Experience with rotator cuff injuries

Discussion in 'Kettlebell' started by SJT, Nov 20, 2019.

  1. SJT

    SJT Still New to StrongFirst Forum

    Does anyone have experience with rotator cuff issues here? I’m not looking for medical advice, rather, if anyone has “self-addressed” pain in this area successfully.

    An ultrasound revealed a small (3.2 mm) tear along 50% of my supraspinatus. An MRI is at
    least a month away, and PT looks to be the likely course to fix this. Perhaps surgery if said MRI reveals further damage...though there do appear to be studies which suggest PT may be a viable alternative.

    Any feedback would be appreciated!
  2. rickyw

    rickyw More than 500 posts

    Bottoms up kettlebell work in the form of:
    Rack holds, supine holds, one armed bench press, rack carries, etc, provided there isn’t pain

    Also, light TGUs through your available pain free range of motion

    Any activity that aggravates symptoms should be thrown out
  3. runninggirevik

    runninggirevik More than 300 posts

    TGU and windmills took care of mine - 12 years ago.
    JamesPTA likes this.
  4. offwidth

    offwidth More than 5000 posts

    If you have a rotator cuff injury then medical advice is exactly what you should be seeking. Plenty of us here have had rotator cuff and similar shoulder problems. Many of us have indeed self addressed the issue; (Some successful; some not) but that doesn't mean that you should. We are all different. My recommendation is to follow your doctors and physiotherapist's advice.
    Mark Limbaga and Steve W. like this.
  5. Steve W.

    Steve W. Quadruple-Digit Post Count

    As one of the people here who have had rotator cuff problems, I'll share my experience, which is (hopefully obviously) not a substitute for medical advice, or advice itself.

    I have had arthoscopic repairs for supraspinatus tears in both shoulders at different times. Both tears were due to acute injuries incurred while playing basketball.

    The first injury also included an obvious tear of the biceps tendon (long head). The surgeon was optimistic about being able to repair both the biceps tendon and the rotator cuff, but said that if I waited to have the surgery the chances of being able to repair the biceps tendon would diminish over time. This caused me to opt for surgery immediately without trying nonsurgical rehab first.

    The surgeon was not able to repair the biceps tendon after all, and although he deemed the rotator cuff repair "successful," it was actually ultimately a failure. I went through recovery and rehab, and met all the benchmarks for the the physical therapists to release me from therapy, but my shoulder was still painful, the range of motion was still limited, and it just didn't feel right. I actually felt worse after surgery than I had before.

    I got a follow up MRI and sought additional opinions from two other doctors. Both told me that the MRI showed a supraspinatus tear, and that with that MRI and my current symptoms, a second surgery was recommended.

    I actually had a second surgery sheduled with one of the new doctors, but cancelled it at the last minute and started a trial and error self-treatment program. Ultimately, I was able to rehab my bad shoulder to the point where I have minimal pain and relatively full function. My range of motion in external rotation is a little restricted, and I have occasional mild twinges, but I can basically do anything I want with it -- pressing overhead, snatching, heavy clubbell and mace work, basketball, throwing a ball or whatever.

    The second tear was a lot more initially severe, and the doctors I consulted all recommended surgery. But based on my first experience I was very leery of another surgery and was determined to avoid it.

    BTW, rotator cuff surgery really, really, really sucks. The recovery is very long and painful, I had to sleep sitting up in a chair for over six weeks, wearing a sling is extremely uncomfortable, and my normal activities were extremely hampered for a long time. So on top of the bad outcome the first time, I definitely did not want to go through that again.

    Based on what I had learned rehabbing after the first surgery, and being able to avoid a second repair on that side, I was hopeful that I could rehab the new injury and I worked really hard and consistently at it for months. But it became apparent that it just wasn't going to work. There was actually a lot of training I was able to do with the bad shoulder, it improved a lot from the time of the injury, and the doctors I consulted were amazed at what I could do despite the injury. But I was still in a lot of pain, couldn't sleep on the injured side, and was substantially functionally limited. Progress then plateaued for a long time, and it seemed clear that it just wouldn't improve further.

    So I had surgery on the second side with a new doctor who I felt very comfortable with. The recovery and rehab were still very long and unpleasant, but ultimately successful. In addition to the prescribed physical therapy, I also employed a lot of my own self-designed therapy (in consultation with my doctor and therapists), some of which is listed below. That shoulder is now completely pain-free and fully functional.

    Here are some of my big bang for the buck shoulder tuneups that have gotten and keep my shoulders feeling great.
    --Original Strength crawling and rocking variations.
    --The David Allen band pull-apart super series:

    --Mace and clubbell swinging.
    --Dislocates using a PVC pipe (I didn't start noticing results from these until I did them very consistently and patiently over time, keeping my hands at a comfortable distance and not trying to force progress).
    --KB snatches.
    --The D I C K Hartzell band stretches (I have to write his first name that way or the language filter makes a mess of it -- the filter does not approve of the nickname for Richard), especially the set up with the band looped around the elbow and hand in the video below. I do my own variations of this kind of stretching, but I find that the band set up that captures the elbow makes a huge difference (and IMO should be widely used in physical therapy circles, although none of the many physical therapists I've worked with had ever seen it before):

    --Various swings with light indian clubs (not necessarily the traditional indian club drills, but mainly ballistic swings in various patterns to explore the range of motion, some of them based on Scott Sonnon's Intu-Flow program, which is on YouTube).

    Things that have been counterproductive:
    --Any sort of wall slide variation.
    --The bodyblade.
    --Focusing on "packing the shoulders" when lifting overhead. In my opinion and experience, rigidly keeping the shoulders "down and back" (as "shoulder packing" is commonly taught and implemented) is a recipe for impingement.

    Things that have been of marginal benefit:
    --I, Y, T, W exercises.
    --Hanging from a bar.
    --KB armbar variations.

    These drills may be more or less appropriate at different stages of rehab. And I'm not going to detail all the variations within them (and instead of and in addition to them) that I did when my injury was more acute or I was earlier in my surgical rehab. But they are the basics of what has worked for me, and continues to keep my shoulders working well and feeling good.

    Some general principles or strategies that I've found helpful:
    --If it hurts (during or after), don't do it.
    --Drills that are "low threat" and don't force awkward and uncomfortable positions. Train your nervous system to accept comfortable and non-threatening movement and gradually expand the range and/or load (for me, this means NO wall slide drills)
    --Drills that get the muscles around the shoulder firing reflexively (such as the David Allen pull-apart series, OS crawling, clubbell and mace swinging).
    --Drills that develop strength in the end ranges of movement (such as the Jump Stretch band stretches, and various other contract-relax stretches).
    --Drills that move the joint quickly and ballistically through the range of motion, under minimal tension. (such as the light indian club swining mentioned above). I've found that the nervous system will accept moving ballistically under low tension through ranges of motion that are painful with slow motion -- there is less threat response and the nervous system is disinhibited from protectively tensing the muscles, restricting the range of motion and causing sensations of pain.

    Finally, through the experience of rehab and training around my injuries, I've developed a much better felt sense of healthy and pain-free shoulder mechanics. Unfortunately it's not something I can really describe or give instructions for, but I definitely think it's helped me avoid further problems.

    I also unfortunately can't give any specific advice, but hopefully my experience is helpful in some way.

    Good luck.
    Last edited: Nov 21, 2019
    godjira1, DrFierce, Antti and 6 others like this.
  6. Steve Freides

    Steve Freides Forum Administrator Senior Certified Instructor

    If you asked this in a room full of lifters, half would raise their hands, and the other half would like to but can’t raise their arms above parallel.

  7. SJT

    SJT Still New to StrongFirst Forum

    Thank you all very much for the replies.

    Regarding listening to the docs-I was told 15 years ago I needed back surgery. Through my own reading, research, and hard work, I've been pain free for sometime now. I'm shooting for the same thing here. I'd simply rather exhaust all of my options prior to going under the knife. I'll listen to my doctors & clear everything I'm doing-but surgery is a last resort.

    In this case, my shoulder mechanics & particularly scapular mobility seem to be at issue. Scapular depression & retraction are particularly weak. My lower traps are incredibly weak & tight compared to my uppers.

    All of this points to bad posture & weak stabilizers.

    The bottoms up, windmills & TGU's all make sense as the job of they are all "stabilizing" movements.

    Thank you for your detailed post & shared experience Steve. I can't agree more with everything regarding "low threat" & reflexive strength. Your experiences match perfectly with mine.
    runninggirevik likes this.
  8. North

    North Double-Digit Post Count

    I would be cautious equating back pain and recommendation for surgery with a rotator cuff injury — in particular an actual tear — and a recommendation for surgery (after an appropriate trial of PT). These are very different things.
  9. rickyw

    rickyw More than 500 posts

    Conservative management of rotator cuff lesions can be effective. Size, location, and direction of the tear matter.

    Not regarding rotator cuff tears, but still the shoulder, I just read today during some continuing education that 80% of a symptomatic baseball pitchers have some degree of labral pathology.

    Same kind of thing goes for meniscal tears in the knees of NCAA basketball players.

    And the list goes on. Despite structural changes on imaging, you can be pain free and functional, though it really does depend on the nature of the structural damage. Sometimes we can get a little too excited about treating the MRI and not the individual.

    Discuss your rehab ideas with your PT/doctors. Seek a second or third opinion if need be.
    Oscar, offwidth and JamesPTA like this.
  10. Steve Freides

    Steve Freides Forum Administrator Senior Certified Instructor

    Credit goes to Pavel T. for this joke, btw - much funnier when he says it. It's on YouTube somewhere if someone wants to post a link.

  11. Acbetten

    Acbetten Still New to StrongFirst Forum

    I was diagnosed with a torn rotator about 3-4 years ago and due to work obligations couldn’t really consider surgery and the extensive rehab and time off. My issue, like yours, was caused by extremely weak back muscles- scapula, traps, etc due to a work position which had me leaning forward and my hands coming together up front. Much like working on a computer keyboard. To strengthen those muscle I simply would do sets of med band pull-aparts. Usually 3 sets of 10. Then a variation in which (while holding either end of the med band) I’d hold one arm straight down by my side and raise the other up like a dumbbell raise until my bicep was beside my ear for about 10 reps. Then hold that arm straight up and lower the other arm until down by your side. Repeat on the other side. Again this is done with the medband as light resistance. I followed this with foam rolling to then relax the last and prevent impingement and increase range of motion. This was all aimed at strengthening the scapula, traps and mid back. Most importantly, I made the most progress when I committed to taking 3-4 weeks off from anything other than these med band pull aparts. Until that, I would make progress then aggravate the injury again and knock myself back to square one. After the 3 week period of just medbands and foam rolling I started to incorporate pushups. Grease the groove with only 2 pushups throughout the day. My shoulder was so bad that the 2 pushups were my max (for a few weeks at least). I then incorporated 2 hand swings. Packing the shoulder and activating the lats helps strengthen the scap, etc. All the while continue with the med band work as a warm up but with fewer reps and always with the foam rolling.
    4 years later- no surgery, no limitations in my workouts regarding movements and absolutely no trace of the injury.
    Oscar, Antti and rickyw like this.
  12. Mark Limbaga

    Mark Limbaga Quadruple-Digit Post Count Elite Certified Instructor

    Dealt with impingement a few times. I always default to what the physio recommends and the make adjustments from there as needed to my training

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