What is the most commonly injured area in CrossFit athletes?

The shoulder! (reference)

Even if you are not a crossfitter, this article will contain many helpful tips on how to get your shoulders moving better to set up up for less discomfort and better function!

This wonderfully mobile joint can be a source of pain and frustration. Fortunately, there is much we can do to put ourselves in positions to feel and move better to be stronger, healthier and happier.

Anatomy Overview

Let’s start by talking about the shoulder’s structure and function. First and foremost, the shoulder is designed to move. In fact it’s the most mobile joint in the body. It is often described as a ball and socket joint similar in architecture and proportion to a golf ball on a tee. 

What prevents that large ball from falling off the small socket? A combination of the ligaments, labrum, joint capsule and muscles. The joint capsule, labrum and ligaments are connective tissues that surround the ball to hold it in place. When you reach your arm up the ball spins, rolls and slides in the socket. The capsule stretches to permit motion as the labrum and ligaments restrict the ball from falling out of the socket. The rotator cuff muscles activate to suck the ball into the socket. Larger muscles of shoulder, chest and back further stabilize the region. 

When these structures are mobile, balanced and strong, the shoulder moves efficiently through its movement overhead or behind the back. If our shoulders lose range of motion, strength or coordination, stress increases on the joint, labrum, ligaments and tendons. Additionally, a poorly functioning shoulder may cause compensation at our necks, and lower backs, often exposing those structures to higher rates of loading. Thankfully all tissues in our body are resilient and adaptable. When stress is just right, we become stronger! On the other hand, if the stress of an activity exceeds a tissue’s capacity the result is usually pain.

Common Dysfunctions

I work with barbell athletes who have shoulder pain all the time. Interestingly, the underlying issues contributing to their pain tend to be common. The big 4 areas of dysfunction are as follows: stiff upper backs, restricted lats and shoulder joints, decreased rotator cuff  strength and scapular coordination. 

Instead of waiting around for an injury to happen. Let’s present you with a system to self test and treat yourselves to set you up for success. As the old saying goes, “an ounce of prevention is worth a pound of cure.“

Assess, Don’t Guess!

Here’s the simple, yet effective test: raise your arm overhead! Now what we qualify as “good” when the arm is raised: it is perpendicular to the ground, your head is vertical, lower back in neutral, elbow straight, shoulder blade not shrugged. If someone is standing next to you as you do this they should be able to see your ear with your arm slightly behind your head. If you are unable to perform this movement then your overhead shoulder mobility is compromised. You may be driving a car with a slowly leaking tire. 

Movement is Medicine

Next, try these exercises below. After performing each, return to the shoulder raise test. Note your overall mobility, and how it feels. If you are moving further, feeling better and/or compensating less, then you have identified a great exercise to unlock your shoulders to make them more resilient and super!

Shoulder mobility is heavily influenced by the upper back, which consists of the thoracic spine and ribcage. The shoulder blade slides up and down the thoracic spine and ribs. If this region of the body is stiff, then the range of motion will be compromised. Perform 6 sets of 10 arm raises. After each set move the balls an inch lower on the back.

Next we will mobilize the muscles and tissues governing the shoulder’s position and mechanics of overhead mobility. The largest muscles attaching to the shoulder is called the latissimus dorsi. It is our pull up muscle and, also, plays a role in stabilizing the lower back. If we sit a bunch, poorly organize our spines or perform more pulling than pressing exercises, then this muscle’s flexibility becomes compromised. Work on each shoulder for 2 minutes.

Think of the shoulder joint capsule as an incredibly strong seran wrap. It must stretch to allow the ball to move on the socket. Rotation is the most simple method to improve its movement. For this exercise I recommend a light to medium sized kettlebell for 2 sets of 20 reps.

Next up, let’s focus on moving with coordination. In a study looking at 79 crossfitter’s with and without shoulder pain, a group of PTs and MDs tested the strength, function, and muscle activation to identify any differences between the two groups. What they found was the activation of the lower trapezius, which assists in upward rotation to limit excessive shoulder shrugging, was decreased in the painful shoulder group. This exercise should be performed smoothly, and slowly for 2-3 rounds of 8 reps.

Last, but not least, we turn our attention to rotator cuff strength. A study of 29 male crossfitters identified a deficit in strength of the external rotators of the shoulder. In previous studies of volleyball, tennis and baseball athletes, a decrease in the external rotators correlated with increased injury rates of the shoulder. It would stand to reason that a complimentary strength routine to enhance the strength of these muscles will decrease shoulder issues and improve performance in crossfit athletes.

In this exercise, I recommend counting the number of repetitions you complete till you hit failure. Use a weight between 2 to 5 pounds. Your shoulders should complete a cumulative number of repetitions that are within 10% of each other. If not then you have a significant deficit! When including external rotator exercises in your weekly schedule, aim for 2-3x a week and 1-2 sets of  AMRAPs.

That’s a Wrap

It is my hope you are able to find an exercise that improves how you move. I recommend using an exercise you found helpful as part of your warm up, as accessory work, or on your recovery days. If you can commit to doing the drill consistently over a 4 to 6 week period of time you will notice improvements in how you feel and perform! Brownie points for posting a short video or picture of you completing 1, or all of the exercises on Instagram or Facebook.  Don’t forget to tag @joenorton_pt!

If you or someone you know is struggling with shoulder pain, let’s find a time to talk to help you find the solutions to enable you to feel and move better!