February 6, 2022

Becoming the Wolverine (Shoulder Rehab)

Please note: this is an article for general shoulder health and pre/rehabilitation. It’s important to diagnose your shoulder problem first, and assistance from an expert is often the best way to go. With sensitive overuse/imbalance injuries, such as impingement where inflammation is high, some exercises could cause more irritation and make things worse. So step one: diagnose.

Having said that, I am also a great believer in Kelly Starrett’s (The Supple Leopard ) popular statement that “All human beings should be able to perform basic maintenance on themselves.” This means that whilst a professional might be the way to go in specific cases, there really are basic things that you can do yourself on a day-to-day basis to both prevent and cure injury. You just need to learn them, and put them into practice.

**Injury: Prehabilitation and Rehabilitation**

“If you move, you get hurt. If you don’t move… you get hurt.”

Injury happens. Whether it’s trauma, overuse, genetic or imbalance related, during play, during training or when not training, at some point over the remaining course of your life you will get injured. A couple old maxim’s to put us in the ‘prehabilitation’ mid-set:

“Fail to prepare, prepare to fail”… “Prevention is the best cure”… “Prior preparation prevents piss poor performance”… “There is no bad movement…only lack of preparation…”

Prehabilitation is anything you do not only to help prevent yourself from getting injured, but also to reduce the extent of injury when shit happens. If you are involved in any type of physical training and are not including some type of prehabilitation work of around 15-30mins at the beginning and/or end of your workout, don’t be surprised when shit DOES happen. Because it will – and you will only have yourself to blame. Lesson learnt.

Rehabilitation is work performed on areas you are currently suffering from with injury or areas that are beginning to feel overused, perhaps showing some early symptoms of tendonitis with some inflammation (think developing shoulder impingement).

Here’s the thing: if you do not have specific protocols in place to deal with both rehabilitation and prehabilitation, when something happens you will feel absolutely lost. You will get depressed. Your injury will affect not only your training, but your personal life. You will give all the hours you didn’t spend focusing on prehabilitation, just to know how to begin treating your injury. This is all caused by one thing: a lack of knowledge. So here’s step one: educate yourself. If you train regularly and have no idea about basic rehabilitation and prehabilitation protocols – educate yourself. If you spend more time researching the best bench press and squat technique than how to develop a healthy rotator cuff and mobile hip complex, see how well those techniques works when suprasprinatus or your ACL decide to give you a hard time.

Shoulder Injury: What and Why

“Whilst the hips crave intensity, the shoulders crave complexity.”

The shoulder joint is the most complex in our body, designed to allow us near full-range of motion in a 360 degree space (before we start reducing that with repetitive, mid-range movements in training environments and our every day lives). So how is the shoulder so attuned to movement complexity? Just take a look at it – only around 1/3rd of it sits in a shallow socket – the rest just kind of hangs out, almost taped on with the assistance of tendons and the surrounding musculature. However, whilst this affords us great movement complexity, it also increases the risk of injury drastically.

Whilst trauma (i.e. and accident) can really mess up a shoulder in unexpected ways, developmental shoulder problems can be prevented, although ongoing and often tricky business. Developmental shoulder problems commonly occur due to imbalances in the surrounding musculature of the shoulder and poor scapulae development, most notably with retraction (i.e. pulling the shoulder blades back until they ‘pinch’ together whilst keeping the shoulders depressed). A couple of key causes are consistent pushing exercises (such and bench press/overhead press) without an equal amount of focus on strengthening the opposite retractors, as well as lifestyle choices (such as constant sitting) which, again, reduces scapula functionality and the ’rounded back’ syndrome. I’ve trained layman and athletes who have both had a complete inability to pull their shoulder blades right back until they ‘pinch’ without compensating with elevation. The verdict? It is a matter of motor-unit recruitment, not strength. So it doesn’t matter if you’re a desk jockey or a crossfit nut – you can both develop the same problem and here’s a nice video with some insight into that.

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Basic Shoulder Pre/Rehabilitation Protocols

First-Step Protocol: Massage

What’s your automatic reaction when something muscular doesn’t feel quite right? You rub it. I believe that massage is an integral first-step protocol when it comes to shoulder injury, and much of this can be done by yourself for the basic fact that you can reach your own shoulder. It just takes a little know-how and common sense. Some brief benefits of massage: breaking-up scar tissue, mobilizing affected muscles, restoring functionality, promoting blood flow for quicker healing.

I’m not going to do into detail with massage – I’m not a massage therapist. But here’s some things that worked for me and some follow-up information. Oftentimes I massage after a hot shower and use some kind of hot/cold gel/cream to facilitate the process:

Cross-friction massage (i.e. across the muscles fibres), performed more at the origins/insertions of specific tendons. For shoulders, we can focus this toward the suprasprinatus – here’s a video about how to locate it.)
Soft-tissue massage along the entire muscle belly of the offending area.
Self trigger-point massage.
Tennis/lacross/’black-ball’ massage – I find this most effective for releasing trigger points around the scapula. Here, Kelly Starrett shows how this can be done on the ground – the band stretch is useful too. I personally prefer ball-massage against a wall as it’s much easier to change the amount of pressure and also the position.
Not too much/too little – as in the above article, on a scale of 1 to 10 (1 being painless and 10 being intolerable) aim for a 4-7.
Work massage regularly throughout the day. In early cases of injury, I generally aim to build up 30 minutes worth throughout the day.

As a note – injury often comes with muscle spasming, often causing more discomfort than the injury itself. I have found regular trigger-point massage to be the most effective method for reliving these spasms when performed a couple of times a day. Keep a ball handy for this purpose.

Second step to Final step protocol: MOVEMENT.

This is a video of my own 4-week recovery from shoulder injury. It’s still ongoing, however I owe the swift progress of my early stages of recovery to the Ido Portal method. The basic idea? Pure rest rarely cures muscular injuries – if anything, it often makes them worse. Take the basic example of a broke arm in a cast for 6 weeks – how does it look, smell, feel afterward? Like a degenerated piece of shit. That’s what ‘rest’ will buy you. Your chosen movement, however, needs to be specific and calculated. This is what the Ido Portal method provides.

A couple of notes/credits…

Ido Portal – A proponent of ‘movement training’, a discipline whose goal it is to develop the human body by increasing movement complexity. This requires a generalist style of training which is innately interdisciplinary. http://www.idoportal.com/watch
The Ido Portal Method – Specific methodologies developed by Ido and taught by the Ido Portal team through international workshops as well as a wealth of online material. On a micro-level, this can detail step-by-step processes to develop specific physical abilities, such as a muscle-up or a backbridge rotation, as well as sequences of movements with the goal of developing effective and efficient movement patterns. On a more macro scale, the ‘Ido Portal Method’ gives insight into his personal philosophy when considering the elusive heading of ‘movement’ and how we can develop our movement repertoire by following a three-step process of ‘isolation -> integration -> improvisation’, as well as how to reconcile ‘movement’ with our sedentary culture.

Here’s the bread and butter of what I used/am using. I will not go into the benefits of passive/active hanging, the importance of a functional scapula, the ability to build motor control and express your full range of motion… this are all details you will learn if you research the concepts outlined in these video further. I’ll just tell you I did this stuff pretty much every day and still do:

Passive hanging and active hanging: Shown to improve/cure many shoulder issues, even in the face of surgery. Based on the concept that connective tissue in the shoulder is best developed through traction forces (i.e. the shoulder pulling away from you). Generally, the active hang is a progression of the passive hang. If you experience shoulder pain in the passive hang, however, start with the active and progress to the passive.
Shoulder/scapula rotations: this can be done anywhere at any time. The goal is to work your way into new ranges of motion and promote blood flow in order to quicken the healing process – it will also help you build neurological pathways giving you more access to your end ranges. I took this idea from John Sapino’s recovery from a complete pec tear, without surgery – a must watch for injury-recovery inspiration.
Ido’s Basic Shoulder ROM & Stability Routine: whilst I added a few things to this (a couple extra rotator-cuff movements and also performing the routine facing the wall to help strengthen the posterior muscles, this is the bare-bone routine. Take it easy with this one in the early stages of injury and don’t over-work the range of motion. For pre/rehab purposes, I perform this at least once per day, often twice (before and after workout).
Ido’s Scapula Mobilization Routine: as with the above, I perform this at least once per day, sometimes twice. The band assists you in accessing your end ranges of motion, and by using strength in those end-ranges you build neurological pathways i.e. mobility.

** I can’t stress enough that none of these exercises should cause pain. Discomfort, perhaps, but definitely not pain. If you are feeling pain, that’s a basic sign that either you’re pushing it too hard, your shoulder isn’t ready for it yet, or it’s not the best movement for your specific shoulder injury. Perhaps all 3 at the same time. Use your awareness and start things easy. If you’re sweating out and making weird faces/grunting noises with the resistance bands, you need to chill the f*** out and remember that this is REHAB work, not maximal strength development or hypertrophy.

Following a routine: Frequency and Consistency

To be honest… that’s basically everything. The key? Consistency. Don’t massage yourself a couple of times, do the routines once or twice and then stop because you haven’t noticed anything. This is stuff that you will have to keep ongoing… well… forever. Just in larger and smaller doses as of when you need them. These routines also become prehabilitation, after recovering from rehabilitation. In fact, my pre/rehabilitation routines look pretty similar – the only difference is more massage with rehab and some more specialist exercises specific to the injury. So here’s a run down of what daily rehab/prehab looks like:

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AM: Hot shower, keep shower head on affected shoulder for a few minutes
Followed by: 5-15 minutes massage on the shoulder
Followed by: 5 -15 minutes shoulder/scapulae rotations
During the day:
- 5-15 minutes massage on the shoulder
- 5 -15 minutes shoulder/scapulae rotations
- Passive hanging – 3 sets for time

Prehabilitation (performed before training – also good for a warm-up)
- 5-10 minutes shoulder/scapulae rotations
- Passive hanging – 3 sets for time
- Active hanging – 3 sets, 5-10 reps, 3 second isometric hold at the top
- Scapula Mobilization OR Shoulder ROM routine (perform once).

Rehabilitation (performed after training)
- Passive hanging – 3 sets for time
- Scapula Mobilization OR Shoulder ROM routine (choose the one you didn’t do before – perform once).
- 5-10 minutes shoulder/scapulae rotations
- Any other injury-specific rehabilitation work.

PM: Hot shower, keep shower head on affected shoulder for a few minutes
Followed by: 5-15 minutes massage on the shoulder
Followed by: 5 -15 minutes shoulder/scapulae rotations

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So, yes, all of this could add anywhere between 30-60 minutes to your existing workout, plus the extra time throughout the day. But guess what – you have a shoulder injury and you have to deal with it. That means dedicated time and spending every waking moment with recovery on your mind. Haven’t done rotations for a few hours? That’s all time your shoulder is retreating back into limited range of motion. Move it.