Biceps Tendonitis

[jacob cloud]

Rip,

Just got back from my ortho and have been diagnosed with biceps tendonitis of the right shoulder, mostly of the long head where it rests in the humerus, but also some irritation of the short head near the coracoid process. I received a cortisone injection, topical NSAID gel (for when the cortisone wears off), instructions to ice, rest, and a prescription for PT. Since my insurance runs out on Monday and I share your great love of PT's in general, I'm looking to you for a bit of advice on how best to continue training while making sure this thing heals properly.

I'm 6'1", 230lbs, and here are my current 1RM lifts (thanks completely to your books and articles - I was a weakass chump 2 years ago):
BS: 445, DL: ~465 (est), PC: 225, BP: 255, OHP: 175, Push Press 225

I am trying to hit the magical 200/300/400/500 numbers, and have jumped back on SS/TM full force, along with GOMAD and lot of meat, fruits, and veggies. My current workout schedule looks like this:
M: OHP/BP 3x5, BS 3x5, Chins 3sets, Dips 2sets (just added the dips)
W: BS 2x5 (light), BP/OHP 3x5, DL 1x5
F: OHP/BP 3x5, BS 1x3-5RM, PC 5x3, Pullups 3sets
(So...SS linear style for OHP/BP, Volume/Recovery/Intensity for BS, a mild twist on the novice routine in PP - once I stall on the pressing movements I will shuffle the whole thing to TX Method)

I have cut out all metcon work, and am focusing on full recovery (food, sleep, etc.). I placed OHP/BP work first in my workout because I feel this is a personal weakness (I've never had any luck making major progress there, as opposed to squats, which come easily to me w/o much volume), and based that on Starr's article "Maintaining Balance." (http://ditillo2.blogspot.com/2009/03/maintaining-balance-part-two-bill-starr.html) I am OK making slow progress on squats and trying to milk some more linear gains out of my pressing work.

However, how does my latest injury factor in? I have read in several places to "stop going overhead" but this contradicts the 1:1 pressing:bench ratio you typically give out. I've read that ring work (ring supports, ring dips) can help stabilize things such as this, and am willing to work that in if appropriate. If I am performing too many chins or pullups, I can cut that out. I haven't done much "bicep work" since I started following your programs, do I need to?

Any guidance is appreciated. My next long ass block of text will be an email to Michael Street @ CFE to schedule some one on one time to really dial in my form on the big lifts and possibly go for even bigger numbers down the road.

Many thanks,

Jacob

[Mark Rippetoe]

You have not mentioned your thoughts on how this injury was acquired.

[jacob cloud]

Good point. Rolled through my logs and it's been bothering me all summer. My left shoulder had an AC decompression surgery awhile back. Here are some pertinent notes:

MAY - performing standard SS routine
5.04 Right distal bicep pain after bench press
5.06 Right shoulder pain (rear/side of delts) during press - doubled fish oil intake
5.13 Press felt OK
5.18 Right shoulder pain during squats
5.20 Press PR, shoulders OK, fish oil seems to be working
5.21 Massage, emphasis on right shoulder
5.30 Pulled/strained right trap behind shoulder during press

JUNE - Altered training for Mt. Rainier summit attempt
6.11 Quit NSAIDS based on Kstar's article (http://sanfranciscocrossfit.blogspot.com/2009/06/get-off-ibuprofen-peoples.html)
6.20 Still in pain - right shoulder, bicep, forearm all whining distinctly after BS 445 PR

JULY - Still training for mountains, minor strength work
7.15 Shoulder feeling better
7.23 Shoulder decent, added shoulder dislocates w/ broomstick before/after workouts

AUGUST - CFFB WODs...half-assedly
8.6-13 Sick
8.14 Way too many powercleans, shoulder on fire

As you can see, my training has been...stupid for some of the summer. I was trying to get my fat ass up Mt Rainier but ITBS in my right knee stopped that. During that time (June/July), I was focusing on lots of hiking, adding heavy squat work 1-2x/wk, along with a lot of chins, dips, ring dips, and push presses. Not very structured, but I lost about 15 pounds of fat. I also distinctly remember my shoulder bothering me extensively after a day of throwing deep bombs in a pickup football game.

So...the injury could have been acquired from anything from squats to presses. PC's seem to aggravate it. Press seems to make it "sore." OR, it could just be that my Tom Brady impression was the real kicker. Any input you have has to beat the hell out of what my PT told me this morning (no overhead work, pink DB curls, theraband crap, etc).

[Mark Rippetoe]

Have you had an MRI on the right shoulder? I'll bet there's an AC inferior spur, and I'll bet the throwing is what made it go acute. As for rehab, you're probably going to need some type of short-term NSAID, hard massage, and some 90-degree-elbow barbell curls for sets of 25.

[Smolandski]

Why 90-degree-elbow barbell curls and not full range curls?

[Mark Rippetoe]

Because they address the proximal bicep function, and this is how you'd rehab the injury.