I’ve been having pain in my left shoulder for a few years. It used to be mainly when reaching across my body or behind my torso. I started some physio about 8 months ago but this made the pain more severe and made it occur more of the time, so I stopped the physio.
I was having shoulder pain when squatting with a straight bar (despite trying low and high bar, wider grip, falcon/talon grip), so I’ve switched to a Marrs bar to squat. Overhead press is usually only painful if I drift too far back at the top. Bench press sometimes has a little discomfort but I don’t notice that benching aggravates the pain. Deadlifting feels fine.
I recently had an x-ray and an ultrasound completed. X-ray results:
No acute bone or joint abnormality identified radiographically. No fracture or joint dislocation/subluxation.
The left glenohumeral joint appears grossly normal.
Mild OA changes at the left AC joint.
Ultrasound results:
Long Head Biceps Brachii Tendon: Normal.
Subscapularis: Normal.
Supraspinatus: Diffuse mild tendinosis. No tear.
Infraspinatus: Normal.
Teres Minor: Normal.
Bursa: Normal.
AC Joint: Normal.
Impingement: Pain elicited during shoulder motion. No evidence of anatomic impingement.
Given the above, are there any movements that I should avoid? Are there any exercises (or other interventions) I can do to improve the tendinosis and/or osteoarthritis?
Hey Jonathan,
Before I start, I should say that none of the following is intended to be a diagnosis or a replacement for medical care. We can’t do that through the forum.
Good news first: the imaging is reassuring. Mild supraspinatus tendinosis and mild AC joint OA are extremely common and show up in plenty of pain-free shoulders. And the ultrasound noting pain on motion but no anatomic impingement suggests there’s no big structural issue.
On movements to avoid: I wouldn’t give you a permanent avoid list. What you’re already doing is the right instinct, using the versions you tolerate. I suspect there are other variations of the press and bench that you may tolerate even better, and expanding your movement variety is likely a good idea, though I don’t know your current program. I also think some direct cuff and isolation shoulder work would be good ideas. Finding the entry point and gradually increasing from there is the ticket.
One reframe on the physio: flaring you up is usually a dosing problem, too much too soon. It doesn’t mean the exercises themselves were wrong per se.
That’s exactly why, for a multi-year shoulder that a previous plan aggravated, I’d point you to the Shoulder Rehab Template. It’s a 13-week structured graded-loading program built to reintroduce and progress shoulder load without the flare-ups, which is the piece that was missing. If you’d rather have someone build it around you directly, we also do pain and rehab consultations.
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