A tight shoulder capsule is not an injury.  But don’t try telling that to someone suffering through one.  It is an excruciating experience.  The pain makes it impossible to sleep.  It robs you of your range of motion turning simple tasks like dressing into gruelling tests of pain tolerance.  It may incapacitate your arm entirely.  It is a very disabling condition even though there may be no actual injury present.

So what is it?  Plain and simple, it is a result of inflammation inside the shoulder capsule.  And because the shoulder contains so many moving parts, even a little inflammation can cause a lot of pain and dysfunction. 

What causes an inflamed shoulder capsule?  It could be from pushing too hard in a workout if, for example, you were participating in an athletic competition.  It could be from inadequate sleep, if you were working extra long hours.  It might be triggered by stressful situations like caring for a sick loved one.  It could be from eating inflammatory foods, anything high in carbohydrates like lasagna or cookies would qualify.  It could be from holding it in a bad position for a prolonged period such as during sleep.  Most likely it is a combination of two or more of the above factors that conspire to create the perfect storm.

How do you treat it?  Movement.  The lymphatic system is responsible for clearing inflammation but unlike the circulatory system, the lymph has no heart muscle pumping it, instead, muscular contractions are required to pump inflammatory waste products out of your body.  The more sedentary you are, the longer it takes to clear that painful inflammation.  But when you’re hurting, movement is the last thing you feel like doing.

Most folks would prefer to pop a pain killer and use a scan or a doctor’s rest orders as an excuse to avoid getting back into action.  Lucky for me, when I chose to make a career as a fitness coach, I burned my bridges.  Moving is not optional for me.  My ability to feed my family depends on me staying in action.  Painful or not painful, I must move to survive so I am plenty motivated to recover my strength and pain-free range of motion ASAP.

What’s good for a tight shoulder capsule?  Hanging.  If you have an inflamed shoulder capsule, you do not want to hear this.  Just getting your arm overhead is painful enough without adding the insult of suspending your bodyweight from the traumatized limb.  But hanging repositions the shoulder in the socket and creates space which alleviates painful constrictions.  It’s the best thing you can do for shoulder pain caused by tightness.

Here’s how you do it:
1) Find a pull up bar low enough to the ground that you can reach it with your feet still on the floor 
2) Use your good arm to gingerly guide your restricted limb overhead   
3) When you have both hands on the pull up bar overhead, slowly soften your knees gradually taking more weight in your hands until your discomfort level reaches about a 3 out of 10.
4) Now just stay there and breathe into your diaphragm allowing yourself to relax into this position for 10-30 seconds
5) Then slowly take your weight into your feet again and come to standing, carefully releasing the affected arm and even supporting it with the good arm if necessary 
6) Take a moment to recover and then repeat the steps a second and third time.

Do this a couple times each day and you will find your pain-free overhead range of motion gradually improves.  If you spend a lot of time seated in front of a computer all day, your shoulders are probably already tight and rounded forward compressing the space in the socket.  Daily hanging is key to restoring your posture and correcting shoulder function.

Here is a case study documenting the shoulder rehab process over the course of several days.  What we are looking for is small but consistent increases in strength and range of motion each day without any events that produce setbacks.  

Here are a few benchmarks I use to monitor daily progress:
1) Ability to raise arm overhead
2) Can hang without pain
3) Can sleep through the night
4) Shirt on/off without pain
5) Can flush toilet with affected limb

Day 1: Tuesday October 1st
Woke at 3am with excruciating pain in left shoulder.  Rose to try to release and found myself unable to raise arm.  Unable to sleep, proceeded to attempt the usual recipe of Original Strength, Muscle Balance and Function and banded shoulder rehab exercises.  Unable to perform most.  Did the few portions of my weekly reset that the shoulder permitted.  Skipped swimming, unable to change clothes or climb into/out of pool. 

2pm physio appointment resulted in 20% increase in range of motion.  Returned home to repeat rehab exercise efforts adding in some isometrics. 

Progress Report
1) Ability to raise arm overhead - no
2) Can hang without pain - 10 seconds with feet on floor
3) Can sleep through the night - no
4) Shirt on/off without pain - no
5) Can flush toilet with affected limb - no

Day 2: Wednesday October 2nd
Another attempt at reset.  Able to include a few more movements than yesterday but range of motion still severely limited.  Practiced all rehab exercises to the extent of my ability.

Progress Report
1) Ability to raise arm overhead - no
2) Can hang without pain - 30 seconds with feet on floor
3) Can sleep through the night - no
4) Shirt on/off without pain - no
5) Can flush toilet with affected limb - no

Day 3: Thursday October 3rd
Back in the gym.  WOD includes running, kipping pull ups, strict pull ups and weighted pull ups.  I find that I can finally hang without pain and am even able to perform a few lat pull ups.  The arm is comfortable running which is an improvement.  Each round I perform 15 slow ring pull ups then 5 each of slow, strict pull ups on the bar and then on the rings.  Reaching up for the bar and releasing the bar is uncomfortable but I am pleased to discover the discomfort is minimal if I perform the pull ups very slowly and intentionally.  In the first round I am limited to singles but in the 2nd and 3rd round I am able to do sets of 2 and 3 pull ups at a time.  Tried to walk my feet up the wall for a handstand hold but found it too painful.

Progress Report
1) Ability to raise arm overhead - yes!
2) Can hang without pain - yes!
3) Can sleep through the night - no
4) Shirt on/off without pain - no
5) Can flush toilet with affected limb - no

Day 4: Friday October 4th
Today I wanted to catch up on Wednesday’s WOD which I missed.  It was an EMOM.  The first minute started with wall balls, I could throw the ball up but even with the 4lb ball, catching it was painful.  Instead I set up the crossover symmetry bands at their lowest setting, held the handles and did very slow and controlled banded thrusters at a pace of 1 rep per 5 seconds which only got me 10 reps per minute but allowed me to practice the full range of motion.  The shoulder was tender in the overhead position but did not exceed the 3 out of 10 pain threshold.  I expected the deadlifts to be no problem but in round 2 my right knee tweaked painfully on the second rep forcing me to drop the barbell.  I tried again in round 3, this time the knee tweaked on rep 3 so deadlifts were a bust.  For muscle ups I did seated banded muscle ups with a thick green band and performed three strict, slow reps.  At first it felt like it might be too painful but when I slowed down and focused on proper mechanics I was pleased to find the movement therapeutic as long as I did not work into fatigue.  Was able to walk my feet up into a handstand and hold it for 10 seconds with only mild discomfort.

Progress Report
1) Ability to raise arm overhead - yes!
2) Can hang without pain - yes!
3) Can sleep through the night - yes!
4) Shirt on/off without pain - yes!
5) Can flush toilet with affected limb - no

Day 5: Saturday October 5th
Attended Big Cat’s 10am group class which was a 12 minute AMRAP of ring dips and box jump overs.  I went very slowly focusing on small sets of very strict ring dips, occasionally taking a break to do a bar hang in between sets to alleviate any impingement.  I completed 2 rounds Rx’d.

Progress Report
1) Ability to raise arm overhead - yes!
2) Can hang without pain - yes!
3) Can sleep through the night - yes!
4) Shirt on/off without pain - yes!
5) Can flush toilet with affected limb - yes!

Day 6: Sunday October 6th
Another reset, this time I could complete most of the movements with the exception of the Sott’s press.  The forward and backward rolls were very scary but despite my fear, did not cause any significant discomfort.  At first the judo push ups and Turkish Get Ups felt too painful but by slowing down and really concentrating on perfect execution I was ultimately able to do a very short set of each.  The Turkish Get Up in particular required all the rotator cuff muscles to adjust position and after two reps the affected arm was exhausted.  I followed the reset up with the kettlebell swing/goblet squat WOD with a 45lb kettlebell. 

At this stage I have recovered more than 90% of my range of motion.  The shoulder is still achy with sharp pain in certain positions if I am not careful.  But it is more or less usable and quickly regaining strength through most ranges of motion.  I estimate a week or two before it is fully operational and I anticipate many WOD modifications in the week to come but I am pleased with the progress.

Life is going to hand you setbacks.  Sometimes even sleeping can leave you temporarily incapacitated.  The worst thing you can do however, is to stop moving.  The secret to quick healing is to keep moving and keep mildly challenging the irritated or injured tissue as it repairs.  And don’t forget to feed it lots of high quality protein!

Monday
Here’s some different modification options for you today:
If you cannot do the 800m run, try a 400m single dumbbell carry at 35/50lbs.  Carry teh dumbbell anyway you want.  It is not that heavy and you can put it down to take a break if need be.  Avoid the temptation to sell yourself short by going lighter.  This is not a heavy load! 

If you do not have unassisted pull ups you might try a progression like this with your pull up option increasing in difficulty each round: 
Round 1: Beat Swing pull ups from a box
Round 2: Ring Rows
Round 3: Band-assisted Pull Ups

Warm Up
1 min Each:
A. Ring Rows
B. Cross Crawl March
A. Bar Hang
B. Skipping
A. Lat Pull Ups
B. 25 ft Shuttle Runs
A. 200m Run
B. Beat Swing Pull Ups on a Box

Tech
Pull Up Options

WOD
800m Run
25 Kipping Pull Ups
800m Run
25 Strict Pull Ups
800m Run
25 Weighted Pull Ups

Finisher:
50 OHS