T Nation

Need advice on an injury

Hey Fellow T-Men and vixens,
Am needing some advice. I injured my shoulder/rotator cuff/pec on the left side about 3 months ago. Have tried to work through it, doing light weight, or just avoiding exercises using those muscles all together. I CANNOT seem to get it to heal. I am thinking about taking a solid month off of training, just doing light leg work 2x a week, a little cardio, and abdominal work. Would this be advisable? Any suggestions on how to maintain lean tissue while not lifting? ANy other tips for rehabing this injury? BTW, am currently seeing a sports physician for the problem.

ransomed, I’m sorry to hear about the injury. Can you get a referral to a physical therapist?

I had some shoulder problems that I’ve struggled with for the past year and a half. I’m finally on the mend, but it involved finding a competent ART practitioner and getting treatment for a week. Where do you live?

Have you read up on ART (Active Release Techniquie)? Properly done, it’s pretty amazing/incredible stuff.

Tampa-Terry,
Thanks for the sentiments. I have not read up on ART yet, but will this evening. Any good links to articles. On the therapy route, i have been seeing a doctor at a local sports medicine clinic which specializes in sports related injuries. The doctor seems to think that the pec injury is correlational to middle back problems. At any rate, it’s been a real bitch to rehab. I was trying to design a routine that would avoid any kind of strain on the area, but as i’m sure you know, almost any kind of activity uses the shoulder in some way. Was thinking about trying to implement some of the exercises in the first few phases of Ian king’s Limping series into a lower body workout, such as king deads, 1 legged squats,etc. Am thinking about totally scrapping any kind of upper body workout for the next 3 weeks or so, and supplementing with creatine and glutamine to aid in muscle retention. Any other suggestions as to what might be beneficial in recovery, or any programs which i could impliment while on the disabled list?

ransomed, do a search here on T-mag for Leahy. He’s the guy who “invented” ART. There’s also a book called, “Release Your Pain, Resolving Repetitive Strain Injuries with Active Release Techniques.” It’s written by a guy named Abelson, and you can get it on Amazon for $20 or so.

There’s also a web site, www.activerelease.com that will allow you to search for a provider. There are a lot of people who do it, and there are a few who are very, very good at it. I’ll see if I can get Dr. Gregg to stop by with his comments.

ART w/ a sports therapist worked great for me. The pain level in my shoulder was at a 6 (on a 1-10 scale) from August to December. I went to a sports therapist (based in the gym) and after 12 sessions it has been reduced to a steady 2. It seemed a little like voodoo or witchcraft, but it worked pretty well. Now I have a home ?stim. unit? (sends low level electrical current through the muscle) to use a couple times of week. I keep myself in tune to any changes, learned some specific exercises to perform a couple times of week and things seem as back to normal as they will ever be. This article inspired me to get it looked at by a professional:

This quote from the article was what scared me into action:

?Most shoulder pain begins fairly innocuously, so we ignore it and push on. Before we know it, we have a fully blown challenge that’s preventing loading and participation in many exercises.?

I recommend you get this squared away before it gets to the point of catastrophic failure.

Good luck

ps: my insurance would have paid for a prescription (drug therapy), but did not pay for this therapy. The Doctor was willing to bargain on the fee?but you need to ask.

ransomed,

May I ask what exercise that you think you injured your shoulder on?

From a weight-lifter’s point-of-view, I would try a Shoulder Horn to work the rotator cuff muscles. Many of these injuries are due to an imbalance between the anterior (usually pec muscles) and the posterior muscles because we tend to over-develop the pecs with benchpresses, etc. From a physician’s point-of-view, you may want to try corticosteroid injections which have worked for me in the past (tennis elbow). If you can afford ART, that’s great, but around here (southern Wisconsin) it’s kinda cost prohibitive.

Ransomed,
Good to read that you are seeing a PT for this. It is to be hoped that he or she is progrssive and open to various forms of treatment. There are several issues you need to address to heal properly and, even, address any imbalances that led to this partcicular injury. Here are some very effective strategies for injury prevention and care:
Begin a series of stretches that address your injured areas. At the end of these stretch routines place Ice over the areas for 12-15 minutes. This will depend on your body ft%. The leaner you are the less time you will need to ice. Try this 2 x per day.

Always Ice the area after working it out, follow the above time reccomendations.

Seek out and visit a good massage therapist who practices ART (Active release) or PRT (Posistional Release). A good massage does wonders.(Probably more good than your PT will do) Most likely your healing process is stymied by scar tissue from the original injury. This scar tissue impedes healing in many ways. However Massge/Ice/Stretching can and will dramatically reduce scar tissue and eventually smooth it out to the point where this tissue is unoticable.

Finally, supplementing whith chondroitn may help since there could be some tendon or joint damage/irritation. I use this with many subjects who have muscular and tendon/joint issues and it works wonders. A 3-4 week heavy dose regiment works the best.

You should lick the probelm in no time implementing these stratagies. Remember that injuries need to be addressed with the same fervor and care as the main bulk of your training regime. You may also find that if you incorporate these techniques with your training you will significantly reduce the chances of injury and dramatically increase recovery time.
Best of Luck
LTurn

Ransomed,
I forgot to add that if you would like more indepth explanations of the techniques mentioned or have any questions feel free to P.M. me.

LTurn

Thanks for all of the advice. So far, my PT has been using a muscle stim. unit and treating the area. We have been working on rotator cuff/lat exercises, with particular emphasis on rear rotator cuff strength to help open up the area to more healing. So far, has been working pretty good. My fear is that I have hindered progress by not taking the correct time to heal, and being stupid as to the correct steps to take to rehab the injury. I initially injured the area doing high weight/low rep benches similar to a 5x5 program.
I intend to continue to get the area treated, and will also try supplementing with Chrondolin (THANKS FOR THE TIP ON THAT, BTW!!). How much per dosage, and how often should I take? What would be an adequate training regiment during this healing process?

Well ransomed, you’ll be on the disabled list for a long time if you don’t get the injury properly treated. Waiting it out will not fix the problem. After an injury your body responds with a programmed mechanism which includes a stage where scar tissue is laid down that causes adhesions within the muscle belly and between surrounding structures such as other muscles, ligaments, tendons and nerves. Adhesions cause shortening on the muscles and also causes pain. Like I said, these adhesions cause muscles to be tight and contrary to popular belief a tight short muscle is a weak muscle. The injured area causes the body to compensate and alters proper mechanics at the shoulder and along the kinetic chain (hand, elbow, shoulder and neck). What you need to do is decrease the restrictions and restore normal tension in the structures withing the shoulder complex. The only technique out there that does this effectively is ART. After treatment then you can strengthen the rotator cuff to avoid re-injury with specific rotator cuff rehab exercises. Also you might have to look at your form when lifting or evaluate your exercise program to avoid certain movements that cause increase stress on the shoulder.
Good Luck

Thanks guys! Picked up some glucosamine/chrominium today at the supp. store, and will begin taking today. Dr. Gregg, thanks for the reply. Have been seeing a doctor, and have noticed the compensation you mentioned. Specifically, the area directly behing the injury in my back seems to be tensing up. The Sports Dr. i’ve been seeing has been adjusting it and treating with muscle stimulation to aid in the healing process, but i’m definitely not working the area. Is it permissable with this type of injury to continue to work lower body, and upper body isolation exercises, such as curls and the like?

Ransomed,
Working your lower body would be fine however you should start on isolation exercises for the rotator cuff with no weight. Also improving the proprioception (3-D awareness of where the joint is in space) would be very beneficial for full recovery. If you can’t find an ART provider in your area I would suggest traveling for 3-4 sessions with someone. The results are remarkable!
Keep working hard

You HAVE to fix the back problem. I may be able to suggest some ways, but I would need you to elaborate on your doctor’s diagnosis of the problem. Many things can go wrong. For a 3-month-old injury, though, you should be exercising with the right rehab movements quite aggressively.

It sounds like your doctor doesn’t think there is anything structurally wrong with your shoulder. Hopefully, he has reached this conclusion through carefully ruling out the possibilities. If your doctor is right, then you should probably be working that shoulder.

Eh, i think my old doc sucked. He mainly just worked on realigning my back and had me doing rotator cuff work. Started seeing an ART therapist this week. WOW! What an amazing difference! Already feel better. Dr. Gregg or others, my therapist said to stretch/heat the area and do a few sets of almost no weight db benches to begin to work my ROM. It turns out it was my pec that was partially torn. WOuld you still suggest rotator cuff exercises as beneficial with this treatment? WHat other steps should I take to maximize recovery, ie diet, exercises, etc? (am currently supplementing glutamine/creatine/glucosamine/chrondolin/multivitamin to aid in muscle retention and recovery of the injury.)