Shoulder Rehab After Surgery: Under the Bar

by Charity Hambrick | March 22, 2018

Since finding Starting Strength four years ago, I have evolved, from someone who just wants to get stronger into an athlete – chasing PRs and adding the occasional shiny medal to my gym wall – and a coach. I have my own home gym where I train clients 20-25 hours a week. And I have a personal crusade to help seniors gain a better quality of life through strength training.

I don’t give in to my clients’ excuses to get out of training. So, in September of 2016, when I began having acute pains on the anterior side of my left shoulder, a learning opportunity developed for their coach: a lesson in rehabilitative training.

I had developed a subacromial impingement that required surgery, a subacromial decompression (an acromioplasty). At first, I had intermittent pain that kept me from training both my press and bench press. It also affected my squat, the pain preventing me from getting into the low-bar position. I had to start using the safety squat bar instead. When the acute pain I had first experienced became chronic, I consulted an orthopedist. I was told that without decompressive surgery, I would eventually need a full shoulder replacement.

Being a strength athlete, I know that being competitive, rather than training just to be stronger, means accepting an added risk of injury. But I also know that life happens, for me and for those I train, and working through this injury, the surgery, and the rehab would make me a better coach.

Importantly, pressing was not the root cause of my shoulder impingement. In a normal, healthy shoulder, impingement is impossible during the press. The normal function of the trapezius muscles elevates the scapula and rotates it medially, toward the spine, as the arms raise the bar overhead. This movement pulls the acromion away from the head of the humerus, making impingement impossible.

During my surgery, the surgeon discovered a bone spur – an osteophyte – that was the natural consequence of old injuries and aging. This bone spur had effectively narrowed the space between my acromion and humerus. Despite the movement of my scapulae in a normal pressing motion, the head of my humerus would pinch the soft tissues trapped between the two bony structures. The osteophyte had caused inflammation and scar tissue that manifested as impingement, making pressing very painful and damaging the head of the humerus.

The surgeon removed the bone spur and some floating calcified pieces within the soft tissue, and resurfaced the head of the humerus where these bony occlusions had made it rough and pitted.

If you can’t train at your best, you have to do your best training within your limitations. Prior to surgery, I still trained three days a week with safety bar squat, deadlifts, and heavy rack pulls. And I kept training right up to the day of the surgery.

I also studied. To prepare for my rehab I reviewed the following resources from Starting Strength:

• Shoulder Rehab Case Study by Mark Rippetoe
• Low Bar Position Stretch by Paul Horn
• Rehabilitation by Mark Rippetoe

And I sought advice from Darin Deaton, DPT SSC. He said that I should let pain and quality of the movement be my guide, making sure the movement quality stays perfect and not to alter the movement due to pain. Darin teaches that gentle motion allows damaged tissues in the shoulder “to calm down” as the inflammation from the surgical trauma subsides over the first 14-21 days. “Motion is lotion,” he says.

The first week I kept the inflammation down with NSAIDS and began restoring my range of motion in the Continuous Passive Motion (CPM) Chair. This started the day after surgery. CPM moves a joint through a preset range of motion for an extended period of time. The CPM chair is motorized so that movement occurs without muscular contraction, which would be prohibitively painful so soon after surgery. I used the chair for two hours, three times a day, for the next seven days. Each session, I increased the range of motion 5-10 degrees until I reached the physician’s prescribed ranges of motion.

The next week I began the Rippetoe Shoulder Rehab Model, using rings and a dowel rod, then a 6-pound pipe, then a 15-pound bar until I could incorporate the partial press. This process (discussed in Rip’s Case Study video) and Paul Horn’s shoulder stretch helped increase my range of motion. Letting pain and movement quality be the guide, I gradually increased the weight on the bar forcing the tissues to adapt and heal as they got stronger.

I regained full range of motion on my press and bench and was able to get back into the low bar position in six weeks. From there, I began a linear progression. I was able to run a modified Linear Progression from August through October. Eighteen weeks after the surgery, I squatted 300, pressed 134.5 and pulled 322.6 at the USSF Fall classic at WFAC in October. In January 2018, I competed at USSF National meet in Oakland, CA, where I squatted 306.4, pressed 136.6, and pulled 324 and took second place in the 198 weight class.

If there is something that I took away from this experience, for myself and for my clients, it’s that rehab is just another form of training: planned, intentional stress that cause the adaptations that move you toward your goals – in my case rebuilding my shoulder and returning to competition. As Rip says in his Shoulder Rehab Case Study, “You make things heal, you don’t let them heal.”