CrossFit and Shoulder Injuries

For those of you who do not know what CrossFit is, it is a mode of exercise that targets cardiovascular and respiratory endurance, strength, flexibility/mobility, stamina, power, speed, agility, coordination, and balance. The workouts change daily and can be performed by individuals at all fitness levels. Specializing in the shoulder, I have recently seen a handful of patients from the CrossFit community with pain in this region and thought I would address it. 

Since CrossFit performs a variety of exercises that include Olympic and gymnastic movements, the shoulder can be placed in extreme positions that can put stress on important structures within the joint. Because I believe that CrossFit is one of the best modes of exercise out there, I want to educate you, not discourage you, from participating. I believe that if you have a better understanding of the shoulder complex, you can incorporate this knowledge into your workout routine to avoid injuries, and if injured, treat yourself immediately. 

The first thing you need to know is a brief Anatomy 101 of the shoulder complex. Between the scapula (shoulder blade) and shoulder joint, is the subacromial space. In here, three structures are housed: the supraspinatus (one of the rotator cuff muscles), biceps tendon, and subacromial bursa. Making up the rest of the rotator cuff are two external rotators (infraspinatus and teres minor), and one internal rotator  (subscapularis). The biceps tendon attaches at the labrum, which originates from the socket of the shoulder’s ball and socket joint and provides stability.  

The most common condition I typically see with the shoulder is what we call subacromial impingement syndrome. This occurs when one of the three structures within the subacromial space is irritated and inflamed. There are multiple reasons as to why this can happen (and as a physical therapist, this is where I come in to diagnose and treat). Some of the most common reasons for this condition is due to poor thoracic mobility, weak scapular stabilizing muscles, decreased muscle length, poor posture/scapular positioning, and imbalances in rotator cuff internal and external strength. When one (or more) of these occur, we see tilting of the scapula, which closes the subacromial space. 

For example, try this: slouch down and try to raise your arm forward as high as it will go. Now, sit up as straight as you can and perform the same motion. It’s a lot easier, right? That’s all because of scapular positioning. I’m sure my patients are sick of me using those two words all of the time in the clinic, but it is vital in preventing and treating these conditions. Now let’s relate this to the CrossFit world. Say you have a shoulder that has been aching (only a little bit so you think you can still perform today’s daily workout). Most of my patients who participate in CrossFit have massive deltoids, beautiful upper traps, and chiseled biceps, however muscles such as the lower trapezius, serratus anterior, and other vital stabilizing muscles are underdeveloped. Because of this, we begin to see tilting and poor scapular positioning. Now perform an overhead squat (let’s say 100 lbs) over your head. The subacromial space closes even more, putting increased stress and irritation on those structures.  

Standard push ups, handstand push ups, push press, push jerk, kipping pull ups, hang power clean, hang power snatch, ring dips, overhead squatting, and many more are all great exercises, however are very stressful on the shoulder - if you don’t have proper scapular positioning and proper stabilizing strength throughout the rotator cuff and scapula. So the next time you are performing these, focus on where your shoulder blade is positioned and try to avoid what we call “winging” by keeping the shoulder blade “pinched back”. 

I have also come along a program designed within the CrossFit community called Bulletproof Shoulders (http://www.youtube.com/watch?v=ACAz6HFj1xE) out of CrossFit New England (which I highly recommend you include in your routine) that target the scapular stabilizers that prevent “winging” while working out from occurring. If you do experience shoulder pain while working out - DO NOT WAIT. I have too many patients that come in to see me saying the same thing, “my shoulder didn’t hurt real bad and I figured it would go away within a day or two, so I worked through it.” I usually see them three months later with full blown subacromial impingement syndrome. I always recommend icing as soon as you can, as well as taking an NSAID (such as Aleve). The sooner you can decrease the inflammation, the sooner you will be back to participating in CrossFit symptom free. I provide free consultations for all injuries, so take advantage and call me if you start to experience any symptoms.

See the full article: http://www.wiscopt.com/1/post/2014/01/crossfit-shoulder-injury-prevention.html

Michael Roberts, PT, DPT
Owner/Doctor of Physical Therapy
Wisconsin Orthopedic Physical Therapy


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