[bigironhorse]

I've had problems with my left shoulder for as long as I can remember. I've taken months off trying hard to try and let it completely heal and whilst it gets a lot better (barely noticeable) once in a while it get pretty painful to move arm above shoulder height. Pretty sure its rotator cuff tendonitis but could also be bursitis. Anyone have any ideas on why it keeps coming back/ have similar problems? Going to physio on wednesday so should know a bit more then.

[Boredboy]

Type 1 SLAP lesions are a common cause of chronic recurrent shoulder pain in overhead athletes. Quite hard to pick up on even by the most experienced Physio, but it could be the rotator cuff / long head of biceps or bursitis. Also there could be some movement dysfunction present like poor scapulohumeral control or poor thoracic spine mobility leading to impingement when you're climbing. Here's one of the best uk websites for shoulder info:


http://www.shoulderdoc.co.uk/article.asp?section=15

[bigironhorse]

Cheers, I'll have a look at that. It doesn't tend to hurt while climbing, it hurts for a few days afterwards when it does hurt.

[fatdoc]

NICE guidelines and experience opinion.. Usual Internet consultations ts and cs apply :


Go for steroid injections and expert physio before surgery.

[shurt]

Go for steroid injections and expert physio before surgery.

Personally I'd be wary of steroid injections. I had them for a rotator cuff injury and if anything it made it worse. After seeing a lot of people I had really good success with an osteopath rather than a physio. Try and work out specifically whats causing the pain if you can, its a good place to start.

[bigironhorse]

Try and work out specifically whats causing the pain if you can, its a good place to start.

Yeah I'm hoping the physio will be able to tell me exactly what's going on. They've been pretty vague in the past though, usually mention tendonitis, bursitis and build up of bony spurs on the acromium.

Cheers

[SA Chris]

Are you doing any stabilising exercises with theraband etc?

[bigironhorse]

Not at the moment as it only became painful again the other day, just taking ibruprophen so far. I usually warm up my shoulders with theraband/stretching before I climb though.. Have done other exercises using light dumbbells to work it out in the past, will wait to see what the physio says before I start up anything like that though.

[Lund]

Go for steroid injections and expert physio before surgery.

Personally I'd be wary of steroid injections. I had them for a rotator cuff injury and if anything it made it worse. After seeing a lot of people I had really good success with an osteopath rather than a physio. Try and work out specifically whats causing the pain if you can, its a good place to start.

Osteopathy?  Mostly quackery, like all complementary and alternative medicines.  Steer well clear.  Listen to fatdoc, he is after all, a doctor.

The only other thing I'd add is that you need to be doing the shoulder exercises religiously if you've a history of shoulder pain, not just as a recovery plan.  It's a pain in the backside, but you can't get away with not doing them or it'll just recur.

At the risk of injecting yet more anecdotal evidence, I have acquaintances who've had good outcomes with surgery.

[SA Chris]

The only other thing I'd add is that you need to be doing the shoulder exercises religiously if you've a history of shoulder pain, not just as a recovery plan.  It's a pain in the backside, but you can't get away with not doing them or it'll just recur.

+1. I've history of shoulder injuries and I don't do them as often as I should, but still do them once or twice a week. Prevention is better than cure and all that.

[bigironhorse]

Thanks everyone, I definitely need to be a bit more disciplined with the shoulder exercises in future, hopefully it won't get to a stage where I need surgery anytime soon! Will let you know if the physio highlights anything interesting.

[stupot]

Hi,

I too suffer from long term shoulder issues. I have recently started climbing again after a long lay off (not due to my shoulders) . I have previously had rotator cuff issues years ago and had injections which didn't seem to help.
my recent shoulder problem is related to oa in my ac joint causing impingement of my rotator cuff again. Luckily there was no tear in the rotator cuff, just ac joint capsular enlargement. I had injections 2 months ago into my shoulder and they seemed to have worked. They were done under X ray guidance and initially was due to just have one in my ac joint but the consultant decided after chatting on the day of inj to give me a sub scapula inj as well. Think this fact that they were done under xray guidance ensures they are put in the correct place...ultrasound guidance even better but my hospital wouldn't do that?
Good luck.

[bigironhorse]

oa in my ac joint

Cheers for that, is that oa for osteoarthritis?

[stupot]

Yep, oa osteoarthritis. Early start of it at 39!!

Have found though that sleeping on my right shoulder is worse for it than the climbing!

if your shoulder needs some diagnostics on it try to get ultrasound done; but depends on MSK ultrasound availability at your hospital. Too many shoulders are referred straight to MRI which is also good but the ultrasound can be done dynamically and should be first line investigation before MRI if available. Prob end with xray first mind you.

Cheers

[duncan]

Does 35 years count as long-term? First episode at an age when most people are indestructible which should have been a clue to what would happen later. I’ve had regular problems since 1998. I spent most of the 00s bumbling along at F6b / HVS with half the year out due to shoulder issues. In the last 3-4 years I’ve got better idea about what to do about it, I’m now climbing at a more respectable F7a / E3-4 and getting better.

I've had cortisone injections three or four times, not helpful, and surgery to "tidy up" a SLAP lesion from a world-famous shoulder specialist, doubtful help. I’ve seen at least 5 different physiotherapists, two very helpful, the others less so. The famous one I paid most to see was not very helpful. The most useful ones were the most recently seen so it is possible that knowledge and standards are increasing. I have a professional interest in such things which has been both a help and a hinderance. 

Obtaining a precise diagnosis from medical practitioners has been surprisingly unhelpful, learning prevention and self-management ideas has been the key to dealing with it in the long term.

I have a range of strategies to deal with my shoulder now.  I don’t consider it as either fixed or injured but as having a likelihood to suffer tweaks which can minimised. I've got a better idea on what aggravates the problem in the first place (pulling down with the arm nearly fully extended, particularly high gastons), exacerbated by my climbing style (very static, I should slap more; I fight my way up routes and should rest or give up more often). I have more idea about the personal and lifestyle issues that predispose me to injury (work stress, a tendency to perform rather than train). I have a range of exercises which I need to do daily. The alternative is reverting to not climbing harder than HVS again.

I still get tweaks but they are less frequent and less severe. I’m also lot more aggressive in my rehab. so I have much less down-time. I usually start exercising two or three days after a tweak rather than waiting weeks or months for everything to settle. It has taken some time to get this right.

Regarding specific exercises, I do a range of scapular stabiliser and rotator cuff style exercises. Most physios. will prescribe these and I have tried variations on them for decades but there have been two key changes that have helped me climb and train harder in the last 3-4 years.

The first one was focusing much more on the scapula stabilisers. I do lots of side and front planks and dynamic versions of these exercises: side-to-side push-ups, single-arm push-up, push-up into side-plank. These need to be done with excellent form. I think you need someone who knows what they are doing to teach you and correct any movement faults. If I was younger and stronger I would do handstands and handstand push-ups. I’m not, so I do supported hand-stand push-ups http://manbicep.files.wordpress.com/2013/06/handstand.png  or push-ups in a ‘downward dog’ position.

These latter two exercises also apply the second key change which was making exercises much more specific to the aggravating position and movement. The classical theraband rotator cuff exercises with the elbow on the hip are ineffective for me. Arm by the side is nowhere near the difficult position for my shoulder and rotator cuff muscles don’t rotate the shoulder, they stabilise it. I now do lots of overhead work - close to or in the aggravating position - using the theraband to do resisted ‘gaston’ type movements. I do military presses with dumbells, with lots of variations in shoulder position. I do some scapular stability exercises with my arm high in the air.

None of this is a recipe. It’s meant to be an illustration of how I have attempted to analyse my own problems and address them. I’m still trying to learn about why things go wrong - and why they don’t. You have to become an expert in your own management - your background training and climbing style, other lifestyle issues, and your exercise regime - the ‘self-physio’ed climber’.

[bigironhorse]

Cheers Duncan, I guess I'll just have to try and find out what works best for me by trial and error and work harder on preventative exercises. Think I'll be giving the unassisted handstand pushups a miss for now though

[Sloper]

NICE guidelines and experience opinion.. Usual Internet consultations ts and cs apply :


Go for steroid injections and expert physio before surgery.

I agree, from a personal perspective both shoulders are more than a bit iffyand the steriod injections have greatly aided in recovery, suregry carries with it a well recognised risk of 'frozen shoulder' and other things you'd want to avoid.

If it's a long term / chronic problem avoid 'alternative' practitioners, after all would you take your car to an alternative mechanic?

In respect of climbing, the best answer is smooth, controlled and stylish, if you're gurning or grunting the chances of injury will increase massively.  Better to bumble & bimble than not to climb at all.

[shurt]

Go for steroid injections and expert physio before surgery.

Personally I'd be wary of steroid injections. I had them for a rotator cuff injury and if anything it made it worse. After seeing a lot of people I had really good success with an osteopath rather than a physio. Try and work out specifically whats causing the pain if you can, its a good place to start.

Osteopathy?  Mostly quackery, like all complementary and alternative medicines.  Steer well clear.  Listen to fatdoc, he is after all, a doctor.

At the risk of injecting yet more anecdotal evidence, I have acquaintances who've had good outcomes with surgery.

So the only opinion that anyone should take any notice of is a doctor?
I thought the idea of the tread was asking people about their experiences of shoulder injuries?
I have learned to manage my shoulder injury as Duncan mentioned. The only person who offered any help with that was an osteopath (who are available on the NHS btw) I didn't find physios any help including the then GB climbing team physio...

[bigironhorse]

Go for steroid injections and expert physio before surgery.

Personally I'd be wary of steroid injections. I had them for a rotator cuff injury and if anything it made it worse. After seeing a lot of people I had really good success with an osteopath rather than a physio. Try and work out specifically whats causing the pain if you can, its a good place to start.

Osteopathy?  Mostly quackery, like all complementary and alternative medicines.  Steer well clear.  Listen to fatdoc, he is after all, a doctor.

At the risk of injecting yet more anecdotal evidence, I have acquaintances who've had good outcomes with surgery.

So the only opinion that anyone should take any notice of is a doctor?
I thought the idea of the tread was asking people about their experiences of shoulder injuries?
I have learned to manage my shoulder injury as Duncan mentioned. The only person who offered any help with that was an osteopath (who are available on the NHS btw) I didn't find physios any help including the then GB climbing team physio...

Tbh I just started the thread to get an overview of other peoples expiriences and I would happily accept anecdotal advice from  anyone with a similar problem, doctor or not. I wouldn't rule out seeing an osteopath, don't think it could do to much harm.

Ideally I'd like a few expert opinions and an x-ray/scan to find out exactly whats going on.

[Lund]

So the only opinion that anyone should take any notice of is a doctor?

That's not what I said though is it?  I said osteopathy is mostly quackery.

Wikipedia has its flaws, but

The use of osteopathy is not always based on science, and there is limited evidence that osteopathy is effective in treating any medical condition other than lower back pain.[2][3] In the UK, the National Institute for Health and Care Excellence only recommend osteopathy for the treatment of persistent lower back pain. There is no good evidence that osteopathy is effective for non-musculoskeletal conditions and limited evidence that osteopathy is an effective treatment for neck pain, shoulder pain, or limb pain.[3]

That's why it's on the NHS: for lower back pain.  Anything else is, according to current scientific opinion, a waste of money and time.

[shurt]

So the only opinion that anyone should take any notice of is a doctor?

That's not what I said though is it?  I said osteopathy is mostly quackery.

Wikipedia has its flaws, but

The use of osteopathy is not always based on science, and there is limited evidence that osteopathy is effective in treating any medical condition other than lower back pain.[2][3] In the UK, the National Institute for Health and Care Excellence only recommend osteopathy for the treatment of persistent lower back pain. There is no good evidence that osteopathy is effective for non-musculoskeletal conditions and limited evidence that osteopathy is an effective treatment for neck pain, shoulder pain, or limb pain.[3]

That's why it's on the NHS: for lower back pain.  Anything else is, according to current scientific opinion, a waste of money and time.

But I wasn't talking about current scientific opinion, I was talking about my opinion and I found it really helpful.
Life isnt black and white you know. We could segue in to the effectivness of drugs, side effects and the hard selling of medication to doctors if you like? Doctors and medicine have their place (they fixed my hand like a beauty when I slashed through it) but they don't fix everything all the time...

[Lund]

Doctors [...] don't fix everything all the time...

This I think is the problem with so many of our injury problems.

Some things just can't be fixed.  What is wrong with your shoulder, exactly?  It's likely that nobody knows, not exactly.  Even if they do, they don't know how to fix it perfectly.  It's too complicated, too hard, too uncertain.

If it were your car, you wouldn't stand for it. 

What do you mean, you can't fix it?

Imagine experiencing a lack of acceleration in third gear.  You take the car to the garage.  They keep it for two weeks, and then you get it back.  You look inside the bonnet, and they've "fixed" it by taking a part from another car that was in a major accident and ended up on fire.  They've cut directly into the gearbox using a welding torch, pulled some of the gears out, and rammed in gears from the dead car.  Then they've taken some metal from the door, and used it to patch the gearbox closed. 

It still doesn't fix the problem properly.  For the first two months, you've got to drive in first or second gear, and then after that only going into third for limited periods for another two months.  Finally you can use all the gears, but fifth is very dodgy, it crunches every gear, and you have to double de-clutch to go into reverse.  In another couple of years you'll probably have to have the clutch replaced in the same manner as a result.  Forever, every day you've got to put a pound coin into a slot by the steering wheel, or the new cog will somehow cause the entire car to simply stop working.

Unfortunately, that I think is the reality of medicine.  Yes, it's much better than years ago - putting horses blood into a human is known not to work now - but it's not a car.  You can't fix it perfectly, we don't know exactly how it works everywhere, and the option of writing it off when things just can't be fixed isn't a palatable option.

At some point, you just have to realise, like Duncan, that your car is fucked, it's not as good as the new models, but there's no way to trade it in.  You've just got to take care of it.

I guess the problem is that fundamentally the human body isn't designed to dangle from small edges on a 45 degree bit of marine ply four times a week.  Doing so fucks it up, and it can't always be fixed.

If you don't believe any of the above, weight until you're north of 35, and then unless you're lucky, you will then.

[thekettle]

To add a bit of positivity:
Both my shoulders grumbled for 4 years (through rest, exercises, physios etc) before I finally managed to get an MRI on the NHS (through Professor Funk  , the man behind http://www.shoulderdoc.co.uk/ ) with revealed SLAP tears to both.
Three months after two surgeries (aged 32) and I was fully recovered, soon climbing harder than before. Still good to this day, and I'm much more aware of managing my posture and technique (particularly scapular stability) whilst climbing. Be persistent in seeking answers and don't write off your climbing career until you've got to the bottom of the problem.

[Sloper]

Lund, wait until you're over 45 (and I epxect Andy Popp etc to join in the x4 Yorkshiremen routine) but your point about age & mileage is spot on, the older one gets the more damage accumulates and the lest flexible we become.

Shurt, we know homeopathy is available on the NHS and we know that's total bollocks.

In respect of medicien it is an alloy of art and science, but only a fool would ignore the over whelming evidence base on which most of modern practice is based.

There may be a simple mechanical cause for the symtoms, or there may not, I don't know if it's true but I have been told (by surgeons) that some knee arthroscopies are essentially conducted for placebo effects!  The point is if you witha qualified opinion can exclude all obvious and treatable causes of your symptoms, the choice of crystal or lager thereapy doesn't really matter too much.

[petejh]

Doctors [...] don't fix everything all the time...

This I think is the problem with so many of our injury problems.

Some things just can't be fixed.  What is wrong with your shoulder, exactly?  It's likely that nobody knows, not exactly.  Even if they do, they don't know how to fix it perfectly.  It's too complicated, too hard, too uncertain.

If it were your car, you wouldn't stand for it. 

What do you mean, you can't fix it?

Imagine experiencing a lack of acceleration in third gear.  You take the car to the garage.  They keep it for two weeks, and then you get it back.  You look inside the bonnet, and they've "fixed" it by taking a part from another car that was in a major accident and ended up on fire.  They've cut directly into the gearbox using a welding torch, pulled some of the gears out, and rammed in gears from the dead car.  Then they've taken some metal from the door, and used it to patch the gearbox closed. 

It still doesn't fix the problem properly.  For the first two months, you've got to drive in first or second gear, and then after that only going into third for limited periods for another two months.  Finally you can use all the gears, but fifth is very dodgy, it crunches every gear, and you have to double de-clutch to go into reverse.  In another couple of years you'll probably have to have the clutch replaced in the same manner as a result.  Forever, every day you've got to put a pound coin into a slot by the steering wheel, or the new cog will somehow cause the entire car to simply stop working.

Unfortunately, that I think is the reality of medicine.  Yes, it's much better than years ago - putting horses blood into a human is known not to work now - but it's not a car.  You can't fix it perfectly, we don't know exactly how it works everywhere, and the option of writing it off when things just can't be fixed isn't a palatable option.

At some point, you just have to realise, like Duncan, that your car is fucked, it's not as good as the new models, but there's no way to trade it in.  You've just got to take care of it.

I guess the problem is that fundamentally the human body isn't designed to dangle from small edges on a 45 degree bit of marine ply four times a week.  Doing so fucks it up, and it can't always be fixed.

If you don't believe any of the above, weight until you're north of 35, and then unless you're lucky, you will then.

If it isn't (and I suspect it's not) then this definitely should be the preface in Dave Macleod's forthcoming injury book.