feelgood.MD]

I see...!!!!
I hope everybody in Europe is whitnessing the persisting "dawn" over germany, it must be so bright that you must be wearing sunglasses...;-)
Thank you very very much for helping and sharing
Man how could I be so blind...
And of course your right about the compliance...
have a great day in UK

[polar]

hi

to combat the problem with body builders and compliance with muscular imbalance, is to explain to them that if they get the muclulature around the shoulder working in the correct way then then stability around the shoulder will be better allowing them to become stronger on thier compound exs eg. bench press and over head press.

this normally works because they will then see an increase in the amount of weight they can lift which is what they are always striving to do and therefore lift bigger and heavier.

[Yarok]

hi
do agree with caren, on top of that, bodybuilders do not train ext/int isolated rotations, and when train horisontal extention dont emphasise post delt and motion is more in scapular abd/add (rhomboid).explain them how to move arm without moving scapula.

thanks

[physiofixme]

Don't forget when trying to sort out their muscle imbalance to stretch the tight anterior structures especially pec minor as this is usually the main culprit at pulling the head of humerus anteriorly. Also check for tightness of Lat Dorsi. Posteriorly I'd look at lower trapezius as well and focus on strengthening this. If the upper traps are really tight it maybe causing compression over the brachial plexus (as would a head of humerus sitting anteriorly) which would give the neural symptoms in the arm/hand.

Good luck.

[parvezshaikh]

Most of the body builder ends up in building gross musculatures only...
I too have many clients with the similiar problem and will long experience we can resolve the problem by training them with core stabilizers first..
in the case of shoulder it could be training rotator cuff's muscles...
i do it by thera bands and tubes.
again stretchings are equally important.
regards.

[physiofixme]

Just be careful you don't give them too many rotator cuff exercises to do before you work on their scapula stability as you can effectively create a secondary impingement. Once they have better scapula stability you can introduce rotator cuff strengthening, ensuring that the scapula positioning is being maintained while working the rotator cuff. I reckon shoulders are the most challenging region physios have to treat!!

[Yarok]

hi

to physifixme when muscles are tight i.e.pecs and pull humeral head,it means the frontal wall is overstretched not tight and usually rear part is stiff.

thanks

[physiofixme]

Hi Yarok

Interesting........I'd be keen to see if anyone else agrees with you or if you are alone with this theory. I can't quite see how a pec muscle which is overstretched can pull a humeral head forward?? I do however agree that the "rear part" is stiff but it isn't usually the muscular component causing the stiffness but the intervertebral and costovertebral joints causing the stiffness so some mobilisation here would help. The original question was about complaints of shoulder instability which is why I mentioned strengthening the scapular stabilisers.....of coarse this has to be done in conjunction with rotator cuff at a later stage but I believe working on the scapula initially to provide a stable base and then bringing in the dynamic stabilisers of the rotator cuff later is a better approach. I'd be interested to hear more about your theory.

[physiofixme]

I just thought I'd make another comment as I'm wondering if there may be some confusion here over anterior shoudler instability which is atraumatic and dynamic instability. I was under the impression we were talking about dynamic instability caused by muscle imbalances brought on by body building and overtraining some muscle groups vs others. On reflection, Yarok's comments about overstretched anterior structures would fit with an overstretched anterior capsule leading to instability in which case posterior structures often are stiff. This may be where some confusion has crept in. My understanding though is that atruamatic anterior instability is more common in athletes who are engaged in repetitive activities involving extremes of range of movement which overstress the capsule such as tennis, throwing as in baseball pitching etc.

[Yarok]

hi

i try fit a frame to the picture,the theory is based on S.A. Sahrmann and could fit( based on little info from Feelgood) into humeral anterior/superior glide syndrom.sorry but i can guess only.

[sdkashif]

It seems to be that rotator cuff muscles have been abused or not properly trained. An other cause may be improper training regimn of progressive resisted exercises has been used. Body building needs to follow the priciples of progressive resisted exercises like DeLorme method or MacQueen method or other standard methods of progressive resisted exercises properly. It is highly unlikely a standard rigimn will produces faulty results in the muscles. As all of us know humeral head stability depend highly upon intact good rotator cuff muscles.

[Feelgood.MD]

Problem solved,
Thanx everybody for the great help!
Got the bodybuilders to strengthen their rotators, was helpfull, ontop got them to build up their rhomboids - after that even better, although some hihgher friction on plexus occured - gave them self-mobilisation for it working slightly into ULNT - after that GONE!
we´re now fixing it with mostly lumbar stab and got a shrink working their overtraining and overintension workouts ;-)
Thanx all again

[linbin]

hi
i agree with the suggestions of casuses
overtraining of pecs,lats
ignoring og rotator and scapular stabilizers
theory of following path of least resistance by humeral head as described by shirley shermann
other factors that might be contibuting will be lack of proper warm up and cool down phases,lack of stretching of the muscles,general mobility exercises
improper body mechanics while doing weight training,for eg latts pull behind the head is shown to cause trauma to cervical structures.latts pull down toward chest is suggested as an alternative

[Hadden]

Hi.....,

I like to do body building and really nice to have this forum for it...