I had a long-standing general pain in my right shoulder, and then it got really painful, along w/ a really funky feeling sensation in what felt like my right clavicle as well. I'd already had some foot surgery earlier in 2008 so I had already paid up my yearly deductible and decided to go get the MRI. The first doc I saw decided that there was a pinhole tear in the rotator and to try rehab. I did that for a month and nothing changed, so I got 2 other opinions from a couple other docs (all this was done at Stanford Hospital so I was working w/ some excellent doctors). We all decided to do some arthroscopic surgery - and repair whatever they found in there. It ended up they never saw any tears, but cleaned up some frayed tendons, took out some arthirits (the funky feeling in my clavicle) and scraped back the bone to allow a little more room / less compression on any inflammation in the joint. Granted there was noi repair done and only clean up, the healing process was about a month from surgery to completely done w/ rehab. By the time I was out of rehab, I had full ROM but was still moving 1-2 lb weights. Within another month I was at full capacity for the most part, and had already started prep for another show.
Unfortunately I seem to have jacked it again - a week before my last show in 2010, being completely depleted and dropping water already, I was doing too-heavy Arnold presses and jacked it. It hasn't been the same since - gets tired quickly and always causes the muscles in my upper right back to engage where they shouldnt' and end up w/ everything out of whack and needing regular readjustment and knots taken out via chiro + massage. I've cut way back on my training in pursuit of dropping to a smaller category for competition and the time off has helped a lot, but I haven't gotten it MRI'd recently to really know what's up yet.
On a side note, I just saw Charles Poliquin post this article on FB - training around a shoulder injury leveraging structural balance. Excellent article and gives some good guidance around just how much volume / frequency is appropriate for shoulders. Because they are tangentially involved in all upper body work, they tend to get overtrained very easily. And being such a complex joint and also so integral to other stuff we do outside of the gym, continued overwork.
How to Train Around an Injury: Shoulders | Poliquin Article
Although knee injuries seem to attract the most attention from the media, shoulder injuries are just as common ? and are especially frustrating to resolve. Among the most common injuries are collarbone fractures, frozen shoulders, labral tears, rotator cuff impingement and tears, and shoulder dislocations and separations. Many shoulder injuries are a result of accidents, some due to overuse, and some are simply a result of poorly designed workouts. Case in point: the bench press.
There is no question that the bench press is the most popular weight training exercise. Yes, the squat is king, but if you compare the number of trainees working out on their own who perform bench presses and the number who perform squats, you?ll find it?s no contest. The bench press is so popular that many trainees perform the exercise several days a week, year-round. And whenever there is a lack of variety, overuse injuries are likely to result.
You can often speed up the healing process by addressing the buildup of adhesions within the muscle, between muscle groups or between the nerve and the muscle. Adhesions can occur in any muscle structure, but the one most often responsible for bench-press-induced shoulder pain is the subscapularis muscle, which is involved with medial rotation of the upper arm and as such is considered a workhorse in pressing exercises. The good news is that adhesions can be found and ?cured? quickly, such as with a soft-tissue management technique called Active Release Techniques?, or ART.
While taking the appropriate steps to resolve a specific shoulder injury, you should use this time productively to work on other areas of the body that could be weak, such as the legs. If holding the bar in conventional squats causes pain, consider many of the variations of cambered barbells that allow you to position your hands lower, or perhaps the ?safety squat? bars. And of course there are always leg press and hack squat machines. Although exercises involving pressing movements may be out of the question for the meantime, you may be able to handle pulling motions, enabling you to do specialized work on the upper and mid-back muscles.
For trainees whose shoulder injuries have healed sufficiently to resume training, here are two practical suggestions.
First, keep in mind that only 20 percent of your training volume for pressing exercises should be performed from a supine position. The remaining 80 percent should be from an incline, decline or standing position. Further, 50 percent of presses should be performed with dumbbells because they offer a more natural movement pattern and provide a more challenging workout for the muscles that stabilize the shoulder. Following the above guidelines will go a long way in helping to resolve overuse injuries, or at least prevent them from becoming worse.
Second, make structural balance a priority. The concept of structural balance refers to the strength ratio between two muscle groups. A ratio that is off-kilter can predispose an individual to injury. For example, if the strength of the pectorals is significantly greater than that of the external rotators of the upper arm (teres minor and infraspinatus), this could result in a sharp pain in the superior anterior portion of the upper arm. More specifically, rotator cuff strength should be about 9.8 percent for 8 repetitions of what you can lift in the bench press for 1 repetition.
Even if you?re not ready for pressing exercises, you still must make structural balance a priority, especially in the muscles that externally rotate the shoulders and those that pull the shoulders backward. The following upper body workout contains no pressing but includes two specific exercises to improve structural balance in the shoulders. It uses a combination of station training (all sets of an exercise are completed before moving to the next one) and supersets:
A. Sternum Chin-up, 5 x 6-8, 4010, rest 120 seconds
B1. EZ Bar Pronated-Grip Bent-Over Row, 3 x 8-10, 3011, rest 10 seconds
B2. Seated Rope Rowing to Neck, 3 x 10-12, 3011, rest 90 seconds
C. Wide Pronated-Grip Lat Pulldown, 3 x 12-15, 3010, rest 60 seconds
D1. 30 Low-Pulley External Rotation, 3 x 12-15, 2011, rest 60 seconds
D2. 30 Incline Trap 3 Raise, 3 x 10-12, 3011, rest 60 seconds
Once you?ve recovered from a shoulder injury, follow the training advice in this article to ensure you can train hard and pain free.
Copyright ? 2012
