The Strong AF Climbing Podcast 24. Shoulder Series Part III - Rethinking rehab & surgery for shoulder pain
In this episode, I unpack why traditional shoulder rehab often fails climbers — and how to rethink the entire approach. Using guided reasoning and evidence from leading studies, we challenge the most common myths about shoulder pain and rotator cuff injuries.
You’ll learn:
🔹 Why rest and avoidance aren’t the answer
We explore why rest often leads to temporary relief but long-term setbacks — and how graded loading is the true medicine for shoulder pain.
🔹 The problem with “banded exercises forever”
Progressive overload matters. We break down what kind of exercise actually works — and what the latest research says about exercise.
🔹 How to train through pain — safely and effectively
We dig into the Smith et al. meta-analysis showing that tolerable pain during rehab isn’t harmful — and may even improve outcomes when managed correctly.
🔹 Why surgery isn't the gold standard — and might not be necessary at all
We review landmark studies showing that:
Pain does not correlate with tear size (Dunn et al.)
Most small-to-medium rotator cuff tears can be rehabbed without surgery (Moosmayer et al., Kukkonen et al., Karjalainen et al.)
Even full-thickness traumatic tears respond well to rehab (Boorman et al., Kuhn et al.)
Failed surgical repairs don’t always lead to worse outcomes (Holtedahl et al.)
Sham surgeries work just as well as real ones (Paavola et al., Schroder et al.)
🔹 What effective rehab actually looks like for climbers
We close the episode by showing what real rehab should include: climbing-specific loading, total-body strength, education around pain, and a progressive plan that actually builds capacity instead of avoiding discomfort.
This episode is packed with practical insights and paradigm-shifting takeaways that will help you — or your clients — stop spinning their wheels and start seeing real progress.
🎧 Hit play now and find out why your shoulder rehab hasn’t been working — and what to do instead.
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