Question
Hello.   I had written you about two years ago and found you extremely helpful in identifying a herniated disc in my back.  Everyone I went to locally couldn't identify the problem until I got an MRI and it confirmed what you had told me.  

I've since had a nagging issue with a sore left should and was hoping I could get your opinion on it.  I have lifted weights pretty regularly in the gym for about 12 years but have always focused on warming-up, stretching, and proper lifting motion in all exercises.  
I've been experiencing a sore left shoulder for about 2-3 months now when performing overhead dumbell presses and to a less extent incline bench press.  The pain was initially 7-8, out of 10, when I first experienced the problem.  I found it difficult lowering the dumbells below the top of my head without getting an ache or pinching sensation inside my shoulder.  The weird thing was it hurt more warming up (say with 60 lbs) than it did when I went heavier (say 70 or 80lbs).  Initially I didn't think it affected my strength that much and thought it would take some time to heal.  It didn't really bother me much on my flat bench but I could definitely feel it on the incline bench.  Worse with overhead presses.
During a shoulder workout I found myself constantly stretching the sore shoulder and performing rotations that would often result in small pops.  (similar to knuckle cracking).  The shoulder muscle would feel tight or stiff until it released and then it felt more relaxed.
I went to a chiro who wrongly diagnosed a disc in my neck.  I went to phiso therapist who thought it was a my rotator cuff and performed ART and Acupuncture for 4 weeks.  He also had me doing shoulder exercises (rotator cuff) for about 3-4 weeks and rested it for 2 weeks.  I had always worked at rotator cuff strengthening in the past and would usually warm up with it on shoulder and chest days.  I've since learned to perform these exercises after workouts. (typically 2-3x/week for 20 reps).
I've just tried a shoulder work out and I've lost some strength on that side and the pain is still there, maybe a 5-6 out of 10. Still hear some cracking when rotating through the shoulder motions. Any thoughts or suggestions.  I'm thinking about getting my family doctor to write me a requisition for an ultrasound but not sure if that will see anything.  I'd hate to tie up an MRI machine when other people have more urgent need for it.

Any thoughts or help is greatly appreciated.
Regards,
Ian

Answer
Ian,

How old are you?  Late 30's maybe? [just guessing]  When shoulder pain doesn't go away, when it hurts initially with activity and then gets better, and when it aches during the day, you must consider a diagnosis of tendinosis and bursa irritation.  There may also be some arthritic changes brewing.  The cracking sounds, crepitus, is a sign that there is a problem.  Acupuncture is not going to help.  ART will only help if the problem is a myofascial adhesion.  Simple x-ray of the shoulder will show bone spurs and other arthritic conditions that affect the bone, and it will also show calcifications in the tendons or bursa.   If you have no bone spurs or arthritic changes to the joints, and you have calcium deposits, then therapeutic ultrasound should work well (when it's used in a 100% duty-cycle beam of sound verses pulsed sound).  If the x-rays come back clean, then the MRI is one way to see if there are tears or cruddy tendons (tendinopathy).   You can avoid the MRI if the x-rays are normal, and just assume that there is tendinopathy, and this would require Graston Technique as best modality to get at the tendons.  Go to the grastontechnique.com site.  Also, low level laser is good to add to the treatment protocol, since there is some evidence that it is beneficial for tendon conditions.  You will have to back off any shoulder workouts for a short time.  The Graston Technique provider must be diligent in carefully and deeply working the affected tendons.  They also must address the surrounding cuff muscles and shouder girdle muscles.   If you find that a few GT sessions makes your shoulder feel grand, then bag the MRI.   If not, consider it.  After GT sessions (with laser or ultrasound), use some proprioceptive taping around the shoulder.  KT Tape is a brand that you can find in some sporting goods stores and you can learn to tape yourself or have a friend do it for you (go to kttape.com).  See if you can find a credentialed sports chiropractor via www.acbsp.com;    

'Hope this helps.

Dr. G
www.drgillman.com