rotator cuff

N

naiveguy

New Member
I think I've injured my rotator cuff--I feel some minor shoulder pain when I raise my left arm to the side. There's no pain if I raise my arm in front of my body, or straight overhead. The strange thing is that the pain set in two days after my last workout (I'm in the last week of my 9th hst cycle, and my last workout consisted of deads, push presses, bent-over rows, and weighted dips.) I'm planning to rest for two weeks, and was wondering when I should start trying some rehab exercises, such as
these
Should I wait a few days before trying some of those exercises?

Thanks in advance for any advice,

Tim
 
Hi Tim,

I have bursitis on my left shoulder due to a rotator cuff injury. I'm sure yours is not that serious but it's better to be safe than sorry.

I had to take a year off while going to a rehabilitation center for it to heal enough so that I can start working out.

I would suggest taking time off from working out till the pain goes away. In the mean time while you're resting, make sure you do the rotator cuff exercises & simple stretches just to get the "Burn". Do not over-do it, it's all about how many reps you do not how much weight you can use. Then at night, try to put an icepack or a bag of frozen peas over your shoulder to ease the burn.

Also, always always always warm up before you workout. You want to warm up your muscles rather than stretching. Once it's warmed up then it's most beneficial to stretch.

Hope you get better quick!
 
Thanks, sayw0rd.  I always have been careful about warming up, doing about ten minutes of light cardio followed by some dynamic stretching--squat thrusts, overhead squats with an empty bar, etc, followed by warmup sets before all my work sets.

I wonder if anyone here has tried this piece of equipment:shoulderhorn

Tim
 
I'm going to try to see an orthopedic doc next week. And today I ordered the shoulderhorn (link in my post above). Keeping my fingers crossed that I'm not looking at a long layoff from training.
 
When I broke my shoulder and tore the rotator cuff, the biggest help I found was a shoulder harness with special magnets. It improved my range of motion about 70% after one night of using it. I would recommend that you use only Nikken magnets as they are the only ones that I personally know that work.

BTW, that shoulder horn looks like a decent piece of equipment. Jus make sure you start with the pink dumbells!
smile.gif
 
what is the shoulder harness with magnets, old and grey? Was it something a physical therapist suggested?

I'll post here (or maybe in the equipment forum) about the shoulder horn once I've had a chance to use it for a while.
 
First of all, see a doc like all these guys suggest.  Then, read on...

Doesn't seem like you have anything seriously wrong with the a/c joint.  Most likely you have either subscapularis tendinitis or an impingement of the supraspinatus tendon.  Both of these are tiny muscles that aren't well irrigated by blood, so it takes a long time to heal.  

The subscapularis medially rotates the humerus, so it keeps it in a correct position when you bench.  Do a bench press.  If it hurts when you push the bar off the chest, it's probably the subscapularis.  The supraspinatus abducts the humerus, so if it hurts when you try to raise your arm laterally, it's most likely the supraspinatus that's injured.

All that babble was just to give you an idea of what might be injured, but I think the catalyst to your problem is that  you have an imbalance.  When this happens, these tiny muscles have to overcompensate and then you have injury.

Here's my solution:
Stop benching or doing any overhead movement for a period of 12 weeks.  Do nothing but elevated close grip pushups for your chest & shoulders.  This will build up your serratus anterior.  Go here to learn the why and hows ---  http://www.t-nation.com/free_online...ing_performance/pushups_face_pulls_and_shrugs

Do this HST style (3 times per week).  Do 3 sets of high repetitions.  If you can do more than 30 reps, do them weighted. Work it hard.  After 12 weeks, you may slowly get back into benching/overhead pressing.  Make these close grip pushups part of your permanent routine (to keep yourself balanced) for the rest of your workout life.  This has worked wonders for me. You MUST stop benching and doing overhead pressing for the first 12 weeks. It sucks, but it's worth it.
 
Great post Steve.  I too have had shoulder issues for the last 4 months and I fall into the category of pain when benching or pressing overhead.

My question is what exercises for chest / shoulders could I still incorporate whist on this rehab routine? I feel no pain with low cable flyes or low decline bench flyes for chest and likewise no pain on lateral / front / rear raises for shoulders. I can get away with dips where I really lean into it even when strapped with a fair bit of weight but I'm guessing these are a bit too risky. What do you recommend?
 
Hi Steve,

Thanks for the great post--thoughtful and very informative. I read the article at T-nation. Quite an eye opener. A couple of questions (in addition to the ones asked by rpopple). How do you incorporate the pushups into your routine after the 12-week rehab? Do you alternate with benches or dips in an A-B scheme?
What do you use to increase the resistance? Chains? I checked out the xvest mentioned in the T-nation article, and it looks like a great product:  xvest

Thanks again, Steve. This site is fantastic, the best place on the web, I think, for intelligent information about training.
 
<div></div><div id="QUOTEHEAD">QUOTE</div><div id="QUOTE">My question is what exercises for chest / shoulders could I still incorporate whist on this rehab routine?</div>

I can't in good conscience recommend any kind of shoulder or chest movement except the pushup for the first 12 weeks, especially when it comes to an exercise like dips, which require strict form to avoid putting undue stress on the shoulder joint. Just one slip up causes too much damage while your shoulders are trying to heal.

<div></div><div id="QUOTEHEAD">QUOTE</div><div id="QUOTE">How do you incorporate the pushups into your routine after the 12-week rehab?</div>
When I do HST, I do them after I finish my workout.  I do a 2 week cycle, using progressive resistance (65%*, 72%, 79%, 86%, 93%, 100%)  I always do 3 sets every workout day, and subtract 10 on each set, so if I do 30 on the first set, I only do 20 on the second set, then 10.  Always elevated, always close grip.  

*65% of maximum number of pushups

When I'm on my plifting routine (which I usually am), I have my heavy days &amp; light days.

So, nothing magical about this setup, just how I choose to do them.

<div></div><div id="QUOTEHEAD">QUOTE</div><div id="QUOTE">What do you use to increase the resistance?</div>
I use a weight vest.  If you can do over 30 elevated close grip pushups wearing a 100lb vest or weights on your back, then you're out of my league, and I should probably be taking advice from you.

<div></div><div id="QUOTEHEAD">QUOTE</div><div id="QUOTE">Thanks again, Steve. This site is fantastic, the best place on the web, I think, for intelligent information about training.</div>
I'll assume you're talking about this website and not t-nation. Every now and then, t-nation has some good stuff, but I've seen a ton of garbage on there also.  Kind of like most sites out there.  I actually first ran across that article when someone on this site posted it about 1.5 yrs ago. Kind of scoffed at the idea at first, but did it anyway.  Didn't notice any real results until I was about 5 weeks into it.  I have a shoulder horn, several RC manuals, tubing, bands, etc. etc. These all helped me alot, but nothing has worked as well as these pushups.  I don't even do RC exercises anymore.  I can do flat benching with a grip as wide as 28&quot; and it doesn't bother me (not in the shoulders anyway).  Doesn't happen overnight though. Just slow steady improvements.   I've never tried magnets like Old and Grey.   Sounds like those help quite a bit.
 
Yes, Steve, I was talking about this site.


Thanks for the link, O&amp;G.

So, my plan: SD for the next two weeks, which means I miss the last three workouts of my current cycle. After two weeks (assuming my doctor okays it) I'll start another hst cycle, which I think will look like this:

A
squats
chins (maybe palms facing each other to make it easier on my shoulder?)
elevated pushups
shoulderhorn work with v. light weights, maybe pink ones

B
deads
bent-over BB rows, Rippetoe style (weight to floor after each rep)
elevated pushups
shoulderhorn work

I'll stick with that for 12 weeks, then carefully resume my regular hst workout, identical to the above A/B plan but with powercleans and benches added to A and overhead presses and dips added to B.

How's that look?
 
<div>
(naiveguy @ Nov. 06 2008,5:37)</div><div id="QUOTEHEAD">QUOTE</div><div id="QUOTE">Yes, Steve, I was talking about this site.


Thanks for the link, O&amp;G.

So, my plan: SD for the next two weeks, which means I miss the last three workouts of my current cycle. After two weeks (assuming my doctor okays it) I'll start another hst cycle, which I think will look like this:

A
squats
chins (maybe palms facing each other to make it easier on my shoulder?)
elevated pushups
shoulderhorn work with v. light weights, maybe pink ones

B
deads
bent-over BB rows, Rippetoe style (weight to floor after each rep)
elevated pushups
shoulderhorn work

I'll stick with that for 12 weeks, then carefully resume my regular hst workout, identical to the above A/B plan but with powercleans and benches added to A and overhead presses and dips added to B.

How's that look?</div>
First and foremost, what your doctor says takes precedence.  Once he gives his diagnosis, we'll know alot more about what is wrong with your shoulder.

I like everything except the bent over BB rows.  See, the serratus anterior is the muscle that causes the scapula to move forward.  If you do barbell rows, you're causing the scapula to retract, and that (I think, providing your doctor confirms this) is your problem. For these 12 weeks, you want to try to become balanced by focusing entirely on protraction.  So, I recommend replacing the bb rows with face pulls or, better yet, MORE PUSHUPS.  I know it sucks and you feel like you won't be working your back at all, but 12 weeks is really a short amount of time over the long haul.   The only other problem I see is your choice of dumbbells.  I prefer baby blue or fuschia over pink.
 
Thanks again, Steve. I'll do chinups instead of the rows for the B workout. But I'll probably still go with pink weights with the shoulderhorn.
 
Steve, you have some good ideas.  Are you a physical therapist?

The reality is, there's nothing magical about the incline close grip pushup.  That's just the particular angle which you have found that allows you to contract your serratus with the most control.  I personally prefer single arm dumbell on an incline bench for my serratus.  I do them in neutral (palms in) and full internal rotation (palms forward).

And just to clarify, Steve's example is the same movment as a close grip decline barbell bench press.

Edit: also doing rows should not affect your serratus. That's like saying don't curl if you have a tricep injury.
 
<div></div><div id="QUOTEHEAD">QUOTE</div><div id="QUOTE">are you a physical therapist</div>
nope...and these aren't my ideas. This is just information I get off the web.

&quot;rows potentially promote a downward scapular rotation syndrome and internal rotation of the shoulder joint&quot;  I pulled that off the webpage.  This indirectly effects the serratus.   There is nothing wrong with presses &amp; rows, but neglecting movements that involve pulling and rotation can cause an imbalance, which is what I propose that might be wrong with naiveguy

Yeah, I've heard of the dumbbell incline bench to work the serratus,  so on the surface it might be a good exercise to do.  The whole point of all my suggestions is to not retract the scapula and focus only on protraction to try to get your balance back.  So, whatever accomplishes that is good in my book.    


.
 
Steve, your research is solid bro. And regarding your last point, you hit the nail on the head. As long as you're protracting the scapula, you're accomplishing the goal.

Protraction can be performed in a &quot;punching&quot; motion at the end of a push move. Picture your shoulder blade wrapping around your chest and moving forward after your elbow is already extended. The &quot;punch&quot; should be a slow controlled move to be sure you feel the serratus contract.

By the way fellas, the serratus is a real thin muscle. So even super light dumbells work great, like in the 15-25 pound range. The reason I prefer 1 arm at a time is twofold.

1) You already have pathology or pain on 1 side. So it's not reasonable to think that both sides are going to have symmetrical mechanics.

2) The mind muscle connection to the serratus is difficult for some. It might take a bit more mental focus to get this one down pat.
 
Just a thought from someone who has had a partial thickness tear of the supraspinatus (rotator-abducting of the arm).

Look to the condition of your scaps. Are they protracted slightly? Do you have slight rounding of the shoulders? Do you sit at a desk? If so then it sounds like impingement and postural issues. No amount of work or horns will help if you don't fix posture during other 23 hours in a day.

My improvement came with improvement to upper back strength and stability in the following movement. The more I was able to row chest to the bar, the more I improved. This along with bodyweight only rehab.

http://www.youtube.com/watch?v=dvkIaarnf0g

These have been very helpful in my rehab in conjunction with the help of my sports med doc. I took some of this stuff to my PT who was in agreement with most of it.

http://www.t-nation.com/article....ers&amp;cr= The first part (by Cosgrove) was particularly helpful as part of my rehab strategy. The mobility tests were an eye opener for me.

http://www.t-nation.com/article....iii&amp;cr= parts 1,2 linked at top.

http://www.t-nation.com/article....ugs&amp;cr=
 
Thanks for the links, tonester. I'm going to be seeing a sports medicine doctor on the 19th of this month. I think whatever I did was quite minor, because I don't feel any discomfort in my shoulder at all now, but I'm still planning on avoiding benching and overhead presses for the next 12 weeks, as Steve suggested. I think the problem started when i did a very stupid thing during a warmup bench press set. I tried adjusting the angle of my upper arm while I had the bar on my chest; moving my arm around that way with a loaded bar probably wasn't the smartest thing to do.
 
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