Back/shoulder blade injury

Hey climbers,

I'm coming to you for any advice / experience you might have regarding my back problem. It's been ongoing for more than a year now, and although I have been through a primary practitioner and roughly three months of PT there is no end in sight. Still, at this point, no one even has a clue what the actual injury is. All of the doctors I met were completely stumped by my symptoms, but I'm hoping because my injury was climbing-induced someone here might know something useful.

OK here's how it happened, and the original symptoms. I had been developing a small amount of pain in my left mid-back lat area for a while, but it was nothing major and didn't seem to get worse while climbing, swimming or doing other exercises and didn't improve after nearly an unrelated month-long break from climbing. If it's not getting worse or better, I thought, why change what I'm doing? After a trip to Smith, all of that changed. I woke up in the middle of the night after a day of sending unable to sit up in bed, or even lift my head off of the pillow without incredibly intense pain in the area between my left shoulder blade and spine. I was able to leave the bed in the morning with the help of my partner, and after three or four days was able to do this pain free by myself. Still, at this point, turning my head more than ~10-15 degrees to either side was pretty painful.

I saw my GP as soon as possible (1 week of waiting) and was immediately referred to a PT, and to my surprise, without any imaging. After waiting nearly three months for an availability at the PT office the pain had decreased to the point of it not getting in the way of daily activities, but I was still careful to not to look too far over my shoulder while cycling, and was not sleeping on my left side due to the pain. The PT wasn't sure what to do, it seemed, and after two months settled on a tentative diagnosis of a rotator cuff injury/stability problem, although that didn't make a lot of sense to me given the pain during neck rotation. I was given several rubber band exercises which I was able to progress in somewhat, but always seemed to cause some pain the next day which I would describe as a mild burning sensation in the shoulder blade area. After three months of this semi-ineffectual PT my employment changed and with it went my insurance and PT. Since that point, I've been sticking with the rubber band exercises in the hope that it is actually doing something, but little has changed in the months since then.

I will have insurance again starting early next year, but this is driving my crazy and I'm worried that A) the injury has become chronic after being un or mistreated for so long, and at this point has started causing other problems in the back/shoulder area due to restricted ROM etc, and B) If this continues along the present trajectory, it's unlikely I'll climb again.

Do my symptoms sound like anything you've heard of/experienced? The shortest description of them would be restricted neck movement, both rotation and forward tilting, that manifest as acute pain near the shoulder blade , and an ever-present burning sensation in the shoulder blade area. There are probably multiple things going on here, but I do not have a lot of confidence that the PT's diagnosis of a rotator cuff injury is very accurate.

I've been through multiple other injuries and always bounced back to climbing after absences of up to a year or two of rehab, and I'm willing to put in the time to recover properly, but this one doesn't seem to be going anywhere.

I went through similar symptoms last winter. I had been doing a little training with hangboarding, making good progress, then one morning after my workout I got a burning sensation tweak in my neck on my right side. That day my neck locked up like yours.

I went to a chiropractor to get function returned. Based on his recommendation, I went to see a shoulder specialist. Like you I was skeptical. I had x-rays but no scans (MRI/CAT). Prescribed massive amounts of ibuprofen, which did not mix well with my stomach lining, and going to PT, which prescribed shoulder rehab.

My diagnosis was that irritation in the rotator cuff, not severe enough to call a separation, which bound up my neck muscles and it to lock up. The contributing factors for me were the increase in training without balancing my shoulders, and an increase in desk activity at work at not having my monitor properly lined up.

Getting back into climbing after taking the summer off, due to my neck/should but probably more to my now 13 month old daughter. My non-medical advice is that yes, it sounds like a shoulder problem that manifested in your neck locking up. Neck muscles do not liked to be messed with as they carry precious cargo and they can lock up for a long time. The shoulder is incredibly complex, with a huge range of motion, and a little swelling can really mess things up.

Max out ibuprofen throughout the day to reduce swelling, and continue with rehab that was given. I did not take a lot as it irritated my stomach and I like beer. Sounds like you might be doing it too intensely, you are trying to get the muscle back in shape and the stabilizing muscles don’t need much resistance. In my experience, I have never been sore doing the rehab.

Not saying that we have the same injury, just giving my experience. Hope it gives you confidence that you can return to climbing.

The injury centainly sounds more like a neck injury than a RTC injury, although obviously nobody can examine you over the internet. Significant loss of cervical range of motion can occur with shoulder injury however it is usually from pretty severe shoulder injuries...it is much more likely to occur after a neck injury. Pain between the shoulder blades is common after neck injuries and uncommon after shoulder injuries. Pain associated with rtc injuries is usually felt on the anterolateral aspect of the shoulder. First onset of pain while sleeping is also more common which neck injuries than shoulder injuries (my experience, I don't believe I've ever seen this discussed in the literature).

Also, 3 months to get into a PT's office is ridiculous. If I were in your shoes I would find another PT. I recommended in another thread PTs who are certified by the McKenzie Institute (I'm in no way associated with them).

mckenziemdt.org/disclaimerT…

Even better, ask around to see who is recommended in your community. You could also go the route of seeing the local orthopedist but be prepared for him to possibly order an MRI which can be expensive even with insurance. And the current literature shows that MRI findings are weakly correlated at best with both shoulder and neck pain generators. The latest study I've read concluded that 88% of us will have a disc bulge or worse on MRI and the vast majority of these are asymptomatic.

Your symptoms sound similar to mine, in particular the inability to turn your head. I had pain in between my shoulder blades off and on for years. I always assumed it was my shoulder, and with rest and ibuprofen it would eventually go away. One summer it started flaring up more and more often, and a belayer standing near me as I complained told me she had the same thing and I should see an ortho doc, as hers was a cervical neck problem.

It had never dawned on me it could be my neck, but sure enough it was. Over several years it progressed from flaring up to being almost constant, couldn't lift my head from a pillow, couldn't tilt my head to hold a phone on my ear with my shoulder (no hands), and couldn't turn my head as if to look behind me. When I started to get numbness and tingling down my arm my doc said I should think about surgery, and when I started getting weakness in my hand the doc said surgery for sure.

MRI and my symptoms indicated a problem in cervical disk areas c5-7, but they werent sure why. There was no bulging disk, and no obvious injury. About 3 years after this all started I went on to have surgery, and it turned out I had a bone spur that was growing into my nerve roots and starting to slice them. Glad I had surgery! Turns out I had damaged that area many years earlier in a kayaking accident where I hit my shoulder on a rock and subsequently whiplashed my neck. I assumed that was a shoulder injury too, but it triggered a bone injury in my neck.

Surgery was a huge relief, and the episodes are gone. It still gets irritated sometimes, but nothing like before. I now know what triggers it, and interestingly climbing at Smith is one of the triggers. Unfortunately Smith is my home crag so I just deal.

Triggers for me include reaching high over my head and pulling, think lat pull downs or putting a dish away on a high shelf. Craning my neck way back to watch a climber is bad, and I always wear belay glasses when belaying now. Hard sport climbing isn't great for me, if I get tense I recruit my shoulders and then that can set off my neck. The hard starts with bad feet at Smith give me problems.

That's probably way more than you wanted to know, but hopefully it sends you in a new direction of getting your cervical spine evaluated. I would never have known except that belayer happened to casually mention it. I hope this doesn't scare you, not saying its the same situation as yours but maybe it will help.

It sounds like you've got a lot going on.

Sub-scapular muscle tears are common in climbing, difficult to rehab and present themselves as pain or a knot under the shoulder blade. Rotator cuff tears should be relatively easy to PRELIM diagnose by a good PT or shoulder specialist ortho doc. Most people noticed rotator cuff injuries as an aching pain at night when lying in bed. The limited ROM and related pain in your neck may be related to a cervical impingement.

If I were in your shoes I'd ask my doc about c-spine and t-spine x-rays to start, followed by a multiple modality approach to rehabing the injury(s). This would include deep tissue and trigger point massage, chiropractic manipulation and accupuncture. ALL THREE ARE EQUALLY IMPORTANT and may require multiple visits to multiple practioners. Hot baths followed by injury-specific icing and ibu should also be utilized.

As climbers, it's a good idea to incorporate a few scapular mobility and rotator cuff strengthening exercises into your warm-up. YouTube is a great resource for these.

This approach may result in a larger out-of-pocket expense not covered by your insurance but sometimes you have to take responsibility for, and aggressively direct, your own healing.