The reason you’re having pain here is that the supraspinatus is being mechanically impinged beneath the acromion process of your scapula at terminal extension. This happens because the external rotators (depress the humerus) aren’t strong enough, your internal rotators are tight, and/or you have a structural abnormality that is predisposing you to the injury. I highly doubt that your supraspinatus is weak. In fact, it’s probably overworked and just pissed off at you!
A comprehensive preventative program would include:
Appropriate balance between horizontal pushing and pulling.
General balance between vertical pushing and pulling exercises. This is a trickier one, as the involved musculature is a little more complex. Suffice it to say that you don’t want your upper traps to be too strong for your lats.
Daily stretching for a ton of muscles, largely to correct poor posture and inattentiveness to #1 and #2.
Dynamic stabilization and muscular endurance training for the external rotators and scapular rotators.
Rest! The shoulder is the most overworked joint in the body!
Keep an eye out; I might put together an article on this in the near future.
Oh yeah, I forgot #6: extra training for the scapular retractors to correct pre-existing imbalances (see #1).
If I was you, I’d lay off overhead pressing for a while. Opt for decline presses for a bit, too. Focus on stretching and strengthening the aforementioned muscles, do some extra lower body and core work in the meantime, and ice that SOB. If you can, get some ART and/or ultrasound, too.
As for your friend, it’s tough to say, as internet diagnoses are virtually impossible. Ideally, he’d get an MRI with dye injection to determine if a labral injury is present. In my case, I’ve got some reactive changes in the acromion process of my scapula due to years of tennis (and on and off impingement). My ortho is going to fix that arthroscopically in December. You can actually palpate the abnormality on my shoulder. He might have something similar; that’s why x-rays and MRIs are good things to have.
rest the shoulder joint (sould I do rows, pull ups (pull ups hurt as well) and cleans? should I rest before starting cuff work? stretch the internal rotators. how long should I rest?
work on retracrors(rhomboids/lower traps), external rotators (with your program), scapular rotators (lats?)
at what stage should I return to pudhing exercise? flat bench press does not cause me any pain whatsoever, although I dont mind not benching for a while.
on a side note, I read a good article about shoulder bursitis which claimed it can also be caused by cuff rotator hypertrophy resulting in impingements since they “dont have room to grow to”. how do I avoid that?
rest the shoulder joint (sould I do rows, pull ups (pull ups hurt as well) and cleans? should I rest before starting cuff work? stretch the internal rotators. how long should I rest?
NO PULLUPS. GO RIGHT INTO THE CUFF WORK.
work on retracrors(rhomboids/lower traps), external rotators (with your program), scapular rotators (lats?)
THE LATS AREN’T SCAPULAR ROTATORS. MY PROGRAM IS A PREHABILITATION PROGRAM; YOU NEED A REHABILITATION PROGRAM. STICK WITH LOW PULLEY EXTERNAL ROTATIONS, SIDE LYING EXTERNAL ROTATIONS, AND SINGLE ARM EXTERNAL ROTATIONS WITH THE ELBOW SUPPORTED AT 90-DEGREES IF THEY DON’T CAUSE PAIN. SEATED ROWS AND PRONE LOWER TRAP RAISES SHOULD BE MAINSTAYS.
at what stage should I return to pudhing exercise? flat bench press does not cause me any pain whatsoever, although I dont mind not benching for a while.
THERE’S NO REALY TIMETABLE FOR THIS. FIX THE PROBLEM, AND YOU’LL KNOW.
on a side note, I read a good article about shoulder bursitis which claimed it can also be caused by cuff rotator hypertrophy resulting in impingements since they “dont have room to grow to”. how do I avoid that?
YOU’RE BETTER OFF AVOIDING BAD LITERATURE, AS THAT STATEMENT HAS NO SCIENTIFIC BACKING. TENDONS DO NOT HYPERTROPHY TO THE SAME DEGREE THAT MUSCLE BELLIES DO; IT WON’T BE A PROBLEM. EVERY PT IN THE WORLD USES MUSCULAR ENDURANCE AND HYPERTROPHY-RELATED REP RANGES IN THEIR PROGRAMS; RESULTS REINFORCE PRACTICE, SO DON’T SWEAT IT.
THAT LAST RESPONSE WAS DISSAPOINTING. IF YOU WANT TO ACHIEVE SOMETHING IN THIS FIELD DONT DITCH ANYTHING BEFORE YOU READ IT. THAT STUPID, AND ALSO ASSUMING I CAN’T DISTINCT IS. THE FACTED THAT I ASKED FOR YOUR OPINION DOESNT MEAN YOU KNOW MORE THEN ME OR KNOW EVERYTHING.
I just typed out a ton of information for you that I’ve worked my ass off to attain. Meanwhile, I have four exams and two papers due this week and next. If you were a client, I’d charge you for it. You ignored that and sought out something on which you could give me a hard time.
All that aside, let’s see the citation for this article. Specifically, in what PEER REVIEWED publication did it appear?
although you gave me some good advice here, you sound a little lecturing/full of yourself. don’t give me shit about helping people cause I do that alot, to. but I was trying to disscuss things with you and you where suddenly dissmiss what I worked my ass of on. I invest in my replies as well.
regarding the article: it was puvlished in muscular devlopment in the year 1999. when I’ll be home I’ll get you the exact reference.
You distinctly asked for advice. You asked, that is, put it in question form to a person you obviously felt knew more than you in that particular area.
Then you dis him.
Do you think that, by doing so, you’re going to continue to get objective, informative, quality, and free information?
I suggest going to your doctor, who’ll be happy to charge you lots of money while you sit and critize and contradict him.
Memo to Eric: Some of us out here actually benefited from your knowledge. Thanks.
Ryno-Gotcha. I saw weightlifting highlighted. I just hate when people call bodybuilders “weightlifters”, or lump everyone together. hehe, I’m just touchy…
the article is called “subacromial bursa: Understanding and preventing shoulder pain” By steven Alaway, PHD, FASCM. published on muscular development, july 1999
and I quote:
“Allthough large muscles are necessary to ward off shoulder injuries, there is also a downside to large muscles that have to live in a small area. For example, A thickly muscled person who has developed wide and thick shoulder muscles(especialy the supraspinatus) has not simoultaneously increased the small space under the acromion, in which the supraspinatus muscle and its tendon must slide in order to act at the shoulder joint.
Thus, there is a greater risk for impingement types of injuries simply because the bones do not grow a wider space to accomodate the larger muscle. The subacromial bursa gets squashed more then they would in a scrawny muscle, even if the movements of the shoulder joint are relatively small.”
fuck, I dont want to fight. I got very upset wat what you said. now I’m cool. I just don’t want you to diss stuuf that I say so quickly.
check this out and tell me if it’s “bad literature”
Yes, tendons can hypertrophy; it’s one way that they get stronger. However, no one will deny that they are not capable of the same degree of hypertrophy as the muscles to which they are attached.
In this scenario, the involved tendons are usually not hypertrophying extensively due to direct training. There are a ton of factors that contribute to each of several types of impingement. You can have hypertrophy/reactive changes in the subacromial bursa, coracoacromial ligament, and acromion process (the shape of which also plays a crucial role in causation). In reality, what’s occurring with the supraspinatus tendon (and tendon of the long head of the biceps) is compensatory. Take away a tendon’s space to move, and it’ll get irritated. Then, it gets pissed off and hypertrophies to prevent future problems.
IMO, tendons are never the primary cause; they hypertrophy due to the pre-existing factors and chronic overuse to which they are subjected in the presence of an imbalance. Otherwise, why would noticeable atrophy of the supraspinatus and infraspinatus muscles be symptoms of Stage 3 impingement? The fact of the matter is that they grow because they’re irritated temporarily (tendonitis); eventually, this condition leads to weakness. On the other hand, consider hypertrophy of your quad or any other muscle; does it get weak after you bulk it up? Nope. The reason? It hypertrophied for the RIGHT reason in the first place.
Granted, the subacromial space is tiny. However, let’s not forget that these are small muscles with poor blood supplies, too; they can grow, but not as big as you might think. Besides, the hypertrophy is occurring predominantly at the muscle belly and not the tendon. The author is wrong in stating that the muscle itself will get impinged; the gaster (muslce belly) never passes through the subacromial space. It’s all tendon.
So, I suppose it’s one of those “which came first; the chicken or the egg?” questions. I just want to point out that hypertrophy occurs for several reasons; I’m yet to come across an instance when an MRI technician shouts out, “Jesus; his tendon is WAY too big for those bones!”
Hopefully, this came out somewhat clearly, as I’m in a hurry.
Also, I’m not here for confrontations, but I should point out that it isn’t right to quote someone if you’re going to retype it with spelling errors.
That link simply reinforces what I just typed. Nowhere does it say that training the rotator cuff leads to impingement-causing hypertrophy. The swelling/irritation comes after the fact (e.g. other causes).