Shoulder Instability

I thought about piggy-backing off the other shoulder thread near the top right now but decided to start my own. Injured my right shoulder on a hard gaston move (repeated tries, didn't hurt that day, hurt super bad the following days/weeks, trouble turning on light switches or over-head movements, etc.). Right shoulder kind of got better (at least pain went significantly down), climbed more and my left shoulder was feeling weak. Tried one more route and there was a hard gaston move with my left shoulder. Heard a pop and immediate burning pain on left side now (yeah I'm dumb). Lowered off. Haven't climbed in 2 months. Finally got it checked out a couple days ago. Ortho diagnosed me with "shoulder instability". He didn't think my rotator cuff was injured which was my initial guess. No MRI's or surgery he thinks, just PT and potentially climbing by early March (obviously no guarantees).

Does anybody else have experience with this? If I understood him correctly basically my shoulder was partially pulled out of the socket while in a strenuous position and it stretched and weakened the muscles holding the shoulder in place and now they are weak and inflammed. I ocasionally have pulled onto the wall and done like 5 moves of 5.8 and my shoulder doesn't hurt on the wall but it feels weak and sloppy, then I get down and there's a 1 minute delay and then a low, burning pain towards the back of my shoulder (generally tops out at a 2 out of 10 on the pain scale). My left is worse but they are both injured. I have PT scheduled soon so I'm excited to hopefully start making progress and hopefully be ready for a spring climbing trip but we'll see. Anybody else gone through this?

Bryan...I'm no doctor, but have had multiple shoulder injuries. The Dr's at Kerlan-Jobe Institute diagnosed a torn rotor cuff. Then, injured the other shoulder. Same diagnosis. If you were Aaron Donald or LeBron James you'd have had an MRI within hours of the  injury and under the knife the next day, if the injury was serious. As you know pushing through the pain and doing that last route and further injuring your left shoulder was a bad call. I've done it myself. Do your PT and strengthen the shoulder muscles/joint. DON'T rush back into climbing until the shoulder is 100%. That means until you don't even think about the shoulder anymore. Don't be young and stupid like me and push through the pain and continue to climb and further injury your shoulders. Do PT, work on core or something and take a break from climbing. You'll be glad you did.

^^^+1^^^ regarding the Theraband exercises.

Bryan, I had a very similar thing going on (might have been even the same injury) this past summer (mid June), exactly as you described, hard gaston move repeated several times on the right shoulder. It was definitely not the rotater cuff as I was still able to move my arm forward/back with no pain, but if I tried to lift the arm up, I could not get it past about 45 degrees from a resting position until the pain flared up.

Took about a week of rest, sport climbed a little (did 2 5.11 routes with no problems), and then tweaked it bad a few days later (on July 4) on some weird grovely 5.8 move 3 pitches up an 8 pitch route. Had to finish the route with basically 1 arm, it sucked. After that day, my shoulder was very aggravated and I could barely do anything. Simple chores like washing my hair, sleeping, etc became quite painful.

I got some suction cup therapy, stretched with an exercise band multiple times per day, and did not climb for almost 4 weeks...then slowly eased back in to it, making sure to avoid any sort of gaston/weird groveling moves. Shoulder is totally fine now, has been for several months, and I'm back to feeling comfortable pulling strange moves with that arm/shoulder. Sometimes I still feel a very slight ache (nothing crippling though), in which case I'll ease off it, and then it's fine.

Your shoulder will get better, it will just take time. Key things are not climbing at all and the stretch band. Plenty of resources online about how to utilize the band for your shoulder. 

Thanks for the input everybody. I have full range of motion in both shoulders right now. I had pain anytime my right arm was overhead at first but that has receded. It's been about 12 weeks since I injured my right shoulder and 8 weeks since I've injured my left one. The ortho gave me a print-out with exercises but I have PT scheduled in like 4 days so I'm just waiting until that to get more hands on exercises. I was expecting the doctor to order an MRI so I was surprised when that wasn't on the agenda but if the PT doesn't help then I think that will probably be the next step.

Yeah Benjamin I have a bad habit of pushing through injuries and making things worse, sorry to hear you went through the same. I was hoping to plan a trip to Red Rock in March but my ortho recommended making plans that don't involve a plane in case I am not able to climb by then (which is super reasonable but many of us climbers aren't very reasonable are we). I have a week of PTO that I have to use before May, maybe I can just go to the valley in early May then to give myself more of a buffer. I've just been losing my mind without being able to climb (it's a bigger deal than I thought it would be, these Minnesota winters can be tough without physical activity and goals and trips planned).

Good advice on core I actually just did a core work out with a little stair-stepper so I'll try to keep doing stuff like that in the meantime. Then once I rehab my shoulders hopefully my core will be strong enough that I can stay engaged and not hang on my shoulders/skeleton and keep getting injured.

David - glad to hear you're back at it now. Gives me a little hope. For a while there I just had to believe that I was never going to climb again and try to push it out of my mind, which worked for a month or two but now I'm psyched on climbing again so hopefully I can get to the same place you are at, it definitely sounds like a similar injury.

My ortho was able to manipulate my shoulder partially out and back into the socket (I think that's what he was doing) and said he could feel it "sliding" which it shouldn't. I feel pretty motivated to do the PT so hopefully I can stabilize those muscles to hold everything in place.

Caped Baldy wrotez; No one will be able to properly diagnose you without an MRI.  Until that happens, it's just a guessing game.  

Finding the right doctor and physical therapist is imperative.  

Don't try to self diagnose and self help for this.  I attempted to find PT exercises and what-not on YouTube etc. at first. 

The first two statements are absolutely false. An MRI is definitely not required for a proper diagnosis in many, if not most, cases of musculoskeletal injury. In addition, a physical therapist does not need an MRI to test and treat an injury. A PT may receive an MRI/MRA film and report and they may not even factor it into their decision for treatment course, for either perfectly fine or negligent reasons (I've had this happen - in this case, it was detrimental, although most PTs are not going to decide treatment based on a film image, unless it's something which can't be treated with PT).

I would not ask for or pay for an MRI right away unless a) you have great insurance and the copay amount and time to get it done is nbd, or b) there is some reason that a medical professional does not believe trying conservative treatment first (like PT) is the right option -- and in that case, I would get a second opinion before going straight for imaging. 

Keep in mind MRIs often show absolutely nothing, despite the fact you are in pain. I have also had this outcome. Doesn't mean nothing is wrong, but they essentially capture "bread slices" of your body during an MRI, and your problem may happen to be just inside a slice and therefore invisible. Or you may need MRI with contrast to see things better, but this is usually performed only if the doc sees signs and symptoms of such an injury immediately, and/or the regular MRI film and attempted physical therapy treatment hasn't produced any concrete improvement or results after an expected time. 

I do agree with finding the right medical professionals and to avoid self diagnosis and treatment.  Good advice.

To be honest, the OP's problem sounds like a standard subluxation occurred, most likely stretching the joint ligaments, tendons, and joint capsule to some degree. This rarely needs surgery afaik (unless you become a recurrent dislocator maybe - and you are the right gender and age for that to be a statistical possibility). Standard PT is the treatment. It won't be rocket science. Good luck and stop "pushing through" injuries.      

For PT, look for a chiropractor certified in ART (alternative release therapy).  My guy has done wonders on my shoulder.  It is NOT a traditional chiro approach.  Also, check out the American Orthopedic Association website and search for rotator cuff.  They have a series of exercises that will, over time, strengthen rc muscles and help stabilize the shoulder.  Good luck.

Not sure if what Idaho is talking about is the same thing or not, but I have a shoulder that is toast, and myofacial release worked wonders for me. My right was four inches shy of my left when extended, and it corrected that and more. I had major shoulder pain, and diagnosed for a new shoulder, some people are magic with their hands.

Idaho Bob wrote: For PT, look for a chiropractor certified in ART (alternative release therapy).  My guy has done wonders on my shoulder.  It is NOT a traditional chiro approach.  Also, check out the American Orthopedic Association website and search for rotator cuff.  They have a series of exercises that will, over time, strengthen rc muscles and help stabilize the shoulder.  Good luck.

ART stands for Active Release Technique. It can be a wondrous tool, but I am not sure it would be helpful for excessive joint laxity. It's used primarily to release adhesions that restrict movement or nerves. So maybe it could be an adjunct therapy to PT in this case, but I wouldn't go straight for ART with his symptoms.

Having a powerlifting and climbing background, here is a great rehab protocol that has worked wonders for me anytime my shoulders have given me fits.   dieselcrew.com/how-to-shoul…

Caped - thanks for sharing your experience. This is exactly the kind of stuff I was hoping for posting the thread. I'm glad to hear you're (partially) back to climbing. I would be fine if I could climb 5.10 crack again, although I do like sport climbing and gaston moves. I'll take what I can get. I'll have to see if the PT that I have is any good or not, otherwise it is probably worth it to shop around, you seem like you hit the gold mine with yours. That's what my ortho said, 2.5 months of PT and then if not better then we'll have to explore other options. Hopefully you keep getting better!

Aerili - I don't have great insurance so I think I'm holding off on the MRI until I try PT first (which is cheaper than I thought it would be, I called my insurance company and I'm paying $40 per session, I thought it would be at least $100).

Eric - bookmarked that protocol, appreciate it.

I will look into ART and myofacial if the PT doesn't seem to be making progress later. Thanks for the tips everybody.

+10 for active release technique. It was the only thing that worked for both my shoulder and ankle. The problem with my shoulder was that my subscap was too tight, and the months of strengthening my external rotatation muscles was never going to overpower my overdeveloped subscap. Very little relief with months of strengthening. Immediate relief with active release, the strengthening is important and important to keep up so it won’t go back, but didn’t fix it. 

Quick update - I've been to two PT appointments now. Is there a big difference between skilled PT's and average ones for this type of injury? My therapist seems fine but doesn't seem to specialize in climbers or anything like that. I imagine it would be hard to find a PT who is also a climber (or specializes in climbers) while also having them being covered by my insurance. I am keeping it mind to potentially see one of the "big name" climber PTs next time I am traveling and local to one of them. Probably wouldn't be covered by insurance but would be interesting.

My PT confirmed my diagnosis of shoulder instability (I think subluxation is the same thing or maybe a subluxation leads to shoulder instability? I hear subluxation more in relation to climbing). First appointment he gave me one exercise of laying on my stomach with arms at my side, raising them a couple inches up and holding them for 5 seconds and do a set of 15-20 (I think these are the "I's" of I's, Y's, T's). I did that and other exercises probably about 5 days out of 7 between that and my appointment today. Appointment today we added internal and external rotation (which I was doing on my own already) and a "body blade" - long stick that you do micro-movements on to get it to oscillate back and forth to work stabilizing muscles. Additionally, we added full planks - I have always done them on my elbows but I am doing them in a full pull-up position now. I scheduled an appointment for two weeks out (skipped a week to save a little money and just keep doing exercises on my own). Posting to either get feedback and/or leaving this information here in case anybody else is dealing with a similar injury and wants the exercises.

I know shoulders are complicated and take a while to heal and to trust the process but there is a part of me that feels like doing exercises isn't going to improve my shoulder. It feels like it's been injured for a while and it's hard to imagine just doing stabilizing/strengthening exercises and it getting to a point where I can climb pain free. Does anybody have any input there? Do your shoulders just start to feel a little stronger or more stable - and then you just get the feeling at some point that you will be able to climb and not have it hurt? I don't want to jump the gun and start climbing too soon and make it worse. I asked my PT today and he said there isn't really a way to know when I'm ready to climb, just to listen to pain. I know it will be at least a couple weeks or months but do you end up kind of feeling when you think you will likely be able to start climbing again? It's easy for me to just even pull onto the wall and do like 3 moves on jugs but I don't know when to start testing that. I will definitely ease back into it and climb easy vertical things at first, no more gastons, listen to the body, have light sessions, etc. Sorry for the long post but just looking for any experiences.

Do you have pain when lifting relatively light weight with your arm extended straight out to your side(dumbbell lateral raise)? Did they also diagnosis impingement?
Those strengthening exercises are great and the basic foundation for reducing instability. One thing you want to also focus on when climbing and doing all the exercises is focusing on keeping your shoulder blades down and back. Even once you’re back to full strength focus on that in warm ups and when climbing for training.

Ryan, I just tried that with 5 pound weights. No pain. They did not diagnose impingement. Thanks for the input, I am definitely more conscious of my shoulders now and will try and keep that focus when I start climbing again.

Great thread, thanks for starting.  I am currently in the process of being on the other side of Bryan, feeling the frustration of shoulder injury easing.  Had MRI work up, the whole schebang.  Doc laughed and said your injury is very minimal, 4 weeks or PT should clear it up. 5 months later the pain was same/worse.  Found a clinican that did ART/massage(along with exersizes...etc.) and was almost instantly better.  I will 100% agree with caped baldy above(very good advice), I'm not in the clear yet but everyday has gotten better and to see it through. I'm confident that in time it will heal.  So Bryan, you might try getting ART or massage in conjuction with doing your exersizes.  My dude also said stay hydrated and ice it a few times a day with a very specific ice pack.  Link below.  https://www.amazon.com/%C3%BCbertherm-Shoulder-Pain-Relief-Cold/dp/B0727RCSBZ/ref=sr_1_1_sspa?ie=UTF8&qid=1546463622&sr=8-1-spons&keywords=ubertherm+shoulder&psc=1

To all the other commentors above, could yall elaborate on the strengthening exersizes and theraband exersizes?  What did you search for or which in particular do yall use?  Thanks!

Haha baldy I had to buy the same thing! 

I've had lots of shoulder problems over the years and surgery on each, the last 2 weeks ago. I've also been to a total of 5 MD specialists and shit loads of PTs, most of which were not effective. To me, a diagnosis of "shoulder instability" is BS! That's just jargon for "something is wrong but we don't know what." After all something is f'd up. You could have an irritated supra or subscap tendon causing weakness in the muscles and other rotator cuffs over compensating which would throw your scapular out of alignment, cause clicking and impingement. Or, you could have a torn rotator cuff, most likely supra. Or you could have a bicep tendon subluxation. Alas, with all of these you will have labrum damage, bursitis and other junk irritating your shoulder joint. Point being, you are undiagnosed!

My latest injury was also the result of a desperate gaston and then climbing "through it" for a few more days. My strategy then became, rest and PT. I have a guy who is a climber and one of the best PT for shoulders, so I was lucky (but it took a long time to find him). After marginal improvement, I went to the same Doc that did my right shoulder. I went in there with the mindset of getting an MRI ASAP, and he knew that's what I wanted, so there was no wait and see, do this and that... MRI came back, showed that my bicep tendon has sublexed and I had partial tear of supra and subscap (larbral tear is implied). The bicep tendon def needed to be fixed. He also wanted to do some work on the rotators. Instead of heading straight into surgery, I got 3 more opinions. All the same for the bicep, all differed with what needed to be done with everything else. In the end, I went with the Doc who was most highly regarded and didn't think anything but the bicep tendon needed work. That's important b/c rotator work can add 6+ months to your recovery. In the end, my supra had like a10% tear and my sub scap was totally fine.

You've been to the doc and he says no MRI needed. The thing is, climbers are really strong and it is easy to fake all the clinical tests as I did with my right shoulder. I had a full tear of supra and 75% tear of subscap that went undiagnosed until the MRI. Point being, get an mri! Even if you don't have any tears, you may still have a subluxed bicep tendon, which can then cause a subscap tear down the road. You don't want a subscap tear! All MRI's are not created equal. Also, if it isn't a hi res machine then make sure you get an mri with contrast.

After you get the MRI and if there is some work to be done, it's time to shop for the 2nd/3rd opinions. PM if that's the case, I've gotten good at finding the right Doc.

How to find the right PT: Call around and try out a bunch of them! I'm assuming you live in/near the city. If they whip out the ultra sound machine and/or other electrical devices or give you a swedish massage and a few stretches, it's time to move on!

Hope this helps, good luck!

Bryan wrote: Quick update - I've been to two PT appointments now. Is there a big difference between skilled PT's and average ones for this type of injury? My therapist seems fine but doesn't seem to specialize in climbers or anything like that. ...

My PT confirmed my diagnosis of shoulder instability (I think subluxation is the same thing or maybe a subluxation leads to shoulder instability? I hear subluxation more in relation to climbing). First appointment he gave me one exercise of laying on my stomach with arms at my side, raising them a couple inches up and holding them for 5 seconds and do a set of 15-20 (I think these are the "I's" of I's, Y's, T's). I did that and other exercises probably about 5 days out of 7 between that and my appointment today. Appointment today we added internal and external rotation (which I was doing on my own already) and a "body blade" - long stick that you do micro-movements on to get it to oscillate back and forth to work stabilizing muscles. Additionally, we added full planks - I have always done them on my elbows but I am doing them in a full pull-up position now. I scheduled an appointment for two weeks out (skipped a week to save a little money and just keep doing exercises on my own). Posting to either get feedback and/or leaving this information here in case anybody else is dealing with a similar injury and wants the exercises.

I know shoulders are complicated and take a while to heal and to trust the process but there is a part of me that feels like doing exercises isn't going to improve my shoulder. It feels like it's been injured for a while and it's hard to imagine just doing stabilizing/strengthening exercises and it getting to a point where I can climb pain free. Does anybody have any input there? Do your shoulders just start to feel a little stronger or more stable - and then you just get the feeling at some point that you will be able to climb and not have it hurt? I don't want to jump the gun and start climbing too soon and make it worse. I asked my PT today and he said there isn't really a way to know when I'm ready to climb, just to listen to pain. 

Bryan, yes PTs vary in skill but shoulder injuries are bread and butter for PTs and just isn't rocket science - although it would be good to ensure your PT does work with a lot of shoulder injuries in athletes. As someone who assisted in rehabbing many, many shoulders in my distant past career (including doing this exact protocol for my own shoulders for similar instability problems), your rehab so far sounds like SOP, tried and true for overhead athletes. Completely, 100% correct. You will not see a miraculous difference in 2 appointments or a couple weeks. You need to give yourself 6-12 weeks to see REAL results. 

Subluxation is not just a thing that happens in relation to climbing, but yes it is common to overhead athletes. Climbers are a type of overhead athlete. But we are not really special snowflakes when it comes to shoulder injuries.

Do not follow these other posters' advice on going down the catastrophe/"I'm a complicated case" rabbit hole until you have tried standard shoulder therapy for at least 2 months. 

I've had recurrent shoulder injuries, some that persisted for months, most related to shoulder instability. (Btw, it's not a bullshit diagnosis but a legit term that encompasses laxity in some/all of the shoulder ligaments, tendons, and capsule, and usually points to weakness of the cuff to some degree.) I have rehabbed them ALL with exercises. Never had an MRI, never had surgery. Yes, your shoulder will begin to feel intrinsically more stable and stronger once you really break through. Trust the process and give it time. Probably wouldn't try any climbing til you've been faithfully rehabbing for 6-8 weeks. Be patient.   

I tore my rotator cuff about ten years ago, and it finally gave out a few months back
Now I'm looking at a reverse shoulder replacement.
Jump through the hoops and get an MRI, otherwise your playing with your health.

Bryan, yes PTs vary in skill but shoulder injuries are bread and butter for PTs and just isn't rocket science

We'll have to agree to disagree on this. The shoulder is one of the most complicated joints to rehab and every well qualified therapist I've been to does things differently.

Do not follow these other posters' advice on going down the catastrophe/"I'm a complicated case" rabbit hole until you have tried standard shoulder therapy for at least 2 months. 

I agree, 2 months at least, that's if you're religious with your homework. I should have been more clear about this before I jumped into my rant about how I would deal with doctors.

... a legit term that encompasses laxity in some/all of the shoulder ligaments, tendons, and capsule, and usually points to weakness of the cuff to some degree.

That's not a diagnosis! It's a catchall for, "There's something wrong with your shoulder."

Aerili wrote:

Bryan, yes PTs vary in skill but shoulder injuries are bread and butter for PTs and just isn't rocket science 

I also have to disagree with this statement.  The shoulder is very complicated and it can be quite difficult to get the diagnosis correct, even with MRI's.  Lots of nuance and skill and intuition involved with treating shoulder problems.  

I've been an outpatient ortho PT for 31 years and I've treated hundreds and hundreds of shoulder patients, both surgical and non-surgical cases. (as way of qualification for my statements above)