I originally wrote this in an effort to spread awareness of shoulder pain and why it happens in our CrossFit world. The 2016 CrossFit Open is rolling right along, and I figured I’d share for all to understand shoulder pain and what to do about it.
CrossFit Recovery Blog 1: Shoulder impingement
Shoulder impingement is the primary cause of most of our shoulder pain in CrossFit. You may experience a popping or clicking sound, pain that radiates down the arm, general shoulder weakness, or even trouble lifting your arm above your head. This type of injury occurs when your tendons become “pinched” and stuck in the subacromial space in the shoulder. If you do not seek treatment, this could lead to constant fraying of the tendon, chronic inflammation, and possibly, a tear.
What causes this?
The key aspects in CrossFit come down to four common reasons we suffer from shoulder impingements:
- Rotator cuff weakness
- Forward rolling of the shoulders (abnormal posture)
- Overactive deltoids
- Muscular imbalance of the scapulae
- Rotator cuff weakness
Let’s start off by describing your shoulder joint. The shoulder joint itself is referenced as a ball and socket joint. When you hear the term “ball and socket”, it may lead you to believe that your shoulder is a much protected joint that sits deep inside of something. It is actually completely opposite of that thought. Picture a large golf ball on top of a very small tee. This, unfortunately, is the picture of what your shoulder (glenohumeral) joint looks like and this is why it is so very important to utilize strength to protect it. This is the very means of the rotator cuff. It is made up of four muscles designed to protect the shoulder socket throughout all ranges of motion. If weak, the humeral head (top of your arm bone) will tend to excessively move upwards which then closes off that subacromial space.
- Forward posture
To say we live in a society where abnormal posture is common is an understatement. Our bodies have been redesigned in such an awkward, shortening posture that can and will eventually affect every aspect of the way our body functions. To say the least about this (I could write a whole blog), it is a combination of tight chest muscles, weak upper back muscles and poor thoracic spine mobility. This position screams dysfunction and alters the proper mechanics of the scapula (wings or shoulder blades). If your scapula are not working properly and are unable to fire in an overhead movement, there goes your shoulders, rounding forward, causing the imbalance!
- Overactive deltoids
Your deltoid is made up of three parts, anterior, medial and posterior deltoid. It is the primary muscle involved in elevation of the shoulder joint (raising your arm above your head). In a perfect situation, there is a nice balance between the deltoid and rotator cuff muscles in overhead activity. Again, just like the forward posture idea, imbalance between the deltoid vs. rotator cuff can lead to the ball moving upward in your socket, decreasing that subacromial space. When we perforam dynamic overhead movements in CrossFit such as the push press, HSPU, Oly lifting, we are placing a huge emphasis on deltoid strength. The nature of these movements can create an imbalance that could lead to impingement issues.
- Scapular imbalance
What was the first muscle that you noticed to develop first when you began CrossFit? Was it your traps? Most of us will agree, our traps became quite noticeable. CrossFit is very trapezius dominant, as a lot of movements are pulling from the floor or hips. There is a group of muscles that stabilize your scapula: upper trap, lower trap and serratus anterior. Let’s call these muscles a tripod. In order for a tripod to work, they all must, for example, be the same length and/or fire correctly. If one of the legs of that tripod is off balance, the stability of it is compromised. As in what we do, we are very upper trapezius dominant. That will throw off your tripod. It results in not allowing the scapula to contract and rotate upwards in the overhead position.
What do I do to fix this?
In order to keep your rotator cuff muscles strong throughout W.O.D’s, you have to first be sure to take adequate time to stretch and hydrate (as with all muscles of the body). You need to rid the toxins of creatinine and lactic acid that accumulates in these muscles. You can do it yourself by foam rolling, utilizing the lacrosse balls, or have someone do it for you, by scheduling a massage.
Nutrition is key – not only hydration, but adding Magnesium to your diet. 400mg after a workout or 30 minutes before bed. I recommend Pure Pharma: $25 for 120 capsules. Nutrition is another blog for another day.
Compression is a great tool also. Wrapping your arm with voodoo floss or sitting in the Recovery Pump Arms will also push out unwanted toxins. A dam is a good reference for this. When the water is released, the lake will rush with fresh water. The 30 second squeeze causes fresh, oxygenated, nutritious blood to be brought into the injured area, while pushing the stagnant, stale blood out. (Which that stagnant, deoxygenated blood will flow through the veins, back to the heart where it will become oxygenated again and flow out through the arteries, what a cool cycle!) This fresh oxygenated blood contains the nutrients necessary to heal damaged tissue.
Graston soft tissue therapy is probably one of the absolute best things you can do for the rotator cuff muscles, as I am truly biased, but see firsthand how effective this method is. It acts almost like compression, pushing out (with a tool) unwanted toxins and promoting blood flow to the tissue.
RockTape will actually lift up the first layer (epidermis) of skin which decompresses the injured tissue below it. Decompression leads to proper blood flow. Another great use that RockTape can provide is joint and muscle support. Finding a RocDoc that understands the proper protocol can help decrease your recovery time.
Laser therapy is an incredible resource that you all have available to you. The LiteCure laser is the laser used in the NFL, NBA, NHL and most all D1 colleges. To have this at your disposal and not be utilizing the power of a laser is crazy to me! The laser has what’s called a photobiomodulation effect to your tissue. The laser pumps in light energy via Joules deep into your tissue. That energy will have a reaction with your cell (the basis of all living things). The adenosine triphosphate (ATP) is your cells energy. The laser helps to increase the ATP in your cell, allowing your tissue to recover faster and heal your tissue.
Crossover Symmetry is also a tool to carry in your toolbox. There are certain protocols for pre workout, post workout, plyo training and IRON Scap. I have most of my adolescent (still developing spines), utilizing the active pre workout program in order to build better posture (most have their noses in their cell phones/devices all day). I’m a huge fan right now of the post workout protocol for my CrossFit athletes. The post workout requires more work with negative sets. These negative sets help to break up an adhesions or scar tissue that begin to lay after a workout. Picture you have a handful of hay. Toss that hay on the ground-that’s how your scar tissue forms- twisted in no particular rhyme or reason. Negative exercises via Crossover Symmetry pull apart that scar tissue, not allowing it to lay which keeps your muscles mobile.
Now comes my shameless plug. All of this can be found at my office, Sports Performance+Spine, LLC. A chiropractic adjustment is just the basis of what we can do for you. Call (724) 519-8261 to schedule! Have a look at the website: www.sportsperformanceandspine.com. Thanks for reading!