So first off, I got quite a lot out of my consultation with the BBM rehab team (shoutout to Charlie Dickson who managed my rehab!). Last year I couldn’t find a good DPT in my area with a strong strength training background and Charlie certainly fits that description! I’m 58 - so likely I’m in that “gray hair” range where rotator cuffs on average are a bit more problematic for people.
I worked with Charlie for about 6 months and learned a fair amount about programming along the way. My 4 day program ultimately looked something like this (I do experiment with minor variations on these):
- warmup exercises (high rep range) 2x/week: external rotations, lat raises, pron Ys, shrugs, scapular pushups
- primary movements (high and low rep range) 2x/week: deadlift (conv/sumo/pause/RDL variations), squat (front/split), overhead press (barbell, landmine, dumbbell, kettlebell), bench (currently dumbbell - tried barbell, swiss bar, cable, declined), seal row, pullups (body weight and weighted) I’ve been keeping with that program with some occasional adjustments. The problem is that the should pain (around the AC and near the clavicle) returns and I have not made much progress at all on my upper body movements. I’ve noticed that the movements that are most likely to cause problems are the barbell bench press and the landmine press - those two get tweaky very easily, but it could be because the load tends to be higher for those than for dumbbell bench or “Arnold” style dumbbell overhead press which I haven’t (yet) had a problem with.
So here are two theories I have about this. Any thoughts or advice would be very much appreciated!
- Load: I suspect I’m increasing the load too soon or operating at a load just a tad too high for recovery to set in. I absolutely hate the idea of reducing things down too much because I want to see progress - but that mind set may be the actual problem. I just can’t tell. I think I have a hard time estimating RPE, but I don’t know. I hate the idea of reducing load to the point where I’m still not recovering but I’m also getting weaker… So yeah, I may need to really take a step back and de-load my auxiliary days. It’s hard for me to believe this because I don’t think the load has been particularly high.
- Lifestyle: I’m a desk jockey. When complaining about this problem someone insightful pointed out to me that I am spending around 8 hours a day at a desk in a certain position. That position could present a challenge to my shoulders - I honestly don’t know. 1 hour of training 4 times a week may not be nearly enough to “undo” whatever it is I am putting my shoulders through. This does seem like something I could diagnose and address. There are life-long habits that might have to be undone. Thank you for your time reading all that and for any feedback you can offer!
-Fred
Hey @fresharic
I’m glad to hear you got value out of our time together and it was a pleasure working with you. To your questions: 1. Progressing load too soon/too quickly or overshooting RPE is usually a contributing factor when it comes to the emergence of symptoms. With that in mind, there are numerous ways we can go about managing load in training. For your case, I would recommend cutting back on some of the accessory work included in the ‘warmup exercises’ category by reducing volume (1-2 sets instead of 3) and/or eliminating any of them you don’t find much of a benefit from. The intention with those is more to serve as a warmup to get your shoulder feeling better prior to your compound lifts (i.e bench/OHP). For the bench press specifically, you could increase the rep range (6-10’s instead of 1-5’s) used to help with reducing load while also satiating your desire for progression in that new range. One of the strategies we used initially when introducing the bench press was using a tempo (3s on the way down, 1s pause on the chest for example) to help with reducing load and tends to be a little more tolerable when working through symptoms. One strategy we didn’t explore was modifying the range of motion. With this strategy, you could work up to a top set of let’s say 4 reps @ RPE 7-8 using pins, so you would have the bar pause on the pins just above the point of discomfort. This would allow you to work a little bit heavier on the bench, and then you could drop the load 15-25% and do some full range of motion work. Speaking of RPE, simply reducing the RPE prescription can be a useful tool as well. If you find that you’re 8’s become 9+ pretty easily, try working up to RPE 7 and using to help guide load selection. Lastly, aiming to stay as active as possible with your leg drive (or pushing yourself up the bench) and thinking about ‘reaching your chest up to the bar’ can help to generate some more tightness and may be more comfortable for you.
2. I think there is something to be said for varying the positions you’re in throughout the day and becoming more active. One way to conceptualize this is to frame it through the lens of load management. For me personally, there is only so much time I can spend in one position (let’s say sitting on a plane) before my knees/low back start to ache, granted I do have an injury history in both of those areas. My solution here is to simply change positions more frequently to ‘load’ those areas in a different way, which tends to mitigate symptoms. Using the plane seat example, I may shift from a more slouched position to more upright, leaning on my right hip to more on my left, or stretching my leg out into the aisle instead of having it bent. If i’m working this might mean going from standing for 30 mins to sitting for 30, or going for a 5 min walk every hour. I wouldn’t say you need to ‘undo’ anything here as much as simply moving more. This could also be a good opportunity to increase your physical activity levels by introducing some more frequent walks to serve as rest breaks. I would also expect that managing training load will help with sensitivity from spending too much time in certain positions.
Hope that helps!
Charlie
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@Charlie_Dickson - great to hear from you and sorry for the late response! This is great advice and I really appreciate it!
I caught a recent BBM YouTube clip on “Ego Lifting” and how to handle it. I feel this is very relevant - it’s much clearer to me now that the hard thing is to accept that the right weight may be lower than my brain wants to accept. What makes it a bit harder is that we’re already talking pretty light weights - but a 20% difference is significant whether we are talking 10lbs vs 8lbs or 300lbs vs 240lbs. I’ve toned down the rotary cuff movements (external rotations, pron Ys) and that is definitely helps a lot.
Instead of barbell bench I’ve been doing a lot of dumbbell bench and cable press in a high rep range. I really like pause rep sets with dumbbells. The dumbbell bench and cable press always feel pretty good and I’ve improved my form a bit on these. But for some reason the barbell bench generally doesn’t feel right. It’s possible that the weight range is the problem - going from 45-50lb dumbbells to higher weight range on the bench may be the issue - but I think it might also be the neutral position of the dumbbells vs the barbell that makes a difference. I’ve tried pressing with my Swiss bar but the grip position isn’t right (and not adjustable). I like your idea of doing pinned barbell bench presses and I might try that - but I might also see how things go if I start a bit lower in weight and build up more gradually with the bench press.
I have an oddly similar problem with the overhead press. The barbell overhead press generally feels great and I’ve been very slowly increasing the load on that, but the landmine press for some reason comes very close to tweaking my shoulder. It seems to be the grip position that makes the difference. I actually bought one of those handles that lets you switch your grip on landmines by 90 deg, but recently instead of doing that I’ve just been lowering the weight way down to see if I can adapt to whatever is going on with the shoulder in the standard landmine position.
Your second point is very well taken. For a while I was doing very well with working more SSLI activity and I fell out of that pattern, but I definitely intend to get back to that - it was helpful in several different ways.