supraspinatus tendinosis eccentric exercise therapy

[Kokanee]

hey guys,

I've been battling supraspinatus tendinosis for 4.5 months. haven't done upper body at all in this time. it's gotten a lot better but progress is extremely slow. I've heard about the swedish study for achilles tendinosis where they did eccentric loaded calf raises which sped up recovery by a lot.

this video talks about a similar technique for supraspinatus tendinosis (eccentrics at the end of the video)



Does anyone know anything about this? In another one of his videos he says that massage is not effective for supraspinatus tendinosis. For rehab i've been doing mostly heating and massage. Now I'm thinking about doing heat and these eccentric exercises.

I don't really know how heavy to go, though. I did 5 lbs which was way too light. 7.5 seemed a little light as well so I went to 10 lbs. Don't know if this is too much or not. Also I don't know if this should be done everyday and if there are any other exercises I should do.

[Kokanee]

just looked up the swedish study and they did eccentrics 2x per day, 7 days per week. 3 sets of 15.

[Bnice76]

5-10 lbs is sufficient. i'm assuming you're talking about a scaption exercise where you raise your arms up in a "V" motion. the supraspinatus muscle/tendon as well as other rotator cuff muscle bellies/tendons are relatively smaller compared to normal "bodybuilding-focused" muscle groups so you do not have to use heavy weights. when people lift heavy for these rotator cuff muscles, that's when they typically get injured.

when looking at form, make sure as you raise your arms you're able to keep your elbows straight and that you're not shrugging your shoulders up during the lift. if your shoulders start to shrug or lift up, the weight is too heavy.

[Kokanee]

i don't know why the embed isn't working. this is what i'm talking about

http://www.youtube.com/watch?v=DsosC...os=OaBtHHw8tFY

he just raises his arms laterally. i've been doing it that way but i've heard of people raises their arms more forward like you described in order to hit the supraspinatus.

[Bnice76]

yes the "V" motion is the optimal motion for supraspinatus strengthening. the "V" motion is actually the position in which the shoulder is tested when testing for a possible supraspinatus tear or tendonitis. just make sure to watch the form and don't try to push the weight limit like other muscles. i'd stay within the 5-12 lb range and don't raise above shoulder level. this exercise is called "scaption" and you will rarely see people performing them in the gym, however, they are very important to ensure overall shoulder stability and balance.

[SuffolkPunch]

I heard about this too - I have another thread around here somewhere...

I am going to try doing what they recommend in the video.

[Kokanee]

my shoulder's starting to feel better already after only 3 days. maybe it's a coincidence, maybe it's psychological. benched for the 1st time today in 4.5 months and did 205 pretty easy. not as weak as i thought i'd be. rows still bug it though.

maybe i can start DLing again.

[SuffolkPunch]

my shoulder's starting to feel better already after only 3 days. maybe it's a coincidence, maybe it's psychological. benched for the 1st time today in 4.5 months and did 205 pretty easy.

Congrats.

Wish I could bench

[Kokanee]

thanks man. i still can't do upper body with max effort since it's not 100%. today was just an experiment unfortunately Hopefully soon though.

[Kokanee]

DL for first time today in 5 months. 375x3 pretty easy. Did biceps, shrugs, and tricep pushdowns as well. Arms are very weak, especially my left.

I'm movin' on up in this world. So far so good with my shoulder. We'll see how it feels once the endorphine runs out.

edit: several hours later my shoulder feels incredible. This is the most I've stressed it in 4.5 months by far and it feels great. I have a hard time believing that this is a coincidence.

tomorrow i'm gonna try benching for real.

[Kokanee]

ok just to update this thread, my shoulder didn't handle heavy lifting well. it flared up bad the day after I DL'd. after that day, i stopped weightlifting, but continued rehab for a while and eventually had to stop even rehab as well until the inflammation went away.

the inflammation eventually went away and I've now been doing the same rehab exercise for the last month. it isn't getting worse, but it isn't improving either.

I'm getting really frustrated now. the tendon has improved to the point where it doesn't get irritated by daily activity (unless I do too much overhead work or reach too far back) but I can't lift without it going bonkers. It's been 7.5 months now. Any input?

[nassstnate]

Kokanee,
I've ben struggling with almost the same exact issue and presentation of symptoms (details below). I hope you've recovered....how are you doing now? If you have indeed recovered, what worked for you? Anything you can share?

I strained my rotator cuff in July playing hockey. I was diagnosed with supraspinatus tendinitis and did PT for 2 months with limited success. The docotor finally gave me a cortisone shot 2 months ago, which seemd to really help within a week (symptoms went away completely) and I started doing my normal activityies again (rock climbing, lifting-but lighter sets, like starting at 135# bench, hockey). I tweaked it 3 times in a week a few weeks after the shot (twisting out of a backpack, hockey again, and rock climbing) and the pain came back worse than ever, but this time only lasted a day or so - probably because I still had the cortisone. I finally got an MRI to confirm there was no partial or full thickness tear (there wasn't), but was then diagnosed with supraspinatus tendinosis, and just told to rest it. I've stopped climbing and lifting upper body for about a month now, and just do the occasional set of pullups and exercise band shoulder work. During my daily activities since then, I hardly feel it but can still tell it's there. However, it's not getting any better either, even with daily application of ice. My brother is a physical therapist and recommended I try this regiment (below): We'll see how it works. I guess I jut need to be patient, and force myself to stop doing activities to take this rest thing serious (hard to do!).

~~~~~~~ (sorry, forum won't let me post links yet, since I'm new, so I parsed them below)

This is a real good article I found that sums up whats going on with your shoulder: scribd.com/doc/9914740/Overuse-Tendinosis
Masage: youtu.be/9FFWDyWWe0E
How you would do eccentrics with the supraspinatus: youtu.be/wlqkOE8HTQE
FYI, this is concentric Supraspinatus strengthing: youtu.be/ANLxvBcC0z4

To summarize: Do Eccentric strengthening of the supraspinatus....REST REST REST....Ice the **** out of it, no heat. Stop taking anti inflammatory drugs. Try some trigger point massage on it. If it's chronic total rehab time is 4-6 months.

[Kokanee]

It's been almost 2 years... and it isn't fully healed. I can do most exercises, but it gets irritated with heavy presses. I have to use good form and lighter weight or I risk a flare up. I haven't been doing PT religiously though. I do some exercises with thera bands and one for the serratus. I'll check out those links, thanks.

It's been healing very very very slowly. I must've injured the hell out of it.

[Dale1988]

It's been almost 2 years... and it isn't fully healed. I can do most exercises, but it gets irritated with heavy presses. I have to use good form and lighter weight or I risk a flare up. I haven't been doing PT religiously though. I do some exercises with thera bands and one for the serratus. I'll check out those links, thanks.

It's been healing very very very slowly. I must've injured the hell out of it.

I have something similar to what you have. You say you have had it for 2 years. If you are doing any sort of heavy lifting, fighting, etc you might as well forget about it ever going away brah. Stop all heavy lifting, do religous PT and your problem MIGHT go away. Assuming you havent damaged the tenodon past the point of no return (which there is).

[Kokanee]

I have something similar to what you have. You say you have had it for 2 years. If you are doing any sort of heavy lifting, fighting, etc you might as well forget about it ever going away brah. Stop all heavy lifting, do religous PT and your problem MIGHT go away. Assuming you havent damaged the tenodon past the point of no return (which there is).

Where did you hear this?

[mc-]

I have something similar to what you have. You say you have had it for 2 years. If you are doing any sort of heavy lifting, fighting, etc you might as well forget about it ever going away brah. Stop all heavy lifting, do religous PT and your problem MIGHT go away. Assuming you havent damaged the tenodon past the point of no return (which there is).

Wow,
the above is why nearly everything posted on this forum is wrong. http://forum.bodybuilding.com/showth...hp?t=129391851

for the OP and other suffering.
Sorry to hear about all the shoulder issues, but gang, the site of pain is NOT the source of pain. An awful lot of the time esp with shoulders - the shoulder is just where the issue shows up - there are other issues at play - including the gut. Right side shoulder stuff often has a visceral component - hows that for interesting? sometimes it's a muscle imbalance or a kind of motor amnesia in some supporting muscles. sometimes it's actually a balance or verstibular issue.
http://forum.bodybuilding.com/showth...hp?t=138178583

Two main things: never move into pain (here's what to do instead http://forum.bodybuilding.com/showth...hp?t=138874633)
and if you care, find a way to connect with a movement specialist to help you get out of pain and back in action.
about that:

Please note that tendons CAN take ages to heal for a variety of reasons. Sub 40 year olds - 3-4 months; above forty - sometimes longer. But if it's two years and still having pain/issues - it's not your shoulder's issue: your shoulder is likely paying for something else, somwhere else.

Hence see a movement coach/specialist

best
mc

[Kokanee]

Wow,
the above is why nearly everything posted on this forum is wrong. http://forum.bodybuilding.com/showth...hp?t=129391851

for the OP and other suffering.
Sorry to hear about all the shoulder issues, but gang, the site of pain is NOT the source of pain. An awful lot of the time esp with shoulders - the shoulder is just where the issue shows up - there are other issues at play - including the gut. Right side shoulder stuff often has a visceral component - hows that for interesting? sometimes it's a muscle imbalance or a kind of motor amnesia in some supporting muscles. sometimes it's actually a balance or verstibular issue.
http://forum.bodybuilding.com/showth...hp?t=138178583

Two main things: never move into pain (here's what to do instead http://forum.bodybuilding.com/showth...hp?t=138874633)
and if you care, find a way to connect with a movement specialist to help you get out of pain and back in action.
about that:

Please note that tendons CAN take ages to heal for a variety of reasons. Sub 40 year olds - 3-4 months; above forty - sometimes longer. But if it's two years and still having pain/issues - it's not your shoulder's issue: your shoulder is likely paying for something else, somwhere else.

Hence see a movement coach/specialist

best
mc

You sure? When I got my MRI way back in the day, it should tendinosis and bursitis in the supraspinatus. The symptoms nowadays are pretty much the same as back then, at least when it flares up. Normally it's ok unless I lift heavy for a while and irritate it.

[mc-]

You sure?

about what?

When I got my MRI way back in the day, it should tendinosis and bursitis in the supraspinatus.

sure. why not?

The symptoms nowadays are pretty much the same as back then, at least when it flares up. Normally it's ok unless I lift heavy for a while and irritate it.

So what does flare up and irritation tell you? a guarding reflex perhaps on the part of your nervous system that doesn't want you going there again? that a lot of pain signaling's been wired there? and that perhaps you're still not firing your lats in a press or that your extensors are asleep at the wheel - still.

if the REASON for the shoulder issue hasn't been addressed, no kidding the pain will come back as protection. Doesn't mean there's an injury.

Pain and injury are not the same thing.

one can have an injury without pain; one likewise can have pain without physical trauma.

mc

[Kokanee]

it flared up again doing deadllifts... i'll see a PT. The problem is that the PTs I've seen in the past have all been idiots... they just give me some generic routine and tell me to come back in a week so they can monitor my progress (yeah right) and make some contrived change to my routine.

what is your opinion on rotator cuff stretches? like using a broomstick and whatnot.

right now my PT consists of internal rotations, external rotations, a serratus exercise, and internal rotator stretches.

[mc-]

it flared up again doing deadllifts... i'll see a PT. The problem is that the PTs I've seen in the past have all been idiots... they just give me some generic routine and tell me to come back in a week so they can monitor my progress (yeah right) and make some contrived change to my routine.

what is your opinion on rotator cuff stretches? like using a broomstick and whatnot.

right now my PT consists of internal rotations, external rotations, a serratus exercise, and internal rotator stretches.

i can't really offer an opinion without doing an assessment - your problem showing up in the cuff may have nothing to do with your cuff per se. or very little

i'd suggest considering instead of another PT, another approach: if you'd like to connect with a movement specialist, PM me

best
mc

[schwa299]

I read a pretty big study recently that stated if tendonosis/itis is found in an MRI of the supraspinatus it could be a tendon tear and that an mri cannot distinguish between a tear or tendonosis..


how can we distinguish?

[nassstnate]

I read a pretty big study recently that stated if tendonosis/itis is found in an MRI of the supraspinatus it could be a tendon tear and that an mri cannot distinguish between a tear or tendonosis..


how can we distinguish?

can you provide a citation or link to the study you are referencing?
it's really nothing new that MRIs are not perfect at diagnosing, so I'm curious to read the specifics of this study.

eventhough my mri was read as tendonosis and not a tear, i am no better off than i was 7 months ago, despite religious icing, PT, and rest - since I'm 29 and doing all the "right things" and have no apparent motion problems, i'm wondering if i do in fact have a partial or full thickness tear. i've scheduled a follow up now to see what might be logical next step.

[Kokanee]

i can't really offer an opinion without doing an assessment - your problem showing up in the cuff may have nothing to do with your cuff per se. or very little

i'd suggest considering instead of another PT, another approach: if you'd like to connect with a movement specialist, PM me

best
mc

hey mc,

i don't think it's a movement issue just because of my injury symptoms.

when i first got the injury it was just a gentle ache and I worked out through it. That eventually turned into excruciating pain that continued months after I stopped lifting. It took about 6 months to a year before I could raise my arm above shoulder height without feeling a twinge. Because of how it built up and whatnot, it seems like there was an injury that gradually got worse and is just taking a very long time to heal. Right now it's 100x better than a couple years ago, I just can't lift heavy without it flaring up. I'm not sure what kind of movement issues could lead to these symptoms.

The stretches do seem to be helping. I've been doing a number of stretches (including one's specific for the supraspinatus) and my shoulder feels much better. Deadlifted 405x3 yesterday and I barely feel anything in my shoulder today.

[schwa299]

can you provide a citation or link to the study you are referencing?
it's really nothing new that MRIs are not perfect at diagnosing, so I'm curious to read the specifics of this study.

eventhough my mri was read as tendonosis and not a tear, i am no better off than i was 7 months ago, despite religious icing, PT, and rest - since I'm 29 and doing all the "right things" and have no apparent motion problems, i'm wondering if i do in fact have a partial or full thickness tear. i've scheduled a follow up now to see what might be logical next step.

I do not remember where I read the study because I was frantically searching after my shoulder dislocation..

My injury feels better too after 7 to 8 months and there is more strength but its probably because scar tissue has filled in a lot...

There is a strange indent in my shoulder and docs say its nothing so does the MRI but it wasnt there before... Probably have a ligament tear ...

[magnetman224]

hey mc,

i don't think it's a movement issue just because of my injury symptoms.

when i first got the injury it was just a gentle ache and I worked out through it. That eventually turned into excruciating pain that continued months after I stopped lifting. It took about 6 months to a year before I could raise my arm above shoulder height without feeling a twinge. Because of how it built up and whatnot, it seems like there was an injury that gradually got worse and is just taking a very long time to heal. Right now it's 100x better than a couple years ago, I just can't lift heavy without it flaring up. I'm not sure what kind of movement issues could lead to these symptoms.

The stretches do seem to be helping. I've been doing a number of stretches (including one's specific for the supraspinatus) and my shoulder feels much better. Deadlifted 405x3 yesterday and I barely feel anything in my shoulder today.

Hey dude, not to revive a 4 year old post, but how is your shoulder now? Did the symptoms eventually go away? What exercises did you do? I got my diagnosis 7 months ago of supraspinatus tendinosis and its been restricting me from getting back in the gym/martial arts so much that I decided to go to a PT today (manual therapy). He did some massaging, a set of about 3 exercises, then sent me on my way. I feel like I should do my own PT exercises at home and maybe switch to a better one. Let me know how its going dude!

[Getup1982]

Supraspinatus tendinosis often stems from a plethora of underlying issues and likely won't go away simply by letting it rest.

In my case it took me some 10 months or so to get rid of it, from the moment I started tackling it with a structured game plan. It seems that you have not even reached that moment yet.

If you are not comfortable with your existing PT, U would suggest to find a new one with a clear background in treating athletes.

Without a clear assessment of a pro it is almost impossible to come up with a focused game plan. Such a game plan likely will entail mobility work, myofascial release, strengthening and - very important - posture work.

Most likely your gym life won't be the same for the next half year and you will loose some gains. But it may be the only way. That's the ugly truth:-)

[jkeithsr]

Most likely your gym life won't be the same for the next half year and you will loose some gains. But it may be the only way. That's the ugly truth:-)

Great post Getup. I'm in my late '60s and play senior men's baseball and workout regularly. A recent MRI shows two minor tears, rotator cuff & a SLAP tear at the bicep, plus a boatload of tendonosis in my shoulder. Had a shot yesterday. I want to hurriedly rehab my way thru this and start throwing again. I can't. I've got a wonderfully knowledgeable Physical Therapist who insists that I....
1) do my exercises religiously, 2) don't train pain, and 3) stabilize with obsession. I'm on a shorter leash than most of you. My window of functionality on the pitcher's mound is slowly closing. But I'll be damned if I'm going to make things worse by trying to speed things up. Take your time. Get a diagnosis. Ask questions. And learn. You won't be sorry.