Posture and Shoulder Injuries

I've had shoulder pain on and off for (being realistic) many years. But I only started really noticing it a year or two ago, and have now come to the conclusion that it has been a somewhat chronic issue spanning a far larger time frame than the 3 years I've been climbing. I believe climbing has aggravated the issue, mainly due to the strenuous and repetitive overhead arm movements. But i no longer believe the issue is cause purely by climbing, as I had previously thought.

The pain has been in both shoulders, but the dominant one more so, and more frequently. Back when I was training regularly, with multiple sessions in the gym every week, outdoor climbing almost every week, and supplementary hangboard training and occasional campusing, I was always a bit sore. At the time, I didn't mind that slight constant soreness because I believed it just meant I was getting stronger. And I was. But that meant any signals of real injury had to be louder to get through the noise of the more general soreness.

The effect this had was I only noticed pain in left (dominant) shoulder, and believed it to be bicep tendonitis based on the location of the pain and articles on the internet. Did I see a doctor? No. But self diagnosis is, as it turns out (and often said), not the way to go. After a subsequent wrist injury, I was forced to stop any real training and stop climbing at my physical limit (which was never very high, but it was my limit none the less). This allowed me to feel the lesser pain in the right shoulder, as there was nolonger any muscular soreness "background noise" to mask it. But I still didn't see a doctor, figuring instead that time off from climbing hard or really at all would fix all that ailed me. And as projects at work (steel fabrication) slowed too, physical demands were low.

Well rest fixed my wrist, and I thought my shoulders. But no. I start climbing and working again and back came the pain in my shoulders. So have I seen a doctor yet? Yes. Two of them. But not perhaps the specialists I should have seen. I went to see a chiropractor that I used to visit, who also practices sports PT. And I stumbled upon a posture specialist due to an inaccurate website a friend and fellow doctor had set up on his behalf, which suggested he was a PT and knew quite a lot about the shoulder. This was not the case, but he's still been very informative. Both separately came to the conclusion (though not as official diagnosis) that my issue is supraspinatus tendonitis. After reading more into this condition, I think they may have it right. And maybe there's more to it.

My posture has never been great. I work hunched over, sit hunched over, drive hunched over, and sleep with my shoulders rolled forwards. So after a phone called cleared up the the posture specialist was not all that the website set up by his friend suggested, I decided to visit anyway. He believes that bad posture over decades (and not necessarily climbing specific) has resulted in shoulder impingement by reducing the space available within the joint and compressing sections of the rotator cuff and bursa. The reduced space leads to friction and wear with increased overhead arm activity. This definitely explains why breaks from climbing and certain types of tasks in my work result in the pain disappears, and then resurfacing when I resume those activities.

So, should I see a specialist? Maybe. After all the discussion, various tests, icing, chiropractic visits and mental efforts to reform my posture, I'm seeing some very positive results within a one week time-frame. So I think this avenue is worth pursuing further before I seek any additional consultations. And in the mean time, I'm avoiding the activities that exacerbate the issue, to see if this is a viable solution.

The main reason I'm posting (and I realize this is a long post) is to suggest that perhaps a focus on posture correction can help cure some chronic shoulder conditions in others too. After all, something has to be the root cause of such issues, and I refuse to accept that this level of discomfort and negative impact to quality of life, is the price one pays for climbing.

Have you done any serious scapula retraction exercises?

Mathias wrote:

I've had shoulder pain on and off for (being realistic) many years. But I only started really noticing it a year or two ago, and have now come to the conclusion that it has been a somewhat chronic issue spanning a far larger time frame than the 3 years I've been climbing. I believe climbing has aggravated the issue, mainly due to the strenuous and repetitive overhead arm movements. But i no longer believe the issue is cause purely by climbing, as I had previously thought.

.....

My posture has never been great. I work hunched over, sit hunched over, driver hunched over, and sleep with my shoulders rolled forwards. So after a phone called cleared up the the posture specialist was not all that the website set up by his friend suggested, I decided to visit anyway. He believes that bad posture over decades (and not necessarily climbing specific) has resulted in shoulder impingement by reducing the space available within the joint and compressing sections of the rotator cuff and bursa. The reduced space leads to friction and wear with increased overhead arm activity. This definitely explains why breaks from climbing and certain types of tasks in my work result in the pain disappears, and then resurfacing when I resume those activities.

.....

The main reason I'm posting (and I realize this is along post) is to suggest that perhaps a focus on posture correction can help cure some chronic shoulder conditions in others too. After all, something has to be the root cause of such issues, and I refuse to accept that this level of discomfort and negative impact to quality of life, is the price one pays for climbing.

So, I think you are saying that we shouldn't hunch our shoulders forward or we might get shoulder pain. 

I think this is good advice that is consistent with my recent experience. 

I recently started having shoulder pain about a day after climbing or doing pull-down exercises. After experimenting with various exercises, I found that the only thing that stopped my pain was to focus on  pulling-down with my shoulders pulled back (or chest pushed forward) and shoulder-blades down. In connection with what you're saying, it seems like shoulders back, chest forward is one aspect of "good posture". 

kenr wrote: Have you done any serious scapula retraction exercises?

Not yet. I'm assuming that will be "homework" from the doctor fairly soon. It's been pretty amazing how sore my back, neck and chest have been during the past week, just from actively trying to correct my posture. Short muscles don't want to stretch, long muscles tire easily trying to keep the slack out of themselves. I'm guessing he didn't want to overload me with additional exercise until that initial hurdle was over. But I was going to ask about that today. It seems like the next logical step.

Jon Nelson wrote:

So, I think you are saying that we shouldn't hunch our shoulders forward or we might get shoulder pain. 

I think this is good advice that is consistent with my recent experience. 

I recently started having shoulder pain about a day after climbing or doing pull-down exercises. After experimenting with various exercises, I found that the only thing that stopped my pain was to focus on  pulling-down with my shoulders pulled back (or chest pushed forward) and shoulder-blades down. In connection with what you're saying, it seems like shoulders back, chest forward is one aspect of "good posture". 

Basically, yes. Apparently rolling the shoulders forwards reduces space between the head of the humerus and bone and tissue that make up the "socket" of the shoulder. And then things rub together that shouldn't rub together. If they rub together enough, that causes even more problems.

I'm glad you figured out what was causing your shoulder pain and addressed it. You certainly figured it out faster than I did.

Have you had it imaged? And, do you have point tenderness at the AC joint?

I developed shoulder pain last summer. Thought it was the deltoid because abduction hurt, but it turned out to be the supraspinatus, which does both abduction and external rotation. Rest didn't help, PT didn't really help, so I got an MRI. That showed a bone spur on the underside of the acromion, impinging the supraspinatus. But also osteoarthritis at the AC. And the shoulder specialist says the arthritis was primary, that bony deposits sometime form secondarily. They gave me a shot of cortisone into the AC which made it feel great for a month, then good for a month, then less good for a month, then back to bad. So three weeks ago I had arthroscopic surgery, distal clavicle resection and acromium remodelling to remove the spur. Healing well so far.

As far as posture, my PT agrees that poor posture probably contributed to the osteoarthritis. She has me working my scapula retractors, and being conscientious to keep the shoulder blades down and back. So better posture might have avoided the problem, but once that bone spur had formed, posture wasn't going to fix it.

Good luck, let us know how it goes.

kevin neville wrote:

Have you had it imaged? And, do you have point tenderness at the AC joint?

I developed shoulder pain last summer. Thought it was the deltoid because abduction hurt, but it turned out to be the supraspinatus, which does both abduction and external rotation. Rest didn't help, PT didn't really help, so I got an MRI. That showed a bone spur on the underside of the acromion, impinging the supraspinatus. But also osteoarthritis at the AC. And the shoulder specialist says the arthritis was primary, that bony deposits sometime form secondarily. They gave me a shot of cortisone into the AC which made it feel great for a month, then good for a month, then less good for a month, then back to bad. So three weeks ago I had arthroscopic surgery, distal clavicle resection and acromium remodelling to remove the spur. Healing well so far.

As far as posture, my PT agrees that poor posture probably contributed to the osteoarthritis. She has me working my scapula retractors, and being conscientious to keep the shoulder blades down and back. So better posture might have avoided the problem, but once that bone spur had formed, posture wasn't going to fix it.

Good luck, let us know how it goes.

I have not had any imaging done yet. And if this line of posture correction doesn't remedy the situation, that will likely be my next step. I don't have tenderness on my AC joint. The tenderness has always presented around the top of the humerus, very close to the groove where the long head bicep tendon sits. And on both sides. Which is what led me to suspect bicep tendonitis originally. But the triggers for the pain line up consistently with a supraspinatus issue. For example; it hurts to put a jacket on.

I suppose it is possible that the cause, in my case, could be a bone spur. But being that I also have the same symptoms in my right shoulder, though to a lesser degree, it seems that impingement might be the more likely cause. And I hope that's the case, rather than osteoarthritis or a bone spur, which sounds very unpleasant.

I'm glad your surgery went well and that you're seeing improvement! 

One more thing I'd like to point out regarding posture: Although I've recently learned my posture has been pretty bad, I didn't realize that it was until I saw this posture specialist. Comparing myself to many of the climbers I see, I had the mistaken belief that my posture was pretty good. 

This could potentially be the case for the majority of climbers. So just because *your* posture is better than that hulking beast pulling down on some V-hard problem, doesn't mean it's good. A self assessment might be worth your time.

Mathias wrote:

One more thing I'd like to point out regarding posture: Although I've recently learned my posture has been pretty bad, I didn't realize that it was until I saw this posture specialist. Comparing myself to many of the climbers I see, I had the mistaken belief that my posture was pretty good. 

This could potentially be the case for the majority of climbers. So just because *your* posture is better than that hulking beast pulling down on some V-hard problem, doesn't mean it's good. A self assessment might be worth your time.

Good point, Mathias. I've heard it said that serious boulderers tend to have a 'hunched-over' appearance. 

Better posture might also help alleviate some climbers' back problems. 

Jon Nelson wrote:

Good point, Mathias. I've heard it said that serious boulderers tend to have a 'hunched-over' appearance. 

Better posture might also help alleviate some climbers' back problems. 

I think that's very likely true. It seems hunched shoulders and a rounded upper back, go together. Often (this is all new information to me btw) a flattening of the lower spin is also present - as the hips are rolled forwards - and the head sticks out in front of the shoulders. Apparently this puts a huge strain on the whole spine, which is understandable because our spine is not "designed" to support or body in this position. When you add to this craning your head up to watch a climber as you belay, you can see how neck issues are also more likely. Belay glasses, I have recently discovered, are wonderful!

One of the simple tests for bad posture that the chiropractor had me do was as follows: Stand in front of a mirror with your eyes closed. Relax yourself so that you are standing normally with your hands by your side. Now open your eyes and look at your hands. How many knuckles (not including the thumb) do you see?

Correct posture should put your arms at your sides, and not in front of your thighs or hips, and in the mirror you should see the "U" made with your thumb and index finger. So you should only see the knuckle of your index finger. When I did this I could see the knuckles of my index, middle, and ring finger, but not of my pinky. Some people may see the whole of the back of their hand. This is apparently really bad.

I've been dealing with pretty chronic proximal biceps tendonitis in both shoulders for a while now.  Additionally, I have pretty bad anterior pelvic tilt (largely due to running), which has caused years of lower back pain.  I did a couple rounds of Graston at a PT, which helped, but it wasn't until I started doing  proscribed exercises at home that I really noticed improvement.  Luckily, YouTube is a bottomless repository of solutions to these problems- here's a couple vids my PT sent me that have helped a lot (especially the second vid with the barbell).  Get a lacrosse ball, a foam roller, and a rounded scraper (butter knife, comb, etc.), and you should be pretty well set up for self care.  

There should be plenty of anterior rotation vids in the sidebars of these vids as well.

https://youtu.be/eveYJP1indI

https://youtu.be/jUeMFbY6Q4U

Mark, those seem like good resources. I could feel the stretches just watching him. I'll likely follow my chiropractor's instructions for a little while more before I introduce too much extra, but I'll go over some this with him and see what he says.

I feel confident that these exercises would have been very beneficial back when I was really pushing myself and dealing with constantly tight muscle. Hindsight! So I'm sure others can get good use out of them too.

Not only is it posture when standing but also sitting in general that is bad for the back. Staying in static positions (sitting AND standing) for too long is also not good for the body. The PT in that second video above has a really good book called Deskbound that I would recommend anyone with chronic pain (back/knee/arms) to consult. The entire body is connected and muscles will take on more strain to accommodate weak muscles, which leads to injury. A good prescription of preventative care like stretching, massage, and rounding out the strength of ALL your muscle groups will work wonders for pain. 

Mathias wrote:

just because *your* posture is better than that hulking beast pulling down on some V-hard problem, doesn't mean it's good. A self assessment might be worth your time.

Funny, I see bad posture much more frequently in the less muscular, route dominant or otherwise less powerful climber population.

reboot wrote:

Funny, I see bad posture much more frequently in the less muscular, route dominant or otherwise less powerful climber population.

Oh, I was just using the stereotype as and example. I'm beginning to see bad posture almost everywhere I look, now that I'm paying attention.