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-   -   Possible SLAP tear? Need advice (http://www.catalystathletics.com/forum/showthread.php?t=5566)

Peter Little 07-07-2010 10:03 PM

Possible SLAP tear? Need advice
I've been dealing with ongoing pain in my right shoulder for about 4 months now. I don't remember any traumatic or sudden event preceding it, but do recall first really noticing it on a day of high numbers of dips. The pain is hard to duplicate, deep bench press, dips, and overhead motions seem to be the most common places where I can provoke it-based on everything I've read, seems to be suspicious for a SLAP lesion or something related?

I've been able to do the Catalyst strength gain/olympic/main site workouts for the past couple of months without it getting worse, but am concerned about continued use with heavy weight aggravating the situation. We took some videos of my lifts the other day and it was visible that my right shoulder was catching snatches in a lowered and uneven position related to my left.

At the moment I'm uninsured, but if things go right, should have good workplace coverage in the next three months sometime. I'm wondering if there are exercises which should just be avoided-olympics/strength lifts which maintain shoulder strength and chest strength without aggravating it?-Are there modifications I could do that help to maintain/strength gain for the next few months but go easy on the shoulder until I can get better professional attention on it? Im assuming that maybe snatch and jerk might be out, but possibly cleans, deadlifts, squatting? bench press with limited depth? other ideas, particularly compounds which still maintain chest and shoulder strength without aggravating the injury? Pull-ups haven't seemed to bother it? I've been working the Diesel Crew shoulder rehab protocals for weeks now, and feel like Ive got stable shoulder girdles...

Anyone with more experience have any thoughts on this?

Peter Little

Steven Low 07-07-2010 10:36 PM

If you want a real diagnosis, see an orthopedic doc.

If you want a guess by myself, we can do that..

1. Google a pic and mark where it hurts.

2. What exercises hurt? Which shoulder articulations hurt?

3. What type of pain is it? Burning? Ache? Tingling? Sharp?

4. Acute or chronic? What date was onset?

5. Any previous injury history?

6. How's your posture?

7. What is your current workout routine for that bodypart? Do you play any sports?

8. Have you been training through pain? If so, how long?

9. Check the tissue quality of the surrounding muscles. Which ones are tight? Which ones are tender? Is there any swelling?

10. What have you been doing for recovery purposes?

11. Any other information I should be aware of or that comes to mind that may help?

Initial impressions -- Can't really tell much from your descriptions.... since a lot of stuff hurts it's not very detailed.

Peter Little 07-08-2010 11:08 AM

I appreciate the response
1.The pain is hard to pinpoint-feels deep in my shoulder. None of the rotators or external muscles are provokable on palpation.

2. Push presses, shoulder presses, deep bench press, dips hurt. None of the shoulder articulations listed on your link consistently produce pain. It hurts when I have weight loaded overhead, but only for portions of the motion.

3. Its somewhere between an ache and a sharp pain. Occaisionally it'll be very slightly provoked when sleeping, is not consistent or constant-only during very limited ranges of motion with specific activities.

4. I think Im about four to six months out from onset of the pain. Has been slow progression. Is in not way deblitating at this point, but I can see it doesn't seem to be going away, so want to get ahead of it. I think its definitely creating weakness and guarding in my right shoulder with overhead lifts...

5. No previous history of injury-got caught in a rockslide last year and had the upper half of my thumb on that hand crushed and rebuilt, but had no related shoulder injuries. My grip is strong as it was at this point, no notable defeciencies, although no hook grips as the thumb is too short.

6.I think my posture is good. I have a strong core, do a fair amount of compound exercises and overhead lifts and try to pay attention to how Im moving...

7. Current workout routine-lately I've moved between crossfit type work-outs and spending a couple of full rotations on the Catalyst website's main page-so metcons mixed with weeks of olympic lifts, five days a week, two solid rest days with just light stretching.

8. Have been training through pain-as its been hard to isolate, hard to identify, and slow onset-as I noticed it really begin to get worse, I laid off dips and bench press. Past few weeks I've been doing the shoulder rehab posted by Deisel Crew folks on youtube, and have begun attempting to do high rep, eccentric loading with machines mimicking dip and bench press type motions. Still been cleaning, deadlifting, flipping tires, rope climbing, pull-ups, sprints, haven't done snatches in a few weeks. Dumbell thrusters and push press are in there from time to time too.

9.Can't find any tenderness, swelling, or tightness anywhere in the shoulder area.

10. For recovery-ice, as noted above, laid off the shoulder for a few weeks then began using bands and machines to do eccentric loading in dip and bench type motions with light weight, flies, and the diesel crew rehab protocal usually something like 40-50 reps with a four to ten second negative in three or four sets every few days. Otherwise training as noted above, sans snatches...

Is this anymore helpful? In terms of isolating the pain-for example-I hoisted a 75 pound box of books onto my right shoulder, with my right hand supporting the box from underneath, and proceeded to walk a few blocks with the box in hand, and this was able to provoke the pain. Otherwise it will hurt during a couple of degrees of the range of motion while doing overhead presses, snatches, dips, bench presses, and otherwise feel fine....

Thoughts-I appreciate it...

Steven Low 07-08-2010 04:48 PM

Yeah, I would get yourself to an ortho if possible to get checked.

Overhead pressing movements, in particular, if shoulder gets tight can lead to some impingement of hte posterior labrum and possibly tearing.

Although it could also be SLAP lesion.

Is the pain more anterior or posterior inside the shoulder?

Does an internal rotation stretch such as sleeper stretch hurt?

Either way, pain inside the shoulder is usually indicative of labral issues so get yourself to an ortho.

Peter Little 07-09-2010 08:51 AM

Two noteworthy pieces-if I can figure a way to transfer it here, I'll post video, but looking at my snatch overhead catch, the injured shoulder catches out and lowered from the uninjiured-ive assumed this is guarding from pain, but also realize that there may be some chicken-egg stuff going on here...

The pain is not distinctively posterior OR anterior. If I had to pick its vaguely more anterior. Totally negative for pain or limitation on sleeper or internal rotation stretches.

My main question is this-Im probably a couple of months out from insurance coverage-are there things I just shouldn't do in my training in that time, things I can or should be doing?? Good compound exercises and strength stuff to help maintain chest and shoulder strength without aggravating whatever is going on in there? Any ideas? Static overhead type stuff? Pull-ups ok? Limited ROM bench or push-ups? Deadlifts? Cleans??? Any thoughts?

Thanks again for responding Steven-I've followed your posts on various boards for awhile and see you must stay pretty busy entertaining people's pains and injuries...


Justin Gross 07-09-2010 07:59 PM

The biceps tendon attaches to the labrum so pretty much anything you do with your arm is gonna aggravate it. When they opened mine up the tendon was so frayed that he just cut it and reattached it to the humerus.

An ortho is probably going to tell you to get a MRI, but it's still hard to tell even from that. The only way they're really going to know is to scope it (in surgery).

If it truly is a labral tear, the only solution is surgery. I had done it last November and my shoulder's 100% now. (I don't do kipping pull ups or muscle ups anymore)

Peter Little 07-11-2010 10:08 PM

thanks for the responses folks.

Its interesting, because I swam today, felt great, pain is minimal, comes and goes...At this point Im really just weighing out how to train safely in the window until I can actually get good access to health care...

Patrick Haskell 07-20-2010 08:50 AM

Might be a SLAP lesion; might not. You might have one but the pain could still be related to bursa or the rotator cuff and proper PT would be the solution.

The diesel crew shoulder prehab series is as good as any approach - sight unseen. Some folks swear by KBs for rehab, some by low-weight OHS and controlled kipping pullups (of all things). A few thoughts:

Without or after surgery, you first need to get the inflammation down to effectively rehab it. This means avoid the movements that consistently cause pain, including rehab exercises or favorite lifts that cause pain. Rehab can hurt sometimes, but if it consistently hurts an injured area, you're probably not doing yourself any favors.

I'd stay far away from bench press and dips and the surrogates you've been doing excentrically, and I'd avoid them until well after you can overhead lift comfortably. Also, stay clear of flies and, though you didn't mention them, upright rows. If you have an impingement, these are likely to aggravate it and don't have much benefit anyways.

You may simply have to accept that you'll lose some chest and shoulder strength as you work through this. The fact of the matter is that your raw pushing strength is currently greater than your ability to comfortably stablize it. Get the inflammation down, work your mobility (stetching/, improve scapular stability and rotator cuff strength, and then rebuild pressing strength. In the meantime, you can do unilateral work on the uninjured side. It can have more carryover than you might expect.

The general rule of thumb when rehabbing a shoulder injury is to work 3 pulling exercises for each pressing exercise. Now this rule of thumb is based on a population that spends its days hunched over a computer or steering wheel. If you dig ditches for a living, that ratio may change depending on how much pushing and pulling goes on between 9 and 5. Scapular mobility and stability/strength are key to effective shoulder function. There are tons of exercises to choose from. Hafe at it.

In terms of pressing exercises, you'll want to concentrate less on maintaining bulk strength at first and instead work the stablizers needed for the pressing movements. You can gradally add more demanding pressing work as you discover variants that can be done pain-free, a list of things that will grow larger as inflammation decreases.

In terms of reintroducing exercises, start working limited ROM before full, isometrics and slow speeds before full speed, unstable (stablizer biased) before stable (skeletal biased). For example, you might start with pushup variants, incorporating isometric holds and fewer reps. You might work slow pushups with your feet elevated on a stability ball before attempting regular pushups. The next step might be neutral-grip DB floor presses. You might find that barbell board press work before full ROM DB bench presses (or not). Either would come before a close-grip bench press, which would come before a standard bench press.

You'll need to find your own way through this. If it hurts, try something else. I was able to go to overhead pressing well before I could bench and incline bench has been a no-no for most of my adult life. Other folks can bench before they can lift overhead. The shoulder is a complicated joint with many degrees of freedom, so there's a long list of things that can go wrong, and diagnoses like GIRD or even SLAP tear might not adequately describe the manifestation of your particular issue. One thing for sure, if your overhead form is messed-up because of the shoulder problem, you aren't doing yourself any favors pushing on with the training program. Get the problem fixed, maintain

Garrett Smith 07-20-2010 09:08 AM

Stop all kipping.

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