T Nation

Best Approach for Shoulder Rehab?


#1

I recently started a thread asking for advise as to what I need to do to resolve my shoulder pain. I did a chest workout yesterday and today I had to come home from work early as my delt was pinging!

I will take the advise given to me regarding form,routine (which I plan to post later for you guys to take a look) and warm up exercises but for now I've come to the conclusion that I need to take a break from my workouts.I've put my body through hell this year and it has finally taken its toll.

I have been clean bulking for about 3 months and due to a strict diet with no cheat meals I have achieved some great results but have managed to put on a bulk belly. ( I used to have a beer belly so it tends to go back there very easily)

If I am to stop working out for any period of time how should I go about diet and exercise?

Obviously I would stop eating at a calorie surplus...That's a no-brainer.

Should I eat at maintanence level and add some cardio?

Calorie deficit with some cardio to get rid of some chub? (whilst keeping leg days and deadlifts)

Up the protein,BCAA's, glutamine,good fats and lower the carbs? (like a mini cut)

I don't know what to do and I'm not sure how long it will take to recover from this shoulder injury so what approach should I take in the meantime?


#2

1.Try to find ONE pressing movement that does not hurt. For me It was either DB incline or floor press. Only do that one movement, ramp to ONE work set a week.

  1. Increase volume and excersises for your back. Shrugs, face pulls, Dumbell powercleans, dumbell rows are personally my favorites for shoulder rehab. DB rows, and seated DB powercleans especially.

  2. internal and external rotations on a shoulder stack

  3. Are you doing lateral raises? Do them.

5.What does your posture look like? slumped forward shoulders? Fix it.

  1. I needed to avoid pulling hard and dynamically on my vertical pulling movements. YMMV, avoid it anyways however. A consistant amount of force pull from top to chin level may help

  2. Warm your shoulders up with lateral raises, front raises, arm circles with 2.5-10pound weights 1x12 for each movement before bench pressing.

  3. More information may by helpful


#3

What worked for me after a bad shoulder separation:

Resting for a long time - longer than I thought I should have, when in reality I should have rested more.

Doing extra work for the upper back and smaller muscles around the shoulder (facepulls, DB pullovers, external and internal rotations, etc.)

Easing back into shoulder and chest training very lightly and cautiously after a while, and emphasizing good form.

Stretching daily, and taking an anti-inflammatory after upper body workouts (only if needed).

Above all, the most important things to recovering (and I’m not even 100% yet, after 6 months) were: REST, doing a shoulder-prehab warmup before each upper body workout (YTW+ext. rotations), REST, keeping bloodflow and heavy circulation through the injured shoulder with stretching and light dumbbell movements, REST, avoiding anything that caused pain, and REST.


#4

I would like to add ice shoulder injuries as often as possible if it is a joint/inflammation issue. 3 times a day at minimum, which can be a pain, but it is very helpful.

I would do ice packs for 20 minutes at work usually 2-3 times/day, then ice massages morning and post workout. Easiest way is to take styrofoam or dixie cups, fill them w/ water and stick them in the freezer. Afterwards peel away part of the cup and massage it in and around the area. Do this for about 5 minutes, or until the area is numb to the touch. Make sure to move the ice around so you don’t give yourself frostbite.


#5

I would like to also add… LOL @ “clean bulking for 3 months” and getting a “bulk belly”


#6

Thanks for your replies guys.

I don’t completely understand all of what was mentioned therefore I am researching you replies before I discuss this any further as I don’t want to waste your time. Time is something that I’ve been short on this last week.

My physiotherapist is suggesting very similar stratagies but it seems you guys are more familiar with this kind of injury.

He got a second opinion today from a more experienced physiotherapist and they seem quite puzzled as to why it is causing the pain and said that it is not a typical “common” injury. They did say that I had a well balanced muscle development therefore they believed it is not my routine that is the problem but I will post that later anyway. Over development of my traps were mentioned but discounted.

While benching the pain is not severe until I put the barbell down and THEN its hit me hard at the back of shoulder and back of my delt.

I will research what I dont understand from your replies, put it into practice and then I will have more info to discuss this matter further and hopefully remedy this problem as fast as possible.

Thank again guys for your advise as this is really frustrating for me.

P.S. To Mr Popular

At the start of this year I looked like a beached whale ( due to my love for beer and spirits) and I went on a < 30g carb a day diet with high intensity, long duration cardio for 14 weeks until I nearly faded away… But I STILL had the remains of a beer belly even after losing over 35lb! I had to just draw the line and start a bulk. It’s been 3 months now and I have put on 19.8 lb some of which will be water as I was completely carb depleted at the start of my bulk but ,yeah its a bulk belly for sure.
I’m not sure if im gaining weight too fast but as far as I know my diet is near perfect.

Cheers!


#7

[quote]mr popular wrote:
What worked for me after a bad shoulder separation:

Resting for a long time - longer than I thought I should have, when in reality I should have rested more.

Doing extra work for the upper back and smaller muscles around the shoulder (facepulls, DB pullovers, external and internal rotations, etc.)

Easing back into shoulder and chest training very lightly and cautiously after a while, and emphasizing good form.

Stretching daily, and taking an anti-inflammatory after upper body workouts (only if needed).

Above all, the most important things to recovering (and I’m not even 100% yet, after 6 months) were: REST, doing a shoulder-prehab warmup before each upper body workout (YTW+ext. rotations), REST, keeping bloodflow and heavy circulation through the injured shoulder with stretching and light dumbbell movements, REST, avoiding anything that caused pain, and REST.[/quote]

What he said. Rest, rest and rest.

In my personal case, I suffered from chronic shoulder pain for a long time, but I kinda sucke it up. Then my bench press starting dropping down to the point I could not do anything with more than a 45lbs plate on each side of the bar.

So I completely took off chest training for about 2 years. Plus, but trial and error and some consulting, I ended up with a long list of stuff that over the course of time helped me tremendously:

  1. Rest (did I mention that?)
  2. Get a few deep tissue massage sessions on the shoulders, chest and triceps (it’s going to hurt like a bitch).
  3. Stretching both internal and external shoulder rotators.
  4. Strengthen the external shoulder rotators (face pulls, lots of it).
  5. Strengthen the internal shoulder rotators without engaging the pecs major.
  6. Strengthen the serratus anterior (push ups on a stability ball do this.)
  7. Avoid front, lateral and rear delts for a while (a long while.)
  8. Increase flexibility in your neck and improve shoulder depression.
  9. Lots of stability work (dips on rings and push ups on stability balls.)

Once I was able to bench press again, I opted for the pbuilder form, elbows tucked in. I never flare my elbows out unless I’m using a light weight in the vicinity of 12 to 20 reps. Anything heavier than my 8RM, elbows tucked in.

Another thing that help is to try to do twice as many “pulling” reps as “pushing” reps. The moment you tip that balance in favor of “pushing” exercises, that’s the moment your shoulders and chest might start bitching.

Take it for what it is, just anecdotal stuff that worked for my specific situation. Hope it helps.


#8

It’s been more than two weeks now and although I’ve tried all the advise given to me by you guys on this thread my shoulder pain is still just as bad as it ever was. The pain has been fine only because i took all pressing exercises out of my routine as I could not get away with incline nor dumbels.
Today I just performed about 12 push-ups and bang there it was… instantly came back.
I’m fucking devastated!
My physiotherapist is baffled as to why it is causing the pain and he’s had a second opinion from another physio.
Do you guys know how effective cortosone injections can be for rear shoulder pain?
I’ve heard mixed opinions about cortisone injections and I just would like to know if any of you guys have had them and if so how it went.


#9

If it’s in your deltoid it may be a irritated tendon of the biceps (probably the long head). There was an article here on T-Nation where it said that eccentric training (only lowering the weight) would make the tendon stronger, so it doesn’t get irritated as easy.

I myself had this kind of shoulder pain for quite a long time and I tried eccentric training with biceps curls and I found that after 2-3 weeks of eccentric training and not doing bench pressing the shoulder pain got better and vanished.
But still from time to time it pops up when I’m doing much bench pressing.

About the cortisone injection: it weakens the tendon so there is a greater risk afterwards of tearing it (and the success rate is quite low if I remember right.


#10

[quote]McMuscles wrote:
It’s been more than two weeks now and although I’ve tried all the advise given to me by you guys on this thread my shoulder pain is still just as bad as it ever was. The pain has been fine only because i took all pressing exercises out of my routine as I could not get away with incline nor dumbels.
Today I just performed about 12 push-ups and bang there it was… instantly came back.
I’m fucking devastated!
My physiotherapist is baffled as to why it is causing the pain and he’s had a second opinion from another physio.
Do you guys know how effective cortosone injections can be for rear shoulder pain?
I’ve heard mixed opinions about cortisone injections and I just would like to know if any of you guys have had them and if so how it went.[/quote]

How long did you COMPLETELY REST that part of your body?


#11

2 weeks of no pressing at all… the pain completely vanished until I tried some push-ups today…it was only minor pain therefore I stopped straight away but It’s prominent enough to know that i can’t lift anything serious.
I’m still resting it now as I’ve cut pressing out all together but usually tommorrow is my chest day and I was just seeing where I was at injurywise.

I have been doing a lot of extra pulling exercise as well as rehab exercises and was just hoping that they may have helped somewhat.


#12

As has been said, shoulder injuries tend to take a long time to heal for whatever reason, and you will see your best results by just sucking it up and resting the damn thing for a good month or two before you “test it out”. In the meantime, by all means work on whatever you can but definitely don’t do ANYTHING that causes any kind of pain or tightness in the area.

  • ice and stretching

#13

[quote]mr popular wrote:
As has been said, shoulder injuries tend to take a long time to heal for whatever reason, and you will see your best results by just sucking it up and resting the damn thing for a good month or two before you “test it out”. In the meantime, by all means work on whatever you can but definitely don’t do ANYTHING that causes any kind of pain or tightness in the area.

  • ice and stretching[/quote]

Yeah your right. Thanks a lot for your help.
I’ve just done everything in my power this year to get the best results possible in the shortest amount of time and my results have been greater than I imagined therefore this has been a real kick in the gut that’s hard for me to accept.
I have been working a 4 day split (working 1 muscle group per week) so now I’ll need to come up with a different routine that doesn’t involve pressing at all.
My routine has been:

Mon-chest/tric
Tues-legs
Wed- Off
Thur- Back/bic
fri- Off
Sat- Shoulders/Deadlifts
Sun- Off

During the last two weeks I have simply moved triceps to Thursdays and have been working out 3 days a week.

I’m a little confused as to what routine I should be following now that chest days are out of the question.

Do you think that I’m able to work muscle groups twice per week now? I know a lot do but as I started from virtually no muscle whatsoever it really has been taking a full week to recover.

Without any advise I was just planning to forget about what day of the week it is and workout as follows-

back/bic
legs
off
shoulders
deadlifts
back/bic …ect

But I’m open to advise.

Cheers


#14

[quote]McMuscles wrote:
mr popular wrote:
As has been said, shoulder injuries tend to take a long time to heal for whatever reason, and you will see your best results by just sucking it up and resting the damn thing for a good month or two before you “test it out”. In the meantime, by all means work on whatever you can but definitely don’t do ANYTHING that causes any kind of pain or tightness in the area.

  • ice and stretching

Yeah your right. Thanks a lot for your help.
I’ve just done everything in my power this year to get the best results possible in the shortest amount of time and my results have been greater than I imagined therefore this has been a real kick in the gut that’s hard for me to accept.
I have been working a 4 day split (working 1 muscle group per week) so now I’ll need to come up with a different routine that doesn’t involve pressing at all.
My routine has been:

Mon-chest/tric
Tues-legs
Wed- Off
Thur- Back/bic
fri- Off
Sat- Shoulders/Deadlifts
Sun- Off

During the last two weeks I have simply moved triceps to Thursdays and have been working out 3 days a week.

I’m a little confused as to what routine I should be following now that chest days are out of the question.

Do you think that I’m able to work muscle groups twice per week now? I know a lot do but as I started from virtually no muscle whatsoever it really has been taking a full week to recover.

Without any advise I was just planning to forget about what day of the week it is and workout as follows-

back/bic
legs
off
shoulders
deadlifts
back/bic …ect

But I’m open to advise.

Cheers[/quote]

if this injury has been any lesson for you it might do good for you to cross check the following for long term upper body health and strength :

1>your general posture (slouching shoulders–>short pecs, weak neck , protruding chin, weak posterior delts, inactive or sub-active lower traps, lats and serratus , weak rhomboids and poor rotator cuff function) coupled with neutral hip alignment (anterior /posterior pelvic tilt??)

a> http://www.tmuscle.com/free_online_article/sports_body_training_performance/heal_that_hunchback

b> Neanderthal No More series (Part1-5)





c>shoulder saver series



d>although the following addresses training issues for a sedentary desk job oriented lifestyle it could also help to correct postural imbalances and set a base for future progress–

e>great rehab and accessory shoulder stuff – http://www.tmuscle.com/free_online_article/sports_body_training_performance/the_weakest_link

f>another postural analysis and corrective article (a must do set of exercises) http://www.tmuscle.com/free_online_article/sports_body_training_performance_repair/pushups_face_pulls_and_shrugs

g>lower trap activation and integration – http://www.tmuscle.com/free_online_article/sports_body_training_performance/top_priority_for_lower_traps&cr=

h>hip alignment stuff part of postural analysis and correction–

i>http://www.tmuscle.com/free_online_article/sports_body_training_performance_repair/back_on_track
http://www.tmuscle.com/free_online_article/sports_body_training_performance_repair/wanna_grow_gotta_row

shoulder rehab protocol which will set you on the right track as far as upper body health is concerned from the smittydiesel channel on youtube run by Jim Smith (he’s awesome)–

on a personal level i would always recommend you to also accessorize your training with a lot of bodyweight shoulder drills cuz they helped me a lot to rehab my badly injured shoulder and helped in recovering/relearning my shoulder movements which complimented the weight room stuff i was doing–
1>all sorts of leverages of pushups(two armed /wide grip narrow grip, one arm, one arm/one leg, Lalanne pushup, handstand pushups etc.) with progression in mind from easy leverage drills to tough ones like gymnastic ring crosses, even gym ring pushups, ballistic pushups.
2>L-sits. etc.

Hope it helps , this is my first post on T-Nation (has helped me a lot) .Sorry for such damn long post.