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Bodyweight Anyone with a lot of experience have some input on this pushup/shoulder issue?

bluejeff

Level 6 Valued Member
So, I'm sure some of you know that I like to blab on and on about the shoulder. It's because my shoulders have sort of been through the wringer. I realize this post is massive, but I wanted to include as much info as possible to see if anyone with a lot of experience has any thoughts.

After dealing with a right shoulder injury and subsequent surgery (labral debridement, removal of bone spur under right acromion process, clean up of AC joint tissue) as well as a right hand (dominant hand) movement disorder, I had to rely on my left arm and hand for about 5 years, while being a right handed person.

Long story short, I believe this led to some of the left side dysfunction. My right arm is fine with pretty much any strength training now, but the left has had the sort of issue you see below for a long while now. I am convinced it is a prime factor in my stagnation with training; I just can't load it much without it doing what you'll see below.

YES, I HAVE SEEN A PHYSIO, and she has helped me tremendously. I would like to work with her more, but I am a poor, poor college student, and I just can't afford to see her that often. The only reason I am putting this on the forum is to see if anyone by chance has dealt with something similar, or if any instructors here have seen this and been able to correct it.

There's no pain, but the obvious asymmetry going on with the left side causes a lot of tight neck and upper back issues,and those can lead to neck pain and headaches. From a purely muscle perspective, the scap doesn't upwardly rotate well; my left levator is under a lot of tension (I think) and that, I think, is messing with my neck. Upward rotation movements (overhead-ish positions) seem to help. From a PRI/DNS perspective, we think my posterior upper ribs are collapsed, creating less space for the scap to glide. PRI-style breathing drills help a lot to bring relief, but they don't seem to make progress that sticks. I think there is a neuromuscular component; that is, something is not coordinating correctly. If it's at all like the issue I had with my hand, I need to somehow feel the correct motion and practice it so my nervous system can re-learn the movement.

Since it is an upward rotation issue, I can do some overhead pressing without much issue, and inclined pressing (such as landmines). It's when I have to push horizontally that the scapula misbehaves. It also misbehaves when I do other closed chain pushing/pulling such as pike pushups and sometimes even pullups/rows.

The first clip is late September, the second was a week or two ago (and for some reason it was better?!), the third clip is today, where it seems worse again. In some of the clips, you may be able to see how my left ribs seem to "drop" towards the floor compared to my right ribs, making it look like the left scapula is sort of winging. The attached photo is a still shot from the first clip, where I have highlighted the medial borders of my scapulae, so you can see just how much the left downwardly rotates compared to the right.


Huge thanks if anyone takes the time to read and look through all that! I would love very much to just be able to do pushups (I love pushup variations of all kinds) without the penalty of neck aches and pains.
 

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Sam Goldner

Level 5 Valued Member
Have you been working on the upward rotators of your scapula? Upper/middle/lower traps and serratus anterior?

What did you work on with your physio?

Thanks,
Sam Goldner, DPT
 

North Coast Miller

Level 8 Valued Member
I have only two suggestions, hangs and isometric loading starting at the midpoint ROM working down to the start point.

The movement issues might never resolve, but is def possible for you to loosen the muscles that are likely the cause.
 

Pavel.Kosenkov

Level 2 Valued Member
Alright. I have read it. A lot of details. A lot of info.
An idea (the one that you have probably had already): have you tried to modify / adjust your hand positions in the pushup? Wider, narrower, more to the front, more to the back? Also, have you tried doing it on pushup handles? In short - have you tried to figure out the way of modifying the exercise?
 

bluejeff

Level 6 Valued Member
Thanks for the replies guys.

Have you been working on the upward rotators of your scapula? Upper/middle/lower traps and serratus anterior?

What did you work on with your physio?

Thanks,
Sam Goldner, DPT
Yes. I do serratus specific drills pretty much every day, as well as various breathing drills for the ribs and rib-pelvis alignment. For serratus it’s stuff like the reach roll and lift, or serratus slides. I also use landmine press variations (by far the least problematic pressing move I can do), and light “rack scrape presses” (like an overhead press where you push the bar against the rack on the way up). I’m hesitant to just do band pull aparts or whatever for the traps though; it would seem that I need something that trains the motor pattern I need improvement in, unless you have some other thoughts there?

On the note of land mines: they are the only pressing move that almost never gives me issues (unless I go too heavy). It’s just that when I go to push-ups after doing them, there’s not much change.

My PT is of the opinion that it’s more a rib-position issue than a muscle one, as the breathing drills have definitely helped. The issue used to be worse. Like I said though, I think there’s a neuromuscular component because the shoulder wants to retract and downwardly rotate on its own throughout the day. I have to consciously relax it sometimes.

I have only two suggestions, hangs and isometric loading starting at the midpoint ROM working down to the start point.

The movement issues might never resolve, but is def possible for you to loosen the muscles that are likely the cause.
Do you mean to start at the mid point of the push-up and lower? Or hanging? I’ve tried isos for it here and there but it’s difficult to get the scapula into the correct position to begin with sometimes.
Alright. I have read it. A lot of details. A lot of info.
An idea (the one that you have probably had already): have you tried to modify / adjust your hand positions in the pushup? Wider, narrower, more to the front, more to the back? Also, have you tried doing it on pushup handles? In short - have you tried to figure out the way of modifying the exercise?
Thank you, yeah I’ve tried a lot of different stuff. The only “modification” that makes it any better is pushing at at an upward angle, like in pike push-ups, landmine presses, etc…
 

North Coast Miller

Level 8 Valued Member
….it would seem that I need something that trains the motor pattern I need improvement in, unless you have some other thoughts there?

Do you mean to start at the mid point of the push-up and lower? Or hanging? I’ve tried isos for it here and there but it’s difficult to get the scapula into the correct position to begin with sometimes.
Your issues exacerbate as you drop, at the top is almost balanced. So lower just a bit, maybe 20% of the travel and slowly ramp up the tension. Concentrate on matching the scap position. If this helps, start pushing the hold point further down into the range of motion. This to be done over days/weeks, not in a single session.

Am curious if a similar issue arrises when doing benchpress.
 

bluejeff

Level 6 Valued Member
Your issues exacerbate as you drop, at the top is almost balanced. So lower just a bit, maybe 20% of the travel and slowly ramp up the tension. Concentrate on matching the scap position. If this helps, start pushing the hold point further down into the range of motion. This to be done over days/weeks, not in a single session.

Am curious if a similar issue arrises when doing benchpress.
You’re spot on. I think this is why overhead work is less troublesome; the scap starts in a more upward position. It’s when the humerus gets below ~90° shoulder flexion that the scap starts to misbehave.

I’ll try your suggestion!
 

Sam Goldner

Level 5 Valued Member
I’m hesitant to just do band pull aparts or whatever for the traps though; it would seem that I need something that trains the motor pattern I need improvement in, unless you have some other thoughts there?
I hear your concern; stuff like that isn’t what I generally reach for first. However, if you haven’t tried targeted work for the various traps and the problem is still there…perhaps it’s worth trying. Worst-case scenario is they don’t help and you have ruled that out as the path to success.
On the note of land mines: they are the only pressing move that almost never gives me issues (unless I go too heavy). It’s just that when I go to push-ups after doing them, there’s not much change.
Have you tried Incline Bench Press? That will let you slowly change the angle over time to the regular bench press which will be a horizontal press, like the pushup. Find the angle with no symptoms, work there for a while, then decrease the angle to the next if you don’t have symptoms, work there for a while, repeat over weeks/months

What happens if you do something like Judo Pushups or Dive bomber pushups (versions that let you transition from the pike position into/through the bottom of a traditional pushup)? Those can also be done with a partial range of motion, so only get as horizontal as your body allows without symptoms.

Also, what happens if you do horizontal pressing movements like pec flys? Or some other horizontal movement that keeps your elbows farther from your sides (shoulder abduction)?

My PT is of the opinion that it’s more a rib-position issue than a muscle one, as the breathing drills have definitely helped. The issue used to be worse. Like I said though, I think there’s a neuromuscular component because the shoulder wants to retract and downwardly rotate on its own throughout the day. I have to consciously relax it sometimes.
Downside of forum advice is I don’t have a great way of telling you for sure; not your fault, just an issue with the medium. I am targeting my suggestions towards the shoulder because that is what I can clearly see; it is entirely possible your PT is correct, or that it’s a combination.

Thanks,
Sam Goldner, DPT
 

bluejeff

Level 6 Valued Member
Thanks @Sam Goldner , I appreciate the advice.

Re incline bench: it may be worth a try. I had to do a bench test for a class I am in and it didn’t bug the shoulder at all. I wonder if it has to do with being open chain, or the fact that I was laying on my scaps and they inherently probably weren’t moving as much. I would just have to find a way to do inclines at home, where I have a barbell set but no bench.

Re judo/divebombers: I like those kinds of movements a lot. The degree of my symptoms is largely inconsistent doing them however. It can be a little better if I do very slow reps and focus really really hard on relaxing the troublesome areas. I had okay success doing pike push-ups for a long time, but even then, symptoms were inconsistent. I all but abandoned them for the time being because they didn’t seem to be improving the issue at all.

I’ll have to play with wide pressing movements. I recall trying a few wide pushups and noticing they generally felt better. I just wasn’t sure if that would translate into elbows-in movements, which is where I would like to get (to get back to calisthenics movements someday).
 

Sam Goldner

Level 5 Valued Member
The general approach with most things is to find what you can do, do it, and slowly expand that category over time. Keep the goal the goal, not necessarily what you are doing right now at the moment.

Thanks,
Sam Goldner, DPT
 

3letterslong

Level 6 Valued Member
I'm not an expert, so take what I say with a grain of salt. I went through some scapula dysfunction (and am always continuing to improve it) and these are 5 things that benefited me that I have not seen suggested so far:

1. Retraining the muscle with Original Strength. Before I could move it properly, I had to hold it in place properly. This video taught me how to fire up the muscles for the first time in my life.


2. Becoming conscious of how to extend the thoracic spine while lowering the ribcage and keeping my chin retracted through movements (basically holding perfect posture during all movements and terminating the exercise's ROM early if it took me out of posture). If I let this lapse, even slightly, my scapular control goes out the window. I had to train a lot of basics (pull-ups, push-ups) very lightly and with a limited ROM for a long time. As control built up I was able to train heavier and expand the ROM. For me, I had to gain competence at any position that would come to me and then slowly expand my scapular control.

3. Practising muscle control and activation. Short- and long-duration isometrics, high rep work, visualization, etc. I had to do a lot of frustrating practice with the individual muscles before they would all turn on at once and work as a unit. TBH, this probably would have been unnecessary if I figured out how to activate my back with posture earlier, but I'm mentioning it anyways.

4. Once I had learned how to activate my scapula muscles and hold perfect posture, I remembered something called Optimal Length Training I discovered a decade ago. A guy named Rob Thoburn created a system around studies that showed your muscles are most powerful (or steady or something along these lines, I forget) when you're in a standing position with your hands hanging at your sides. So he would lay on his back and statically hold dumbells at his thighs (with straight arms), working the front of his body. Then he'd lay on his front and work the back of his body. I duplicated this using a suspension trainer, standing with the handles at my thighs, while leaning away from it (facing towards it and away to work front and back). Ensuring the constant integrity of my posture, I slowly expanded the angle of the lean over time. Basically the absolute baby steps of front and back levers.

5. Bodyline drills. Once I could hold all bodyline drills with perfect scapula action, I started challenging my stability by moving my body around slightly. I had to start them all at a super-light level, doing them all unweighted in the air until I figured out how to duplicate that activating sensation I had discovered with OS. For me, the key is rib cage down, thoracic spine extended and chin retracted.

I still do all of these drills. Hopefully some of them sound useful to you. If you have any questions, feel free to hit me up on private message.

(I completely agree with @North Coast Miller suggestions since both of those things helped me immensely, but one of the things I had to do was learn how to hang in scapular retraction -- starting so lightly you wouldn't even believe it -- in a way that activated my entire back like in YWTL drills. Also, I first had to learn how to activate my back at all with YTWL drills. If hanging doesn't work for you, see if it makes a difference to hang in a way that duplicates the sensation of total back activation in YTWL work.)
 

bluejeff

Level 6 Valued Member
This video taught me how to fire up the muscles for the first time in my life.
Same here. That exercise was one of the first to really change the way things were working in my shoulders. I ought to do it more often.
Practising muscle control and activation. Short- and long-duration isometrics, high rep work, visualization, etc. I had to do a lot of frustrating practice with the individual muscles before they would all turn on at once and work as a unit.
After playing around with all sorts of stuff yesterday afternoon, I came to the conclusion that this is what I need the most. “Plain old” proprioception/interoception. For example, all day today I have been noticing that when I reach with my left arm, my torso want to twist along with it instead of letting the scapula move first. This is just how the brain ends up working when you’ve had to rehab a movement disorder for the last three years…..

Anyways, I like those ideas too. I think my sessions for a while will be mostly OS and crawling with a lot of just finding what makes things feel better …
 

R-J Williams

Level 2 Valued Member
Certified Instructor
Chest supported scapula retractions/protractions.


Love these because you can really load them up and use the bench to close down your front ribs. So I set up with the chest off the bench a little bit to have the top of the incline bench help me close down the ribs as i go through scap retraciton + protraction. Eventually progressing these to including a row. Also not a bad idea to try doing these single arm and getting someone to film how your scap moving. To get more rhomboids/mid back I think of down and back but I think for your case especially on the L side, playing around with scapula retraction with slight elevation of the L side. And then when you protract reach the DB's out in front a little bit to help the slide and glide of the shoulder blade.

Happy Training
 

bluejeff

Level 6 Valued Member
Dropping a progress report:

I have basically been incorporating a lot more shoulder prehab drills, and reducing the intensity of exercises such that I can slow down and feel my neck relaxing while I do things. Here's a list of things I have been doing:

Pushing cue: pushing = internal rotation. I think this was a big part of how my shoulder got messed up. I thought "external rotation = good, so I must maintin ER at all times!!!" I neglected this fact even after learning that the humerus must pass through internal rotation around 90 degrees of shoulder flexion. The easiest way to achieve this, for me, is to maintain two points of contact with the ground when doing pushing: the pisiform (heel of the palm) and the base of the index finger. The latter was super important. If I just focus on keep pressure there, and build my push from the hands up (not consciously activating upper arm musculature) my shoulder seems to go where it's supposed to.

So I've been doing slow rocking pushups this way, and even just knee pushups, with the goal of coordination before intensity.

Ido Portal's old scapula stabilization routine. It is short enough not to interfere too much with other training, and seems to cover all the angles I need. I'm still doing scap shrugs without a band though. On the pushing and forward movements, I think WIDE scapulae, like my torso is a big tree trunk they are wrapping around. For the pull downs and dislocates, I direct the tension away from my torso and only move once I feel my neck relax.

On all these movements, if I do them right, I can feel my left shoulder girdle "decompress." Everything has been pulled back, and I need it to create space. If I accomplish this, things seem to work much better.

It's nowhere near normal, but I think I am making progress. Will continue on for another 2-3 weeks and then try and post a new video.

side note: I thought that we could edit the titles of threads we started, but I guess not? I just wanted to add "progress", but no biggie
 

Boris Bachmann

Level 7 Valued Member
I do a lot for shoulders/scaps. Always have. After decades I can't say there are any magic exercises or drills, I can only say 'keep at it'.

The things I do on a regular basis right now are: "YATs", rear delt flys (bent over laterals), pull-ups, rows, doorway and mantle (chest opener) stretches. Occasionally, I'll do dislocates with bands or broomstick, shrug variations (overhead, bent over, dip/bench variants, etc), banded stretches, and stretches over a foam roller (not what I would consider "foam rolling").

 
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