General recommendations for programming with recurrent left rotator cuff tendinopathy

Hello Doctors,

I’m a big fan of your articles and enjoy your podcasts. Late last year I finished four months of training with Darin Deaton and SSOC and enjoyed it very much. I’m a 49 year old male with a very healthy lower body who was able to take my squat to 3x5x315 and my deadlift up to 1x5x375. I’m now on the verge of a 400lb DL for reps. The problem for me (and the reason Matt Reynolds assigned me Darin Deaton) was my recurring left shoulder pain. My upper body is significantly behind my lower body due to this. I’ve had two shoulder surgeries and suffer from a bit of GH arthritis, but still have plenty of joint space where this is not a major issue for me yet. The vast majority of my pain is due to tendinopathy primarily in my left infraspinatus (some in the supraspinatus).

I worked with Darin to fix my shoulder placement in the squat as well as adjust programming to eliminate the bench press for the time being. I made some progress with Darin who also gave me some rehab exercises, but now am becoming extremely frustrated by the fact that it’s always so damned easy to re-aggravate my shoulder that I feel I’ll never lift heavy or be able to significantly progress my upper body.

The reason I’m writing is to get some additional professional advice from a slightly different perspective and perhaps a more general approach to programming with rotator cuff tendinopathy to see if I can get this thing to heal as best I can once and for all. Are you guys possibly interested in a podcast episode where you can delve into some of the details of how to train with these kinds of injuries? I’m finding this particular kind of tendinopathy to be extremely challenging because even squatting and deadlfting heavy puts enough isometric intensity on the rotator cuff to keep it inflamed and irritated. I’ve had this condition for many years now so I expect that some hypertrophic damage is likely permanent or at least going to take a very long time to properly strengthen and heal so that I can properly bench press, chin, etc without pain and with decent intensity.

What I’d find really useful is the best possible general recommendations on

  1. How to listen to your symptoms properly to know when it’s ok to train it and when to rest it.
  2. How to train around the injury in terms of exercises and timing and how to program properly for intensity.
  3. How to properly progress as well as how to set expectations for healing of tendons (I understand it takes a long time).

If you already have great resources like articles and such that you think can help me, feel free to point me there. But I imagine I am not alone and given how challenging this kind of tendinopathy is (literally everything I do can aggravate it), perhaps many people could find a dedicated podcast episode to be very helpful if you gentlemen are interested.

I sincerely appreciate any attention you can give me. I enjoy lifting way too much to be this frustrated.

Best regards,

J. Metcalf

Sorry to hear about your difficulty. Tendinopathy is a complex topic. As for your questions:

  1. Pain that worsens with progressive loading tends to make me back off. I don’t recommend outright “rest”, but re-consider the stress dose (in terms of volume, frequency, and intensity) that I’m exposing the tissue to.

  2. Training around injury is a case-by-case sort of thing. We talked about this in our injury management podcast, but we generally regress to the closest / most specific exercise we can to the “parent” movement and try to progress from there back to the parent movement over time. There is no way to “program properly for intensity” in this context, because intensity (i.e. 1RM strength) is not our primary concern here. The metric we care about is symptom improvement.

  3. Again, this is unfortunately a case-by-case situation.

I do not quite follow how you said that squatting, for example, puts so much isometric tension on the tendons of the rotator cuff that it exacerbates your symptoms. If that’s the case, I’d simply switch you to a high bar or SSB squat. Also a bit unusual to have the deadlift causing problemsh ere too.