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Training with joint instability and asymmetry

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  • Training with joint instability and asymmetry

    Dear Dr. Baraki and Dr. Feigenbaum,

    I apologize for any formatting issues or grammatical errors in advanced, as I am writing this on a mobile phone. As the title suggests, I have been struggling for a few months to train with issues with my joints. I can't tell if it is mainly an issue of social learning or genuine cause for concern, because these issues seem to have arisen (separately, and on and off) within the past 6-8 months out of a few years of training.

    First - the shoulder: my right shoulder is far more mobile than my left shoulder to the point of feeling unstable: doing dead hangs from a bar can result in a "slipping" feeling where my shoulder "slips out" of place, usually without much pain, but it's uncomfortable nonetheless. But recently, pull ups have been hurting to perform (specifically going from the "unpacked shoulders" bottom to the pull, but doing pull ups, both with and without the bottom part of the ROM, involves a "bicep clicking" in my left bicep which is occasionally accompanied by pain) and my movement pattern on OHP is altered a bit because the range of motion on my left side is far more limited than my right side. Also, whenever I extend my left arm to about 45 degrees upward from horizontal in a "pushing" motion (unweighted), there is a noticable "pop" and a feeling of fear and instability. This does not occur with standard OHP, which I am able to accomplish with reasonable ROM-- my concern is mainly pull ups and bench press. Pull ups are characterized by left bicep "clicking" as if the something is moving back and forth, and right shoulder moves in and out of proper position throughout the ROM. Bench press feels weird when approaching a higher RPE, maybe about 8, and has a sharp pain in the right shoulder, which can be mitigated in MOST reps by staying extremely tight ("rowing the bar on the descent") and performing at a slow tempo, but sometimes pain is still there.

    Second, the knees: I only have an issue with my right knee at the moment and not my left knee. There's often an audible pop in the knee about once a day which I am not concerned about, but there's a "pop" on every rep through the squat ROM, just before I can reach parallel (maybe a little higher than this--the ROM before it pops is quite limited). If I place my finger over the inner portion of my right knee, I can feel it "pop" when going to the range of motion, but I cannot feel the same "pop" in my left knee. There is an aching sensation of pain when approaching that part of the squat (particularly the knee bend) and a feeling of soreness the next day, even with bodyweight squats. This pop occurs at all of the hip angles, toe angles, degree of forward lean, etc that I have tried.

    Third, the lower back: when doing deadlifts and rack pulls, I would often notice pain in the lower back (right side). This pain was not too bad and could probably easily be managed by the suggestions in your pain management podcast. But one thing I did notice is that when looking in the mirror at my back (picture through my phone's camera), my musculature on the lower right side of my back (I think it is the spinal erectors) is noticably more developed and extends lower on the back (all the way to the glutes), compared to the spinal erectors on the left side of the back only being visible to a few inches above the glutes. This could simply be a muscular imbalance arising from poor training, but my lifts are generally very symmetrical when performed.

    I am a student and my studies are my #1 priority and I normally weightlift in my extra time, but all the strategies for management of these pains are becoming frustrating. For reference, my lifts (1RMs) are around 135 OHP, 300 DL, 255 squat, 200 BP, but I haven't hit a high # on the squat for about 6 months and BP in 1 month (due to a combination of pain during the squat and business in training), but I have been doing 135 for sets of 5 to 8 recently after progressing to that from 95 (a substantial deloading) -- each workout is inconsistent in the amount of pain I experience. I just don't want to fall in to the trap of "not training" as a lot of (outdated/not evidence based) recommendations would suggest and causing anything to deteriorate physically, but at the same time, trying everything to make sure I avoid issues is becoming increasingly exhausting and energy consuming, when I would prefer to work on school and feel generally healthy.

    Thus, what would your recommendation be with regards to these issues? For shoulders I am still able to OHP and row, but will I ever / how should I progress back to pull ups, and is the feeling of instability and increased range of motion in the right arm a cause of concern, especially when dead hangs involve popping?

    For my back, is it fine to continue loading the back (with occasional pain nearing higher RPEs) in the presence of a perceived asymmetry?

    For the knees - and this one is the tricky one - it is unclear what I should do, as there is an actual "pop" that sometimes involves pain (but minor pain), which persists throughout most ranges of motions and can even affect my deadlift (usually when setting the bar down during the eccentric, it puts me in a position that stresse/ me knee a lot).

    Thank you very much for your time.