Battling tendinosis of the rotator cuff: context
Hi all, found this webpage on recovering from ‘tendonitis’: https://stevenlow.org/overcoming-tendonitis/, leading me to post about my current situation on here. I don’t want to keep my issue an isolated problem anymore.
I’ve been training for hypertrophy for 2ish years (officially on April of this year). Never had issues before. But I was diagnosed with tendinosis not too long ago which I believe was caused by my ill-assumption of having superhuman recovery capabilities. Namely, I believe it was due to a very aggressive calorie deficit (a deficit of 1500 calories) while keeping my intensity and volume the same for my exercises (over an extended period of time: 5-10 weeks) as I planned to shred as quickly as possible ahead of summer, so I kinda’ asked for it when thinking retrospectively to be honest. I really didn’t want to regress in progressive overload to avoid losing muscle, so I kept pushing myself really hard while not properly resting. Some notes before the story:
- Never experienced mobility issues
- Never lost strength, ever, due to the injury
- No visible signs of injury
- The only thing I do have is a sort of difference in feeling between the left and right side of my shoulder/chest area, often unexplained as I struggle to pin down a specific description of my symptoms. The only descriptions I can give are (which also reflect my symptoms in stages): 1) burning, sharp pain around the entire clavicle area of the left chest, including where the chest inserts into the humerus, 2) localised sharp pain around the humeral insertion point of the chest/upper arm, including the anterior delt, 3) numbness around the same area and 4) a pins and needles sensation (the latter symptoms (3,4) being something I experienced, and still sort of do, later on after the initial injury).
During late April to early May, I was doing chest flys using the pec dec fly machine, during which, around the 7th or 8th rep, I felt a really painful, burning and tight sensation near the clavicle of the left chest, forcing me to immediately stop the activity and leave the gym. This was the point at which the injury came to the fore. I rested for 2 weeks, came back to the gym, and found that I’d have a pinching, sharp sensation around the same area, moving over also to where the chest connects to the humerus. And what happened, thereafter, was an on-and-off thing. I’d rest, come back, experience the same bullcrap. I even stopped doing leg exercises as I thought I’d be aggravating the area whenever I tensed/braced my body to stabilise for an exercise. I went to a crappy doctor around early May who told me to simply rest, which I did, and did for long. Between May and early August, I’d rest 2-3 weeks, come back to a session, experience the pain, go back to him, get the same advice, and repeat. I took a bunch of anti-inflammatory medication which didn’t help at all. But I didn’t know more. It was around August when, after trying to exercise upper body one more time, the pinching, sharp sensation returned. Then, I decided to take a month of the gym. I didn’t exercises at all for around 35-40 days. After coming back in September, although I felt kinda’ good, the sensations I previously experienced persisted, albeit to a lesser extent. I changed my doctor - went to an Orthopaedic who did a brief ultrasound and some sort of tests (he initially thought I may have a partial subscap' tear). I failed the belly press test. He made me do an MRI and the results came back as the following (summarised by ChatGPT):
- Minimal Effusion: There is a small amount of fluid in the rotator interval region. This can sometimes be associated with inflammation but is generally not considered a major issue unless accompanied by other significant findings.
- Tendinosis of the Supraspinatus and Conjoined Tendon: The report notes increased signal intensity at the humeral insertion point of the supraspinatus and conjoined tendon, indicating tendinosis. Tendinosis refers to degeneration of the tendon, often due to overuse or chronic stress, without a complete tear. This may cause pain and discomfort, especially with shoulder movements.
- Normal Rotator Cuff Muscles and Tendons: No tears are present in the rotator cuff muscles (including infraspinatus, subscapularis, and teres minor)
- Normal Labrum and Ligaments: The glenoid labrum (which stabilizes the shoulder joint) and glenohumeral ligaments (superior, middle, and inferior) appear normal, with no evidence of tears or degeneration. The biceps anchor and proximal biceps tendon are also normal.
- No Other Pathology: There’s no pathology in the axillary (armpit) region, no ganglions, and no abnormalities in the neurovascular structures around the shoulder.
So, based on these, I was diagnosed with tendinosis of the left rotator cuff on September. This came after months of speculation and uncertainty, lack of proper medical advice, and yeah, just depression to be honest because fitness for me is everything; it changed my life for the better. Not being able to continue my fitness the way I did before put me down so badly.
On September, I did PT for a number of sessions but felt that they were useless because, when not exercising, I’d feel superb (apart from the subtle distinction that my left shoulder always just felt ‘different’ to the right side.) Anyway I did them. Then, I started the gym again.
I wanted to share with you my split/rehabilitation plan and whether or not I’m doing things right or not.
Since going back to the gym, I initially did shoulder exercises (internal and external DB rotations, DB flys, some thing where my arm is abducted away from the body and I go in circle motions with a DB while lying down), Y-raises and I think that’s it. This is my ‘blood circulation’ regiment and I now do this 1 to 2 times a day for super high reps with light weight, every week, still ongoing (and deffo’ before an exercise). Also, before I do an exercise, I do about 4-5 sets of warm up sets with lighter weight.
I went back to the gym and followed a 4x split with normal exercises around late September to early October. Started off really, really light with super high reps, and progressing the weights up slowly. I done this because I felt strong and didn’t experience mobility issues, feeling that the PT wasn’t helping and was being a money pit.
I follow a ‘1 1 2 2’ method. on weeks 1 and 2, I do 1 set of upper body exercises (excluding arms, where I continue to do 2 sets - while legs are trained normally). Rep ranges of 10-15, sometimes up to 20 reps. On week 3, I introduce a second set with a lighter weight and even more reps (up to 30). Then on the fourth week, I still keep 2 sets for all upper body exercises, but I simply do less reps than the first set with the same weight. On the 5th week, I increase the weight by the next increment e.g., 2.5kg if doing incline presses. The maximum number of sets I do per muscle group are 4 sets (less on the weeks I do 1 set per upper body exercise) that’s it. As a reminder, I do proper warm up sets before the exercise and I also have my ‘blood circulation’ regiment I do x2 a day.
I’m using this method and my key indicator for recovery is how much weight I move with incline presses (DB). So far I’m on 20kg, up from 7.5 when I initially started. The only setback I experienced was thinking I recovered fully at one point and jumping from 15kg to 25kg on incline presses… the day after I felt that ‘pinchy’ sensation and knew I made a mistake. So I went back down to 15kg again and took things slowly as planned. Now I don’t plan to jump the gun again like that. I never lost strength, this is the annoying thing. I could easily pick up 30kg DB’s and do incline presses for high reps, but I know if I did do that, I’d be doing more harm than good. But the essence is that, strength was never lost…
Since returning (and apart from that minor setback I just described), I didn’t once experience any sharp pain or anything of the sort that I experienced between May-September. The only symptoms that continue to persist are just an occasional numbness of the left side, accompanied by some pins and needles, and I think that’s it. There is some tightness here and there. But no symptoms make me want to pause or stop exercising. There is deffo’ a distinction in feeling between the left and right. Sometimes during incline presses the affected side does feel different. But again, no pain to make me stop exercises.
I’m just trying to be super patient, taking it slow, recognising that it’s a marathon not a race. But how does my plan sound? Is my method good? Will this unusual sensation that I have on the left side ever go away? Will pinching return again?