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Toen rotator cuff: replacement chest/delt exercises ?

Discussion in 'General Health/Fitness & Injuries' started by philph, Aug 12, 2008.

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  1. philph

    philph Well-Known Member

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    An examination today revealed that my chronic shoulder problems are associated with a torn supraspinatus tendon, most likely of gradual onset due to impingement of the supraspinatus and related to extreme tightness (e.g. in the pecs). The physiotherapist estimated that the tear itself has been there for a few months and is perhaps a 20% tear.

    There are several exercises and stretches I'm going to do to help the rotator cuff to heal more quickly, but meanwhile I was wondering if anyone can suggest some replacement exercises for chest and delts, as pressing movements above 45 degrees are problematic. My equipment is limited to a flat/inclined/upright bench, DB, BB, and single high and low cables.
     
  2. erik.whitman

    erik.whitman Active Member

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    Whats up Phillip. Lookin YOKED as usual. I have been battling the same problem for almost a year now. I have more or less cut out almost all direct delt work (no shoulder pressor side/front/rear raises) and that has helped alot. I am also ver careful to warm up my chest and delts before any direct upper body work. Jump ropeing actually works quite well for me fo this. As far a exercises goes for my shoulders, I do shoulder (band/rope/whatever) dislocations, facepulls, and YTW's to keep my shoulders supple and prevent (hopefully) inflaming the rotator. I still Bench, and my only "direct" shoulder work comes from Clean & Jerks or Push Press' for low reps, moderately heavy (for me :D) weight.
     
  3. MannishBoy

    MannishBoy Senior Member

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    I've had the best recovery from just completely removing push work for awhile until pain subsides.

    Also, in addition to rotator work and pec stretches, don't forget scapular work and thoratic spine flexibility work. Those are just as important IME.
     
  4. philph

    philph Well-Known Member

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    Thanks Eric & Mannish. Those are some helpful starter points.

    I'm thinking that, to a large extent, pain will be a guide when it comes to gradually reintroducing pressing movements with decent loads.

    Meanwhile, even before I got the diagnosis, I was considering adding extra emphasis to upper back, thorax extension and serratus anterior and now I'm definitely going to do that.
     
  5. zenpharaohs

    zenpharaohs Elite Member
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    Yeah me too. And I will expand on this - what sort of rowing were you doing before? You really want to balance pressing with rowing. And for direct rotator I use the Jobe exercises. And I agree that the scapular work (like pushups especially scapular pushups) is important.

    I'm not quite as certain about the thoracic spine work but it's a good thing you should be doing anyway.
     
  6. MannishBoy

    MannishBoy Senior Member

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    I think the thoracic spine work is to allow for proper posture in the upper spine so that the shoulder and scapula will be positioned correctly. I've not got the greatest posture for a few reasons (desk job, etc), so making sure I keep at the work in this area is important for me. I'm much better than I used to be, but still have a way to go.
     
  7. philph

    philph Well-Known Member

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    Yup—I had been intending to increase the emphasis of rowing and thoracic extension, etc, largely for the kinds of reasons discussed above. The years of long hours at the computer have added to my toll of postural and mobility problems and I'm kind of at the point now where I don't feel I can make any further physique progress until I tackle these things.

    The shoulder injury really just further focuses the mind.
     
  8. philph

    philph Well-Known Member

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    Does anyone have any recommendations for mass-building exercises for the pecs that won't hurt my shoulder? Heavy BB and DB bench press are both impossible right now because I don't have a spot and I can't safely unrack/mount anything heavier than about a 12- or 15-rep max weight.

    About the only thing I'm doing right now that hits the chest is press-ups, and I was considering making this heavy some of the time by elevating my feet, etc. Any other suggestions?
     
  9. philph

    philph Well-Known Member

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    Progress report:

    I haven't touched any weights for two weeks, having decided that this was a good time for a long overdue extended rest from training. During this interval, I've focused my attention on being kind to my shoulder and letting it rest from heavy work or awkward movements.

    I've also been doing a stability exercise—it's the kind of thing people often laugh at. To perform it, you dangle an elastic band from a fixture high up, and hold the band with the hand on the injured side, with arm raised and abducted. Then you stand on one foot (on the non-injured side). And close your eyes. And try to stay balanced for a minute. The idea is that it forces the rotator cuff muscles to work overtime as stabilisers.

    Today I had my next appointment with the physiotherapist, and I'm delighted to say that she agreed that I'm making great progress. I can now raise my injured arm, with minimal pain, in various planes nearly as far as I can raise my other arm, and I can also lower it with far less crunching and grinding than I could before.

    The physiotherapist also observed that my scapular is moving far more freely and correctly now. For example, during a rowing movement or the eccentric part of a push-up, I'm now getting (and feeling) the desired scapular upward rotation, and less tendency for tilting (winging).

    I'm also very happy to report that she says I am now ready to start working with weights again. The plan is to resume with light weights and low volume and build up again as my tolerance allows.

    She said that to gauge this, I can pay attention to the degree of soreness and irritation I get at night from lying on the injured side—if the nighttime discomfort doesn't get worse over time, it means there is no increased inflammation and I'm not overdoing it. I like this—it gives me something fairly near to quantitative.

    Meanwhile, during my two rest weeks, I've gained 4 kg and my morning weight is now just over 100 kg. This is fine. I never wanted to be in a weakened state just in time to endure the shock of starting training again. A little extra body fat and minimised muscle-loss gives me more room to move in than the alternative right now.
     
  10. philph

    philph Well-Known Member

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    This is starting to look a little like a journal, so if John prefers to move this to the journal section (and correct the typo in the thread title for me!) that's cool.

    Well I've now tentatively started using DBs again. My absolute priority is to get my shoulder working properly ASAP. Whatever way I look at it, this is a longterm issue and there's no escaping from the fact that this has to be fixed before I can do any proper training again.

    “Fixed” in this context means not only that the tear in my tendon has healed up—that alone could be achieved simply by totally resting my arm and waiting for the body to repair itself. It also means fixing the way my shoulder works so that I'm not constantly risking further damage.

    Today I did flat DB bench press 5 sets of 20, lat pulldowns 5 sets of 20, lateral raises 3 sets of 12, and bent over reverse flies 3 sets of 12. In every single rep of all exercises I made a conscious effort to upwardly rotate my scapulae. My goal is simply to brainwash my body to move in the right way. I used fantastically light weights, e.g. a pair of 12.5 kg dumbells for the presses. The weight will go up only as fast as I can lift while maintaining good (and conscious) scapula control.

    With bench press, being on your back on a rigid surface can mean that the scapulae are pressed into the surface too hard for them to be able to move properly. My little innovation for dealing with that is to lie on a tightly rolled up sheet tied in shape with elastic bands. This elevates my spine off the bench slightly and leaves just a slight gap either side so my scapulae can move more freely.
     
  11. Jokat

    Jokat Well-Known Member

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    Hey philph,

    I was diagnosed with osteolysis of both AC joints and banned from any pressing movements about a month or two ago.

    I have taken the following approach to my training until I heal or have surgery (if the healing doesn't work out so well).

    Day 1: Squat Day (Legs)
    Day 2: Cardio Day
    Day 3: Deadlift Day (Back)
    Day 4: Cardio Day
    Day 5: Isolation Day (Biceps, Triceps and Calves)
    Day 6 - 7: Rest or light cardio

    I am testing the theory that all you need to do in the gym to grow is squat and deadlift and I am hitting those two exercises with all my energy and willpower.

    That is my solution for the time being, if you are interested in knowing. :)
     
  12. philph

    philph Well-Known Member

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    Hi Jokat,

    What an excellent opportunity to test that theory! I hope you'll let us know how it goes.
     
  13. Rishi P

    Rishi P Well-Known Member

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    This is a great thread as I keep having recurring R/C tendinitis. I have not lifted weights for about 2 months. Was going to get a second opinion as my doc suggested a cortisone shot, but I wanted to find the route of the problem as I feel cortisone will only be a temporary relief. My PT had me doing several scapular exercises and I still keep up with them before every workout as a warm up, however I feel some of them may even be aggravating my shoulder. Anyone have any suggestions on which ones to concentrate on and/or have pics/examples of exercises. For the RC itself I only do external/internal rotations as advised by my PT (anyone have any suggestions on other exercises please state them). I started with the weights again this past week and just went extremely light with no pressing involved. I feel as if I should just keep lifting light for the rest of my life as every time I begin to build muscle and add more weight in the gym my shoulder aggravates again. Any thoughts would be appreciated.

    Thanks
     
  14. philph

    philph Well-Known Member

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    Hi 97civicboy, an important part of my recovery plan is to reeducate the scapulae to move correctly, which means they have to move in a way that is coordinated with other movements (e.g. arm movements). I've come to believe that this is more of a neurological task than a strictly muscular strength one.

    No amount of strengthening the rotator cuff muscles with those external rotation cable or DB exercises is going to teach the scapulae simply to move at just the right time.

    One specific exercise I've been doing a few times every day is the one I mentioned earlier in the thread. You hold (with the hand on your injured side) onto the end of a length of an elastic that is attached overhead, stand on the opposite foot and try to stay balanced. The rotator cuff is forced to keep readjusting and to act as a stabiliser.

    I recently started using the weights again, and I am now able to do flat bench press again with extremely light dumbells. The first time, even 12.5 kg in each hand was challenging. Within a few days, 15 kg was effortless.

    I'm using a tightly rolled up sheet between my spine and the bench so that my shoulders are not pressing against the bench (thus the scapulae are free to move). I make sure that as the DBs come down each time I can feel a lot of upward rotation of the scapulae, and I'm springing off from the resulting stretch in the chest. If my chest and scapulae are at their extreme, I regard it as the bottom of the rep; I'm not forcing it down further just to get more range.

    I will increase the weight as fast as I can without sacrificing the scapular element of the exercise or inducing the wrong kinds of pain. If it takes me six months or a year to reach a decent weight, so be it. For the sake of my patience I'll be able to benefit from lifting safely for the rest of my life.

    I'm using a similar approach for shoulder exercises like lateral raises, and also for rows. Until the shoulder heals up more, I'm not doing any direct arm exercises or other exercises where I can't move my scapulae correctly, or where there is too much risk of instability or sudden jarring that can aggravate the injury.
     
  15. Gordo

    Gordo Well-Known Member

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    #15 Gordo, Oct 7, 2008
    Last edited: Oct 7, 2008
  16. Rishi P

    Rishi P Well-Known Member

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    great links and vids man...thanks....however that last one didn't work :(
     

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