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Unusual shoulder/scapula imbalance affecting low-bar squats
My 28 year-old wife is beginning serious strength training for the first time, and she is finding low-bar squats excruitatingly painful due to a shoulder/scapula imbalance. She has constant acute pain in her left shoulder when the bar is on her back and is unable to get into the proper position. Her left shoulder 'hitches' up and the bar rests aysmmetrically on her back. If she spends a few minutes in that position over the course of a workout, the shoulder is very sore for ~12-24 hours afterwards and the discomfort prevents her from sleeping. Images below:
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She cannot think of any injury she has suffered which might have caused this. No car accidents, falls, broken bones or anything of the kind. However, she did play violin in an orchestra throughout her youth under the guidance of irresponsible tutors/conductors who had her practice for so many hours at a time that her posture deteriorated and she developed back pain. Apparently all the violinists would rush to another room each break to lie down and release the pain, and there was an Alexander Technique practitioner on staff to help them. I have no idea if that's a likely cause of this problem but thought it was worth mentioning.
My wife has seen a sports physiotherapist who admitted she had never seen something like this before, but estimated that it is a weakness in the smaller muscles in her left shoulder and in her rotator cuff in particular. She said the pain is being caused by an impingment occuring as the larger muscles on her left side try to compensate for the weakness of the smaller muscles. She advised against low bar squatting until this issue is corrected as continuing to do so (aside from being intensely painful and technically incorrect) would reinforce the asymmetry and cause the larger muscles to further dominate the smaller muscles, preventing the smaller muscles which need to be strengthened from adapting. She has prescribed the following eight-week programme of exercises to strengthen the shoulder and correct the imbalance:
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On the one hand we're glad to hear that the problem seems to be weakness rather than a skeletal abnormality. On the other hand, I've spent enough time around Starting Strength to have developed a healthy scepticism of physiotherapy. The physio cautioned my wife before hand that the exercises would look 'weenie,' 'pointless,' or 'stupid,' but that they'd be the most effective way to solve the problem. My wife's current plan is to find out if she can high-bar squat painlessly and symmetrically or not. If she can, she intends to follow the physio's programme whilst doing a novice linear progression with a high-bar squat instead of a low-bar squat. She has no problem with any of the other lifts, and my layman's suspicion is that presses, bench presses, and pull ups performed with correct technique will do more than the physio's programme to produce a balance of strength across the shoulders. Low bar squatting is simply out of the question right now until something changes.
I'd really appreciate any thoughts on this. Has anyone seen an issue like this before? Is the physio correct in assessing it as an asymmetrical weakness in the shoulder, and if so what's the best course of action? If she's wrong, should we try something else instead? I don't see any harm in trying the physio's programme other than wasted time if it doesn't achieve anything, but I'd love any input from the forum.
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What happens if she widens her left grip to match her right? There also seems to be something wrong with her face.
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A bit more detail: Apparently the pain starts as the feeling of an intense, sharp pinch right at at the humeral head/acromion. If she stays in the low-bar position, it begins to spread down her arm and across her scapula.
If she widens her grip, the pain lessens but doesn't subside altogether. Also, in order to make it tolerable she has to widen her grip far enough to make the bar position unstable.
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She needs a shoulder MRI study. Probably has a bone spur.
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Thanks Rip. We've discovered that high-bar is no better - the only way to avoid terrible pain, particularly with neutral wrists/forearms, is to allow the left shoulder to 'hitch up,' pushing the bar into a diagonal position on her back (further forward on the left, further back on the right). We're not sure what to do in the short-term - perhaps safety-bar squats are better than no squats or only leg presses?
It's very hard to get an MRI in my country as GPs typically refuse to make a referral for one (socialised healthcare); however her father has a bone spur in his shoulder which is currently underoing ultrasound treatment because it is literally ripping his tendon to pieces, so that might persuade them it needs to be examined properly.
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But the good thing about socialized medicine is that it's free!
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