Rock climbing shoulder injury

[edmclen]

For almost seven years now, I've been nursing an on-and-off sports injury in my left shoulder that seems to occur mostly during multi-day rock climbing trips.

What typically occurs is that on the third or fourth (sometimes even second) day of a multi-day climbing trip, my left shoulder develops intense soreness that stretches from the outside of the upper-arm (deltoid?) almost to the middle of my upper back. The soreness typically arises within 30 seconds to a few minutes of resting after physically intense climbing (especially bouldering). If the pain is intense enough, my left hand will feel weak and even a bit numb. The pain and soreness will gradually subside after ceasing climbing (typically after 30 minutes to an hour). The pain seems to respond favorably to ibuprofen.

I have seen several sports injury specialists and have been prescribed exercises and stretches aimed at increasing shoulder stability. The exercises involve thera-bands: one involves pulling my shoulder blades together with my hands pulling backward against a thera-band attached to a stationary point in front of me and the other involves lateral (outward) rotation of my hand (forearm horizontal with elbow at side) against thera-band resistance. I've been doing these exercises regularly for years, but their effectiveness seems limited at best. Taking regular glucosamine/chondroitin supplements seemed to help to some extent but not 100%.

While the symptoms are similar to that for impingement, they are different enough to make me believe that there may be another cause, especially since I have not felt pain while undergoing the impingement tests. Does anyone have any other suggestions for what may be causing the injury?

Thank you.

[Darren_H]

The pain does seem to be mechanical rather than chemical in nature. It does seem to be more likely to be related to instability of some sort by your description. As your shoulder fatigues your strength of the muscles stabilizing the shoulder may be inadequate. Thus resulting in some pain. The instability may be at the glenohumeral joint, the scapula, or even a/c joint (although not as likely unless you've had a traumatic injury). Unfortunately you cannot "heal" the instability with exercises and strengthening. I've got some shoulder instability as well and notice more trouble with bouldering vs. top rope or lead. Likely because it can be a little more dynamic. Unfortunately there isn't too much to do except keep on working on strength and stability if that is the case. Keep climbing too.

[Heidi]

I agree with Darren_H that it is probably an instability problem.
I think you need to keep up with the strengthening exercises. How often do you do them and have you seen much progression?

[edmclen]

I do the exercises between two or three times per week. I've recently added a few others that I found on this website and elsewhere, as it seems like the exercises I was doing may have left out an important muscle group or two (i.e. the lower trapezius).

In addition to the exercises I described in my first post, I've also been doing push-ups, shoulder presses w/ body weight, and dips. Are these likely to have as much value as exercises focused specifically on the stabilizer muscles? Also, should I strive more for medium weight and medium reps (10-15) or low weight and a higher number of reps (20-30)?

As for progress, I had kept pain to a minimum for over two years until fairly recently when a four-day climbing trip brought on serious pain on the final morning (after which I took a week off... followed by another week off after another trip). Since then, the pain seems to come on more quickly and after lower intensity climbing. Is it likely that I just need to take more time off to return to the previous state of pain onset?

Thanks for your responses!

[Heidi]

Hi
I would say that you should be doing low intensity, high rep work at least every other day, focasing on the stabiliser muscles such as the rotator cuff, lower trapz and serratus anterior.
Work to the larger, more global muscles is ok, although I would also keep this at a low weight and high reps, I don't know if Darren agrees.
You should try to rest from any activity which aggravates the pain. As it has been quite a long-term injury, this may require quite a hefty rest period.

[Danny24]

it sounds to me like tendonitis. this is an overuse injury causing the tendon of the muscle(s) involved to become inflamed, causing pain,discomfort and swelling all tho there are four types of tendoitis. its hard to tell without doing an assesment but it sounds like its your latissimus dorsi that is the problem just going on what you have told us and the activity involved with rock climbing this would heavely utilise this muscle the fact that you have said that ibroufen seems to improve the problem only states claim to this. Regarding exercises be carefull as to what exercises you do and how much you do as if it is tendonitis it has been the over activity that has caused this in the first place. I would advice that you cut your activities have plenty of rest i would suggest that you cut down on the ibroufen if your still taking them, although they cut down the pain any medication can slow down the healing process. Instead of strengthening exercises start with progressive mobillity exercise along with your stretches. Hope i have been of some help, if you need any any more advicce or have any questions dont hesitate to ask.

[Darren_H]

Heidi's right, higher reps with low weight. Hit all the muscles that she mentioned. Low weight/high reps will also help with keeping your technique spot on so that your activating the right muscles. As for some of the push-ups, dips, and shoulder presses, make sure that you are doing exercises for the back and chest. Balance pushing exercises with pulling exercises. So rows and pull downs/chin ups. Make sense?

[edmclen]

Thanks again for the advice.

One question I have regarding instability versus tendinitis: are the two mutually exclusive diagnoses or potentially cause-and-effect?

At the moment, I'm doing the following exercises every 2-3 days: interior rotation, exterior rotation, scapula-setting exercises, horizontal abduction (plus lower trapezius variation), and the serratus punch. I also do dips, body-weight shoulder presses, and push-ups about twice per week. I also stretch my shoulder daily. Are there any additional exercises that I should be doing or any that I'm doing that are unlikely to help?

Regarding "pull-muscle" exercises, my impression was that overuse of the pull muscles relative to the push muscles was something of an inherent feature in climbing. Thus, it would seem that doing additional pull muscle exercises, outside of climbing, would be counter-productive. Is this not correct?

Lastly, while the pain does seem to respond well to ibuprofen, I do not take ibuprofen regularly. At the onset of pain, I typically stop climbing (at least within a day or two) and take a three-day course of ibuprofen. I usually rest from climbing while taking ibuprofen over the course of several days.

[Heidi]

Hi
It is possibly a case of cause and effect. Instability and muscle imbalance at the shoulder can result in changes in posture and this is in turn can cause rubbing of a tendon and result in tendonitis. This is all usually interlinked.
The exercises you are doing seem good so I would carry on with those. You seem to be addressing all of the main areas.
I believe you are right that the pulling muscles are used more in climbing. Whether you work on these in your routine will depend on whether or not you have an imbalance, with these being stronger than your pushing muscles (i.e. the chest).

[shane]

Well i have seen several sports injury specialists and have been prescribed exercises and stretches aimed at increasing shoulder stability. The exercises involve thera-bands: one involves pulling my shoulder blades together with my hands pulling backward against a thera-band attached to a stationary point in front of me and the other involves lateral