Shoulder Rehab

Many people experience some type of injury while performing some type of exercise during their lives. The shoulder appears to be one of the most commonly injured areas. The reason for this is that the shoulder is one of the most mobile joints in the body and endures a lot of wear and tear every day.

For those of us that have had or are experiencing a shoulder injury, the people at CrossFit Invictus have a great post dealing with shoulder prehab and rehab. The following post was written by Mike Hom:

"I have been rehabbing a slightly bum shoulder since January. I tweaked something while bench pressing. Fatigue had set in and I got a little loose and flared out my elbows – which is not good. The result was that my left shoulder and surrounding area was feeling hot, and not in the good way. I spent the next several weeks trying to let it heal on its own with some stretching and mobility work but saw no improvement. After almost 2 months, I needed to do something. Through a bit of trial and error, I found that overhead pressing didn’t bother it, and actually made it feel a bit better. I did some homework and conferred with some coaches, then decided to overhead press my way into rehabilitation using the Bill Starr rehab protocol, coupled with diligent mobility work, massages, and some additional recovery work. How to go about it? Read on, my friends.

The Starr rehab protocol is typically used for injuries to the muscle, not connective tissues. However, my own opinion is that you don’t just want to let your shoulders sit in poor positions that aren’t conducive to helping them heal (e.g., sitting in front of a computer all day). If you are going to let them heal, let them rest a bit and then start with some active recovery, using the shoulder in a functional manner. I suspect there is carry over with the tendons and ligaments that mix in with that muscle tissue injuries that this method primarily addresses.

For a longer description of the Starr rehab protocol, visit Coach Rippetoe’s forum post on it here. If you don’t want to read that post, then read the following: After letting the injured portion of the body heal for a bit, use a light weight and do 3 sets of 25 reps practicing absolutely perfect form with as much symmetry as you can possibly muster. Generally, you will know when this is the right time to rehab because the injury will start to feel better, and the surrounding area will start to feel mobile. If there is more pain–we’re talking about that bad kind of pain that intrinsically feels like re-injury, not the “yeah-it hurts-but-it-feels-better” pain–at the end of that set then there was in the beginning, you probably want to call it a day and wait another day or two.

If things have gone well the first day, then in successive days, add small increments of weights and do 3 sets of 25. You can slowly increase weight each set or do them straight across. The point is to use small loads, practice perfect form, and not to let yourself favor any one side (unless you’re doing unilateral exercises!). After about 2 weeks of this, decrease the reps to between 15-20, then to 10-15, then to 5-10, then to 5s. The rep decreasing should occur over time relative to the weights being used.

During all of this, you should be actively working on mobility. You should be rolling out that area before and after, as well as doing stretches that hit those target areas and surrounding musculature. What areas do we want to roll out? Have no fear, for our fine coaches at Invictus have already written up several quality posts that you can find here, here, and here. I also use a lacrosse ball and roll out my pectoral against a wall. To do this, grab a lacrosse ball, put it in between your pectoral muscle and the wall, lean into it and move it around. This, like so many of our stretches and self-inflicted massages, feels fantabulous. For the case of shoulder rehab, you want to hit the clavicular areas of the deltoid and pectoral muscles (the junction between your shoulder and pec and surrounding musculature).

Let’s also not forget about some prehab mobility drills that will help strengthen the muscles that help stabilize the shoulder. I am, of course, talking about strengthening the serratus anteriors, doing your Ys, Ts, and Ws. These will help strengthen the musculature in the upper back that often gets overlooked in the face of large compound exercises. You don’t go through whole workouts with these exercises but you do want to do them in your warm-up. This not only helps just your shoulders but your overall posture.

At the end of all of this, you want to get a nice ice massage in. Massage the spot with ice until you feel the onset of numbness and then back off so blood can rush in. Once you feel your skin go back to a relatively normal body temperature, repeat the massage. Do this for about 20 minutes at a time every hour for a couple hours and then call it a day. Do it while working on other body stretches in front of the tube or while reading a book. Nothing screams productivity like stretching, ice massaging, and reading at the same time.

What’s happening here is a combination of things. First, understand that for whatever injured muscle(s) you are rehabbing, you are basically going through a process of re-tooling coupled with lots of proper prehab and rehab techniques. You are allowing blood to get flushed through the injury while forcing those tissues to work in a proper manner to prevent and minimize scarring while performing the press. Warming up the tissues properly allows those muscles to get accustomed to the work they will be doing and introducing blood flow into them. Releasing those same tissues during the massages again flush blood through the area to promote healing. And, of course, the ice helps minimize swelling and inflammation.

So, why go through all of this work? The obvious is injuries suck. I had all the pieces to shorten my recovery and rehabilitation period but couldn’t quite put it together. Are some of the elements I’ve written about unnecessary or excessive? Maybe, but these certainly didn’t hurt and probably made me for structurally sound all around. The consistent overhead pressing helped promote healing and forced me to work on some bad habits I accrued in the past. Further, doing the accessory mobility drills helped improve my posture and strengthen musculature I’ve always had problems with but neglected to address. Third, this method of active rehabilitation minimized the possible formation of scar tissue since the musculature was forced to heal in a functional manner. Finally, the volume of overhead pressing, starting with just a barbell and working back up to higher weights also indirectly helped with strengthening other areas in my body, particularly my midline stabilizers. I’m now back up to pressing my bodyweight overhead with far better form and efficiency. I look forward to making more steady progress over time. I’m also back to benching and just passed the same weight I struggled with back in January that gifted me with the injury in the first place.

This is not the end-all-be-all method for shoulder rehab but it is A method that seems to be quite effective, from my own experience. Even if your shoulders are not injured, do yourself a favor and follow the prehab and rehab techniques described here because they will help you in too many ways to describe. The end result, however, is improved human movement."