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Rehabbing with a purpose


Injuries suck. There’s no doubt about that. As a lifter, injuries are a nightmare that you wouldn’t wish upon your worst enemy. The immediate feelings of helplessness and despair are natural, but it’s how you proceed from this point that will determine your success. You can stretch, foam roll, mobilize, and see your chiro as many times as humanly possible, but ultimately if you’re pushing your limits frequently, they’re inevitable.

When I was roughly 16 years old, I was dirt jumping in a trail system near my house. Being young and dumb, I took a bad landing and had to bail on my bike from about 13 feet in the air. I landed straight on top of a stump, dislocating my shoulder and shearing my right scapula in half (this is a feat on its own). At the time, the doctors did no imaging beyond an x-ray to determine whether or not there was severe muscular damage. As the years progressed, I could tell that there was something visibly and internally wrong. My shoulders didn’t hang properly, my clavicle was uneven, and in the weight room, I could feel severe instability.

Fast forward 10 years, 9 years of lifting, and several other serious injuries to the same region, I’m stupidly arm-wrestling my friend and hear a distinct and familiar crack and pop in my shoulder. Yay, labral tear! The MRI determined that not only was my labrum torn, but that the humeral head had been depressed back by almost 18mm in the socket for almost a decade, stripping away cartilage at an alarming rate. The connective tissue in this area looked like string cheese (I will spare you the orthoscopic images). Needless to say, an intense shoulder surgery was in dire need. This injury wasn’t going to fix itself, so after a lot of bitching I went under the knife.

I should note, that prior to surgery I spent a good amount of time doing research to find the best possible surgeon I could. I chose Dr. Michael McAdam of Orthopedic Physician Associates here in Seattle, a shoulder and sports med specialist. After 5 separate incisions and a Kevlar cable permanently securing my shoulder together, I was out of the hospital and on my way home. The next day after the intense anesthesia wore off (I highly recommend getting a shoulder block), I returned for a follow up and spoke with the team. They informed me that the surgery couldn’t have gone better, but reminded me that rehab was looking like about 8-9 months before returning to my prior levels of strength.  DESPAIR.

I moped around the house for the first week, taking drugs around the clock so I could sleep, and generally felt sorry for myself. Towards the end of the week I made the decision to get back to work the following Monday. During this time, I began to weigh out my options regarding physical therapy and rehabilitative work. I had little to no interest working with a PT who didn’t understand the needs and demands of an athlete, and more specifically a strength athlete. After doing more research and calling around, I was beginning to realize that either the PT’s I had called would be useless, or that our schedules conflicted. I wanted to begin rehabbing the first day I was cleared to do so, and so I did, on my own.

You won’t believe what happens next!

Prior to the surgery, I spent countless hours reading about rehabilitative methods from trusted sources and talking to friends who had experienced similar injuries. By this time, you can probably see a reoccurring theme here. Do your homework! I ended up doing several sessions of PT, but our sessions included many of the same ROM (range of motion) drills that my surgical team had provided me with on the first day. I was fairly unimpressed and was already keeping up with my prescribed movements and excelling at them, so I developed my own program.

Before I continue to describe some of the movements and progressions I used and am using in my rehab, I would like to remind you that I am not a doctor, nor do I hold any genuine qualifications to write a scholarly article on this topic, aside from my multiple training certifications. This is merely what I developed, and what continues to work.

Most movements can be categorized as a push, a pull, a squat, or one of many combinations of the aforementioned. I will include what I did to develop strength and mobility back in these main three categories:

Squatting:

Until you can bear load to the shoulders:

-KB Hip Belt Squats: 99% of conventional facilities will not have a hip belt squat machine, so you have to get creative. Hook kettlebells up to a dip belt, and set up two boxes alongside each other. The boxes should be wide enough and tall enough that you can squat to depth comfortably without the hanging weight banging in to the floor or hitting the boxes. High reps, low weight. There’s no reason to dip below 8 reps at this point.

-BW Lunges: Self-explanatory.

-Leg Machines: Self-explanatory.

Once you can bear load to the shoulders, introduce specialty bars. If you don’t have access to specialty bars, you won’t be squatting for a while. I suppose you could use a smith machine:

-SSB (Safety Squat Bar): Start with no hands and just the bar, test out the weight, is your shoulder healthy enough to bear the bar alone? If yes, use the empty bar for a day. Next session, add a little bit of weight. If it makes your injury seriously uncomfortable, stop. Use pausing, slow tempos, and volume to primarily control the intensity. After several sessions, begin to use your hands and you guessed it… add a little more weight.

-Camber Bar: Once your shoulder is significantly stronger, you can introduce the camber bar. Because the hand position on this bar is so low, the amount of pressure felt in the front delt should be mild at most. If there’s still a significant amount of pressure, you aren’t ready. Once again, pausing, tempo, and high reps are your friend.

http://instagram.com/p/w9fNIESH6l/?modal=true

Pressing + Press Assistance

UNTIL YOU CAN MOVE THROUGH 85% ROM ON YOUR OWN, DO NOT ATTEMPT.

Finding press and press assistance movements I liked was the biggest challenge. I do not have access to cable machines at either of my facilities, so I had to improvise with bands, kettlebells, barbells, and dumbbells:

-Wall Pushups (bilaterally and unilaterally): Yep, just like it sounds. Tuck your ego away, get on a wall, and find an angle that challenges you without causing pain.  Keep your elbows tucked in. Perform multiple sets of high reps.

-Front and Lateral Delt Raise Supersets (KB/DB): Normally, these are movements I stop even at the plane of my shoulder. But, as I was trying to rebuild mobility and strength through a wide ROM, I took these movements past what would be considered normal. 10+10 with no rest in between and taking 3-5 seconds on each rep is a serious burner. I started with 2-pound dumbbells, FYI.


-Banded Presses: Attach a band of low-medium resistance to an upright, brace your torso, and press out and away from the body with control. Focus on the concentric and eccentric portions of this movement. Begin closer to the upright, so there is very little tension at the bottom. As you progress, come further away to add more tension.

-Banded Tricep Pushdowns: Self-explanatory.

More advanced movements:

-Single Arm Kettlebell Bench and OHP (kettlebell inverted, weight at the top): Wait until you’re a little bit further along for these, but they’re great for stability. No different than the conventional execution of these movements, but the inverted bell will cause you to take the weight down and execute with tempo and control.

-Football/Swiss Bar Bench and OHP: The neutral hand position feels so much better. Trust me here.

Last:

-Bench and OHP w/ Hanging Kettlebells: Set up a barbell in your preferred plane of motion with light bands hanging off of each side with kettlebells attached to the bands below. If benching, the KB’s should be tied high enough that they will not touch the floor during any point in the movement. The weight loaded below will not be forgiving as you fight to create an even bar path. Push your shoulders all the way through full ROM. Strive for perfection. A set of 12 should take about a minute to complete. High reps, low weight.

Pulling Based Movements

-Banded Rows (unilateral and bilateral): Attach a low-medium resistance band to at upright, and face away from it. Keeping your trunk locked, loop one or two hands though the band and execute what would traditionally resemble a dumbbell/barbell row. Treat any of these movements as a bodybuilder would, slow, squeeze, slow.

-Banded Face Pulls: Self-explanatory.

-Banded Lat Pullovers: Self-explanatory.

-Banded Curls: Self-explanatory.

-SSB Good Mornings: The reason I’m including them here, is because before I could deadlift, I needed something that would challenge my spinal erectors and keep them strong. Performing these with no hands is REALLY hard.

-Deadlifts (all double overhand): The first few sessions I used an axle with a double overhand grip and used no more than 70 pounds. I wanted to make sure I could execute at a very low weight without feeling ANY instability or pulling in the shoulder girdle. I used tempo and static holds at the top, striving to maintain perfect positions and control. After I had worked up to axle deadlifts that I could no longer grip double overhand and hold for long periods of time, I moved to a barbell. Same thing, tempo, static holds, and perfection. Finally, I began doing some rep work around 70% of my old max. That felt great, so as the weeks went by, I began to push a little bit further. Once I got to weights that I couldn’t hold double overhand, I resumed using straps as normal. Developing symmetry in my movements was important, and as such I have not done a single mixed grip deadlift yet.

-Passive and Active Hangs: Sometimes the “movement” world can get a bit kooky, but after talking to my fellow coach, Jessica Oftebro, at CrossFit Deliverance, I began Ido Portal’s hanging challenge/progression. It’s as simple as it sounds. Hanging from a pull-up bar/rig with varied amounts of time and scapular positioning. My shoulders feel stronger than they ever have. Look this guy up.

Conclusion

6⃣7⃣5⃣. 50 more to go. #deadliftordie #notacomeback #powerlifting #liftbigeatbig

A post shared by Matt Falk (@_mattfalk) on

As you can probably see, I didn’t really do anything terribly specialized in my rehab. I used common, staple movements and added challenging means of execution and volume to promote intensity. If you do not have a firm grasp of basic movement, or extensive knowledge in exercise, I would not challenge you to embark on this journey alone. I should add, I did not choose to take this upon myself because I thought I knew better, but because I was unable to find an external system that really worked with my needs and schedule. That being said, I pulled 675 last week (50 under my old max), and my shoulder has never felt stronger. I am 12 weeks out.

I could not have done this without the help and support of my family, friends, and training partners. But, ultimately I would not be this far along if I hadn’t spent hours a day working through my injury. Some of this you can do after you have your morning coffee, on your lunch break, or while watching Netflix. Be diligent and keep moving forward, it isn’t that bad.

3 thoughts on “Rehabbing with a purpose

  1. Hey Matt. Great post!! I have never been impressed with my PT’s since I started competing. Every one of them tells me I am not their normal client or that they don’t know how to assess my strength deficiencies. I was recently told that I have a similar shoulder problem (location of humerus is socket) due to a couple of old rear dislocations. Outside of some mobility issues, it’s not a hinderance at the moment. I’m hoping to postpone any surgery for as long as possible, but am glad to know that recovery is possible. Thanks!

  2. one of my shoulder breaks 6 months after rotator cuff repair with 3 screws. 11 months after this broke scapula in other shoulder as well as 6 ribs ankle and elbow tendon tear. (motorcycle accident)
    thanks for the motivation to keep going!
    I feel your pain.

  3. I had a surgery in August of 2014 to repair a giant hole in my left supraspinatus tendon. Full thickness tear. As a weightlifter (olympic weightlifter, that is), you kind of need your shoulders to do your sport, so I was right there in the thick of the despair. My PTs were thankfully pretty useful, and 9 months out I’m 100% healed and lifting weight again. The nerve block was absolutely crucial that first night, so I second that sentiment. I don’t think I’ve ever been in so much pain before as the day after the surgery. Now that I’m healed, I’m just trying to push through the weakness and get back to my pre-surgery numbers. It’s taking a long time, but I figure I’ll get there eventually.

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