Articles
Shoulder Dislocation Rehabilitation for Weightlifting: Part 3
March 16 2016
March 16 2016
Last week marked 6 months post-op and 7 months post-injury for me. According to the surgeon, this means that the tears and repairs are fully healed now. My mobility has improved fairly steadily and while it’s still not back to 100%, it’s finally close enough within range to reassure me that it will in fact recovery fully eventually, which I was not convinced of for the first several months.
For the first 4 months of my recovery, I was going to physical therapy twice weekly with an additional visit to my long time chiropractor/manual therapist. In the last two months, I’ve reduced to once weekly PT as I’m at a stage when most of the work that needs to be done I can do myself.
Shoulder flexion and external rotation were extremely limited. This seemed to be a combination of general tightness from immobilization and lack of use, but also a lack of glide of the humeral head on the scapula—trying to raise my arm overhead would force my shoulder blade to flare out wildly to achieve the extra range. The end range of anything was fairly painful as well, and the end ranges were extremely weak.
The first significant breakthrough was finally being able to back squat on a normal barbell. I had been squatting on a safety squat bar and occasionally trying to hold a PVC pipe in a back squat position to stretch. By mid-November, I was able to hold a barbell on my back well enough to back squat with a little weight, although I still could only get my fingertips under the bar on my left side. Each day I would do this and work on getting a fuller grip on the bar, and each day it would feel a little better. I also was using the PVC to stretch this position multiple times daily. I was extremely anxious to get off the safety squat bar and squat for real. At the end of November, the position felt secure enough that I tried to squat heavy, and was able to hit 180.
Around this same time, I tested out push-ups very carefully. The physical therapist had me start doing 1-arm supports from the knees a couple weeks earlier, which were incredibly difficult and caused me almost instantly to shake. I was able to do 5 slow, controlled push-ups.
At this point (November 30th), my passive shoulder flexion (i.e. the therapist working on me and then forcing my arm back) reached 157 degrees (as a reference, my right side can get 180 active), and I could reach about 150 degrees actively while lying supine and using some gravity assistance.
By January 12th, I hit 155 degrees active flexion while standing, and was able to do 3 sets of 10 push-ups. The next week, I tried bench pressing at a low incline and could do 10s with 40kg with slight discomfort but no pain—the key was depressing and retracting my shoulder blades the entire time. A few days each week, I would try holding an empty bar in a clean rack position, which was uncomfortable, very tight, and not a great position—a narrow grip and on my fingertips.
I started doing some light, slow clean pulls around this time—a few sets of 5 with a fairly controlled and constant speed from bottom to top, i.e. no big acceleration. This was usually 70kg or so initially.
Somewhere around this time, I started trying overhead squats with a PVC pipe. The position was pretty awful—left side quite a bit lower than the right while the left shoulder was hiked way up, and the left hand a bit too far forward. But at least it was a reasonable attempt.
Two weeks later, I tried front squats with 50kg. I had to use a considerably narrower grip than usual, couldn’t get a full grip as I normally use, and my left shoulder wasn’t quite in contact with the bar—I was lacking adequate protraction and elevation.
The first week of February, I was able to front squat 100kg for a few doubles, which was the first time I used any real weight. The rack position still wasn’t great, but definitely improving. A few days later, I tried cautiously hanging from a pull-up bar with about a jerk-width grip. My shoulder wasn’t able to open completely, and I didn’t feel comfortable hanging for more than a couple seconds, but it was a huge step considering how limited my flexion had been for so long. I tried to do a pull-up but stopped about halfway up—I probably could have completed it, but decided not to be an idiot.
The following day, I was able to overhead squat a barbell. Still not fully in position on the left side, but close enough that I could stabilize it. I followed that with my first pull-up.
The next week, I tried some hang muscle snatches with a 10kg barbell. I had essentially no pain, just the weird discomfort and tightness trying to move it into the final overhead position. After a few sets of that, I did some hang power snatches with the same basic results. I had enough mobility to perform the turnover pretty well (i.e. elbows high and bar close), but just couldn’t get it all the way into the proper overhead position.
Cleans still weren’t happening. Even though I could get into a reasonable rack position, the turnover itself wasn’t fluid enough to be a good idea. I did 1 power clean with 70kg and decided to leave that alone for now. I’ll stick with some muscle cleans with the empty bar to keep working on that movement and mobility.
I had been increasing my pull weights, and had added snatch pulls and shrugs to the mix. Clean pulls were up to about 130kg and snatch pulls up to about 110kg for sets of 5, and I started working acceleration at the top. All are done without straps to start trying to get my grip strength back.
Over the next week, I worked up to doing a few sets of 5 muscle snatches, overhead squats, power snatches and snatches with the empty barbell. Then the following week, I did the same with 30kg. This is likely where I’ll stay until I can get into a better overhead position. I can also now do sets of 10 presses with an empty bar, although I can’t reach the final overhead position—but previously, my arm couldn’t even move properly to press.
On the first of March, which is 3 days shy of 6 months post-op, I reached 168 degrees of active flexion in physical therapy after being assaulted for 45 minutes, and later that day was able to do 5 pull-ups.
I’ve also reached a point where I can work through my formal standard shoulder warm-up series, although my left side is a bit limited in movement. But it gets more and more fluid every day.
Workouts
I’ve kept my training to 3 days/week for the last few months, in part because I’m limited in what I can do, but more because my work schedule hasn’t allowed more than that anyway. The most recent several weeks have looked something like this:
Day 1
Squat
Lunge
Pressing Strength
Pulling Strength
Day 2
Squat
Drop to Split
Snatch Pull
Day 3
Squat
Good Morning
Clean Pull
Shoulder Strength
Arm/Forearm Strength
Lunges are something I just have to force myself to do because I have pretty poor unilateral strength, which bites me in the ass with heavy jerks. Drop to split also helps me train that strength and footwork precision and speed (and confidence) while I’m unable to do jerks.
I do back and ab work daily, such as weighted back extensions, unweighted back extensions and glute-ham raises, along with one heavy ab exercise (like weighted sit-ups or incline sit-ups) and one light ab exercise (like crunches, reverse crunches or planks). The pressing and pulling strength work consists of things like some kind of bench press variation and row variation first, and then a lighter, higher-rep exercise like push-ups and DB rows.
Shoulder strength work is pretty limited, so it’s usually more push-ups, close-grip bench, and DB front raises, then tricep and bicep work, and some kind of forearm/grip work. After the injury I lost a lot of weight along with strength, so I’m doing a lot of more of this beach work than usual to try to gain some of that weight back. I’m still about 5kg light.
Mobility
I try to do the full set of stretches a minimum of once daily. Initially, I was doing it 2-3 times each day. On a good day now, I’ll get it in twice. This includes rolling the underarm area with a softball, which is unpleasant to say the least, and then a series of stretches including:
I usually throw in a few more that may vary a bit day to day depending on how I’m feeling or what I remember to do. Hanging from the pull-up bar seems to be the most effective at this point, although that was totally inaccessible prior to maybe a month ago.
Strength
I think that the more strengthening I did, the faster my mobility improved. Of course, it took a lot of work and time to get to a point where I could really do much strengthening. For a long time, it was limited to very short range Theraband stuff, which is as boring as it is frustrating, and things like lying external rotations with small plates. Once I was able to do push-ups, I feel like it started improving more quickly.
I now do a series of band exercises each day that are pretty standard shoulder/scapular stability movements like internal and external rotation, shoulder extension with scapular retraction and depression, 30-degree abduction (to strengthen my repaired supraspinatus), rows, standing Ys (which are pretty awkward when one arm doesn’t do what the other does), and scapular protraction. Abduction is still probably the weakest movement for me.
Future Plans
My progress has reached a point at which I’m more confident I’ll be able to actually snatch and clean & jerk again with significant weights. The surgeon told me in my last follow-up that he estimates my risk of reinjury to be only 5-6% greater than before the injury… which is basically zero considering that’s probably about how much higher my risk would be just turning 36 as I did today.
I don’t know what exactly I’m going to do yet long term with regard to training and competition. For the last few months, I’ve been fairly resigned to not really lifting, but once I did a few snatches, I started getting that urge again. If life allows it (and by life, I mean coaching and work), I’d like to compete in at least one more senior national championships to make a complete comeback—and ideally snatch more than the weight I blew out my shoulder with (142kg). I have about 15 months until that nationals, and about 13 months until I’d need to make a qualifying total (probably right around 300kg). I think it’s doable, but it will largely depend on my obligations outside of training, which are large and many.
For the first 4 months of my recovery, I was going to physical therapy twice weekly with an additional visit to my long time chiropractor/manual therapist. In the last two months, I’ve reduced to once weekly PT as I’m at a stage when most of the work that needs to be done I can do myself.
Shoulder flexion and external rotation were extremely limited. This seemed to be a combination of general tightness from immobilization and lack of use, but also a lack of glide of the humeral head on the scapula—trying to raise my arm overhead would force my shoulder blade to flare out wildly to achieve the extra range. The end range of anything was fairly painful as well, and the end ranges were extremely weak.
The first significant breakthrough was finally being able to back squat on a normal barbell. I had been squatting on a safety squat bar and occasionally trying to hold a PVC pipe in a back squat position to stretch. By mid-November, I was able to hold a barbell on my back well enough to back squat with a little weight, although I still could only get my fingertips under the bar on my left side. Each day I would do this and work on getting a fuller grip on the bar, and each day it would feel a little better. I also was using the PVC to stretch this position multiple times daily. I was extremely anxious to get off the safety squat bar and squat for real. At the end of November, the position felt secure enough that I tried to squat heavy, and was able to hit 180.
Around this same time, I tested out push-ups very carefully. The physical therapist had me start doing 1-arm supports from the knees a couple weeks earlier, which were incredibly difficult and caused me almost instantly to shake. I was able to do 5 slow, controlled push-ups.
At this point (November 30th), my passive shoulder flexion (i.e. the therapist working on me and then forcing my arm back) reached 157 degrees (as a reference, my right side can get 180 active), and I could reach about 150 degrees actively while lying supine and using some gravity assistance.
By January 12th, I hit 155 degrees active flexion while standing, and was able to do 3 sets of 10 push-ups. The next week, I tried bench pressing at a low incline and could do 10s with 40kg with slight discomfort but no pain—the key was depressing and retracting my shoulder blades the entire time. A few days each week, I would try holding an empty bar in a clean rack position, which was uncomfortable, very tight, and not a great position—a narrow grip and on my fingertips.
I started doing some light, slow clean pulls around this time—a few sets of 5 with a fairly controlled and constant speed from bottom to top, i.e. no big acceleration. This was usually 70kg or so initially.
Somewhere around this time, I started trying overhead squats with a PVC pipe. The position was pretty awful—left side quite a bit lower than the right while the left shoulder was hiked way up, and the left hand a bit too far forward. But at least it was a reasonable attempt.
Two weeks later, I tried front squats with 50kg. I had to use a considerably narrower grip than usual, couldn’t get a full grip as I normally use, and my left shoulder wasn’t quite in contact with the bar—I was lacking adequate protraction and elevation.
The first week of February, I was able to front squat 100kg for a few doubles, which was the first time I used any real weight. The rack position still wasn’t great, but definitely improving. A few days later, I tried cautiously hanging from a pull-up bar with about a jerk-width grip. My shoulder wasn’t able to open completely, and I didn’t feel comfortable hanging for more than a couple seconds, but it was a huge step considering how limited my flexion had been for so long. I tried to do a pull-up but stopped about halfway up—I probably could have completed it, but decided not to be an idiot.
The following day, I was able to overhead squat a barbell. Still not fully in position on the left side, but close enough that I could stabilize it. I followed that with my first pull-up.
The next week, I tried some hang muscle snatches with a 10kg barbell. I had essentially no pain, just the weird discomfort and tightness trying to move it into the final overhead position. After a few sets of that, I did some hang power snatches with the same basic results. I had enough mobility to perform the turnover pretty well (i.e. elbows high and bar close), but just couldn’t get it all the way into the proper overhead position.
Cleans still weren’t happening. Even though I could get into a reasonable rack position, the turnover itself wasn’t fluid enough to be a good idea. I did 1 power clean with 70kg and decided to leave that alone for now. I’ll stick with some muscle cleans with the empty bar to keep working on that movement and mobility.
I had been increasing my pull weights, and had added snatch pulls and shrugs to the mix. Clean pulls were up to about 130kg and snatch pulls up to about 110kg for sets of 5, and I started working acceleration at the top. All are done without straps to start trying to get my grip strength back.
Over the next week, I worked up to doing a few sets of 5 muscle snatches, overhead squats, power snatches and snatches with the empty barbell. Then the following week, I did the same with 30kg. This is likely where I’ll stay until I can get into a better overhead position. I can also now do sets of 10 presses with an empty bar, although I can’t reach the final overhead position—but previously, my arm couldn’t even move properly to press.
On the first of March, which is 3 days shy of 6 months post-op, I reached 168 degrees of active flexion in physical therapy after being assaulted for 45 minutes, and later that day was able to do 5 pull-ups.
I’ve also reached a point where I can work through my formal standard shoulder warm-up series, although my left side is a bit limited in movement. But it gets more and more fluid every day.
Workouts
I’ve kept my training to 3 days/week for the last few months, in part because I’m limited in what I can do, but more because my work schedule hasn’t allowed more than that anyway. The most recent several weeks have looked something like this:
Day 1
Squat
Lunge
Pressing Strength
Pulling Strength
Day 2
Squat
Drop to Split
Snatch Pull
Day 3
Squat
Good Morning
Clean Pull
Shoulder Strength
Arm/Forearm Strength
Lunges are something I just have to force myself to do because I have pretty poor unilateral strength, which bites me in the ass with heavy jerks. Drop to split also helps me train that strength and footwork precision and speed (and confidence) while I’m unable to do jerks.
I do back and ab work daily, such as weighted back extensions, unweighted back extensions and glute-ham raises, along with one heavy ab exercise (like weighted sit-ups or incline sit-ups) and one light ab exercise (like crunches, reverse crunches or planks). The pressing and pulling strength work consists of things like some kind of bench press variation and row variation first, and then a lighter, higher-rep exercise like push-ups and DB rows.
Shoulder strength work is pretty limited, so it’s usually more push-ups, close-grip bench, and DB front raises, then tricep and bicep work, and some kind of forearm/grip work. After the injury I lost a lot of weight along with strength, so I’m doing a lot of more of this beach work than usual to try to gain some of that weight back. I’m still about 5kg light.
Mobility
I try to do the full set of stretches a minimum of once daily. Initially, I was doing it 2-3 times each day. On a good day now, I’ll get it in twice. This includes rolling the underarm area with a softball, which is unpleasant to say the least, and then a series of stretches including:
- Hanging from the pull-up bar both pronated and supinated, usually with my feet still supporting some of my weight
- Sleeper stretch for internal rotation
- Apley for internal rotation (I get my hand behind my back, then grab a power rack and pull it farther across and squat a bit to move it higher)
- Lying on a foam roller (parallel with spine) and doing flexion with a PVC pipe from wide to narrow grip
I usually throw in a few more that may vary a bit day to day depending on how I’m feeling or what I remember to do. Hanging from the pull-up bar seems to be the most effective at this point, although that was totally inaccessible prior to maybe a month ago.
Strength
I think that the more strengthening I did, the faster my mobility improved. Of course, it took a lot of work and time to get to a point where I could really do much strengthening. For a long time, it was limited to very short range Theraband stuff, which is as boring as it is frustrating, and things like lying external rotations with small plates. Once I was able to do push-ups, I feel like it started improving more quickly.
I now do a series of band exercises each day that are pretty standard shoulder/scapular stability movements like internal and external rotation, shoulder extension with scapular retraction and depression, 30-degree abduction (to strengthen my repaired supraspinatus), rows, standing Ys (which are pretty awkward when one arm doesn’t do what the other does), and scapular protraction. Abduction is still probably the weakest movement for me.
Future Plans
My progress has reached a point at which I’m more confident I’ll be able to actually snatch and clean & jerk again with significant weights. The surgeon told me in my last follow-up that he estimates my risk of reinjury to be only 5-6% greater than before the injury… which is basically zero considering that’s probably about how much higher my risk would be just turning 36 as I did today.
I don’t know what exactly I’m going to do yet long term with regard to training and competition. For the last few months, I’ve been fairly resigned to not really lifting, but once I did a few snatches, I started getting that urge again. If life allows it (and by life, I mean coaching and work), I’d like to compete in at least one more senior national championships to make a complete comeback—and ideally snatch more than the weight I blew out my shoulder with (142kg). I have about 15 months until that nationals, and about 13 months until I’d need to make a qualifying total (probably right around 300kg). I think it’s doable, but it will largely depend on my obligations outside of training, which are large and many.
Good luck with your continued recovery and future plans!
Giovanni