Rehab of shoulder AC joint inflammation from the trainer's perspective

[UnSafe]

I've been grinding through 3 months of Right shoulder acromioclavicular joint inflammation- aggravated by benchpress, press and sleep position. Dropped down in weight, reps and frequency, icing it daily and eating ibuprofen at a therapeutic dose. This reduces the pain and inflammation somewhat, but it's slowly getting worse. Visited with a pudgy PT, got fairly worthless advice to stop all weightlifting involving the shoulders for 6 weeks, then resume "normal" activities and progress to "toning" only, with weights (WTF?).

For the time being, I'm avoiding visiting an Orthopod, knowing that the accepted routine for "Weightlifter's Shoulder is to inject the AC with a corticosteroid (Like Decadron) once or possibly twice, then if no improvement, chop the end of the clavicle off- (Mumford procedure or similar).


So, from a Coach's or Trainer's perspective- Have you had success with resolving this type of injury by modifying workout routines? And for those that you've trained that ended up with a claviclular resection, were they eventually able to resume strength training at their previous levels?

[Mark Rippetoe]

How severe are the bony changes in the joint now? You are close enough to me that you could drive down and let me check your form.

[theuofh]

I have had the same experience. I was running the performance menu programming and my left ac joint got inflammed to the point where there was a visibly noticeable lump protruding through the skin. I think it was caused by direct trauma from an ugly clean or dumped front squat.

I went to see my ortho, who I had previously let give me a cortisone shot for a similar condition, and I didn't know any better at the time. He suggested another one and went on to say that if the pain continued I would have to get my distal clavicle resected. I was kind of awestruck at first, that he couldn't recommend physical therapy, or a more conventional course of rehab, but he didn't seem to have and qualms about giving cortisone shots on a regular basis.

I'm now going to a chiropractor and having some success. He is primarily doing electro-stim + stretching, particularly stretching of the upper traps and neck, soft tissue work, and rehab work consisting of primarily band external rotations, scap retraction, and scap depression.

It is working, albeit slowly, and I have added some lower trap activation work that is helping a bit. I haven't been able to squat, press, or even do pull ups for about 3 weeks now. I'm hoping to be back to hard, unmodified programming in 2 more weeks. Until then, I'm doing what I can w/o aggravating the shoulder failure. This is primarily leg press and back extensions, c2 rower, and my shoulder rehab, w/ occasional pushups plus scap protraction and full chinups.

I'm intersted in some of the long term effects in the weightlifting population too, as my ortho seemed to say it would be about 6 months before I would be able to train productively again and even then I wouldn't be able to go heavy. He was a runner though, so I kind of expected that.

I had some small bone spurs in my shoulder, the ortho said nothing too major though.

[r_graz]

For the time being, I'm avoiding visiting an Orthopod, knowing that the accepted routine for "Weightlifter's Shoulder is to inject the AC with a corticosteroid (Like Decadron) once or possibly twice, then if no improvement, chop the end of the clavicle off- (Mumford procedure or similar).

I'm facing the same thing right now. A relatively high volume of c&j, snatch, and heavy OH press has resulted in a pretty inflamed right AC joint. You mention seeing a PT but not an ortho - did you get an x-ray of the joint? Seems like before you talk about distal clavicle osteolysis (weightlifter's shoulder) and possible resection, you should have at least an x-ray to confirm the condition and its degree. In my case, the gap between the acromion and clavicle was highly suggestive of osteolysis.

I'm waiting to see how this progresses before I make any decisions about surgery, but the lifters I've talked to who've had the procedure have been mostly happy with the results. Most seem to be training again within 4-6 weeks, and back to or beyond their old bench or press PR's not too long after (and without pain).

[Joel Chapman]

I had the same problem. What worked for me was following Mark's sticky rehab post using the bench press. I started with the empty bar. After a couple weeks I had 185# on the bar for 10-15 reps. Then I went into a SS template, alternating bench and shoulder press. I only increased the bench by 5#, then eventually 2.5# per workout. I am up to 250# for sets of 5 now and still progressing. The key was not rushing the progression.