Junior lifter shoulder pain

Pain & Rehab Forum [Moderated]
1

Hi BBM team,

I have been coaching a junior lifter for about 4 years now. He was around 14 when we started and nowadays he is 18 years old. First two years were like general strength programming, but after that he became much more interested about powerlifts: squat, bench and deadlift so we started doing more powerlifting style of training. Last year we were at youth nationals and got a silver medal.

However this past year he has had a lot of pain in both of his shoulders. In the beginning we used a lot of tactics I have learned from you guys, change intensity/RPE, change rep range, change range of motion, change the movement altogether and those changes helped a bit, but like I said this past year has been very difficult and the pain has become slowly worse and worse and eventually we stopped doing back squats like past summer and we havent done bench training nor any kind of pressing movements for the past 6 months.

The pain was affecting so much and nothing felt good. He is at school, in the construction work kind of school where like you may guess he does a lot of holding and carrying stuff with his hands. Everything at the school and at the gym hurt a lot.

This lead as to seek help from doctors and they did MRI for neck and shoulders => found nothing, they also did ENMG test for the arms and found nothing.

The boy was then directed to physiotherapist whose diagnostic was this:

Too specific strength training started at young age combined with growth has caused muscles in the shoulder to become too big and cant fit to the area anymore. This has caused major muscle stiffness in the area and neural pathways are kinda trapped because there is not enough room. Also boy’s mobility in the shoulder area is very bad and he is overall very stiff in the upper body.

The physiotherapist has given the boy different kind of stretches and dynamic movements to help the issue, to get blood flow in to the area and release stiffness. the physiotherapist has done a bit of foam rolling in the area and stuff like that. Nevertheless the pain in the shoulder area is still becoming worse and worse and actually the pain got worse quicker once the boy started seeing and doing the stuff the physiotherapist ordered. The physiotherapist said this quicker worsening of the pain is good news explaining that its a sign of that the muscles stiffness is releasing a bit and thats why the neural pathways are getting a bit free from the entrapment and thats why the pain signal is higher as the signal can travel better.

The physiotherapist said this recovery might take like 6 months or even longer…

My question is simply this: with this information I provided here, does this sound like we are on the right track to figure this out OR does this sound like horseshit to you?

Apologies english is not my main language and I am not 100 % sure did I translate everything correct.

BR,
Kimmo

2

Hey Kimmo,

I would fundamentally disagree with much of the assessment from this physio. The muscles in the shoulder becoming “too big” isn’t a thing and if so many of us in the lifting community would have succumbed to its danger long ago. “Muscle stiffness” also is not really measurable with any physio test and falls more in the category of technobabble that makes the physio sound cool. I would fundamentally disagree with the physio’s reasoning for symptoms increasing once the athlete started working on their home exercise program. It’s basically them using the same logic to say that something was a problem and taking that something now as a solution.So yes, overall I would put this much more in the horseshit category…

However…

I would give a little credence to the early sports specialization component given what is listed here. We are obviously advocates for resistance training in the youth population but just like any other sport, singularly doing one thing can be problematic.

If we take this off the knowledge in front of us, the upside is that all imaging came back negative. This would also throw a pretty big wrench the in the current physio’s opinion. It’s difficult to give specific recommendations given we don’t know what exacerbating activities currently are, what has been attempted thus far, and what the horizon for timeline needs to be. If it were me in general terms, I would likely be heavily utilizing the SSB/belt squat/hack squats for squat movements. As symptoms settled I would start back with high bar then walk to low bar. I tend to keep the accessory movements as the primaries in the beginning and use barbell squats later in the week more as an exposure exercise at low RPE and letting symptoms guide progressions more than effort. For pressing, it may be machine work for the time being or things like pin/dumbbell bench. The key is finding what is most tolerable and starting there then adding to it. I also tend to take a rising tide raises all ships approach to shoulder rehab in programming a good deal of variation. Nothing is out of bounds and if an exercise lets some work be done without symptoms, it is a good one. For each exercise, I scale it accordingly:

-light and slow
-heavy and slow
-light and fast
-heavy and fast

The first being to move with minimal issues then increasing load. As strength improves then I drop the load and start working more on intent of movement. There are a host of upper extremity plyometric exercises that work here but even taking big drops on exercises like bench (40-50% is pretty common) and working more on speed can help get both exposures and confidence. There isn’t _a_way to approach this but if using the principles above, I have a feeling the athlete will make more progress than what the physio is currently recommending.

There is a confounder here as well with employment and manual labor. You’re going to see bigger fluctuations in weight and symptoms dependent on what the athlete is doing at work. I try to make this apparent to the athlete as well so there hopefully isn’t as big of an anchor to hitting prior weights as things start to build back.

3

Hey Derek,

Thank you very much for your response, which was like I anticipated it might be. Confirming the nonsense thats going on with the treatment. Its tough though because thats how they are proceeding with his treatment and not thinking anything else. They have decided its this huge muscle tightness + neural entrapment and all is because he was training too specific during growth phase.

Its very hard to find any kind of entry level to training anymore, because the pain is present all the time. During construction work the pain is bad, but the boy said he can take it because there is no other choice. He has to endure it, so that he can continue at the school and eventually graduate. After school/construction work the pain is so bad he cant do anything. Even the arms and hands are shaking sometimes… During days when there is no construction work the pain is very bad also, and he often has problems sleeping because the pain is there constantly. What I am trying to say is that the pain levels are pretty high pretty much all the time. For example during christmas time he only trainned a bit legs with leg press and walking lunges, did nothing with upper body, there was no school/construction work for several weeks and the pain did not change at all, it was high all the time…

The boys mother has been thinking about arthritis and other possibilities because the pain just keeps getting worse and worse as time goes by. She even suggested that to the physio, but physio said thats not worth looking into and neither is anything else worth looking into.

To be honest I think I am not able to find a solution for this. I will talk to the mother about your answer and suggest that they would consider taking a consultation from you guys.

Thank you very much,
Kimmo