Post SLAP Tear Surgery - Advice Needed

j_raby

Second Post
Hi everyone! This is kind of a "two-fer" post - intro and question. Thanks in advance!!

I've been following the blog and the forum off and on since Pavel started StrongFirst, but have never been active on the forum. I was training with a single 16kg doing "The Program" from the SFG User Course I took in December 2014 with Coach Karen Smith (GREAT course and coach! Thanks so much!) until I hurt my shoulder this past March. I wasn't untrained when I attended the User Course, but was certainly detrained and overweight. I made great progress on the program and lost about 20 pounds, so I am definitely a believer in the principles used and espoused by StrongFirst.

I just read Steve Freides' thread on asking for training advice, so I'll just hit the points in order:

Restrictions: I'm ~12 weeks post-op for a SLAP repair/destabilization surgery on my right shoulder. My surgeon in Oklahoma City, Dr. Calvin Johnson, has cleared me to start doing some exercising in the gym and yoga. He told me I could do horizontal rows and all the rotator cuff exercises with the little pink dumbbells type stuff. Still no pressing other than planks, especially in the front-leaning rest position. Also, curls and triceps pushdowns were okay, along with leg presses and leg curls. The PT who works specifically with my surgeon agreed that OS resets like crawls, rocking, etc. would be great to do as well (I showed him some of Tim's videos on YouTube). The PT also told me farmer's carries and suitcase carries were great choices. I've been doing bodyweight squats and hinge practice for several weeks, too, but not on any real regimen. Jumping rope is also acceptable. I assume working up to weighted goblet squats and kb deadlifts is okay as long as the weight stays fairly light. Will call Tuesday to confirm.

Demographics: Male, 28 yrs old, 5'4", 190lbs (getting body comp checked soon at the YMCA)

Injury history: My injury history is decently long and varied with no interesting stories. I originally hurt my shoulders in Aug. 2008 and eventually did PT for about a month for AC joint impingement. I've had several tweaks in the years since. I was coaching a boxing class for my university's campus recreation program at the time and that was my only meal ticket - I'm sure I did way more damage to my shoulders than I otherwise would have had (Dr. Johnson told me I needed surgery a long time ago). I've also had 3 bad groin/hip flexor strains (Sartorius) since I was in elementary school taking Kempo. The most recent two were in college around 2009-2010. I also hurt my right wrist learning power cleans at a CrossFit establishment and push-ups and barbell presses seem to make it flare up. I've had it x-rayed but the doc couldn't tell me anything. It's been bothering me recently but kinda seems to settle down after a warm-up. I've followed all sorts of exercise programs and protocols since entering college from following Ross Enamait to CrossFit to Starting Strength and have never been able to progress very far without hurting my shoulder or hip flexor and needing to reset at "square one."

Movement history: I had a FMS screen in Aug. 2014 and got at least 2s on everything but the shoulder thing with my hands behind my back. Was cleared after a month or so of ART and chiro work to start training TGUs and eventually presses. Didn't get another FMS done before he told me I could do presses as long as I didn't have pain.

Sports history: Several martial arts including Kempo as a kid and boxing in middle/high school. I did a little Judo and BJJ in college but mainly coached the boxing class. I've also done some rock climbing and mountain biking. I would love to participate in martial arts, biking and climbing again, as well as archery, if I can. Otherwise, I just want to raise my right arm overhead again.

Moving forward: As I said, I really just want to raise my arm and be able to help a friend move, etc. without fearing another subluxation/dislocation. Maybe reach behind me to tuck in my shirt for work instead of doing it terribly with my left hand. Before needing the surgery I was working on getting back down to 160lbs and reenlisting in the National Guard (I had to separate after BCT in 2012 for personal reasons. I received an "Uncharacterized" discharge with an RE3 since I wasn't MOSQ), but I doubt that's an option anymore.

I do have an idea for a plan that kind of follows StrongFirst's principles, Max Shanks' Ultimate Athleticism and Dan John's Intervention book (as well as I understand them, anyway).

Wed is a beginner yoga class at the YMCA I thought I'd take. Was thinking M/W/F would be good for yoga and walking/light LSD cardio or crawling.

T/Th/Sat in an A/B format:
Workout A
OS Presets (rolling doesn't seem safe to me at this point)
Crawl - some distance on the indoor track in the YMCA x3
Cable Rows - work up to a 1,2,3,4,5 x 5 ladder before increasing weight
(a1)Tricep Pushdowns - 10x3
(b1)Curls - 10x3
(c1)Some yoga move from class x10 breaths on each side
(a2)Goblet squats - work up to a 1,2,3,4,5 x 5 ladder before increasing weight
(b2)KB Deadlift - work up to a 1,2,3,4,5 x 5 ladder before increasing weight
(c1)Some other yoga move from class x10 breaths on each side
Farmer's carries x3
OS Resets


Workout B
OS Presets
Crawl some distance on the indoor track in the YMCA x3
Batwings - work up to a 1,2,3,4,5 x 5 ladder before increasing weight
(a1)Front-leaning rest plank - 3 sets
(b1)Curls - 10x3
(c1)Some yoga move from class x10 breaths on each side
(a2)Goblet Bulgarian split squats - work up to a 1,2,3,4,5 x 5 ladder before increasing weight
(b2)Single-leg deadlifts - work up to a 1,2,3,4,5 x 5 ladder before increasing weight
(c1)Some other yoga move from class x10 breaths on each side
Suitcase carries x3
OS Resets

That, to me, has all of Dan John's essential movements, unilateral and bilateral lower body movements, works in the OS stuff and Dan John's idea of doing correctives between sets. I have access to very light dumbbells (5, 7.5, 10, 12.5, 15lbs+) and kettlebells (7, 10, 15, 20lbs+) for doing the batwings, squat variations, and carries. I thought I should stick to unloaded squats & deadlifts until I get to the 5x5 ladders and then add weight. It seems like a good way to get the groove back but to also build work capacity, keep from going to heavy for my shoulder, and not get greedy with my progress.

Am I on the right track? I've done 6 weeks of PT and have had good progress, but I'm having trouble with my insurance right now and can't afford the $288/hr fee. The surgeon told me I needed to start strengthening my shoulders back up and that "getting back in the gym" is what I can do moving forward.

Thank you to anyone who has stuck with me this far and again in advance for any advice you may have. I greatly appreciate it!

I hope you all have had a great Labor Day weekend!
 

Steve Freides

Forum Administrator
Staff member
Senior Certified Instructor
IMHO, you have too many things in your program, _way_ too many things. When people have a chronic upset stomach, they often go on an elimination diet - they eliminate everything but a couple of foods, e.g., rice and apple sauce, and for a few days they eat only rice and apple sauce. After they've proven that neither of those bothers their stomachs, and then they add things back into their diet very slowly, one at a time, to try to find what's the cause of their problems.

You need this same approach to training.

Start with walking and one weight lifting movement - and that's it. See how you do for a while.

Walking and goblet squats sounds like a good combination to me. Maybe add kettlebell deadlifts after that. Pay very close attention to all the technical details, especially those that, if not attended to, could make your injuries worse. Learn how to open your hips for the goblet squats, learn how to keep your shoulder packed during the deadlifts.

Consider a program like Kettlebell: Simple & Sinister, which features two lifts. In your case, there should be no thought of "essential" movements - you need to Do No Harm as the first order of business. Less is more here.

Someone who hasn't crawled in a long time might need a regression into that pattern rather than just diving into it. Limit what you do, make sure you're doing what you're doing correctly and it's not making you worse - and then and only then consider adding something to the mix.

You can help your friends move again when you've got your situation figured out - until then, no. You've got shoulder issues, groin issues, wrist issues - let's not add to the list, and let's make improving those things your top priority.

-S-
 

Tarzan

More than 500 posts
I think that's way too much rehab work too. You can't force it back into functionality by doing a lot of work.

I've had a SLAP tear too, mine was complicated by an ossification of bone on the humeral head and several torn rotator cuff structures. I dislocated mine hundreds of times, sometimes the dislocations were from impacts and other times the dislocations were from simple things like rolling over in bed or sneezing.

After I had my operation, there wasn't a great deal of rehab as the ortho seemed to believe that joint would take over a year to heal properly and let the joint tighten back up. His opinion was too much work would interfere with the joint tightening itself back up and regaining mobility. (possibly because I was a young man and most young men overdo things to extremes) Overdoing things in the first year could delay the recovery.

It's a bit of a paradox in some respects, the joint has to regain mobility and improve stability at the same time.

My rehab was focused on light weight rotational exercises. Starting with something like a can of beans or soup etc gripped in the hand whilst laying in supine position (on my back) and on my side (the opposite side to the arm being worked) and gradually extending the range of motion for high rep sets of external & internal rotations of the shoulder with the elbow bent at 90 degrees and held close to the body.

The aim here was not to build strength initially but to extend the range of active flexibility while keeping the shoulder joint packed.

After the first six months the rotational movements were extended to include different elbow positions ie the elbow was moved gradually away (over several months) from my body and the lightly weighted external rotations were done again in a supine position. Some standing rotations were also included at that time. and the weight lifted gradually was increased.

I've got to stress that the early rehab work is not strength work, it's about regaining active flexibility and keeping the shoulder joint packed. In many ways it's a learning process that is designed to teach you how to rotate your shoulder through slowly increasing ranges and aspects of rotation whilst keeping the joint packed and preventing sublaxations and/or dislocations at all costs.

It also retrains the neural pathways in some respects and teaches your nervous system the limits of ability, you really have to learn your limits and stay within them.

Many people with shoulder problems focus on the standard linear movements that are typical in gym training these days but in my experience with myself and training many footballers with shoulder problems, linear exercises are almost useless for shoulder sublaxations and dislocations. You need to do rotational exercises (internal and external with different elbow positions) to stabilise the joint in all aspects of rotation but don't rush it or push to the point of sublaxation.
 
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j_raby

Second Post
Thank you guys for your help! I apologize for waiting so long to reply. I've taken your thoughts and advice to the PTA that was running my therapy and she agreed I needed to scale it way back. Planks, light cable rows, and light farmer's carries are what she specifically told me to work on, along with the stretches I've already been doing.

Thanks again!
 
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