Shoulder pain over 40

[MaDmaN2]

Weight lifter's shoulder:

When I do flat bench my delts kill right in the tie in..but not the muscle it's the joint.I notice it alot when going to bed moving my arms around or turning in bed it kills,also driving my truck ill put my right arm up on top of the passenfger seat and after a few minuets I move it I really feel the pain...Im taking Glucosomine and MSN for it but the pain is still there...I will try not doing flat bench for a while just inclined and see what happens...Do you guy's think this is the rotator cuff.. After doing some research on my own i am looking into the possibilliy of Distal Clavicle Osteolysis, or (weightlifter's shoulder)

Clinical Presentation
In both traumatic and atraumatic osteolysis, the patient usually reports a dull ache that localizes over the AC joint. It may radiate to the anterior deltoid or the trapezius. With posttraumatic osteolysis, the patient will relate the onset of the pain to a direct blow to the shoulder. The traumatic episode may be as recent as 4 weeks, or it may have occurred years prior to the patient's presentation (13). These patients may or may not be involved in repetitive physical activities with the affected shoulder.

With atraumatic osteolysis, the patient has an insidious onset of pain in the region of the AC joint. These patients are usually weight lifters or heavy laborers who do not recall a specific incident that precipitated their symptoms. Weight lifters often have the most pain while performing bench presses, push-ups, and dips (2). Night pain is not often a complaint, but the patient will have difficulty sleeping on the affected side (9). Activities of daily living may become painful as the patient's symptoms progress (14).

On physical examination, patients consistently exhibit point tenderness over the AC joint and pain with cross-body adduction. Patients generally have well-developed shoulder musculature and full range of motion, but they can have pain with the impingement test, making diagnosis difficult. In this situation, 1 mL of 1% lidocaine hydrochloride can be injected directly into the AC joint. Patients with isolated distal clavicle osteolysis will have a temporary resolution of their symptoms after injection, whereas patients with other shoulder pathology will continue to have pain with provocative testing.

Treatment
Treatment of the patient with osteolysis needs to be individualized. Factors to be considered include the extent of disability, hand dominance, activity level, and age.

Nonoperative treatment. Patients are initially started on a nonsteroidal anti-inflammatory drug (NSAID) and instructed in activity modification. Specifically, weight lifters should avoid bench presses, dips, flies, push-ups, and other lifts that elicit pain. Most patients will respond to activity modification; however, symptoms often recur if the previous weight-training schedule is reinstituted (2). Intra-articular corticosteroids can be considered for short-term symptom relief, but studies to date have not shown any long-term benefits (11). Because patients generally retain normal shoulder function, formal physical therapy is generally not initiated unless there is concomitant shoulder pathology. Patients whose condition does not respond to conservative management or who cannot limit their activities require surgery.

Operative management. Both open and arthroscopic distal clavicle resection have been successful in alleviating pain and returning patients to previous activity levels (2,9,10,14-17). Open resection is a relatively simple procedure, but a 4- to 5-cm incision is required. It also entails at least partial detachment of the deltoid; therefore, patients must avoid strenuous use of the arm for 3 to 4 weeks. The arthroscopic technique is technically more demanding, but it is more cosmetically appealing, and patients return to activities as soon as they are comfortable (18

anyone try the antinflamatory medication and what kind is the best....

[Fastone]

I've had a similar problem and it's the shoulder that caused my long layoff, definetely check with your doctor. I bought a shoulder horn, brought the amount of weight down that I was using and have used msm and Alleve. The biggest thing is not to push it, you don't want to lose the ability to train altogether.

[MaDmaN2]

Good advice Fastone,I just started taking Aleve and it really helps...Thank's...

[klusk2]

The 7-Minute rotator cuff Solution book by Dr. Horrigan and Dr. Robinson really helped me. Can be a difficult book to find, but worth it. Tore up my shoulder pretty good and followed the workout routines and avoided the exercises they talked about and I'm feeling good again. Some libraries have it, so take a look at it and see for yourself.

[gymNut]

I found that I have to be really careful how I sleep. I like to lay with one arm under my head, and that was causing some of the trouble. I found a way to use two pillows to take some of the pressure off the shoulder, and since then the problems have been a lot less. Have also found that different shoulder press machines affect me differently, they're at slightly different angles. It sucks to have to work around the aches and pains of an aging body ! From your photo, looks like you manage just fine.

[MaDmaN2]

Originally Posted by gymNut

I found that I have to be really careful how I sleep. I like to lay with one arm under my head, and that was causing some of the trouble. I found a way to use two pillows to take some of the pressure off the shoulder, and since then the problems have been a lot less. Have also found that different shoulder press machines affect me differently, they're at slightly different angles. It sucks to have to work around the aches and pains of an aging body ! From your photo, looks like you manage just fine.

Thanx GymNut..Your right on about the angles what a difference they make...

It has now been almost 10 month's since I began my comeback...and all my shoulder pain is gone...I load up on fish oil caps alot as well..

[panhead]

I've got that soreness in my right shoulder too. That's made me choose exercises that don't over stretch it out. The way I'm getting rid of it is just like I've had to fight other sore mustles. That's to make sure it's stretched out before and after workouts.

[tblunt]

I was taking Aleve before my workouts due to a shoulder problem. Not any more:

http://cbsnewyork.com/healthwatch/he...355214922.html

[Hawkwind]

I saw that this morning!
I'm pretty sensitive to medications. I've found three things that help me with joint pain and inflammation.

Bromelain: Reduces inflammation and helps with pain relief
Yucca: Reduces inflammation
And a combination of: Glucosamine/MSM/Chondroitin
Taken together they help to reduce inflammation, rejuvenate synuvial joint fluid and strengthen the ligaments and tendons.

[slopedoctor]

I have had a marked improvement in my shoulder pain latley with a critique from my chiro.5-8 min warm up on the cardio of choice,then stretch properly,then i do two sets of rotator cuff exercises and this has dramaticly improved my workouts.......best advice I have had since my warranty expired...lol

[tblunt]

What rotator cuff exercises are you doing to help?

[slopedoctor]

My doc instructed me to use a cable pull machine with the lighest weight (about 10 pounds) set the pully at a height so the handle is level with your elbow,Standing sideways pull the handle toward you and let it pull back so your forearm(level with the floor) swings in about a 90 degree arch. Make sure you pivot around your elbow.Do not let your elbow move .This isolates the rotators and keeps tension on them.By using a pulley there is no weight pulling your hand down (gravity recruiting the bicep).If you increase the weight you will recruit other muscles and not do any better for the rotators. By increasing the reps you will strenthen them and it also incresees blood flow to them as well.This has helped me tremendously.Give it a try .Its better than light DB's.By rolling up a towel and holding it tight under your armpit ,it will help you keep the upper arm in the right place.Hope you find this helpful!

[Bugjune]

Slopedoctor,
Could this pully exercise be modified to a free weight? I have similar shoulder pain (left side) and was wondering if I could hold a 5-lb weight at elbow height (arm bent) and just rotate my arm across the front of my body, then back to start position.

I also take Glucosamine and Chondroitin supplement each night, but have had a stiff shoulder ever since some JERK bashed into me on a bicycle and sent me sprawling onto my left side.

[Hawkwind]

Yes, you can adjust the exercise to use a 5 pound weight. That is how I have to do them.

Have you tried a Chondroitin/Glucosamine supplement with MSM? MSM in combination with the other two helps to reduce swelling.

[JinnTonic]

i have the same problem...when it gets unbearable, i take 3 500mg ibuprofen tabs at bedtime...usually don't have to take them but once every 2 weeks...i also started using the first set of reps as warm ups...add 5-10 for the next set, then go to failure on the third set...

[DidOmIziO]

is there any way i can still get a chest work out in while avoiding the pain??? help because i havent done a chest workout in 2 months becuase of this

[JinnTonic]

warm up...i did chest this morning and my right rotator cuff was on fire...i started with low wts and did 3 sets of 12...went to rear delts...again lighted wts...then to triceps...

it took me longer cause i kept coming back to the chest and adding 10 lbs each time...on my 4th set, i benched more than i ever have (which ain't much)...and now as i'm typing this, the pain in shoulder is minimal...

so...warm up...don't hurt it further...

[JinnTonic]

got to thinking about the 2 mos thing...that's a long time for shoulder pain...you've either got a pretty good injury, something like arthritis(sp), or you're doing some type of lift that's keeping it irritated...try warm up lifts for all upper body muscles for a while and see if it doesn't improve...

[kakarott]

Originally Posted by Hawkwind

Yes, you can adjust the exercise to use a 5 pound weight. That is how I have to do them.

Have you tried a Chondroitin/Glucosamine supplement with MSM? MSM in combination with the other two helps to reduce swelling.

I tried that combination. The stuff was called triple flex. It helped out a lot. I no longer have the pain in shoulders anymore. It took a while for it to take affect.

[soccergrub]

I posted a link to this article in the Sports performance .... area. Thought I'd post the whole article as I feel it has really helped my shoulders (sorry couldn't get all the pictures to transfer)

Shoulder the Load
by Mike Robertson


Since I’ve started writing for the T-Nation, I’ve gotten 100’s of e-mails asking me varying questions about the rotator cuff and its many somewhat magical qualities. While it may not be as cool as big quads or a great set of guns, a well-developed rotator cuff is sexy in its own, injury-free kind of way.

One of the most frequent questions I get regarding the rotator cuff is what exercises can I use to develop my external rotators? In our ADHD generation, it seems we can never have enough options when it comes to training, so this article is designed to give you just that!

I’m not going to get hard and heavy into the anatomy here, as Eric Cressey did an excellent job in his "Cracking the Rotator Cuff Conundrum" article featured previously. I am, however, going to give you several exercises that you can implement immediately to develop your external rotators and keep you driving those benches up without fear of pain or injury!


Basic Principles

As I stated before, I’m not going to get too in-depth with the functional anatomy of the rotator cuff. Instead, I want to give you a few tips that will make your training more effective.

1. Start off light in the beginning

I’m sure some of you are cringing just reading this, but developing the external rotators does not involve developing your ego as well! While these exercises do a great job of isolating the necessary musculature, the goal is to work the desired muscles and not everything else around them. If you want to use massive weights for your first workout here, you’re barking up the wrong tree!

2. Use slower tempos in the beginning

This goes hand-in-hand with my first point: The goal of these exercises is to develop your external rotators, nothing more, nothing less. If you are simply trying to muscle the weights around, it’s highly likely you are bypassing the very muscles you are supposed to be training! Now I’m not saying to use a 20-20-20 tempo scheme here, but a 3-1-3 tempo works well for those just starting out. Work on feeling these muscles work and controlling the movements from start to finish.

3. After starting off slow and light, periodize your training!

One thing that frustrates me about external rotation training is people who use 2 pounds on these exercises, perform like 100 reps, and use a super slow tempo FOR ALL THEIR TRAINING! I’m not going to say any protocol is inherently good or bad, but there are times when certain applications are better than others.

So after you’ve started off light and gotten these muscles working, train them like anything else! I’m not saying you want to do heavy singles, negatives, or the Weider forced reps principle, but you should still periodize your training like you would any other muscle group. Periods of higher reps are necessary at times, while in others you want to focus purely on getting these muscles strong. It’s nothing fancy, really, just smart planning and application of your training.

4. De-bunk the external rotator myths

I’ve had so many arguments regarding the external rotators, it’s ridiculous. Here are two of the most heinous quotes I’ve heard:

"You shouldn’t EVER do less than 12 reps per set."

"You shouldn’t EVER use more than 5 pounds on these exercises."

First off, 12 reps per set is fine in the beginning as you are focusing on improving motor control, increasing strength in the tendons and ligaments, or simply getting some much-needed blood flow into the area. But what if you’re in a max-strength based mesocycle, moving 400-pound bench presses for heavy doubles, would you still be doing sets of 12 with 3 pounds on your external rotation movements? I hope not.

As well, do you think a 200-pound bench presser and a 500-pound bench presser should be doing the same amount of weight in their external rotation movements? I certainly hope not! I have seen men who can press well over 100 pound dumbbells for reps, but can’t externally rotate more than 2 pounds for a set of 10! If you subscribe to the idea of never using more than 5 pounds for external rotations, you probably also think that squats are bad for your knees or that deadlifts will ruin your back.

I may sound a little callous when it comes to these myths, but it’s really frustrating trying to convince people that the external rotators aren’t much different from every other muscle group in your body. I liken them to the abdominals; everyone has a "theory" as to the best set and rep scheme for the abs. But, it really comes down to knowing what the desired training effects are, and then using the right training regimen at the right time. Proper application here is paramount.


Now that I’ve filled your brain with some basics on training the external rotators, let’s get on to describing the movements!


Shoulder Horn

The shoulder horn is a pretty nifty gadget that most of us would love to have. While it may seem a little pricey at nearly 60 bucks, even the most bull-headed trainee will have a hard time screwing up the movement.

Proper execution is pretty simple: Grab a pair of dumbbells and slide your elbows into the grooves of the horn, and let the arms hang down a little bit below parallel to begin. From the starting position, slowly rotate the dumbbells up to a point perpendicular to the ground, and then lower under control to the starting position and repeat.

Poor Man’s Shoulder Horn (DB external rotation)

Okay, so we all know the shoulder horn is great…but what if you don’t have an extra 60 bucks to shell out? In comes the poor man’s shoulder horn, which costs you zero dollars and is damn-near just as effective!

Set-up is easy; sit down on a bench and put one foot up on the bench in front of you. With a dumbbell in hand, "screw" your elbow into the side of your knee and let your arm hang down. From here, slowly rotate the dumbbell up to a point approximately perpendicular to the ground, and then lower under control to the starting position. One thing you have to watch here is your leg; if your leg is moving in and out throughout the movement, you are probably using too much weight and/or trying to improve your leverage. To fix this, think about pushing your elbow into your knee while simultaneously pushing your knee into your elbow. This will keep everything tight and force your external rotators to do the work.



90 degree external rotation

This simple variation of the external rotation can be done virtually anywhere; just don’t be a geek and take up the reverse hyper to do your external rotations! (It’s not quite as bad as curls in the squat rack, but it’s close.) The version below is pictured with an adjustable bench angled at 90 degrees.

With a dumbbell in hand, rest your elbow on the top of the bench. Try to make sure that your shoulder is abducted to 90 degrees from the body, as well as your upper arm/lower arm at a 90-degree angle as well (hence, the name 90-degree external rotation!) From the starting position, everything else is pretty standard; slowly rotate the dumbbell up to a 90-degree position, and then slowly lower under control to the starting position.



Low cable external rotation

You know those fancy 3-D cable machines you have in your gym? Well here’s a little tip: They DO actually serve a purpose! The low cable external rotation is one exercise that is best performed on a multi-planar cable machine. A machine that locks you into a groove will be somewhat cumbersome and not nearly as effective in this case (you can see this in the pictures below, as I have to contort my body slightly to complete the movement).

To begin, set a single-arm cable attachment to a position at or below navel level. As shown below, the right side is facing the machine, while the left arm is holding the attachment. The elbow is pinned to the side, and the left hand is adjacent to the right hip. (Note: You can also roll-up a small towel and place it in-between the elbow and side to increase the range of motion). From this position and keeping the elbow pinned to the side, rotate the arm laterally towards the left hip. Hold at the end point for a second, and then slowly return to the starting position.



Muscle snatch/Cuban Press

The muscle snatch/Cuban press is a pretty humbling experience. I consider this movement more of a "complex," where several movements are combined to produce one fluid movement. However, as with every complex, there’s got to be a limiting factor, and that factor here is the external rotation part of the movement. Remember, start off light and perform the movement correctly!

With a wide overhand grip, upright row a barbell up to approximately nipple level. From this position, externally rotate the bar to a point just in front of the forehead and the press overhead. You’ll follow the same movement path on the way down. I tell all my clients to focus on making the movement controlled and deliberate, almost robotic, as most have a tendency to load up the weight just because they can upright row and press a lot more than they can externally rotate. Start off slow and use the appropriate musculature; your body will thank you!

Side-Lying External Rotation

This is another one of my favorite external rotation exercises. Since you need a bench to do it, make sure to perform it at approximately 4 PM on Monday when the rest of the gym is trying to get a chest workout in….they’ll love you for it!

Grab a dumbbell and lie on a bench with a small towel rolled up between the side and elbow. Place the elbow on the pad and let the arm with the dumbbell hang down towards the navel. From the hanging position, rotate the dumbbell up to a point where it’s approximately perpendicular to the ground, and then lower under control to the starting position. Make sure to raise and lower under control! This is a tough one, believe me.



Well there ya go; six exercises to help keep your training fresh. Whether your goal is to press more weight, stay injury-free, or just impress your friends with your guru-like knowledge of the rotator cuff, these exercises can help you attain all those goals. Most importantly, don’t forget that chicks really dig a guy with a set of well-developed external rotators. You can thank me later!


About the Author

Mike Robertson, M.S., C.S.C.S., U.S.A.W., is the Director of the Athletic Performance Center (a Division of Allen County Family & Sports Chiropractic) in Fort Wayne, Indiana. The APC offers sport performance training, injury rehabilitation, and personal training services to its clients. Mike received his Masters in Sports Biomechanics from the Human Performance Lab at Ball State University. Mike has been a competitive powerlifter for the last 4 years and is currently the USA Powerlifting State Chair in Indiana.