Written on March 4, 2017 at 10:25 am, by Eric Cressey
I've got a wonky shoulder. Actually, the term "wonky" probably doesn't do it justice. As of a MRI in 2014, here's what I've got:
"There is a high-grade partial thickness articular surface tear of the posterior fibers of the supraspinatus that measures 15 mm AP x 15 mm RL. The undersurface tendon fibers are delaminated and retracted 15
mm.
"There is a high-grade partial-thickness cartilage defect over the posterior medial aspect of the humeral head
(near the posterior-superior labrum) with cartilage flap formation that measures 8 mm SI x 5 mm AP."
That was about three years ago, and it may be worse now. The truth is that it started with internal impingement during my high school tennis career, and gradually progressed over the years. In comparing the 2014 MRI to one I'd had in 2003, you see that the damage has progressed (as expected), but the symptoms have actually gotten substantially better.
My (occasional) pain is your gain, though. You see, the symptoms (or lack thereof) can actually teach us a lot about how we view contraindicating exercises.
I can bench press as heavy as I want with zero issues. Pull-ups, rows, pullovers, overhead carries, landmine presses, Turkish get-ups are all completely asymptomatic. They're in my safe exercise repertoire.
And, as long as I don't go crazy with volume or intensity, I can throw a baseball just fine. I long-tossed out well over 200 feet with my pro guys consistently this offseason and it wasn't a problem.
Overhead pressing is weird for me, though. If I tried to push press 135 pounds, my shoulder would hate me for the next 6-8 weeks. Interestingly, though, if I keep the weight lighter, stick to dumbbells in the scapular plane, control the tempo, focus on perfect technique, and don't go crazy with volume, overhead pressing actually makes my shoulder feel better. I'll work it in as an assistance exercise every other month.
Interestingly, though, back squatting is what destroys my shoulder the most. This is consistent with an internal impingement diagnosis, but doesn't make a whole lot of sense when you consider that I can throw pain-free. Even if I just try to put a 45-pound barbell on my shoulders, it lights my shoulder up in a very bad way.
This weird collection of symptoms can actually teach us three really big lessons, though.
1. Everyone's symptoms and provocative patterns are completely different. Two people might have a very similar medical diagnosis, but dramatically different safe exercise repertoires.
2. Too often, we contraindicate simply contraindicate exercises. In reality, we should be looking much broader, considering factors such as absolute loading, tempo, volume, and exercise technique.
3. An individual's "safe" exercise repertoire may evolve over time due to changes in movement quality, tissue quality, recovery capacity, and structural integrity. Our programming needs to evolve to accommodate those changes, too.
Certainly, some exercises are inherently bad and not worth the risk, but it's important to evaluate each individual and situation individually to make the determinations on all those "middle of the road" exercises that deliver great training effects and make strength and conditioning fun.
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Thanks for this thoughtful piece. It’s all SO personal. You have to know yourself and what works for you… and what doesn’t. I wrote you last year about my own large, full-thickness rotator cuff tear seeking guidance regarding a surgical repair. I cancelled the surgery and have done months of recovery. I can play full-steam tennis, with serving, and yet… I would never throw a baseball. And overhead presses are not my friend. But I’m so glad I didn’t have surgery.
March 4th, 2017 at 11:18 am
Can you offer a few examples of inherently bad exercises?
March 4th, 2017 at 12:10 pm
Would you have surgery to fix your shoulder if somehow your life and business obligations would not suffer post-surgery ?
March 4th, 2017 at 12:54 pm
Very well put Eric! Thank you!
I’m dealing with a sad shoulder right now and I couldn’t agree more.
Lift Life!
March 4th, 2017 at 3:45 pm
Thanks for this thoughtful piece. It’s all SO personal. You have to know yourself and what works for you… and what doesn’t. I wrote you last year about my own large, full-thickness rotator cuff tear seeking guidance regarding a surgical repair. I cancelled the surgery and have done months of recovery. I can play full-steam tennis, with serving, and yet… I would never throw a baseball. And overhead presses are not my friend. But I’m so glad I didn’t have surgery.
March 4th, 2017 at 3:59 pm
Eric – do you use a safety squat bar? It would seem to be custom made for you!
March 6th, 2017 at 7:28 am
Eric, your story is a great example of my dictum: “You don’t treat the x-ray (or, in this case, the MRI). you treat the patient.”
March 11th, 2017 at 8:22 am
All the time! It’s been huge for me.
March 11th, 2017 at 8:23 am
Alex – I’m sure I will need to have it at some point!
March 11th, 2017 at 8:23 am
Andras – how about a behind the neck pulldown? Zero added benefit.