Daily Mobility Exercises by Dr. Kelly Starrett › Forums › Shoulder › Posterior Capsule Impingement of Shoulder

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    • 05/10/2013 at 3:17 pm #70190
      AvatarJonah Buzila
      Participant

      I have a high level, dedicated Crossfit patient that first presented with posterior shoulder pain on the right.  He has pain when he does bench press, dips, snatch, pull ups, anything overhead. The pain was first in his Infraspinatus/teres minor insertion area, it seems to have now moved/localized to the posterior capsule.  Today when doing banded rotator cuff internal rotation exercises he was having pain there.  When I laid him down and stuck my foot in his armpit and did an arm distraction maneuver while internally and externally rotating his arm, internal hurt, external felt better.  I translate that as a posterior capsule impingment.

      I’ve been mobilizing his shoulder, adjusting his c spine and t spine, and doing all kinds soft tissue work from ART type work to Guasha, to all the stuff in the Supple Leopard.  We’ve even Voodoo Flossed it and used a cold laser on it. He’s also had massage.  Nothing is improving it for more than a day.  He has begun to lay off all overhead and basically all upper body work at the box.  What else can we try?  Thanks.

    • 05/10/2013 at 9:31 pm #71956
      AvatarBryan Jackson
      Participant

      John any tenderness in the anterior shoulder?  Bicipital tendon? Pec? Anterior Deltoid? or Sub Scap?  I have had many Crossfit patients that present with some posterior pain but really hurt while trying to perform similar lifts like bench, dips, snatch, most overhead stuff and even pushups.  We have had pretty good success working the pec, Sub Scap, Anterior and Middle Delt, and mostly the long head of biceps.  Most of our athletes are dealing more with anterior impingement than posterior.  Too much tight tissue in the front.  I’m finding a lot of these guys have some pretty bad basic posture to start with not to mention some poor mechanics on almost all the lifts.  They are just ripping apart their shoulders and it finally catches up with them.  Then they(me too) want to be back in 2 to 3 days.  May take some time for him to rebuild from ground up and allow some time to heal.  Just a thought.  Keep me posted.

    • 05/10/2013 at 9:34 pm #71957
      AvatarBryan Jackson
      Participant

      John one other comment.  Most of the guys we have with similar conditions need a ton of work on Thoracic Mobilization.  Have them tape the 2 balls together and go to work on T-Spine Mob.

    • 05/10/2013 at 10:10 pm #71958
      AvatarJonah Buzila
      Participant

      Eric,

      Thanks for the response.  I have checked Biceps Tendon before, that’s not it.  I do see that a ton though.  You are right on with the subscap and pec though.  His pec is like steel cables.  Subscap is real tight too.  He doesn’t have a good pain threshold though.  2 passes of ARTish work and he’s tapping out.  And yes, his T spine is a wreck.  When I adjust him he says he feels like he’s spasming in the midback after every time.  I told him he needs to live on the peanut (2 balls) then. 

      I will continue to have him focus on t spine/pec mobility.  Thanks for the comments.  It’s good to know I’m not forgetting anything, just need to stay the course and be patient. 

      This community is awesome, thanks KStar!

    • 10/31/2013 at 6:03 pm #73092
      Jeffrey LindbomJeffrey Lindbom
      Participant

      Would be interested in an update from this case study.

      I have been trying to troubleshoot similar symptoms for months if not going on a couple years now.
      Mostly, I present posterior shoulder pain when hanging from a pull-up bar (more pronounced with a supinated grip) and can “pop” my shoulder by internally rotating my humerus or, interestingly, retracting my scapula and flexing the humerus. The “popping” becomes more pronounced with increased abduction (former case) or retraction (latter case).
      Interestingly, any kind of rowing movement is most problematic as it increases my “need” to pop my shoulder (which I see as detrimental but necessary in that it is extremely uncomfortable to walk around in a state of hypertonicity).
      Also, I have noticed working on the soft-tissue of downward rotators of the scapula (rhomboids, lats, levator scapula) with various smashing and band-mob techniques and then doing some light overhead dumbbell pressing helps my symptoms but the relief is relatively short-lived (~24 hours).
      I would love to get back to being able to train my upper back and throw a baseball again pain-free.
      Thanks!
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