I recently had this exchange and thought others could potentially benefit from it:
From Tyler (in italics; I’m always in bold):
“I’ve been reading a few of your articles and discussions on T-Nation and I was wondering if I could ask you a few things regarding my shoulder issue. I’m a pitcher and I’ve been having issues throwing for the last 6 years. Recently I had a huge scare while pitching. I heard a huge click/pop in my shoulder when pitching. I have all my strength and have been working with a very good chiro in my error and it seems to be slowly getting better.
I have subscap firing problems and a very tight posterior capsule and external rotators along with some winging, tight rhomboids and pec minor and a little weak of weakness in my lower traps.
I was wondering if I could shoot a video going through some motions and see if you can pick out whats going on.
Thanks alot”
Hey Tyler,
Nice to meet you. Shoot me some videos and I’ll be glad to take a look.
-Brian
Ok will do after workout. It definitely feels like the upper trap is weak and lengthened and rhomboid takes over when trying to elevate. I have held my right shoulder in the back and down for years and its in a pulled down state.
Here’s video. It definitely looks and feels like my right side is more retracted then left and upper trap isn’t allowing proper upward rotation due to tight rhomboids. also have issues with GIRD although it has gotten better
You are a bit too retracted. And your right shoulder is pretty depressed. However, in anyone with a throwing history it’s common to have a depressed shoulder.
Your upward rotation is actually good. You’ll notice with throwers often times their shoulder is depressed in a resting position (like yours), but once you begin to elevate the shoulder it will actually catch up to the other side causing things to pretty much even out. You can see this pretty easily with your shoulders. Your right starts lower but then catches up as you fully upwardly rotate.
Your biggest issue I can see in the videos is your humerus is excessively gliding anteriorly. Look at the 32 second mark when you perform internal rotation. You can see the humeral head become quite prominent as you internally rotate compared to the left. AND you SHOULD have less internal rotation on the right side than your left. (Because of your throwing history.) However, you’re accomplishing extra internal rotation by excessive anterior glide.
If you look at the posterior cuff muscles when you perform internal rotation at 1:01 you can see your right cuff muscles are wayyy hypertrophied. One because this is your throwing arm, two is likely because the posterior cuff muscles are compensating for a weak subscapularis. (The muscle responsible for your excessive anterior glide). Then at 1:10 you can see how much more extension you are getting on your right arm compared to your left. I.e. your right elbow goes much further back than your left. Again, this is indicative of excessive anterior glide.
Let me know if that makes sense.
-Brian
Oh it makes perfect sense. I’m seeing a chiropractor who is taking care of the subscapularis as we speak as it was neglected from the very start from other doctors. I was told to continue doing external rotation and stretch right chest and strengthen back.
I have zero issues reaching overhead on my right side especially. I get issues during the cocking phase and release when throwing. Obviously due to faulty subscapularis firing. It has come along way in the last month since I’ve started seeing my new Chiro. I started doing the overhead shrugs you posted online an it’s been helping a lot. (Note to readers, see this link 3 common weak muscles ) My right trap is definitely weaker then the rest of the muscles. When I have it propped up in its proper position I can do all of my exercises and stretches a lot easier with no pain. So by your findings, what would you suggest me start/continue doing?
Also, with my right side it always feels like it is being pulled externally and away from my body and my palm faces forward. When I keep it closer to my body and slightly internally rotates, it feels like a lot of stress is being taken off of my external rotators.
Also when going over my rhomboids with a lacrosse ball it is so beat up and feels so lumpy and knotted. Could this be a reason for my shoulder issues?
Glad to hear the shrugs are helping. Definitely keep doing them.
As far as the rhomboids, are you sure you are rolling the rhomboids and not the posterior cuff? Because your posterior cuff looks like it’s what’s knotted up. I don’t see too much going on with your rhomboids.
Why are you doing external rotations? I’d have trouble keeping those in if I were you. You already have a hypertrophied posterior cuff, which is responsible for external rotation. And you have pain during the cocking phase, which is external rotation. I’m just not sure you need it and I have a feeling you may be overdoing this motion. You ESPECIALLY need to make sure when you perform external rotation you have ZERO anterior glide from the humeral head. However, I’d be much more concerned with working this during internal rotation.
Be very, very careful about how you stretch your pecs. If you do it wrong you may be stretching the anterior capsule. Obviously, you now know this is a huge no-no for you. Your anterior capsule is already too flexible. You want to make sure you are stretching the pecs with a posterior glide on the humerus. This way the subscap is not excessively stretched, nor the humeral head.
Have you read my article on the subscapularis? (Note to readers, see this link: Best exercises for the subscapularis ) It has a lot of info in there that would be applicable to you.
The overhead shrugs have helped a lot. I’ve been keep a slight contraction in them and everything feels a lot more symmetrical. Yesterday I threw and everything felt a lot better. I’ve been loosening up the pec minor, rhomboid and posterior capsule with a lacrosse ball. I had no pain throwing and once it loosened up I had a lot of power. Very minimal soreness today.
It really feels like the upper trap was the biggest thing along with the posterior capsule. My lower trap feels really strong compared to my left one. The right side just feels depressed and no hunched forward like my left one.
I have read the article on the subscapularis and I’ve really started to focus on those exercises and they’ve helped a lot.
I haven’t been doing external rotations. I meant it felt like my shoulder was being pulled into external rotation even in resting phase.
Also the rhomboidal are very beat up with regards to their tissue quality. Very knotted and bumpy as are the posterior capsule and pec minor.
Although when I keep my shoulder from going into anterior glide, all of the trap exercises feel much easier to do and I feel the muscles working more. Also doing posterior capsule stretches feel better as I feel I am keepin it from gliding anteriorly which was causing my joint pain
Great to hear! It sounds like you’re heading in the right direction.
Ya big improvement within the last few weeks. Yesterday was a huge eye opener and I’m really exciting. I was throwing 87-90 pretty much all arm and in tons of pain so I want to see where I can go from here. Thanks a lot for your input my friend. I really appreciate it.
Glad I could help!
Alex nielsen
October 21, 2013
Another great article. I notice from the video that his right scapula is more adducted then his left, I don’t have much experience in baseball but could this imbalance contribute to the problem?
reddyb
October 21, 2013
Yes, absolutely.
Tangent:
Years ago, when I was more involved in the overhead athlete population, it was considered normal for a shoulder to a bit low / depressed. (This often accompanies an adducted / downwardly rotated scapula.) It was considered an adaptation from throwing so much. Basically, it was considered normal and ok.
Now, with more experience under me, I don’t believe this is so much an adaptation / ok aspect of a thrower. It may be something they’ve acquired due to throwing, but it’s also likely something they’ve acquired because of everything else they do. Right handed people, whether they throw or not, very often have a lower shoulder, and it is not “normal” or “ok.” It’s a problem, and it’s correctable.
You can see in the conversation above how I was leaning towards the old point of view. One of “It’s so common it must be ok.” I was vacillating at the time on this as many well respected people have the aforementioned point of view. Now I’m very much on the side of, “No, just because it’s so common does not mean it’s ok. We need fix it.”
The other thing is, you can fix it.
The analogy here is in an overhead athlete their shoulder will structurally change to where they lose internal rotation, but, gain external rotation. Usually, as long as they lose what they gain, they should be ok as the shoulder’s total range of motion hasn’t changed. Furthermore, because the bone has morphed, you can’t really expect to even this out. That is, gain the internal rotation back and lose the external rotation. The bone isn’t going to morph back.
This is why those who don’t learn to throw at a young age usually can never really throw. They never acquired the bony changes, and after a certain point, they’re never going to.
A low shoulder used to be (and I believe still is) considered of this vain. I don’t agree with that view. A low shoulder is not a structural change, where as shoulder rotation range of motion often is, at least in overhead athletes.
Neal, in this post, has an extensive overhead history, and you can see him improve his shoulder positioning in only 6 weeks: http://b-reddy.org/2013/08/18/example-of-improving-a-low-shoulder/
Alex nielsen
October 23, 2013
I work as a sports massage therapist and I continually see right handed individuals present with- tight right rhomboids, tight right pec minor (observed in supine), lengthened right upper trap that manifest, as you have said, in a depressed and downwardly rotated right scapula.
I have exactly these imbalances which I am continually working on but cannot effectively self stretch my right pec minor. Apart from finding a sharp corner to jab into my coracoid process which is not a pleasant experience. Do you have any pec minor stretching suggestions?
Many thanks for your responses,
reddyb
October 23, 2013
I would avoid the corner stretch for that very reason.
Some pec “stretches” I often use:
Sam
March 3, 2015
I have had shoulder pain for over a year. I have trouble doing overhead presses, bench presses, pullups, bicep curls, almost all upper body exercises. I have excessive humeral anterior glide and GIRD.
The MRI athrogram revealed a type 2 SLAP tear. This means the superior labrum is completely detached from the glenoid. The doctors claim that re-attachment via surgery is the only way to go, if I am interested in full recovery (that is, to be able to lift heavy again with this hand). They say the labrum will not be reattached by itself and it will cause even more problems as I age, especially to the long head of the biceps. To tell you the truth, I’d like to avoid surgery, if possible and I have been trying to do everything in this direction.
For some time (about two months) I have been trying to loosen up the lats with the various types of overhead movements you recommend. I have indeed managed to loosen up the lats but the pain and the humeral anterior glide is not improved at all. I am pretty sure now my “stiff lats/rhomboids” or my “weak upper traps” are not the problem. It is the humeral anterior glide caused by (or having caused?) the labrum tear. The exercises for GIRD (such as the internal rotation that strengthens the subscapularis) can only take you that far. It is almost impossible for me to avoid humerus moving anteriorly at all, no matter how careful I am.
Have you had experience with clients with SLAP tears? Do you believe it is possible to treat my case only with corrective exercises or will I be just losing time again? What would you do if you were me?
Thanks a lot for the answer.
reddyb
March 4, 2015
First thing I’ll say is loosening up / working certain types of exercises are no guarantee anterior glide will be diminished unless diminishing anterior glide is happening during those exercises. This is a key point. The loosest lats in the world don’t guarantee a humerus won’t anteriorly glide. (It may help, but it may not.)
Moving on:
I’ve had clients with (shoulder) tears who have ended up doing just fine without surgery.
Plenty of people have all types of tears and are not in pain. Eric Cressey and others have written about this. One example here: http://www.ericcressey.com/healthy-shoulders-with-terrible-mris
In general, there are very few surgeries where surgery clearly beats exercise. And I do mean *very* few. I wrote about this, specifically with the knee, here: http://b-reddy.org/2014/03/05/more-evidence-against-knee-surgery/
This type of stuff requires a thorough investigation of the research, as this research is rarely clear cut. (See my knee surgery posts for examples.) I do know in general, this is becoming a stronger and stronger theme i.e. surgery not outperforming non-surgery. Considering the people doing this research -doctors and surgeons- this theme is likely hugely underreported in the research.
I haven’t delved into this with the shoulder in a long time, but I can tell you my approach with anyone with an “abnormal MRI” is exercise AND lifestyle modifications first; surgery = plan Z.
That *doesn’t* mean the labrum is going to grow back or reattach. It means using those types of things as your only barometer is a flawed method. See people with fully torn menisci, fully torn ACLs or PCLs, hell, even some with achilles ruptures, who are just fine. (Doesn’t mean they’re brand new; but surgery doesn’t guarantee that either.)
I’d have to see you move in some capacity, but I have a hard time believing if I had you do something like this, that you truly wouldn’t be able to prevent anterior glide at all: https://www.youtube.com/watch?v=Yr9W20OcTZk
After all, the labrum doesn’t really have any contractile element to it. Those which have a contractile element sound fine from what you’re saying.
I strongly lean against practically all orthopedic procedures. That doesn’t mean surgery isn’t the right choice for some though. Age, activity level, history, quality of exercise recommendations / pair of eyes watching you, and much more are all factors.
Sorry for the somewhat vague response, but this is a tough topic to address in a comment reply. I plan on writing about this thoroughly -beyond just the knee- in the future.