Phone: 03 8822 3723

Case Study For Shoulder Pain - How This Guy Got Rid Of Pain For Good

Written by: Nick Jack
Category: 2014
on 11 September 2018
Hits: 4361

Here is a great case study example of a young guy who came to see us for help with a chronic neck and shoulder problem. We wanted to share this story of how we were able to very quickly help him turn his life around using exercises that many never even consider. Chronic neck and shoulder problems are extremely common with today's modern world of computers, smartphones and general lack of exercise and postural awareness. I see so many people who rely solely on massage, stretching and treatments to release trigger points and stiffness to get rid of their pain, but never do they consider finding the source of the pain, and finding the real solution that lies in learning to MOVE efficiently. This case study is a great example of how we were able to help a guy who had put up with chronic pain for years, seen several therapists for little or no result by simply improving his movement function, stability and strength.

Christian's Story

Before getting right into the detail of this case study here is the whole story as written by Christian after he had spent 6 months working with us. The pictures shown below are of him completing a Turkish Get Up with a 32.5kg dumbbell and a trap bar deadlift with 105kg! He was barely able to move with his body weight when we first met him. You can read his and over 100 other testimonials by clicking here.

"After years of coping with pain I had finally crashed hard in January 2017. I was lost in deep depression and pain that was hard to describe. I spent every waking moment focused on the pain and the disability it was inflicting in my life. Couldn't sit, couldn't run, couldn't lift, couldn't do anything without paralyzing fear. I had tried massage, chiropractor, osteo etc. I was all out of options and truly lost and hopeless. Finally I came across the No Regrets testimony page and after reading some of the stories I decided to drop in and have a chat to Nick. Straight away everything he was telling me made sense, I had put my trust in so many heath professionals however so i was naturally a little pessimistic that what he was talking about could actually fix me. The pain I was experiencing in my neck was so strange that I felt no one could possibly understand what it was or how to fix it, I had been convinced it was a herniated disc, or a bulging disc, or maybe even a dodgy spine that would inevitably cause tremendous pain for the rest of my life. 

After 3 months of hard work and listening to the team at No Regrets, I was finally experiencing a reduction in pain and had regained hope.

Fast forward 2 more months and here I am now, doing Jiu Jitsu again, sitting for hours again, running again, doing whatever I want! The pain no longer rules my life. It's not until now, 5 months later that I realize that what really saved my life was the fact that the team at No Regrets were not entirely responsible for fixing me, they were teaching me how to regain my freedom myself. They simply showed me what I needed to do and the rest was up to me. I had to to lift the weights, I had to put in the hard work. Thank you Nick and Nathan for showing me there wasn't anything wrong with me that I couldn't fix with time and hard work. You have given me hope that has truly saved my life.

If you're reading this and you're in pain right now, you have come to the right place. The team at No Regrets will change your life."

Christian Haider

You Must Look For The CAUSE Of The Pain

Firstly I will say these case studies are also learning applications for us as many times these uncover great methods and strategies that end up becoming a big part of our program. And this is an example of where applying the opposite to what our instincts told us and what appeared to be needed and relying on the results of the assessments and how he moved. With assistance from Exercise Physiologist Nathan Fejes who spent considerable time training with Christian, we explain exactly what we did, and how we changed our approach several times to adjust for what was working and what wasn't.

As mentioned earlier most treatments focus on the area in pain and treating the symptoms of neck or shoulder pain. And while this is this helps to begin with, and is an vital part of the rehab process it fails to answer this big and very important question;

WHY are you STIFF & TIGHT?

Problems with the body such as a poor movement habits, slouched posture, ignorance to flexibility and strength all contribute to instability of joints like the neck and shoulder. If you continue to ignore this instability the body is forced to find another way to protect the joint from severe damage and will adopt STIFFNESS! Stiffness is false stabilization. And no trigger point therapy, stretching or pain medication will make alter stability or weakness. Only exercise can do this but you must be careful with exercise choice. You can read our full article Stability Training What Is It Really & How To Do It Right for a detailed explanation of stiffness versus stability.

When Christian came to see us he had already tried many of these treatments and was regularly stretching which he found relieved the pain, however only for it to return in a day or two. Not only was this taking a toll on him physically but also mentally as he was unable to compete in his passion of sports like jujitsu and football. As you saw in his story after only 6 months seeing us his daily neck pain was completely gone and was back playing those sports pain free!

How did we do this?

Assessment To Find The WHY

When he came and saw us, Christian noted how we were very different from other practitioners, we assessed his flexibility, stability, posture and strength of not only his neck, but his entire body.

One of the most important findings was that Christian was more of a hyper mobile (too much flexibility) person than someone with high degree of muscle stiffness. He passed almost all of our stretch assessments easily, and found many of the difficult tests for shoulders comfortably. Instantly we began to suspect stability and strength was going to be a big problem, but based on past experiences this can be very difficult to find.  With shoulders it is such a complex joint with a close interaction between the thorax, scapula and glenohumeral joint, and even the pelvis! There was really multiple possibilities to explore. Watch the videos below of things we needed to consider in our evaluation.

 

After completing our detailed assessment we found several key weaknesses.

  1. Poor scapula upward rotation
  2. Poor pelvic stability
  3. Poor single leg stability
  4. Weakness in the legs exposed with load

His hypermobility enabled him to perform movements that looked good to the eye. But his method for stabilizing these movements we exposed by placing him either in single leg stance, or with load. Both of these situations brought on his trigger points and pain. This also indicated his breathing strategy for creating pressure was faulty and this became the starting point for his program.

You will find the complete assessment process, exercise instructions and step by step programs we use for evaluating shoulder and neck injuries in our detailed program below. Click here to see more or click the image to get your copy straight away.

Where To Start?

We explained to him that ironically we would not really be working much on the shoulder at all to begin with, and that our focus would be on improving his poor strength of the core and legs. Having bad balance and stability of the lower body will mean the shoulder and neck have no chance to stabilize during movement. Remember stiffness will be recruited as an alternative and the development of tonic muscles and trigger points is inevitable.

For the first 2 months we worked on the foundations of stability and movement skills for the whole body. Flexibility wasn’t a main focus because he already showed good flexibility throughout his whole body. Also we knew he was doing a lot of stretching before coming to see us and in many ways this was creating more damage, as we was weakening some muscles that were already weak.

We did not completely ignore the shoulder and what we did show him was how to release trigger points and use mobility drills and stability drills immediately afterwards to teach the body the correct method for movement. This was a key learning part of the program for him and set the foundation of his strength work that was to come. Example is shown below of where we used the trigger point release of teres major and infraspinatus first, followed up by the wall slides stability drill for the serratus anterior and lower trapezius.

 

Other great exercises we used at this point were:

  • Horse-stance variations: This was a great stability challenge for him as it improved his ability to stabilize his joints at the shoulder and pelvis simultaneously. 
  • Single arm cable pull with weight shift: We originally tried pushing exercises without the weight shift, however, it was giving him too much pain. Adding the weight shift improved his timing that led to a reduced constant static tension of the muscles. Even though this was actually a progression it actually worked significantly better than all of the simpler more static pulling exercises. We had the added benefit of improving leg strength too.
  • Thoracic rotation mobility drill: We regularly use this exercise with almost ALL shoulder and neck pain people in the beginning of their program as they usually suck at this. Christian was pretty good already but we were concerned he might stiffen too much when we added loads. So we carefully added this in between sets of strength exercises using cables and dumbbells, this was used to mobilize his joints between sets to instantly relieve some tension. This was a good one to use because it didn’t statically stretch his body too much, it lightly freed up his body when it wanted to tense up again.
  • Multi-directional lunge: A fantastic exercise we incorporated to improve his hip mobility, pelvic stability as well as strength-endurance. This exercise is more complex than a normal lunge as it demands huge degree of hip movement without sacrificing stability. Very important for all sports and in particular his sports of jujitsu and football.

We completed these exercises in addition to basic stability and movement skills for squats, single leg stance, rotation etc for 1-3 months. We only saw Christian for 30 minute sessions twice per week and he completed his stability and mobility drills at home as advised. Our goal at this stage was to improve his movement skills, timing and stability. 

If you watch the video below you will see examples of several these and more and a detailed explanation of why stretching the neck will make things much worse.

After 3 Months

After 3 months we could see a big improvement with his movement skills, leg strength and overall stability. He still had bad days where the trigger points would surface but he was able to get on top of it quickly using the various drills we had shown him. We knew we were at a point where we progress to more strength training exercises and load and introduce movements that would potentially aggravate his pain such as pushing movements which up to this point would bring pain on quickly! It sounds crazy to suggest but this is where his long term solution would be found. Everything up to now was to get him to this point!

We know that one of the best exercises for serratus anterior strength, great scapula control and overall upper body strength is the push up! We had to find a way to help him learn this movement.

Push up: We worked closely with Christian on technique and breathing within the push up to overcome the pain he had previously experienced with this exercise. Better hand position, pelvic control and thoracic positioning were all factors to getting this right. We also taught him the Yoga Push Up regression that encourages great upward rotation of the scapula.

See article - Why The Push Up Is The Best Upper Body Exercise

 

Deadlifts: Another great exercise to improve your overall strength, and requires a lot of skill to create good stiffness and tension in your body to lift something heavy (and yes I mean “good tension”). Improving his breathing mechanics was a big factor prior to lifting heavy things, as this was another component in reducing the tension built up in his neck, and now transferring that pressure being built up around his whole body when lifting heavy loads. We had to teach him how to not "grip" and squeeze hard on his scapula at the top and learn to move efficiently with control. We gradually built up from 40kg to over 100kg in the last 3 months.

 

Turkish get-up: This exercise was an incredible milestone for him, as overhead pushing movements were originally giving him neck pain. When he saw us at the beginning grabbing 10kg equipment from the shelves at work was painful, 6 months later he can carry a 32.5kg weight over his head up and down the floor, and with one arm! He never experienced any pain by this point lifting these heavy loads. We gradually increased this weight from an 8kg dumbbell to the 32.5kg dumbbell over the 3 months. We rate the Turkish Get Up as the ultimate shoulder stability and mobility exercise and this is a big part of our shoulder program.

See the article - Why The Turkish Get Up Is Such A Great Exercise

 

Single Arm Dumbbell Overhead Press: If ever there was an exercise to aggravate a shoulder or neck this is it. However we had to get to this point to complete the job and ensure he had full movement of his arm in all directions. Any weakness left unattended would be potential disaster in Jiu-Jitsu. After 5 months and completing all the other drills and exercises he was able to complete 15kg overhead presses with the one arm pain free! As with the push up we did use a variation of the upside down kettlebell press first as seen in the videos below.

 

Now he is at the point of his lifestyle where he gets minimal neck pain, he does his exercises in the gym twice a week between his jujitsu training days. In the off-season he will do the heavier loads, when he is doing jujitsu he will keep the weights lighter just to maintain his strength.

Summary

I hope you have enjoyed reading this case study and this gives you an idea of looking to treat pain and dysfunction at the source of the trouble instead of just treating symptoms. Christian's answers were all found to be with stability and strength. Once he learned how to move correctly with the right timing and positioning he was able to strengthen his body to hold the adjustments. His previous strategy of just releasing stiffness was going nowhere for he was not addressing the reason it was there in the first place. If there is one thing to gain from this entire article it is - FIND THE REASON WHY YOU ARE IN PAIN. Answer that and you have your solution.

There is some great FREE Reports you can download below with great tips and instructions of how to execute many of the things discussed in this article.

And if you live in Melbourne and would like to know more about our Personal Training or Rehabilitation programs click the image below to request a free postural and movement assessment.