Wandering pain

[Bestafter60]

Coach, I've read most every thread pertaining to lateral epicondylitis. I'm two weeks into attempted recovery. Your post about pain that "blurs" is interesting. I'm doing chins and other exercises very similar to reverse dumbbell curls and pronation/supination with a hammer. I'm noticing not only the blurring of pain but also the fact that the point of tenderness is moving over time. My guess is this indicates inflammation has left the area which has been directly exercised, and there is leftover inflammation nearby, which emerges as the new point of tenderness. And based on that, I'm chasing out this residual inflammation by slightly modifying exercise angles until I feel the most discomfort, indicating the new "high water mark" of inflammation, and then attacking that area directly.

I wonder if you or others agree with my thought process and remedy?

[Mark Rippetoe]

Shoulder pain is famous for behaving this way too. I think it makes much more sense to keep to the program, which works the entire area in question, as opposed to attempting to chase down every new symptomatic muscle slip/tendon. In your piecemeal approach, what if you leave something out? Work the whole thing, and the whole thing will adapt.

[Mark E. Hurling]

I can't speak to the program or how to ameliorate or remedy the pain of which you speak.

But I have experienced the same kind of "moveable feast" of pain in my feet and ankles over the years. It might start in my arch or instep and then orbit around to the other parts of my foot over a period of 2-5 days with such severe pain I either need a cane or cannot walk at all. I have no idea what brings it on, but since I have quit running for cardio, it has occurred less frequently.

I get pain in my other joints, but it doesn't seem to travel around. Once my knee, or elbow, or AC, or wrist gets boogered up, it stays specific to that area and doesn't move.

[Bestafter60]

Will do, and thanks for the reply. A related question: it's my understanding that the likelihood of musculoskeletal injury goes up when there is a strength imbalance between protagonist and antagonist muscles *at a joint. If that's true, don't we need to strengthen the forearm extensors to balance the increase in grip strength that we get from deadlifts and chins? Could muscular imbalance be part of the cause of tennis elbow, along with overuse?

Shoulder pain is famous for behaving this way too. I think it makes much more sense to keep to the program, which works the entire area in question, as opposed to attempting to chase down every new symptomatic muscle slip/tendon. In your piecemeal approach, what if you leave something out? Work the whole thing, and the whole thing will adapt.

[perman]

Shoulder pain is famous for behaving this way too. I think it makes much more sense to keep to the program, which works the entire area in question, as opposed to attempting to chase down every new symptomatic muscle slip/tendon. In your piecemeal approach, what if you leave something out? Work the whole thing, and the whole thing will adapt.

My shoulder pain has been like you describe, moving around from place to place, for a little over a year now. Started with pain around the coracoid process from benching, hit both sides (haven't trained the bench since, only tested if it produces pain now and again), though only left side has persisted. It has since moved around to become a general neck shoulder issue on the left side. I can click my traps by moving my head towards my right shoulder fairly often. I've had pain, trigger points, or soreness or whatever the correct word is around the traps fairly consistently, around the posterior shoulder blade, typically on the top of the shoulder blade or around the rhomboids. For a few months now I've often had some pain on the very top of the press laterally outside my arm pit.

Have spent probably lots of hours accumulated at this point with a ball rubbing against my traps, rhomboids, around the edges of the shoulder blade. Have kept pressing and chinning like you said you should, but have otherwise also experimented with various stuff that's supposed to help like face pulls, band work, rows (even though I've seen you call those types of movements silly shit).

So I guess I'm wondering how this type of situation is supposed to resolve itself? It's nothing unbearable, and it's slowly gotten a little bit better, but it feels a little bit like a game of whack-a-mole where some shoulder-neck shit just moves around and never truly disappears. I previously tried to get an MRI like I've seen you often recommend for shoulder issues, but my doctor refused to prescribe it since it wasn't that bad, so I got a PT referral and wasted a couple of sessions there. He concluded it was an AC joint issue since benching caused it, and wanted me to stop aggrevating it, which I had already determined to do anyway. Seen lately that both you and Will Morris don't recommend MRI's for non-serious shoulder issues, so I figure I'm just gonna try to train it out, but it's still annoying to have to deal with for the foreseeable future.

[Mark Rippetoe]

shoulder injury it's been 8-9 weeks now...

Will do, and thanks for the reply. A related question: it's my understanding that the likelihood of musculoskeletal injury goes up when there is a strength imbalance between protagonist and antagonist muscles *at a joint. If that's true, don't we need to strengthen the forearm extensors to balance the increase in grip strength that we get from deadlifts and chins? Could muscular imbalance be part of the cause of tennis elbow, along with overuse?

You have an inaccurate impression of what's going on in the forearm when when you're chinning. Both agonist and antagonist groups are active.

[Will Morris]

He concluded it was an AC joint issue since benching caused it, and wanted me to stop aggrevating it, which I had already determined to do anyway. Seen lately that both you and Will Morris don't recommend MRI's for non-serious shoulder issues, so I figure I'm just gonna try to train it out, but it's still annoying to have to deal with for the foreseeable future.

I can't speak for your Physical Therapist, but I can speak for me, and I am batting almost 1.000 with AC Joint patients by teaching them how to bench properly. Every now and again, I start them with dumbbells and I train them in a fairly specific technique. Once they get comfortable doing that, I move them to the barbell and all is good. The only one I didn't get all the way back to full activity ended up with a Mumford, but I was able to get him another 9 months of training before the Mumford was performed.

[Bestafter60]

shoulder injury it's been 8-9 weeks now...



You have an inaccurate impression of what's going on in the forearm when when you're chinning. Both agonist and antagonist groups are active.

Ok, not doubting your knowledge and certain of my lack thereof - here's why that's hard for me to understand: I believe only one of the opposing muscles can be in contraction at a time, and I observe contraction of the flexors throughout the chin up or deadlift, notably because otherwise the grip would fail. And I associate the extensors with opening the hand. So, at what point are the extensors contracted and strengthened? And were can I learn more about this? (Cuz I gotta get rid of this tennis elbow and I like to know how things work). Thanks in advance if you continue to indulge me on this.

[Mark Rippetoe]

Because when you grip the bar in a chin, your wrist is also in extension. Make a fist. Look at it. Feel your forearm.

[Will Morris]

I believe only one of the opposing muscles can be in contraction at a time

Co-contraction of the opposing muscles is every bit as important as the contraction of the agonist muscle. Rip is right on, grip something and feel the extensors.

For example, I had an ulnar nerve injury during a recent surgery. This ulnar nerve injury has caused pronounced flexor weakness in my 4th and 5th digits in my right hand (ring and pinky finger). Without a solid co-contraction of my finger flexors, when I actively extend my 4th and 5th digits, they immediately go into hyperextension (almost to the point of subluxation) due to the extensors being mostly unopposed. This works the same way throughout the body. If the hamstrings don't co-contract, when you contracted the quads, you would immediately go into hyperextension of the knee.