T Nation

Fixing Asymmetry Resulting from Injury


Ok, so I initially posted this in the Injuries and Rehab forum, but due to the lack of response, decided maybe it would have been better placed here. A link to the original post: http://tnation.T-Nation.com/free_online_forum/sports_body_training_performance_bodybuilding_injuries/asymmetry_following_slap_tear_in_shoulder_labrum

The bottom line is that I had a torn labrum in the shoulder diagnosed as a SLAP tear about two and a half years ago, for which I did not get surgery and through which I have been carefully training following some physical therapy. What I discovered recently is that my good arm and shoulder (the left) are now substantially larger than the injured ones.

I've read about impingements and nerve issues being a cause for pronounced asymmetry such as this. I figured there can also be an issue of overcompensation, although I consider that less likely since much of my upper body work has been of the unilateral variety, and I always allow the injured arm to dictate the reps on each set.

Really quickly, here's a sample of the kind of training I'd been doing over the past six to nine months (when the disparity became most pronounced). It's sort of an upper/lower, horizontal/vertical split with a lower body day in the middle, where each pair of exercises is done as an antagonist set:

Day 1:

High Standing Cable Flies
Reverse Standing Cable Flies (rear delt)
Push-ups (elbows in)
Seated Rows (close, neutral grip)
External rotations (cable)
Internal rotations (cable)

Day 2:

Bulgarian Split Squats
Leg Curls
Leg Lifts
Seated Calf Raise
Tibialis Raise

Day 3:

Lateral Raises (cables, to shoulder height)
Standing Lat Pressdown (to shoulder height)
Dumbbell Shoulder Press (started on an angle [to the side], worked my way to upright)
Lat Pulldowns
Decline Tricep Extensions (EZ-Curl)
Alternating Dumbbell Hammer Curls

Feel free to critique my routine, but to answer some questions in advance, this routine was largely about training through a lower back injury and the SLAP tear, which is why there were no heavy loads like squats and deadlifts. The push-ups are my first horizontal pushing movement as I work my way back to floor presses and maybe someday dumbbell presses (I may need to get the surgery, though, for that to be possible).

I am currently on a new routine, but figured the one I have been doing over the period of time when the asymmetry became most pronounced would make the most sense to post, since it might help to make it clear if my training could have contributed to the problem or not. The biggest differences now are that I am now doing front squats, trap bar deadlifts, push-ups with feet elevated, wide grip seated rows, and a few other tweaks that are less relevant. For the dumbbell shoulder press, I've reverted back to Angled Shoulder Presses, a la page 2 of the following article: http://www.T-Nation.com/free_online_article/sports_body_training_performance_repair/jointfriendly_training (although I don't even go as high as the person shown).

Any advice for me? Since I was doing mostly three sets of 8 to 12, my current plan has been to switch to four sets on certain exercises, doing only two sets for the left side and four sets for the right. For arms, I was going to skip training my left side altogether for a while and see what happens. What worries me is that I've been training both sides and my right seems to have not grown at all, so just continuing the same volume makes me worry that it will never catch up.

Anyway, thanks for taking the time to read my post.


do you have a picture of what your shoulders like in comparison?

my only advice right now would be to get your shoulder fixed. I had a SLAP tear in my left shoulder and got it taken care of. Its not 100% but its way better now.




I'll look into getting some pictures up tonight, if you think it would help. Honestly, it's the arms differential that's really most striking. I'll see if I can manage something with my cell phone camera.

I did always plan on getting the surgery, it just wasn't feasible at first for a number of reasons, one of them being financial, and also I was in the process of interviewing for jobs and didn't want to have one more strike against me by showing up in an arm sling.

Regarding your surgery, can you give me some idea of what you mean by "not 100%"? Are you talking about pain and discomfort, permanent strength or mobility losses, or just exercises that you can no longer perform?



Hey man,

Thanks for the link. However, it appears that Mike is referring more to muscle atrophy during the post-surgery recovery period from lack of use. I'm not sure the situation is similar enough that I would feel confident following his advice for that situation.

Sure, there was a period of lack of use on the injured side initially, but training-wise, I wasn't lifting at all during that period anyway, and when I started up again, I made sure never to neglect the injured side. If I couldn't do an exercise on the right, I wouldn't do it on the left. And the size disparity really didn't become pronounced during the recovery period, so I don't think "atrophy" is the case. If anything, training seems to have contributed to the asymmetry more than anything else.