2nd Shoulder Subluxation in 6 Years. What Now?

Bigger Stronger Leaner Injuries and Rehab
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Hi guys,

Feeling pretty down at the moment and hoping to get some advice from you other lifting addicts out there. I subluxed my left shoulder in mid-2014 while doing dumbbell shoulder presses; it popped back in after a few seconds but I ended up with a Bankart tear and Hill-Sachs lesion, plus some bone spurs. Although I was advised to go the surgery route, I didn’t want to take six months off, plus I must admit I’m terrified of the pain having heard many horror stories about it. So I went to a great sports physio, did rehab religiously for a year, and got back in the gym cautiously. I have been babying my shoulders - basically laid off all shoulder work for 5 years, only did floor presses (both DB and BB), avoided DB flyes, etc.

Fast-forward to 2020 and I’m in better shape than ever before - been hitting regular PRs for my squat, DL, floor press etc; can run a 6k in under 30 minutes; lift thrice a week and do cardio/HIIT the other four days; even managing to do some shoulder work with the landmine attachment. I thought the labral tear was a thing of the past, and arrogantly thought I could stop with the rotator cuff exercises and leave my theraband to rot. And then, go figure, I sublux my shoulder again doing of all things - a f**king ab roller! Failed to control while rolling out and my left shoulder pops right out. Really bad this time. Passed out from the pain, my wife called an ambulance and when I get to the ER the doctor manages to pop it back in (probably just under an hour after the incident).

I’m still not keen on surgery if I can at all avoid it. Given I was able to rehab successfully with just regular physio last time, and actually became way stronger, I am hopeful I can do the same this time. But I’ve been reading up and it’s all very discouraging, since it seems like after a second subluxation the chances of repeat incidents go sky-high (although from what I can tell, none of the other victims have gone as long as six years without a repeat incident - most people seem to suffer a second subluxation or dislocation within a year). I have an MRI scheduled later this week, and I’ve made an appointment with the same physio who helped me out last time for the following week as I’m still experiencing some soreness issues and want to let the shoulder rest a bit before going into rehab exercises. The good thing is I have ROM - I can lift my arm all the way overhead if I move slowly, but it does hurt from certain angles and internal/external rotation does cause a pretty sharp deep pain.

Any ideas on what I can do in the meantime? I’m definitely not going to be an idiot about this and jump right back into it - gonna take at least 4-6 weeks off the left upper body. I’m thinking about doing legs twice a week, core twice a week and some cardio (either outdoor slow jogs or incline walking on a treadmill). I also have been reading up on cross-education and am considering working out only the right upper body with single-arm dumbbell rows and floor presses, just in case it helps me keep some muscle on the left side too.

In particular, advice on what leg/core exercises would be suitable (i.e. unlikely to put any pressure on my shoulders joint) would be fantastic. I probably shouldn’t pick up anything heavy for a bit in case the shoulder falls out again, so I’m thinking hack squats, leg presses, cable pull-throughs and standing leg curls for lower body; and maybe crunches (hands on chest, not by the ears), cable reverse crunches and flutter kicks for the core. I also need ideas for what I can do cardio wise - anyone know any footwork drills or other HIIT movements I can do? Things like push-ups, mountain climbers and jumping jacks are obviously out of the question for the time being, and I’m not sure what other options I have. I put on weight really easily so I’m very worried about getting fat.

Thanks guys for reading this long-ass post. It just sucks because I thought I had this beat, and my over-confidence has led me to throw five years of hard work down the drain.

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For your first week or two, isometric pushes for your shoulder are ideal. Find a position your feel comfy in (0-90 degrees of flexion, whatever range of rotation is tolerable) and do isometric flexion/extension, adduction/abduction and internal/external rotation against manual resistance or an immovable object. Durations up to 30-45s, intensity as limited by pain.

After a week or two, return to training the shoulder, as limited by pain. Limit your trainable shoulder rom to 0-90 degrees of flexion. Floor presses are still in, just choose a load that’s tolerable and build up again. Don’t get weaker, as that will predispose to reinjury. I’m talking sets of 25 floor presses with the pink dumbbells if needed. Just load to what your current pain level can handle.

Same goes for rowing, do things like single-arm cable rows as light as you need to not be in significant pain, but don’t stop loading.

Yep, do that

Machines are your friend. Hack squats and leg presses are in, as are leg curls to train your hamstrings. I would prioritise seated leg curls, if possible, over standing.

Footwork drills are not HIIT movements. Which one do you want to do?

For HIIT:

  • bike is your friend
  • sprints on a treadmill that’s turned off (so it’s like a prowler push)
  • sled drags if possible
  • Hill sprints if tolerable, just hug yourself (arms wrapped around your body). That should Delgado shoulders and it’s a useful upper/lower body dissociation drill anyways

For footwork drills your ladders and stuff are fine, but again just hug yourself until your shoulder can handle it. You can also do things like Multi-directional hopping, bounding and jumping

Then don’t. Cardio won’t stop you getting fat. Food choices will.

You haven’t thrown anything down the drain mate. Unless you get surgery, you’re looking at a 5-8 week turnaround which is peanuts. In future, you might just need to make better exercise choices (maybe lay off ab wheels, for example), but with correct rehab you could be back training hard and after 2 months

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I would highly encourage you to get the surgery. I had 9-10 subluxations around 2003, just kept coming out after rounds of PT. A bankart repair did the trick for a long time. 2017 had a full dislocation though. My shoulder is stable now, but my rotary cuff gets irritated a lot because it’s working its ass off to keep it all together. I really wish I would have listened to the doc that recommended a latarjet repair in 2017 vs the one that thought it was overkill. The recovery is long, but not as bad as repeat events, which become more likely with each recurrence.

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This is not accurate. I’ve had 3 RC surgeries to date. Its not fun but its also not a death sentence in the gym either. With the right Doc, pain is not too bad. A “nerve block” is a must and it will let you get ahead of the pain post surgery. Pain is usually the worst the day after surgery and reduces pretty quickly.

You are immobilized for 6 weeks in a brace but that is also manageable since a good PT will start doing passive movements on you within 2 weeks of surgery. After the brace comes off, movement comes very slowly but, again, a good PT is your savior. I told my PT I wanted to get back to my gym levels and he took me there. Its a lot of hard work but its worth it.

You can still go to the gym with your brace. I did legs and one-armed exercises.

If you can get it, I injected BPC-157 post surgery and I was already on a daily regimen of HGH, all which helped me heal tremendously. My surgeon also injected stem cells during surgery.

Get it fixed brother. Its not going to fix itself.

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Thanks everyone for the very helpful advice! Just saw the orthopedic doctor and did my MRI (report will be out on Friday).

Doc said he’s 90% certain the original Bankart tear has healed itself - I questioned this as my understanding was that labral tears never heal by themselves, but he said he has seen it before and it’s unlikely I would’ve gone 6 years without a repeat sublux if the tear hadn’t healed (keeping in mind my heavy lifting). So he thinks it’s likely a new tear rather than the old one getting bigger, and sees no reason why it can’t respond to conservative treatment like last time - subject of course to what shows up on the MRI. Fingers crossed any tear isn’t too huge! I’m not 100% opposed to surgery (especially given the feedback you guys have provided) but given my positive experience with the PT route last time, my inclination is definitely to try PT first and then consider surgery if another incident occurs, if that’s the medical advice. Doc has my left shoulder in a sling for now to minimise aggravation of the tear and hasn’t okayed me to do any weight training yet.

Pain is generally a lot better now, although I had some weird muscle spasms when I woke up this morning (could literally see the muscle twitching - not sure what that was about!). Been doing some very slow jogging and walking 3-4 km a day, with my left hand over my heart to stabilise the elbow, just to keep active.

Anyone have any thoughts on whether I should significantly cut down on my caloric intake? I’m around 2700 cals maintenance normally, but have read conflicting reports on whether to cut down (to minimise fat gain) or stay around maintenance (to keep muscle and also fuel recovery for my injury).

Would also appreciate info on unilateral training. I’m not too sure if I should be doing the same weight /volume for the good arm, or should scale back to avoid a potentially huge hypertrophy imbalance that will make me look like an idiot.

Cheers, and thanks for all the advice again - it means a lot to me.

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I dislocated my left shoulder at least 10 times, went to the hospital 3 times because I couldn’t pop it back in. Never got surgery because I heard it can make it worse, and I met a guy who got the surgery and he was more fucked than ever several years later. Maybe it depends on the actual issue, I never had any MRIs or anything to diagnose the situation (this was over 15 years ago) but I just did a lot of shoulder rehab stuff, rows and chin ups, and what pressing I could do. I trained on and off and only started training seriously a few years ago, now I bench over 400 and my shoulder is fine.

If it subluxed using an ab wheel your rotator cuff muscles must be really week.

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No. Aim to keep your bodyweight relatively stable, but be tolerant to a little bit of loss.

At the very least, do not let the strength of your unaffected side get worse. You can decide whether or not that means you’re happy to let your unaffected side become significantly stronger during your recovery, but at the very least, do not let it get worse. Pick a few indicator exercises - I would use single-arm pulldown, single-arm cable row, single-arm DB bench and single-arm landmine press - and measure your 6-10RM and/or rep max at a given weight. Make sure these indicators aren’t getting worse over your rehab period

Bang on. Training is the best form of rehab and prehab.

Also probably not properly bracing/tensioning with the lats.

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OP’s not talking about a rotator cuff repair. He’s talking about an anterior stabilisation surgery which is significantly more invasive and destrutive, and has a much longer rehabilitation requirement.

Does have a higher success rate than RC repair though

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According to this

Reduced calories seem like a mistake indeed

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They still put you under, they still do the repair, they still isolate your shoulder, they still send you to rehab. What about any of that can the OP not find useful?

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The labrum is basically an o-ring on a shallow dish. It’s funny you mention the dr thinking it can reattach, I had one who said there was absolutely no chance of that, and the other thought it could possibly scar up and reattach. If you’re on the fence be sure to get a second opinion, either route try to get a well regarded sports oriented doc, there definitely seem to be some that are just in business to put old people back together temporarily.

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It’s not that it wasn’t useful just a different context.

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Please update!

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It sounds like the second subluxation was actually a dislocation I had this problem ( 5 dislocations from age 8-25. I was able to manage the problem in the gym but after the last dislocation I decided to get my shoulder repaired, done with the scope and 19 yrs later I have not had an issue at all and am so glad I had mine repaire. good luck to you

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This is a great follow on to the other concurrent discussion on shoulders in the injury forum: Shoulder Pain With All Chest Exercises and DB Shrugs, but Not with OHP - #43 by Dr_Grove_Higgins

The problem with repeated/chronic dislocations is that the shoulder capsule becomes torn and loose, along with joint surface, muscle, and tendon damage. The big issue here is the loss of structure and structural instability. If the system does not “tighten up” with the initial and repetitive injury-induced inflammation, it won’t happen quickly or at all. Without the ligaments being tight, providing passive stability, the muscles have to work overtime to do the work. Eventually, the muscles suffer from repetitive motion/cumulative trauma and will fail to stabilize the shoulder.

This is where surgery becomes the last resort option.

However, I encourage you to look at PRP/BMAC therapy also. It’s expensive, but I have seen great results… with the correct doc diagnosing and doing the procedure. Here is a link to resources specific to that: Read this if you want to understand orthopedics of the shoulder from a layman’s point of view: Download Your Copy of Shoulder 2.0 - Centeno-Schultz Clinic

They are the only people I trust for this work in the USA.