How I rehabilitated my shoulder back to full strength!

(If you prefer to watch videos, then check out my YouTube video about it here)

I get a lot of questions about how to rehabilitate different injuries so that you can return to training and get even stronger. So today, I will go through the process of rehabbing my shoulder as a case study, from not being able to put on a t-shirt properly to being able to bench press 150kg again.

Although the specific exercises, limitations, and time span will vary for different injuries, the basic principles and process still apply.

Disclaimer, I am not a doctor or a physiotherapist, so this is not medical advice. My first recommendation is that, like myself, you go and see a physiotherapist or relevant medical professional to assess the situation.

My expertise picks up where the physiotherapist puts down: when you are cleared to return to training.

Some quick context on what happened to my shoulder. I had a sprain of the ligaments in the AC joint, which is that pointy bit that you can feel on the outer end of your collarbone.

Although I did not have a full tear or separation of the joint, you could still feel the clavicle (collar bone) pulling away from the acromion process, which is a finger-like bit that sticks out from your shoulder blades over the top of your shoulder. This was super painful, and if you do not deal with it properly, you can end up with that joint being permanently loose and slowly wearing away at the cartilage.

Step one after recognising that there was something wrong with my shoulder was booking in to see a physiotherapist to get a second opinion. Although I was pretty sure I knew what was going on, you don't know what you don't know, so it is always worth seeing the relevant medical professional.

The physio assessed the situation, reassured me that I hadn't completely torn the ligaments, and gave me some initial recommendations for light movements that I could do to keep the shoulder moving.

Step two was figuring out what exercises I could do to keep the rest of my body training. I couldn't do anything that put pressure on my shoulder or required me to hold onto a lot of weight hanging from my shoulder like deadlifts. So machines became my friend - leg press, other leg machines, back extensions, you name it, I did it.

For my arms, I figured out that if I kept my arms in a neutral position by my side, I could do tricep pushdowns and bicep curls, but only at lightweight and high reps.

I started to include blood flow restriction training (BFR) with both my arms and legs, which allowed me to use even lighter weights and required less force through my shoulder when I had to either hold onto the machine or hold my arms still.

Step three was figuring out what the shoulder could actually do. The key to rehabbing the affected area of any injury is using graded exposure. This simply means doing what you can without aggravating the area further and continuing to do that until it becomes easy and you can do more. Doing more could mean more load with the same movement, more reps or sets of the same movement, or a more challenging movement for that area.

For example, I figured out that I could do very light rows if: 1) I kept my shoulders neutral (not protracted or retracted), 2) I kept my upper traps consciously relaxed, and 3) I didn't let the row go all the way out or try to pull it all the way in. Over time, I was able to slowly increase how far I was letting the rows out and pulling them in, and then I started to increase the load.

Often, less can be more. Try 1-2 sets once to twice a week, see how that goes, then add a set, see how that goes, and so on. What you don't want to do is introduce a new exercise and do a million sets once a week or suddenly do it every day.

Some guidelines when doing this: 

Work within a low pain range.

Some discomfort in the affected area is fine and normal for most injuries, but it shouldn't be excessively sore during or after the exercise. If it is, you have probably “overcooked” it a bit and might need to give it a cool-down period to recover before doing it again.

Don't feel like you need to take the exercises close to failure.

In the early stages, try to leave at least 5 reps in reserve (RIR). This will be heavy enough to make progress but will allow you to perform all the reps in a very controlled manner and not fatigue the affected area too much.

If you progress things slowly you will have plenty of warning if you are overdoing it and can then pull back and adjust. As long as you are progressing week to week or every couple of weeks with what you can do, even if they are small steps, then you are heading in the right direction

Disclaimer: The above guidelines are different for different injuries, so please ask your medical professional what the appropriate guidelines are for you.

Tip. Machines are your friend. Weight machines allow you to perform a movement in a very controlled manner. As long as the machine moves in a way that is comfortable for you, it will provide stability and safety to your exercises as you slowly reintroduce new movements.

I first started pressing movements on a machine chest press, again, lightweight, high reps, several reps from failure (high RIR) and with whatever range of motion (ROM) was comfortable.

From here, it has just been a matter of continuing to expose the area to more and more challenging things slowly - adding load, adding ROM, and changing from machine to free weights. Each time I introduce something new, I keep the sets and reps low and the RIR high until I am confident that the affected area is tolerating it well. And in 2 weeks, I am set to hit 150kg on the bench again, which is only 5kg from my all-time best.

A few things people get wrong:

Expecting overnight results.

Different injuries take a different amount of time. I see too many people try and rehab an injury for 6-12 weeks, and then if it's not 100%, they assume they can never again do what they used to.

It has taken about 1.5 years for my shoulder to go from not being able to put on a t-shirt normally to being able to bench press the same weight again, and it is still not 100%. I still have to be mindful of it and do things carefully, but in time, it will probably fade from my memory, and I will stop having to think about it. I have seen the same thing with many of my clients with backs, hips, shoulders, ankles, you name it. Often about half of the function comes back quite quickly, and you can get around during the day, but the time span until you hit new PRs in the gym can be longer. But if you don't stick with it, you will never get there.

Expecting it to be linear.

Even if you have the perfect rate of progress and never overdo it in your training, there are still going to be times when the injury takes a step back. That's okay, that's normal; pull back on how you are training and slowly build up again.

Chances are there will be days where you overdo it a bit (I know I have) because we want to get back to the training and activities we love sooner rather than later. When that happens and you notice more symptoms than there should be, step back, slowly reintroduce what you are working on, and then keep going.

Pain does not equal physical damage.

Sometimes, as you go through the process, you can have days where you are more or less sensitive in an area and sometimes, even after the physical tissue has healed, you will still get pain from the area being sensitive. Part of the rehab process is not just helping the tissue to heal but also regaining an appropriate level of sensitivity in the area. Again, ask your medical professional, but for me, allowing a 2-4/10 on the pain scale during the movement means that I was continuing to expose it to new levels of training but not pushing it so hard that it was detrimental. Pain is a general term, different sensations in different areas can mean different things, so please, if you are in any doubt, talk to the relevant medical professional.

This is a huge topic but I hope that you found this helpful.

The biggest thing I can say is that your body can do amazing things, and chances are you can get back to doing the things you love in some shape or form.

Don’t be disheartened; stick with the process, and if anything, every time I have rehabbed an injury, the lessons learnt have improved my overall training methods going forward.

If you have any questions, feel free to email me. I am happy to help you figure out the next steps you should take. 

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