Friday 6/5 A Message from Jim S

 "Running Tommy V"

21 Thrusters

400m Run

7 Rope Climbs (16/12)

15 Thrusters

400m Run

5 Rope Climbs

9 Thrusters 

400m Run

3 Rope Climbs

 

Shoulder Pain Management by Jim Sullivan

After operating at Crossfit Redondo for a few months now I’ve noticed another major area of complaint is shoulder pain. Often, members describe their ailment as having strained their “rotator cuff”. The term has become a catch-all for describing any issue with mobility in the shoulder. Normally it is fine to just point to an area of pain and with some basic description I can assess what massage action will be benefit the athlete most. However with the shoulder, there is a lot going on and it’s not an area where the classic “push through the pain” is always the best option. My goal is to help educate those who are reading this so that they can gain a little more understanding of the Rotator Cuff and how it affects your workouts. Ultimately I’d like everyone at the gym to have a basic understanding of shoulder anatomy so that when the occasional injury begins to present itself, you can make an educated decision to stop the activity of modify the movement to finish the workout.

The Rotator Cuff consist of the four muscles and tendons. These originate on the Scapula (shoulder blade) and insert on the Humorus (upper arm). These muscles provide stability to the shoulder joint and allow for the great range of motion that shoulder enjoys. However such a great range of motion comes at a price. The inherent mobility of the shoulder means that there’s a lot that can go wrong when the individual muscles and tendons of the rotator cuff are put under stress. Below is a diagram of the muscles of the muscles the rotator cuff.

Muscle NameMuscle Action

SupraspinatusAbducts Humorus / Raises arm (to shoulder level)

InfraspinatusLaterally rotates Humorus / moves upper arm outward

Teres MinorLaterally rotates Humorus / moves upper arm outward

SubscapularisMedially rotates shoulder joint / moves shoulder inward

Each muscle in the rotator cuff allows the Shoulder Joint and Humorus to move in different ways. Infraspinatus and Teres Minor sit right next to each other, so their actions are basically the same. Below is another helpful diagram that demonstrates the points of pain that can occur when one of these muscles has become strained.

Supraspinatus is the common culprit when the Rotator Cuff is injured. This is because it is involved with just about every action of the shoulder since it needs to be activated in order for the Humorus to move. Exercises such as HSPU’s, Press and any Overhead movements put a considerable amount of pressure onto Supraspinatus. It’s not necessarily a bad thing to put major pressure onto these muscles. In fact the only way to gain strength is to push these muscles. It’s now important to learn what your limits are, and what to do when pain arises.

Often times the pain you feel in the shoulder is actually a muscle imbalance coming to the surface. For instance if you have no history of shoulder pain but you’ve recently developed a little bit of discomfort after a pull-up heavy workout, this may be a weakness in one of the aforementioned muscles. Chances are one of the three is not quite as strong as the others and they are becoming irritated by compensating. Unfortunately this is the first step towards major problems since extra stress on any particular aspect of the rotator cuff will lead to injury. Fortunately, at this point, if the weak muscle can be identified and strengthened the potential issues can be avoided. Therefore it is important to mention any discomfort to a trainer, or to myself. We can give you exercises to help improve the stability of a certain muscle and prevent major issues in the future.

Since the shoulder is a very complicated structure in the body there are many other things that can go wrong with it. Below is a list of other issues and a description of what they feel like. The goal here is to not alarm anyone who has shoulder pain and have them self diagnosing themselves. Instead familiarize yourself with these potential injuries and if you feel something similar, notify a trainer and augment the WOD so you can finish without exasperating the issue.

Rotator Cuff Tendonitis: Repetitive overhead use of the arms (such as pull-ups or over head press) can cause this painful strain injury. For this you will feel pain when a rotator cuff muscle is actively being used. Pain will be non-existent or a slight dull ache when at rest.

Rotator cuff impingement: The tendons of the rotator cuff are squeezed between the humerus and the Acromion Process (See illustration below). This can be caused by muscle inflammation from trauma (a fall, failed lift , etc.) or by overuse. Symptoms are very similar to tendonitis but you also feel pain when the muscles are moved passively (afflicted muscles are not engaged but moved by an external source).

Subacromial bursitis: Inflammation of the small sac of fluid called a “bursa” that cushions the rotator cuff tendons from the Acromion Process. This can also arise from overuse or hyper extending the shoulder joint. For this injury one will feel pain when the shoulder is at rest. It may not hurt when the muscles are engaged.

Rotator Cuff tear: This injury occur when a tendon that’s been weakened by age or wear and tear. These tears are graded on a scale from 1-3. On top of pain when engaging muscles, Tears begin to feel like one arm/shoulder is weaker then the other. This is dues to the fact there is literally less connected tendon/muscle tissue to move the arm/shoulder. If you suspect this injury, stop the workout immediately and substitute the activity for something else.

  • Grade 1 - Tear is very small (less then 3 mm) and may hurt but the body will ultimately heal itself if the exasperating activity is stopped and the area is allowed to rest.
  • Grade 2 - Tear is about 3-6mm and is no more then half the thickness of the tendon. At this point the damage is bad enough that the body will not be able to heal itself but it’s effects can be minimized by allowing the area to rest then engaging in strength building exercises to increase stability of the remaining tissue.
  • Grade 3 - Tear is greater then 6 mm or tendon is completely severed. The only option here is surgery or to give up mobility of the afflicted shoulder.

Source: Partial Thickness rotator cuff tears : Arthroscopic classification by Ellman

Ellman H, CORR, (254) 64-74, 1990

Another area of the shoulder that should be discussed is the Labrum. The Glenoid Labrum is a fibrocartilaginous ligament that goes around the perimeter of the shoulder joint (see illustration below) . It protects the ball and socket joint of the shoulder by providing a cushion between the head of the Humerus and the Glenoid cavity of the shoulder. It is possible to injure the Labrum through trauma (i.e., falling with your arm outstretched) or over exertion (i.e., failing a lift that involves an extreme pulling motion). Pain from such an injury will be when the shoulder is at rest or when passively moved. Resisted motion will also be painful, but active motion may not be effected.

With this new understanding of the Rotator Cuff and Labrum you can make better decisions about your workout when potential injuries arise. The Rotator Cuff needs special attention because of the complex nature of the shoulder joint. This complicated mechanism can be hindered in many ways and is very difficult to fix when truly broken. It is important to monitor the health of the Rotator Cuff at all times since ignoring the issues will lead to a lot of pain down in the future. For example many of us know of a person who is 50+ who has torn their rotator cuff. Now these individuals are not necessarily athletes and it is puzzling how they could get such an injury with a sedentary lifestyle. The reason is that they had an issue with the Rotator Cuff from years prior and never addressed it. The inflammation that occurs in this region can be very damaging when left unchecked because the canal which the Rotator Cuff muscles pass through is very narrow. Any inflammation or impingements can cause a bottleneck effect and begin to strangle the tendon portion of the Rotator Cuff. Since Tendons by nature do not have the best circulation, they begin to atrophy and weaken under the added stress. Ultimately this will lead to tearing, even when only engaged in mundane daily activities. To help prevent such injuries be sure to mindful of your body and exercises. Take seriously the mobility portions of the work out and spend extra time stretching these muscles out. The more mobile the Rotator Cuff muscles/tendons are, the more blood flow they will get in the shoulder. When the eventual injuries to pop up, or if you would like some extra attention on these areas, I am available by appointment to give your Rotator Cuff some serious bodywork. Feel free to discuss any part of this post with me during my walk in hours on Mondays and Wednesdays from 3-7 pm.  Please check out bodyworkredondo.com for more info!