Help with: Knots and Myofascial Pain

David C

Level 5 Valued Member
Does anyone have ideas for getting rid of scapular knots and myofascial pain? The knots prevent my shoulder musculature from functioning well (and thus joint placement). Even though I've been cleared for pressing, I can't press or swing without pain because the shoulder and scapular musculature isn't keeping the joints where they should be. I've had a recent MRI that showed minimal damage with the doctor suggesting there was no need for repair (slight labral tear, AC joint inflammation/arthritis). There's lots of snapping and popping. Some of the knots have existed or returned for a number of years, though, for a year prior to Dec 2017, the tissue quality have been good). I've persistently tried deep tissue massage, self trigger-point release (rolling on ball, thera-cane), dry needling, acupuncture, and various shoulder rehab protocols. I'm at a loss. Any thoughts?
 

Antti

Level 9 Valued Member
Have you tried heat/cold treatment? Like sauna and cold showers? It won't likely help on its own, but it could be a great addition to the other treatments you're having.

As a more extreme measure I once had a physiotherapist cause an inflammation in my triceps by physical trauma, as in massaging the muscles very roughly with a smooth piece of metal. If I remember right he reasoned the inflammation would stretch the fascia. I think it did have a positive effect, but I required some corrective training to get to the bottom of it.
 

Anna C

Level 9 Valued Member
Elite Certified Instructor
@David C I can relate to your shoulder issues. knots, trigger points, tight muscles, tension that won't go away, shoulder not staying where it should be. I haven't had an MRI but from an x-ray the orthopedic doc said the shoulder joint was fine, so must be myofascial. It's been ongoing for 4 years. My primary care doctor says we probably don't need imaging because it likely wouldn't change the treatment (I'm sure it's nothing that requires surgery). I don't have any pain while exercising and it doesn't restrict my movement very much at all, but the tension and tendency to get muscle/fascia knots never completely goes away.

So I haven't found a complete solution, but these things seem to help: dry needling, massage therapy balls, massage, and learning to let go of tension. That last one can be tricky -- I think when a part of our body has a chronic inflammation or pain, we tend to hold a bit of tension there. It takes practice to release it. Yoga, stretching, and breathing practice can all be helpful in this way, because they teach you to relax PAST the normal resting state. Then this carries over into exercise; for example, between sets of swings, get-ups, etc., focus more on actually relaxing (fast and loose, breathing), which helps blood flow and recovery between exercises. This seems to help things stay less knotty in general.
 

Groove Greaser

Level 3 Valued Member
Have you introduced anything new into your diet or upped your consumption of a given food? I know it might sound a little crazy - but my right shoulder/neck region tenses up when I eat too many nuts (and other muscles don't recover as quickly). I'm still testing it out myself to see if that's really the cause, but so far every time I get a couple of bags of cashews I don't recover as well and my shoulder (which has had other problems before) tenses back up.

Mark Sisson frequently talks about how his (what he thought was) arthritis went away when he stopped eating grains. I'm not saying it's nuts or grains for you - only suggesting that diet might be worth looking into. A food journal might help if you decide to go down this path.

Whatever happens I wish you the best. I was sidelined from BJJ and training for a few years while I figured out my nagging shoulder issues - so I have the utmost sympathy.
 

Al Ciampa

Level 8 Valued Member
Certified Instructor
Does anyone have ideas for getting rid of scapular knots and myofascial pain? The knots prevent my shoulder musculature from functioning well (and thus joint placement). Even though I've been cleared for pressing, I can't press or swing without pain because the shoulder and scapular musculature isn't keeping the joints where they should be. I've had a recent MRI that showed minimal damage with the doctor suggesting there was no need for repair (slight labral tear, AC joint inflammation/arthritis). There's lots of snapping and popping. Some of the knots have existed or returned for a number of years, though, for a year prior to Dec 2017, the tissue quality have been good). I've persistently tried deep tissue massage, self trigger-point release (rolling on ball, thera-cane), dry needling, acupuncture, and various shoulder rehab protocols. I'm at a loss. Any thoughts?
An intense daily breathing practice. Learn it; execute it; then wait for the good changes to occur.
 

Steve Freides

Staff
Senior Certified Instructor
Elite Certified Instructor
@David C, can you hang from a chinup bar? If so, do that, with relaxed shoulders. Both a completely passive hang and also some kid-like wiggling around while holding on the bar are good, and they are good for loosening up what's tight.

-S-
 

elli

Level 9 Valued Member
@David C, can you hang from a chinup bar? If so, do that, with relaxed shoulders. Both a completely passive hang and also some kid-like wiggling around while holding on the bar are good, and they are good for loosening up what's tight.

-S-
+1
And scapula push ups might help for mind muscle connection and right shoulder positioning.
Stretch out lats and pecs!!
Take hot Epsom salt baths for relaxation!
If you search for climbers shoulder problem on yt you will get a bunch of good stretching routines!
 

David C

Level 5 Valued Member
@Antti Thanks for the hot/cold idea.

@Anna C You mentioned yoga and stretching for releasing the tension. Do you have a program minimum for yoga that you could recommend?

@Groove Greaser That's something I haven't ever considered. I usually don't eat many grains but since Thanksgiving/Christmas I've added them back in more. I need to run some experiments.

@aciampa I started Oxygen Advantage-ish programming for breathing last year...and to think about it, during that time, I probably was as healthy as I've been. I need to get back to my breathing practice. I'm sure a Buteyko breathing course would get me further than I was.

@Steve Freides I have done to hanging but I was a little nervous about it, so I'm sure I was more tense. I'll give it a try again today and see if i can relax.

@elli Thanks. Do you have a specific shoulder routine you've found helpful?
 

offwidth

Level 9 Valued Member
@David C
Good advice from all thus far.

The hot/cold really works wonders. But by cold we mean ... cold!

Many shoulder routines for climbers involve theraband training. Unless you see a PT for specific direction (which I highly recommend) you are just going to have to google around a bit.

Another thing that some find useful is EMS

You might also want to take a look at some of the shoulder routines from SJ and FS.

You indicate a "slight labral tear, AC joint inflammation/arthritis"
To be perfectly blunt... your shoulder health is poor. (As is mine)
Those things aren't going to go away. Ever. The best you can do is to manage the damage.

Last year I could not swing nor do TGU without extreme pain. So much so I just couldn't even do a naked TGU. Today I am mostly pain free, doing S&S with 24kg, edging into 32kg territory, and back to doing pull-ups, and climbing at a reasonable level for a 60 year old geezer...

I saw a good sports medicine specialist.
I got treatment from a good sports medicine physiotherapist.
I did my home physiotherapy religiously and daily for over a year!!
When I eased back into kettlebells and pull-ups I did so at a glacial pace, and I paid the strictest attention to form and detail. I had already received hands on training from an SFG at a course. But I went back through the course material and my notes just to make sure.

Which brings me to the last point. Once you are medically cleared to train you should seek out instruction from an SFG (if you haven't done so already) to ensure your form and technique is dialed in.
 

Anna C

Level 9 Valued Member
Elite Certified Instructor
@Anna C You mentioned yoga and stretching for releasing the tension. Do you have a program minimum for yoga that you could recommend?
I don't have anything specific to recommend, but I think any will work. As Steve Freides once said, "the goal is to learn to relax the muscles, not stretch them" (hence the name of Pavel's book, "Relax into Stretch.") Breathing, stretching, and relaxation go together. Any practice that focuses on any of these will incorporate the other two as well. Doing just the stretches in S&S is a good start. Incorporate relaxed and focused breathing into it. For both the QL straddle and the 90/90 stretch, on the inhale, elongate the spine up and forward. On the exhale, sink deeper into the stretch. Don't push into it where the muscles feel like they're getting pulled -- just relax and let them go. Give it time... it may take several minutes for the tension to dissipate. You'll be surprised how far you can go if you just give your body time to release the tension it's holding. As you get better at this, the stretches become more effective in less time. It's possible that some stretches specifically for your shoulder would be helpful, but I'd be cautious there. It's mainly the practice of relaxation that you need, and that will carry over to the rest of your body.

A very simple practice for getting rid of tension in a relaxed state, just like on the floor in yoga Savasana pose (sometimes called "the hardest yoga pose", because it is!), breathe diaphragmatically so that your belly is moving and your chest is not, and scan your body for tension. Focus on one area at a time, and let the tension go. Focus on relaxing further, and further. It's not a sleepy time thing - your mind should be very alert and focused on helping your body relax.

And during exercise, as soon as you set the weight down, stand up, shake out, relax the muscles that were holding tension. Breathe diaphragmatically here too, and be as relaxed as possible as you stand and walk around during active recovery. Do that same thing of scanning the body for extra tension and letting it go.
 
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