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Two things: Scapular Pain and Bicep Tendinopathy

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  • Two things: Scapular Pain and Bicep Tendinopathy

    Hello Doctor Derek Miles and Dr. Michael Ray,

    Dr. Derek Miles will already know a bit about what I am about to describe, as he was the one that stated that Bicep Tendinapothy is what is most likely afflicting my shoulder. I learned a lot from him during a unrelated rehab consultation, the most important piece of knowledge being that most symptoms are a result of loading being chronically too high. Using this fact, I have tried modulating the intensity of my upper-body training to slowly increase the tonnage that I am able to withstand. However, this is taking a while, and I am unsure if I am doing things correctly/efficiently. What I have been doing is done sets of 5 at weights that hurt a little, but not too bad. Then after a week or so I try and increase the weight. I currently press 2x per week and bench 1x per week (Bench is less affected by this pain), and have been doing 4 sets each day that I press or bench. Recently I have (temporarily?) decreased to 2 sets of 5 for press each of the two press days due to increase in pain levels.
    My problem is that every time I get to around 75 lbs on Press (1 RM was 115 right before this started), the pain is at a level where I don't feel like I can continue increasing the intensity (even though the reps are incredibly easy). So I have dropped back down a couple of times and have had to repeat the process. Should I be using more reps per set for this stage of rehab, and are there any additional exercises that are worth my time that can aid in recovery? I want to start making some real process.

    Also, within the past two weeks, I have been dealing with some scapular discomfort (left side). It mostly presents itself closer to the mid-line of the body, although occasionally it can migrate further outward. I would like to be able to say that it is just loading mismanagement in the Press and Bench, but I have been already going light on these lifts due to the potential Biceps tendinopathy. The only other reason this might be presenting itself is my arm positioning when I squat (High Bar). What I do is I externally rotate my arm quite a bit, so that in the bottom position of the squat, my forearm is more vertical than my torso in relation to the ground. This is only the case with my left arm, as my right forearm is about the same or less vertical than my torso in relation to the ground. My shoulder and left side upper back does feel worse after squats from what I can tell, although I haven't really payed attention to it that much. Another thing to note is that the pain has seemed to decrease after doing bent over rows, for what it is worth.
    I bring up the scapular pain so soon after it begins because I have been dealing with the shoulder for more than a month now. Having two different symptoms in parts of the body that are very inter-connected seems very complicated at the moment, and I feel like I could use some guidance.

    I would like to be able to learn how to do all of this rehab stuff by myself, as you guys are trying to teach all of your readers/followers. However, it seems like there are so many things that come up when I am training that I only have too options: spam Barbell Medicine forums for help (to the point that I feel guilty for asking so much), or go to a physical therapist and potentially waste money and time doing nearly useless rehab exercises (unless I could find a physical therapist who actual knows how to rehab effectively).

    Thanks,
    Cole



  • #2
    Originally posted by ColoradoMinesCole View Post
    Dr. Derek Miles will already know a bit about what I am about to describe, as he was the one that stated that Bicep Tendinapothy is what is most likely afflicting my shoulder. I learned a lot from him during a unrelated rehab consultation, the most important piece of knowledge being that most symptoms are a result of loading being chronically too high. Using this fact, I have tried modulating the intensity of my upper-body training to slowly increase the tonnage that I am able to withstand. However, this is taking a while, and I am unsure if I am doing things correctly/efficiently. What I have been doing is done sets of 5 at weights that hurt a little, but not too bad. Then after a week or so I try and increase the weight. I currently press 2x per week and bench 1x per week (Bench is less affected by this pain), and have been doing 4 sets each day that I press or bench. Recently I have (temporarily?) decreased to 2 sets of 5 for press each of the two press days due to increase in pain levels.
    My problem is that every time I get to around 75 lbs on Press (1 RM was 115 right before this started), the pain is at a level where I don't feel like I can continue increasing the intensity (even though the reps are incredibly easy). So I have dropped back down a couple of times and have had to repeat the process. Should I be using more reps per set for this stage of rehab, and are there any additional exercises that are worth my time that can aid in recovery? I want to start making some real process.
    Yes, I suspect you're loading things a bit more aggressively than the tissues are ready to handle due to the rep range you're using. We typically start these sorts of rehab processes with much higher reps, i.e., 12-15 reps per set.

    Originally posted by ColoradoMinesCole View Post
    Also, within the past two weeks, I have been dealing with some scapular discomfort (left side). It mostly presents itself closer to the mid-line of the body, although occasionally it can migrate further outward. I would like to be able to say that it is just loading mismanagement in the Press and Bench, but I have been already going light on these lifts due to the potential Biceps tendinopathy. The only other reason this might be presenting itself is my arm positioning when I squat (High Bar). What I do is I externally rotate my arm quite a bit, so that in the bottom position of the squat, my forearm is more vertical than my torso in relation to the ground. This is only the case with my left arm, as my right forearm is about the same or less vertical than my torso in relation to the ground. My shoulder and left side upper back does feel worse after squats from what I can tell, although I haven't really payed attention to it that much. Another thing to note is that the pain has seemed to decrease after doing bent over rows, for what it is worth. I bring up the scapular pain so soon after it begins because I have been dealing with the shoulder for more than a month now. Having two different symptoms in parts of the body that are very inter-connected seems very complicated at the moment, and I feel like I could use some guidance.
    It sounds like you're becoming a bit hyper-vigilant to some of the positioning minutiae here, that I'm not sure is useful or relevant to the discomfort. As much as we always want to have a "cause" or a "label" for our aches and pains, I don't think anyone will be able to accurately tell you what exactly is going on here. I've had tons of these sorts of transient aches and pains over the years, and -- particularly in the early stage -- they most often tend to improve on their own over time. If/when they don't, we revert to the rehab approaches that Dr. Miles seems to have educated you on.

    Originally posted by ColoradoMinesCole View Post
    I would like to be able to learn how to do all of this rehab stuff by myself, as you guys are trying to teach all of your readers/followers. However, it seems like there are so many things that come up when I am training that I only have too options: spam Barbell Medicine forums for help (to the point that I feel guilty for asking so much), or go to a physical therapist and potentially waste money and time doing nearly useless rehab exercises (unless I could find a physical therapist who actual knows how to rehab effectively).
    I understand. Our goal is to instill as much self-efficacy in folks as possible, so they can effectively self-manage. It just takes time and accumulated experience. You'll be ok, man
    IG / YT

    Comment


    • ColoradoMinesCole
      ColoradoMinesCole commented
      Editing a comment
      Thank you for the helpful response! I was wondering if you had a approximate suggestion of how often I should decrease reps/increase weight (realizing that it could be different for me depending on how my body responds), assuming that I start doing 12-15 reps per set for Press and Bench.

    • Austin Baraki
      Austin Baraki commented
      Editing a comment
      Assuming you're training the movement in question 2-3 times per week, I'd aim to add a little bit of weight each time -- as long as you don't have persistent / debilitating pain during the subsequent 24-36 hours after training. As the weight increases, you'll start getting closer to RPE 10 in a given rep range, which would be your cue to drop the reps down a bit (say, from 14-15 to 12-13 to 10, then 8s, 6s, 5s, 4s, etc.)
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