Training around a (possible) shoulder labrum tear

[danradin]

Coach –

After a year of an uncomfortable right shoulder, I saw an orthopedist, who gave me an exam, x-ray, and sent me for an MRI. It hurts going overhead taking off a shirt. Pullups hurt. It doesn't hurt when I bench (after the first couple of warmup sets) or press, but it has gotten progressively worse.

The doc did an exam, which showed my right supraspinatus to be weak. The radiologist's MRI report (can add specifics if helpful) showed AC joint inflammation, supraspinatus impingement, and a possible labral tear. The orthopedist basically said to listen to my body and that sending me for PT would be a waste of time. I definitely do not need surgery at this time and have had a good week of pain-free bench and overhead pressing.

I have added thumbs-down dumbbell raises at 30 degrees to the body as the orthopedist suggested these to strengthen the supraspinatus. I've also been feeling less discomfort the more religiously I incorporate face pulls into my programming. The ortho said the more I can keep my shoulders out of internal rotation, the better they will feel. Working with a lacrosse ball and foam roller at the end of training feels good but I'm not sure I'm getting anything out of it.

Are these good selections? Are there other things you'd suggest for me to strengthen around the possible tear in terms of warmup or corrective work? I appreciate any insight you have.

Many thanks,
Dan

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Sully Template
- 33, M, 10 years of half-assed gym lifting, powerlifting training for nine months. BP 275x5, OHP 205x5
- Shoulder pain at the bottom of the bench press, pullups, and other overhead positions
- No acute incident
- Pain (on a scale of 1-10) has been in the 2-3 range for most of the last year, 3-4 the last few months, maybe 5-6 now. Overhead (taking a shirt off) is a 7. Laying on my side is a 7. Never really beyond that.
- Describe the pain (burning, shooting, aching, deep, sharp) Sharp/stab, sometimes feels like it's loose in the socket, grinding. Never burning or shooting. No loss of sensation.
- What makes it better? Nothing.
- What makes it worse? Internal rotation.
- How do your symptoms behave throughout the day? Position-based, predictable pain. No pain at rest.
- Signs and Symptoms (describe what the area looks like....swelling, bruising, etc.) Top of the shoulder AC joint looks like it's a little more prominent on the right shoulder than the left. Clicking sound.

[Mark Rippetoe]

I have added thumbs-down dumbbell raises at 30 degrees to the body as the orthopedist suggested these to strengthen the supraspinatus. ......

The ortho said the more I can keep my shoulders out of internal rotation, the better they will feel.

Think about these two things.

[JM3]

Thumbs down raises cant be done without internal rotation, as soon as your shoulder gets better, backhand that motherfucker (dont punch- thats internal rotation)

I guess my question to OP is: why would you ask a guy who, at every turn, advocates systemic stress over isolation work, and writes pages of downright invective against people using isolation work as rehab, what he thinks of isolation work?

[danradin]

I appreciate that. I suppose there are two non-labrum issues: impingement and supraspinatus weakness. I'm no orthopedist, but I suppose the latter is a symptom of the former. Do you have a recommendation for strengthening the supraspinatus without being in internal rotation? Any other recommendations?

[John Petrizzo]

I think it is safe to say that his orthopedist should stay away from prescribing exercises for his patients.

[Mark Rippetoe]

I appreciate that. I suppose there are two non-labrum issues: impingement and supraspinatus weakness. I'm no orthopedist, but I suppose the latter is a symptom of the former. Do you have a recommendation for strengthening the supraspinatus without being in internal rotation? Any other recommendations?

I can't think of a single thing that works the rotator cuff muscles besides little shiny 2-pound dumbbells and rubber bands in the PT's office. Nope, can't think of a single thing.

[danradin]

Maybe I'm asking the question wrong. Coach, my shoulder hurts. I went to the doctor and got an MRI. What do you recommend I do so it hurts less?

[Jonathon Sullivan]

I can't think of a single thing that works the rotator cuff muscles besides little shiny 2-pound dumbbells and rubber bands in the PT's office. Nope, can't think of a single thing.

For fuck's sake, Rip, that's just not true.

http://startingstrength.com/resource...ad.php?t=41723

[JM3]

Maybe I'm asking the question wrong. Coach, my shoulder hurts. I went to the doctor and got an MRI. What do you recommend I do so it hurts less?

If youve read his books and articles you know what he thinks. His thinking on this has been pretty consistent for the last 5 years.

[dun08032863]

When I hurt my shoulder, I was diagnosed with type 3 hooked acromiums meaning I had such a small space in my shoulder for tendons to pass through smoothly.

Anyway, what did my PT prescribe me to do? Thumbs down lateral raises, for someone with rotator cuff tendonitis, bursitis and type 3 hooked acromiums...... To cut a long story short, she nearly crippled me. Thank the lord for the military press, thank the lord.