rotator cuff concerns, maybe a snatch problem

[drpsnell]

Originally Posted by azmark

I'm assuming that it's the snatches that are causing the problem. What's the likelihood that it's the presses? I tried to isolate it, but the movements themselves don't cause any pain. It's only later after I cool off.

Hey Azmark,
The shoulder is a complicated joint and from your description it sounds as if you may be dancing with a rotator cuff impingement. Since it sounds as if you're not near an RKC, you're either working through this on your own or you need other professional help in figuring out what the pain generator is and what the faulty movement is. So, brief anatomy lesson...

The rotator cuff is comprised of 4 tendons that insert on your arm bone (humerus) whose function is to pull the humerus down and back into the joint as the arm raises above 90 degrees. They are aided in that endeavor by the stabilizers of your shoulder blade, mid/lower traps, etc. To cut to the chase, most modern humans experience problems here due to habitual postures that pitch the body forward, reducing exension in the thoracic spine and reducing the ability of the scapular stabilizers to hold the joint in place so that you can lever off of it. To build sustainable shoulder motion, work on extension flexibility in the thoracic spine and control with the scapular stabilizers. Rowing exercises will help, exernal rotation exercises with Theraband or sidelying with lightweight KB will also help.

McGill speaks of "bending the bar" with your lats when performing overhead presses of any kind. This helps to plug your shoulders into your core so that you're grounded. Try doing that with C&P and snatches and see if that helps.

Back to anatomy...the cuff tendons occupy a narrow space (subacromial space=SAS) between the humerus and a bone above called the acromion. When you raise your arm above 90 deg, that space is narrowed further. The postures above further narrow the space, meaning that if you have crappy posture AND raise you arm above 90 deg, then you increase risk of impingement. To test this for yourself, poke your head forward, rotate your arms inwardly and raise them. Feel how it's difficult to raise very high? Now rotate the arms outwardly, sit up straight and repeat. Easier, huh and you can go further. This little demo shows a free way to increase the SAS and lessen chance of impingement. Work on the external rotators of the arm and the scapular stabilizers and you're on your way. Another effective way to increase SAS is with acromioplasty surgery and you'll find any number of local orthopods quite willing to help you with that. Most folks prefer to sit up straight and do a little appropriate exercise first though ;-)

If you have injured the cuff tendons, then they swell, narrowing the SAS further. If that is the case, that needs to heal and the swelling resolve before you keep performing overhead lifts. Then you need to correct the form error that brought this on. Consider a good local PT or DC to work you up and get you back to training ASAP.

Hope this wasn't too much or too confusing. Cheers.

Dr. Phillip Snell
www.FixYourOwnBack.com/blog

[faizalenu]

While the functionality of your post is correct, there are some anatomical points that are not correct.

The shoulder is a complicated joint and from your description it sounds as if you may be dancing with a rotator cuff impingement. Since it sounds as if you're not near an RKC, you're either working through this on your own or you need other professional help in figuring out what the pain generator is and what the faulty movement is. So, brief anatomy lesson...

The rotator cuff is comprised of 4 tendons that insert on your arm bone (humerus) whose function is to pull the humerus down and back into the joint as the arm raises above 90 degrees.
==> The rotator cuff is four muscles, not four tendons
* Subscapularis - originate on the underside (ventral) of the shoulder blade. Also assist in flexion/internal rotation of the shoulder joint
* Supraspinatus - originates on the upper back part of the shoulder blade and assist in abduction of the shoulder joint
* Infraspinatus - originates on the lower back of the shoulder blade and assists in extension/external rotation of the shoulder joint
* teres minor - originates on the lower lateral part of the shoulder blade and assists in extension/external rotation of the shoulder joint. Its "line of pull" is parallel to the infraspinatus.
==> all of the rotator cuff muscle assist in stabilizing the shoulder joint, but in different directions (not always back and down)

Back to anatomy...the cuff tendons occupy a narrow space (subacromial space=SAS) between the humerus and a bone above called the acromion.
==> The acromion process is a growth off of the shoulder blade/scapula.

Dr. Phillip Snell

[drpsnell]

For Faizenlu...this is not a clinical forum so I apologize for the clinical impreciseness of my previous post which I deemed to be directed to a non-clinician. Toward clarifying, from Dorland's...

rotator cuff a musculotendinous structure about the capsule of the shoulder joint, formed by the inserting fibers of the supraspinatus, infraspinatus, teres minor, and subscapularis muscles, blending with the capsule, and providing mobility and strength to the shoulder joint.

A tendon is the part of a muscle that attaches to the bone. Technically we're both right. Anatomically, they are tendon at the point where azmark indicates where his pain is, as the fibers of the cuff there are collagenous, dense connective tissue and elastic fibers with scarcely any contractile fibers and very little vascularity. This much is plainly apparent under gross anatomical inspection and also the reason for the difficulty of healing injuries there owing to the low vascularity.

" The acromion process is a growth off of the shoulder blade/scapula."

acromion (ә-kro´me-әn) the lateral extension of the spine of the scapula, forming the highest point of the shoulder.

It's a bony process, not a "growth", which is not a clinical term.

"all of the rotator cuff muscle assist in stabilizing the shoulder joint, but in different directions (not always back and down)"

Point taken, subscap is an internal rotator while the remaining 3 muscles are primarily depressors, external rotators and for supraspin, a weak abductor of the humerus. For that matter, the subscap insertion on the lesser tubercle may be the pain generator in azmark's condition given his pain on the C&P.

The supraspinatus is a weak abductor in the first 30 deg of abduction, and it's primary function as an abductor has been called into question since Van Linge, et al in the 60s. This has not changed much in the publishing of textbooks however, except that now the muscle is seen more as an initiator of abduction and then a stabilizer of the glenohumeral joint, helping to centrate the humeral head in the labrum. Based on my clinical experience, the anatomy at fault here is less important than the functional faults that caused it.

Bottom line, this condition, if it doesn't improve promptly with the advice rendered by the collective members, should be evaluated by a clinician trained in physical medicine.

Phillip Snell, DC
www.FixYourOwnBack.com

[mc]

Originally Posted by drpsnell

For Faizenlu...this is not a clinical forum so I apologize for the clinical impreciseness of my previous post which I deemed to be directed to a non-clinician. Toward clarifying, from Dorland's...


Bottom line, this condition, if it doesn't improve promptly with the advice rendered by the collective members, should be evaluated by a clinician trained in physical medicine.

Phillip Snell, DC
www.FixYourOwnBack.com

Philip,
you sure don't have to answer this, but i am curious:
why are you here?

I don' think you've posted about being a kettlebell practitioner or trainee, or someone who uses any of the products here. As far as i can tell on the web you have a chiropractic practice on the west coast, i think? So what's the attraction to this forum for you?

best,
mc

[drpsnell]

Happy to answer mc. My interest and my practice are focused on simple, inexpensive, science-based, functional training methods to keep people active and help keep people from needing the services of people like me. Basically it's about public health. While that makes me something of an odd type of DC in the minds of many, it helps me sleep at night. Candidly, I'm more interested in what the science says about how to help avoid alot of common health issues and figuring out ways to apply them to the general public than I am about espousing some chiropractic BS.

My exposure to RKC began 2 years ago with ETKB. While I saw the value of the training methods at the time, I was not excited about the marketing. That said, I reviewed Pavel's instruction and was very impressed that the quality of the instruction was great. I began incorporating KB into workouts and recommending them to patients. I have winced at the schlock on YouTube that passes as KB instruction that ignores current science and places people on the fast track to lumbar disc herniation. As such, I've encouraged patients to seek out the help of experienced KB trainers. They would in turn ask the logical question of how to determine whether someone was knowledgable in healthy KB training. Part of my reason for me being here is to find out what you RKC instructors know, so that I can determine if this is a reliable source for me to refer my patients to.

I have recently become more interested in kettlebell training as several common threads of sports med research that have influenced me, have looped around to this organization. Namely, Stuart McGill's research and Gary Gray's affiliation with RKC. That interest brought me to this forum.

While I'm a newbie to this group, I'm not a newbie to biomechanics, anatomy and physiology, sports medicine and rehab, and training. Given the manner in which some of my colleagues have conducted themselves in public, you've a right to question my motives and place here. Thanks for giving me the opportunity to give a clearer picture of who you're dealing with. Cheers.

Phillip Snell, DC
www.FixYourOwnBack.com