Rehab after a complete rupture of the AC ligament.

[jmz34]

Hi coach. I'm a 23 year old male who has been lifting for 4 years (albeit more intermittently than I would like because of a relentless run of injuries for most of that time). I currently weigh 160lbs but I've been as heavy as 190lbs.

I completely tore my AC ligament in a motorbike accident back in September 2012. After an initial rest period of around 6 weeks (the hospital doctor said it would take 6-8 weeks for it to heal) I started working it lightly using cable isolation work and light free weights. However, I found benching to be persistently painful and so I substituted it for a push press for the past three months. I've also had pain doing pull ups, lat pull downs and barbell rows but I've generally worked through and around it the pain. The rep ranges typically span from 1-7 on compounds and up to 15 on the assistances.

The pain is at its worst after a set of bench presses of around 140lbs 3x5. I'd say it's a sharp pain of around a 4 out of 10 in intensity and hurts at the AC joint.

Leaving it to rest for a couple of days makes the joint feel normal, I can do everyday activities without any pain. However, as soon as I lift it returns.

Bench pressing, pull ups, dips and front raises cause the most pain.

Although I can feel a minute bump where the collar bone meets the scapula (it is different from the normal shoulder), I saw a physio 3 weeks ago and they didn't mention anything about this. They referred me for a physiotherapy course which has yet to commence.

I would like your thoughts/advice on how to progress from here. I know it's a complex joint and I've probably done an unsatisfactory job of explaining it, but would you recommend a complete lay off? When would I recommence? What kind of pain is OK to work through? Is avoiding pain an exhaustive indicator of doing the right things? (i.e. even if I'm not feeling pain with some exercises I may yet be preventing the ligament from healing properly?) Finally, what kind of rehab strategy do you recommend?

Thanks a lot for your time.

[Mark Rippetoe]

I recommend that you stop the benches for 6 months and start pressing and chinups 2x/week. Why are you not pressing? Front raises and dips are the last things I'd do for a shoulder in this condition.

[jmz34]

I learnt early on that front raises and dips cause the most pain and haven't tried them since. What set and rep scheme should I use for chins and presses? I found that the bottom portion of the press was causing a bit of pain, so I thought I'd switch to a push press.

Many thanks coach.

[Mark Rippetoe]

High reps, with light enough weight that you can stand the pain.