T Nation

Rotator Cuff Injury & Non-Surgical Rehab

I wanted to see if I could get some expert opinions and input on my shoulder/rotator cuff situation, and how best to get back to 100% from here. I’ll start with an explanation of my situation.

Around June of 2002 I started developing pretty severe impingement in my right shoulder, something I had had on and off in years past, but was always cured by my ART practioner (who is a certified ART instructor). I should note that right before the injury I was able to flat bench 330 for 8, incline bench 290 for 8, do standing military presses with 185 for 8, lateral raises (both hands simultaneously) with 40-lb dumbells for 10, reverse-grip bent-over rows (Dorian style) with 335 for 8. ALL of these were done with excellent form and no help from spotters – these were NOT bullshit reps.

I went to the ART guy for many, many weeks, and he just wasn’t able to make a dent in the problem. (I had stopped benching or doing any direct shoulder work in June of 2002, and started doing the routine for rehab of an external rotor injury found in “The 7-Minute Rotator Cuff Solution”). He sent me to get an MRI, which showed a partial tear of the supraspinatus tendon, which seemed odd to him, since when he tested me in certain movements that would test the supraspinatus, I seemed to test strong. He referred me to a couple of the best shoulder surgeons in New York City, and I finally went to see one of them in January 2003. The surgeon looked at the MRI and took an X-ray of my shoulder (which found a bone spur on the acromium). He explained what the surgery would entail: that it would certainly involve shaving off the spur, which was not that big a deal, but he wouldn’t know whether or not the cuff tear warranted repairing until he was in there (if he did end up having to repair the cuff tear itself, the rehab period would be pretty major).

So I kept the surgery idea in the back of my mind, but decided to see if lots of time off from direct chest/shoulder work, combined with the rotator cuff exercises, would help. (I also looked into prolotherapy, as was suggested by someone on the forums here, but the only MD doing it in NYC, who I had one consultation with, seemed like a TOTAL quack, and the other guy in the City doing it is only a DC, which I would have concerns about). Well, taking over a year off has definately helped; it no longer hurts when I sleep on my right side for extended periods of time. I started easing my way back into benching a few weeks ago. My shoulder feels about 98% fine while benching (occasionally there’s a TINY bit of inflamation in the AC joint while doing it, but it’s very minor, and there is no feeling of impingement). I’m depressed, of course, by how much chest size/strength I’ve lost, although I’m not a complete wuss, I guess: I can now do 285 for 6 (compared to 330 for 8 pre-injury). I’m still doing the rotator cuff exercises, but have also begun doing Arnold pressed (I can do 7 or 8 reps with 85-lb dumbells with zero pain). I have continued, all along, doing the Dorian rows, as they never bothered me, and probably helped to balance things out. I also (about 3 weeks ago) started taking a glucosamine/chondroitin/MSM supplement, and I continue to take Omega-3 capsules.

I am wondering whether it is best to continue my benching with relatively low reps (5-6) so as to get used to what heavy weights feel like again, or if I should lower the weight and go with higher reps. I’m also wondering if I should try regular dumbell military presses (as opposed to Arnold pressed, since I have zero pain with those), since I would like to get my delts back (or if that would just be suicidal). The funny thing is, I have a feeling that the most direct cause of the tear was probably – and it’s just a guess – the dumbell lateral raises I was doing. I had never spent much time doing them in years past, but in the months leading up to June of 2002 I decided to really give them a shot, and they seemed to really add a decent cap to my delts. Unfortunately, they are probably the one exercise that most directly uses the supraspinatus.

Any other suggestions on things to do (or not to do) in order to get my strength and physique back to where they were? Thanks for listening – I know it’s been lengthy.

Despite not having any solutions for your problem I just wanted to say that I feel your pain bro. Having read your post it seems as though you’ve had an unfortunate year. I hope someone has some decent info for you.

Aside from that, your legs must’ve grown like mad during the time away from your chest. :slight_smile:

I got almost the exact same diagnosis. My problem was years of tennis, which I have since given up, leading to reactive changes in the acromion process. I’m going to have it taken care of arthroscopically on December 17.

As for your problem, I think part of it is just the fact that you overwork your shoulders. I’m of the opinion that they get plenty of work through chest and back training. A few sets of lateral raises is all you should need.

Damici,

The first thing I would do is to stop all bench pressing. I would guess that benching gave you that injury to begin with. I have seen many guys through the years with very similar injuries as you describe. All from Bnch Pessing

There is a tremendous amount of pressure on the shoulder joint in the down position bench pressing. It is an odd movement, taking your shoulder into an unnatural range.

Just stand, or sit, where you are right now and make believe that you have a bar in your hand and bring it down to even with your chest. See how far back your shoulders go? Now imagine 300+ pounds sitting on your joint in that position.

While some can BenchPress for many years and never have a problem, others such as yourself, are not that fortunate. I have found that longer armed people usually are the ones who wind up with shoulder problems from benching. Just a personal observation.

I like the supplements you are taking. I would add MSM, which has helped many, (including me)I have found from my own studies.

Stop associating being a “wuss” with how little you can bench! You are not your bench! You did not say how old you were in your entry, but if you want to be working out 20 years from now you will not bench press anymore!

There are many fine exercises that you can do which will give you great satisfaction. Barbell presses, Squats, Deadlifts, clean and Jerks and many others. Just do yourself a favor and stop investing so much of yourself in something that happens to be dangerous for you.

One last thing, if you do not have a “shoulder horn” buy one! It has worked wonders for many whom I have known. Use light dumbbells.

SUMMARY: 1. Never Bench Press again!
2. Take MSM
3. Use a “Shoulder Horn”.
4. Never Bench Press again!
5. Never Bench Press again!

And finally, I may have forgotten to mention: NEVER BENCH PRESS AGAIN!

Best Of Luck To You!

I’m not sure that I agree with the logica of never benching again. I’d much rather see him abstain from training chest for 2-3 months out of the year, and focus on inclines and declines for the other 9-10.

Eric,

I did not state never train chest again. I stated never Bench Press again.

Does he need to recovery time? Yes. Should he see a qualified doctor? It will certainly help.

Should he abandon the Bench Press forever? No. He may want to alter it to make it safer (bringing his upper arms only until parallel to the floor, as stated by Paul Chek).

Zeb, kindly share what other chest mass/strength builders you do…perhaps you spend your time with Dumbell flies, cable flies? Incline flies maybe?

A variation of the Bench Press is needed for maximal chest development - DB Press, BB Press, Cable Press, Incline Press, Decline Press, Weighed Push-ups, explosive push-ups… These are your mass and strength builders. Not FLIES.

“Squats, Deadlifts, clean and Jerks and many others.”

Interesting. I never knew Squats, Deadlifts, Cleans worked your chest which is our point of discussion.

If you need to get a vaccine for Tuberculosis, but you dont want it, are you going to substitute it for a Flu shot because they’re both going to help you? NO! Because they’re like potatos and Fish - completely different things.

How do you recommend Squats and Deadlifts in lieu of Bench Press as if they were the same thing? If you’re taking away his chest movement GIVE HIM another chest movement, not a damn leg movement which he already does if he’s been a regular for any period of time.

I suffer from very similar problems and it’s chronic. Some people have shoulders that can take bench pressing. Others don’t. I’ve gotten in bad shape and laid off for one to six months at a time. It eventually returned and just kept getting worse.

I quit benching and I quit doing military presses and I revamped several other exercises and haven’t had a problem in the last year. For chest work, I use a Nautilus fly machine, a decline press machine, and finish off with dumbbell incline presses. I throw in laterals with a machine or dumbbells for my shoulders. Plenty of rowing takes care of the rear delts fine.

Uh, ZEB, where did I say that you said to never train chest again?

“I’m not sure that I agree with the logic of never benching again. I’d much rather see him abstain from training chest for 2-3 months out of the year, and focus on inclines and declines for the other 9-10.”

diesel23,

You are becoming famous for your sweeping inaccurate conclusions of others posts.

Kindly point out where in my post that I stated that either I, or Damici do Dumbbell Flies? It is not there! As that is not my recommendation.

As for my suggestion that he do other exercises such as Deadlifts, Squats etc. This was to help boost his emotional state. As he complained, “although I am not a complete wuss, I guess” complaining about his lowerd Bench Press number. I stated, “there are other fine exercises that you can do that will give you great satisfaction”.

Plenty of times an injury in one area of our body can act as a catalyst in helping us achieve success in other areas of our body. It can also, as suggested above, help lift us emotionally.

diesel, I suggest if you want to contribute in a positive manner to this board, as I am sure you do, that you take a bit more time in reading the posts.

This is the third time with me, and multiple times with others I have noticed, that you have jumped to conclusions and responded in an erroneous manner.

ZEB -

First, I agree with your response to diesel.

Next, out of curiosity, what would you recommend for chest exercises? Given the concerns you expressed with respect to flat bench, do you have similar concerns with incline bench given the different plane and, thus, the different impact on the shoulder and the back?

I had my shoulder scoped about 7 weeks ago. Last week, I pointedly asked the surgeon about benching and other exercises. He did not seem to have much concern about anything other than behind the neck military presses. Nonetheless, I don’t want to see him again, so I appreciate any additional insights I can get.

I have a rotator cuff injury and I don’t bench. I do tons of other exercises in leiu of it. I’m trying to make my back and legs much much thicker, because hey, they could always use it.

You are correct about Diesel Zeb.

Hey J Wright!! Did you get the last PM that I sent you concerning the cuff exercises?

I have suffered from similar shoulder pain, even hurt at night
laying in bed. I’m 90% better and never gave up bench pressing.
Just made adjustments on hand spacing and board press.
Use a 2x6 on chest so I don’t get the pull at the bottom. Also
get B12 shots in the shoulder and that works wonders. Stopped
all military or over head pressing. Just my .02.

Maverick,

Sorry to hear about your injuries. Injuries can be emotionally as well as physically debilitating, if you let them.

Whenever I have had an injury over the years I have tried to look at it as an opportunity to focus on a different part of my body.

Doing this ususally restored my confidence, making me feel better not only physically but emotionally as well.

As to your problem: The rotator cuff is a group of four muscles, which help lift your shoulder up towards your head. And also rotate it toward and away from your body.

Because of the intricacy of the joint there are an abundance of problems that can occur: Rotator cuff tendonitis; Rotator cuff tear; Instability impingement, etc.

When one person states: “I never gave up benching and my shoulder feels fine”. They may have had something totally different than what you or I have. Also, I would only suggest that if you alter bench pressing by adding a board to the chest, or doing it on the floor. You have changed the original bench movement. You are no longer actually doing bench pressing. You are doing a variation. And if the pain is gone then you did a good thing!

The reason that I think we have pain from traditional bench pressing is that it is not a natural movement. While you are sitting there in front of your computer bring your arms back to the sides as if you are bench pressing and have a bar in your hand. It is difficult to bring them all the way back. In fact, you almost need a weight in your hands to get them to that position. This is not a natural movement and causes many of us pain after many years of doing it.

Some will state that they have been bench pressing for years with no pain. I agree, I have seen this and can only state that some of us are less efficient mechanically than others. Perhaps longer arms are a hinderence, I do not know for sure. However, enough have been injured doing bench presses for me to notice through the years.

Another movement that you mention is pressing behind the neck. Again, as you are reading this post, bring your arms up in a pressing fashon over your head. Now as you lower them bring them down behind your head. If you try to stop at around the base of the skull you will see how difficult and unnatural this movement is too. Can some do it and get away with it? Yes. Does that make it biomechanically correct for all of us? No!

Regarding healthy chest developing movements: I like weighted push-ups. These can be done with a plate on your back, or better yet a weighted vest so that small amounts of weight can be added in a progressive manner. I have had the pleasure of knowing several gymnasts throught the years. I have yet to see one with a shoulder problem. And as you know they do many hundreds of push-up type movements.

I also like dumbbell bench pressing. When you dumbbell bench press you do not bring the weight down quite so far, giving the shoulder a break. You can also rotate the wrists during the plane of movement. I found that this helps as it does not lock your shoulder joint in one position. I have handled very heavy dumbbells in this exercise with no pain!

Lastly, I would be remiss if I did not give you what I feel are four of the best joint tissue supplements available: 1. Glucosamine (nothing new). 2. MSM, I have found this to be a great inflamation fighter. 3.Hydrolyzed Collagen, which is has been clinically reported to nutritionally support healthy joint function. 4. Boswella, this is from the Boswella Serrata tree. A large branching tree found in the hily regions of India.

(If anyone would like more informaition on where to purchase the above please send me a PM).

I wish you many years of happy and healthy lifting!

Hi,

I’m kind of bogged down at work right now, so I’ll try to jump back in with some followup questions later on today, but I just wanted to thank everyone for their input so far. Much appreciated.

My doctor and PT both told me I could start with flat benching and avoid incline benching & flies and military press behind the neck. They also recommended that the first couple months back that I do not go through the full ROM on flat bench and shoulder presses and to continue to strengthen both my RCs and warm them up prior to these exercises.

A nice “forgotten” exercise for the chest is pullovers. Alright it hits the lats as well. Also it may be stressfull on the shoulders but it’s worth a shot. :wink:

Wow, the consensus seems to be leaning away from continuing to do flat benching, which I’m kind of tempted to do, since I’m making some progress with them and they feel OK now (albeit with less weight than I used to handle). Are inclines thought to put less stress on the shoulder joint? I always kind of instinctively thought they’d be even more potentially harmful, but I did try them out yesterday (albeit VERY lightly – 135 – just messing around), and they didn’t seem to hurt at all. DB bench pressing actually seemed to bother my shoulder for some reason – I’m not sure why.

Does everyone agree that I should avoid dumbell militaries (or any military pressing)? I’m quite frankly afraid to even THINK of trying lateral raises, no matter how light; I think I’ll just immediately reinjure myself. Any thoughts on whether light DB laterals would actually strengthen the supraspinatus, or would they just risk tearing it again?

Maverick, can you tell me how the recovery process went after having your shoulder scoped? The surgeon I spoke to made it sound as though, if I had it scoped only (without having to repair a cuff tear), I’d be back in action almost in no time. Did you experience much pain? For very long?

Eric, are you planning on getting your shoulder scoped only, are on getting a cuff tear stitched up? Has your doctor given you any insight into how long the recovery process is? I read an interview with Arnold (yes, THAT Arnold) a few months ago where he said that he tore his rotator cuff doing some move with a rifle during the filming of T3, and he said something like, “A rotator cuff tear is the worst injury you can get, because the recovery is so painful.” Kind of made me think . . . .

Thanks again.