Athlete with shoulder problem needs help

[ocyrus411]

Hello to everyone on this forum, I've come here to hopefully gain more insight into this problem of my shoulder..

Basically the ball of my right shoulder doesn't sit in it's socket like my left does. My right shoulder creeps forward when I stand naturally. Physiotherapists have explained that the muscles in my back right shoulder blade aren't connecting properly to my spine, and the muscles in my neck have a part on this problem as well but I can never remember the conversations I have with my physiotherapists because the terminology is overwhelming. I've gone to a sports physiotherapist and been given exercises which I've worked on for months but no progress. I've also gone through the boehn (sp?) technique on my whole body to balance out my frame but still no results. From the picture I've provided, you can see that my left pectoral is much more dense in muscle as opposed to my right pectoral. This is because when I perform any pectoral exercise, (ex. bench press) my right shoulder creeps forward and restricts me from isolating my complete pectoral muscle. I have had this problem for a few years now and I'm getting very frustrated, but I am still patient and still willing to fix this and not just let it be. Thank you in advance to those who reply, much appreciated.



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[Canuck Physio]

I too weightlift and can appreciate the problems that you have come across.

Although I am not entirely sure as to what your diagnosis is, from what is being mentioned the ball or head of humerus (long bone of the upper arm) is not sitting within the glenoid fossa (part in which the head of humerus sits in like a fist in an semi-opened hand).

Firstly could you tell me what your workout routine has predominantly been for the past little while (ie. how much bench press, arm work etc.) and when you noticed the problem.

I think if you have been provided exercises before, they probably needed to be progressed. If you have been completing the same exercise for so long the 'training effect' even for the small muscles would be diminished significantly. I am surprised you have not been re-assessed and given a progressive plan of treatment.

Finally, you will need to be patient no doubt, because it takes some time for muscls to be retrained as stabilizers, something that your pec major and larger muscles are probably compensating for at this time

[physio.smith]

If you are working out in a gym then get a spotter (preferably a good sports trainer, therapist etc) to watch what happens at your shoulder as you perform you weight training techniques. Get them ot let you know when they see your shoulder drifting forward. This will give you an indicator of the range in which your shoulder is weak in, or at how many reps / the weight you are / are not able to lift with good technique.

Everytime you are completing an exercise where you shoulder is drifting forward you are reinforcing this habit / patterning.

You also may need to look at the specific exercises you are doing. As Canuck mentioned an idea of the sort of program you are using / discussing with a physio / sports specialist / strength and conditioning coach etc would be useful. Doing fly type exercises for example can make this type of problem worse if not properly controlled.

Other things to consider are the amount of time spent on the small control muscle around your shoulder. A lot of people using weights tend to focus on rhomboids and upper traps exercises (as well as pecs), tending not to focus on the lower traps and stabilisers.

Be interested to know what you have been given exercisewise by therapists in the past and what your regime involves.

[Judith Mollet]

This may sound like a stupid question but what is exactly the problem? Do you have pain? does your shoulder problem influence your work or sport enormously ?has there been an accident in the past?recurrent dislocation???? We are not built symmetricaly. Shape of thorax spine and ribs and state of the muscles joining shoulder blade to body influences how the shoulder blade lies and therefore also direction of the "socket" of the shoulder joint. We can always influence muscles and function but can't always iron it all out when nature gave us an asymmetric body.

[physio.smith]

Agree we are all different and if it is not broken then why try and fix it. There is often a case though for preventing injuries occuring or trying to optimise performance.

Asymmetries are very common.

Do you have problems with your shoulder? / Have you had paticular problems with it in the past?

What sports do you participate in?

Treated a lot of patients who are not symmetrical...due to sports they did....tennis, pole vaulting, boxing...few sports are symmetrical and as previous post noted very few people are symmetrical.

[Canuck Physio]

Hmm.. I don't know,

I have seen far too many athletes who suffer from muscular imbalances, postural asymmetries. Not to mention the long term effects of poor posture, leading to significantly obvious stiffness and poor posture in many elderly.

Additionally, weightlifters suffer from significant loss of local stability around joints that are imbalanced from training.

I would suggest for optimum long term health (something not studied in research often), that you balance the body early on. Fix these problems now before they become long term chronic issues.

Regards

[ocyrus411]

Thanks for all the input, I deeply appreciate everyone's contribution.

I was able to take a few pictures of my back which gives you a little more insight into this problem of mine. In these pictures I'm naturally raising both of my arms over my head, arms stretched out, and arms relaxed at sidehowever you can see my right shoulder blade isn't level with my left, and the muscle groups on my right side are forming in different positions. Judging by this picture, is it safe to say this is a muscular problem or a skeletal problem? I'm not sure whether to invest my time and money in a physiotherapist or a chiropractor.

[Canuck Physio]

I was able to take a few pictures of my back which gives you a little more insight into this problem of mine. In these pictures I'm naturally raising both of my arms over my head, arms stretched out, and arms relaxed at sidehowever you can see my right shoulder blade isn't level with my left, and the muscle groups on my right side are forming in different positions.
Some of the asymmetries that are visible in the picture tend to be natural, are you L handed or R handed? Normally there is a difference between trapezius, and thus shoulder level heights because people are predominantly one hand or another.
Judging by this picture, is it safe to say this is a muscular problem or a skeletal problem?
The scapula is virtually attached to no bone at all, except for the acromioclavicular joint. Either through genetics, or via different muscular loading around the shoulder joint the position of the scapulae can shift significantly. There are multiple muscles acting on this area, hence the difficulty determining your 'exact' problem via the pictures.

I'm not sure whether to invest my time and money in a physiotherapist or a chiropractor.
If you have had poor luck with physiotherapy, try again. I would not recommend Chiropractic unless it was a highly sports orientated chiro, and only really for athletes. Although many physiotherapists resort to using non-evidence based modalities within their treatment, I would still hedge my bets on a properly qualified physio who is willing to work with your muscle/joint/recruitment problems, as opposed to someone discovering subluxations in your back as the root of all your shoulder problems.

Addiitonally, from my perspective it would be helpful to know which exercises you do in the gym which aggravate the problem, as well which daily activities you complete that aggravate the problem. As well when does the problem alleviate?

Regards

[Judith Mollet]

I'm still not clear as to why the problem is a problem (Pain??, aesthetics??) but here's a suggestion. There's an excellent book called "Diagnosis and treatment of movement impairment syndroms" by Prof. Shirley A. Sahrmann who is north america based. Washington Uni at the time of publication. Any physio who has really taken to this sort of movement analysis would be able to help you. Otherwise Physios out of the "Kinetic Control" scene, (one name to mention would be Mark Comerford who is UK/AUstralia based but there must be many more out there and in Canada by now) could help. I would also not recommend chiropractic for something which looks like a muscle thing. Wish you luck.

[jesspt]

I agree with the previous poster - what is the actual problem? From the subjective history, it wounds like we're treating a cosmetic issue - asymmetry. If that's the case, neither a chiro or a pT will help you much. None of us are symmetrical.

[physio.smith]

If you are looking for help with this shoulder then I agree with previous posts that practitioners familiar with S. Sahrmann's work or who are kinetic control trained are you best bet. There is I believe a Canadian (?was from Quebec area) who lectures on the Kinetic Control circuit, try their website Kinetic Control, there maybe someone who can direct you.

If there are underlying structural (skeletal) asymmetries, which are extremely common, then obviously the overlying muscles will also appear asymmetrical. I remember as a student that every practical class we had we found that 90% of us were not symmetrical, had muscle weaknesses etc. etc.

Without a hands on assessment of the problem it is difficult to say whether it is the underlying skeletal structure or a muscular (training) related problem. I would tend to avoid chiropractors for this type of thing.

There may be little you can do to change this...it may just be how you were made and how you grew.

[Yarok]

hi

looks like slight scoliosis re spine, and anterior -superior syndrome re shoulder
thanks

[caz]

Hi there

I'm not a physio but am a fellow 'patient'! I think Yarok is right about the scoliosis. I have similar problems with my right shoulder - the shoulder is rotated forwards and my right shoulder blade sticks out more than the left. This is caused by the spine being twisted, rather than a problem with the shoulder itself.

Sorry I can't suggest anything to help though...

[WrightDPT]

Another avenue to consider is possible injury to the long thoracic nerve. This nerve innervates the serratus anterior muscle which protracts the scapula, assists upward rotation, and stabilizes scapula against thorax. Some asymmetry in scapular position is certainly observable in pictures. This could also account for difficulty during bench press as the serratus works hard to protract scapula. This nerve can be injured via direct blow, compression against chest wall (backpack injury), or repetitive strain. Any thoughts on this?

[CenteredHealth]

hi

looks like slight scoliosis re spine, and anterior -superior syndrome re shoulder
thanks

I couldn't agree more. There is definite spinal involvement, especially evident during bilateral shoulder elevation. I also have a question regarding the protrusion on the left upper thoracic spine; a cyst perhaps? I truly hope it is not the spinous process of C7.

[jesspt]

Let me repeat my question from a previous post - what is the actual problem here? The original poster stated their only concern is asymmetry. No problems with pain or functional limitation. If the only "problem" is slight asymmetry, I don't think there's really a problem at all.

[CenteredHealth]

Let me repeat my question from a previous post - what is the actual problem here? The original poster stated their only concern is asymmetry. No problems with pain or functional limitation. If the only "problem" is slight asymmetry, I don't think there's really a problem at all.

Hi Jess. I understand your concerns regarding this "problem." It appears as though the original post is concerned only with aesthetics and asymmetry. And I also understand that asymmetry is 'normal'. However, at the risk of being unpopular I will add this; asymmetrical postures of the body are due to an imbalance, typically of the myofascial structures. And if that imbalance goes on for long enough, I believe it would be fair to say that would create unwanted tensions and stresses on bodily structures that would eventually break down. Of course the body will compensate for this imbalance, which we can see it doing through his photographs, however the body can only compensate for so long until it either runs out of compensations or those compensations themselves break down. I think the original poster is on the right track in identifying the asymmetry as a potential problem and seeking appropriate treatment. And although that treatment might not need the skill that you can offer, I believe it is fair to say that an appropriate regime of stretching and strengthening exercises along with some postural re-education would prove beneficial. Thanks, replies welcomed.

[jesspt]

asymmetrical postures of the body are due to an imbalance, typically of the myofascial structures. And if that imbalance goes on for long enough, I believe it would be fair to say that would create unwanted tensions and stresses on bodily structures that would eventually break down. Of course the body will compensate for this imbalance, which we can see it doing through his photographs, however the body can only compensate for so long until it either runs out of compensations or those compensations themselves break down.

Centered -

All of the above is strictly supposition. We've got little to no hard data that supports that imbalances are clinically relevant, that they occur more frequently in the myofascial structures than the osseos ones, or that if they exist that they place unwanted stress on any other structure. I think that a lot of therapists think in this vein because it results in the design of a treatment plan that falls within our area of expertise : stretching and strengthening exercises.

I'll pose a question: do we tell a patient who present like the original poster that he has an actual "problem" because we think he may develop a problem down the road, without any real data or clinical findings to bakc this up, or should we wait until a problem actually develops (which may likely never happen)?

[CenteredHealth]

Centered -
I'll pose a question: do we tell a patient who present like the original poster that he has an actual "problem" because we think he may develop a problem down the road, without any real data or clinical findings to bakc this up, or should we wait until a problem actually develops (which may likely never happen)?

Hi Jess. Enjoying our conversations....

I knew that my post was going to be received as unpopular, which is why I alluded to that fact previously.

I believe in preventative care. Call me old-fashioned, call me whatever, but I definitely believe in the adage "An ounce of prevention is worth a pound of cure."

As I stated in my post, this person may not need skilled care from a PhysioTherapist or another health care provider. However, I hope we can agree that identifying this as a potential problem and treating it appropriately (on his own) will only benefit him in the long run.

Is that too much to say?

[jesspt]

I've no problems with the patient carrying out an exercise regimine on their own, as long as the patient is also instructed that although he has assymetry, there is little to no data that implicates it as potentially problematic. Essentially, I think we need ot tell them that they can perform an exercise program that may or may not help, but won't hurt, either.

[BrianB]

Ocyrus411, u still around? it's been nearly 3 years since u created this thread and i was wondering how things are looking for u now? i've been lifting on and off since i was 18 and have dealt with something very similar (if not the same issue) for all of that time. i finally feel i understand what's going on...although it doesn't appear there's too much that can be done about it.