Rotator Cuff Strain Treatment Rotator Cuff Strain Treatment

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Thread: Rotator Cuff Strain Treatment

  1. #1
    Join Date
    Mar 2020
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    Default Rotator Cuff Strain Treatment

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    I've been diagnosed with a rotator cuff strain which has been bothering me for about 2 months now, and I'm looking for advice on how to rehab it and if I should / how to alter the novice linear progression to account for this. I've found a lot of information on tears, but very little for strains and I'm not knowledgeable to know how much of that information directly carries over.

    My lifting partner and I set our one rep maxes in a pseudo lifting meet every winter. February 2nd after benching 255lbs I noticed my left shoulder was sore, but not in a way that seemed that odd at the time. There was no sudden or sharp pain. For the next 2-3 weeks it was mildly sore at all times with sharp pains when raising my arm and noticeable movement inside the joint. I didn't attempt to bench or OHP in this time. After three weeks the pain was gone and I tried benching again slowly working up to 185. There was very slight discomfort later that day, and the subsequent few days the same pain as earlier returned but not as intense.

    After that I made an appointment with a sports medicine ortho, after an exam and xrays I was told it was a strain and he didn't believe there was a tear. He recommended not lifting for another month or two. After a week or so I started doing some very light back exercises like barbell rows (65 lbs) and back flys (15 lbs) with light weight just to keep blood flow in the area.

    That was about a month ago. Yesterday I started benching again and slowly worked up to 185, today I feel exactly the same as I did a month ago. I still haven't been able to OHP.

    Am I being impatient? Is there something I can do to speed up the process or do I just need to wait it out a bit longer?

    Background, 34 year old male office worker, working out for 3 years, properly training ~1 year, 6'2" 205 lbs. 280 squat, 365 deadlift, 255 bench.

  2. #2
    Join Date
    Nov 2012
    Location
    Long Island, NY
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    Hey thelastdeadmouse,

    First thing is that strains and tears are the same things. Strains are described by the severity of damage in three grades:
    Grade 1 strain usually causes stretching of a few of the muscle fibers.
    Grade 2 strain has more significant damage, and some muscle fibers are damaged or torn.
    Grade 3 strain is a complete rupture of the muscle.

    I think your doctor was probably saying that there was not a complete rupture and that you had acquired a grade 1 or 2.

    Where is the problem when you try to press the bar? Is it in the bottom/start position that is most uncomfortable? The top of the press? or is it the act of pressing?

    If the bottom is the problem start at the top and do partial ROM on the way down like the video below.
    If the problem is the top start with press starts and gradually increase the ROM to the top.
    If the problem is worst as you are pressing start with a loaded stick and make a smaller increase than you want to each session.


  3. #3
    Join Date
    Mar 2020
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    Hi Nick, thank you for responding.

    Thanks for the information on strain vs tear, that was very helpful. The shoulder has a low level dull ache most of the time, the kind you wouldn't notice unless you were thinking about it. The actual pain starts when raising the upper arm once its about 10-15 degrees below horizontal in a front raising motion, no pain during a lateral raise however. There's also pain when raising the arm to the rear like during a squat, but it starts only at the end of range of motion so its not really interfering. The last time I had attempted to press before posting here I could barely get the empty bar above eye level before the pain was severe enough that it felt unwise to proceed.

    Since I posted this I've watched just about every Starting Strength video with the word shoulder in it including that one. My squat rack is short enough that I was able to replicate the motion by putting my arms on the chin up bar and walking under it. I started that Tuesday. Wednesday I was able to press an ez curl bar with only modest pain. I noticed that the pain would lessened the further into a set I was. Yesterday morning I was able to work up to 80lb. seated press (my temporary Covid gym has a low ceiling).

    You say go slower than I want, normally my instinct would be to let the pain be my guide and proceed as long as its not too bad, instead should I just stick to increasing 5 lbs a session or even back it down from 80lbs, even if the pain isn't restrictive?

    Since benching seems to aggravate the shoulder for a couple days but doesn't cause any real pain during the movement, I'm unsure whether or not I should remove it from my program during this process or not. Any advice there would be appreciated.

    Thanks again.

  4. #4
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    Nov 2012
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    I would proceed with the press. As a general rule of thumb don't make your session to session jumps larger than 10%. I'm not sure how much you were pressing prior but I'm going to guess in the 165-185 range. I would do 5lb jumps for a few sessions until you are in the 100-115 area. If things are still feeling good then you can up it to 10lb jumps. Nudging the pain during training is fine. Pushing through and ignoring pain can get you in trouble. Expect rehab to look like the stock market (how it normally functions) and to have both good and bad days.

  5. #5
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    Mar 2020
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    Thanks for the help Nick. I'll keep going, its great to know that I can take active steps in my recovery instead of just waiting. Any thoughts on if I should continue to bench press during this time? Similar plan as the press?

  6. #6
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    Nov 2012
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    Long Island, NY
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    As long as it's not debilitating sure. Whichever exercise feels better on your shoulder do that 2x/week. The other exercise do 1x/week.

  7. #7
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    Mar 2020
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    Coming back to this after a few months. My shouldn't hasn't been improving and I suspected a misdiagnosis when the symptoms less and less seemed like a rotator cuff injury. Any exercise that used the rotator cuff or upper back was painless, bench press and to a lesser extent overhead press were painful. I took May off from lifting due to personal responsibilities. During that time the pain mostly went away except during a few specific movements, mostly pulling my arm across my chest or overhead.

    When I start lifting again I dropped the weights, everything felt fine so I resumed the NLP. As the weights went up the pain crept back in progressively until it was enough to make me stop at one set when my bench got back to 230. The next time it forced me to stop at my 185 warm up, the next time at 155.

    Screenshot_20200910-122125.jpg

    Two weeks ago I went in for an MRI, today the doctor told me that the problem was AC joint inflammation, rotator cuff looks fine. He said it was likely due to wear and tear, its common for power lifting to cause arthritis in this joint. That doesn't quite square in my mind since I haven't been lifting that long, and I can point to the single one rep max lift when the pain started. I can still do pulling motions just fine, but have been holding off on pressing motions until I got the diagnosis back. If it possible for a one rep max bench to cause a low grade AC joint separation? He didn't notice any indication of AC joint injury in the x-ray taken 1 month after the injury.

    This is the description of the MRI from the paperwork, its too technical for me to really follow unfortunately; I work with computers, not users.
    "FINDINGS: There is mild increased signal in the supraspinatus tendon most of which
    appears to be related to tendinitis/tendinopathy. The supraspinatus and
    subscapularis tendons are intact. The biceps tendon is mostly within the bicipital
    groove.

    There are marked hypertrophic changes with significant inflammatory component in the
    acromioclavicular joint. There is mild downward depression of the supraspinatus
    tendon which in the correct clinical setting may yield impingement syndrome. There
    is a small amount of fluid in the subacromial/subdeltoid bursa. The labrum appears
    intact.

    IMPRESSION: Mild tendinitis/tendinopathy of the supraspinatus tendon. Inflammatory
    degenerative changes of the acromioclavicular joint as described above."

  8. #8

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    starting strength coach development program
    Hi Nick,

    I'm currently following Rips' rehab program to heal, what I've been told, is a rotator cuff strain.

    Can you tell me how many sets and reps of chins I should be doing, please?

    My max is 15.

    Thanks

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