UKC

Strong shoulders aren't necessary healthy shoulders. Ever had pain or twinges in your shoulders?

In this classic UKC article Gabriella Frittelli - climber and physiotherapist - explains how you can prevent shoulder impingement and keep on climbing all year long.

Read more at http://www.ukclimbing.com/articles/page.php?id=119

In reply to UKC Articles:

I'd be interested to have some references to the research on the causes of SIS and in particular research showing that these exercises make a difference in prevention and rehab. I find the article plausible. I'd just like to see the research.

I streeeeeetched up for a grip on a bouldering wall and felt a scrunch in my shoulder. I had mild to moderate pain when raising my arm above my head for a while and saw a physio. Impingement was the diagnosis and he gave my the same exercises as in the above article.

What sorted me out, and was a chance discovery shortly after the physio visit, is surfing. I can only assume it's all the paddling. So perhaps swimming crawl would have the same effect?

In reply to ericinbristol:

Agreed, but equally i'd be interested to hear from people who can say they've noticed definite improvement from doing these excercises (mixed with a little climbing maybe).

I've been doing them as and when I can based on a physio's diagnosis of SIS. Maybe I haven't been as religious as I should be but it feels like simply climbing is making my shoulder stronger. Although the symptoms still seem to randomly crop up every now and again.

Buggered knees and a buggered ankle has led me to believe no matter what I do, my shoulders are also soon to be well and truly buggered.

In reply to OwenF:

Yes, I'd be interested to hear that too and people reporting no improvement or deterioration.

My wife's view (she's a physio) is that in some cases SIS has nothing to do with the muscular imbalances referred to in the article and it can be simple overuse. That appears to be the case with my occasional SIS: it is very easy to trace it to overdoing it (especially indoors bouldering, slapping for holds).

In reply to UKC Articles: I’ve been suffering from shoulder problems since the end of last year. I’ve been seeing a physio that diagnosed Supraspinatus impingement. Months of shoulder stability exercise have given me an improvement to the point where I’m able to climb relatively unaffected and some days I experience no pain at all. I still get pain occasionally.

Recently I saw an upper limb specialist who seemed to think it could be a Bursa problem or a tear in the bicep tendon. I have an MRI scan on Wednesday which should hopefully clear up the cause and allow them to treat it.

In reply to OwenF:

But as she says < Please note: This article is not intended as a treatment guideline for shoulder injuries. > Doesn't this imply that the exercises are more effective as prevention and not as a cure for an already damaged shoulder? I needed surgery to cure my SIS (which was definitely an overuse injury) but before it came to that, I tried all these exercises, with the help of my physio. Unfortunately the pain prevented me from doing them anywhere near effectively.

In reply to jon:

Regardless about what she wrote about her intent behind the article and even if they are generally aimed mainly at prevention rather than rehab, the fact is that these exercises are routinely recommended for rehab as well as prevention. Hence my request for accounts of rehab experiences makes sense.

In reply to OwenF:

I had a shoulder problem a few years ago that sounded like what the article talks about. After about 3 weeks of doing these exercises (this article was first published several years ago) once a day, the problem went away. I kept doing the exercises for a few months, then stopped. After a few months of not doing the exercises, the problem came back again--re-started doing the exercises and the problem went away again!

In reply to alicia:

Thanks for the rehab+prevention info. Is it your impression that the exercises made the difference or, looking back, is it that you eased off on the intensity of climbing and that was what helped?

In reply to ericinbristol:


Yes, I was in fact (rather clumsily) agreeing with your sentiments. Certainly, once a SIS gets to the point where just the movements described are too painful to contemplate, they are of little use. After my op and after weeks of very gentle physio to regain amplitude of movement my physio started me back onto these exercises. The shoulder gradually got better and now only complains slightly after a particularly strenous session on overhanging routes. The op was however six years ago(!) and even at the time there was no way to say whether the exercises had any bearing whatsoever on my recovery. I suspect they didn't, as I didn't do them very religiously at home...

In reply to ericinbristol:

I definitely didn't ease off on the intensity of climbing, so it wasn't that, although it could have been something else that I wasn't aware of. It did seem to be connected to the exercises, though.

In reply to UKC Articles:

In my experience (as a patient) these exercises are very useful in correcting muscular imbalances. They also have some use as a preventative measure.

However, exercies alone often aren't effective without some form of treatment to the injured area as well, for example massage therapy and ultrasound.

In reply to UKC Articles:

Interesting to read this article and some of the replies. I have had quite a few shoulder injuries over the years, including a couple of rotator cuff tears and one very nasty one that left my shoulder out of action for years - to the point of having some very noticeable atrophy in the shoulder and running down into the outer part of my right bicep.

I have seen physios a number of times, but lets face it our health system is not the best for treating this kind of injury. However, I have found one literally magical cure for these injuries - Acupuncture combined with fairly aggressive massage.

After years of struggling with only around 40 percent use of my right arm/shoulder, following a very nasty bouldering injury, I finally paid for a course of acupuncture and massage. Literally, within 6 weeks (about 8-10 sessions) I had around 95 percent use back of my arm back and zero pain in my shoulder! It was like magic, utterly amazing!! I could not believe I had suffered for so long.

I have since torn the rotator cuff in my left shoulder and immediately got treatment. This time it was not quite as effective, but the injury settled very quickly. I then gave it a little time, went back about 6 months later for a few more treatments and again, cured!

I can not stress enough - If you are suffering the shear nightmare of these injuries then you must try it. It is well worth the cost and far less invasive than surgery!

In reply to shartlan:

Acupuncture was my last ditch attempt to avoid surgery. I went to someone who had cured a friend's chronic golfers elbow in much the same way that you describe for your shoulder. I went with an open mind about it and had numerous sessions. Sadly it didn't work for me and at €50 a session I couldn't afford to keep trying. I agree with you though - try everything to avoid the nighmare of surgery and it's painful aftermath.

In reply to jon:

On that point, how's your recuperation coming on?


Chris

In reply to UKC Articles:

On a related note, anyone have any thoughts on my little theory?!

In reply to Robert Durran:
On a related note, anyone have any thoughts on my little theory?!

Oops. forgot the link: http://www.ukclimbing.com/forums/t.php?t=475865&v=1#x6566725

In reply to OwenF:

I experience improvements from doing antagonist exercises like those mentioned, and if I dont do them, my shoulder problems reoccur. A couple of years ago I underwent succesful arthoscopic surgery on my torn supraspinatus tendon. I could have prevented this by paying attention to these preventive exercises.

Cheers,

In reply to UKC Articles:
As many of you above I also suffered from impingement and some undiagnosed shoulder problems. I had to stop climbing for a couple of months, although iceclimbing worked alright.

I did all the exercises 4-5 times/week shown in the article. After a month or two when shoulder was better I also did this (but with a light dumb bell, started with 2kg now 4kg 3*20)
http://www.styrkeprogrammet.se/ovningsarkiv/431

After starting that exercise the shoulder got much better. Now I do all exercises once a week. Fingers crossed it´ll be enough to keep injuries away!

In reply to UKC Articles:

I had shoulder surgery a year ago for a large full thickness tear of my supraspinatus and complete tear of my infraspinatus. It took me 6 months of hard work to get vertually full movement back and 9 months before I was able to start some easy climbing. The consultant said that I "may" recover fully in 18 months. However the muscle loss has been massive. Any excercises that can prevent this sort of injury should be heeded!

In reply to UKC Articles:

Well timed and helpful article as I've just blown my shoulder out this weekend pretending to be a ninja and front rolling around in a field...

In reply to UKC Articles:
Having incurred shoulder injuries on both and been subject to some questionable medical advice, my view is the article is good when aimed at those who want to prevent injury and have no issues at the moment.To be fair to the article it does state this.

If you are suffering from problems, there is only one thing for it, MRI scan and ultrasound as well.A good consultant specialising in shoulders ( sports injuries) is a godsend.Whatever you do do not go to a physio first, get a doctors referral up the chain.

In reply to proze:


I've suffered from shoulder impingement on and off since I dislocated my clavicle several years ago. I find I have to be very careful when I start a swim training program and build up *very* slowly - if I don't, I'll end up unable to climb for several weeks till it settles down. Then again, it's a pretty complex place to get an injury so what works for some probably screws up others.

As others above have said, the exercises do work for me, until the next time, and I suspect if I could motivate myself to continue doing them when things are good, I'd have a lot less issues!

In reply to Ciro:

Interesting responses from everyone there. I'm at the point at the moment where I'm not even sure now if my, albeit minor, shoulder pain is due to the SIS I was diagnosed with a while ago reoccuring or just exhaustion from doing too much all the time. A clue is that not only my shoulder but back, arms, elbows ache aswell!

As was said above, although the article was aimed at prevention, it is true that these excercises are given as treatment/rehab.

I think I will continue to do them as and when I can, as they can't really be doing any harm (as long as they don't cause pain of course!)

I'm useless at admitting to injury because I always ache after working hard but if I keep up preventative measures I should slowly be making my shoulder stronger. The other thing is; admitting to injury/going to doctors/getting surgery....whatever, is all time out of action that I don't want to have. In some respects I'd rather risk further injury and but have it sorted when im not in the prime of activity.

In reply to OwenF:
Try telling that to yourself when you have completley wrecked your shoulders and you might be out of action for a long time.Do not ignore it.

In reply to OwenF:


That's just it. At 25 you really aren't at your prime. You just think you are...

In reply to jon and neil:

Fair points indeed and definitely not ignored! I mean't prime of activity, as in; at this moment in time i'm in the position to be doing more climbing/mountaineering than i've done to date.

So then, I first experienced a NEW sensation of pain in my shoulder over 6 months ago, which I saw a physio and was told 'classic SIS'. Was given the stretchy band excercises, a short course of ultrasonic/sound whatever it is, etc.

Half a year later having done moderate overhead activity in that time(although increasing a lot just recently) and i'm still occasionally feeling 50% of the original pain every now and again. This is without serious effort with the excercises until just recently.

Would you go to a doctor and progress the matter without committing a bit more time to exercises? My concern is that i'll just get sent away with the same diagnosis and same excercises. In other words, I want to be SURE that its a problem before I go looking for a solution.

In reply to neilh:

I'd disagree with that. Go straight to a GOOD physio rather than wasting ages on referrals. If the physio is decent they'll still advise an MRI scan IF it's necessary which it won't be for the majority of patients.

In reply to Michael Gordon:
MRI scans do not reveal tears, ultrasound does.

Saw 3 good physios, when all said and done they are not qulified doctors/consultants .They are experts in rehab, prevention etc, but diagnosing the problem...no. use them afterwards. Even use fitness coaches after the phsio, because a physio can only take you so far.

In reply to neilh:

But they will reveal an impingement, no?

I have a imbalance between internal and external rotators at present. My internal rotators were used frequently (such as bench pressing) and my external rotators were neglected. This resulted in lots of nasty popping in the joint and eventually severe pain when doing any training at all at the gym or wall.

I have been training my external rotators independently using exercises identical to the ones in the article but with light dumbells and the difference it has made is outstanding.

I have also dropped gym exercises which cause abnormal rotation of the shoulder such as barbell upright rows and bench pressing in favour of dumbell equivelents which allow natural rotation and work the stabilisers.

In reply to UKC Articles:
Hi guys,
A few quick thoughts speaking as an experienced orthopaedic physio and experienced climber:

- an experienced chartered physio (preferably specialising in orthopaedics/sports)will give you a more accurate diagnosis than your average GP (no offence to reading GP's!) and i woulod advise it as your first port of call.

- Yes, Ultrasound Scan is usually sufficient for simple impingement diagnosis (including specifics of tendon versus bursal involvment), BUT - MRI is much more detailed and it does identify tears. It is also required (usually MR Arthrograms invloving dye contrast) if other problems such as SLAP lesions are to be confirmed.

- Impingement Syndromes are usually classified as Primary (often surgery required as anatomical problems) or Secondary (usually biomechanical/muscle imbalance and respond to conservative rehab), but 4 versions are now commonly identified:
1) Primary Impingement
2) Secondary Impingement
3) Subcoracoid Impingement/Stenosis - TUFF’s (Tensile Under-Surface Fiber Failure) Lesion
4) Internal (Glenoid) Impingement - Posterior-Superior Glenoid Impingement (PSGI)

Quick summary in IMHO - accurate diagnosis is key++. Rehab, rehab and rehab some more. Surgery is a last resort.