[Scouse D]

I've had intermittent shoulder beef for a few years now, manifesting itself as anterior shoulder pain and limited external rotation with trigger points in the infraspinatus. Releasing said trigger points relieves the pain very well indeed (used travell and Perkins trigger point book). So, I've not been climbing much of late but road biking and the trigger points are there again as is the anterior shoulder pain and a bit of bicep pain which corresponds with trigger point referral patterns(arms out in front for long periods sometimes four hours or more). I am absolutely certain the infraspinatus is at least partly to blame so question: do I need to stretch it or strengthen it? If strengthening ( which is what I think I need to do, should I concentrate on light weight activation of the muscle, or some more complex, general rotator cuff strengthening as no one muscle works independently of its synergists?
Any advice from physios to help would be gratefully received. I am self taught and as such will not take offence if you tell me I'm well off or talking bollocks.

[mrjonathanr]

I am not a physio but infraspinatus is a pain for me so my experience may be helpful.

Stretching the muscle may irritate as well as help it so gentle range of motion exercises eg wall angels better me. Doorway pec stretch to alleviate tightness at front ( eases chronically strained infraspinatus at rear).

I strengthened slowly with light weights. Side-lying dumbbell external rotation targets infraspinatus well. Strengthened stability of clavicle too with face pulls and Vs with theraband. All high rep, low weight, plenty and often.

I do other stuff too but that’s plenty to start with.

Works for me, shoulder is improving.

[Scouse D]

Useful that. Cheers. I was doing the side lying dumbell shiz already so nice to know that's a good thing. Literally doing them holding a tin of beans. Its a frustrating injury but glad to hear that you are making progress with yours. Will do some light theraband stuff like you suggest. Thanks again.

[user deactivated]

Hey up Dave, (for what it’s worth) I’m not a big fan of lots of repetitive rotation / theraband exercises. Trigger point massage can give symptomatic relief. But in the end it’s about staying the healthy side of aggravating factors for a long enough period for the whole thing to settle down while engaging in functionally orientated rehab. E.g reps of medium level problems with variety or my preference would be a season fiddling in wires on chee Tor. Great angle, perfect moves and opportunity for shoulder stability and functional strengthening as well as improving head and technique in a lovely place. Start the bouldering again slowly next end of summer. I know you wanna 😉

[Scouse D]

Cheers Dan, your opinion on physio stuff is always appreciated! I suppose for me I find it really hard to go easy when climbing. I too am not a fan of the repetitive exercises as they always feel like they are not very applicable to the real world ( maybe if I was recovering from an acute tear or surgery they could be more useful?). I was thinking last night how I managed to get on top of it last time and I think it was down to doing a lot of crawling exercises which seemed to strengthen the cuff more reflexively. I think I just neglected those exercises once the shoulders felt good again.
I'll keep doing those side lying external rotations for a while as they seem to be reducing the anterior shoulder pain, then maybe do some crawling/ easy climbing like you suggested( though most likely not chee tor!)

[user deactivated]

It’s not so much the easy climbing as holding static positions under low load like fiddling in a wire, the combination of function, distraction, proprioception and stabilising endurance in a pain free way. Let’s face it we’re not getting any younger and trying at 20-60-80% is probably better than 100%

[user deactivated]

To replicate that bouldering or on the wall is pretty dull so covering new ground and getting the synapses firing is more of a mind opener

[sheavi]

Do you do any other exercise other than climbing, more specifically involving the upper limbs and spine etc, you mentioned cycling anything else?  What is your job - lots of sitting or active?  I often find that doing exercises such as the Arnold shoulder press beneficial plus general neck and upper back/thoracic mobility stuff useful, in addition to the things already mentioned by other folk. 

I wouldn't focus too narrowly on the infraspinatus but think a bit more broadly. I, Y & T's can be quite useful.  Give them a try see how it goes. https://www.climbing.com/skills/essential-shoulder-strengthening-exercises/

[Scouse D]

cheers all. Got myself a plan now so thanks for your insight