Shoulder pain of a strength athlete
A 51-year-old man came to my practice with shoulder pain on the left, among other things. An inflammation of the shoulder without further designation was diagnosed. The associated pain had meant that my patient had not been able to exercise for over a year. It was strength sports at an intensive level. He had been doing this sport for many years and had developed an impressive muscle corset with athletic phenotype all over his body. The upper body and arm muscles were so pronounced that an abduction position of the arms while standing and lying down was imperative. The pain was very intense with high inflection and internal rotation and was perceived by him in the delta area. On the right shoulder, he had been operated on 4 years ago for an impingement.
At the time of the consultation in my practice, he had undergone various therapeutic attempts, all without success.
The clinical examination was surprising. From the medical history and the previous medical history, one could easily have concluded an impingement on the left, but the investigation did not reveal this. On the contrary: The active and passive mobility was finally possible, but the internal rotation and flexion with pain ventrally along the clavicle to the delta range. Support exercises with absorption of a large part of the body weight on the arms as with push-ups were possible without pain. Side position left and right as sleeping position could be taken at night without pain. Palpations of the rotator cuff attachments were possible painlessly, albeit difficult due to the mass and tone of the muscles.
Further examinations of the abdomen did not relate to shoulder pain.
As a first treatment approach, I gave up some muscle stretching exercises as a home program: stretching of the hand and forearm flexors, chest muscles and shoulder outer rotators. Limiting the therapy to a few aspects of the suspected pain triggers brings me, as a therapist, clear feedback for the subsequent treatments. In this case, the stretches did not lead to any success: After 3 weeks of self-stretching, the symptoms had not changed. My conclusion from this: The problem is not the muscles, but the fascia. I have had the experience that this is a difference: muscular stretches also reach the fascia and, if used consistently, lead to the goal of improved mobility and pain reduction. However, if muscle stretching is unsuccessful, a muscle appears to be resistant to stretch, the muscular fascia are affected as envelope structures of a muscle. In order to reach them, a different approach is needed.
I manually felt the painful region below the clavicle into the armpit. Even with slight palpation, very intensely painful muscle fascia transitions of the pectoral muscles of the delta and the latissimus came to light. I treated these areas with direct fascial techniques and then controlled the still painful internal rotation, which hurt significantly less after treatment. Since my patient's partner was a physiotherapist, she should continue the therapy she took. Otherwise, yellow balls, acupressure mats, TMX, etc. are suitable as self-treatment for such fascial disorders.
4 weeks later, he appeared for the 3rd. Treatment almost painless. His partner had treated him once a week for about half an hour. He had resumed his strength training with reduced intensity. As agreed to continue the therapy taken in this way.