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Thread: Shoulder impingement and training

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    Shoulder impingement and training

    I hate to post a thread discussing training during this time, but I think that Coach Pendlay would want for us to keep trying to get better.

    I have been having shoulder pain for the better part of a year. Here recently, after taking off a few months over the summer, it has gotten worse. So, I went to an orthopedic, as well as had an MRI performed. It turns out that I have a small tear (6mm) in the infraspinatus tendon footprint, some slight tearing in my labrum, and a small cyst. The orthopedic mentioned that I might want to have surgery to anchor things back together and to remove the excess fluid. When he mentioned that I would be in a sleeve for 3-4 weeks after surgery and then another 3-4 months of rehab before I could start training again, I asked about other options. He said that it might heal on itself, but he would probably have the surgery done (he said to give it a few more weeks to see if it starts to improve, but he finds it unlikely to be the case).

    So, after that background, here are my questions. Has anyone had shoulder impingement? If so, what worked for you to get past it? Also, did you alter your training any? I can't snatch heavy (over 50%), it just hurts too much when I overhead squat, but power snatch, cleans, power cleans, jerks, pulls, are all okay. Should I just continue my training but limit/exclude full-squat snatches? Or should I move towards a more `off-season' routine? Finally, for anyone that has had surgery for this type of thing (torn rotator cuff/shoulder impingement), how was the rehab and afterwards?

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    I have been working on a lot of tendon research lately. Maybe in a few weeks I will have a big post ready.
    I recommend dropping classic lifts altogether. You are facing surgery after all... Tendons still need to be loaded to heal. I will post meta analysis below. Something I am doing for shoulders and knees is isometrics. Find a load you can hold for 20 seconds without failing or too much pain (4/10 on pain scale is considered acceptable), but not more than 25 seconds. This should be approximately 70%1RM. From there you will do sets of 12 seconds 2x per week. Start with 5 sets, if possible, and work up to 10 sets slowly.
    Exercise 1: What i call diaganol raise. This is between lateral and front raise. Make sure you turn your thumbs up a little. Find a load you can hold at shoulder level for 20s.
    Exercise 2: What I call snatch raise. This is like a rear delt fly, but you are going to push the weight towards your waist, and have your hands spaced about the same as snatch grip. Make you you are pushing the scapula down, don't shrug up. Find a load you can hold at waist level while bent over for 20s.

    If these hurt too much, don't do it. Also I don't know anything about the cyst issue.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4532714/

    I highly recommend the gelatin and vitamin C protocol as well.

    https://www.ncbi.nlm.nih.gov/pubmed/27852613

    Also, do NOT increase the load for 4 weeks. Give the tissue time to adapt. After that check with the doc to check the effectiveness, and if all is good, then retest your 20 second max.
    Last edited by Matt Erdman; 09-08-2019 at 03:04 AM.

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    Good stuff Erdman. I have had some tendonitis symptoms recently in patella and adductor, and I have been looking into stuff myself more than previously. It is a tricky business that's for sure. The activity/rest balance, the enough stimulus for recovery vs too much and irritating it again, when to push and when not to.

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    About the gelatin/Vit C, do you have any practical way of implementing this?

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    Thanks for the information. Would you stop cleans, jerks, etc., even if they don't hurt to perform? What about pulls and squats?

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    Quote Originally Posted by CNL View Post
    About the gelatin/Vit C, do you have any practical way of implementing this?
    Thanks. Look for plain gelatin and take 15 grams and 200-500 mg vitamin C about 45 minutes prior to tendon-specific training. There are also collagen supplements that are becoming more popular, but you should only need about 10 grams of isolated collagen. As i understand it, gelatin is ~70% collagen. You can start with 5 grams if you want to limit the possibility of digestive upset. So if you are doing some snatches/C&J first, then you might take it right when you start. That way it will be circulating when you do slow movements for the tendons.

    FWI with patella, single leg or split squats will allow you to get more time under tension without so much systematic fatigue as barbell squats. I have been working on that for a little while, but I want to get a few more weeks in before posting about it.

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    Quote Originally Posted by jackie View Post
    Thanks for the information. Would you stop cleans, jerks, etc., even if they don't hurt to perform? What about pulls and squats?
    Yes, I would stop pulls and all that. We are talking about surgery right? Surgery doesn't mean 100% everything is fine you know. Back squats might be ok with a wide grip. Don't do anything risky if you hope for a good report in 4 weeks.

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    As i understand it, gelatin is ~70% collagen.
    gelatin is hydrolyzed collagen. They have very similar amounts of glycine, proline, and hydroxyproline besides the other trace AA. I've seen 10 up to 20g. If you eat a fairly high protein diet, you really won't be that low in those AA but it's good to have extra to be utilized for collagen synthesis after whatever is used to for normal bodily function.

    TBH, I would say throw out all Sn, Cn, and Jerk movements. Basically anything with significant speed/force. DL sure, press besides squats. DB stuff sure. pullups, pushups maybe depending on how much they irritate.

    it'd be great if you could keep pulls, PC, and cleans in the mix. I think you could keep in pulls but PC and Cleans generate significant force. While you mention jerks don't irritate your situation, like cleans they generate a lot of force. It all depends on loading I suppose.

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    Quote Originally Posted by jackie View Post
    I hate to post a thread discussing training during this time, but I think that Coach Pendlay would want for us to keep trying to get better.

    I have been having shoulder pain for the better part of a year. Here recently, after taking off a few months over the summer, it has gotten worse. So, I went to an orthopedic, as well as had an MRI performed. It turns out that I have a small tear (6mm) in the infraspinatus tendon footprint, some slight tearing in my labrum, and a small cyst. The orthopedic mentioned that I might want to have surgery to anchor things back together and to remove the excess fluid. When he mentioned that I would be in a sleeve for 3-4 weeks after surgery and then another 3-4 months of rehab before I could start training again, I asked about other options. He said that it might heal on itself, but he would probably have the surgery done (he said to give it a few more weeks to see if it starts to improve, but he finds it unlikely to be the case).

    So, after that background, here are my questions. Has anyone had shoulder impingement? If so, what worked for you to get past it? Also, did you alter your training any? I can't snatch heavy (over 50%), it just hurts too much when I overhead squat, but power snatch, cleans, power cleans, jerks, pulls, are all okay. Should I just continue my training but limit/exclude full-squat snatches? Or should I move towards a more `off-season' routine? Finally, for anyone that has had surgery for this type of thing (torn rotator cuff/shoulder impingement), how was the rehab and afterwards?
    Surgery doesn't mean improved outcomes. It's entirely possible you'll have less range of motion afterwards after rehabilitation, or still have pain in the shoulder. It's a bit irresponsible for the orthopedic surgeon not to recommend physical therapy as conservative treatment, especially since it looks like it's a pretty mild tear. Surgery in this case is going to be bit of a gamble that it'll turn out the way you want, and the initial choice should be physical therapy, and if it doesn't work, then look into surgery. I would see a sports physical therapist. Maybe there's a physical therapist registered with clinical athlete near you.

    I see a fair amount of patients that are post-OP RC repair and they sometimes never regain their full range of motion overhead, especially with certain surgical techniques.

    It's pretty common to get patients with similar presentations like this and then with some treatment they get greatly reduced pain and full function. Rotator cuff tears, especially mild ones, are very common, and aren't really well correlated with pain and loss of function. It's entirely possible it's an old injury and for some reason or other you started developing pain in the shoulder.

    Researching is good and all, but it doesn't replace having a healthcare professional diagnosing and treating you. The physical therapist is going to have the research knowledge...plus years of education and experience. Researching and then trying to do it yourself is a risk, and given it's your shoulder I wouldn't gamble on that unless you have significant financial concerns.
    Last edited by SilverStar; 09-08-2019 at 08:03 PM.

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    Quote Originally Posted by Matt Erdman View Post
    Exercise 1: What i call diaganol raise. This is between lateral and front raise. Make sure you turn your thumbs up a little. Find a load you can hold at shoulder level for 20s.
    Exercise 2: What I call snatch raise. This is like a rear delt fly, but you are going to push the weight towards your waist, and have your hands spaced about the same as snatch grip. Make you you are pushing the scapula down, don't shrug up. Find a load you can hold at waist level while bent over for 20s.
    [/U]
    Exercise 1 won't target the infraspinatus very well, as the infraspinatus is mainly an external rotator. While your shoulder will externally rotate if you keep it thumbs up in scaption (which is the motion you're describing) it's going to be a secondary thing. Exercise 2 is a similar issue, assuming if I understand the exercise correctly. It will mainly target your shoulder adductors.

    Both of those exercises will provide benefits in the sense of overall shoulder/glenohumeral shoulder stability, which can potentially help your shoulder pain. It just won't directly target the muscle/tendon involved.
    Last edited by SilverStar; 09-08-2019 at 08:25 PM.

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