Shoulder Impingement Recovery

[rob]

Hi all,

I have recently been suffering from what I think is shoulder impingment. It started in my left shoulder, but has also appeared in my right since I did not stop training  - stupid I know, but I really didn't want to stop training or climbing until my trip to Portland (UK) this last weekend. Anyway, now that's done (a very successful trip fortunately), I'm looking to rest and rehab my shoulders in a structured way. Has anyone else had any experience of this injury before? And if so, what did you do that helped?


My guess is that my over-concentration on pulling exercises and lack of pushing exercises has caused it, as well as a lack of flexibility in my upper body (see UKC article below for a better description of the cause). The pain is mainly at the back of my shoulders, where the end of my collar bone joins my shoulder joint and where the rotator cufff muslces all join at the tendon, but I also have had some small pain in the front of my shoulders, but to a much lesser extent. It started around 4 weeks ago, and has felt worse the day after training sessions. It has lessened lately, and I barely felt it at all when I was climbing this weekend (but I know it's still there and overusing my shoulders could easily cause it to come back worse than ever).

www.ukclimbing.com/articles/page.php?id=6022

My plan now is as follows (I'm adopting a mini season approach to peek before the weather turns bad here. :

Week 1 (this week): Total rest from any exericse
Week 2: Shoulder specific rehab (4 sessions of light, progressive shoulder exericses including rotator cuff strengthening exercises, light dumbell shoulder press and the exercises shown in the above ukc article, as well as a lot of upper body stretching to loosen up alll the muslces invovled in the cause of the injury)
Weeks 3-6: Standard RCTM hangboard routine followed by shoulder rehab sessions (adding some weighted press ups) - also I may do a small number of light outdoor sessions (onsighting), as we don't get many good weather windows in the UK.
Weeks 7-9: Either campus + LB or Max recruitment HB workout if shoulders are still sore. Again I will continue with shoulder exercises here.
Weeks 10-13: PE + Performance


Is this enough rest? Do I need to have week 2 only concentrating on rehabing the injuries, or should I start HB sessions this week? Any thoughts would be appreciated.

[joev9]

Only comment I would make would be to design your HB workout to favor small holds with lots of weight removed. I find when I go with bigger holds and a lot of weight added it really hits my shoulders hard. I have had much less shoulder stress by going really small with lots of weight off (up to 50% BW on the smallest hold). By removing the shoulder stress of HB'ing, I think you could then focus on quality SE's that continue your rehab efforts.

[MarkAnderson]

I had a fairly debilitating impingement in my left shoulder last fall (bad enough that it prevented me from climbing hard), and a minor one in my right shoulder around the same time. Sounds like the pain was in a similar spot to yours (back of shouler). Not really sure what caused it, but I remember driving home after a climbing day and noticing some pain in my shoulder. I even commented to Kate that I must have done something to my shoulder while climbing. I kept right on climbing for a couple more weeks with no problems, but over the course of trying to ignore it for two months or so (including some rest periods) it just got worse and worse.

What I did was experiment with various impingement rehab exercises (there are countless exercises--google it) until I figured out which motions seemed to really irritate the injury. Then I did those exercises starting with no resistance. I would do them several times a day (when I woke up, while sitting in the office, etc). After I started to improve, I gradually increased the resistance (using a Theraband type device). Once I started climbing again I included them in my warmup with no resistance, and at the end with Theraband resistance.  I was pretty much back to normal in a few weeks, and I've had no issues since.

The key exercise for me was "External Rotation in Abduction" described here.  I also did the exercise shown in the bottom here, and push-ups.  Once my shoulders were healthy-enough, I added my standard shoulder-intensive Supplemental Exercises (Shoulder Press and Lateral-to-Front Raise)

[rob]

Ok thanks for the comments both. Joe, I think that's definitely something ill consider while
planning HB workouts, hadn't really thought of how they could make it worse.

Mark, good to hear someone else has had it and has gotten over it relatively easy. When playing around with various exercises in the last few weeks I've found lying dumbbell external adduction really aggravates the injury (but I that strangely nice way)so ill definitely stick with those.

Thanks again. Will let you know how it goes.

[Chris W]

A true shoulder impingement is often caused or exacerbated by forceful abduction with internal rotation of the shoulder. It's typically a space issue, with the muscles and tendons getting pinched between the acromion and the head of the humerus. For example, doing a lateral raise with your pinkie pointed up (ouch!) or pulling a gaston type move with the hand lower than the elbow. I would avoid anything that reproduces this effect (internal rotation of the shoulder, especially with abduction) during your regular training and/or rehab.

[rob]

Jul 8, 2015 3:16:05 GMT -7 Chris W said:

A true shoulder impingement is often caused or exacerbated by forceful abduction with internal rotation of the shoulder. It's typically a space issue, with the muscles and tendons getting pinched between the acromion and the head of the humerus. For example, doing a lateral raise with your pinkie pointed up (ouch!) or pulling a gaston type move with the hand lower than the elbow. I would avoid anything that reproduces this effect (internal rotation of the shoulder, especially with abduction) during your regular training and/or rehab.

Okay, thanks for the heads up. I see what you mean when doing the lateral raise with the pinky up. Any particular exercises that you think create this sort of effect other than what you mention? Or is it simply a case of avoiding this internal rotation when doing my normal exercises?

[MarkAnderson]

One thing I remembered overnight--when I started I could not do the full range of motion (for "External Rotation in Abduction") due to pain. So I would start with limited ROM reps, and as I warmed up I would increase the ROM. Typically after 1 or 2 sets of 15 (with only body weight) I could do the full ROM.

[Chris W]

Rob, another common culprit is the "upright row", typically performed with a barbell. Also, when doing bench press or shoulder press type exercises, I don't go (much) past a 90 degree bend in my elbows. Sure, you're not working the exercise through it's ENTIRE range of motion, but the risk of injury isn't worth the little bit of extra motion.

Regarding internal rotation, our shoulders like to do that. We're typically stronger there and a lot of major muscles facilitate that. true external rotation, however, is basically up to the several tiny muscles in the rotator cuff. I try not to make mine mad, but if I do, I have to be extra nice to them for a while.

[rob]

Yeah I've always avoided upright rows as they seem to put alot of stress on the shoulders, but ill be more aware of avoiding that awkward interbal rotation feeling

Thanks for the advice all.