Popping in shoulder after doing weighted disclocs

[Brian Comstock]

Hi, I am experiencing a popping in my left shoulder that occurs throughout the day when I move it to pop/click it in a certain pattern. I have had it for about 2 years now, although with no pain. THe only thing I could correlate its onset with was doing weighted dislocations and perhaps progressing with weight to quickly; I lost complete control of the 45lb bar at the end range of motion and heard/felt some crunching/clicking, which I figured is normal from listening to Coach Sommer on the Tim Ferriss podcast. 

I have tried everything I can think of: physical therapy, hanging/traction, rest, but nothing seems to fix it. 

Any insight or help would be appreciated. 

[Alessandro Mainente]

Hi Brian, probably in order to check for causes you should consider an imaging diagnosis.

why did you lose control of the bar? strength? mobility? were you fatigued?

have you have already checked for an orthopedic?

[Coach Sommer]

6 hours ago, Brian Comstock said:

perhaps progressing with weight to quickly; I lost complete control of the 45lb bar at the end range of motion and heard/felt some crunching/clicking, which I figured is normal from listening to Coach Sommer on the Tim Ferriss podcast. 

I have tried everything I can think of: physical therapy, hanging/traction, rest, but nothing seems to fix it. 

Hello Brian,

You need to have the shoulder evaluated with MRI by a professional therapist.  It is the only way to know what is going on inside.

Small cracks and pops from within a cold joint warming up are normal and to be expected.  Two years of issues are not.

Yours in Fitness,
Coach Sommer

[Nick Murray]

Shoulders are a topic dear to my heart.

Everything below assumes no actual injury. As other people have mentioned, see a PT if you are really concerned; preferably someone who treats gymnasts or circus performers.

What happens if you remove the 45 lb for a few days and repeat the dislocate?

Are you also working on stretching pecs and lats?

As 45lb is a considerable weight for a dislocate, the rotator cuff has a lot of work to do to keep the humeral head in the glenoid. Are you doing any rotator cuff specific strengthening? Including subscap?

The words "certain pattern" gave me a clue: you will adapt to the dislocate/inlocate movement pattern and likely reinforce that pattern as you add weight. Adding weight increases the feedback your nervous system gets and makes it more difficult for the rotator cuff muscles to activate in a different way.

So a suggestion for regression and then progression over a few weeks or even months is:

* remove the weight and perform the dislocate/inlocate starting wide and going narrow over a few sets, perhaps not as narrow as you can get at present. See if this makes a difference.

* add a small weight, but not in the centre of the stick, and/or a light theraband on one or both ends of the stick, with different anchor points. The idea is to give the nervous system some different input within the context of the dislocate/inlocate movement, and perhaps (maybe!) train the rotator cuff out of its  "standard' pattern of movement. You could even use a length of electrical conduit (PVC pipe), 1/3 filled with water and capped at both ends. This will slosh around a bit and be unstable, making your rotator cuff really think about what to do.

Good luck!

[Brian Comstock]

On 11/7/2019 at 3:20 PM, Nick Murray said:

Shoulders are a topic dear to my heart.

Everything below assumes no actual injury. As other people have mentioned, see a PT if you are really concerned; preferably someone who treats gymnasts or circus performers.

What happens if you remove the 45 lb for a few days and repeat the dislocate?

Are you also working on stretching pecs and lats?

As 45lb is a considerable weight for a dislocate, the rotator cuff has a lot of work to do to keep the humeral head in the glenoid. Are you doing any rotator cuff specific strengthening? Including subscap?

The words "certain pattern" gave me a clue: you will adapt to the dislocate/inlocate movement pattern and likely reinforce that pattern as you add weight. Adding weight increases the feedback your nervous system gets and makes it more difficult for the rotator cuff muscles to activate in a different way.

So a suggestion for regression and then progression over a few weeks or even months is:

* remove the weight and perform the dislocate/inlocate starting wide and going narrow over a few sets, perhaps not as narrow as you can get at present. See if this makes a difference.

* add a small weight, but not in the centre of the stick, and/or a light theraband on one or both ends of the stick, with different anchor points. The idea is to give the nervous system some different input within the context of the dislocate/inlocate movement, and perhaps (maybe!) train the rotator cuff out of its  "standard' pattern of movement. You could even use a length of electrical conduit (PVC pipe), 1/3 filled with water and capped at both ends. This will slosh around a bit and be unstable, making your rotator cuff really think about what to do.

Good luck!

6

Thanks Nick. I Have done a lot of rotator cuff / external rotation exercises but I have neglected the subscap / internal rotation strengthening because I figured as a desk-jockey external was always better than internal to reverse my postural issues / forward shoulders. I haven't been doing weighted dislocs for awhile so I agree I can regress and progress again, will try both those things. The "certain pattern" is further explained here, please see my video for more context: https://www.loom.com/share/898a5b3740454ca59ef1f5017c3bf575

 

My best guess is I have worn down cartilage from a few subluxations in HS and general wear and tear of multiple sports and dumb training, etc. Would love to know the right set of exercises or otherwise to manage and improve it.

On 11/7/2019 at 3:20 PM, Nick Murray said:

 

 

 

On 11/7/2019 at 5:03 AM, Coach Sommer said:

 

 

 

Edited November 9, 2019 by Brian Comstock
Added a piece

[Nick Murray]

Thanks for the video. It's not conclusive

As far as I'm aware, clicking, popping and clunking are mostly different expressions of gas coming out of the synovial fluid within the joint. If the surfaces of the humerus and glenoid aren't perfectly aligned, the fluid compresses (or at least, the gas is compressed out the fluid) and a pop occurs for a small compression, and a clunk for a large amount of gas. I have both popping and clunking, and from several surgeries have been told that I have full-depth cartilage loss in some places. However, the clunking isn't humeral head hitting glenoid, but more likely the gas thing occuring because the surfaces don't align.

I have had my left shoulder lock up due to "loose bodies" within the joint and where I literally have to shake my arm to free up the shoulder joint.

Cartilage will remodel (reshape itself under load) but this will take a long time. What helped the locking problem was to back off the maximal-effort isometrics of Foundation, and add a few days of "normal" eccentric/concentric rotator cuff and shoulder exercises. I have no evidence for this other than my own experience, but I think that focussing on shoulder extension and shoulder presses had some benefits. Specifically:

1. the landmine lunge variation at http://shiftmovementscience.com/easy-4-exercise-progression-to-return-to-overhead-pressing-after-a-shoulder-injury/

It's in the video somewhere.

(While Shift is gymnastics-focussed, it's more aimed at athletes in a full-time program rather than Foundation).

2. The Pilates reverse tabletop:

However, here is how I do it:

* Get into the position. In the picture, the model's shoulders are internally-rotated, you can do it in ER if IR is too difficult.

* warm up by keeping the elbows locked, but allowing your torso to depress between your shoulders.  It's like sPL/PE1, only inverted. Perform x 10 or so. I like to do table rocks after this, pressing hands into the floor and lifting the chest as much as possible to load the shoulder  in as much extension as I can manage and really making the rotator cuff work hard.

* Back in the static table position, lift the left hand, take it over the body and tap the floor outside the right hand, so you get some spinal twist as well. It's hard to keep your hips extended in this position!

I've been doing these two exercises since January, when I had an MRI confirming the "loose bodies". Since then, my left shoulder hasn't locked up at all.

It may not have been anything to do with the exercises, of course. 

This post has just been a long way of saying: "make your shoulders do different things, with different load, in all ranges of motion. Especially the difficult ranges (like extension)". Hopefully it might help.

 

[Brian Comstock]

9 hours ago, Nick Murray said:

Thanks for the video. It's not conclusive

As far as I'm aware, clicking, popping and clunking are mostly different expressions of gas coming out of the synovial fluid within the joint. If the surfaces of the humerus and glenoid aren't perfectly aligned, the fluid compresses (or at least, the gas is compressed out the fluid) and a pop occurs for a small compression, and a clunk for a large amount of gas. I have both popping and clunking, and from several surgeries have been told that I have full-depth cartilage loss in some places. However, the clunking isn't humeral head hitting glenoid, but more likely the gas thing occuring because the surfaces don't align.

I have had my left shoulder lock up due to "loose bodies" within the joint and where I literally have to shake my arm to free up the shoulder joint.

Cartilage will remodel (reshape itself under load) but this will take a long time. What helped the locking problem was to back off the maximal-effort isometrics of Foundation, and add a few days of "normal" eccentric/concentric rotator cuff and shoulder exercises. I have no evidence for this other than my own experience, but I think that focussing on shoulder extension and shoulder presses had some benefits. Specifically:

1. the landmine lunge variation at http://shiftmovementscience.com/easy-4-exercise-progression-to-return-to-overhead-pressing-after-a-shoulder-injury/

It's in the video somewhere.

(While Shift is gymnastics-focussed, it's more aimed at athletes in a full-time program rather than Foundation).

2. The Pilates reverse tabletop:

However, here is how I do it:

* Get into the position. In the picture, the model's shoulders are internally-rotated, you can do it in ER if IR is too difficult.

* warm up by keeping the elbows locked, but allowing your torso to depress between your shoulders.  It's like sPL/PE1, only inverted. Perform x 10 or so. I like to do table rocks after this, pressing hands into the floor and lifting the chest as much as possible to load the shoulder  in as much extension as I can manage and really making the rotator cuff work hard.

* Back in the static table position, lift the left hand, take it over the body and tap the floor outside the right hand, so you get some spinal twist as well. It's hard to keep your hips extended in this position!

I've been doing these two exercises since January, when I had an MRI confirming the "loose bodies". Since then, my left shoulder hasn't locked up at all.

It may not have been anything to do with the exercises, of course. 

This post has just been a long way of saying: "make your shoulders do different things, with different load, in all ranges of motion. Especially the difficult ranges (like extension)". Hopefully it might help.

 

@Nick Murray I really appreciate the breakdown. I headed off to open gym to give these a try. Interestingly, I have only done the landmine press once in my life, recently, and did notice the popping subsided a bit. I have found random things like this to temporarily subside the popping, but no permanent solution. I will keep at it and let you know of any progress or otherwise. Struggled with this for years so any bit helps. Appreciate ya mate. 

[Nick Murray]

One thing that comes to mind during landmines (as a progression to kneeling shoulder presses): Landmines aren't just shoulder presses - you have to lean forward to get maximum shoulder extension ***and you have to control your hips as you do so***.

Think about pressing forward with the hip as well as lifting the bar (whichever arm you're lifting with, that same knee is on the floor).

Also check that you're not poking your chin (or whole head) forward as you lift - this is a compensation when trying to generate more tension in the shoulders. If anything, tuck your chin a bit.

Please do keep us all informed!