Postoperative Adhesive Capsulitis - Second Follow-Up (@ 1.5 Years)

[AikiPapi]

Hello, Will and Friends –

I hope the new year finds you doing well. I have been meaning for some time to provide an update on the situation with my frozen shoulder originating in 2023 (in case that might be useful for anyone) and maybe even get some further advice.

About a year-and-a-half out now from the peak freezing of my left shoulder (which for me was ~10 weeks after rotator cuff surgery), pain-free mobility did continue to return slowly on its own up to what I would estimate at about 95% original ROM. Following Will’s advice, I stopped any aggressive stretching a long time ago and have been able to train pretty normally, setting PRs on almost all lifts (even the Press is close!), but I still can’t get my hands up on the bar for a LBBS. That specific type of rotation of the shoulder, along with reaching around behind my back, continues to be limited (and quite painful if I push it) and from time-to time the shoulder will remind me during the course of the day that it’s still not completely happy (occasional twinges, etc.).

Otherwise, with a proper warm-up, there’s really no more pain while training (or stiffness afterward) than during/from any other activity. This all has me wondering if there is still hope to regain full ROM this late in the game and whether there’s something I can somehow do proactively at this point to push for the final few yards (e.g. a daily low-bar position stretch?) given that progress feels like it’s plateaued. So far, about once a month or so, I try to hold the bar in a LBBS position but it’s always a no-go. In a pinch, I can manage keeping my hands on the bar for a HBBS but it is still quite painful and given that the combination of using lifting straps with the increased surface contact of a bowed bar on the back have worked so well for the past year-or-so, I don’t expect to deviate from this approach unless I can make some progress with the mobility or just invest in a proper safety squat bar (or similar).

As always, any insight is greatly appreciated!

[Mark Rippetoe]

Did you follow my shoulder rehab protocol?

[AikiPapi]

Hi, Rip -

I did indeed follow your rehab protocol quite closely following the initial repair, noting this in my original post October 2023. It was working quite well until the shoulder froze up and threw a helluva wrench into the gears. As pre-op strength has returned, at least as evidenced in the Press and Bench, my assumption has been that the lingering pain and stiffness is an artifact of the freezing. The longer these things continue however, the more I wonder if at some point it's not worth another visit to the ortho and MRI as the bar position in the squat was the primary trigger of the pain originally (before the repair). I suppose my only hesitancy (other than the obvious cost) is that I actually had a post-op MRI when the shoulder started to freeze because the ortho had me scared that I might have damaged the repair with the lighter deadlifting a few weeks after surgery. This follow-up scan did show that the repair (anchors, etc.) was indeed intact and looked "very good".

[Mark Rippetoe]

You just woke up one morning and couldn't move your shoulder?

[AikiPapi]

Essentially, yes. To be fair I would say that the "freezing" probably came on over the course of a couple days (hard to remember exactly how quickly it peaked), but most of the ROM I had re-established very quickly became nearly impossible. In fact, this felt significantly more debilitating than my immediate post-surgical state, but of course there were no nerve blocks involved now.

At the 6-week follow-up, my surgeon both commented on my shoulder being in better shape than 90% of patients having a similar procedure (thanks to using your approach) and cautioned me against being too aggressive with the rehab. By week 9 I was pressing an empty barbell overhead, doing light pull-downs, and pulling deadlifts with 200 lbs.

Then about 10 weeks post-surgery, I woke up with a very new kind of stiffness and pain that really had me thinking that I had somehow messed up the shoulder repair. Following the MRI which showed only some bursitis and inflammation, the surgeon strongly suggested that my issues were likely brought about by excessive use of the shoulder before the rotator cuff muscles were strong/secure enough to properly seat the head of the humerus in the glenohumeral joint and its “loose” movement in the shoulder capsule during this excessive usage had likely caused the inflammation. Sounded a little sketchy, but I didn’t have an alternative explanation. After the peak of immobility had passed (I'd estimate a week or two later), I was able to start reclaiming ROM to the tune of about 2-3% per week (training as best I could along the way, per Will's advice) until progress seemed to come to an end about 6 months ago.

As Will had advised of what is usually the "self-limiting" nature of this condition, I wanted to make sure I gave things a reasonable amount of time to resolve before following up and asking if you guys thought the current situation merits anything beyond just continued plugging away and remaining hopeful.

[Will Morris]

Essentially, yes. To be fair I would say that the "freezing" probably came on over the course of a couple days (hard to remember exactly how quickly it peaked), but most of the ROM I had re-established very quickly became nearly impossible. In fact, this felt significantly more debilitating than my immediate post-surgical state, but of course there were no nerve blocks involved now.

At the 6-week follow-up, my surgeon both commented on my shoulder being in better shape than 90% of patients having a similar procedure (thanks to using your approach) and cautioned me against being too aggressive with the rehab. By week 9 I was pressing an empty barbell overhead, doing light pull-downs, and pulling deadlifts with 200 lbs.

Then about 10 weeks post-surgery, I woke up with a very new kind of stiffness and pain that really had me thinking that I had somehow messed up the shoulder repair. Following the MRI which showed only some bursitis and inflammation, the surgeon strongly suggested that my issues were likely brought about by excessive use of the shoulder before the rotator cuff muscles were strong/secure enough to properly seat the head of the humerus in the glenohumeral joint and its “loose” movement in the shoulder capsule during this excessive usage had likely caused the inflammation. Sounded a little sketchy, but I didn’t have an alternative explanation. After the peak of immobility had passed (I'd estimate a week or two later), I was able to start reclaiming ROM to the tune of about 2-3% per week (training as best I could along the way, per Will's advice) until progress seemed to come to an end about 6 months ago.

As Will had advised of what is usually the "self-limiting" nature of this condition, I wanted to make sure I gave things a reasonable amount of time to resolve before following up and asking if you guys thought the current situation merits anything beyond just continued plugging away and remaining hopeful.

Adhesive Capsulitis, at 18 months, is likely completely resolved. The typical course is 12 months, however, one thing that is being neglected is that you had an incomplete rotator cuff repair rehab, and depending on the state of the RTC when it was repaired, the surgeon may have had to mechanically stretch the tendons to repair them which would lead to a very tight shoulder. RTC rehab is really damned painful, and you are getting into the back half of RTC repair rehab after an 18 month break. Also, the re-rupture rate of rotator cuff repairs is drastically high. There is every chance that you will end up re-tearing the repaired tendons during normal course of life, but the outcomes with the re-ruptures tend to be better than the initial tears.

I'll probably break from most on this board and would offer this: squatting imperfectly is better than not squatting at all. If a correct LBBS is not in the cards, it isn't in the cards. There are lots of reasons why some people can't LBBS. If you have really given it the old college try to get back to it and still finding that you are unable to do it, maybe just find what you can do and focus on making that lift as strong as it can be.

[AikiPapi]

Thanks so much for revisiting this issue with me, Will – your perspective here is enlightening.

I actually do remember wondering where the sudden onset of immobility brought about with the “freezing” would leave me with the original (and ongoing) reclamation of ROM once it subsided, but it’s been so long since the actual surgery that I clearly had lost that line of thinking.

Given that the original efforts to rehab were going well with Rip’s approach (focusing on the “compound” pressing movement), I have been able to regain that overhead mobility, and isolative shoulder rotation stretches are generally frowned upon, is there anything you’d recommend toward trying to improve at the margins of what I believe is internal rotation?

As mentioned, what I’m dealing with now is livable but there is always some degree of pain, clicking, twinging, etc. and any potential for significant improvement there would probably be worth pursuing, even if still needing to adapt the squat. I suppose I’m just not ready yet to fully accept more chronic pain as the new status quo as I age (turning 54 next month), given the effort that goes into training to stay relatively fit/healthy and what feels like just a bad break and timing. Of course, I also understand that what’s “in the cards” for any individual is not always knowable or controllable and whether we like it or not, there will be times when we get dealt from the bottom of the deck.

[AikiPapi]

Apologies for pre-empting any potential response here, but I just wanted to clarify a bit. There is some pain with significant movement of the shoulder in almost any direction (and often when just sitting still) but because training is very important to me, and training properly requires very specific ROM and positioning, I am hyper-focused on the internal rotation thing that currently limits me there. Again, usually at least tolerable with most other movements, just very annoying. All seemingly quite consistent with the description of a “very tight shoulder” though and as much as I’m hoping to have something a little more positive to hang my hat on while I continue on and grit my teeth, perhaps a future rupture (and subsequent re-repair) would be the only opportunity to really make some progress.

[AikiPapi]

Hope I don’t overstay my welcome here but as this situation has deteriorated rapidly, I’m hoping to get a sanity check that I’m thinking about this the right way now.

I’ve been able to push the Bench and Press to PR weights since regaining enough ROM to effectively train them, but last week’s bench volume workout (5x5) resulted in me waking up about 4 hours later with the shoulder on fire (no pain anywhere near that intensity during or immediately after lifting). Interestingly, this was with a weight I had gotten not too long ago done for 3x5 and I don’t have any reason to believe there had been a significant breakdown in form since as I’m pretty conscious of things like elbow position given the now chronic lower-level pain that is a constant reminder. I was able to beat the pain back enough over the next couple of days with NSAIDS and ice to try to get my volume press workout in (which actually went well), but skipped the intensity bench work thinking that I would lay off the bench until I could try transitioning to CGBP for volume work this week.

Unfortunately, the pretty intense shoulder pain re-surfaced (again, a few hours after the presses) and I’ve been hitting it with NSAIDS and ice for about 5 days now to no avail. This leaves me thinking that I have little choice but to re-visit the ortho and MRI tube to determine if I’ve re-torn the RC or perhaps accomplished something new and uniquely exciting in that shoulder . For what it’s worth, the pain, often alternating between throbbing and searing just beyond the end of the acromion, is unlike the original injury (partial supraspinatus tear, etc.) which more so radiated a dull ache down the upper arm.

I suppose my question is simply whether there’s something I may be missing here before what feels like going back to square one and hurtling toward another potential surgery.


As always, I can’t thank you guys enough for taking the time to read this and advise (if at all possible).