Diagnosed with Subacromial Bursitis/Mild Impingement of Supraspinatus

Injuries and Rehab
#1

Hi all,

For 15 years I’ve known something was wrong with my shoulder, repeated trips to the GP’s over that time who merely said, “Ok, lay off training a while”. This all made Benchpressing, Dips and any heavy OHP work a very bad idea - but the pain was still there. Finally my new GP stepped up, and recently sent me for an MRI, and the result on Wednesday is the above for my left shoulder. No other RC damage.

Now, I want to move onto heavy work so I can get my arms and shoulders good and huge. I know I need to do a lot of stretching to bust up the inflammation and create more Subacromial space. How should I ease back into training, and what do I need to do/take to minimise current/future inflammation of the shoulder, if not eliminate it altogether?

Thanks,

Jaybee.

#2

I’m assuming you don’t have a partial or full tear. Look at your scapular mechanics first. Stretching probably wouldn’t hurt but most should problems have to do with a lack of muscle balance/activation so you should peg that down and rehab accordingly. Did your GP say anything about a hypermobile AC joint?

As far as inflammation goes there are so many options today. Fish oils, bromelain, large doses of vitamin c, etc. You can do all that but if you still eat refined sugar and processed foods it’s like pissing in the wind. The best thing in my opinion is just a clean diet.

#3

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#4

[quote]grrrsauce wrote:
I’m assuming you don’t have a partial or full tear. Look at your scapular mechanics first. Stretching probably wouldn’t hurt but most should problems have to do with a lack of muscle balance/activation so you should peg that down and rehab accordingly. Did your GP say anything about a hypermobile AC joint?

As far as inflammation goes there are so many options today. Fish oils, bromelain, large doses of vitamin c, etc. You can do all that but if you still eat refined sugar and processed foods it’s like pissing in the wind. The best thing in my opinion is just a clean diet.[/quote]

That’s cool. Meanwhile, as it’s simple inflammation, does this mean that I’m ok to resume training as long as I don’t mind the pain?

#5

Follow what grrrsauce and BBB recommended. In terms of is it ok to resume training, if it hurts, I’d recommend staying away from pressing movements or anything that causes pain for multiple reasons:

  1. Overuse of pressing movements in your training was probably a huge contributing factor into you developing the subacromial bursitis/impingement, so some time away from the pressing movements or at least performing them minimally would help you out a lot. Replacing the pressing movements with extra pulling movements (with focus on proper scapular retraction/depression) and stretching of the pec major and minor (as BBB recommended) will help open up the subacromial space.

  2. If there is pain and you work through it, your body has the potential to shut down specific muscles neurologically due to that pain. This can result in improper movement patterns and make the situation worse.

  3. With the impingement going on, if you continue to go through motions that cause pain and go into that impingement, you are causing excess irritation and rubbing of those tendons, which can further cause damage and trauma. Basically, you aren’t letting it heal.

#6

Understood, both of you. One further question, what kind of timescales should be expected for full healing?

#7

Depends on severity of the condition and what type and frequency of treatment/rehab. Considering you have had the inclination that something was wrong with your shoulder for upwards of 15 years, I would assume you have some long standing, significant improper motor patterns and muscular imbalances that will probably take some time to correct. I know it isn’t a specific answer in the least, but it’s the best that can be given.

#8

[quote]LevelHeaded wrote:
Depends on severity of the condition and what type and frequency of treatment/rehab. Considering you have had the inclination that something was wrong with your shoulder for upwards of 15 years, I would assume you have some long standing, significant improper motor patterns and muscular imbalances that will probably take some time to correct. I know it isn’t a specific answer in the least, but it’s the best that can be given.[/quote]

Well, on Wednesday I had the first and last shot of Cortisone that I’m going to - and I don’t think it has worked, I can still sometimes feel the pain when I’ve lifted NOTHING, mild though it is. As for Rehab, I will commit to a series of daily exercises and stretches, and I’m willing to give them up to 2hrs per day

#9

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#10

[quote]bushidobadboy wrote:

[quote]Jaybee wrote:
[, and I’m willing to give them up to 2hrs per day[/quote]

Sometimes more does not equal better, especially if you are not doing the exercises 100% correctly.

BBB[/quote]

I agree with BBB here. If you are working with a therapist, I would say upwards of an hour should be the max at one time and that would include manual therapy along with modalities, etc. If you are doing it on your own, 30 mins should be plenty, with focus on proper technique and movement patterns. You can do hours upon hours of “rehab” but if the proper technique and movement patterns are not used, it won’t be worth the time.

#11

[quote]LevelHeaded wrote:

[quote]bushidobadboy wrote:

[quote]Jaybee wrote:
[, and I’m willing to give them up to 2hrs per day[/quote]

Sometimes more does not equal better, especially if you are not doing the exercises 100% correctly.

BBB[/quote]

I agree with BBB here. If you are working with a therapist, I would say upwards of an hour should be the max at one time and that would include manual therapy along with modalities, etc. If you are doing it on your own, 30 mins should be plenty, with focus on proper technique and movement patterns. You can do hours upon hours of “rehab” but if the proper technique and movement patterns are not used, it won’t be worth the time.[/quote]

Fair enough, good form it is, I’ll check out some vids to see that I’m mirroring precisely what needs to be done. I’ll also eliminate refined sugars and other foods known to fuel inflammation.

I’m still unsure about what timescale to expect for improvement in the incidents of pain. Presumably there’s some kind of sliding scale between the frequency/duration/severity of pain, vs the intensity with which I progress with my usual training.

For example, before taking up any OHP/Benchpress work I fully expect I need to have made some progress in reducing the incident frequency/severity etc, for which I need to create a benchmark and follow progress. I’m basically asking what schedules would be commonly realistic, ie if the pain hasn’t halved between zero and X weeks, then try different movements.

#12

[quote]Jaybee wrote:
Fair enough, good form it is, I’ll check out some vids to see that I’m mirroring precisely what needs to be done. I’ll also eliminate refined sugars and other foods known to fuel inflammation.

I’m still unsure about what timescale to expect for improvement in the incidents of pain. Presumably there’s some kind of sliding scale between the frequency/duration/severity of pain, vs the intensity with which I progress with my usual training.

For example, before taking up any OHP/Benchpress work I fully expect I need to have made some progress in reducing the incident frequency/severity etc, for which I need to create a benchmark and follow progress. I’m basically asking what schedules would be commonly realistic, ie if the pain hasn’t halved between zero and X weeks, then try different movements.[/quote]

Couple things that concern me with your response. Checking vids online can be good, but it is a crap shoot. Some vids are good, others are atrocious. I’d highly recommend finding a therapist local to you to see and get some instructional work with. You can do the rehab on your own, but as I said, the videos you find online are a crap shoot as to whether they are quality information and even if they are quality info, they may not be geared towards your specific injury/situation.

Also, you already are asking about benching/pressing movements. I’d recommend taking a good break (several weeks or longer) away from all pressing movements (maybe with the exception of push ups). I’m only making assumptions without a physical eval, but generally people are way too “push” orientated in their lifting and with your prolonged history of shoulder discomfort, as I said before, you would benefit from some focused pulling movements.

The one thing I have forgotten to ask you about is what your goals are. Why are you lifting? Performance based? Sports? To “look good nekkid”?

#13

Consider looking at your lifting mechanics. Perhaps training mechanics are putting your shoulder into positions of impingement. I.e. on bench press, pull your shoulders backwards (scapular retraction). What this does is actually open up the subacromial space.

Consider cycling your exericises. I find that dips and military are the exercises that get me in trouble, but I rotate them in and out of my regimen.

beef

#14

[quote]LevelHeaded wrote:

[quote]Jaybee wrote:
Fair enough, good form it is, I’ll check out some vids to see that I’m mirroring precisely what needs to be done. I’ll also eliminate refined sugars and other foods known to fuel inflammation.

I’m still unsure about what timescale to expect for improvement in the incidents of pain. Presumably there’s some kind of sliding scale between the frequency/duration/severity of pain, vs the intensity with which I progress with my usual training.

For example, before taking up any OHP/Benchpress work I fully expect I need to have made some progress in reducing the incident frequency/severity etc, for which I need to create a benchmark and follow progress. I’m basically asking what schedules would be commonly realistic, ie if the pain hasn’t halved between zero and X weeks, then try different movements.[/quote]

Couple things that concern me with your response. Checking vids online can be good, but it is a crap shoot. Some vids are good, others are atrocious. I’d highly recommend finding a therapist local to you to see and get some instructional work with. You can do the rehab on your own, but as I said, the videos you find online are a crap shoot as to whether they are quality information and even if they are quality info, they may not be geared towards your specific injury/situation.

Also, you already are asking about benching/pressing movements. I’d recommend taking a good break (several weeks or longer) away from all pressing movements (maybe with the exception of push ups). I’m only making assumptions without a physical eval, but generally people are way too “push” orientated in their lifting and with your prolonged history of shoulder discomfort, as I said before, you would benefit from some focused pulling movements.

The one thing I have forgotten to ask you about is what your goals are. Why are you lifting? Performance based? Sports? To “look good nekkid”? [/quote]

Definitely the latter, but also clothed!!!

I’m keen on heavy press work as, because of my shoulder, I’ve had precious little opportunity to do it. I don’t make any excuse or apology for my enthusiasm, and I daresay you’d feel the same if you had foregone benching/OHP for years. And yes, a few more weeks WOULD matter if there is no prior indication of what kind of progress milestones the recovery ought to have.

Also, since I had the shot, I’ve noticed another pain, usually in place of the first, around the mid-point between the left shoulder blade and the spine.

#15

Have you seen any practitioner besides the GP? Any ortho? Have you had a movement analysis done? Had you technique critiqued by a qualified person?

Especially with this new symptom coming up, I’d recommend (as beefcake recommended as well) seeing a qualified S&C coach or movements specialist to analyze your lifting technique and write you a properly balances program. The new discomfort could be due to increased pulling work (if you had already started that) and the lower/middle traps are now sore, or could be indicative of a thoracic mobility issue causing a rib issue, scapular issue, and/or other deficits. I’m leaning more towards the latter.

What has your normal lifting routine consisted of? What type of rehab have you been doing for the shoulder?

#16

[quote]LevelHeaded wrote:
Have you seen any practitioner besides the GP? Any ortho? Have you had a movement analysis done? Had you technique critiqued by a qualified person? [/quote]

Last year, just after first seeing the GP, I went for Physio. The guy was young, only a few years out of Uni and happily allocated more brain cells to remembering what reason I’d given 3 weeks prior for not doing the recommended excercises that week, than to remembering which shoulder was faulty. He also misdiagnosed the malady as one of the Infra, not Supra, based on the feel of the muscle which he said was “grainy”. I finally saw a specialist surgeon 10 days ago who ran me through a series of excercises and suspected it was actually the Supra, and the subsequent MRI confirmed this.

[quote]Especially with this new symptom coming up, I’d recommend (as beefcake recommended as well) seeing a qualified S&C coach or movements specialist to analyze your lifting technique and write you a properly balances program. The new discomfort could be due to increased pulling work (if you had already started that) and the lower/middle traps are now sore, or could be indicative of a thoracic mobility issue causing a rib issue, scapular issue, and/or other deficits. I’m leaning more towards the latter.

What has your normal lifting routine consisted of? What type of rehab have you been doing for the shoulder? [/quote]

Just to be clear, I haven’t done ANY weight-training (apart from shopping bags!) whatsoever in the last 6 weeks, due more to pressure of work. However that’s settled down, but has only moderated, not eliminated the shoulder pain. For the last couple of days, I’ve been stretching the shoulder by pulling the left elbow towards a point slightly above my right shoulder, and holding it there for 30 seconds or until I feel the very first hint of pain, whichever is the sooner.

My usual training split was as follows, 3 sets of 4-6 reps per movement, plate changes done as far as possible with the RIGHT arm:

Mo - Legs (Squat/DL) + leg curls/xtensions

Tu - Back (Lat pulldowns + B/o rows)

We - Upper Arms (BB curls/Tricep Pushdowns, both palms up/neutral/down)

Th - Forearms (Wrist Curls/xtensions)

#17

Can you do back squats without any discomfort to your shoulder?

A few links for you to read about rehabbing your shoulder. I hope they still work. The links I mean.

Shoulder the Load
by Mike Robertson
http://www.T-Nation.com/readTopic.do?id=538204

Long Live Your Bench
by Ian King
http://www.T-Nation.com/readTopic.do?id=460658

Out of Kilter IV
Stop Shoulder Pain Cold!
by Ian King
http://www.T-Nation.com/readTopic.do?id=459716

8 Weeks to Monster Shoulders
by Alwyn Cosgrove and Chad Waterbury
http://www.T-Nation.com/readTopic.do?id=818555

Question of Strength
By Charles Poliquin
http://www.T-Nation.com/findArticle.do?article=2cp

Cracking the Rotator Cuff Conundrum
by Eric Cressey
http://www.T-Nation.com/findArticle.do?article=280rotator2

Heal that Hunchback!
by Mike Robertson, M.S., C.S.C.S., U.S.A.W.
http://www.T-Nation.com/readTopic.do?id=459846

Shoulder Savers: Part I
by Eric Cressey
http://www.T-Nation.com/readTopic.do?id=1053531

Shoulder Savers: Part II
by Eric Cressey
http://www.T-Nation.com/readTopic.do?id=1055409

Shoulder Savers: Part III
by Eric Cressey
http://www.T-Nation.com/readTopic.do?id=1153915

#18

I’ve been dealing with subacromial bursitis and supraspinatus issues for about a year and a half now and have had 3 real bad flares ups in that time. Twice I needed cortisone shots into the bursa to calm it down because the impingement was so bad. I’ve literally had to cut out all overhead movements.

Been doing lots of face pulls, band pulls, rows, etc. trying to get everything good and stable, which has helped up to a point but I still get a lot of minor flare ups. Mostly I just work around it now and have resigned myself to not doing a lot of direct shoulder work. Let me know if you come across something that really does the trick for you.

#19

[quote]siouxperman wrote:
I’ve been dealing with subacromial bursitis and supraspinatus issues for about a year and a half now and have had 3 real bad flares ups in that time. Twice I needed cortisone shots into the bursa to calm it down because the impingement was so bad. I’ve literally had to cut out all overhead movements.

Been doing lots of face pulls, band pulls, rows, etc. trying to get everything good and stable, which has helped up to a point but I still get a lot of minor flare ups. Mostly I just work around it now and have resigned myself to not doing a lot of direct shoulder work. Let me know if you come across something that really does the trick for you.[/quote]

Yours seems a lot worse than mine, mine just haunts me like a Bogeyman sporadically in training, and occasionally out of the gym, andsaying, “I’m here, if you don’t want to get injured, go easy, go light, and work around”…fuck that noise!

Did you do everything I did/will? Exercise rehab plus special anti-inflammatory diet? I’ve been doing some stretches for a couple of days and they’ve already had some effect, though they’re supposed to be done for several weeks.

#20

[quote]Jaybee wrote:

[quote]siouxperman wrote:
I’ve been dealing with subacromial bursitis and supraspinatus issues for about a year and a half now and have had 3 real bad flares ups in that time. Twice I needed cortisone shots into the bursa to calm it down because the impingement was so bad. I’ve literally had to cut out all overhead movements.

Been doing lots of face pulls, band pulls, rows, etc. trying to get everything good and stable, which has helped up to a point but I still get a lot of minor flare ups. Mostly I just work around it now and have resigned myself to not doing a lot of direct shoulder work. Let me know if you come across something that really does the trick for you.[/quote]

Yours seems a lot worse than mine, mine just haunts me like a Bogeyman sporadically in training, and occasionally out of the gym, andsaying, “I’m here, if you don’t want to get injured, go easy, go light, and work around”…fuck that noise!

Did you do everything I did/will? Exercise rehab plus special anti-inflammatory diet? I’ve been doing some stretches for a couple of days and they’ve already had some effect, though they’re supposed to be done for several weeks.[/quote]

I’ve done most of it in some capacity. I try to keep my diet pretty anti-inflammatory. Several grams of fish oil a day, lots of berries, very little processed food. Took curcumin @ about 1.5g/day for about 3 months but didn’t notice enough of a difference to keep on it. I strengthened my rotators quite a bit but haven’t been as diligent with that work lately. I do stretch, but I’m sure I could do more. I mostly focus on lots of warming up with whatever movement pattern I’m going to be doing, especially bench press. I’ve also changed my bench style to more powerlifting setup with scapula back and down and a lot more tricep involvement, which has helped a lot. And i haven’t done an overhead press in about 9 months. I’ve gotten a little lax in my routine because I haven’t had a flare up in a little while and I’ve switched up my training enough I think to avoid one. I probably just got frustrated with slow improvement as well. This thread has inspired me to get back to it some though.