Recovered!

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They say “the road to hell is paved with good intentions”. That’s my feeling about writing a post about the specifics of my rotator cuff injury. But finally I found some time to devote to this! As with all of my more technical entries, please understand the disclaimer that I am not a doctor. This is my personal experience and I’m sharing it anecdotally with you. If you’re in pain I highly recommend getting it properly diagnosed by a Physical Therapist, Orthopedist or Osteopath.

It’s been quite a journey, but the long-of-the-short-of-it is after over two months of PT helping me build some awesome rotator cuff muscles, but not helping the pain, I finally went in for an MRI. The good news is I did not have a labrum tear; that would have potentially required surgery but I already had an alternative plan in mind. I did have bursitis (inflammation/fluid in the bursa) and tendonitis of my supraspinatus.

This picture does a great job of illustrating both: ucx.subacromial.bursitis9

 

As you can probably tell from the picture above, the bursa is aggravated by raising my arm, a movement I certainly do often when climbing. I also have a type II acromion process (the bone that falls on the lateral, or outside, edge of the shoulder).

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As you can see from the picture, the type II acromion has a slight curve to it. That means I’m slightly more at risk for bursitis, especially with how hard I am on my shoulders. Someone with a type III would be even more at risk, and someone with a type I should go climbing right now! I mean, only if you want to. 😉

Since the majority of what I love to do involves putting weight on my arms while they are outstretched and/or overhead (e.g. climbing, pull-ups, weight lifting, even yoga and practicing massage) this was kind of the perfect storm. That said, it could have been prevented and now I know how to prevent it and other injuries in the future.

The #1 key is evenly strengthening all of my shoulder muscles and other supporting muscles. Since most of what I was doing involved keeping my arms outstretched, I had fairly noticeable muscular imbalances. The large muscles in my arms and upper back were fairly strong. I have well developed forearms, biceps, triceps, pecs, traps, etc. However, the antagonists, my poor posterior rotator cuff muscles and supporting posterior muscles were not getting the attention they needed. That means they were stretching like a rubber band while my more powerful muscles were in action and over time that caused inflammation and could have led to a more serious injury.

So how did I heal? I’ll share with you the main exercises I’ve been doing, but I also want to be very clear that after pleading from my PT, Orthopedist and my partner I finally caved and got a cortisone shot in the bursa. I had an unusual reaction to it at first that led to several days of new pain, but it’s been almost two weeks since then and (knock on wood) I feel really great. I’m not a fan of jumping to a steroidal shot, but I did my due diligence with PT, massage and other self-care and while I was gaining strength I was not finding relief and the pain was beginning to negatively effect my day-to-day life. I had pain while sleeping, while practicing massage and yoga and while climbing. Those things actually got worse while I was in therapy.

I will admit that I was under the misconception that the cortisone shot was purely for pain relief. I could handle the pain, even though it was annoying. The shot actually reduces inflammation, and the shoulder is one of the least painful and most effective parts of the body to get a shot since there is plenty of room in the rotator cuff. While the shot was intended to cure the bursitis, I was told it also would most likely relieve the tendonitis as well and so far that has been the case. Woo!

I did the following exercises to help strengthen my rotator cuff, lats and upper back. I did and continue to do these at least three times a week. Please note that I started from a place of being considered in good muscular shape so while I worked primarily with free weights, many people would start with a theraband or just bodyweight. Your PT or doctor can help guide you on what’s best for you.

Side-Lying Lateral Rotation

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  1. Start with a very lightweight. I started with only 3lbs even though I was regularly lifting much heavier weights. You really want to target the small and most-likely weak rotator cuff muscles so if you start with something heavier you are more likely to use bad form and lift with the larger muscles thereby defeating the whole purpose of the exercise.
  2. Lie on one side with the weight in your upper hand and your head supported by your lower arm. The weighted hand should be down almost to the floor/table.
  3. While keeping your elbow glued to your body, slowly laterally rotate your arm (lift the weight up and back). When you get as far as you can go lower it back down. You should be able to feel the posterior rotator cuff muscles engage during this exercise.
  4. I do three sets of 15 reps each side. I progressed to 5 and then 8lbs.

Reclined Weighted Shoulder Opener

I failed to find an image for this so I’ll have to take some for you at a later date.

  1. Start lying back-down on a workout bench. Choose very light-weights for this (I started with 3lbs).
  2. With a weight in both hands, star with weights together in front of you and arms bent at 90 degrees.
  3. Keeping the bend in the arms, move arms up, out, circle down and back together. The movement is similar to tennis serves and you’re working on gently stretching the pecks as you work through an opening circle of movement.
  4. I personally feel this is a dangerous exercise to do with anything other than very light weights. It’s much more of a stretch that’s facilitated by the weight than it is a pure strength-training exercise and the shoulder is brought through some positions that would be too unstable to support much weight. While I have moved up to 5lbs, I do not intend to go any higher than this.
  5. I do 3 sets of 15 reps each.

Bent-Over Reverse Flys

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  1. This one wasn’t just recommended by my PT, it was also recommended by a climber-specific PT as it’s excellent for climbers! You start in a half-squat position, leaning forward with a flat back. I started with 3lb weights and now use 8lb.
  2. Extend the arms so the weights almost touch the floor (I start in more of a squat than the woman pictured, ensuring my knees are behind my toes and my back is flat).
  3. Then using your shoulder strength lift the arms to a T-shape, squeeze your rhomboids a bit at the top and lower back down. Try to really focus on your shoulders for this. If you use momentum and/or a weight that’s too heavy for you you will only be working your larger muscles and won’t get the true benefit of the lift.
  4. I do three rounds of 15 reps each.

Reclined Barbell Lift

Also failed to find a picture of this one.

  1. Lie back-down on an exercise bench with an olympic curl bar in your hands (a straight bar would be fine too).
  2. Keeping your arms straight, protract and retract your shoulders (move your shoulders forward and then back down).
  3. The purpose of this is to strengthen your lats and improve glide for the shoulders. I did three sets of 15 reps for this.

Bent-Over Rows

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  1. This targets the larger muscles in the upper back while also strengthening the rotator cuff. Since we can rely on more heft from those larger muscles I also used a heavier weight for this. While I was in recovery I was using 10lb dumbbells but I’m now back up to two 26lb kettle bells.
  2. Start with knees slightly bent, butt back, back flat and weights in both hands.
  3. Squeeze shoulder blades together while pulling the arms back and keeping the elbows in line (they should glide right next to the ribs as you pull back).
  4. I did 3 set of 15 reps of these (have you noticed a pattern here?).

So those were the rotator-cuff specific exercises I’ve been working on. I also stopped doing binds in yoga and only did pull-ups with a band. Other than that it was business as usual. And, yes, I continued to climb through the injury. As with my quad tendon injury last year, I’ve come out the other side better for it. I’m stronger now and I have much more knowledge. I’d just like to not make this a yearly thing and hope I can preempt future injuries by thinking more holistically about my training and trying to evenly train my muscle groups.

So what’s next? My workout plan slightly shifted this summer due to the rock gym changing it’s hours and no longer offering early morning hours on Mondays (boo!). The good news is that’s opened up a morning for me to finally do Crossfit! So:

  • Mondays I’m at Mountain Strength Crossfit in the morning and then generally bike or walk in the evening and do any PT exercises that Crossfit didn’t cover in some way.
  • Tuesday I teach yoga at 6am (come join me!) so it’s an active recovery day.
  • Wednesday I toprope or lead climb in the morning and then do my PT and maybe some biking in the afternoon.
  • Thursday morning I either lead climb or I do 30 minute of bouldering and then hit the weight room to do a Crossfit-style workout using their olympic weights and other fun toys. Then Thursday night I go to a 75 minute Intermediate Yoga class that I LOVE!
  • Friday I do 15 minutes of cycling and then either do just my PT weights and yoga if I did a weight workout the day before or I do a Crossfit-style workout without the olympic lifts (e.g. a HiiT, Tabata or AMRAP) and then yoga.
  • Saturday I’ll do 60-90 mins of yoga or pilates (another active rest day).
  • Sunday I try to take as a rest day but this time of year I’m more inclined to go for a bike ride.

In other words, I’m still very active and I hope you are too! I’m grateful to have such an awesome PT who helped me stay active through injury and helping me get quite a bit of new definition in my back! Woot to happy healthy muscles!

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