Anyone here gone to a physical therapist for shoulder pain? Can they discover the problem without an X-ray?

thups

New member
I have a minor shoulder issue that does not seem very serious, but it affects my workouts and I can feel some slight pain every now and then. I really just want to not make things worse.

Once the corona virus things subside (hopefully) then i hope to go to a physical therapist or some type of specialist to find out what is going on.

Anyone know if these specialists able to figure out what is going on by moving your shoulder and doing other tests without having to do xrays and mris and all that?
 
@thups Just to give my personal experience, unless there has been an acute injury with obvious loss of strength/mobility, it has been difficult to figure out exactly what is wrong.

I had pretty severe pain in one shoulder at the end of my range of motion, was physically examined, and had x-rays, contrast MRI, and CT scan. Nothing conclusive shown. Dr. said he'd have to do exploratory surgery to figure out what was wrong. I opted for PT instead, and felt better in six months (not sure if it was the PT, or just the healing process). Dr. thought there was a partially torn or frayed labrum, but again, MRI didn't show this.

As I've gotten older, I just have to figure out the best exercises that I can do pain free, and not feel like I "have" to do a particular exercise. Try and find substitutes. I try to avoid pressing exercises where my arms are internally rotated, and where the shoulder joint might receive excessive amounts of stress. Also, i've found that my shoulders get more tweaks and pain when I don't work out- regular exercise helps avoid aches and pains.
 
@jjenniem To add to this, I was having a lot of upper back and shoulder problems towards the end of 2018. Had an MRI done and same deal, it showed nothing. Started up with a personal trainer early last year to try and sort out my form. I learned a few warmup and mobility exercises that over time have help my shoulder to hurt less and make things like shoulder presses more tolerable when I do them. I use a resistance band for those and it helps my range of motion and keeps both sides more even (I'm very right hand dominant and it can throw off my lifts). Keeping two dedicated "active rest" days has also helped (i.e. just warm up and stretch for the day or do a light yoga class).
 
@jjenniem Curious what you do to train chest? I’m in a similar boat and find I can’t do the press exercises without aggravating my shoulder.
 
@minda First thing I do are some exercises to stabilize the scapula that I learned in PT, small arm circles both ways to warm up rotator cuffs, and some stretches that loosen up my lats.

Then, if I do flat bb bench press, I focus on form: take a shoulder distance grip (wrists right under shoulder), elbows at 45 degree angle, and try to bend bar in a "U" shape when pushing (try to end of bb to your toes), this will externally rotate shoulder. Also, keep shoulders down and retracted, and dont let bar drift over your neck/face. When I do this, I'm usually ok.

Other substitutes are db bench (same principles as above, but your shoulders can move into more external rotation) push ups, weighted pushups.
 
@minda I use a football bar that has angled handles. It helps my shoulder a lot compared to a straight barbell. I also mix in pushups, which don't seem to stress my shoulder that much. I also incorporate dips and cable crossovers (with bands).
 
@jjenniem Exact same story for me, except I did the exploritory surgery. They pulled out some arthritis and filed down a small bone spur.

After 3 months of PT to regain mobility, I was pain free.... for 1 month. Then I started to feel the same pain as before, but very minor like back when I first noticed it. I know that if I keep pushing it the pain will return.

Unfortunately I had to stop lifting weights completely. I run now for exercise. It sucks, but that's life.
 
@thups Yes, a physical therapist will be able to evaluate your shoulder and help to determine if you have any physical issues, and if you need to seek imaging. They should also be able to identify any impairments and help you recover from them.
 
@soulsavingangel333 My PT was able to pin point exactly where to stretch to in order to stop my shoulder pain as a result of my cervical disc bulge. Turns out my quads were tight which had a chain reaction effect all the way up to my neck. Amazing how the body works.
 
@thups I've found physical therapists are sometimes great at this, and sometimes terrible. It seemed so hit and miss to me for a long time, but now I'd suggest looking at the existing function of each aspect of the shoulder, and understanding whats working and whats not. And thats something you can do on your own.

If there is some aspect of joint function that is absent from what is expected, I've had a lot of benefit from restoring that specifically - and then seeing problems become less and less and eventually go away as the different pieces start to do more of whats expected from each. And if any function isn't what it should be, I'd suggest improving that before trying to focus on any particular diagnosis or problem.

Assuming you can do these through a pain free range of motion, here are a few ideas to explore your shoulder. First, what is the range of active control in internal/external rotation:

If those display less range that expected, improving that would be a good 1st priority, as the rotational aspects need to be working as the first prerequisite - and the other types of shoulder movement will always be limited if the rotation is not what it should be.

If that seems to be working as intended, you can start to explore the other aspects of shoulder motion by learning a shoulder CAR = controlled articular rotation. Here's some info on that:

And a version narrating a bit more detail:

Because the shoulder and scapula work together so much, it can also be good to consider looking into how much disassociation you may have between the two - using scapular CARs:

The idea with CARs would be to do a few minutes daily, gently exploring the motion - not only can they help directly improve the health of the joint, they are a self-assessment tool to help you understand where you have joint function thats good, and where any specific aspect is coming up short.

If you're interested in this approach of identifying and improving whatever may be your weak links in terms of joint function, consider looking at /r/Kinstretch where they teach these things in a class setting. I'm also happy to help you identify what parts may/may not be working as they should, and making a plan to make specific improvements in those particular aspects of your movement. While there are generally no quick fixes for this stuff, you can definitely adapt your body back into the function it should have, and when everything is working nicer, its much less likely to have problems.

(One last note - while you are describing a problem in your shoulder, depending on when you feel the problem, there could be another joint not pulling its weight. For example, if your wrist had limitations in movement, during a bench press that could cause the shoulder to compensate by being asked to do too much. So it can be worthwhile to understand whats going on in the neighborhood as well - to try and determine if the shoulder is working ok but overloaded because of a problem elsewhere - or if the shoulder is not working ok on its own merits.)
 
@thups Hey there! I have been a PT patient, and I also work with people trying to get on top of their mobility as a trainer.

It's wise to get on top of little tweaks/twangs before they get worse. Once something gets to the point where it HURTS, it needs additional work to bring it back from the pain before addressing the underlying sub-optimal mechanics that caused it in the first place.

In the meantime, pay attention to form! Take video of yourself, ask for form checks in the fitness subs here.

Yes, PT's can figure out what's wrong by moving you around, asking you to move around, asking you to NOT move when they're pushing on you, and just watching you move. Probably don't need any special imaging.

You will make things worse if you push through pain. That's why pain is there-- to tell you to back off. Trust it!
 
@thups Yes, absolutely. A physio should be able to diagnose based on range of motion and location of pain. I went from a nearly frozen shoulder back to near-normal range of motion with a few weeks of physio (ultrasound and massage) and exercises at home.
 
@thups I had a shoulder issue which started as tightness and progressed into pretty severe discomfort and limited mobility. I started with massage therapist who promptly told me to see a doctor. Had an xray which showed no structural damage but had swelling in the joint which was causing my shoulder to almost pop out of socket, said the next step was a series of 3 cortisone shots and if that didn't work, exploratory surgery. After the 2nd shot, been pain free and it's been maybe 6-7 years.
 
@thups I have never had good luck going to physio for diagnostic work. It is required by my insurance before they will pay for MRI or other diagnosis by specialist after being seen by my GP.

You may have to see one, and they might get lucky, but in my experience they are exponentially more effective if they are working from a diagnosis rather than arriving at one on their own.
 
@renatusfueritexaqua I've been to 3 over the last 15 years. I got lucky with my third, haven't actually had to ask a doctor about anything since, dude is a magician that has a surgeon's understanding of anatomy. When I need his help it's usually b/c I've fucked up an obscure muscle or nerve somewhere deep under things that I haven't been able to figure out on my own. Unsurprisingly shoulder/lower back/hip are common places for that sort of thing (for me, subscapularis and piriformis are likely candidates for shoulder/back respectively).
 
@thups I went to a physical therapist and they were able to identify a SLAP tear (bicep attachment got tore inside the shoulder socket) just with physical manipulation. It took them quite a while and I was concerned after several minutes they weren't going to find anything, but once they hit the spot, oh boy, I yelped. I knew exactly how I injured it, so that may have helped them diagnose it. I did "fix" it (i.e. doesn't hurt anymore), but not by conventional means. I tried Crossover Symmetry and that actually made me re-injure it. DM me if you want to know what I did.
 
@thups Probably, depending on the issue and the medical professional. And if they want to do an MRI for minor shoulder pain without even trying physical therapy first, leave. X-ray isn't too unreasonable but possibly unnecessary. And in the meantime, you could try doing some physical therapy exercises on your own. A few rotator cuff exercises with a resistance band can help with various minor shoulder issues.
 
@dawn16 Yeah the rotator cuff term scares me for sure. Does not seem like i have it but there’s a possibility. Wondering if it can be fixed without surgery if it’s minor
 
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