Recommendations for Shoulder

[Andy Baker (KSC)]

Rip,

Client of mine is a 49 year old female. Been complaining of a pain up in her trapezius. I thought it might have been a pinched nerve similar to what I've had a few times. Massage and chiropractic adjustment had no effect.

MRI report states the following:

"Type II curved acromion with mild hypertrophy of the AC joint and coracoacromial ligament without rotator cuff tear. Clinical correlation advised for impingment syndrome."

Any reason why the pain she would feel is up in her traps? Also, recommendations for training her going forward?

[TravisRussellDC]

Rip,

Client of mine is a 49 year old female. Been complaining of a pain up in her trapezius. I thought it might have been a pinched nerve similar to what I've had a few times. Massage and chiropractic adjustment had no effect.

MRI report states the following:

"Type II curved acromion with mild hypertrophy of the AC joint and coracoacromial ligament without rotator cuff tear. Clinical correlation advised for impingment syndrome."

Any reason why the pain she would feel is up in her traps? Also, recommendations for training her going forward?

Sure, because the Type II acromion was an incidental finding and not the true cause of her pain. You mention chiropractic adjustment. Did she have a single adjustment or was she treated multiple times? What kind of examination protocol did she go through to detmermine if the pain she was feeling was myofascial or joint related?

Possibilities could include that the pain is visceral and referred from another source, the wrong musculoskeletal structures were addressed, not enough time was given to adequately affect change, the aggravating activities were not stopped and the correction provided was not allowed to affect change, etc.


Just a side note, pinched nerves do not cause pain. Pinched nerves cause a loss of function to that nerve which will produce numbness, tingling, muscle weakness & atrophy, etc. Nerve irritation which causes overactivity of the nociceptors (pain receptors) can manifest as pain due to heightened sensory afferentation. So, the pain receptor nerve is at a higher chemical activity level which makes it easier to fire and once it fires enough, chronic pain has set in causing the nerve to fire automatically. It's kind of like a training response for the nervous system.


Your client is in pain because there is something that is causing those sensory nerves to fire more than she should. The massage therapist and chiropractor either didn't treat the cause or the aggravating factor was not determined and addressed. She needs a better examination.

[Mark Rippetoe]

Didn't even see this before it was somehow approved. But Trav is right on the money: the cuff/AC situation is asymptomatic. She has a C6-7 ding of some sort. She has a chiropractic case now, perhaps a neurosurgery case in several years. But this is typical of diagnostic problems, in which you may find problems that aren't really there when you do MRIs. Many asymptomatic low backs will MRI positive for herniations and other pathology, while many painful low backs will MRI negative. Strange but true. Same deal for navicular disease in horses.

[JLascek]

Rip and Travis,

We have a friend here at the gym who is 60 and has some disc problems (4 to be exact), but notably in his C6-C7. It closes down on his foramen and makes the lateral and posterior aspect of his left arm go to shit when doing any presses. He's getting decompressed 5 days a week, and this has helped so far. I'm working with him now, and Rip gave some advice as to what to do in his training.

My observation has been that when he makes a concerted effort into going fast in his presses that this neurological limitation is less existent. I attributed this to the speed increasing the recruitment of motor units. Am I on the right track, or am I neglecting something?

As of yesterday (8/19/09), we weren't able to advance even to 135 for more than 4 reps (the protocol was to do sets of 10 to 15 at a lighter weight since his strength is not a limitation -- he used to do 225 for sets of 20). I did notice that he could pop off a double or single, so I just set him on a clock and had him do some singles every 20 seconds. Any more reps and the neuro case would limit his left arm.

1. Is this a valid method of trying to get some training volume at a slightly heavier weight given the limitation? Or...
2. Would it be more sensible to drop to something he could handle for the desired rep range? I decided against this at first since we know strength isn't the limiting factor.

On a side note, we dropped to 95 and he wanted to see how many he could do (he's pissed about the huge strength loss because of this neuro case). He got 25 by doing them fast, and didn't have much form degradation until the last few reps.

Anyway, I typed all this because I was hoping others could learn from it.