Written by Dr. Durlan Castro
09 September 2006
  My title fits this article perfectly.  That's because this month's information concerns shoulder injuries.  

Let me run this simple scenario by you.  How many times has your training been going great, your diet is "on point", and your body is responding like never before.  Then, all of a sudden, you take the bar off the rack for your third set of shoulder presses and "Uh Oh", you feel it?

"It" is the twinge of pain in your shoulder; usually located slightly anterior to or on top of the deltoid muscle.  Your first response is, "Shit, why me? Why now?!" then you finish your workout and hope it just disappears by tomorrow.  Maybe it's just a knife that will work its way out?

The very next day is "CHEST" and you like to start your workout with incline bench presses, so you load up the bar with 45lb plates on each side and do your set.  "Whew, no pain, great.  Maybe it was just a kink," you say to yourself.  Next, you put another 45lb plate on each side, since you're feeling so good, and you start pressing the bar.  "SHIT!!"  There it is-- that pain that stops you in your tracks.  The kind of pain you know is going to mess your training up for weeks, if not months, to come.  Screw it, you're big, hard, and strong and you'll work through the pain for now.


Three to four weeks go by and now the shoulder is starting to really bother you; even in your sleep.  You can't lay on the injured side because it's throbbing by the time you wake in the morning.  Small movements become harder.   Bringing your arm behind your back to put on a shirt on even pulling a shirt off becomes impossible.  Your lifting becomes a matter of working around the injury and using light weights.  Psychologically, things are starting to affect you, and you begin to become irritable and depressed.  After all, your bench is down 50-100 lbs, and forget about doing military presses altogether!

                                           Help Is On The Way    

    So, you've broken down and decided to seek medical attention.  A trip to your
family doctor should get you a weeks worth of anti-inflammatory pills and a "stop
lifting weights" Rx from a guy who calls himself a doctor yet is 50-60 lbs
overweight and dresses horribly.  Next!

Your next hope is an orthopedic surgeon.  He will thoroughly examine you, take
x-rays, and tell you that you have what's called an "impingement syndrome or rotator
cuff syndrome".  The doctor then prescribes physical therapy three times a week
for 4-6 weeks.

You're getting a bit closer to the treatment of choice.

                                            A Fix is On the Way

I would say 75-80% of my practice consists of shoulder injuries.  After all, my
niche of patients are primarily bodybuilders, powerlifters, and fitness buffs.  Let me
tell you, this is a great group of individuals to work on because they listen and share a single goal-- to get back into the gym.

 The following are examples of the typical problems I find with "traditional" care, I'll share you how I treat shoulders with about a 94% success rate.

                                      Rehabilitating a Weak Muscle


I've seen frustrated bodybuilders come to my office after 4, sometimes 6 months, of
physical therapy, only to find that when they try to military press the pain is still

 Don't get me wrong, physical therapy is essential to this type of injury and we do
have a physical therapist in my office who works with all my shoulder patients.  The
problem is trying to rehab or strengthen a muscle or groups of muscles that have
been weakened by an injury.

    When I use the word "weaken", I'm talking about a muscle that gets strained to the point where there's inflammation.  Inflammation blocks the local blood circulation which, in turn, causes the body to lay down scar tissue at the site of injury.  This will effectively change the tension and movement of the muscle almost immediately.  If you were to dissect a muscle with scar tissue you would see a bunch of cross fibers and metabolites engulfing that tissue.  What this means is that if a muscle tendon, ligament, or muscle itself has its fibers tangled or changed, it loses its function, motion, and tension.

Picture this, you have an injured rotator cuff muscle (for instance, the

infraspinatus muscle).  You go see a physical therapist and he teaches you how to perform rotator cuff exercises to supposedly "strengthen" the area.  The usual scenario is MUCH time with MINIMAL results.  Why?
Because that muscle cannot function normally until it feels, moves, and acts normal.
If the muscle is loaded with adhesions (or scar tissue), it's probably weak and is going to transfer its stress to the other assistor muscles of the rotator cuff.  And as soon as you go back to the military press,

"Bang", there it is, your old friend, the pain.

                                                   Let's Fix It  


The first thing you must do for these injuries is to clear the muscle of all its adhesions.  Active Release Techniques (ART) does this like no other soft tissue technique out there can.  By having the patient move his shoulder and arm in different directions the doctor is able to "trap" the adhesion under his fingers and break them up.  Very often, the destruction of these adhesions can be heard as a "crackling" or "popping" sound.

After the first treatment, the patient should notice an increase in motion and a lessening of pain.  A first treatment involves an examination-- which includes muscle testing, orthopedic, and range of motion reviews.  Also, it's important to make sure the patient doesn't require surgery.  This is a primary concern.  Once the exam is performed and it's confirmed that there's no breaks, fracture, or tears, treatment begins.

                                          5-7 is The Magic Number

Five to seven office visits is what it usually takes to remove all the adhesions from an injured muscle.  Once this is accomplished, the patient will see a physical therapist for very specific exercise protocols to strengthen the injured and surrounding muscles.  .

            Remember, the main objective is to get you back in the gym and under the bar doing military presses and inclines as soon as possible.  Usually, after the second
treatment I tell the patient to work out (start out by cutting the weight in half) and test how the injured area feels.  Most of the time there's no pain.  It's important to get the injured athlete back in the gym for the following three reasons:


(1)  To test the muscle and bring blood flow to that area  

(2)  To begin normal motion in the muscle with the same specific exercises that once hurt
(3)  Mentally, lifters need to feel positive about their progress. 


There you have it.  Lift safe and next time you have a nagging injury, see your local ART therapist.

To Contact Dr. Castro:  This email address is being protected from spambots. You need JavaScript enabled to view it. or call (516)-541-6030