The Strong AF Climbing Podcast

24. Shoulder Series Part III - Rethinking rehab & surgery for shoulder pain


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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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The Strong AF Climbing PodcastBy Natasha Barnes

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