Sunday, May 15, 2022

The Shoulder Re-Hab Program - Bill Starr (1991)


It was one of those hot, humid dog days of summer, the kind of day that seems to suck energy from your body, the air thick, heavy, suffocating -- especially so in the non-air-conditioned basement gym where I was training. The basement of an old high school provided facilities for county athletes -- adequate, but there was little air flow on this day. It was the type of day I call a three-shirt day because I go through that many in a two-hour session.

I stepped into the dressing room to get a drink of water and to put on my second T-shirt of the workout. I found Jack, sitting on a bench, grimacing and rubbing his right shoulder. 

"Hurt yourself?" I asked, pulling a fresh shirt over my head.

"About two weeks ago," he replied sulkily, still rubbing his shoulder gently. "I got conned into doing some negatives on the bench with Mac and Herb.' 

"Those guys are fools -- you know that. Negatives have probably caused more shoulder problems than any other single exercise. They're useful, but only for an advanced lifter." 

"I know," he agreed softly. "I deserve it.' 

"Know what it is?" 

"The doctor said tendonitis. Gave me some pain pills, but I don't like to take them before training. Figure I might do more harm than good." His tone was most grave. 

"You're right. Don't use them when you train. Disguising the pain could make it a lot worse. Just use them at night to help you rest better." i moved over to him, asking, "Can you pinpoint the pain or is it generalized?" 

"It's right here," he answered, putting his index finger at the point on the crown of his deltoid where the scapula meets the clavicle. I checked it for swelling -- there was none -- then asked, "Did the doctor say anything about bursitis?"

"No," he returned glumly. "Why?" 

"Because you deal with bursitis differently than you do muscle dings or tendinitis. For example, you don't want to put ice on bursitis, because it aggravates the problem. Let me check it." I can generally detect bursitis by pressing on the three sides of the deltoid. If there is generalized pain at all three points, it usually indicates that the bursa sac has been traumatized and there's nothing worse than a traumatized sac. On Jack, none of these hurt him, so I ruled out bursitis. 

"What are you doing for it?" I asked.

"Nothing really. The doctor said to rest it for a week, but I could tell I was losing muscle tone. I tried to bench today, but it hurt too much," he added morosely. 

"What exercises hurt the most?" 

"Benching hurts the most. It even hurts when I try to hold the bar on my back to squat. Any suggestions?" 

I've helped a few with that type of problem, including myself after I dislocated my left shoulder. If you want, I'll show you a few things." 

"Sure," he responded wistfully. 

Back in the weight room, I had him go through a series of pressing movements, using only the empty Olympic bar. The flat bench, seated press and decline all brought no pain, but not the incline. 

"That's weird," he commented after placing the bar back on the stands. "Why wouldn't inclines hurt like the others."

Typically, there is one pressing motion that you can do, unless the shoulder has been totally wrecked. if you can do even one pressing movement, you're a step ahead. For a time, you should make the incline your primary shoulder exercise." 

"What about my bench?" he asked with a worried expression. 

I know Jack took the most pride in his benching power, and he did have some power. Even though he worked long, hard hours as a house painter and spent a great deal of time with his wife and two young daughters, he was still one of the strongest benchers in the county. At a bit over 200 pounds, he could manage a 425 regularly.

"I think you'll be able to work it, not with a bar but with dumbbells." 

"Why dumbbells?"

"The dumbbells afford you a greater flexibility of movement than the bar does. When you lower a bar to your chest, you cannot vary your hand grip or the placement of the bar on your chest, but you can with a dumbbell. By experimenting and varying how you grip the dumbbell, you can avoid the pain and still work the muscle group. Let's give it a try. You're only going to be using five-pounders." 

After giving me a long, dubious look, he went to the rack and brought back two five-pound dumbbells.

"Lie down," I instructed. I'll hand them to you. Cleaning them is not a good idea until your injury starts to come around."

He did as I directed and I continued, "Try varying the position of your hand on your hurt side. Turn your palm towards your feet, then towards your body, then somewhere in between." 

Following a half dozen tries, he said, "This one doesn't hurt as much as the others, but I can still feel it." 

I took the dumbbells from him, saying, "Any time you're rehabbing you're going to have to put up with some discomfort. There's just no way around it. What you have to learn is to be able to differentiate pain of the acute nature and pain of the chronic kind." 

"How am I supposed to do that?" Jack asked wonderingly.

"It's quite simple really, but you do have to be aware of signals from your body. Chronic pain subsides after 10 or 12 reps whereas pain of the acute nature does not. if the sharp stabbing pain continues you have to stop, for you can cause more tissue or joint damage." 

"Hope I can tell." 

"You will. Now try seated presses with the five-pounders," I said, handing him the weights. "Once again, experiment with your hand position until you find one that doesn't hurt, or at least doesn't hurt as much." 

When he turned his hand on his injured side so that his palm was towards his body, he said, "This doesn't hurt much. Awkward though." 

"Go ahead and do 15 reps. Test to see if the pain subsides." 

On the eighth rep, he said, "I'll be damned, it went away." 

I took the dumbbells and he asked, "What about sets and reps?" 

"While you're rehabbing your shoulder, you'll do most of the exercises in high reps, 25's, and for 3 sets." 

"You said 'most.' Not all of them?"

I shook my head. "No, not on the incline. Since that doesn't bother your ding, you'll use that as your strength movement. You should, however, keep the reps relatively high, eights or tens for five or six sets, but not 25's. And you can use a bar for your inclines if you like." 

"And light weights?"

"Go ahead and work the incline hard, but the higher reps will force you to use a lighter weight on the others. In rehabbing, especially in the early stages, lighter is always better than heavier. Your workload goes up because of the higher repetitions. And I think that you'll find doing 25 even with a light dumbbell can be quite taxing."

"I see. What exercises exactly?" 

"I suggest you do a circuit, performing a variety of exercises that involve all the muscles of the shoulder girdle -- benches, seated presses, frontal raises, lateral raises, shrugs, and make the incline your final exercise. The weaker movements should be given priority." 

"I can understand all of them but the shrug. That's a back exercise," he declared most emphatically.

"True, but the trapezius is an important muscle which helps to support the shoulder girdle. One of the most common shoulder problems I encounter is with football players and other athletes who specialize on the bench and do nothing for their traps. What eventually happens is an example of disproportionate strength. The muscles of the chest and frontal deltoid become considerably stronger than those in the upper back and stress is placed on the shoulder joint, often quite severely." 

"Dumbbells for everything but the inclines?"

"You can also use a bar for the shrugs, unless it causes you pain, but, yes, the dumbbells are better because of their flexibility. And after you complete the circuit, I bet that you'll be able to hold the bar on your back so you can squat." 

"That would be nice, When I have to squat I bitch, but when I can't do them I'm miserable." He laughed and I did too for I knew exactly what he meant. "And the circuit should be the first thing I do?"

I nodded, saying, "Right after you warm up. You may want to do a few calisthenic type movements to make sure your shoulders are warmed up thoroughly even before you start the exercises. Use some muscle rub on it after you warm up and keep the injured area warm while you train." 

"We don't have to worry much about a draft in here," he grumbled. 

I laughed. "Well, I have caught a draft next to the window when my shirt's been soaked." 

"You know," he said, lifting the arm on his injured side with his left one, "I don't think I can do frontal raises at all. It just hurts to try and lift my arm without any weight." 

"Then start by walking the wall with your fingers," I said, demonstrating. I extended my arm until my fingers could touch the wall by the squat rack, then walked them up as high as I could reach, then walked them back down again. "Try it." 

Jack did as I had done, smiled and muttered, "That's strange, but I can feel it working." 

"These will at least allow you to retain your range of motion. Do them until you can't do them anymore. After a time, you'll be able to do the frontal raises witgh a light dumbbell. The body responds remarkably well, thank goodness. Why don't you go through a circuit while I do my dips. That way, if you have a question, I'll be here." 

While he set about his task, I went to mine. The heat was so overbearing that the chalk would turn to a runny mush before I could get from the chalk box to the dip bars. I finished my set, went and stood beside Jack while he was attempting his first set of shrugs. "How you doing?"

"I can do these with a bar too. Should I lower the reps?"

"No, stay with 25's for a few weeks. It'll make sure all the muscles are being thoroughly worked. How do you like the high reps?" I asked, watching him grit his teeth.

"I hate them," he barked. "I never liked doing reps. If I did, I would have gone into bodybuilding." 

"For variety, you can substitute clean or snatch high pulls for the shrugs, but you won't be able to do those for 25's." 

He crashed the bar back on the rack, sucking air. "These are making me dizzy," he blurted, panting. 

"Don't rush. That's not the purpose. Take sufficient rest between exercises. One thing you'll have to concentrate on is to do each and every rep very differently. No hurky-jerky movements. Especially so when you start getting fatigued." 

He nodded that he understood and moved to the incline. After a set of dips, I spotted him as he worked to the limit. He finished with 225 for 10. "That's not bad," I commented. 

"Hey, I'm tickled pink. I can at least do something," he shouted happily. 

"When you work your biceps and triceps, keep the reps high on these also: 25's again. They tie in with the shoulder as well. Use dumbbells for your curls and triceps pressdowns for your triceps. Let the frontal deltoid get involved in the pressdowns. Cheat a bit."

While he tried a set of these, I kept talking. "When you get home, ice the injured area. 20 to 30 minutes at a time and you can do this two or three times a night."

"I got one of those packs that forms to the body. Blue ice. How often should I go through this circuit?" 

"You can do some of it every day, even twice a day. If you have any weights at home you can do presses, lateral raises and walking the wall or frontal raises there. It all helps." 

"I have a three-pound dumbbell that my wife uses." 

"That'll work. Just keep running the reps until you feel the pump. What you're trying to do is get blood into the injured area. The blood carries nutrients to help the healing process. Speaking of nutrients, be sure that you're getting plenty of protein because the amino acids play an important role in rebuilding. Load up on vitamin C, at least 10 grams a day, and take plenty of B-complex vitamins. You might add some B6 to your program too, since B6 is helpful in metabolizing protein." 

"I got all those. Anything else?" 

"Get plenty of rest. For some reason I can't explain, an injury seems to drain energy. Maybe it's because we spend so much time thinking and worrying about the ding, and our attitude goes sour."

"That's a fact. I've been in a sorry mood ever since I hurt myself. How long should I stay on the high reps?"

"Until you feel it getting stronger. Then slowly lower the reps, increase the weight and number of sets. Go slowly, however, and treat the area kindly for a long time. Even after it's stronger, I'd go through this circuit as a warmup just to play it safe." 

"That makes sense." 

"One final thing you can do to help the healing process is to adopt a positive attitude. It may sound silly, but believing that what you are doing in the gym, with the ice and supplements is actually helping , does help."    

"That makes sense." 

He looked at me strangely, so I went on. "The thing I like about being able to rebuild an injured area through exercise and nutrition is that I am in control, to some degree, of my own destiny. Not the doctor or the pharmacist, but me. And believing that I can do something to heal myself helps me respond better than if I'm at the mercy of someone else, no matter how competent he might be." 

Stuffing his belt into his gym bag, he ventured, "I see your point. Gotta run. Coaching a Little League game. Thanks. To tell you the truth, my shoulder feels better than it has for two weeks." 

"Try not to irritate it at work."

He laughed, "I've learned to use my left hand pretty well lately." 

Enjoy Your Lifting!      



No comments:

Post a Comment

Blog Archive