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Other/Mixed Painful push-ups - front delts

Other strength modalities (e.g., Clubs), mixed strength modalities (e.g., combined kettlebell and barbell), other goals (flexibility)
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A lot of physical therapy exercises seem to be formulated like “hypertrophy light.” Smaller muscles are supposed to recover more quickly than larger ones, and small muscles that are supposed to act as stabilizers instead of prime movers are usually trained in such way as to increase their endurance. It’s not uncommon to see rehab/prehab exercises prescribed for sets/reps of something like 3/15 (or 30, like you listed). As much as we are about minimal effective dose around here, I sometimes wonder if that dose is higher than we’d expect depending on the context.
Yes, I noticed that when I was doing physical therapy a year ago for my hip. I had been doing "anti-glycolytic" type training (short sets) and large compound movements for so long I had an aversion to feeling that burn and going towards muscular failure. I had to reset my thinking when it comes to smaller muscles and PT. Those reps/sets can be useful for hypertrophy, and there's no overall fatigue or energy systems effect like there would be if you did squats or deadlifts for sets of 15 or more.

Don’t know if the arm bar would hurt, but I’m not sure it’ll help with pressing stability.
It might help indirectly. As I see it currently, the instability is manifesting with my overhead work, and that's aggravating the shoulders. Then the aggravated shoulders complain when I go to press horizontally or do push-ups. So if I do more stability work (plus the rotator cuff work) and improve that situation, plus backing off a little with the weightlifting, then I'll quit "picking the scab" as Eric described, when I do weightlifting activities like heavier snatch and jerk overhead. As the shoulders become less inflamed and more stable, my pressing will be more productive and less painful.
 
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A lot of physical therapy exercises seem to be formulated like “hypertrophy light.” Smaller muscles are supposed to recover more quickly than larger ones, and small muscles that are supposed to act as stabilizers instead of prime movers are usually trained in such way as to increase their endurance. It’s not uncommon to see rehab/prehab exercises prescribed for sets/reps of something like 3/15 (or 30, like you listed). As much as we are about minimal effective dose around here, I sometimes wonder if that dose is higher than we’d expect depending on the context.

Don’t know if the arm bar would hurt, but I’m not sure it’ll help with pressing stability. Shoulder stability through any pressing movement (except the bench press…) is about the scapula making solid contact with the rib cage, it’s rhythm with the humerus (it’s not uncommon for the humerus to move “more” than the scapula…) and the ability of the rotator cuff to do it’s job effectively. If the rhythm of the humerus and scapula are off, it likely means the rotator cuff has to basically work harder to do it’s job. The arm bar doesn’t seem like it would effectively translate to much of that. It might help train extension patterns (maybe?). I’m not knocking it, but that’s two cents from me.
I agree. I think it's less about compensating for atrophy and more about learning as an "operator" of your body to fire the right muscles at the right time. The longer rep sets help learn the neuromuscular connection perhaps.
 
As the shoulders become less inflamed and more stable, my pressing will be more productive and less painful.
Is it genuinely believed you have inflammation in the shoulder capsule as the root cause of this, and that it is tied to unstable overhead holds?

A test I do with myself when angle or movement specific pain starts to crop up is to heat the area and test, cool the area and test, take a dose of NSAID and test.

If heat improves it then I probably have muscle spasm/tightness aggravating a nerve. If it makes it worse I have soft tissue inflammation.

If cold improves it I probably have inflamed soft tissue repair in progress. If it makes it worse I have overtight or muscle spasm.

If NSAID improves it I probably have cartilage or ligament issues. If it does absolutely nothing I probably have nerve pain.

The more specific the joint angle/movement pattern is that causes pain the more likely it is nerve related.

I am very dubious of "rotator cuff" or "imbalance" diagnosis for stuff like this, these are often trotted out when a cause is not obvious. Just sayin, you're pretty active, have good muscle mass and posture, good mobility in the shoulders. Pain performing a basic movement horizontal push seems like it would be tough to blame on rotator cuff instability. This doesn't mean the current therapy isn't still the best way forward...
 
Is it genuinely believed you have inflammation in the shoulder capsule as the root cause of this, and that it is tied to unstable overhead holds?

A test I do with myself when angle or movement specific pain starts to crop up is to heat the area and test, cool the area and test, take a dose of NSAID and test.

If heat improves it then I probably have muscle spasm/tightness aggravating a nerve. If it makes it worse I have soft tissue inflammation.

If cold improves it I probably have inflamed soft tissue repair in progress. If it makes it worse I have overtight or muscle spasm.

If NSAID improves it I probably have cartilage or ligament issues. If it does absolutely nothing I probably have nerve pain.

The more specific the joint angle/movement pattern is that causes pain the more likely it is nerve related.

I am very dubious of "rotator cuff" or "imbalance" diagnosis for stuff like this, these are often trotted out when a cause is not obvious. Just sayin, you're pretty active, have good muscle mass and posture, good mobility in the shoulders. Pain performing a basic movement horizontal push seems like it would be tough to blame on rotator cuff instability. This doesn't mean the current therapy isn't still the best way forward...

Good thoughts. Yeah it's not a very specific diagnosis, and they're not that dead set on it.

They seem to think (and I tend to agree) that it doesn't matter that much exactly how it started, how it progressed, or even what it is currently. Absent of some specific mechanical cause, which I think is unlikely because I have the same thing going on with both shoulders (just worse in the left), the treatment is going to be the same -- basically, backing off on the aggravating activity, doing some restorative activity, and letting the body heal itself.

Of the things you mentioned, heat helps when the muscles are fired up and tense. Cold helps when the joint is angry. NSAIDS help in general but I avoid them because of the solo kidney. Tylenol helps a bit overall. I only have the nerve pain at night. I did get some of that magic marmot oil that @Period mentioned (it came all the way from Germany from my Amazon order!), but I can't tell if it helps. Same with the Voltaren.
 
Good thoughts. Yeah it's not a very specific diagnosis, and they're not that dead set on it.

They seem to think (and I tend to agree) that it doesn't matter that much exactly how it started, how it progressed, or even what it is currently. Absent of some specific mechanical cause, which I think is unlikely because I have the same thing going on with both shoulders (just worse in the left), the treatment is going to be the same -- basically, backing off on the aggravating activity, doing some restorative activity, and letting the body heal itself.

Of the things you mentioned, heat helps when the muscles are fired up and tense. Cold helps when the joint is angry. NSAIDS help in general but I avoid them because of the solo kidney. Tylenol helps a bit overall. I only have the nerve pain at night. I did get some of that magic marmot oil that @Period mentioned (it came all the way from Germany from my Amazon order!), but I can't tell if it helps. Same with the Voltaren.
Well, best of luck! You know the drill by now.

When I started my block of isometrics was very surprised at the amount of nerve pain I experienced doing OHP considering I had been doing plenty of it with sandbag.

Shooting pain across the delt, in the capsule, and on top of that it felt like I was going to rip my upper pec off the collarbone at the origin. Delt pain would reliably subside over the following 8-10 minutes. Took about 8 weeks of working around it and testing before I could do those 100% pain free - I have no idea what had to remodel or adapt, possibly the actual cartilage had to change shape a bit to accommodate the new loading pattern.

As I've aged increasingly my adaptive response seems to become more and more narrow to the exact movement and loading patterns I'm using, stepping outside them is a mini-adventure. :(
 
Shooting pain across the delt, in the capsule, and on top of that it felt like I was going to rip my upper pec off the collarbone at the origin. Delt pain would reliably subside over the following 8-10 minutes.
Ouch. Not to derail too much here, but out of curiosity was that diagnosed as a nerve injury? Brachial plexus…?
 
They seem to think (and I tend to agree) that it doesn't matter that much exactly how it started, how it progressed, or even what it is currently. Absent of some specific mechanical cause, which I think is unlikely because I have the same thing going on with both shoulders (just worse in the left), the treatment is going to be the same -- basically, backing off on the aggravating activity, doing some restorative activity, and letting the body heal itself.
I'm a bit on the fence there, because diagnosing the cause and progression would seem sort of vital to me in assessing the problem. Of course, it might be that the answer is sort of uncomfortable. As you have hinted, it is not unlikely that your olympic lifting either caused or aggravated the issue. It might be that your technique is putting more strain on certain muscles and the joints that it should, and it might also be that you neglected certain aspects in your training that would be desireable to counteract this. It is not unlikely that you unknowingly encouraged a certain hypermobility in your training, because it enabled you to move bigger weights overhead more quickly. Have you discussed the issue with your weightlifting coach? If so, what does he say?
I did get some of that magic marmot oil that @Period mentioned (it came all the way from Germany from my Amazon order!), but I can't tell if it helps.
If you react to it in a similar way that I did, you should definitely feel a noticeable improvement towards the end of the proscribed 3-week cycle of applying it twice per day, unless you aggravate the issue too much additionally. I massage it in, leave a thin layer on the skin and let that soak in without covering it. Of course, everybody is different etc., but my non-medical advice would be to consider backing off with the oly lifts completely and focus on PT only if the problem persists after three weeks. While stopping your favorite activity and possibly postponing yor SF re-certification for a year might be a bummer, it still beats potentially irreparably wrecking your shoulder in my book.
PS: I am fully aware that I probably wouldn't have listened to this advice back in my competition days (actually, I am pretty sure I wouldn't have), but if reaching my 30ies has taught me one lesson, it's that I probably should have taken my injuries more seriously early on.
 
Ouch. Not to derail too much here, but out of curiosity was that diagnosed as a nerve injury? Brachial plexus…?

I didn't have this diagnosed. I suspect it is related to degenerative cervical disks at C6 and C7, as well as some screwy firing patterns causing pain in the upper pec going from more of an anterior sandbag hold to a much more neutral barbell press.

Was initially doing another hold for abdominal work that caused similar discomfort in exact same area with opposite lines of force.

Supine next to doorframe or similar, hold butt end of a 2" x 4foot dowel with both hands at the center of my sternum and "crunch" the other end of the dowel into the doorframe. Something about bracing with my arms and the angle of force back into the shoulder socket generated some serious nerve pain - I discontinued that one pretty quickly even though it checked all the boxes. The weird thing is both of these have good support in the socket and good support from surrounding musculature that should largely mitigate pressure related pain.
 
I didn't have this diagnosed. I suspect it is related to degenerative cervical disks at C6 and C7, as well as some screwy firing patterns causing pain in the upper pec going from more of an anterior sandbag hold to a much more neutral barbell press.

Was initially doing another hold for abdominal work that caused similar discomfort in exact same area with opposite lines of force.

Supine next to doorframe or similar, hold butt end of a 2" x 4foot dowel with both hands at the center of my sternum and "crunch" the other end of the dowel into the doorframe. Something about bracing with my arms and the angle of force back into the shoulder socket generated some serious nerve pain - I discontinued that one pretty quickly even though it checked all the boxes. The weird thing is both of these have good support in the socket and good support from surrounding musculature that should largely mitigate pressure related pain.
This may seem like a “duh” question so forgive me if it is… are you experiencing more or less neck tension in certain positions? When I say “neck,” I mean the entire area between the deltoid, clavicle, cervical spine, and trapezius. That brachial nerve (if didn’t already know :) ) comes out of the neck there and can get compressed and cause different kinds of trouble. If you haven’t already, it might be worth reading into to see if there’s anything to be learned. Hope it helps.
 
This may seem like a “duh” question so forgive me if it is… are you experiencing more or less neck tension in certain positions? When I say “neck,” I mean the entire area between the deltoid, clavicle, cervical spine, and trapezius. That brachial nerve (if didn’t already know :) ) comes out of the neck there and can get compressed and cause different kinds of trouble. If you haven’t already, it might be worth reading into to see if there’s anything to be learned. Hope it helps.
Not tension, but I will get a slight tingle in my traps from time to time at high compressive loading with scapular component either direction ie upright row or regular row - it dissipates immediately. On rare occasions I'll experience a twinge or some pain through the shoulders with internally rotated overhead movement, even with minimal loading. In context, I've got so much stuff going on that the occasional jolt of nerve pain or sciatica isn't even cause for alarm anymore :cool:

All of what I have going on with my upperback/shoulders can be linked directly to cervical DD. My neuro isn't going to address any of it surgically without severe pain or loss of strength/muscle mass etc. As for PT: "Whatever you're doing, keep doing it - I wish half my patients were managing as well as you". I control it best with posture awareness during the day and a carefully crafted arrangement of pillows when sleeping.
 
It might be that your technique is putting more strain on certain muscles and the joints that it should, and it might also be that you neglected certain aspects in your training that would be desireable to counteract this. It is not unlikely that you unknowingly encouraged a certain hypermobility in your training, because it enabled you to move bigger weights overhead more quickly. Have you discussed the issue with your weightlifting coach? If so, what does he say?

Could be any of those, yes... technique, perhaps, though we work on that often. Have definitely discussed with my coach though I don't think I could accurately represent what he says since it's been an ongoing situation with several adjustments made along the way. I can definitely say it's not moving bigger weights overhead. Maybe more often... but not more. My 1RMs aren't actually much different than when I started lifting this way 2 years ago, but my consistency, technique, and volume is much improved. I could sling an ugly power snatch of 50 kg over my head when I started playing with this in Nov 2019 just because I could deadlift over 300 lbs. But doing an actual snatch at 50kg... has been a long time coming. I've done it just twice in training recently, and 49kg at my recent meet.

If you react to it in a similar way that I did, you should definitely feel a noticeable improvement towards the end of the proscribed 3-week cycle of applying it twice per day
Aha... I haven't been using it that consistently. I'll try that.

Of course, everybody is different etc., but my non-medical advice would be to consider backing off with the oly lifts completely and focus on PT only if the problem persists after three weeks. While stopping your favorite activity and possibly postponing yor SF re-certification for a year might be a bummer, it still beats potentially irreparably wrecking your shoulder in my book.
PS: I am fully aware that I probably wouldn't have listened to this advice back in my competition days (actually, I am pretty sure I wouldn't have), but if reaching my 30ies has taught me one lesson, it's that I probably should have taken my injuries more seriously early on.

I'm willing to do either, and certainly would forgo anything that would cause a permanent injury, if I could know it ahead of time. I don't think I'm really in that realm yet. Pain and discomfort doesn't necessarily mean injury. All I've been diagnosed with is weakness, and inflammation. But, I'll stay open to the possibility if indicated...
 
I'm willing to do either, and certainly would forgo anything that would cause a permanent injury, if I could know it ahead of time. I don't think I'm really in that realm yet. Pain and discomfort doesn't necessarily mean injury. All I've been diagnosed with is weakness, and inflammation. But, I'll stay open to the possibility if indicated...
Making your body conform to a given technique can be just as injury-prone as lifting more weight - ask any gymnast. You are just as likely in that case to over-compensate in one area or another, and adapting to a given movement pattern doesn't get any easier later in life. But, since I honestly don't know much about olympic lifting, that will be a question for you and your coach to solve.
Inflammation in and by itself is a very normal process of healing, however, it can get highly problematic if it progresses and becomes chronic, since it can lead to joint and tendon degredation and invite injury (both in that area and in other areas, due to overcompensation and involuntary deviation from a learned movement pattern). In that regard, it isn't all that different from an injury - you have to watch out for it, and treat it accordingly. An ounce of prevention can be worth half a ton of cure, or something along those lines.
 
I’d bet there’s a lot of this you’ve already tried or been exposed to, but it’s a pretty comprehensive article and there’s a lot of tests and adjustments to technique and whatnot. May be useful, even if just to see if anything has slipped through the cracks?

 
Shoulder instabity should respond to arm bar, bent arm bar, TGU, a ton of band pullaparts, and someone who k ows technique to go through your lifts. Most of the AC issues are from technique that is off. I have seen irritation from improper triceps pushdowns with the GH joint subluxation. Form. Form, form
 
@Anna C, I'm not a doctor (well, not that kind) but I think you're on to something when you mention that smaller muscles can not only take, but benefit, from a lot of volume. It's an interesting thing for those of us who play a brass instrument - those little embouchure (around your mouth) muscles seem to like to be used a lot. A famous trumpet player - wish I could remember who - once quipped that if he missed a day, he noticed; if he missed two days, his students noticed; and if he missed three days, his audiences noticed. That's quite the opposite of tapering for most athletic events.

-S-
 
@Anna C, I'm not a doctor (well, not that kind) but I think you're on to something when you mention that smaller muscles can not only take, but benefit, from a lot of volume. It's an interesting thing for those of us who play a brass instrument - those little embouchure (around your mouth) muscles seem to like to be used a lot. A famous trumpet player - wish I could remember who - once quipped that if he missed a day, he noticed; if he missed two days, his students noticed; and if he missed three days, his audiences noticed. That's quite the opposite of tapering for most athletic events.

-S-

Yes, indeed! I think of it like bodybuilding for the smaller muscles. Which is exactly what is needed when you need to build up the rotator cuff muscles or similar.

As an update on my situation -- I'm 5 weeks now into Physical Therapy. The first 2 weeks I thought I was improving but then things started getting worse with the more painful left shoulder. I backed off on the overhead work with weightlifting and things seem to be getting better again now. Last week my doctor (who I checked back with after seeing that PT might not be heading me in the right direction) ordered an X-ray so I'm awaiting the results of that. He also gave me lidocane patches to wear at night which seems to help with the nighttime pain. He suggested a steroid shot so I'm contemplating that. As for the original push-up situation... It's about the same as it was. I can do sets of 5 knee-push-ups on using the push-up board, or maybe 2 full body 2 arm push-ups using the push-up board, but it's painful, still in the front delt area. I've only been doing a few here and there while I work on the rotator cuff rehab.
 
Another update, now another 2.5 months later.

4.5 months since I had the original push-up problem and started this thread.

I'm better... and I'm doing pain-free full push-ups.

I've done a whole lot of things... Unfortunately I don't have any clear answer on what was the cause, what was the actual problem, or what made it better. But I have been doing rotator-cuff strengthening PT (and stretches, and a few other therapies) for almost 4 months now, I did get one steroid shot in the left shoulder 4 weeks ago, I've backed off the overhead barbell work for the last 5 weeks entirely though I've continued with other training, and I've managed the overall training volume a bit better.

During this time I also had an X-ray (normal), a great conversation with @Brett Jones about wrist position with weight overhead and shoulders in general, a pain & rehab consult with a Barbell Medicine provider that gave me good perspective on pain and rehab approaches (and convinced me I don't need further imaging or other increased medical intervention, at least now now), and continued great coaching by my coach for almost 2 years now, Randy H.

I think in Dec-Jan-Feb I was on the right track with some of the rehab, but I was doing too much -- and still weightlifting -- which was not a formula for improvement. Feb-Mar has been better and I'm definitely headed in the right direction finally. I have no more pain at night, my mobility is much better, I can do most all movements without pain, and I really don't have much deficit in external rotation or anything else anymore.

Reading back through this thread, there are so many great ideas in it from so many of you, and I have done all of these things, and/or or found them to be helpful or true to some extent:
  • just need to work back into them slow and easy, include a few static holds at the bottom or even just start out with static hold at the bottom, work into more dynamic movement
  • Original Strength rocking
  • pushup board
  • assistance pulling / back work in your program
  • thorough warm up
  • screw hands to the outside when pushing
  • did no heavy shoulder work as I recovered from what I believe were simply overuse injuries
  • stretch your biceps
  • Half-Push Ups from my knees
  • elevating the surface by pushing off a box or bench or even try starting at the bottom of the push-up to find your ideal hand, elbow position
  • Kettlebell arm bar
  • reduce the work directly, scale down your exercises, stretch a great deal. Bring in complimentary exercises in a different plane and test for what induces pain and what doesn’t
  • regular PU but with band assistance
  • anti shrug, ie press your traps towards your hips
  • bench press
  • External Rotator Cuff Strength Training
  • David Allen band pull-apart super series
  • for the scapular to function well on the rib cage, to find a stable base, you actually need a degree of flexion
  • The "camel" portion of cat-camel, for instance (hold it and take deeeeep breaths into your back while pushing into the floor)
  • deltoid and pec smashing
  • allow elbows out at 45 degrees, rather than straight back and close to the ribcage
  • whatever upper arm angle is most comfortable. The more in your elbows are the more the anterior delt has to do initially, but the more the lats can contribute as well
  • let my elbows drift out a lot further at the bottom, coming up I would then pull them in as a first step, really firing the lats
  • One of the things you'll come to appreciate about using a PU board is the clearance for your face - it makes it a lot easier to get low
  • looking at pushup form in particular
  • around-the-worlds with a weight plate
  • build some volume with regular push-ups
  • break for 6 weeks from pressing and hammered my upper back/rotator cuff directly
  • rest and back off, letting my shoulder heal; quit picking the scab for a few months; the shoulder takes a long time to heal
  • physical therapy exercises seem to be formulated like “hypertrophy light.”
  • learning as an "operator" of your body to fire the right muscles at the right time. The longer rep sets help learn the neuromuscular connection perhaps
  • backing off on the aggravating activity, doing some restorative activity, and letting the body heal itself.
  • consider backing off with the oly lifts completely and focus on PT only if the problem persists after three weeks
  • marmot oil
  • arm bar, bent arm bar, TGU, a ton of band pullaparts, and someone who knows technique to go through your lifts
So now, I'm back to doing TGUs with up to 20 kg, full 2 arm push-ups, OAPU regressions (elevated and/or band-assisted), kettlebell snatches to 16kg, windmills, and a few other misc. things I had been really having trouble with a few months back.

Up next is training for OAPU for the Dome and StrongFirst recertification. Master SFG Karen Smith is making me a program for the next 6 weeks. If I'm able to get there, I know her path is the best one to take! I found that I can use my jerk blocks and bands for regressions and I'm looking forward to working on this.

Ideally, I get the OAPU in April, and then move back into weightlifting after that... but we'll see. If it's not meant to be, I have plenty of other training options. Being pain free and fully functional is the main win, and I'm pretty much there already.

Many thanks to everyone for your help and great advice.
 
Anna I havent read the rest of the thread but checked your list above and there is no mention of it here so I will add it:

Macebell / clubbell 360s

I have had shoulder issues on both on and off for a while now. I recently took to focusing on stretching, thoracic rotation, spinal mobility and flexibility, etc.

I then recently incorporated some clubbell and macebell work and oh man is it good for the shoulders/scap/serratus. Its say you'll want to ensure you have the mobility in your shoulders and thoracic spine first, but once you can move onto 360 swings it feels AMAZING. Like a massage for your shoulders and all the muscles around them. I can't recommend it enough. Oh, add some hanging days from a pullup bar and I imagine your shoulders will be all set.
 
Anna I havent read the rest of the thread but checked your list above and there is no mention of it here so I will add it:

Macebell / clubbell 360s
Yes and you're right, no mention of it yet in this thread. I do have some of these. I have a 10 lb and 15 lb mace. I am trying to find the right time to reintroduce some mace training. Doing plenty of haloes for now. It's tough to know when to push a little into new things or thing that previously may have caused problems. There are some slower movements I can do with them (halo-ish)... will give that a try to start with. Thanks for the idea!
 
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