Shoulder Pain in the Overhead Athlete
Published March 1, 2015
Shoulder Pain in the Overhead Athlete
Hi everyone! I have been asked by our CrossFit staff to write a short article about something musculoskeletal. I would like to focus on the one thing that I get asked about most by crossfit athletes. Without a doubt it is shoulder pain without a known traumatic event (no known injury, just starts hurting out of nowhere). Now there are many different shoulder conditions and injuries that occur in all sports. By far the most common shoulder condition in crossfit athletes is subacromial impingement. Now the following information is my opinion and is debatable, but it is based on evaluating lots of shoulders, a painful amount of school, ridiculous number of hours in sports medicine clinics, and performing hundreds of shoulder surgeries. I have been asked about shoulder pain that “began out of the blue” by many many crossfitters and I have developed a little remedy that seems to work well for most folks with subacromial impingement.
Subacromial impingement (SAI) is a conditions in which the tissues that lie underneath the acromion (That bony projection of the scapula bone over the side of the shoulder) are inflamed. The soft tissues under the acromion are comprised mostly of bursal tissue (bursa is soft tissue that provides a cushion between bones and tendons or other soft tissue) and rotator cuff tendon and muscles (the muscles that connect that humerus bone to the scapula). Now the rotator cuff provides a great deal of stability to the shoulder and is a main internal stabilizer of the shoulder.
Some people have a genetic predisposition to SAI as the acromion slopes downward into the tissues (estimates anywhere from 30-70% of people), and this explains why everyone does not have problems (their space is much more open). Common ways SAI presents itself is pain that is not related to an injury and pain with overhead activities. It is common to have pain with crossing the arm in front of the body. It often hurts at night when sleeping on the affected shoulder. It often hurts down the arm to sometimes even the elbow.
I believe what happens in crossfit is that when there are many overhead exercises i.e. push press, jerks, and handstand push-ups, it tends to aggravate this area due to several factors. If the internal muscles are not in balance, or simply just weak, then the shoulder is not optimized and it leads to impingement, especially when doing many repetitions.
Now the good news is that I believe there is a remedy (besides ice and motrin or other invasive treatment modalities). It might surprise you that the solution is not to rest and let it get better--but quite the opposite. I believe that focusing on those internal stabilizers will help to “rebalance” and strengthen the shoulder to prevent further problems. To do this I recommend a simple sequence of focused shoulder exercises three times a week. The trick is to do these exercises with the intent on working hard, raising the heart rate and slowly increasing weight as strength improves. They are quite simple but start with three sets of this sequence only taking breaks after you complete all thirty reps. With dumbells complete the entire set by performing ten lateral deltoid raises, ten forward deltoid raises, and ten reverse deltoid raises for a total of thirty repetitions (again do all thirty reps three times when you start then after a couple of workouts increase to five sets). Do a light weight to start and then work up in weight as you get stronger. Most guys will start somewhere from 15lbs to 30lbs while the women will work with 5lbs to 15lbs. Now another important point is to only bring your arms up to 90 degrees or parallel to floor. Not to bring the arms above parallel as this will possibly aggravate the situation. See the images below.
The shoulder is very complex, and this is only one problem, but the most likely for folks doing high repetitions of overhead work and pain that is very achy and bothersome without a significant known injury. There have been many people who have dealt with this particular issue without any invasive treatments--simply by doing these exercises. Of course if there is continued pain, or another reason to think that this might not be just a simple case then please go see your doctor! Good luck with the rest of the open and see everyone at the gym!