Another Shoulder Injury - Torn Biceps and Subscapularis Tendons - Surgery Recommended

[Al_Orange]

Should I continue to progress the DL, Strict Press, and LPD or should I maintain or even stop training them?

I'd greatly appreciate some advice on how to maintain some form of programming with a specific shoulder injury.

I have a tear in the Long Head Biceps Tendon with some subluxation of the "distal part", and a suspected 5mm tear in the subscapularis tendon. These were identified through ultrasound and match the symptoms I'm experiencing. I have had this issue for about 18 months but it has been worse in the last couple of months. I recently PR'd my Bench without any pain but am now at a point I cannot Bench due to pain.

The consultant has recommended a Biceps Tenodesis and a a repair to the Subscapularis tendon. I have other health concerns that mean my primary focus is on fat loss (and I do not have the £5k that the operation will cost right now) so I intend to hold off the surgery for 6 months or so. The consultant said that tendons will not heal themselves and could rupture completely if I lift too heavy. The consultant has basically said to do no heavy lifting (as expected).

I am currently not Benching (as this does hurt even with 95lbs), I have switched to Strict Press as the bounce/hip thrust seems to irritate it. I can squat. I have progressed my DL but he has warned against going further.


My numbers are low as I am still in the first 8 weeks of NLP due to restarting/injury etc.

Bench was 194 x 5, 215 x 3
Very Close Grip Press is currently 155 x5 but just testing the water with that
Press was 130 x 5
Strict Press is now 105 x 5
Squat is only 245 x 5 due to back injury at 275 x 5
DL is 308 x 5
LPD is 165 x 9
No Chins
No PC

I'm 43, 5'9", 255, significant belly flab but obvious visible muscle too (aiming for 210lbs).


So my question is:

Should I continue to progress the DL, Strict Press, and LPD or should I maintain or even stop training them? I don't really want to rupture the injured tendons but I want to train and use it for fat loss for the next 6 months. If I do continue, what would you advise? I'm happy with a very conservative progression where necessary.

[Will Morris]

Should I continue to progress the DL, Strict Press, and LPD or should I maintain or even stop training them?

I'd greatly appreciate some advice on how to maintain some form of programming with a specific shoulder injury.

I have a tear in the Long Head Biceps Tendon with some subluxation of the "distal part", and a suspected 5mm tear in the subscapularis tendon. These were identified through ultrasound and match the symptoms I'm experiencing. I have had this issue for about 18 months but it has been worse in the last couple of months. I recently PR'd my Bench without any pain but am now at a point I cannot Bench due to pain.

The consultant has recommended a Biceps Tenodesis and a a repair to the Subscapularis tendon. I have other health concerns that mean my primary focus is on fat loss (and I do not have the £5k that the operation will cost right now) so I intend to hold off the surgery for 6 months or so. The consultant said that tendons will not heal themselves and could rupture completely if I lift too heavy. The consultant has basically said to do no heavy lifting (as expected).

I am currently not Benching (as this does hurt even with 95lbs), I have switched to Strict Press as the bounce/hip thrust seems to irritate it. I can squat. I have progressed my DL but he has warned against going further.


My numbers are low as I am still in the first 8 weeks of NLP due to restarting/injury etc.

Bench was 194 x 5, 215 x 3
Very Close Grip Press is currently 155 x5 but just testing the water with that
Press was 130 x 5
Strict Press is now 105 x 5
Squat is only 245 x 5 due to back injury at 275 x 5
DL is 308 x 5
LPD is 165 x 9
No Chins
No PC

I'm 43, 5'9", 255, significant belly flab but obvious visible muscle too (aiming for 210lbs).


So my question is:

Should I continue to progress the DL, Strict Press, and LPD or should I maintain or even stop training them? I don't really want to rupture the injured tendons but I want to train and use it for fat loss for the next 6 months. If I do continue, what would you advise? I'm happy with a very conservative progression where necessary.

To answer your immediate question up front: yes, you should continue to do all the lifts and make modifications to your training, as needed, to continue training uninterrupted. If you rupture the tendons, you rupture the tendons. The stats are in favor of them rupturing outside the gym, during the course of daily life, if they are going to rupture at all. A ruptured proximal biceps tendon will not lead to any noticeable functional deficits, and the long term outcomes with tenotomy vs tenodesis are exactly the same. Unless you are a very vain individual, there is not a compelling case to be made for a biceps tenodesis.

There are coaches out there that specialize in working with conditions such as this. I would advise you seek out a professional working relationship with one of these coaches to help guide you through a supported rehab program.

[Al_Orange]

Thank you for taking the time to respond. Much appreciated.

Does the sentiment go for the subscapularis tendon too? Presumably, that would be an issue if that were to rupture?

[Will Morris]

The re-rupture rate after surgical repair is catastrophically high. I’ve seen dozens, or more, isolated subscapularis tears that were found as an incidental finding. At 43 years old, the chance of you not having any degree of tearing in the rotator cuff is extremely small. A 5mm tear is exceptionally small. Unless it were greater than 50%, most of the surgeons I work with wouldn’t even consider repairing that.

If I were making the decision for myself, given what information I have hear, I wouldn’t dream of having surgery for the findings here. Neither of these findings come anywhere close to the far reaching effects of continued fat loss, and your long term health is drastically affected more by continued fitness training. Any exacerbation of the orthopaedic situation could be reassessed when it occurs. Even an acute rupture of a rotator cuff tendon can be addressed at that time. At least that is the opinion that I hold, and your mileage may vary. I have been accused of being an idiot many times before.