A full-thickness tear of either the supra- or infraspinatus tendon will not heal. You will eventually have the surgery. Go ahead and get it over with while you can still choose your surgeon..
Member
Supraspinatus and infraspinatus tears - advice on training
Howdy Rip,
I've seen you dispense advice on many occasions for rotator cuff injuries, including partial tears, and the general suggestion is to drop heavy benching and pursue pressing and chins as rehab. In my case, however, the movements which aggravate the injuries the most actually are the vertical pushes and pulls. I.e. overhead presses bother my shoulder significantly more than benching (which is, at worst, a mild discomfort that largely disappears after warming up), and chins seem to aggravate the problem, too (though less so than pronated-grip pullups). For that matter, holding the low bar position also bothers that shoulder (left), whereas high bar placement is less of a problem. Possibly due to the degree of external rotation required in a low bar, given the nature of the injury (below), I suppose.
As to the specifics on the injury, the expression was, I believe, "full thickness partial tears" in both infraspinatus and supraspinatus in my left shoulder, 25% for infraspinatus and 75% for supraspinatus. The doctor I saw (brother in law) did not recommend discontinuing exercise, but rather to avoid painful movements. He also recommended PRP (platelet rich plasma) therapy as being potentially useful, and was of like mind to you that surgery should be the absolute last option and, as a rule, avoided at all cost.
Any wisdom you've had and could give me regarding these types of injuries would be greatly appreciated. I've already tried time off (2 weeks of literally nothing but foam rolling and some stretching), which seemed to help, but resuming basic movements (squats, benches, presses, chins, deadlifts) saw a return of the pain pretty quickly, so I'm at a bit of a loss on how to proceed.
TMPHBITEU
A full-thickness tear of either the supra- or infraspinatus tendon will not heal. You will eventually have the surgery. Go ahead and get it over with while you can still choose your surgeon..
Member
While surgery may be necessary in the future, as a currently poor grad student, I am not able to afford surgery at the moment. To be totally honest, I would still use surgery as a last resort, well after I've tried other stuff, and this shoulder issue isn't really more than a couple months old (i.e. prior to this flare-up, I've basically never had persistent shoulder issues). In my mind, given the advances that will likely happen in the next decade or two concerning this sort of thing, it seems wiser to wait, as long as that remains an option. I realize it is obviously not much of an option in certain cases.Originally Posted by Mark Rippetoe
As it is, by avoiding movements which directly bother it, I have very little pain (basically none at rest, and maybe a 1-2 tops for stuff like benches/chins/dips) and no real loss of ROM. At higher reps/lighter loads, or with dumbbells, I can even overhead press largely pain-free. I suppose the point I'm making is that I am very far from disabled, and would prefer a more conservative route for the time being. I figured you had dealt with people who had similar issues but did not opt for the surgical route, so was just curious what you'd do in that situation. Either way, I appreciate you taking the time to look at my case.
TMPHBITEU
If you have no pain at night, I doubt seriously that you have a full-thickness tear. Was this confirmed by MRI?
Member
I actually have had a handful of nights of mild discomfort, but for the most part sleep pain-free. I was actually diagnosed via ultrasound, which is apparently as sensitivite/specific for diagnosis of partial and full thickness tears as MRI:
http://www.ncbi.nlm.nih.gov/pubmed/19457838
He was actually able to point out the tears to me and pull them up on the screen, so it seems pretty legitimate. I admit that my impression of severe rotator cuff tears is not what I have been experiencing, i.e. I have, at worst, low levels of pain/discomfort associated with certain movements and for the most part can move the shoulder normally. Nor have I had previous bouts of terrible shoulder pain or anything, prior to this injury (realizing it may have been cumulative) have not had shoulder discomfort lasting more than a day or two in my life, and those quite infrequently (probably a total of ~5 times in the past 10 years).
Starting Strength Coach
If it is a full-thickness tear, Ripp is right. For what it's worth, I had a full tear in the subscapularis and had it operated on one year ago this week. I was back in the weight room after three months and now back to same strength as pre-tear and have no pain and no limitations. Maybe I'm cavalier about surgeries after having had a bunch, but my philosophy is to get it fixed sooner than later. I'm not going to heal better when I get older.
Walter
Posting Permissions