Long term shoulder injury - what next?

Training Q&A [Moderated]
1

Hey Drs,

I’ll first of all give a background of the injury and what i’ve been doing in the gym, and i’ll then explain what I was told from the doctors i’ve been to and look for advice. And, sorry in advance for any mistranslations - english is not my first languge.

Around 8 months ago I got quite badly injured while benching. I was warming up, and on my second to last warm-up with around 100 kg, which was a weight that was not challenging at the time, I felt a pop in my right shoulder on one of the reps followed by severe pain (I was barely able to lift my arm up for a few days, and even changing clothes was a challenge for around 2 weeks). Around 2 months after the injury I started going to physiotherapy who specializes in sports injuries and within around 3-4 months of going to physiotherapy I was able to get to a point where I was able to do quite a few upper body exercies without pain, but there were a few exercies that were still causing issues:

  1. Any bench press that was not close grip (though now that is also painful - more on this later), including dumbbell bench press and any sort of incline.
  2. Any pull-up like exercies.
  3. Low-bar squats due to the stretch on the shoulder.
  4. Any dumbbell shoulder press (interstingly regular OHP with low weights was OK, though not comfterable, and the same goes for cable lateral raises, though dumbbell lateral raises were painful).

I did make some progress with getting back to benching regularly using the normal BBM protocols for controling pain, and my entry point at the time was 3-0-3 tempo bench with around 60 kg. And, although strength wise I eventually got up to around a 90 kg paused bench for a few reps and 80 kg on incline bench press for a few reps, it was inspite of it being slightly painful. Though, I didn’t rush getting up in weights, it was all very slow over the course of months, though the pain did gradually keep getting worse when. I ended up taking a step back from wide-grip bench due to pain and not being able to make progress in that sense, and I started focusing more-so on close-grip bench which wasn’t painful at the time, though around a month ago the pain from close-grip benching started increasing quite a bit, to the point I had to stop benching altogether. Since then i’ve been doing only exercies that I didn’t directly feel pain (like arms, certain back exercies etc), though the pain kept getting worse even in exercies that didn’t use to be painful, to the point that over the last few days it hurts in my day to day life again and even changing shirts is a struggle.

Around 2 months ago, after I was not really making progress on recovering from the injury and due to increasing pain, I went to a consultation with an orthopedic surgeon who specializes in the shoulder and works mainly with sports injuries, after doing an MRI. I was told the MRI showed a deep partial tear of the SSP tendon, though I was told that it’s very close to being a full thickness tear. This part is a translation so the terms might be wrong - The MRI interpertation itself by the doctor who did the MRI said that I have a “SEVERE HAGL STRAIN”, a tear between hours 1 and 2 in the base of the labrum, and a deep partial tear of the SS in the RI segment (all this was translated to english so take what I wrote with a grain of salt). The orthopedist recommended a shoulder arthroscopy surgery if I want to continue weight training long-term, as he said that this tear can cause some long-term issues if not dealt with due to the severity of the tear (he mentioned that if this tear was not as severe he wouldn’t have recommended surgery). He did mention that the surgery was not urgent, and that I could take time to decide what I want to do next, and he told me in the meantime that he’s comfortable with me weight training as long as I don’t feel more than a slight shoulder pain during training (which is part of the reason i’ve taken a step back from benching, though now as I mentioned every upper body exercise is painful).

I know that this is probably more suited to a consultation if I wanted to get a detailed answer including what to do next, though given this information would you be able to give your thoughts on whether surgery is a sensible route, or whether you’d recommend sticking with the conservative route of dealing with the injury?

If so, is it just the case of running the shoulder rehab template? Although i’d love to work with the BBM rehab team, i’m currently a university student (22 years old) and won’t be able to financially prioritize this at the moment (though hopefully in the future, as in after uni, i’ll be able to work with BBM whether on rehab or 1on1 coaching if I manage to get through this injury). I’ll note in case you were wondering - we have free healthcare to a pretty high standard where i’m from, which is why surgery and local physotherapy is fine in that sense.

Thanks in advance for any help!

2

Nick,

Thanks for the post and detailed history. As you mentioned, this is more appropriate for a consultation. I do not feel comfortable making a recommendation to you via the Internet without more information, follow up, and so on. For cuff-related injuries, consultation for surgery is a reasonable choice in some individuals when non-surgical management fails, especially younger folks, overhead athletes, etc.

Regarding current management, the shoulder rehab template would be reasonable, but likely with a different exercise selection and loading progression than you used previously. I suspect a lot of the loading used was too aggressive in the previous months.

I do think you’re likely to benefit from a consultation in this case, though I understand financially that may not be possible at the moment.

-Jordan

3

Hey Jordan, thanks for the reply.

I have a couple of questions about a possible future consultation if I find that i’m able to save up for a one-time consultation In the short-to-medium term future:

  1. Would the goal of the consultation be to determine whether surgery is the best current course of action, or would it be more-so a case of working-out how to better manage the injury and taking a more conservative approach in that case?
  2. If we find that surgery is the best current route, would it be followed by general recommendations on post-surgery rehab, such as a discussion about the stages of rehab and some detail as to what to expect in each phase (regaining ROM, light exercise, getting back to weight training etc), or is this out of the scope of a one-time consultation and more-so in the realm of continuous rehab programming?
4

Our team could feasibly do all of these things, although ongoing guidance would be better for post-operative rehab. Understand if that is not something you could manage, though.

5

Makes sense, thanks Austin.