Restarting SSLP with a 6+ year old shoulder injury

[DMH]

I'm 36, 5'9", 212lbs. About 6 years ago or so I was doing a half-assed version of the SS Novice Program. My shoulder started to hurt, first noticeable during OHP, subsequently during bench press. I tried to rest, ice, and NSAID it for a couple weeks and resume training. In short, I did everything wrong (up to and probably including my form that may have caused the issue in the first place). Training fell off, I've been doing an off-and-on half-assed approach to the gym for a while as I slowly grew fatter and weaker.

I'm reading/listening to the Blue Book now and trying to piece things together so I can start over properly; exercises and form, diet, and this old injury. In time it faded into the background so that I all but forgot about it. "Normal" activity hasn't bothered it. Active stuff--loading/unloading and stacking 60+ square bales of hay--would leave it aching and sore for a couple of days. Mostly it complained infrequently and I ignored it. Low to moderate (for me) Bench Press doesn't seem to make it act up. I tried to do some dips once a couple of years ago and it was very painful, and lingered for a week or more. Last week I did 4 sets of OHP with light weights (40-50-70 lbs) and low reps (6-8) and it hurt the next day, then sore for a couple more. Now it's back to being "fine."

I want to dive into the SS Novice Program properly, as I said, but I'm concerned that as soon as I start trying to OHP, and maybe when I start getting heavier on Bench, it's going to flare up. I called and made an appointment with an Ortho, but I'm concerned that the age of the injury might make it difficult to actually diagnose. I also read a couple of The Shoulder articles at Barbell Medicine, which make me skeptical about surgical intervention unless there is a very clear smoking gun. So, some questions:

1. Should I keep the appointment just to rule out something more serious that would require surgical intervention?
2. If the diagnostics don't reveal anything, is there a good way to proceed with rehabbing an injury that has had years to heal poorly so that I can get back to getting good?
3. If there is not a good way to do so, how can I work around it to minimize the impact it has on my training?

Thanks.

[Satch12879]

This is really vague, man. “Shoulder started to hurt” could be anything. It’s very, very difficult, nigh impossible to make a diagnosis over the Internet particularly with what little information is here.

Go see a coach when you start back up for sure.

[WFB]

Make a commitment to yourself to get strong, and then go see an SSC before anything else.

According to your profile, you live in Atlanta - there are 5 SSCs listed in Atlanta and one in Savannah.

[DMH]

Yea, that's my bad. I'm not trying to backseat doctor and diagnose myself, and even though it seems like "shoulder impingement" that's everyone's favorite umbrella term these days.

Your thoughts on dealing with shoulder impingement....

I read that searching the forums for any similar issues. If the doctor doesn't reveal any kind of smoking gun I was planning on trying to follow something like what Rip suggests there. I thought I saw Rip say elsewhere that an old injury like this shouldn't follow that approach.

So I guess that's the only real question here: Let's say I go to the doctor, get all the scans, and walk away without a clear diagnosis. What's my next step? Just start back up anyway (with a coach as you suggested)? Try something like what Ripp suggested in that thread? ART?

I appreciate your help. Just trying to get my game plan ready.

[WFB]

Assuming there is no smoking gun, I would start LP as though you have never lifted before and as explained in SSBBTv3. You may be sore after the workout because you just did lifts that you haven't been doing, and that's normal.

Just be cautious that the doctor that you see may likely tell you that there is some sort of degradation of this or that and that you should take it easy...alarms should go off if that's the advice. Just nod and walk away and go get a second opinion And go see a coach - best money I have spent every time!

[Will Morris]

I'm 36, 5'9", 212lbs. About 6 years ago or so I was doing a half-assed version of the SS Novice Program. My shoulder started to hurt, first noticeable during OHP, subsequently during bench press. I tried to rest, ice, and NSAID it for a couple weeks and resume training. In short, I did everything wrong (up to and probably including my form that may have caused the issue in the first place). Training fell off, I've been doing an off-and-on half-assed approach to the gym for a while as I slowly grew fatter and weaker.

I'm reading/listening to the Blue Book now and trying to piece things together so I can start over properly; exercises and form, diet, and this old injury. In time it faded into the background so that I all but forgot about it. "Normal" activity hasn't bothered it. Active stuff--loading/unloading and stacking 60+ square bales of hay--would leave it aching and sore for a couple of days. Mostly it complained infrequently and I ignored it. Low to moderate (for me) Bench Press doesn't seem to make it act up. I tried to do some dips once a couple of years ago and it was very painful, and lingered for a week or more. Last week I did 4 sets of OHP with light weights (40-50-70 lbs) and low reps (6-8) and it hurt the next day, then sore for a couple more. Now it's back to being "fine."

I want to dive into the SS Novice Program properly, as I said, but I'm concerned that as soon as I start trying to OHP, and maybe when I start getting heavier on Bench, it's going to flare up. I called and made an appointment with an Ortho, but I'm concerned that the age of the injury might make it difficult to actually diagnose. I also read a couple of The Shoulder articles at Barbell Medicine, which make me skeptical about surgical intervention unless there is a very clear smoking gun. So, some questions:

1. Should I keep the appointment just to rule out something more serious that would require surgical intervention?
2. If the diagnostics don't reveal anything, is there a good way to proceed with rehabbing an injury that has had years to heal poorly so that I can get back to getting good?
3. If there is not a good way to do so, how can I work around it to minimize the impact it has on my training?

Thanks.

I can certainly empathize with where you are coming from, but, do you really want an honest answer to this?

[DMH]

Just be cautious that the doctor that you see may likely tell you that there is some sort of degradation of this or that and that you should take it easy...alarms should go off if that's the advice. Just nod and walk away and go get a second opinion And go see a coach - best money I have spent every time!

I can certainly empathize with where you are coming from, but, do you really want an honest answer to this?

Yea, absolutely. I'll always take the truth, even if ugly, over a pretty lie. If you think I'm fucked, let me know and I'll do what I can to work around it. If you think I'm just being a big wimp, let me know that too and I'll suck it up and get back to business.

[Will Morris]

I'm 36, 5'9", 212lbs. About 6 years ago or so I was doing a half-assed version of the SS Novice Program. My shoulder started to hurt, first noticeable during OHP, subsequently during bench press. I tried to rest, ice, and NSAID it for a couple weeks and resume training. In short, I did everything wrong (up to and probably including my form that may have caused the issue in the first place). Training fell off, I've been doing an off-and-on half-assed approach to the gym for a while as I slowly grew fatter and weaker.

I'm reading/listening to the Blue Book now and trying to piece things together so I can start over properly; exercises and form, diet, and this old injury. In time it faded into the background so that I all but forgot about it. "Normal" activity hasn't bothered it. Active stuff--loading/unloading and stacking 60+ square bales of hay--would leave it aching and sore for a couple of days. Mostly it complained infrequently and I ignored it. Low to moderate (for me) Bench Press doesn't seem to make it act up. I tried to do some dips once a couple of years ago and it was very painful, and lingered for a week or more. Last week I did 4 sets of OHP with light weights (40-50-70 lbs) and low reps (6-8) and it hurt the next day, then sore for a couple more. Now it's back to being "fine."

I want to dive into the SS Novice Program properly, as I said, but I'm concerned that as soon as I start trying to OHP, and maybe when I start getting heavier on Bench, it's going to flare up. I called and made an appointment with an Ortho, but I'm concerned that the age of the injury might make it difficult to actually diagnose. I also read a couple of The Shoulder articles at Barbell Medicine, which make me skeptical about surgical intervention unless there is a very clear smoking gun. So, some questions:

1. Should I keep the appointment just to rule out something more serious that would require surgical intervention?
2. If the diagnostics don't reveal anything, is there a good way to proceed with rehabbing an injury that has had years to heal poorly so that I can get back to getting good?
3. If there is not a good way to do so, how can I work around it to minimize the impact it has on my training?

Thanks.

1) Would it be reasonable to assume that your shoulder pain (purposeful utilization of that term in lieu of the word "injury") is actually just a response to mechanical loading of the tissue that you are not adapted to? The reason I say this was, if you were to have a true, catastrophic failure of tissue present here, you would likely have either developed some pronounced mechanical dysfunction, or, even more reasonable, daily activities would be painful.

Based solely on the information you provided, which I whole-heartedly understand is scant and lacking in a lot of potentially important details, but I have to say that nothing about what you said would indicate to me that you need any medical appointment at all. From what you stated, in the past 6 years, you have had a couple weeks, and then later a couple days of shoulder pain.....when you think of it in those terms, does that sound like a surgical case to you? If that seems like a reasonable threshold for surgical intervention, orthopaedic surgeons would all be billionaires.

2) Diagnostic imaging should really serve to confirm the diagnosis made by the orthopaedic surgeon, or other healthcare provider with a high level of competence in performing a neuromusculoskeletal examination (orthopaedic surgeons, Physiatrists in an outpatient setting, Sports Medicine fellowship trained physicians, and some physical therapists). The diagnostic imaging should be used to confirm a diagnosis that could be treated surgically to act as a surgical localizer, or, when there are competing diagnoses that the determination of which it was would change the course of treatment. Rehabbing old injuries is virtually useless in the setting of using traditional rehab methods. Even diseased / damaged tissue seems to respond to an educated approach using the Stress-Recovery-Adaptation model.

3) You could find a competent coach. Coaches work around and through injuries all the time.

[DMH]

First: Thanks, Coach. I appreciate you taking the time to respond.

1) Would it be reasonable to assume that your shoulder pain (purposeful utilization of that term in lieu of the word "injury") is actually just a response to mechanical loading of the tissue that you are not adapted to? The reason I say this was, if you were to have a true, catastrophic failure of tissue present here, you would likely have either developed some pronounced mechanical dysfunction, or, even more reasonable, daily activities would be painful.

Based solely on the information you provided, which I whole-heartedly understand is scant and lacking in a lot of potentially important details, but I have to say that nothing about what you said would indicate to me that you need any medical appointment at all. From what you stated, in the past 6 years, you have had a couple weeks, and then later a couple days of shoulder pain.....when you think of it in those terms, does that sound like a surgical case to you? If that seems like a reasonable threshold for surgical intervention, orthopaedic surgeons would all be billionaires.

Yea, it could be. I'm confident there was an injury at one point. I had been doing a program of progressive overload for a few months when the problem first appeared. I think I mostly just started deliberately avoiding doing exercises that aggravated it in the gym, and unconsciously avoided movements that bothered it outside of the gym (for the most part). Now when I do something that causes it to have that same kind of pain I worry it's just going to get worse if I continue.

You're absolutely right about surgical intervention. I don't think that's required. And it's definitely not desired.

Rehabbing old injuries is virtually useless in the setting of using traditional rehab methods. Even diseased / damaged tissue seems to respond to an educated approach using the Stress-Recovery-Adaptation model.

That's pretty much the conclusion I reached, too, especially after listening to some of the Starting Strength podcasts. I've had to do rehab for a couple of other injuries in my life and the outcome has not been impressive. [/quote]

3) You could find a competent coach. Coaches work around and through injuries all the time.

That's the common advice I'm getting. I'll look into it. Thanks again.

[Will Morris]

First: Thanks, Coach. I appreciate you taking the time to respond.



Yea, it could be. I'm confident there was an injury at one point. I had been doing a program of progressive overload for a few months when the problem first appeared. I think I mostly just started deliberately avoiding doing exercises that aggravated it in the gym, and unconsciously avoided movements that bothered it outside of the gym (for the most part). Now when I do something that causes it to have that same kind of pain I worry it's just going to get worse if I continue.

You're absolutely right about surgical intervention. I don't think that's required. And it's definitely not desired.

That's pretty much the conclusion I reached, too, especially after listening to some of the Starting Strength podcasts. I've had to do rehab for a couple of other injuries in my life and the outcome has not been impressive.

That's the common advice I'm getting. I'll look into it. Thanks again.

Truth in advertising - my day job is as a Physical Therapist. I am a Board Certified Clinical Specialist in Orthopaedic Physical Therapy, and my entire clinical career has been spent in the orthopaedic and sports medicine field. Even though I have a vested interest in seeing people come to Physical Therapy, I have to admit that we, as a whole, are just not very good at working with people like you. Unfortunately, my career in PT has shown me that the vast majority of therapists I have worked alongside, under-dose their patients to the point where I have an extremely difficult time seeing the logic behind their therapy prescriptions. I do, however, think my profession is on the cusp of an enlightenment period where more and more therapists are seeing the power of a deliberate application of SRA (as a conceptual framework). This will be a welcome improvement over the status quo.

Physical Therapists are the "movement experts", as they say, but this is mostly true with pathology. When it comes to the proper application of strength training, the training of a PT is woefully inadequate. This is why a coach is a much better utilization of your finances than a therapist.

You are probably right. There was likely an injury at some point, but the nature of the injury was likely overuse / under-recovery and more likely than not, caused by form or programming issues. At this point, it is almost certainly not an "injury" per se, but, in the end, it is likely just semantics. What is really important is that you have a "limitation" in your ability to participate. A solid coach who can identify form or programming issues that exacerbate this, or a coach who can figure ways to train around or through the injury is going to be the best, most clear path across this obstacle.