Strained medial deltoids in left shoulder

Ergonomics and Posture for Classical Guitarists, Aches and Pains, Injuries, etc...
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Mark Featherstone
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Strained medial deltoids in left shoulder

Post by Mark Featherstone » Sat Apr 02, 2016 9:11 am

Apologies for appearing a little needy just now! Don't worry. I tend to disappear for a while after posting in small bursts.

About a month ago I began practicing a study by Sor (Study 9, Op 60). It was beginner level, but was throwing me some challenges and so I worked on it pretty hard. There was a short passage (measure 13 below) that required me to rotate my left elbow away from my side a little bit, not too much. However, I practiced going over this passage a lot, and was quite focused on repeating it over and over again as I tried to perfect my technique. Well, when I finally stopped drilling and came out of my fog, only then did I realize that my left shoulder muscles really ached! With a bit of digging around anatomy figures, I determined that it was the medial deltoids that were aching, precisely those muscles required to help rotate outwards and suspend my elbow.

The point is that I've never recovered. For some weeks now, every time I play, and almost regardless of what I play, my left shoulder starts to ache and remains sore for the rest of the day. It feels better briefly if I apply a hot pack or try to massage it, but it has never recovered. I should say that I don't think there was anything wrong in my hand/arm position, and I don't think I was applying more tension than what was required for that particular sequence. But I guess I should have taken more breaks. Any advice on how to deal with this? Maybe I am accumulating more tension in those muscles than necessary. Should I be exercising those muscles to build up resilience? Should I avoid using them and work around them somehow? Should I...gulp...stop playing for a while?

Oh, I should have also noted that at the time of the injury, I had the guitar riding quite high on its support, so I had to reach higher for the neck. I've since lowered it and that is certainly easier on my shoulder.

The joys of approaching 60. Sigh....
Study 9 measures 12 and 13.JPG
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ronjazz
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Re: Strained medial deltoids in left shoulder

Post by ronjazz » Sat Apr 02, 2016 2:06 pm

Much of this tension starts in the neck and travels. Check out Alexander Technique for solutions, and especially Barbara Conable's little workbook called (What ever Musician Needs To Know About The Body", GIA Publications.
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Re: Strained medial deltoids in left shoulder

Post by jshob56 » Sat Apr 02, 2016 3:36 pm

Mark,

"The joys of approaching 60..." I'm right there with you (see my post from earlier this week "One step up and two steps back"). As we get more "mature", the things that were simple and taken for granted just a few short years ago, can cause some serious damage now.

Since this has been bothering you for a month and isn't going away on its own, have you thought about seeing a doctor or physical therapist? They may suggest some down time to allow it to heal. A few weeks away from the guitar may help prevent future agony when doing something you enjoy so much.

If there is any inflammation, ice/cold packs would be better than heat.

Have over the counter anti inflammatories helped? I use naprosin (Aleve) but any of the ibuprofens are good too.

Try rubbing a muscle linament into the area before sleeping. I use one called Bigeloil. It's actually meant for horses, but works better than any of the others I've tried over the years. The BigRiver shopping site sells it. Get the gel, it isn't as sloppy as the liquid.

I hope this helps. As we get older, the number of things we can do for fun gets smaller. There's no sense suffering when we do them.

Jack
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Mark Featherstone
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Re: Strained medial deltoids in left shoulder

Post by Mark Featherstone » Sun Apr 03, 2016 2:19 am

I appreciate the empathy, Jack! You're right that I should see a physiotherapist. I have been going to an excellent masseuse at the Chinese clinic on campus. The massage helps a lot with other aches and pains, but not so much this particular problem. Can't take ibuprofen type drugs because they do nasty things to my stomach, but I should try a topical anti-inflammatory like Volteren. I always hesitate between heat and cold. But you're right that if I decide to reduce inflammation I should stick with cold. I've ordered the Bigeloil. Thanks!
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Re: Strained medial deltoids in left shoulder

Post by bear » Sun Apr 03, 2016 2:55 pm

You mentioned that you were using a support. Have you tried playing without it. I get the same pain when I've been playing for too long. I've found that sometimes it's easier to move the guitar than to stretch the muscle. I would think that a support would inhibit your ability to drop, tilt or move the neck at will.
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Re: Strained medial deltoids in left shoulder

Post by Mark Featherstone » Mon Apr 04, 2016 1:43 am

bear wrote:You mentioned that you were using a support. Have you tried playing without it. I get the same pain when I've been playing for too long. I've found that sometimes it's easier to move the guitar than to stretch the muscle. I would think that a support would inhibit your ability to drop, tilt or move the neck at will.
I played for several months without a support, and rather used a foot step, but it was a disaster for my back. I am interested in finding alternate positions for the guitar which don't create new problems. For example, dropping the neck any lower is going introduce a nasty bend in my RH wrist. Maybe one those cushions.....
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Re: Strained medial deltoids in left shoulder

Post by bear » Mon Apr 04, 2016 1:26 pm

Mark Featherstone wrote:
bear wrote:You mentioned that you were using a support. Have you tried playing without it. I get the same pain when I've been playing for too long. I've found that sometimes it's easier to move the guitar than to stretch the muscle. I would think that a support would inhibit your ability to drop, tilt or move the neck at will.
I played for several months without a support, and rather used a foot step, but it was a disaster for my back. I am interested in finding alternate positions for the guitar which don't create new problems. For example, dropping the neck any lower is going introduce a nasty bend in my RH wrist. Maybe one those cushions.....
We may be twins. In my 20's, I hurt my lower back picking up something that was too heavy. It has been an on again/off again problem ever since. A couple of years ago I had a thoracic fracture after being trampled by a horse. I also have spinal arthritis with osteophytes. My x-ray looks like it might belong to a Stegosaurus. I use a footstool and a straight back wooden chair. I have a gel cushion (the type used on a wheelchair) that I sit on. I drape a body pillow over the back of the chair and a mesh lumbar support.
I haven't paid much attention to what pieces seem to bother my shoulder. I just react as soon as I feel that little knot/burn by moving the guitar, without interrupting the flow of the piece.
It took me a couple of years to find a comfortable position, but I'm a little stubborn and convinced I can muscle thru it.
2013 Jeff Medlin '37 Hauser 640mm sp
2006 Michele Della Giustina Concert 10 string 650mm ce
2005 Jose Ramirez 4E 650mm ce
2005 Manuel Rodriguez Model C3F 650mm sp
2003 Manuel Rodriguez Model D 650mm ce

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Mark Featherstone
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Re: Strained medial deltoids in left shoulder

Post by Mark Featherstone » Mon Apr 04, 2016 3:50 pm

Wow, bear, you are an inspiration! And a goldmine of good ideas. I am particularly covetous of that gel cushion... BTW, I now think that my muscle "strain" is actually muscle knots or triggers, since they respond positively to heat and massage.
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D.Cass
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Re: Strained medial deltoids in left shoulder

Post by D.Cass » Sat Apr 09, 2016 5:00 pm

I am sorry, but I don't understand how that passage can create any injury. The first measure your shoulder should be down, second measure your wrist should rotate out ( maybe a little rotation of the elbow, but not enough to require a lot of effort from the shoulder), and the second half of the measure wrist rotates to the normal position. The only other thing I can think of would be you are harboring a lot of tension in the neck and should area. Tension can be caused by mentality too. Especially when we come across passages that are giving us fits. I hope things get better soon.

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Re: Strained medial deltoids in left shoulder

Post by Mark Featherstone » Mon Apr 11, 2016 1:08 pm

D.Cass wrote:I am sorry, but I don't understand how that passage can create any injury. The first measure your shoulder should be down, second measure your wrist should rotate out ( maybe a little rotation of the elbow, but not enough to require a lot of effort from the shoulder), and the second half of the measure wrist rotates to the normal position. The only other thing I can think of would be you are harboring a lot of tension in the neck and should area. Tension can be caused by mentality too. Especially when we come across passages that are giving us fits. I hope things get better soon.
I'm quite baffled myself. I got this injury at a point where I felt my left arm was routinely becoming more relaxed, and when I was getting much better at keeping much less pressure from my left thumb on the neck. I've tried to examine whether I unconsciously traded off less grip from my left thumb with more tension in my left shoulder. As you say, I only rotate my left elbow a bit , maybe 15 degrees (?), to play the first part of the second measure. Otherwise my arm is hanging straight down. But I"m sure it's that little tilt in the elbow that provoked the injury after multiple repetitions, perhaps because I unconsciously kept it tense as I repeated the passage over and over.

Paradoxically, I have very recently (i.e. after my original post) had enormous help with stiffness/soreness in both left and right shoulders through the practice of joint mobility drills. I say paradoxically because these drills also involve repetitions of alternate tensing and relaxing of muscle groups, but in a way that is gentle and relatively rapid. My shoulders haven't felt so good in a couple of years, though the deltoid problem is persisting to some degree. Maybe with a bit more time. Here's a link to an intro to joint mobility drills in case anyone is interested:
http://www.traininginparadise.eu/trener ... drills.pdf
Thanks for the good wishes.
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Re: Strained medial deltoids in left shoulder

Post by Mark Featherstone » Fri Apr 29, 2016 2:27 am

There may be one or two people with similar problems, so I'm posting my latest epiphany regarding this issue. First, just to reiterate, it's pretty clear that my lateral deltoid problem is not any muscle damage per se, but rather due to activation of trigger points. I discuss this below/above. Second, and this is the "epiphany", I have a better idea of how I irritated the deltoid (activated trigger points) after reading in Ricardo Iznaola's Summa Kitharologica (vol 1) yesterday. With time, after mis-reading many admonitions to relax my left arm and let it "hang" down, I got into the habit of disengaging the use of my back muscles behind the left shoulder (scapular muscles) such that I really had the impression that my left arm merely hung by the connective tissue at my shoulder. In other words it was very loose at the shoulder joint. I could feel my left arm tugging at the shoulder joint under its own weight. You can argue that it would be impossible to fully disengage those scapular muscles, but my point is that I was doing my best to minimize their contribution.

I think what then happened is that the lateral deltoid was working all by itself to support my left arm when it had to be raised for some fingerings. No help from the scapular muscles. I think this led to strain and activation of trigger points. Isnaola points out that the left shoulder is like the base of an inverted crane, and that base involves a set of muscles that includes those scapular muscles. These have to be employed to achieve what he calls the poised arm. He specifically notes that a hanging left arm does not mean unsupported by the all the muscles that act on the shoulder. My bad. Live and learn.
Francisco Navarro Concert Classical, cedar top, 630 mm scale, 50 mm nut

"The trouble with normal is it always gets worse."
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