Yes, we can usually still train

Once we get out of the inflammatory stage (ie constant pain at rest due to the body’s response to the injury) we are then left with what I like to call ‘mechanical pain’. Ie we only feel the pain when the affected tissue is loaded. With some initial modification, patients can normally still train most body parts with a modified routine. From there, we continue to expand upon your repertoire of allowed movements as knowledge, skill and the healing process advance.

Important Notes:

• For all exercises we will initially modify to keep the shoulder below 80 degrees elevation (around chest height) and not let the elbows drift behind the body

• We are looking for none of the movements to cause sensation on the shoulder (even ‘stretch’ or ‘working’ sensations)

• 2 sets of 12 rep-max (a weight you can do 12 times with clean technique) for one exercise from each category is a good place to start

Cardio:

• Yes:

  • Walking/Jogging (if more comfortable, you can modify arm swing to keep elbows ahead of body, Rocky-style)

  • Elliptical (but without arm movement)

  • Cycling (no aerobars)

  • Stair-Climber (if have hands on the rails, keep them at waist-height)

• No: Swimming, Jacob’s Ladder, Skierg, Rowing (though we can bring this in relatively quickly)

Stretching

• Yes: Most stretches (e.g. legs) that don’t use the arms should be OK

• No: Avoid any upper-extremity stretches that haven’t been prescribed for now. They can be more provocative than you would think

Legs

• Any machines (e.g. leg press, leg extensions, leg curls, calf raises, abductors, adductors, etc.)

• Any free-weights where the arms are low:

  • Yes: lunges/split-squats with dumbbells hanging from side; deadlifts, barbell pelvic thrust/bridge

  • Maybe: Rear-carry (depending on how you look on testing)

  • No: Olympic lifting, front-carry, overhead, kettlebell swings

Core

• Anything where arms stay low and are not used, e.g.:

  • Obliques:

    • Yes: Twisting crunches, obliques side crunch over back extension machine, horizontal oblique cable twist, standing oblique cable crunch

• Low Back: Supermans (but with hands close to your hips and not emphasizing lifting them), Back Hyperextensions (with arms across chest)

• Abs - Any type of sit up, crunch, v-sit, etc. No supporting of body weight (e.g. planks, support position). Keeps arms crossed on chest during movements.

Upper-body

• Back: Rows (any variation but with low and narrow grip), Straight Arm Lat-Pulldown (modified to keep hands below chest height). For both: remember to keep elbows ahead of body

• Chest: None on the first day. We’ll add them in as you prove technique and tissue tolerance

• Delts: None on the first day. We’ll add them in as you prove technique and tissue tolerance

• Arms: Most isolation will be OK, just remember to keep the elbows slightly ahead of body when doing biceps curls/ triceps extensions. No overhead work

Standard Disclaimer:

These resources are intended for Physio Steve Procter's patients, and only as prescribed. To avoid serious complications, it is important to be evaluated, diagnosed, and educated on exercises specific to your particular condition before attempting them independently.

About the Author:

Physio Steve Procter is a physiotherapist and personal trainer practicing in downtown Montreal.

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