I recently found the Shoulder Problems: Reach for the Top through my subscription to UCSF’s Mini Medical School for the Public subscription in iTunes. It is a little long, 1.5 hours, but extremely worth the investment if you have or train people with shoulder issues.
Some interesting facts:
60% of patients age 40 – 55 in Dr. Feeley’s clinic presenting with shoulder pain are diagnosed with Impingement Syndrome, i.e. either pain sleeping on the side of the hurt shoulder or pain (but not weakness) moving overhead. (48:30)
Dr. Feeley, considers Impingement syndrome “along the spectrum of rotator cuff tear pathology.” (50:10) He explains later that just because you have impingement syndrome doesn’t mean you will get a rotator cuff tear, but about 60% do progress to a rotator cuff tear if the impingement issue is not treated, (52:15).
Most older people, I am guessing over 40 but he doesn’t specify, if they had an MRI, would show a partial thickness rotator cuff tear; however, you may be asymptomatic and don’t require surgery. (57:15) This is also stated in Optimal Shoulder Performance, by a strength coach, Eric Cressey, and a PT, Michael Reinhold, which has many references.
MRI is not usually first part of treatment, an X-Ray is, at least in his clinic. His first treatment strategy is, in order of his preference it appears, (58:30):
- Rest, avoid offending activities
- Physical therapy (6 – 12 weeks)
- Rotator cuff strengthening
- Active/Passive ROM
- Periscapular exercises (see below)
- Upper extremity proprioception
- NSAIDS
- Consider steroid injection
- Surgery
What are periscapular muscles? Very simply, according to the Steadman Clinic, they are the muscles “those around the scapula.” You don’t have to know much about anatomy to know that there are a bunch of those, so what are periscapular exercises? Most of what we do at MDF, but you can also try this video I found on Marks Daily Apple.
I’ll have to check these out. We’ve talked about it a few times, but I’ve never been too concerned about my shoulder issues (slightly lower mobility and a little tension/discomfort in my right shoulder when hanging from the bar or rings) because I don’t really have any pain, and I can do all the movements. It sounds from this that, even without pain, there’s a good chance there’s a problem that could progress.
Word to the wise: skin-the-cats are not the time to push your limits!
Kris, We are super lucky to have Ken from Spectrum Orthopedic Sport Therapy and Cathy from Cira Chiropractic helping with both the exercise selection and how to perform the exercises safely and effectively. I know that Cathy has said many times that pain is usually the last symptom to present and the first to disappear, but I think we are getting better at helping athletes though injuries and addressesing both the offending activity and dysfunction.
However, the reason I posted this is to show how important the shoulder warm-up is to performed correctly over time. Many exercise professionals are calling this “Pre-hab.” There is certainly always a chance that you could hurt yourself because of your shoulder dysfunction (i.e. the dysfunction could progress), but by doing the warm-ups correctly over time and, probably most importantly, being aware of your issues and backing off periodically, you will avoid injury, or if you do get an injury, it will be minimal.