In September I stopped working out because my shoulders began to hurt more and more with each subsequent workout. On top of that my knee was also hurting quite a bit when I would attempt to pull my heal up towards my hamstrings. I thought with rest they would get better. Healing never happened so fast forward to now.

I finally went and got an MRI on both of my shoulders and my knee right before Christmas.

Knee: The MRI on my knee was mostly positive. It was a joint effusion with myxiod in the posterior horn of the lateral meniscus. Basically there were no tears but there was prior damage and it is healing so it resulted in fluid build-up.

Shoulders: Turns out I have Type III Acromion for the left shoulder and Type II for the right shoulder. There were other things but my knowledge is sub par on them…supraspinatus tendinopathy, mild fibrocapsular hypertrophy of the acromioclavicular joint, mild subcoracoid bursal effusion, mild peritendonitis of the proximal biceps tendon, mild thickening of the distal insertional supraspinatus tendon.

What is so strange about all of this is that I CAN overhead press without pain. I can’t get DB’s in position to overhead press but with a machine I have no problems as long as I keep my elbow from going too low past my shoulder.

I CAN NOT do any chest exercises with any amount of weight without extreme pain. Dips, flat bench, any incline/decline presses. For instance the most I got up to on bench was 3 reps of 275lbs, NOW I scream in pain with 135lbs. However I can do pushups with very little pain (odd).

Basically I can work to improve the impingement syndrome but because of the structure of the acromion it will always be something I have to deal with.

Q1: My chest was already a weak point from a size persepective so is there anything I can do to keep it at least respectably in proportion to my arms/back?

Q2: Do you think I should ONLY focus on correcting posture issues/shoulder impingement issues for the next year or so in order to get the most out rehabbing? Knowing this approach will cost me muscle mass and I would look more athletic than muscular. Not to mention mentally there would be very little motivation to go to the gym to rehab

Q3: Should I workout normally but take out the Pressing movements and on off days work on the above rehab. Taking the philosophy of Chad Waterbury I came up with a workout. I am not married to full-body, high frequency, or anything else, I just could not come up with a good split without any chest pressing movements and minimal shoulder movments. I would appreciate any advice on whether this would be the best approach in my situation. If not, is there a split that would be optimal-preferably 4 day?

I didn’t realize this would be so long but any advice or help would be appreciated!

In September I stopped working out because my shoulders began to hurt more and more with each subsequent workout. On top of that my knee was also hurting quite a bit when I would attempt to pull my heal up towards my hamstrings. I thought with rest they would get better. Healing never happened so fast forward to now.

I finally went and got an MRI on both of my shoulders and my knee right before Christmas.

Knee: The MRI on my knee was mostly positive. It was a joint effusion with myxiod in the posterior horn of the lateral meniscus. Basically there were no tears but there was prior damage and it is healing so it resulted in fluid build-up.

Shoulders: Turns out I have Type III Acromion for the left shoulder and Type II for the right shoulder. There were other things but my knowledge is sub par on them…supraspinatus tendinopathy, mild fibrocapsular hypertrophy of the acromioclavicular joint, mild subcoracoid bursal effusion, mild peritendonitis of the proximal biceps tendon, mild thickening of the distal insertional supraspinatus tendon.

What is so strange about all of this is that I CAN overhead press without pain. I can’t get DB’s in position to overhead press but with a machine I have no problems as long as I keep my elbow from going too low past my shoulder.

I CAN NOT do any chest exercises with any amount of weight without extreme pain. Dips, flat bench, any incline/decline presses. For instance the most I got up to on bench was 3 reps of 275lbs, NOW I scream in pain with 135lbs. However I can do pushups with very little pain (odd).

Basically I can work to improve the impingement syndrome but because of the structure of the acromion it will always be something I have to deal with.

Q1: My chest was already a weak point from a size persepective so is there anything I can do to keep it at least respectably in proportion to my arms/back?

Q2: Do you think I should ONLY focus on correcting posture issues/shoulder impingement issues for the next year or so in order to get the most out rehabbing? Knowing this approach will cost me muscle mass and I would look more athletic than muscular. Not to mention mentally there would be very little motivation to go to the gym to rehab

Q3: Should I workout normally but take out the Pressing movements and on off days work on the above rehab. Taking the philosophy of Chad Waterbury I came up with a workout. I am not married to full-body, high frequency, or anything else, I just could not come up with a good split without any chest pressing movements and minimal shoulder movments. I would appreciate any advice on whether this would be the best approach in my situation. If not, is there a split that would be optimal-preferably 4 day?

I didn’t realize this would be so long but any advice or help would be appreciated!


Have you tried decline neutral grip DB presses? What about floor presses? Which would only use half the motion, Pronated flys? Weighted pushups using t-handles and a napshack?

If you can't do any chest movements i would be very conservative in your strength gains of your pulling movements.

I really have no opinion on if you should continue to train your back and arms. Legs shouldn't be a problem. The only one i would be weary of is pulling actions.

Good Luck!

Have you tried decline neutral grip DB presses? What about floor presses? Which would only use half the motion, Pronated flys? Weighted pushups using t-handles and a napshack?

I can do nuetral grip DB presses with less pain than other chest movements. I have done these with 35lb DBs and at that weight I have tightness and a dull pain but it is manageable.

Any Fly's kill me. The closer the elbow to my sides the less pain (basically using the lats and tri's to un-isolate the chest). The more the arms are flared out the more pain.



If you can't do any chest movements i would be very conservative in your strength gains of your pulling movements.

I really have no opinion on if you should continue to train your back and arms. Legs shouldn't be a problem. The only one i would be weary of is pulling actions.

Is your thinking that I would have an imbalance? I didn't think about this for long term. I do have posture issues including rounded shoulders that enhance the defficiency so I need to do some work there but I also need to be sure not to take it too far. Thanks for bringing that to my attention.

Would you think deadlifts, overhead presses, tricep work, and pushups variations work the chest enough so that imbalances would not be as detrimental and cause a whole other set of issues?

The doctor said I should do low weight with high reps (I laughed). Is this what you are suggesting by warning me about increasing posterior chain strength?

Thanks I am just trying to get a better understanding of your reccomendations.

I can do nuetral grip DB presses with less pain than other chest movements. I have done these with 35lb DBs and at that weight I have tightness and a dull pain but it is manageable.

Any Fly's kill me. The closer the elbow to my sides the less pain (basically using the lats and tri's to un-isolate the chest). The more the arms are flared out the more pain.





Is your thinking that I would have an imbalance? I didn't think about this for long term. I do have posture issues including rounded shoulders that enhance the defficiency so I need to do some work there but I also need to be sure not to take it too far. Thanks for bringing that to my attention.

Would you think deadlifts, overhead presses, tricep work, and pushups variations work the chest enough so that imbalances would not be as detrimental and cause a whole other set of issues?

The doctor said I should do low weight with high reps (I laughed). Is this what you are suggesting by warning me about increasing posterior chain strength?

Thanks I am just trying to get a better understanding of your reccomendations.

Yeah i was thinking of the imbalance. Here's an article by Poliquin that i haven't looked over yet that gives you some tests to check your balance.

http://www.t-nation.com/readTopic.do?id=459454

If you can do weighted pushups i'd say your in pretty good shape. With all the different hand and foot positions, including rising your feet, your varations are endless.

Just put some iron in a napshack and put it on or get one of those weighted vests :)

btw Scott curls is another name for preacher curls.

Is it the shoulder rotation that causes the pain?

How did you used to bench? Were your elbows flared, BB style? Did you bring the bar down to your chest this way? Those are terrible for your shoulders and will definitely give you pain. Have you tried powerlifting style? There is much less shoulder rotation and more emphasis on the triceps, lats and traps. Decline PL style would probably have the least amount of shoulder rotation than any exercise, but would have a similar motion as a dip, which you said already hurts you.

Is there any idea how this developed? If you were pushing 275 before without any trouble, is there a possibility that the lifting created the problem? I am aware that it tends to be hereditary/genetic, but perhaps there is something in your training that helped trigger the impingement?

There may not be a manner in which you can lift that wont cause pain - but there most likely is: You can't have pain for every range of motion, which is evident as you can overhead press fine. If you can't do any pressing for your chest, do it all overhead. You'll have to experiment and find a method of chest pressing that'll work for you.

Is it the shoulder rotation that causes the pain?

My left shouder pops loudly when I pull my shoulder forward and rotate but from what I understand this is because there is not enough room between the clavical and the acromion. The pain is in the shoulder when I bench press and the bar gets around 6-8 inches away from my chest.

How did you used to bench? Were your elbows flared, BB style? Did you bring the bar down to your chest this way? Those are terrible for your shoulders and will definitely give you pain. Have you tried powerlifting style? There is much less shoulder rotation and more emphasis on the triceps, lats and traps. Decline PL style would probably have the least amount of shoulder rotation than any exercise, but would have a similar motion as a dip, which you said already hurts you.

If I was going heavy i.e. 275 then I would do powerlifting with elbows in-back arched-wider grip.

Is there any idea how this developed? If you were pushing 275 before without any trouble, is there a possibility that the lifting created the problem? I am aware that it tends to be hereditary/genetic, but perhaps there is something in your training that helped trigger the impingement? I have no doubt that my training exposed the hereditary/genetic shoulder structure. Couple that with the fact of rounded shoulders and bad posture and it was just a matter of time. I also never really dealoded. I went up in lifts every week without fail. I think I just pushed to hard each and every time I was in the gym. When it finally got so bad I could not lift I was doing a high frequency program and my shoulders just could not take the multiple lifts throughout the week. When I stopped lifting I thought a week or two and I would be back to normal but 3 months later and it never got better.

There may not be a manner in which you can lift that wont cause pain - but there most likely is: You can't have pain for every range of motion, which is evident as you can overhead press fine. If you can't do any pressing for your chest, do it all overhead. You'll have to experiment and find a method of chest pressing that'll work for you.

I hope this is true. I think I am going to stick to pushups and some decline Db's nuetral presses until I can get some flexibiility/mobility into the shoulders.

Thanks Betastas

Ok, this is the workout I have come up with. As I said in the first post advise is requested and I am not married to this approach or plan. Thanks for Critiquing!

Tuesday:
Back Squat (wide) 4 sets of 6 reps
Seated Cable Row (pronated) 4 sets of 6 reps
Wide Grip BB Curls 4 sets of 6 reps
Lunges 4 sets of 6 reps
Cable Military Press 3 sets of 12
Pushups 5 sets of 12

Wednesday:
Deadlifts (Narrow) 3 sets of 12
Lat Pulls (Palm Up) 3 sets of 12
Rope Pushdown Triceps 3 sets of 12
Seated Calf (In) 2 sets of 20
Reverse Crunch 2 sets of 20
Reverse DB Fly’s 3 sets of 12

Friday:
Back Squat (Narrow) 3 sets of 12
Seated Cable Row (Palms Up) 3 sets of 12
Preacher Curls 3 sets of 12
Step Ups 3 sets of 6
Machine Military Press 3 sets of 12

Saturday
Deadlifts (Sumo) 4 sets of 6 reps
Lat Pulls (Palms Down) 4 sets of 6 reps
DB Skull Crusher 4 sets of 6 reps
Seated Calf (Out) 2 sets of 20
Machine Crunch 2 sets of 20
Reverse Cable Cross 3 sets of 15

A low volume week occurs every third week where I will basically go 5 sets of 5 while working up to ~95% of maxes for 2-3 movements. For instance a workout in week 3 would look like this:

Deadlifts 5 sets of 5
Lat Pulls 5 sets of 5
Hammer Curls 5 sets of 5

When you do your lat pulldown work, are you taking a wide grip? Wide grip is hard on the rotator cuff and since you're trying to avoid that, consider going narrower. You still reap the benefits of the pulldown ever with a shoulder width grip.

When I had impingement, there was no way I could bench or overhead press until I had surgery. But then I had pain with just 20lb dumbbells. Was/is surgery an option? Decompression, where they shave off bone and clean the joint should be fairly straightforward and recovery time is relatively quick. I started rehab within 1 week, and was lifting a decent weight after about 8 weeks. It sounds like I was in more pain and less able to do any lifting than you are though.

I’ve had ‘twinges’ of impingement in my other (non-operated on) shoulder. Fortunately with ice and not overdoing it, it has not got to the stage where it is affecting my workouts, and had gotten better over a few months. But if it ever got bad (and I know I ma susceptible to it), I’ve have surgery in a heartbeat.

As far as the rest goes, I would work with a physiotherapist (not a doctor) for at least several months before lifting heavy again. It may take some effort to find a good one, but it will be worth it, especially as you can expect to have more problems as you get older. I basically found someone I trust and go back to him whenever I have something that seems like more than a minor tweak. Usually 1-2 visits and I can take the rehab from there. Self diagnosis is very tricky, unobvious and I’ve never been able to find the appropriate rehab exercises myself. It wastes a lot of time.

Yes you will lose some muscle, but you'll be better off in the long run IMO. After a couple of months, I'd start back on stuff that does not cause any pain at all, and take it form there.

Sounds like even when/if you fully recover you should take RC strengthening exercises seriously. Even after a year, doing RC exercises frequently, and now lifting heavier than I’ve ever done in the past, I still get sore shoulders and have to be careful with volume/intensity.


In fact I’ve been lifting hard recently (with the X-mas eating and stuff) and tried to workout this morning and realized I need a week off. Then I’ll start back with low volume and intensity and build again from there. I’m feeling fat (or maybe overfed would be a better description), and want to keep lifting, but I know it will only cause more problems down the road. In 2005 I was out of lifting completely for over 9 months – I don’t want to go though that again.


Anyway, good luck.

I can ovhd press pain free but I can not bench (this is what seems to make my shoulder issue different than most peoples). Something I have struggled with is pinpointing exactly in the shoulder where the pain is. I did a test this morning..I somewhat pre-fatigued the shoulders using 3 sets of 12 Machine shoulder presses. I then attempted pec decs. The last half of a pec deck Fly causes me very little pain. The first foot of the initial movement is what causes me the most pain. So the pain is unbearable when there is force either concentric or eccentric applied while my shoulders are in stretched postion. I am not exactly sure what that means but tonight I am going to try bench lockouts and see where the pain begins and ends.(Sorry just some rambling internal dialogue:read: )

Surgery is an option but I wanted it to be a last resort. I have been told that 9 months to one year is the total recovery time. Shaving the bone is exactly what was talked about so I may have to think about that if it only took you a couple of months and you were back to lifting respectable weights. Can you lift 100% pain free now? Any warnings of having to have scar tissue removed once you get older?

I tried self diagnosing for a while and that is why I finally got the MRI. I do need to find a specialist because my chiropractor is the one that ordered the MRI's so he obviously wants to avoid surgery at all costs. He has been working on my shoulders for several months now with little progress.

Do you have any advice on the rehab excercises you did? No matter what, you are 100% correct that I am going to take RC strength and stability serious. I can not think of a worse injury for someone who works out.

thanks for the reply

Surgery is an option but I wanted it to be a last resort. I have been told that 9 months to one year is the total recovery time. Shaving the bone is exactly what was talked about so I may have to think about that if it only took you a couple of months and you were back to lifting respectable weights. Can you lift 100% pain free now? Any warnings of having to have scar tissue removed once you get older?

I tried self diagnosing for a while and that is why I finally got the MRI. I do need to find a specialist because my chiropractor is the one that ordered the MRI's so he obviously wants to avoid surgery at all costs. He has been working on my shoulders for several months now with little progress.

Do you have any advice on the rehab excercises you did? No matter what, you are 100% correct that I am going to take RC strength and stability serious. I can not think of a worse injury for someone who works out.

thanks for the reply

Benching was actually the biggest issue for me too.

From the second paragraph, my initial reaction was 'don't have that doctor do the surgery'. A good surgeon is a must.

9 months is if they have to repair a tear (ligament or tendon). Shaving the bone is just as if you had broken it, but obviously it is a very ‘clean’ break. In addition, once you have had the decompression you cannot do further damage (although you should wait for the follow-up (or 7-10 days) to make sure everything went OK before really stressing it). How quickly you start lifting is really a pain/recovery threshold deal. But actually it needs to be worked to a certain extent (even during the first few days you should start trying to move it and get ROM back). After being out for 9 months before the surgery, I actually took it easier than I should have and ‘protected’ it more than I should have.

Disclaimer: everyone recovers a bit differently – I did quite well, and the doc was very pleased with my progress but I have heard similar stories from physiotherapists and I actually tend to heal very slowly.

Self-diagnosis does not work. You need a good orthopedic doc to look at the MRI report and a physiotherapist to follow up with for any rehab (pre or post operation if you have it). I’ve had tendon ‘tweaks’ since my op and been back to the doc. I thought I knew where the pain was coming from, but it turned out I couldn’t even diagnose that myself. The brain can be quite misleading and there are a lot of nerves and internal tendons and ligaments and it can feel like the pain is in one spot but the problem is actually in another spot (maybe less so for the impingement, but certainly for the tendonitis/tendinopathy).

Each time I’d describe to the doc what I though was going on and he’d perform the tests and tell me something completely different. Then I’d go to the pysio and he’d perform more tests (usually the whole 45 minute first session) give me ROM and strengthening exercises that I’ve never seen on the internet. And they worked. But of course they were specific to my problem at the time – and different than simple RC strengthening ones – those are always good to do though and are well publicized.

I scar really easily, so yes I have scar tissue – 3 little (2-3mm) ‘blobs’ where they inserted the instruments (actually I think they use 2 holes to pull the shoulder apart and one for the cleaning tool – but they don’t tell you that exactly)! I never tried anything to reduce scaring. I think I mis-understood your comment though – your shoulder should have less scar tissue and be in better shape after the operation than before it. It’s exactly the build up of scar tissue that they should remove, as well as shaving any anatomical problem bits of bone. I didn’t phase that well, but there should be no reason to have to go back to re-clean.

Can I lift 100% pain free? Well, my shoulders still get sore. I’ve tweaked tendons in both of them since the operation, so I’m not ‘pain free’. However, the pain that was the problem before has completely gone, although that did take several months. But if you workout at all, I think you will be in significantly more pain from DOMS and general aches, than the result of the surgery. Certainly I am. And I don’t feel it at all lifting.

I mean I started my whole deal with ‘OH my god, shoulder surgery would be an absolute last resort – it will get all messed up etc.. etc..’ Like I said, now I wouldn’t hesitate to have my other shoulder done.

Now, one thing. For my case there was a variation on the MRI that showed a possible SLAP tear. So actually I did go into the operation not knowing if I was going to have a 2 month ‘easy’ recovery or 9 months ‘hard’. If you know for sure there is no tear (and it sounds like it from both your description and the MRI), then it really is not bad.


A long post, but hope it helps. PM me if you still have a bunch of questions about my experience.

Since the acromion is curved and squeezing the tendons against the humerus, you're not going to be able to magic it away. It's a mechanical problem, and it needs to be mechanically addressed. If you don't have any tears right now, then for goodness sake don't screw around until you do have one. Get the surgery, and then do the rehab and get squared away. Your 5 year prognosis is better if you address the problem fully than if you limp along trying to lift the way things are.

The reason you can do overhead press but not benchpress is that overheads are pushing the humeral heads down away from the acromions, which increases the superior joint space. Benching pushed the humeral head right back up against the acromion, squishing the tendons in between, which is bad.

I tried self diagnosing for a while and that is why I finally got the MRI. I do need to find a specialist because my chiropractor is the one that ordered the MRI's so he obviously wants to avoid surgery at all costs. He has been working on my shoulders for several months now with little progress.


I was going to ask what kind of doctor you went to. You need to see an orthropedist. You could have a labrum tear affecting you as well. An MRI has only a small chance of "seeing" a labrum tear, but an orthropedist could diagnose.
I tore my supraspinatus and had surgery to repair. I understand about the popping sound. That was one of the biggest tell-tell sign for me that my should was messed up. It still popped even after surgery, but has since diminshed.
During my rehab, I had the same type symptoms when it comes to doing flat bench and overhead movements. Heck, I tore my shoudler up when I was getting dumbbells into position for incline bench. I was still able to workout and complete military press afterwards in the same workout. Flat Bench is still somewhat of a pain for me even today.