Troy is a certified bad ass. He is a high level CrossFit athlete and awesome coach. He was hitting all-time records in his training until one day his shoulder pain prevented him from doing anything overhead. He couldn’t do any gymnastics movements that required hanging such as pull-ups and handstand walks. The pain was preventing him from doing a big chunk of his training. Not ideal. Injections and physical therapy weren't getting the job done.
His shoulder pain was preventing his passion - working out at a very high level. What’s even worse is he pain was threatening his career; it’s hard to be a good coach if you can’t demonstrate or preform what you’re teaching.
Just like all of us do from time to time, he trained through the pain hoping that it would take care of itself. His shoulder would flare up, calm down, and flare up again. Dedicated to his sport, he kept snatching, hand stand walking, and doing chest to bar pull-ups masking the pain behind pills, injections, and creams. One day, that wouldn’t be enough and he couldn’t even hang from a pull-up bar without his shoulder barking at him.
With his athletic and professional careers on the line, he started looking for something different.
In short - quite a bit. Troy had pain when going overhead at a close angle - such as with jerks or hanging, but was more or less okay with a wider grip such as when snatching. Interesting. Years of collegiate football plus years of training at a high level had made his shoulder a bit worn out. Instead of taking rest, working on positions and technique, and seeking care he trained through it. This led to some mobility restrictions and movement compensations that made his tendons quite pissed off. He also likely has some degree of arthritic changes on the acromion process - a bony protrusion from the shoulder blade under which a rotator cuff muscle lives.
The combination of of poor mobility, probably arthritic changes, and chronic overuse led me to a diagnosis of shoulder impingement syndrome. The main rotator cuff tendon, the supraspinatus, was inflamed as was the bursa it uses for protection. This inflammation and tendon degeneration compressed the space any time he lifted his arms overhead. Tendons and bursae don’t like to be squished when they’re inflamed.
To learn more about how the thoracic spine can affect shoulder pain, read MY BLOG HERE.
Of course standard physical therapy and cortisone shots didn’t do anything long lasting. Modalities like dry needling and shots only serve to cover up pain symptoms. They feel good for a while, but if you don’t change up how you move it’s like picking a scab and reinjuring the area each time you do something you shouldn’t.
Every initial visit uses a combination of movement assessments, orthopedic evaluation, and a thorough consultation to figure out what is wrong and to set our goals. This case was a little special because I had the added advantage of seeing Troy in the CrossFit gym every day. I got to analyze and give feedback on his movement patterns as I saw them which was a tremendous help.
Our movement assessment revealed a substantial decrease in thoracic spine (where your ribs are) extension, and painful arc sign, plus a few other key findings. Painful arc sign is when, upon lifting the arms from your side to overhead, there is an alternating pattern of painful, not painful, then painful again as the arm gets more overhead. This can indicate several things, but in our case here it told us that the A/C joint was injured and painful in addition to the shoulder. Luckily, his rotator cuff tendons were intact which meant that this wasn’t a surgical case. It would require patience, treatment, and tweaking some movement patterns.
DOCTOR’S NOTE: if you are experiencing pain, always get checked out by a qualified healthcare provider. This blog is for informative purposes only and cannot diagnose or treat any illness or injury you may have. It does not establish a doctor-patient relationship.
Luckily Troy had found a doctor who not only knows the difference between a push press and push jerk, but one who can also perform the movements, coach them, and spot movement flaws that may be contributing to his pain. We started on a treatment plan of gentle and specific chiropractic adjustments, Active Release Techniques, and focused rehab exercises. The combination of treatments seemed to be a perfect fit and Troy was disciplined in doing his exercises and modifying his training while we worked through his shoulder issue.
VIDEO - SUPINE PVC PULL OVER
This unique exercise is really great for improving shoulder flexion. We loaded this movement up very light - only up to 7.5 pounds (Troy has a max jerk of around 345 pounds, so 7.5 isn’t exactly heavy) and used the weight to allow eccentric movement into a good position. Tendons respond well to eccentric load - meaning contraction while lengthening such as the quads when lowering into a squat. There are several progressions and if done flat on the floor, the floor is a good blocker to prevent excessive shoulder flexion. We used a bench and then the hollow hold position to more closely mimic the demands of CrossFit on the shoulder.
VIDEO - BOTTOM-UP KETTLEBELL PRESS
The bottom up press is a great tool to help retrain reactive stability when going overhead. The shoulder is inherently not a very stable joint - the old analogy of a golf ball on a tee applies here - so we need to train it in such a way as to resist unwanted movements. This is where the bottom up position can be very useful. Gripping the kettlebell handle and having the weight be over the hand rather than behind it moves the center of gravity in such a way that it makes the kettlebell feel very unstable in your hand. As you press, you’ll feel the bell wobble which is the goal. Fight the wobbles and be stronger than the bell! There are a bunch of positions this can be performed in - on your back, hook laying, 1/2 kneeling, tall kneeling, standing, or if you’re super ambitious, in a Turkish get up. Start very light and move slowly. This one is not about how much weight you can move, but rather more about how well you can control your shoulder.
VIDEO - SCAPULAR PULL-UPS AND SWINGS
Good ol’ scap pull-ups! Most CrossFitters don’t do these well at all. Yes, Troy was able to string together 20+ bar muscle ups but it’s always good to look at the foundations. This combination of movements is the foundation most CrossFit-related gymnastics movements are based off of. They teach control and patience, so next time you do these in a warm-up do them well! We need strong and stable shoulder blades in order to do the fun things we do and this movement, done properly, will help train those patterns.
The saying Hard Work Pays Off is true. It took a few weeks, but Troy is back in the gym full time without shoulder pain. He is hitting PR’s and crushing WOD times as he prepares for The Open and beyond.
AND THAT’S WHY WE DO WHAT WE DO.
If you’ve been experiencing pain when training, find a doctor who knows what your sport demands of you! We can help crush your pain so you can get back to doing what you love!