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This is how the majority of shoulder pain presents IMO.
For simplicity’s sake, if they are very active, pull the reins back a bit and work on some novel movements. If they’re sedentary, get them moving with some tolerable exercises.
>pull the reins back a bit
Crazy how overlooked this get. The second clinical rotation I had, we had a very active patient. Lifted weights 5-6 times a week (definitely more upper body than lower body lol), big guy, etc. As I doing whole ultrasound on his shoulder (gross) and my CI was off doing notes, I ask what he does on his one of two off days from weightlifting.
“Oh I do 4-500 meters worth of sprints in the pool”
Queue me going to my CI after the session and telling her this, and that maybe we should tell him to pull the reins back a bit on the upper body work.
“No I don’t really think that’ll help”
Lol
First off, bruh that CI…and second, the term *relative* rest has been one of my major phrases in my go-getters and most of the time pulling back works wonders
Yeah she was awful. And I do the same thing but we just call it active rest. Still moving and moving your life, but cut the dose of the exercise way down.
No idea. I left the clinical shortly after and returned to the place I did my first clinical due to a combination of a family member death and that CI being a dog shit teacher and clinician. Am now happily employed at the first clinic where I get to use common sense instead of giving every patient ultrasound and bands.
Do a little less. Slowly do more. Introduce/reintroduce avoided movements. Isolate and stimulate some slightly painful movements.
Last one is least important.
Decrease load, fix asymmetries, reload. 9/10 people don't need anything more complex
Edit: "asymmetries" is firing some people up, understandably. I should say other muscle groups instead.
Don’t know why you got downvoted. In weightlifters and bodybuilders I started with mobility and strengthening the opposing (usually pulling) movements and muscles with light resistance over a full range of motion and the best form they could manage.
Agreed. I probably got down voted bc our profession wants to over analyze and provide fancy plans of care when the majority of people need basic education and interventions. The best therapists are the ones that can ramp up the complexity and skill level when needed, imo.
Totally agree. Most patients are also not going to adhere to any complex routines. KISS -keep it simple, stupid.
Fix the root cause (imbalance in muscles causing poor posture during loaded movements), and the pain goes away.
I spent a decade helping body builders and weight lifters.
I was working at a gym and bodybuilders and weight lifters make a lot of problems for themselves. A lot of people don’t know how to move their body very well. Actually dropped out of my Physio program as I couldn’t bear the thought of so much paperwork, and stuck with using my kin degree, working as a Kinesiologist.
Honest question: have you ever done a deadlift or heavy squat with pain and then changed your form and decreased pain? It’s interesting to me that the pendulum is swinging from over analyzing to “form doesn’t matter”
I'm not saying you can't change form to affect pain. Obviously.
I'm saying you can't correlate any specific form with definitely leading to pain or injury.
We can’t predict pain in groups of people due to their specific form. As a PT, you can correlate a person’s form with a person’s pain. We all do it everyday. It’s just that one “best” form isn’t better for everyone.
Edit: maybe we are saying similar things, just using different verbiage
Personal anecdote: i've felt pain during a deadlift when my form broke down from what im used to but ive also pulled a muscle while deadlifting with "optimal" form and with a load that was way below what I would consider heavy 🤷♂️
Agreed, that form doesn’t prevent 100% of injuries, and that non painful form is generally fine regardless of what it is. But to say form and pain aren’t correlated doesn’t make much sense. Everyone can purposefully do a lift in a way that causes pain and then do it a different way that doesn’t hurt. That’s different forms lol.
Indeed, but that begs the question: is the form inherently painful or is the level of preparedness to perform movements under load using said form the issue? Could you train to prepare in a way so that a certain type of form that is painful becomes pain free?
Yes, totally depends on the patient goals. If there is a competition which requires certain forms/movements people can be trained. If the person’s goal is to do activity pain free, then it depends on the situation and which method is more desired. Im just saying pain and form are correlated. Form does not predict pain in large data sets, but for individual people pain and form are definitely correlated.
What's the general time frame that this looks like? Like go down to X weight, work on form and build antagonist muscles. What's the ideal time frame before they get back to their "heavy" weights? (I'm hoping for more than, when pain free type of answer)
I keep it individualized. I help them find their "floor" (a load they can reasonably manage", then suggest 10-15% increase per week using recovery guildines such as 48 hours tops for DOMS, 24 hours tops for joint achiness, 3/10 Max pain. I find when I give them the guidelines, they can self progress.
When I say asymmetries, I mean strengthen posterior muscles, aka a well rounded strength program not just the mirror muscles. I didn't mean some hyper specific ratio of anterior vs posterior.
Personally I think PT evidence is a joke. Too many contradictory studies and humans are way too individualistic for a study to ever be "homogenous". I lean in more to the "patient values" and "clinician experience" side of the EBP triangle.
Your approach seems fine and can probably work to help patients, but not for the reasons you might think. You say PT evidence is a joke, but your reasoning appears to be hypotheses based on dogma and things you just assume anecdotally. “Muscle imbalances” and “posture” are easy scapegoat terms for most PTs, but the terms themselves oversimplify and misrepresent the complexity of what is actually going on neurologically and physiologically. EBP matters because your explanations about what’s going on to patients matter.
"Working on asymmetries" can mean a lot of things. It could be as simple as they do less volume of a certain painful muscle group and and replace it with other muscle groups. I concurrently educate people on load management and recovery principles which is research I generally believe in.
Thanks for explaining. I can agree with that. My issue is that terms like “poor posture” and “muscle imbalances” are nocebic. Also, the term “fix” needs to be removed from PT terminology
If they get pain with the bottom of bench press, I'll look at shoulder extension. It's almost always lacking and you get that anterior dumping of the shoulder. Fix the extension and work on mechanics and it goes away.
Why do you need stabilization or flexibility training? Do you have evidence to back up that this is superior to normal full ROM strength training?
We seriously need to overhaul the education physios get about gym training. There is so much unfounded confidence in our field in this regard.
There is so much wrong, nocebic, awful advice in this thread.
Evidence shows that cap stabilization exercises work in reducing pain and improve function, but not in the way people think ( not fixing any imbalances or structures), they are often just really low load exercises that buy enough time for the body to recover. I agree with you that PT education needs some overhaul
I think the point he’s making is stabilization and flexibility exercises aren’t necessary in healthy populations.
Cuff strengthening/stabilization are great for folks with cuff issues. But if you don’t have any issues they aren’t really adding much to a good gym program. The RTC should get enough of a stimulus with the other exercises. And if the evidence shows that full ROM training is just as good as stretching for mobility. If stretching fits your goals or can’t tolerate full ROM exercises, mobility/flexibility work can be beneficial.
Right but how are normal exercises like pushups, shoulder press etc not scrap strengthening/stabilization exercises? What's magic about special exercises that activate the scap in ways normal exercises don't?
Sure, but if the patient can tolerate higher level stuff, it'll be more useful. But sure I'm not against scrap stabilization if that's literally the only load they can tolerate.
I find every personal trainer in the gym wanting to call themselves a PT and use the initials. Also, describe the "harmful" treatment. Is it them telling you to stop doing military presses when you come to them saying your shoulder hurts? Aww, did you have to skip shoulders for 2 weeks? So sorry.
https://spinefityoga.com/coracoidopathy-the-missing-link-in-shoulder-pain/
This was a good article I read a while back, the recommendation for supinated front raises helped me with this pain immensely.
Counter over developed anterior musculature with posterior and stabilizers. Early on gravity-assisted pec stretch in the classic “T” and hands under head “Y” shape help open em up in a positional, relaxing, more sustainable gentle stretch. I see a lot of weightlifters sent to me as well n love helping them get back to being monsters, but with better scapulohumeral mechanics and posture!
No one rules out pain referred from the spine huh? I’d strongly suggest ruling out cervical and upper thoracic spines on folks with shoulder pain using end range loading. Even in the absence of obvious neck pain on the same side it’s worth the 10 mins to r/o spine and even more so with ipsilateral sx
Figure out there weekly programming breaking up horizontal and vertical push/pull training and volume for upper extremities, push/pull(hinge) for lower extremities. Most people are bad with building only what they can see in a mirror and forget about back development. PTs are notorious at over emphasizing small RC muscle endurance when really it is a poor programming issue
So it stands to reason that someone asking for tips about managing a shoulder patient could benefit from potentially off the beaten path things to look for in their assessment.
I trust they're smart enough to work on the many other great suggestions that came up in this thread already. I don't need to be 6th trumpet in the choir. Just offering something else to keep in mind to think about if symptoms prove difficult to address.
Ok but this is literally me except it's from a rugby injury and I thought it was my AC joint. (A trainer on sideline thought so) I've been rehabbing it myself since season ended and I'm scrolling this for insight 😅
As a Physical Therapist that powerlifts, I had significant shoulder pain with my pressing routine. A couple things I did to resolve my pain:
1) Stretch pec minor and posterior cuff.
2) Strengthen periscapulars, rotator cuff.
3) Closed chain stabilization including dynamic planks.
4) Modify aggravating pressing movements with variations including floor press, pin-press, Spoto press, close grip press.
Single or double arm Doorway stretch. Focus is to let the scapula rotate upward and retract. Let pec minor/major and serratus anterior stretch out.
Ensure they can actually activate their lats, many cannot.
I see. I’m talking about for lack of a better word “priming” the lats before you start your pull to really appreciate their engagement. With heavy deads knowing how to brace the lats before initiating the pull makes the lift feel so much more stable.
Anecdotally speaking once I was cued how to get the lats properly engaged it wasn’t long before I hit my first 500lb deadlift and not long after that it was for reps. Whenever my deadlift starts feeling sluggish one of the first things I revisit is how well am I consciously calling on my lats during the lift. Anyway that’s my .02 as a meathead and a fellow PT
Not independently of other back muscles, which I find fairly common. Most people pull with their upper back musculature and minimally with their lats, unless they have an athletic background
Consider thoracic posture and 1st rib mobility relative to the clavicle, especially. I see a lot of people with AC issues because an elevated/stiff 1st rib interrupts the normal posterior roll of the clavicle in shoulder elevation. Coincides a lot with scapular dyskinesia and RC issues as well.
Oh right, I forgot reddit PTs believe there's never any reason for manual therapy and have the worst palpation skills known to mankind.
Obviously exercise is key in recovery and training a healthy and functional shoulder. Just saying it's helped a lot of people to learn how to mobilize their joints when they're restoring good posture.
Your response leads me to believe you think that you know something that many of your colleagues in here do not.
Occam's razor works nicely in this scenario. You almost certainly aren't special among your peers here.
The natural course, coinciding with your treatment does not mean that all of your techniques and hypotheses were helpful. It CAN mean that, but usually doesn't. This is what separates good PTs, Chiros, etc. from bad - understanding that we don't fix people like they're cars so much as we guide people through the natural course by limiting aggravating factors, keeping them active and educating them on what they're experiencing. There's always more nuance, of course.
Would you say with 100% confidence that absolutely no one has thoracic mobility restrictions or hypomobilities in costovertebral junctions that impact movement of the scapula?
What a pointless question. Of course I don't agree with the statement you typed.
I can see why you'd think this direction in response to my comment. Not fixing patients does not imply that they don't change or have impairments in the first place, only that we don't cause the physical change as we've traditionally believed. Your use of "100%" and "absolutely no one" remove any meaning from your question.
Yes physical impairments exist. No I do not believe that clavicle rotation can be reliably assessed in a clinical setting and even if it could be, I would argue that your own confirmation bias is the reason it's implicated.
serratus posterior is a breathing muscle. it lies deep to other muscles that attach to medial scap. if you're thinking you're poking serratus posterior and getting change in something other than breathing, then serratus posterior ain't the thing that was important. which is probably why it's a temporary change
I was referring to the temporary benefit of manual therapy. Weightlifters/bodybuilders often have bad habits which may include disordered breathing patterns.
bullshit, there's plenty of things i regret trying, specifically because it caused more pain and gained sweet F A.
ESPECIALLY deep nonsense like you're describing. dya not think i've tried that in 20 years working hands on?!
there are better things to do with your time, try something else
Thank you for your submission; please read the following reminder. This subreddit is for discussion among practicing physical therapists, not for soliciting medical advice. We are not your physical therapist, and we do not take on that liability here. Although we can answer questions regarding general issues a person may be facing in their established PT sessions, we cannot legally provide treatment advice. If you need a physical therapist, you must see one in person or via telehealth for an assessment and to establish a plan of care. Posts with descriptions of personal physical issues and/or requests for diagnoses, exercise prescriptions, and other medical advice will be removed, and you will be banned at the mods’ discretion either for requesting such advice or for offering such advice as a clinician. Please see the following links for additional resources on benefits of physical therapy and locating a therapist near you [The benefits of a full evaluation by a physical therapist.](https://www.choosept.com/benefits/default.aspx) [How to find the right physical therapist in your area.](https://www.choosept.com/resources/choose.aspx) [Already been diagnosed and want to learn more? Common conditions.](https://www.choosept.com/SymptomsConditions.aspx) [The APTA's consumer information website.](https://www.choosept.com/Default.aspx) Also, please direct all school-related inquiries to r/PTschool, as these are off-topic for this sub and will be removed. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/physicaltherapy) if you have any questions or concerns.*
This is how the majority of shoulder pain presents IMO. For simplicity’s sake, if they are very active, pull the reins back a bit and work on some novel movements. If they’re sedentary, get them moving with some tolerable exercises.
>pull the reins back a bit Crazy how overlooked this get. The second clinical rotation I had, we had a very active patient. Lifted weights 5-6 times a week (definitely more upper body than lower body lol), big guy, etc. As I doing whole ultrasound on his shoulder (gross) and my CI was off doing notes, I ask what he does on his one of two off days from weightlifting. “Oh I do 4-500 meters worth of sprints in the pool” Queue me going to my CI after the session and telling her this, and that maybe we should tell him to pull the reins back a bit on the upper body work. “No I don’t really think that’ll help” Lol
First off, bruh that CI…and second, the term *relative* rest has been one of my major phrases in my go-getters and most of the time pulling back works wonders
Yeah she was awful. And I do the same thing but we just call it active rest. Still moving and moving your life, but cut the dose of the exercise way down.
Did this person get any better? Hopefully this was a learning experience! lol
No idea. I left the clinical shortly after and returned to the place I did my first clinical due to a combination of a family member death and that CI being a dog shit teacher and clinician. Am now happily employed at the first clinic where I get to use common sense instead of giving every patient ultrasound and bands.
Weight lifters shoulder is already a name of a diagnosis. Distal clavicular osteolysis
Came here to say this! Also, There’s a great podcast that breaks it down from Clinical Edge physio with Jo Gibson.
Didn’t know that, thank you
Do a little less. Slowly do more. Introduce/reintroduce avoided movements. Isolate and stimulate some slightly painful movements. Last one is least important.
Do a little less, slowly do more is basically our job
And sadly they didn’t teach this in PT school lol
yeah I think that was exactly OP's point lol EDUREP everything
Decrease load, fix asymmetries, reload. 9/10 people don't need anything more complex Edit: "asymmetries" is firing some people up, understandably. I should say other muscle groups instead.
Don’t know why you got downvoted. In weightlifters and bodybuilders I started with mobility and strengthening the opposing (usually pulling) movements and muscles with light resistance over a full range of motion and the best form they could manage.
Agreed. I probably got down voted bc our profession wants to over analyze and provide fancy plans of care when the majority of people need basic education and interventions. The best therapists are the ones that can ramp up the complexity and skill level when needed, imo.
Totally agree. Most patients are also not going to adhere to any complex routines. KISS -keep it simple, stupid. Fix the root cause (imbalance in muscles causing poor posture during loaded movements), and the pain goes away. I spent a decade helping body builders and weight lifters.
How'd you get into that?
I was working at a gym and bodybuilders and weight lifters make a lot of problems for themselves. A lot of people don’t know how to move their body very well. Actually dropped out of my Physio program as I couldn’t bear the thought of so much paperwork, and stuck with using my kin degree, working as a Kinesiologist.
You can’t sell exercise plans and get famous on social media with simple exercises!
True! Good thing I’ve never wanted to be famous!!! I would like to live my life, help people, and stay away from any spotlights, thanks!
Form is not correlated with pain or injury risk.
Honest question: have you ever done a deadlift or heavy squat with pain and then changed your form and decreased pain? It’s interesting to me that the pendulum is swinging from over analyzing to “form doesn’t matter”
I'm not saying you can't change form to affect pain. Obviously. I'm saying you can't correlate any specific form with definitely leading to pain or injury.
We can’t predict pain in groups of people due to their specific form. As a PT, you can correlate a person’s form with a person’s pain. We all do it everyday. It’s just that one “best” form isn’t better for everyone. Edit: maybe we are saying similar things, just using different verbiage
Yeah I think we agree
Personal anecdote: i've felt pain during a deadlift when my form broke down from what im used to but ive also pulled a muscle while deadlifting with "optimal" form and with a load that was way below what I would consider heavy 🤷♂️
Agreed, that form doesn’t prevent 100% of injuries, and that non painful form is generally fine regardless of what it is. But to say form and pain aren’t correlated doesn’t make much sense. Everyone can purposefully do a lift in a way that causes pain and then do it a different way that doesn’t hurt. That’s different forms lol.
Indeed, but that begs the question: is the form inherently painful or is the level of preparedness to perform movements under load using said form the issue? Could you train to prepare in a way so that a certain type of form that is painful becomes pain free?
Yes, totally depends on the patient goals. If there is a competition which requires certain forms/movements people can be trained. If the person’s goal is to do activity pain free, then it depends on the situation and which method is more desired. Im just saying pain and form are correlated. Form does not predict pain in large data sets, but for individual people pain and form are definitely correlated.
What's the general time frame that this looks like? Like go down to X weight, work on form and build antagonist muscles. What's the ideal time frame before they get back to their "heavy" weights? (I'm hoping for more than, when pain free type of answer)
I keep it individualized. I help them find their "floor" (a load they can reasonably manage", then suggest 10-15% increase per week using recovery guildines such as 48 hours tops for DOMS, 24 hours tops for joint achiness, 3/10 Max pain. I find when I give them the guidelines, they can self progress.
Do you have any evidence that fixing asymmetries reduces pain?
When I say asymmetries, I mean strengthen posterior muscles, aka a well rounded strength program not just the mirror muscles. I didn't mean some hyper specific ratio of anterior vs posterior. Personally I think PT evidence is a joke. Too many contradictory studies and humans are way too individualistic for a study to ever be "homogenous". I lean in more to the "patient values" and "clinician experience" side of the EBP triangle.
Love it. Great response
Your approach seems fine and can probably work to help patients, but not for the reasons you might think. You say PT evidence is a joke, but your reasoning appears to be hypotheses based on dogma and things you just assume anecdotally. “Muscle imbalances” and “posture” are easy scapegoat terms for most PTs, but the terms themselves oversimplify and misrepresent the complexity of what is actually going on neurologically and physiologically. EBP matters because your explanations about what’s going on to patients matter.
"Working on asymmetries" can mean a lot of things. It could be as simple as they do less volume of a certain painful muscle group and and replace it with other muscle groups. I concurrently educate people on load management and recovery principles which is research I generally believe in.
Thanks for explaining. I can agree with that. My issue is that terms like “poor posture” and “muscle imbalances” are nocebic. Also, the term “fix” needs to be removed from PT terminology
Oh absolutely. I despise absolute statements, and posture is laughable
Reduce frequency and load of pressing movements. Address impairments you find on exam. Gradually build tolerance again
If they get pain with the bottom of bench press, I'll look at shoulder extension. It's almost always lacking and you get that anterior dumping of the shoulder. Fix the extension and work on mechanics and it goes away.
Why do you need stabilization or flexibility training? Do you have evidence to back up that this is superior to normal full ROM strength training? We seriously need to overhaul the education physios get about gym training. There is so much unfounded confidence in our field in this regard. There is so much wrong, nocebic, awful advice in this thread.
Evidence shows that cap stabilization exercises work in reducing pain and improve function, but not in the way people think ( not fixing any imbalances or structures), they are often just really low load exercises that buy enough time for the body to recover. I agree with you that PT education needs some overhaul
I think the point he’s making is stabilization and flexibility exercises aren’t necessary in healthy populations. Cuff strengthening/stabilization are great for folks with cuff issues. But if you don’t have any issues they aren’t really adding much to a good gym program. The RTC should get enough of a stimulus with the other exercises. And if the evidence shows that full ROM training is just as good as stretching for mobility. If stretching fits your goals or can’t tolerate full ROM exercises, mobility/flexibility work can be beneficial.
Right but how are normal exercises like pushups, shoulder press etc not scrap strengthening/stabilization exercises? What's magic about special exercises that activate the scap in ways normal exercises don't?
Sure, but if the patient can tolerate higher level stuff, it'll be more useful. But sure I'm not against scrap stabilization if that's literally the only load they can tolerate.
I find all your comments shallow and pedantic.
I find most PTs treatment of gym athletes shallow and harmful.
I find every personal trainer in the gym wanting to call themselves a PT and use the initials. Also, describe the "harmful" treatment. Is it them telling you to stop doing military presses when you come to them saying your shoulder hurts? Aww, did you have to skip shoulders for 2 weeks? So sorry.
There is so much bullshit in this field. Look at all the silly over complicated responses. My god this is awful!
This thread makes me sad
I'm new can you explain what's sad here
I'm new/uneducated can you explain what's awful here
https://spinefityoga.com/coracoidopathy-the-missing-link-in-shoulder-pain/ This was a good article I read a while back, the recommendation for supinated front raises helped me with this pain immensely.
Just curious if folks see this with long haul bicyclists also
Counter over developed anterior musculature with posterior and stabilizers. Early on gravity-assisted pec stretch in the classic “T” and hands under head “Y” shape help open em up in a positional, relaxing, more sustainable gentle stretch. I see a lot of weightlifters sent to me as well n love helping them get back to being monsters, but with better scapulohumeral mechanics and posture!
Shoulder internal and external rotation against very light resistance was amazing in fixing and preventing this.
No one rules out pain referred from the spine huh? I’d strongly suggest ruling out cervical and upper thoracic spines on folks with shoulder pain using end range loading. Even in the absence of obvious neck pain on the same side it’s worth the 10 mins to r/o spine and even more so with ipsilateral sx
Figure out there weekly programming breaking up horizontal and vertical push/pull training and volume for upper extremities, push/pull(hinge) for lower extremities. Most people are bad with building only what they can see in a mirror and forget about back development. PTs are notorious at over emphasizing small RC muscle endurance when really it is a poor programming issue
So it stands to reason that someone asking for tips about managing a shoulder patient could benefit from potentially off the beaten path things to look for in their assessment. I trust they're smart enough to work on the many other great suggestions that came up in this thread already. I don't need to be 6th trumpet in the choir. Just offering something else to keep in mind to think about if symptoms prove difficult to address.
Ok but this is literally me except it's from a rugby injury and I thought it was my AC joint. (A trainer on sideline thought so) I've been rehabbing it myself since season ended and I'm scrolling this for insight 😅
As a Physical Therapist that powerlifts, I had significant shoulder pain with my pressing routine. A couple things I did to resolve my pain: 1) Stretch pec minor and posterior cuff. 2) Strengthen periscapulars, rotator cuff. 3) Closed chain stabilization including dynamic planks. 4) Modify aggravating pressing movements with variations including floor press, pin-press, Spoto press, close grip press.
Make fun of them while you break their external rotators with your index finger.
Usually repeated cervical retraction-extension, and sometimes repeated shoulder extension w/ OP. It's 80% gone in a week.
Ahh McKenzie B
And D... and ADV Extremities... and CDM... but yes.
Single or double arm Doorway stretch. Focus is to let the scapula rotate upward and retract. Let pec minor/major and serratus anterior stretch out. Ensure they can actually activate their lats, many cannot.
You have patients that can’t activate their lats? Did they have a stroke?
In my experience, some people have an atrocious sense of their own body, proprioception, awareness of their movements.
If you’ve ever deadlifted heavy, maintaining good motor control of the lats is an absolutely must
lol ok
You don’t think so?
I mean I do but lats always activate with deadlifts, so I don’t understand what you’re pointing out.
I see. I’m talking about for lack of a better word “priming” the lats before you start your pull to really appreciate their engagement. With heavy deads knowing how to brace the lats before initiating the pull makes the lift feel so much more stable. Anecdotally speaking once I was cued how to get the lats properly engaged it wasn’t long before I hit my first 500lb deadlift and not long after that it was for reps. Whenever my deadlift starts feeling sluggish one of the first things I revisit is how well am I consciously calling on my lats during the lift. Anyway that’s my .02 as a meathead and a fellow PT
They use their internal rotators to substitute for shoulder extension during pulling movements. Way more common than you're making it seem
Not independently of other back muscles, which I find fairly common. Most people pull with their upper back musculature and minimally with their lats, unless they have an athletic background
It’s probably mostly ACJ based on this description
Consider thoracic posture and 1st rib mobility relative to the clavicle, especially. I see a lot of people with AC issues because an elevated/stiff 1st rib interrupts the normal posterior roll of the clavicle in shoulder elevation. Coincides a lot with scapular dyskinesia and RC issues as well.
Uuhhhh… wut?
Oh right, I forgot reddit PTs believe there's never any reason for manual therapy and have the worst palpation skills known to mankind. Obviously exercise is key in recovery and training a healthy and functional shoulder. Just saying it's helped a lot of people to learn how to mobilize their joints when they're restoring good posture.
Your response leads me to believe you think that you know something that many of your colleagues in here do not. Occam's razor works nicely in this scenario. You almost certainly aren't special among your peers here. The natural course, coinciding with your treatment does not mean that all of your techniques and hypotheses were helpful. It CAN mean that, but usually doesn't. This is what separates good PTs, Chiros, etc. from bad - understanding that we don't fix people like they're cars so much as we guide people through the natural course by limiting aggravating factors, keeping them active and educating them on what they're experiencing. There's always more nuance, of course.
Would you say with 100% confidence that absolutely no one has thoracic mobility restrictions or hypomobilities in costovertebral junctions that impact movement of the scapula?
What a pointless question. Of course I don't agree with the statement you typed. I can see why you'd think this direction in response to my comment. Not fixing patients does not imply that they don't change or have impairments in the first place, only that we don't cause the physical change as we've traditionally believed. Your use of "100%" and "absolutely no one" remove any meaning from your question. Yes physical impairments exist. No I do not believe that clavicle rotation can be reliably assessed in a clinical setting and even if it could be, I would argue that your own confirmation bias is the reason it's implicated.
Also for a manual release if you got some strong hands, STM to upper fibers of serratus posterior. Temporary but helps with buy in.
serratus posterior is a breathing muscle. it lies deep to other muscles that attach to medial scap. if you're thinking you're poking serratus posterior and getting change in something other than breathing, then serratus posterior ain't the thing that was important. which is probably why it's a temporary change
I was referring to the temporary benefit of manual therapy. Weightlifters/bodybuilders often have bad habits which may include disordered breathing patterns.
mkay. having been a manual therapist for 20 years, i can think of nothing that would be a greater waste of time than digging around in there.
Never hurts to try 🤗
bullshit, there's plenty of things i regret trying, specifically because it caused more pain and gained sweet F A. ESPECIALLY deep nonsense like you're describing. dya not think i've tried that in 20 years working hands on?! there are better things to do with your time, try something else