recurring mid/upper back and shoulder problems

[Mathieu]

Hi all,

Mathieu here, I'm a 29 year old male from France who luckily stumbled across Kit's wonderful work and Stretch Therapy forum 2 years ago. Never posted until now, but I've been thoroughly reading posts and I'm so thankful for all the knowledge I got from reading contributions of the ST forum users. I'm no expert, but I'm really looking forward to adding my two cents aswell!

I've been using the Master the Squat program and Liv's follow along pancake and pike videos on and off for 1~2 years and had some pretty good results, although I might have had better ones had I been more consistent.

I've been doing GST for about 5 years but always had a hard time staying injury free. Shoulder tendonitis, golfer's/tennis elbow, wrist tendonitis, back pain... I have experienced all of these with no exception. This is probably due to bad programming combined to a lack of patience that had me recklessly rush through progressions...

Mid/upper back pain has been bothering me for a while too. I often experience pain between shoulder blades,  along the thoracic spine or around the cervicals. I did an x-ray last february and it showed what doctors seem to qualify as a light scoliosis centered on D5 (see below) but I cannot say if it's a serious one or not, nor if my recurring pain is due to that alone. I saw a chiropractor recently and he said it's not an alarming case of scoliosis. I've tried several back stretches to see if it they helped, but after I do them, it seems like my back is more prone to injuries as my back seems sore for a few days. This is the case for both of Kit's daily five stretches. Cannot assess whether this is really making things worse or if it's all in my head though. 

 

 

Since early october, I've been also experiencing shoulder pain. I feel it whenever I do push ups, but funnily don't when my hands are tucked in and along my body. However, as soon as I flare my elbows, the pain is rather sharp. Handstand push ups or declined push ups or a no-no too... I'm not even going to try! It is however when I do the below stretch that I feel the most pain. Pull ups and rowings are ok. Any idea what it could be ? the following question could be the words of a fool , but since narrow push ups do not hurt and do not seem to aggravate the pain, can I still do these or should I stop completely for a few weeks and see if it heals better? Any advice?

Thank you all in advance and have a wonderful week !  

 

[dannyg]

My take on this would be to not worry about your structure too much. It's normal to feel a little sore after some stretches, and remember you might be developing new range - and you haven't learnt to control that new range yet. 

I'm an Osteopath and I have lots of people who have scoliotic spines. It doesn't necessarily to affect function or pain. Many people have structural asymmetries (Usain Bolt has a half-inch leg length difference, for example) and function perfectly. Imaging for pain often does more harm that good (the cynics and skeptics, like myself, often view it as a clever marketing ploy) - more info on Adam Meakin's blog if you want: https://thesports.physio/2017/01/10/a-picture-is-not-always-worth-a-thousand-words/. 

 

Regarding you shoulder - is the pain at the front? What you're describing sounds very much like 'subacromial shoulder impingement' or an AC joint problem. Flaring elbows during pushup and that stretch really seems like you're putting too much stress at that joint. Think trying to keep elbow creases facing forward, it helps externally rotate the upper arm - stopping the shoulder from 'dropping' forward (which is what happens when elbows flare). Usually people flare their elbows because they aren't able to protract the scapula well enough. 

Working on developing serratus anterior to protract the shoulder-blades and 'pushing with your Armpits' (which is one of Craig's Videos) might help. The problem is made worse by tension through the upper fibres of trapezius and Levator Scaupulae which can hold the shoulder in an elevated position.  Also working through pec minor (stretching and soft tissue release) will help being able to open the front of the shoulder properly, allowing the scapula to move more freely. But generally pec major stretches should be helpful too. 

 

The AC joint is the only bony attachment your arm and shoulder blade has with the rest of your body. Usually developing straight arm scapula strength and learning to protract better during pushing movement is something to work on to avoid overworking the symptomatic area. 

 

 

 

[Kit_L]

Liv, Malcolm and I attended a 10-day intensive workshop for physiotherapists and doctors (we were the only non-medicos there) at the Asklepios Schroth Klinik in Germany later the year before last. This is the largest clinic of its type in Europe and famous world-wide, and only treats scoliosis.

The key take-home message from the workshop leader, Alex Hennes, is that scoliosis is no barrier to any kind of movement or exercise. And Alex said publicly to the group that the Klinik work was the starting point, and that people graduating from the Klinik would do well to find the nearest ST practitioner!

Re. the X-ray above: chronic quadratus lumborum spasm can produce this effect, as can an actual leg-length difference (different lengths of femur and tibia, L–R, or asymmetric placement of hip joints in pelvis, or small hemi-pelvis). This kind of scoliosis is a necessary adaptation of the spine if an actual LLD is present; I have one (18mm).

[Mathieu]

On 21/12/2017 at 5:20 AM, Kit_L said:

The key take-home message from the workshop leader, Alex Hennes, is that scoliosis is no barrier to any kind of movement or exercise. And Alex said publicly to the group that the Klinik work was the starting point, and that people graduating from the Klinik would do well to find the nearest ST practitioner!

Thank you very much for your answer, @Kit_L. I'm a bit surprised as I understood from previous posts I've read on the forum about the Schroth method that some stretches / movements shouldn't be performed by people with scoliosis. Should the claims of the following article be thus taken with a grain of salt? http://www.schrothmethod.com/yoga-for-scoliosis

 

On 20/12/2017 at 4:55 AM, dannyg said:

Regarding you shoulder - is the pain at the front? What you're describing sounds very much like 'subacromial shoulder impingement' or an AC joint problem. Flaring elbows during pushup and that stretch really seems like you're putting too much stress at that joint. Think trying to keep elbow creases facing forward, it helps externally rotate the upper arm - stopping the shoulder from 'dropping' forward (which is what happens when elbows flare). Usually people flare their elbows because they aren't able to protract the scapula well enough. 

Working on developing serratus anterior to protract the shoulder-blades and 'pushing with your Armpits' (which is one of Craig's Videos) might help. The problem is made worse by tension through the upper fibres of trapezius and Levator Scaupulae which can hold the shoulder in an elevated position.  Also working through pec minor (stretching and soft tissue release) will help being able to open the front of the shoulder properly, allowing the scapula to move more freely. But generally pec major stretches should be helpful too.

The AC joint is the only bony attachment your arm and shoulder blade has with the rest of your body. Usually developing straight arm scapula strength and learning to protract better during pushing movement is something to work on to avoid overworking the symptomatic area

Thanks very much for this useful answer, @DannyG. The pain is definitely in the front, but I cannot tell precisely where it is located. I don't think it is the AC joint because the pain is not on the top of the shoulder, and the AC joint is on the top of the shoulder if I'm not mistaking... The only thing I can tell you is that when I do push ups with flared elbows or with hands far from each other, it is quite painful. I also experience pain when I do either or the two stretches below. If my palm is try to do lateral raises with my palm outwards, I can feel a tightness in my shoulder when the arm is far back and low, below the waist. My shoulder sometimes pops when I put my hand behind my back and it's a quite painful stretch to hold . I have dropped pressing movements for about three weeks and things seems to be going just a little better. Do you have any idea what it could be? 

Thank you all in advance and... HAPPY NEW YEAR from Paris  

[Kit_L]

4 hours ago, Mathieu said:

Should the claims of the following article be thus taken with a grain of salt? http://www.schrothmethod.com/yoga-for-scoliosis

Those photographs are from the original Schroth Method book, if I recall correctly, published a great many years ago—and the poses that are mentioned will likely be far too advanced for people with scoliosis to attempt before they have stabilised the increasing curves, and progressed to mastering simple poses. In other words, beginners need to begin at the beginning. This is true for everyone, and why we continually emphasise an approach which helps any individual find the exercises best for them, at the time they are playing with them. Over time, everything changes, and the new "best exercises" will change too.

ST endorses the Schroth Method (and we have trained in it, as I mentioned above), and it is a complex combination of bracing/stabilising exercises combined with breathing in particular ways, all designed to activate the body's healing mechanisms and produce adaptations that are beneficial (i.e., which help the body straighten the additional curves, in three dimensions). This is where people whose scoliosis is progressing need to start.

That article no longer reflects the current thinking of the Asklepios Klinik, except for asserting that the advanced poses in this collection are unsuitable for people with scoliosis.

[Kit_L]

Re. DannyG's advice on pushups: I would add (and this is in the plank position, prior to initiating the pushup), strongly contract the lats and lift the chest a little in the plane of the floor—then start to bend the arms. Do a few repetitions and feel how the shoulder responds to this new position.

Re. the first of the stretches illustrated: two restrictions can limit this movement. The first is supraspinatus is too tight (inability to adduct the arm); the second is a lack of internal rotation (external rotators are too tight). Remedial exercises for both are found in the Master shoulder flexibility program. A free one here:

https://www.youtube.com/watch?v=1Pl_p64l_ps

Many others there, too.

[dannyg]

Some bits I copied from the earlier post.

Sounds like 'Subacromial shoulder impingement' or something similar. 

The AC joint IS the front of the shoulder. It is the shoulder complex's only connection to the rest of the skeleton. 

Working on developing serratus anterior to protract the shoulder-blades and 'pushing with your Armpits' (which is one of Craig's Videos) might help. (https://physical-alchemy.uscreen.io/programs/lifting-with-the-armpits)

 

The problem is made worse by tension through the upper fibres of trapezius and Levator Scaupulae which can hold the shoulder in an elevated position. 

Also working through pec minor (stretching and soft tissue release) will help being able to open the front of the shoulder properly, allowing the scapula to move more freely. But generally pec major stretches should be helpful too. 

 

Quote

The first is supraspinatus is too tight (inability to adduct the arm); the second is a lack of internal rotation (external rotators are too tight).

While I agree with Kit here - in my experience the position of the shoulders and tightness in pec minor drawing the shoulders forward (and squeezing the scapulae close to the ribs, superiorly) is what often prevents this position.

 

Do something like this: https://www.youtube.com/watch?v=mghh0eR7Uz4  BEFORE attempting the stretch kit linked to. If it still hurts work on developing scapula protraction rather than pushups for a little while. 

Basically, if pec minor is tight - your scapula can't move freely and it's really easy to do something to the front of your shoulder. 

If you want a picture of the Anatomy: 

 

 

Reduce Tension/ROM via stretching/manual release in: (Depending on how uncomfortable something feels)

Pec Minor,

Pec Major,

Levator Scapulae,

Supraspinatus,

Infraspinatus,

Teres Minor,

 

Strengthen:

Serratus Anterior

 

Learn:

Correct from in upper body exercises and better control of scapula haha. 

 

I hope I've helped a bit. Feel free to ask questions or want more details (or more simple advice).

 

But this is advice on an online forum - I would advise you to see a professional (physio, osteo etc) about the shoulder if there simple things don't seem to help.

 

PS. I am actually still not sure where the location of the pain IS exactly, but the actions you described can fit a subacrimial impignementy symdromey thingy issue very well. (The reason I call it that is because the more we know about the shoulder, the more we know that clinical uncertainty is bigger than we expected. We are not machines, why what see and feel often doesn't reflect what is going on in our bodies accurately).

 

 

Edited January 10, 2018 by dannyg
Grammar