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Cortisone shot 6.5 weeks out - effect on condition
05-16-2017, 06:02 AM
Post: #1
Cortisone shot 6.5 weeks out - effect on condition
Hey all. Basically I've just been diagnosed with almost-certain distal clavicle osteolysis- aka weightlifters shoulder. We're waiting on MRI results to get the full picture. But to cut a long story short, the consultant has said that barring anything really unexpected on the scan, a cortisone shot and exercise modification should get me through to the show (and maybe longer).

But my coach here in the U.K. is dead set against the injection, saying cortisone + cortisol, and I will go flat and soft and won't be able to get in shape.

I'd welcome some input from those with more knowledge and possibly experience.

Thanks guys.
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05-16-2017, 10:13 PM
Post: #2
RE: Cortisone shot 6.5 weeks out - effect on condition
(05-16-2017 06:02 AM)Sermolupi Wrote:
 
Hey all. Basically I've just been diagnosed with almost-certain distal clavicle osteolysis- aka weightlifters shoulder. We're waiting on MRI results to get the full picture. But to cut a long story short, the consultant has said that barring anything really unexpected on the scan, a cortisone shot and exercise modification should get me through to the show (and maybe longer).

But my coach here in the U.K. is dead set against the injection, saying cortisone + cortisol, and I will go flat and soft and won't be able to get in shape.

I'd welcome some input from those with more knowledge and possibly experience.

Thanks guys.

Hey Sermolupi,

Sorry to hear about your injury. A few thoughts:

• I'd go with your coach, but this doesn't mean you can't possibly confer with him / her about the right way to go about this.

• The cortisol shot would probably help with pain, etc, but I'd ask your Doc about it possible perpetuating your issue as cortisol itself is osteolytic. Theoretically, you might make it through the show with the shot (which could dig you a larger hole as far weakness at that site), and then recover thereafter. SO, I'd ask about the time course re-mineralization, etc. and your Doc's specific experience with situations like these.

• I'm not a big fat of cortisol shots in general. In many situations, they are used to band-aid an underlying issues (treat pain, not the cause of it). Because of their negative effects on connective tissue structural integrity, many Docs will limit a joint (or even a person) to a maximum of 2 or 3 shots in a LIFETIME (or within a multi-year period of time when training a joint).

• If you came to me as a client, I'd want to know what you've been doing otherwise to treat the pain (NSAIDS, topical, etc.) and if there are ways for you to work around it with different exercises, etc.

-S

-Scott

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The above and all material posted by Scott Stevenson are Copyright © Scott W. Stevenson and Evlogia QiWorks, LLC. All Rights Reserved.
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05-17-2017, 03:04 AM
Post: #3
RE: Cortisone shot 6.5 weeks out - effect on condition
Hey Scott. Thanks for the reply. Lots for me to do/look into but in brief I'm strongly considering surgery post show, subject to the MRI of course.

Is your suggestion to go with my coach because you think he is right - i.e. Cortisone will cause flatness/softness, or for the other reasons you specified?

Essentially I'm trying to gather all the relevant information so I know what my options are and can then make an informed decision.

Thanks!
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05-17-2017, 08:59 AM
Post: #4
RE: Cortisone shot 6.5 weeks out - effect on condition
To add a little further detail:

*the surgeon is nationally regarded and has experience working with bodybuilders and powerlifters. That said, I certainly now have some things to ask.

*he has said basically that if the MRI shows mild degeneration to the clavicle, then rehab plus exercise modification is likely to be successful, though I might have to accept that I will never be able to go heavy on certain exercises without risking a recurrence. ('Get used to pressing in the 12-15 range with absolutely perfect form').

* If the degeneration is more severe and/or the MRI shows significant other pathology, and I wish to continue training with a view to competing, he would recommend surgery as conservative treatment is unlikely to be successful without a very long layoff (6 months minimum, potentially 2 years).

*in short, a lot depends on the MRI result. We're dealing in hypotheticals until then.

*naproxen offers moderate relief, as does cocodamol. The combination of the 2 is very effective. I'm not especially keen on the prospect of using either/both for an extended period, however. Ice doesn't do a lot. Kwan loong helps a little bit but regular application is causing dry and flaky skin.

*overhead work is essentially out - overhead presses, dumbbell pullovers, and lat pull downs are the especially bad. Seated cable presses and single arm cable pull downs work ok provided I don't go heavy. Wide grip upright rows, lateral raises and monkey rows are all ok.

*pressing is hit and miss. Closer grip incline barbell is ok, at 12+ reps. Ditto incline dumbbell provided I don't go too wide. Hammer strength presses are ok, incline better. Decline cable flyes are out. Decline press has always irritated my shoulders, as have dips, though machine dips are ok (again, if weight kept moderate).

*reverse pec Dec for rear delts is probably the single most painful exercise. Prone reverse db flies are fine.

*i can't put much weight on the shoulder for a front squat or hack.

* As soon as we have the scan results- assuming they're not catastrophic- I'll be seeing a good physio who has experience working with strength athletes to see how he can help. For the moment I'm working on posture and releasing soft tissue.

Sorry for the essay!
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05-17-2017, 09:25 PM (This post was last modified: 05-17-2017 09:33 PM by Scott Stevenson.)
Post: #5
RE: Cortisone shot 6.5 weeks out - effect on condition
(05-17-2017 03:04 AM)Sermolupi Wrote:
 
Hey Scott. Thanks for the reply. Lots for me to do/look into but in brief I'm strongly considering surgery post show, subject to the MRI of course.

Is your suggestion to go with my coach because you think he is right - i.e. Cortisone will cause flatness/softness, or for the other reasons you specified?

Essentially I'm trying to gather all the relevant information so I know what my options are and can then make an informed decision.

Thanks!

The shot would have that effect, but it would be relatively transient in my experience, i.e., it wouldn't cause water retention issues that far down the road.

As far as your post with symptomatology, it does sound like you'll have to wait on the scan. (Sorry if I missed a question in there.)

-S

-Scott

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The above and all material posted by Scott Stevenson are Copyright © Scott W. Stevenson and Evlogia QiWorks, LLC. All Rights Reserved.
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05-18-2017, 10:43 PM
Post: #6
RE: Cortisone shot 6.5 weeks out - effect on condition
Thanks Scott. Fingers crossed for the scan tomorrow
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Scott Stevenson (05-20-2017)
Integrative Bodybuilding - Integrate Your Potential!
05-31-2017, 11:46 PM
Post: #7
RE: Cortisone shot 6.5 weeks out - effect on condition
Well I now have a dilemma.

The MRI shows 'moderate' degeneration to the distal clavicle.

I can, in the specialist's words, 'try' to work round it with exercise modifications, physio, and possibly cortisone. That 'might' buy me anything between 6 weeks and several years, but in his view it is 'very probable' that the condition will progress albeit slowly and I will need the surgery 'at some point' if I want to continue training at a level sufficient to compete at the level I want to. I 'could' be lucky - a few people are.

I'm fortunate to be in a position where the cost is being covered for me, but my decision is this: do I have the op pretty much straight after my comp, and accept 4-6 months rebuilding now, or wait until I really really need it (but with somewhat compromised training until then and the possibility of doing some further damage in the meantime). I'd say my training today (upper load/lower pump) was very productive, but I am sore-ish now (3-4/10).

If anyone has any experience with comparable shoulder procedures, I'd be keen to hear.
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06-01-2017, 12:16 AM
Post: #8
RE: Cortisone shot 6.5 weeks out - effect on condition
(05-31-2017 11:46 PM)Sermolupi Wrote:
 
Well I now have a dilemma.

The MRI shows 'moderate' degeneration to the distal clavicle.

I can, in the specialist's words, 'try' to work round it with exercise modifications, physio, and possibly cortisone. That 'might' buy me anything between 6 weeks and several years, but in his view it is 'very probable' that the condition will progress albeit slowly and I will need the surgery 'at some point' if I want to continue training at a level sufficient to compete at the level I want to. I 'could' be lucky - a few people are.

I'm fortunate to be in a position where the cost is being covered for me, but my decision is this: do I have the op pretty much straight after my comp, and accept 4-6 months rebuilding now, or wait until I really really need it (but with somewhat compromised training until then and the possibility of doing some further damage in the meantime). I'd say my training today (upper load/lower pump) was very productive, but I am sore-ish now (3-4/10).

If anyone has any experience with comparable shoulder procedures, I'd be keen to hear.

I wish I could help more, man.

Have you looked into PRP or stem cell therapy?...

-S

-Scott

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The above and all material posted by Scott Stevenson are Copyright © Scott W. Stevenson and Evlogia QiWorks, LLC. All Rights Reserved.
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06-01-2017, 01:19 AM
Post: #9
RE: Cortisone shot 6.5 weeks out - effect on condition
(06-01-2017 12:16 AM)Scott Stevenson Wrote:
 
I wish I could help more, man.

Have you looked into PRP or stem cell therapy?...

-S

Thanks anyway Scott. Stem cell therapy is 3-4 times the cost of the surgery (c. £12-15000 vs £4000). PRP is more reasonably priced but if I'm honest I don't know much about it or its likely success. An admittedly brief google search hasn't turned up much for its use for the treatment of my condition. It's probably worth looking into further.

As things stand I think just getting the surgery done is my best option long term, but I can't say I'm looking forward to it or the prospect of a long-ish recovery period.
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06-01-2017, 10:26 PM
Post: #10
RE: Cortisone shot 6.5 weeks out - effect on condition
(06-01-2017 01:19 AM)Sermolupi Wrote:
 
Thanks anyway Scott. Stem cell therapy is 3-4 times the cost of the surgery (c. £12-15000 vs £4000). PRP is more reasonably priced but if I'm honest I don't know much about it or its likely success. An admittedly brief google search hasn't turned up much for its use for the treatment of my condition. It's probably worth looking into further.

As things stand I think just getting the surgery done is my best option long term, but I can't say I'm looking forward to it or the prospect of a long-ish recovery period.

It seems this hinges on cost. Have you looked into surgical options worldwide?... (Just thinking about the things I would do if in your situation, at it seems you're paying out of pocket anyway.)

-S

-Scott

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