I’ve been struggling with shoulder impingement/bursitis since December. I’ve been rehabbing it’s since it then. Nearly 5 months later I’m still in pain. I’ve been to several PT’s, haven’t swam a stroke and unfortunately just tried a cortisone with no luck.
So naturally I’ve been reflecting. I’m wondering if my shoulder just needs rest. Complete rest even from rotator cuff exercises, soft tissue work and everything in between. I swear my rotator cuff strength is better than my bench press at this point so I don’ think that is the issue any more.
If anyone has any advice, experience or thoughts on the matter I would appreciate hearing from you.
5 months is a long time. If my patients don’t show some response in 6-8 weeks of therapy, I order an MRI to assess other possible diagnoses, contributing factors, and 3 deminsional anatomy. Sometimes the cause of the impingement is not rotator cuff weakness but instability of the joint and/or the scapula.Your thoughts are good, however. Sometimes rest without any formal attempt at rehab can be beneficial. Especially in someone very motivated : ).
You may have already had and MRI. My indications for surgery (sub-acromial decompression) are, basically, failed conservative care (PT, home exercises, cortisone injection, relative or complete rest), and a tight sub-acromial outlet. Causes may be a type II or III acromion, a spur from the acromion or the AC joint (or both), calcium deposits, and others. Good luck!
5 months is a long time. If my patients don’t show some response in 6-8 weeks of therapy, I order an MRI to assess other possible diagnoses, contributing factors, and 3 deminsional anatomy. Sometimes the cause of the impingement is not rotator cuff weakness but instability of the joint and/or the scapula.Your thoughts are good, however. Sometimes rest without any formal attempt at rehab can be beneficial. Especially in someone very motivated : ).
You may have already had and MRI. My indications for surgery (sub-acromial decompression) are, basically, failed conservative care (PT, home exercises, cortisone injection, relative or complete rest), and a tight sub-acromial outlet. Causes may be a type II or III acromion, a spur from the acromion or the AC joint (or both), calcium deposits, and others. Good luck!
Thank you for writing. Let me give you a little more information…
I had an arthrogram. It said:
Findings are highly suggestive of subacromial bursitis
No rotator or Labral pathology
Lateral downsloping of the acromian (classified as type II)
In theory this has been an issue for 3 years. It flared up 3 years ago and I was able to calm it down. At that time it was supraspinatus impingement. By keeping my yardage at 10k or less I could “deal” with it. In December I tried to increase yardage slowly and it reared it’s ugly head in a bad way.
I’ve also been rehabbing an ITB/Vastus lateralus for the same amount of time with no luck. It makes me wonder if it’s something dietary or systemic.
Again, I really appreciate you taking the time to write.
. Sometimes the cause of the impingement is not rotator cuff weakness but instability of the joint and/or the scapula.Your thoughts are good, however. Sometimes rest without any formal attempt at rehab can be beneficial. Especially in someone very motivated
I have had posterior impingement in both shoulders due to instability. Rather than work on my cuff in neutral positioning, I had to work on my scapular stabilizers in the catch position of front crawl. This is the position that I was having most pain. A swim coach should look at your stroke to determine if there is something you change that may put less stress on your shoulder, as well, work with a PT that understands the stress on the joint with swimming. Good luck, I know firsthand how frustrating it can be.
. Sometimes the cause of the impingement is not rotator cuff weakness but instability of the joint and/or the scapula.Your thoughts are good, however. Sometimes rest without any formal attempt at rehab can be beneficial. Especially in someone very motivated
I have had posterior impingement in both shoulders due to instability. Rather than work on my cuff in neutral positioning, I had to work on my scapular stabilizers in the catch position of front crawl. This is the position that I was having most pain. A swim coach should look at your stroke to determine if there is something you change that may put less stress on your shoulder, as well, work with a PT that understands the stress on the joint with swimming. Good luck, I know firsthand how frustrating it can be.
Thanks for the thoughts. I’ve actually already tried out your advice and had a swim coach look at my form. He said I was good.
I am a one sided breather. However, at this point I can’t even reach for a pen beside me without experiencing pain. Swimming is definitely out of the picture.
8 weeks (3-5 days per week) of “no pain” PT. That means you do shoulder PT and if you feel ANY pain you back off (ie: thinner rubber band, less weight, no weight, assisted ROM). NO PAIN.
Worked for me.
Took a year before I could surf or swim. Has been 11 years with no problems.
8 weeks (3-5 days per week) of “no pain” PT. That means you do shoulder PT and if you feel ANY pain you back off (ie: thinner rubber band, less weight, no weight, assisted ROM). NO PAIN.
Worked for me.
Took a year before I could surf or swim. Has been 11 years with no problems.
Thanks for the advice. Can I ask what your shoulder injury was?
Especially because you said it was bursitis or impnjngemebt, I would probably err on the side of rest for right now. Bursitis is usually inflammation(rest) and impingement is caused either by an obstruction, similar to the lowered acromion, but also from irritation within the muscle/bursa space from a narrowed “tunnel”, leading to further inflammation.
Have you discussed with your PT or seen another one?
An arthrogram? Unless you are talking about an MR arthrogram, which is not the first type of MRI usually ordered, there is still a huge benefit to an MRI. I’ve ordered three arthrograms (dye in the joint followed by X-ray) in 16 years of practice. All were because the patients had pacemakers.
I just think you need to be sure you’ve got an accurate diagnosis.
An arthrogram? Unless you are talking about an MR arthrogram, which is not the first type of MRI usually ordered, there is still a huge benefit to an MRI. I’ve ordered three arthrograms (dye in the joint followed by X-ray) in 16 years of practice. All were because the patients had pacemakers.
I just think you need to be sure you’ve got an accurate diagnosis.
Sorry for being unclear. It was an MR arthrogram. It was explained to me and an MRI with contrast dye to help highlight any problems.
As a swimmer, I have had some shoulder aches and pains and had similar diagnoses as you. Unfortunately, most physio’s are good at treating old ladies, but not athletes. SO, do this diagnostic test: with the opposite hand, reach over the “bad” shoulder and with fingers press into the infraspinatus at the lowest point almost parallel to the armpit (feel around) - or you can have someone else do it for you. While you are pushing onto the infraspinatus, you may feel referred pain in the front of your shoulder, exactly were your problems seem to be. IF you do, you have found your problem, have someone massage the infraspinatus (it will/should hurt) and you will solve your shoulder problem by the next day.
If your treating physician ordered an MR arthrogram then you are probably in good hands. Labral pathology is easier to see with contrast in the joint. So I would agree with a period of rest (6 weeks is a good time period for orthopedic problems). I would then test the shoulder with an easy return to swimming. You’ll know quickly where you stand.
If you still can’t swim, you might want to discuss with your doctor his/her indications for arthroscopic sub-acromial decompression.
Massage techniques may help but you will be disappointed if you expect overnight success.
P.S. I’m looking forward to your wheels becoming available. I will, however, be waiting for the Powertap hub version :^).
Especially because you said it was bursitis or impnjngemebt, I would probably err on the side of rest for right now. Bursitis is usually inflammation(rest) and impingement is caused either by an obstruction, similar to the lowered acromion, but also from irritation within the muscle/bursa space from a narrowed “tunnel”, leading to further inflammation.
Have you discussed with your PT or seen another one?
Thanks for the thoughts. I think it is time to possibly see another PT. I’m going to be broke by the end of this
As a swimmer, I have had some shoulder aches and pains and had similar diagnoses as you. Unfortunately, most physio’s are good at treating old ladies, but not athletes. SO, do this diagnostic test: with the opposite hand, reach over the “bad” shoulder and with fingers press into the infraspinatus at the lowest point almost parallel to the armpit (feel around) - or you can have someone else do it for you. While you are pushing onto the infraspinatus, you may feel referred pain in the front of your shoulder, exactly were your problems seem to be. IF you do, you have found your problem, have someone massage the infraspinatus (it will/should hurt) and you will solve your shoulder problem by the next day.
Good luck
Thanks for the thoughts. I tried that out this morning and unfortunately I had no referred pain. I’ve had a ton of soft tissue work done in the last 5 months and although that has really worked in the past, it’s done little to nothing this time.
If your treating physician ordered an MR arthrogram then you are probably in good hands. Labral pathology is easier to see with contrast in the joint. So I would agree with a period of rest (6 weeks is a good time period for orthopedic problems). I would then test the shoulder with an easy return to swimming. You’ll know quickly where you stand.
If you still can’t swim, you might want to discuss with your doctor his/her indications for arthroscopic sub-acromial decompression.
Massage techniques may help but you will be disappointed if you expect overnight success.
P.S. I’m looking forward to your wheels becoming available. I will, however, be waiting for the Powertap hub version :^).
Thanks again. I’m starting back with a massage therapist again. I’m also looking into scapulohumeral rhythm. I might just need some time off from everything.
Doc (not a good one) said grade 1-2. In sling 2 weeks. Home PT about 4 weeks.
Felt ok. Couldn’t really sleep on it. Sliding glass doors were a bitch. Certain rock climbing techniques hurt.
It was left (weak) side. If it was right side I would not have put up with it for as long as I did.
Fast forward to June, 2000. Pain gets progressively worse. Good Doc (hand specialist) takes one look, says grade 4. X-rays also reveal arthritis on the end of the clavicle. Impingement as well. Evidence of possible clavicle fracture, since “healed”. Just a total mess.
July, 2000. Surgery. Ties clavicle, with GorTex string, to hole drilled in shoulder blade. Also cuts ~1 inch off the end of clavicle (arthritis).
6 weeks in a sling…
Now I’m swimming 9-12k per week and or surf a ton. No problems. Strengthwise about 85-90% (who knows, really?). Pain rarely.
Your issue may not be a extreme as mine was but all I have learned about shoulders says pain during PT is a big no no. If it hurts don’t do it.
Also, if you decide to immobilize for a good amount of time be very careful with what you do when you take the sling off. Your muscles will have atrophied. All that stuff that holds everything in place will be very weak. You can blow your rotator cuff taking a sip of water. During my “no pain” PT I popped my shoulder out of the socket. Twice. Doing assisted ROM.
