8 ms·

Study suggests surgery alternative for rotator cuff pain: push-ups, pull-ups

118 points by HillaryBriss 7y ago

dogma1138 7y ago
Besides that proper face pulls, ideally a resistive band YTWL[1] (another alternative is to do body weight YTWL by lying down [2]) exercise as well as walking with your thumbs forced straight to the front (if your thumbs point towards your hips when your hands are loose you have improper rotator position in your shoulder) helps wonders with any shoulder issues. [1] https://www.youtube.com/watch?v=ELe4fATl-Jg https://www.youtube.com/watch?v=ELe4fATl-Jg [2] https://www.youtube.com/watch?v=3MxHX9j15BU https://www.youtube.com/watch?v=3MxHX9j15BU Another very good exercise is to stand straight against a wall keeping your shoulder blades, mid back, butt, elbows and wrists touching the wall and doing a shoulder press motion. The motion should be done without the elbows and the wrists coming off the wall, even people in tip top shape find this exercise extremely difficult to perform and most people would top out at just under a 90 degree bend in their elbow at first. Unless there is actual damage to the joint (e.g. scar tissue that gets inflamed and must be removed) surgery should be avoided at all costs, nearly all orthopedics conditions can be resolved by strengthening under developed muscles that would make the joints work as they should. Shoulder issues tend to happen due to weak back/rear delts and overdeveloped front delts and chest muscles this is the bane of the modern slouching life style.
- glangdale 7y ago
  "helps wonders with any shoulder issues"? (emphasis mine) That's a bold claim. There are a lot of different shoulder issues. I never found that all that YTWL stuff did anything useful for my shoulder at all (torn labrum from Judo), but doing stuff more like the article (closed chain) and doing some of the flexibility stuff from a 'gymnastics for beginners' type program ("Elements" from GMB - in the end I didn't like the program but I still do the warmup/cooldown) also really helped. Also not getting into impromptu bench pressing competitions with rugby players at the gym was a pretty good idea too.
SketchySeaBeast 7y ago
Push-ups and pull-ups are exercises that get you above that "barely acceptable" level of strength that physiotherapy seems to aim to get people to - to perform those movements you need to actually have a level of strength that you can't develop simply with bands. It makes absolute sense that the solution to having a hurt joint is to make that joint significantly stronger.
- hombre_fatal 7y ago
  Both of those exercises have progressions from variants that anyone can do. Like knee pushups where you don't go all the way down. I'd still call that a pushup exercise, and it's the first step to helping your cuffs apparently.
  - steve_adams_86 7y ago
    It can be hard to imagine for some of us, but sometimes those bottom rung progressions are essential. Injuries can set you so far away from 'barely acceptable' levels of strength that you end up doing wall pushups for weeks before you can consider doing them from your knees. So absolutely, if that's where you're at, it's a pushup exercise.
    - SketchySeaBeast 7y ago
      And most importantly - there's somewhere to progress to. Moving from the grey band to the blue band isn't a goal, and it has no real reward.
- jhayward 7y ago
  > the solution to having a hurt joint is to make that joint significantly stronger This may seem like nit-picking, but I think it's important for people with joint damage to understand: you aren't actually making the joint itself stronger. The cartilage and ligaments, bones are not strengthening. Injuries to those tissues are more or less forever. What you are doing through therapeutic exercise is strengthening the musculature around the joint. The muscles provide most of the support and restraint to keep the joint intact relieving pain and preventing (further) injury. The right muscles, strengthened in balanced form, are what make joints strong.
ashelmire 7y ago
Physical therapy is evidence-based health practice. This is sort of a "no shit" piece. Doctors want to operate on you - it's what they are trained for, it's how the make money. Hospitals make money off of surgery. Yet physical therapy gets better results. Lookup washout studies vs knee surgery with results like this [1]. 1. https://www.scientificamerican.com/article/study-suggests-common-kne/ https://www.scientificamerican.com/article/study-suggests-co...
- qserasera 7y ago
  Absolutely. IMO for a lot of injuries surgery should be the last option. Anyone taking rehab not seriously should be well warned of the consequences.
  - hnick 7y ago
    The doctors I've spoken to in Australia all considered surgery a last resort when I asked why they didn't mention it for this sort of thing. They will happily admit the risks outweigh the benefit until all other options are exhausted. Having universal health care would have a lot to do with that.
    - qserasera 7y ago
      I've seen a whole lot of people go through rehab who just don't want to do the work or see that time is necessary. It's really sad how they just don't allocate time for their healing.
- strstr 7y ago
  At face value, full-thickness tears are different. Maybe you don’t need whatever muscle you broke in half, but that seems surprising. After reading the article I’m not sure what the outcomes actually are. Did the shoulder compensate and just let that muscle atrophy? Did it reattach? Either way this is definitely not a no-brainer.
- joshgel 7y ago
  Yes. I'm not sure this is so true for full thickness tears, but in general I think your point stands. That said, patients also want surgery. I can't tell you how many patients I have referred to physical therapy for conditions which we know are improved by physical therapy (like routine lower back pain, minor muscle strains, etc) and they look at me like I'm crazy. I've seen it work in my patients that actually went and participated, but most go through the motions and stop going after a session or two because 'it wasn't helping'. I think part of american culture is that we want instant fixes, even for problems that have been brewing for decades like heart disease and diabetes... /endRant
simlevesque 7y ago
I don't know if they ever tried that but I play with a yoyo, looping style (2A) and it is a wonderful exercise for the shoulder area. I broke my collarbone two years ago and couldn't use my right arm for almost two months. After that I picked up yoyo and I'm certain that it helped me recover my strength and flexibility.
steve_adams_86 7y ago
This is anecdotal and people should be extremely cautious if they have RC injuries. Talk to a pro, look into proper exercise progressions, and start with baby steps even if you feel strong enough not to. But: My right shoulder was a piece of trash for over 5 years. I couldn't use my trackpad or mouse some days at work because it became incredibly hot and excruciating. I couldn't throw rocks at the beach, ride my bike as far as I wanted, drive in comfort, you name it. Just standing could be incredibly painful if my shoulder needed rest. You don't know how awesome shoulders are until they stop working. One day I decided to try the exercise route after avoiding it for a very long time. I did because someone shared an anecdote of exercise helping on reddit. I started a pull up progression using elastic straps to assist at first. I did push ups from my knees. I started doing stretches in door ways and on a big inflatable ball. I rolled myself on a lacrosse ball like the cross fitters do. If it fixes them it'll fix anything, right? Within a year I was 'cured'. I was doing pull ups with a 45lb plate strapped to my body and push ups with the same plate resting on my back. I began weight lifting fairly seriously and made it up to a 400lb deadlift by the second year. My shoulder was a limiter in my first year, but once I took up yoga as well it never bothered me again. Now, having said that, this all took a lot of time, energy, and will power. It's not easy and it's not a silver bullet. Your body will strengthen though and you can overcome biomechanical issues by working the system carefully, methodically, consistently, and with good sleep and nutrition. But again, don't jump into it and don't expect it to be easy. My experience was positive in the end, but it's a total dog along the way. If you have the money, find a trainer who understands injuries and recovery. Get on a program and commit. The best thing you can do for your body is use it. But never go too hard, and go as slow as you can handle at first. You can make it so much worse in one little moment of overdoing it. Hopefully someone is motivated by my anecdote because someone sharing theirs on reddit ten years ago really did change my life.
- ambicapter 7y ago
  I would say pull-ups are far more dangerous than push-ups, on the shoulders if you do wide-grip, on the wrists if you do close-grip.
  - sethammons 7y ago
jeremyw 7y ago
The trial registration: https://clinicaltrials.gov/ct2/show/study/NCT02750176?show_desc=Y#desc https://clinicaltrials.gov/ct2/show/study/NCT02750176?show_d...
sp332 7y ago
A friend of mine is a personal trainer who put together an incredibly thorough personalizable program for pull-ups. It's aimed at beginners and includes instructions on building strength even if you can just support part of your weight hanging from the bar. It covers warm-ups, stretches, injury prevention, lots of technique (which is extra important if you're already injured), and how to avoid tensing up and causing more soreness the next day. The program is at https://thepullupsolution.com/ https://thepullupsolution.com/ (He doesn't talk like a content marketer in real life.)
- mistrial9 7y ago
  curiously similar name to the works of Jerry Robinson two decades ago, which are still for sale
Stronico 7y ago
I had a rotator cuff injury that went on for about two years before I went to a doctor. Their medical advice consisted of "Check Youtube" and they handed me two meters of resistance band. I was skeptical, but two weeks of rather easy exercises and everything was fixed. It's taken me significantly longer to train myself to remember to use my left arm for anything overhead.
grizzles 7y ago
A year ago I had golfer's elbow and it seemed like it wasn't ever going away. After years of lifting very heavy I thought, this is it - I'm fucked. Well fast forward to now and it's pretty much gone. All I did was knock down my weights, did some physio and have slowly started building back up. I'm not back on the big big weights yet but I'm at least on the big weights. Sometimes things have a simple solution.
- opportune 7y ago
  Just out of curiousity, did you deload on all your lifts or only one the ones that affect golfer's elbow? Substitute things like bench press for those machines that you make a "clapping" motion with?
  - grizzles 7y ago
    If I used my right arm I was feeling it. And I don't do much leg exercises so I'd say I deloaded on everything except cardio/anaerobic.
whytaka 7y ago
My own anecdote is that for 7 months I didn't exercise. My shoulders hurt as I slept on my side and rested my header on my pillow with my arm cradling it underneath. It went away just a week into me restarting my exercise regimen.
- maybemabe 7y ago
  Cannot believe that you have described exactly the position that gives me pain for the last 2 months. Both shoulders. Never had a shoulder problem before and I am playing tennis every week for 15 years.
Ididntdothis 7y ago
I think the most important thing is to not think that one recipe will work for everybody. There are a lot of different types of shoulder problems that are all getting lumped into "rotator cuff". Try a few different things and see what helps. Also keep watching your shoulders. It's really easy to mess them up again.
deleted 7y ago
[deleted]
rsync 7y ago
Any discussion of shoulder injuries should include, somewhere, the PT exercise known as "plate halos": https://www.youtube.com/watch?v=ZG0N6JKNUQU https://www.youtube.com/watch?v=ZG0N6JKNUQU Very, very beneficial and also time efficient as it hits your shoulder from all degrees of motion with a single exercise. Further, the popularity of crossfit "bumper plates" means that a full diameter plate can be very lightweight. The idea is to work up to a normal 45 pound plate but if you are injured or a smaller female, you can find a 10 or 20 pound bumper plate that is the same diameter. (It's not very effective to use a smaller diameter plate, such as a standard 25 pound plate.) I would recommend plate halos as a core piece of any upper body strength routine - I do them in my warmups every time I am in the gym.
joker3 7y ago
The thing to keep in mind here is that studies can only compare the average effects of any treatments they consider. You don't care about that. Instead, you want to know what's going to work for your particular shoulder pain, which might be helped by exercise, or might be something that generally requires surgery.
camkego 7y ago
Has anyone determined the exact six exercises used in the study? This article mentions: "including push-ups, pull-ups, dips and reverse rows — while the end of the limb is braced." But according to the trial registration, six exercises were used. Does anyone know where to find the exact exercise regimen used in the trial? Why is this so tricky to find?
sunstone 7y ago
I've had frozen shoulder in both shoulders in the recent past. Neither was injured beforehand in any physical manner. I agree with the exercise treatment. It worked for me both times. In the end I found that swimming, breast stroke and then freestyle, worked best for me. For me the first couple of lengths were searingly painful but after ten or fifteen minutes it was really surprising how quickly the pain diminished. Each swimming session kind of followed the same pattern, acute pain at first that slowly faded. After maybe a dozen sessions over six weeks it was pretty much gone. One more anecdote.
Fjolsvith 7y ago
I experienced a period of forced inactivity which caused a calcium buildup in my right knee. It was very painful to bend past 15 degrees with my weight on it and would collapse under weight. A friend I had who was a big fitness buff suggested I start walking stairs to fix it. I started out with 5 minutes a day for the first week, then 10 for a week, then 15. I climbed a single story flight of stairs and then turned around and descended, repeating for the workout time. After a month, the calcium buildup was gone. After three, my legs were so strong I felt like I was bouncing on springs when I walked. I was taking the steps two at a time when I climbed and didn't get winded at all. Great aerobic workout!

118 points by HillaryBriss 7y ago

Besides that proper face pulls, ideally a resistive band YTWL[1] (another alternative is to do body weight YTWL by lying down [2]) exercise as well as walking with your thumbs forced straight to the front (if your thumbs point towards your hips when your hands are loose you have improper rotator position in your shoulder) helps wonders with any shoulder issues. [1] https://www.youtube.com/watch?v=ELe4fATl-Jg https://www.youtube.com/watch?v=ELe4fATl-Jg [2] https://www.youtube.com/watch?v=3MxHX9j15BU https://www.youtube.com/watch?v=3MxHX9j15BU Another very good exercise is to stand straight against a wall keeping your shoulder blades, mid back, butt, elbows and wrists touching the wall and doing a shoulder press motion. The motion should be done without the elbows and the wrists coming off the wall, even people in tip top shape find this exercise extremely difficult to perform and most people would top out at just under a 90 degree bend in their elbow at first. Unless there is actual damage to the joint (e.g. scar tissue that gets inflamed and must be removed) surgery should be avoided at all costs, nearly all orthopedics conditions can be resolved by strengthening under developed muscles that would make the joints work as they should. Shoulder issues tend to happen due to weak back/rear delts and overdeveloped front delts and chest muscles this is the bane of the modern slouching life style.

glangdale 7y ago
"helps wonders with any shoulder issues"? (emphasis mine) That's a bold claim. There are a lot of different shoulder issues. I never found that all that YTWL stuff did anything useful for my shoulder at all (torn labrum from Judo), but doing stuff more like the article (closed chain) and doing some of the flexibility stuff from a 'gymnastics for beginners' type program ("Elements" from GMB - in the end I didn't like the program but I still do the warmup/cooldown) also really helped. Also not getting into impromptu bench pressing competitions with rugby players at the gym was a pretty good idea too.

SketchySeaBeast 7y ago

Push-ups and pull-ups are exercises that get you above that "barely acceptable" level of strength that physiotherapy seems to aim to get people to - to perform those movements you need to actually have a level of strength that you can't develop simply with bands. It makes absolute sense that the solution to having a hurt joint is to make that joint significantly stronger.

hombre_fatal 7y ago
Both of those exercises have progressions from variants that anyone can do. Like knee pushups where you don't go all the way down. I'd still call that a pushup exercise, and it's the first step to helping your cuffs apparently.
- steve_adams_86 7y ago
  It can be hard to imagine for some of us, but sometimes those bottom rung progressions are essential. Injuries can set you so far away from 'barely acceptable' levels of strength that you end up doing wall pushups for weeks before you can consider doing them from your knees. So absolutely, if that's where you're at, it's a pushup exercise.
  - SketchySeaBeast 7y ago
    And most importantly - there's somewhere to progress to. Moving from the grey band to the blue band isn't a goal, and it has no real reward.
jhayward 7y ago
> the solution to having a hurt joint is to make that joint significantly stronger This may seem like nit-picking, but I think it's important for people with joint damage to understand: you aren't actually making the joint itself stronger. The cartilage and ligaments, bones are not strengthening. Injuries to those tissues are more or less forever. What you are doing through therapeutic exercise is strengthening the musculature around the joint. The muscles provide most of the support and restraint to keep the joint intact relieving pain and preventing (further) injury. The right muscles, strengthened in balanced form, are what make joints strong.

ashelmire 7y ago

Physical therapy is evidence-based health practice. This is sort of a "no shit" piece. Doctors want to operate on you - it's what they are trained for, it's how the make money. Hospitals make money off of surgery. Yet physical therapy gets better results. Lookup washout studies vs knee surgery with results like this [1]. 1. https://www.scientificamerican.com/article/study-suggests-common-kne/ https://www.scientificamerican.com/article/study-suggests-co...

qserasera 7y ago
Absolutely. IMO for a lot of injuries surgery should be the last option. Anyone taking rehab not seriously should be well warned of the consequences.
- hnick 7y ago
  The doctors I've spoken to in Australia all considered surgery a last resort when I asked why they didn't mention it for this sort of thing. They will happily admit the risks outweigh the benefit until all other options are exhausted. Having universal health care would have a lot to do with that.
  - qserasera 7y ago
    I've seen a whole lot of people go through rehab who just don't want to do the work or see that time is necessary. It's really sad how they just don't allocate time for their healing.
strstr 7y ago
At face value, full-thickness tears are different. Maybe you don’t need whatever muscle you broke in half, but that seems surprising. After reading the article I’m not sure what the outcomes actually are. Did the shoulder compensate and just let that muscle atrophy? Did it reattach? Either way this is definitely not a no-brainer.
joshgel 7y ago
Yes. I'm not sure this is so true for full thickness tears, but in general I think your point stands. That said, patients also want surgery. I can't tell you how many patients I have referred to physical therapy for conditions which we know are improved by physical therapy (like routine lower back pain, minor muscle strains, etc) and they look at me like I'm crazy. I've seen it work in my patients that actually went and participated, but most go through the motions and stop going after a session or two because 'it wasn't helping'. I think part of american culture is that we want instant fixes, even for problems that have been brewing for decades like heart disease and diabetes... /endRant

simlevesque 7y ago

I don't know if they ever tried that but I play with a yoyo, looping style (2A) and it is a wonderful exercise for the shoulder area. I broke my collarbone two years ago and couldn't use my right arm for almost two months. After that I picked up yoyo and I'm certain that it helped me recover my strength and flexibility.

steve_adams_86 7y ago

This is anecdotal and people should be extremely cautious if they have RC injuries. Talk to a pro, look into proper exercise progressions, and start with baby steps even if you feel strong enough not to. But: My right shoulder was a piece of trash for over 5 years. I couldn't use my trackpad or mouse some days at work because it became incredibly hot and excruciating. I couldn't throw rocks at the beach, ride my bike as far as I wanted, drive in comfort, you name it. Just standing could be incredibly painful if my shoulder needed rest. You don't know how awesome shoulders are until they stop working. One day I decided to try the exercise route after avoiding it for a very long time. I did because someone shared an anecdote of exercise helping on reddit. I started a pull up progression using elastic straps to assist at first. I did push ups from my knees. I started doing stretches in door ways and on a big inflatable ball. I rolled myself on a lacrosse ball like the cross fitters do. If it fixes them it'll fix anything, right? Within a year I was 'cured'. I was doing pull ups with a 45lb plate strapped to my body and push ups with the same plate resting on my back. I began weight lifting fairly seriously and made it up to a 400lb deadlift by the second year. My shoulder was a limiter in my first year, but once I took up yoga as well it never bothered me again. Now, having said that, this all took a lot of time, energy, and will power. It's not easy and it's not a silver bullet. Your body will strengthen though and you can overcome biomechanical issues by working the system carefully, methodically, consistently, and with good sleep and nutrition. But again, don't jump into it and don't expect it to be easy. My experience was positive in the end, but it's a total dog along the way. If you have the money, find a trainer who understands injuries and recovery. Get on a program and commit. The best thing you can do for your body is use it. But never go too hard, and go as slow as you can handle at first. You can make it so much worse in one little moment of overdoing it. Hopefully someone is motivated by my anecdote because someone sharing theirs on reddit ten years ago really did change my life.

ambicapter 7y ago
I would say pull-ups are far more dangerous than push-ups, on the shoulders if you do wide-grip, on the wrists if you do close-grip.
- sethammons 7y ago

jeremyw 7y ago

The trial registration: https://clinicaltrials.gov/ct2/show/study/NCT02750176?show_desc=Y#desc https://clinicaltrials.gov/ct2/show/study/NCT02750176?show_d...

sp332 7y ago

A friend of mine is a personal trainer who put together an incredibly thorough personalizable program for pull-ups. It's aimed at beginners and includes instructions on building strength even if you can just support part of your weight hanging from the bar. It covers warm-ups, stretches, injury prevention, lots of technique (which is extra important if you're already injured), and how to avoid tensing up and causing more soreness the next day. The program is at https://thepullupsolution.com/ https://thepullupsolution.com/ (He doesn't talk like a content marketer in real life.)

mistrial9 7y ago
curiously similar name to the works of Jerry Robinson two decades ago, which are still for sale

Stronico 7y ago

I had a rotator cuff injury that went on for about two years before I went to a doctor. Their medical advice consisted of "Check Youtube" and they handed me two meters of resistance band. I was skeptical, but two weeks of rather easy exercises and everything was fixed. It's taken me significantly longer to train myself to remember to use my left arm for anything overhead.

grizzles 7y ago

A year ago I had golfer's elbow and it seemed like it wasn't ever going away. After years of lifting very heavy I thought, this is it - I'm fucked. Well fast forward to now and it's pretty much gone. All I did was knock down my weights, did some physio and have slowly started building back up. I'm not back on the big big weights yet but I'm at least on the big weights. Sometimes things have a simple solution.

opportune 7y ago
Just out of curiousity, did you deload on all your lifts or only one the ones that affect golfer's elbow? Substitute things like bench press for those machines that you make a "clapping" motion with?
- grizzles 7y ago
  If I used my right arm I was feeling it. And I don't do much leg exercises so I'd say I deloaded on everything except cardio/anaerobic.

whytaka 7y ago

My own anecdote is that for 7 months I didn't exercise. My shoulders hurt as I slept on my side and rested my header on my pillow with my arm cradling it underneath. It went away just a week into me restarting my exercise regimen.

maybemabe 7y ago
Cannot believe that you have described exactly the position that gives me pain for the last 2 months. Both shoulders. Never had a shoulder problem before and I am playing tennis every week for 15 years.

Ididntdothis 7y ago

I think the most important thing is to not think that one recipe will work for everybody. There are a lot of different types of shoulder problems that are all getting lumped into "rotator cuff". Try a few different things and see what helps. Also keep watching your shoulders. It's really easy to mess them up again.

deleted 7y ago

[deleted]

rsync 7y ago

Any discussion of shoulder injuries should include, somewhere, the PT exercise known as "plate halos": https://www.youtube.com/watch?v=ZG0N6JKNUQU https://www.youtube.com/watch?v=ZG0N6JKNUQU Very, very beneficial and also time efficient as it hits your shoulder from all degrees of motion with a single exercise. Further, the popularity of crossfit "bumper plates" means that a full diameter plate can be very lightweight. The idea is to work up to a normal 45 pound plate but if you are injured or a smaller female, you can find a 10 or 20 pound bumper plate that is the same diameter. (It's not very effective to use a smaller diameter plate, such as a standard 25 pound plate.) I would recommend plate halos as a core piece of any upper body strength routine - I do them in my warmups every time I am in the gym.

joker3 7y ago

The thing to keep in mind here is that studies can only compare the average effects of any treatments they consider. You don't care about that. Instead, you want to know what's going to work for your particular shoulder pain, which might be helped by exercise, or might be something that generally requires surgery.

camkego 7y ago

Has anyone determined the exact six exercises used in the study? This article mentions: "including push-ups, pull-ups, dips and reverse rows — while the end of the limb is braced." But according to the trial registration, six exercises were used. Does anyone know where to find the exact exercise regimen used in the trial? Why is this so tricky to find?

sunstone 7y ago

I've had frozen shoulder in both shoulders in the recent past. Neither was injured beforehand in any physical manner. I agree with the exercise treatment. It worked for me both times. In the end I found that swimming, breast stroke and then freestyle, worked best for me. For me the first couple of lengths were searingly painful but after ten or fifteen minutes it was really surprising how quickly the pain diminished. Each swimming session kind of followed the same pattern, acute pain at first that slowly faded. After maybe a dozen sessions over six weeks it was pretty much gone. One more anecdote.

Fjolsvith 7y ago

I experienced a period of forced inactivity which caused a calcium buildup in my right knee. It was very painful to bend past 15 degrees with my weight on it and would collapse under weight. A friend I had who was a big fitness buff suggested I start walking stairs to fix it. I started out with 5 minutes a day for the first week, then 10 for a week, then 15. I climbed a single story flight of stairs and then turned around and descended, repeating for the workout time. After a month, the calcium buildup was gone. After three, my legs were so strong I felt like I was bouncing on springs when I walked. I was taking the steps two at a time when I climbed and didn't get winded at all. Great aerobic workout!