shoulder

[hyslop]

hi guys ned some help got the scan back from my shoulder,got impingment syndrome is there any thing i can take to speed up recovery

thanks Daniel

[Shibby]

There are different stages I, II, and III. For the most part it's caused by overusage. So resting would be the thing to do. Look at this and see what type you have.

"Several classification systems are used with the impingement syndrome. Neer5 divided impingement syndrome into three stages. Stage I involves edema and/or hemorrhage. This stage generally occurs in patients less than 25 years of age and is frequently associated with an overuse injury. Generally, at this stage the syndrome is reversible. Stage II is more advanced and tends to occur in patients 25 to 40 years of age. The pathologic changes that are now evident show fibrosis as well as irreversible tendon changes. Stage III generally occurs in patients over 50 years of age and frequently involves a tendon rupture or tear. Stage III is largely a process of attrition and the culmination of fibrosis and tendinosis that have been present for many years."

[muscle_n_blood]

I wouldn't suggest speeding up recovery too much. Rest it. I have had radical surgery on both shoulders (the latest 3 weeks ago, ouch), including full thickness rotator cuff tears, impingments, chondral defects, etc. If you are in the iron sports for the long haul, take good care of your shoulders. Look carefully at your trainng and see that you aren't doing exercises that are hard on your shoulder joints, like behind the neck presses/pulldown, benching with too wide a grip and your elbows flared, etc.

[hyslop]

i am under 25 and the doc says i dont have any tears it's just the tendor in my sholder had some truma 8 months ago when my arm fractured pressing weight. The less i do the worst it seems to be, but it can be repaired says the doc through physio.Just find that the pain comes and go's. I don't find that rest is'nt doing any good.

[NYCmitch25]

I don't find that rest is'nt doing any good.

agreed. i have battled tendonitis....here are my thoughts. things have worked for me.

Some things you can try on your own: (mild-to-moderate pain)
Range-of-motion exercises/stretching - For instance, rotator cuff tendinitis caused by a weak rotator cuff muscle which then causes instability in the shoulder joint. Strenthening the rotator cuff fixes the problem.

Heat/cold - applying an ice pack for 20min periods a few times a day. post workout is good.

Medications - glucocorticoids, NSAIDs (non-steroidal anti-inflammatory
drugs) Ibuprofen (Advil, Motrin, Nuprin)
Naproxen (Aleve, Naprosyn) - they will reduced inflammation and provide pain management but if you dont correct the issue it will return. Be careful with the NSAIDs, long term use will cause a host of problems (hard on the kidneys, can cause bleeding ulcers,etc.) I dont suggest eating them like tic-tacs. 1 or 2 a day - 1 AM and 1 PM.

Rest - take a break, dont train as much for a few weeks. even better
aviod exercise which cause pain - sounds obvious but we are stubborn lol, military presses behind the head bother me so i dont do them.

Diet:
Fish/flax oil - I personally have found omega 3 fatty acids to help.

Treatment you may get at the doctors office: (moderate-to-severe pain)
Ultrasound stimulation - a modality a Physical Therapist may apply to the area. I dont think it works very well.

Referal for PT/AT good rehabilitation program.

Perscription anti-inflammatory drugs - stronger than NSAIDs-COX-2 inhibitors (Bextra, Celebrex->pulled from market).

Cortisol anti-inflammatory injection - This has some risks (damages healthy tissue) but is VERY effective, also make sure the person doing the injection is skilled at it.

Surgery - last resort, also sometimes the injury that lasts a long time will cause the tendon to tear.


plz critique....or add to the list.

[BBAddict]

Medications - glucocorticoids, NSAIDs (non-steroidal anti-inflammatory
drugs) Ibuprofen (Advil, Motrin, Nuprin)
Naproxen (Aleve, Naprosyn) - they will reduced inflammation and provide pain management but if you dont correct the issue it will return. Be careful with the NSAIDs, long term use will cause a host of problems (hard on the kidneys, can cause bleeding ulcers,etc.) I dont suggest eating them like tic-tacs. 1 or 2 a day - 1 AM and 1 PM.

Definitely agree with most of what you said. Regular icing and paying attention to proper form during lifting is key for me--and anything behind the head, whether its presses or pull-downs is just asking for trouble!

As far as NSAIDs, I understand that for effective anti-inflammatory results, one needs to take at least 400mg (2 standard pills) and I have usually been recommended to take 3 pills--but never more than twice a day, like NYCMitch said. I know from experience that for knee swelling, I need 3 pills 2x/day for effective anti-inflammatory treatment.

[Shibby]

Sounds like there may be a bit of scar tissue than needs to also be broken up. Doing shoulder abduction/adduction exercises with a theraband to start would be good. You want to increase the resistance slowly so you can judge if the pain is coming from it being overstressed or the breaking of the scar tissue. One of the players I helped with an ACL rehab was having a slight amount of pain when she was trying to move to the next step. We just had her keep working at what she was doing. One day it just kind of popped got a little swollen and then was better. She was able to start increasing then. There was scar tissue that finally wore down. She had constant supervision and instruction.. This is a little extreme for you to just try and put yourself through, but you get the idea. Stick with the usual NSAID/ice program to start and then increase to the Cox-2's as NYC stated.

[hyslop]

the thing i finding is that its not sore only some times like if i put heat on my shoulder my bicep starts to feel uncomfartable.dieing to get back to the gym,but cant press right with it.

[Shibby]

Sounds like there is just a little bit more rehab to do. The heat is probably because you are expanding everything which is creating some inmpingment also. Just get some small dumbells depending on your strength. Nothing high, just like 10lbs or something. This way you can create force against the muscles and get your shoulder use to the movement. This may also show you how damaged it still is.

[NYCmitch25]

What have they told you they plan on doing for you? Keep us posted. I would wait until your ready. For now you should avoid activity that causes shoulder pain altogether. I would try to maintain cardiovascular fitness instead.

i assume they prob. would start you stretching and stregthening of the 4 shoulder rotator cuff muscles by isolating each muscle group and selectively training that muscle (Isometrics-below) - with no weights. A few weeks?
Again i would wait till after the pain has gone down a little before you start performing shoulder exercises. This will help to maintain the range of motion in the shoulder and prevent scarring from the inflammation.

[edit] post up the MRI's.

[NYCmitch25]

Phase 1 - Isometric exercises.

The subscapularis is the anterior stabilizer of the rotator cuff and responsible for internally rotating the shoulder. It is best strengthened by holding your arm in front of the body, with the arm flexed to 90 degrees, and rotating the hand to touch the belt. The exercise can be performed while lying on your back with the elbow close to your side and flexed ninety degrees. Lift the weight until it is pointing toward the ceiling and then lower it slowly. Add small amounts of weight as you progress, making sure you are in minimal pain at all times. If it gets too painful, stop and rest.

The supraspinatus is strengthened by holding out your arm straight in front of the body, with the thumbs pointed toward the floor. Slowly elevate the weight to above the head. Stop if pain is produced in any portion of this motion, as the rotator cuff is under maximal stress in this position. As you feel better, you can slowly introduce small amounts of weight to continue strengthening of the muscles.

The infraspinatus is strengthened by holding you arm (and later on, a weight) in the position of the ski pole just prior to planting the pole. By rotating the arm from the neutral straight ahead position, to the externally rotated (out to the side) position, the infraspinatus and teres minor are strengthened. Again, this exercise can also be performed while lying on your side with the elbow close to your hip, and flexed ninety degrees. Rotate the weight until it is pointing toward the ceiling. Shoulder exercises are best performed with relatively light weights and multiple repetitions.

The logic behind stretching and strengthening the inflamed rotator cuff in order to speed healing and functional performance is as follows: the inflamed tissue is characterized by increased fluid between the cells, increased numbers of new blood vessels and inflammatory type cells. As a result of this inflammatory reaction, new collagen tissue is laid down in an effort by the body to heal the injured tissue. If the shoulder is immobilized during this time, the new collagen is laid down in a disorganized fashion, creating scar. The goal of gentle stretching, strengthening and anti-inflammatory medication, is to stimulate the cells to lay down collagen along the lines of stress, forming normal strong tendons. The combination of a good warm up, gentle stretching, strengthening below the limits of pain, icing after working out and anti-inflammatory medication has been consistently shown to speed recovery time in the strongest possible fashion.

After you are comfortable with these stretches and have minimal pain and good/fair range of motion in your shoulder, you can move onto resistance exercises. These usual start with what is known as tubing exercises. The 'tubing' is also known as a theraband, which is just a big rubber elastic band that you tie, at one end, to something and you hold the other end and pull the band thereby stretching it and providing resistance for your shoulder.

Phase 2 - Tubing exercises

External rotation: Stand resting the hand of your injured side against your stomach. With that hand grasp tubing that is connected to a doorknob or other object at waist level. Keeping your elbow in at your side, rotate your arm outward and away from your waist. Make sure you keep your elbow bent 90 degrees and your forearm parallel to the floor. Repeat 10 times. Build up to 3 sets of 10.

Internal rotation: Using tubing connected to a door knob or other object at waist level, keep your elbow in at your side and rotate your arm inward across your body. Make sure you keep your forearm parallel to the floor. Do 3 sets of 10.

Extension: Same principles as the other two. Keep the arm parallel. 3 sets of 10. See attached picture


As you feel more confident and you find your strength increasing, you can add more resistance - either in terms of shortening the length of the theraband so you need more resistance to stretch it or by increasing hand held weights in small increments.

Ofcourse, these arent the only exercises for shoulder rehabilitation. There are many more. Ive listed a few more below that ive found from a good website:


Overhead stretch
Lie on your back with your arms at your sides. Lift one arm straight up and over your head. Grab your elbow with your other arm and exert gentle pressure to stretch the arm as far as you can.

Cross-body reach
Stand and lift one arm straight out to the side. Keeping the arm at the same height, bring it to the front and across your body. As it passes the front of your body, grab the elbow with your other arm and exert gentle pressure to stretch the shoulder.

Towel stretch
Drape a towel over the opposite shoulder, and grab it with your hand behind your back. Gently pull the towel upward with your other hand. You should feel the stretch in your shoulder and upper arm.

Shrugs
Stand with hands at sides with no weight in either hand. Raise shoulders to the point of pain and hold for five seconds. Relax for five seconds. Perform this sequence 10 times, 3 times daily. As pain permits, hold dumbbells of equal weight in each hand while performing this exercise. Add weight by using hand-held dumbbells as pain permits.

Bicep curls
Stand with arms fully extended at sides while grasping 2- to 5-pound weights in each hand, held palm forward. Flex the arms at the elbow to approximately 100 degrees, or to the point of pain, whichever comes first. Hold this position for 5 to 10 seconds. Return to the start position. Rest for 5 seconds. Repeat this exercise 10 times. You can increase the weight as pain allows and strength develops.

Triceps curls
Stand with elbows directed upward over the shoulders and with arms relaxed. Extend arms at the elbow so that the hands proceed upward to the point of pain. Hold this position for five seconds. Return to the starting position and relax for five seconds. Perform this sequence 10 times, 3 times daily. As pain permits, add weight by using hand-held dumbbells.

Chest raises
Lie on belly with hands extended along sides of the body. Raise the upper chest from the floor to the point of pain and hold this position for 5 seconds. Return to the start position and relax for 10 seconds. Repeat this sequence 10 times, 3 times daily.

Saws
Reach out and place the unaffected side hand on a corner of a table. Bend at the waist. Flex the injured side arm at the elbow and pull the injured side arm backward and upward as if sawing wood. Slowly bring the shoulder blades as close together as pain will permit. Slowly bring the injured side arm down to its beginning position. Repeat this sequence 10 times, at least three times daily.

Pendulum swings
Stand with the hand of the unaffected arm resting on the corner of a table and supporting some of the body weight. Slightly bend the knee on the unaffected side and extend the other leg sideways. Allow the injured arm to hang loosely over the unaffected side foot. By shifting the body weight, cause the relaxed injured arm to swing in circles to the fullest extent possible as limited by pain. Perform 25 swings in a clockwise direction. Allow the injured arm to cease swinging. Perform 25 swings of the injured arm in a counterclockwise direction. Repeat this sequence at least three times daily.

Flexed elbow pull
Bend and raise the injured side elbow to shoulder height. Grasp the injured side elbow with the uninjured side hand. Gently pull the injured side elbow toward the opposite shoulder until limited by first significant pain. Hold this position for 10 seconds. Relax for 10 seconds. Repeat this sequence 10 times at least three times daily.

The major objectives of rehabilitation from a rotator cuff injury are to increase flexibility, obtain pain-free range of motion, and strengthen the muscles of the shoulders, upper back, front chest, and upper arms.

Im sure there are other exercises that i havent mentioned.

[hyslop]

will do! All the doc said is that my sholders fine and to take it easy when training and that the hospital are going to treat me for having impingment syndrom. any 1 know of any stuff that is safe and that i can take after injury has gone too speed up the strength in my shoulder?

[Shibby]

You are not going to want to take anything. You need the inflimation of everything surround the muscle to go down. Trying to speed up the strength process would probably only cause further damage.