Kicking off my “CrossFit Injuries and How to Avoid Them” series with one of the most common complaints I hear. “My shoulder is killing me coach, I need to modify this workout.” The shoulder is THE most complex area of the body because it is the most mobile joint. It also has the highest risk of injury because this amazing range of motion can place it in the most vulnerable positions. This is especially true when placing the shoulder under a heavy load during overhead presses, dips, and push ups.
My good friend Dave Musgrave (Owner of Croga CrossFit) likes to call our shoulders the “upper cluster fuck” (the lower cluster fuck is your hips)! There’s a reason he calls it this. There are over two dozen muscles, ligaments, and tendons that intertwine through the shoulder girdle. After years of training, injuries, stiffness, etc. this area can become a hot mess! It’s no wonder shoulder injuries are some of the most common in CrossFit.
Since the shoulder is so complex, there are literally hundreds of reasons your shoulder may hurt. Without knowing the exact specifics of your case, it’s impossible for this article to address every scenario. If you’d like specific advice on YOUR shoulder injury, do not hesitate to reach out! I’d love to help.
Impingement or Injury?
Thankfully, most shoulder “injuries” aren’t torn, sprained, or even strained muscles. Most shoulder problems are actually impingements. An impingement is when a specific muscle has gotten tight, stiff, and/or inflamed. A trickle effect occurs and this tight muscle is now “pulling” on another muscle close in proximity. Often times, multiple muscles that are close in proximity are affected, creating a restriction in movement. The restriction in movement often coincides with pain and inflammation, which “pinches” when moved. This can feel like the muscle is torn, sprained, or strained.
How can you tell if it is an actual injury or an impingement? Impingements are usually painful, but with no real loss in strength. Injuries typically have both pain AND a loss in strength. For the purposes of this article I will refer to impingements as injuries because, if left untreated, they often turn into long term injuries.
Without further ado, here are the top 3 most common shoulder injuries in CrossFit, along with how to prevent and treat them. For these shoulder issues, the prevention and treatment is the exact same. Do the prevention and treatment before and after your workout for optimum results. Enjoy!
“The front of my shoulder hurts”
Symptoms – pain primarily in the front of your shoulder when raising your hand in front of your body. You may also feel pain doing any other overhead movement or raising your hands/elbows above your chest.
Many people will think there is something wrong with their shoulder, which would make sense since that is where you feel the pain. Pain in the front of your shoulder is also a classic symptom of a tight, inflexible, or injured bicep muscle/tendon. Your bicep muscle runs from the inside of your elbow all the way up into your shoulder socket (if you feel your bicep all the way up your arm, you will feel how deep it goes into your shoulder).
CrossFitters do a ton of pulling movements. Pull ups, muscle ups, cleans, snatches, and ring rows, just to name a few. When you perform a lot of pulling exercises, your biceps get really tight. When your biceps get tight, the muscle shortens. When the muscle shortens, it starts to pull on your bicep tendon, which then pulls on your shoulder.
All of this pulling on your shoulder causes pain in the front of your shoulder. So although you feel the pain in your shoulder, it stems from your bicep muscles and tendon. Don’t be fooled!
Prevention and Treatment – this includes keeping the bicep muscles loose and flexible. My two favorite ways to do this are a simple wall stretch and mashing your bicep. You can do the stretch anywhere a wall is, and need either a kettle bell or barbell for the mashing.
When left untreated without stretching and mashing, this can turn into a bicep muscle or tendon tear. This is a very serious injury that may require surgery if not properly addressed early on.
For the stretch, find a flat wall. Place your hand flat on the wall, spread your fingers out, and extend your arm so it is fully locked out (elbow extended). While maintaining your arm in this position, rotate your body away from the wall so that you turn your back to the wall. Here is a photograph demonstrating how to do this.
For mashing the biceps muscles. Find a kettle bell to use in order to apply enough pressure to the muscle. I recommend in between a 25-35 pound kettle bell. Lay on your back, extend the target arm out by your side, opening up your bicep towards the ceiling. Place the kettle bell on top of your bicep and let the weight dig in to your muscle.
This will be a bit painful because your biceps muscle is tight! Use the kettle bell as your way of giving yourself a deep tissue massage. Roll the kettle bell around on the muscle for approximately 2 minutes, and try to avoid staying on one specific spot of the muscle for longer than 10-15 seconds. Here’s a picture of what this looks like.
“I feel pinching deep inside my shoulder when I press overhead”
Symptoms – pain described as a pinching deep inside the shoulder. This is a hard one to describe because there never seems to be a specific area where the shoulder hurts. It just feels “deep inside” the shoulder. Sometimes, this one can be pinching felt right under the arm pit area.
You may feel this pinching while pressing overhead or holding a front rack position in the clean or front squat. There is a tendency to feel pain whenever you reach for something behind you. Imagine driving your car and needing to reach for something in the back seat. Does the thought of that sound painful with this type of shoulder injury?
These symptoms are very consistent with a supraspinatus muscle injury or tightness. Your supraspinatus muscle is a very small muscle that is buried underneath your trap muscle (trapezius), and in between your collarbone (clavicle) and wing bone (scapula). This muscle makes up one of the four rotator cuff muscles. Thankfully, most rotator cuff problems are simply an impingement and can be treated with mobility exercises that I will discuss below. It is a difficult muscle to stretch because it is so small and hard to get to.
Prevention and Treatment – my favorite way to loosen this muscle up is by mashing it using a barbell in a squat rack or using the TheraCane. After you mash the muscle, you can stretch it by placing your hand behind you, near the small of your back. If this pain is left untreated without utilizing mashing and stretching, it can lead to a tear which may require surgery.
For the TheraCane mashing, simply apply the end of the TheraCane on top of your trap muscle. Apply as much pressure as possible in a downward angle. Remember, the supraspinatus is deep underneath the trapezius muscle, so you have to press HARD. This will hurt, but stick with it. Massage this area for approximately 2 minutes, and try to make gentle strokes back and forth the whole time.
For the barbell mashing in the squat rack. Set up a barbell in a squat rack and position your trapezius underneath the barbell. Stand into the barbell so the weight of the barbell drives down into the supraspinatus. You may have to stand into the barbell at an angle in order to prevent the barbell from lifting off of the rack. Here’s what it looks like.
“It hurts when I do push ups and dips”
Symptoms – pinching in the back of your shoulder (near your scapula, aka wing bone), under the arm pit, or the front of your pectoralis muscle (chest). This pain usually occurs when doing dips, pushups, muscle ups, or any forward pressing movement. These are clear signs of tight pectoralis muscles. It can be your pectoralis major or pectoralis minor.
In my experience, the pectoralis minor is the root cause of tight pecs because it is a much smaller muscle. The problem with the smaller muscles is that, although small, are used for stability in all of the major lifts. Because it gets used a bunch, and is a lot smaller, they have a tendency to get over used. In the case of these symptoms, I would focus your prevention and treatment towards the pec minor.
Prevention and Treatment – First, mash the pec minor by using a kettle bell or lying on a foam roller. Once the muscle is loosened up by mashing, elongate and stretch the muscle using a very basic chest/shoulder stretch. Think loosen, then elongate.
If left untreated, a pec minor injury can turn into a tear which will require surgery. DO NOT let this muscle get too tight!
To mash your pec with a kettle bell, you’ll need a weight between 25-35 pounds (heavier for some bigger athletes). Lay on your back and place the kettle bell on the upper outside area of your pec. Avoid the actual shoulder joint, you want to be on the pec muscle. Only moving about an inch or two, you want to go side to side and front to back very slowly. Heres a picture of what this looks like.
Other simple, yet effective stretches are these doorway and pvc pipe stretches.
Here is a video demonstration on how to use the kettle bell to loosen up your pecs.
When in doubt, roll it out!
With the shoulder being so complex, intertwined, and such a cluster fuck, sometimes you have to throw everything and the kitchen sink at the problematic shoulder in order for something to work. If the above mobility exercises don’t alleviate the pain, grab a foam roller and get to work. When in doubt, roll it out!
Start by rolling out your lats and upper back muscles. Target the wing bones and rear shoulder muscles. Then, extend your arm over your head and foam roll your arm pit region. Finally, lay on top of the foam roller and place your pec muscles on the foam roller. Slow and controlled motion over the foam roller as opposed to fast motions. Do not stay on one spot for longer than 10-15 seconds, this will reduce blood flow to the area and may cause more damage. Check out this video for a visual on how to get this done.
There you have it, the three most common shoulder problems related to CrossFit training. Thankfully, most of the time they are very preventable and very treatable. Use the mobility exercises before and after any shoulder intensive training session and you will reduce the likelihood of long term injury.
If you feel any of the above symptoms, start mobilizing IMMEDIATELY. The longer you wait, the worse it will get. Remember, most shoulder “injuries” are actually impingements that have the potential to turn into injuries later. This only happens when the impingement is ignored and left un-mobilized.
Do not hesitate to reach out for specific advice on any shoulder injuries you may be experiencing! I hope you enjoy!