I was introduced to Barbell Medicine via Alan Thrall’s YouTube channel, and the injury portion of the presentation really interested me.
I’m 34/M/190lbs doing Crossfit style programming. I’ve been struggling with shoulder tendinitis for 3-4 months now, and I’ve been practicing the “keep training” approach during that time. Unfortunately, the injury is continuing to nag me despite altering my ROM, weight, and excluding exercises that cause pain. Generally speaking, once I’m at the gym and I have worked through some ROM, the shoulder tends to feel pretty good. I’ll sometimes feel pain during exercises such as burpees/pushups (bracing on the way down hurts), kipping (I haven’t touched a pull up bar in months), and things like kettle bell swings overhead. I feel pretty good once I’m warmed up, but my main issue is outside the gym. I can’t do normal life activities like petting my dog or reaching for something without having pain. I have pain during the night as I sleep if I get my shoulder in certain positions or brace with it to toss/turn.
I went to Orthopedic surgeon and started with an x-ray and rotator cuff physical therapy exercises. These didn’t yield significant results so we moved to a rotator cuff injection, which also had limited to no effect. I got an MRI and it showed tedinitis, specifically bicep tendon/supraspinatus/bursis inflammation. Another injection for bicep tendon was offered, but I declined for now. Treatment recommendations were NSAIDS, rest, ice, and stop doing whatever led your shoulder to this point.
I know there isn’t a magic bullet for this type of stuff, but do you have any recommendations based on the info provided? I’m aiming to get my shoulder pain free, but I’m beginning to get really discouraged.
Welcome to the forum. Fortunately, we have a few rehab professionals on staff. I’ll see if they have anything to add here, but they’d also be happy to help you with a rehab consult to help work through this challenging situation in more detail. Contact Us | Barbell Medicine
Hey, sorry to hear about the shoulder tendinopathy. You seem to have the right mindset regrading continuing to train but most likely the wrong dosage. Tendinopathies are about appropriate load management and recovery for adaptation. It’s a slow process with typically bumps in the road. I typically recommend staying away from dynamic loading (like kipping movements, burpees, and kettlebell swings) of the area during initial stages of rehab (six weeks). “I feel pretty good once warmed up…” Oddly enough this is called the “warming-up” period for the tendon and often loading feels better once this occurs but then people notice increased symptoms after the workout and into the following day(s). If symptoms have increased sensitization to the point your activities of daily living are being effected then there’s a good chance major changes need to be made to your training. The cascade of interventions you mention in the OP are a common clinical trajectory until load management is addressed. I’d advise against the NSAIDs, rest, ice, and stopping whatever led to the shoulder issue. Given your age, this is likely a reactive on degenerative tendinopathy and has little to do with inflammation – hence the shift in nomenclature from tendinitis to tendinopathy. Pain free is not the goal currently but rather can you begin loading with less pain. Pain will be part of the process, the key is figuring out tolerable dosage of loading while getting symptoms to decrease. This would likely warrant a consult with myself or Derek. Happy to help.
Thank you Michael for the taking time to reply. I will look into modifying my workouts more extensively in the coming weeks. The tendon warming-up period was leading me to believe I was improving, but as you stated in the days following training the pain would remain or worsen. If things continue as they are, I’ll definitely look into a consult.