shoulder tendonitis

[Philds]

Hi Coach,

I have had a minor ache on my left shoulder (I'm a lefty) since about mid december last year. I finaly got it checked out 3 weeks ago because it felt a bit worse lately. I have had some xrays and an ultrasound exam done and my doc diagnosed it as an inflamed supraspinatus together tendonitis of the supraspinatus tendon. Except for the ache the only thing that is noticible is that when I "scratch" my back my left arm won't bend more then 90?. Which is a lot less Rom than my right arm has.

Should I listen to the doc and lay off lifting for a while and only continue squatting?
If yes, how long does it take to heal in your experience? It's been bugging me nearly 9 months now. But of course, I started pressing, and bench pressing 3 months ago, so that might have been a dumb move.

[Mark Rippetoe]

The doctor always wants you to lay off and let it heal. I have beaten this to death on this board: it will not heal unless you make it heal. You have to train through it. Have you been laying off it this past year, during which time it got worse, or have you been training it like you want it to heal?

Before you answer that let me give you the bad news: sometimes supraspinatus problems don't heal without surgery. But the good news is that sometimes they do, or sometimes you can figure out a way to train around them so that they don't bother you without surgery. I have eliminated the bench and most dips while keeping presses and chins, and mine doesn't bother me much at all, certainly not enough to cause me to contemplate surgery. Are you pressing and doing lots of chins?

[Tiburon]

Hi Coach, I have a related question about rehabbing the rotator cuff. My problem is the infraspinatus, according to my ortho (and she seems legit). I also might have a torn labrum, but she thinks I will be able to hide that if I strengthen the shoulder and if I am careful with overhead throwing (she gave the thumbs-up for overhead pressing).

My question is whether there are any specific modifications to the Starr protocol that you would recommend for the infraspinatus, specifically for weakness with external rotation. My plan is to follow the protocol with overhead presses, and to add in some band work for external rotations and the "empty can" raises with light dumbbells.

Any suggestions would be welcome. Thanks as always for your insight.

[Mark Rippetoe]

I'd just do the presses. The 2 lb. stuff is a huge waste of time in comparison to the work obtained during the press.

[Kazzin]

I have a similar problem, although I never bothered to get it checked out. Originally aggravated my shoulder doing pullups, and later with hanging leg raises. I replaced the pullups with chins, and stopped doing the leg raises mostly because I didn't like them anyway. This was probably over a year ago, and sometimes it aches a bit after low bar squats, deadlifts--pretty much everything actually--and sometimes not. It hasn't gotten any worse though... if anything the pain is less frequent, but it still hurts when "scratching my back" as you describe.

Should I go back to doing pullups?

[Philds]

Thanks for the answer: I started starting strenght because I wanted to get to the root cause of my shoulder problem which is being a skinny fat underdeveloped 34 years old male with bad posture. (Know thyself)

So the first 4 months after the shoulder pain started I didn't do any work, and it didn't make any difference, but neither did the 2 months of SS, nor the 1 month I layed off.
So since I'm damned if I do, and damned if I don't ,I'm starting the program again since it's fun. I'll follow your lead for the moment and stop the dips. I'll see what happens with the bench press. If my shoulder gets that bad it needs surgery well, it probably would then have sooner or later.

One last question: Is doing lying tricep extentions in lieux of the dip worth it, or shouldn't I bother. (I know that it's an isolation exercise)
If yes, would I do sets of 3x5 reps like the press etc. or do the 3x12's?

[TravisRussellDC]

If the problem has been going on for 9 months, then it is no longer an inflammatory condition and tendonitis is unlikely. Once you step into that chronic phase the tendon is no longer inflamed, rather it is clasified as a tendonopathy and the term "tendinosis" is more suited. The tendon itself has likely started to deteriorate and dehydrate. Laying off the exercise will not help this condition. Since you are in a chronic state, you must find a way to break the nociceptive (pain reception) cycle. Stimulation of the tendon while assuming a posture of pain provocation works really well. ART, Graston, cross fiber, friction rub, etc. all work very well for working out the musculotendonous junction area to break the pain cycle and promote healing.

That being said, the majority of rotator cuff pain and dysfunction is secondary to poor mechanics of the scapula. You must fix the biomechanics of the upper extremity, including the cervical and thoracic spine, if you want to prevent further flair ups.

[Mark Rippetoe]

Kazz: I'd phase pullups back in slowly, 3:1 chinups/pullups, the 2:1, and finally 1:1. I'd alternate them from then on.

Philds: I'd be careful about doing LTEs with a shoulder injury. If you use enough weight to make the exercise useful, you'll get into problems with handling the weight safely getting on and off the bench. This would really piss you off, hurting your shoulder again with an assistance exercise.

Trav: I agree with everything in the first paragraph, but I'm afraid you're going to tell me that "poor mechanics of the scapula" is fixed with chiropractic treatment.

[TravisRussellDC]

Not at all. Chiropractic treatment can only release the fixations that the joints are experiencing after months of improper positioning and movement. It's up to him to put forth the time and effort to rehab the shoulder joint complex properly to ensure this doesn't happen again.

I tell my patients this all the time: being healthy and pain free is hard work. But if you're willing to put in the time and effort then I will do everything in my power to help you get there. But I can only direct the body to where it's supposed to be. The patient has to do the work to get it there and keep it there.

[Mark Rippetoe]

I tell everybody that good shoulder mechanics is pressing with correct technique, and that if you do that you won't hurt your shoulders, and if you can't press with correct technique you need to get to where you can in whatever way you need to.