Disclaimer: I am a coach, not a medical professional. I am not diagnosing anyone, and I am not offering medical advice.
My Shoulder Injury
While prepping for the 2020 CrossFit Open I was doing a max unbroken set of Bar Muscle-Ups. On rep 23, I felt my shoulder get pulled out of place. Foolishly, I grinded out two more reps, and in both reps the same thing happened with my shoulder. I was pleased with a shiny new rep max, but my shoulder was in pretty bad shape.
This isn’t the first time this has happened. The original injury occurred in my college wrestling days. An aggressive arm chop resulted in a subluxation (partial dislocation) of my glenohumeral (GH) joint.
I never went to get an MRI, but I most likely tore part of my labrum: the ring of cartilage that encapsulates the GH joint. I didn’t get examined, mainly because I never intended to go under the knife unless it was a last resort, so an official diagnosis really wouldn’t have changed my course of action.
How You Can Benefit From My Journey
In this post, I’ve outlined some of the key learnings from my rehabilitation process.
It would be easy to look at the key points and assume getting back to the things you love after an injury is a straightforward process, but this is far from the truth.
You will, as I did, hit an unknown number of detours and potholes in your journey back to health and performance.
There are a lot of things I wished I would have known during my rehab that I had not.
It is my hope that you will benefit from my loss, and that your journey will be slightly more clear as a result.
So let’s dive into it…
What Causes an Injury?
It’s actually pretty simple; the tissue’s loading capacity was exceeded.
- An MMA fighter gets kicked in the knee and his ACL ruptures. His ligament couldn’t handle the external forces placed on it.
- An endurance runner gets a stress fracture in her tibia. Her skeletal structure wasn’t able to handle the volume of repeated shock waves required to complete her half marathon program.
- A sprinter pulls his hamstring coming out of the start gate. His event got delayed and the internal temperature of his muscle belly was far lower than ideal, resulting in the muscle not being able to handle the eccentric loading of maximal effort sprinting.
- A CrossFit athlete gets biceps tendonitis from repeatedly doing high volume Butterfly Chest-to-Bars under fatigue. She lacks the soft tissue support and rotator cuff strength to prevent her humeral head from sliding around the socket and irritating the surrounding tissues as a result.
In all these cases, the factor(s) that initiated the cascade of events may be unclear (e.g. muscle temp, training volume, micro trauma, rotator cuff fatigue), but the actual mechanism of the injury is simple: the tissue’s loading capacity was exceeded.
Common Injury Scenarios: Five Factors
While there are always freak accidents, there are common themes to when injuries occur.
If you know what these common injury scenarios are you can take steps to mitigate these risks.
(1) Poor Warm-Up: Cold & Stiff
One of the most common -and easily avoidable- causes of injury is not getting a proper warm-up in.
It’s like my mother told me growing up, “If you aren’t sweaty, you aren’t ready.”
You need to be warmed up in two ways.
First is core temperature. You have to do enough easier work prior to the start of your stressful workout to allow your muscles and joints to become pliable and lubricated.
Second is movements. You need to prepare the specific patterns that you need for your work ahead. The foundation of movement is position. Make sure you claim all the positions and range of motion you need to execute the task ahead. Prep those tissues to handle being loaded in those positions.
(2) Poor Positions: Axial Skeleton Misalignment
Often even if people warm-up well, they simply aren’t able to get in a good position. Either they don’t know what a good position is or they can’t get into the position they know they should because they have mobility restrictions.
The most common way I see poor positions resulting in injury is through axial skeleton misalignment. Your axial skeleton is your spine and ribcage. If you aren’t able to maintain a neutral position for your axial skeleton while executing movements, your potential for injury skyrockets.
It’s not just about spinal injuries; It’s a proxy for joint organization and movement quality as a whole.
If you can’t overhead press without going into lumbar extension, and you can’t squat without a posterior pelvic tilt (buttwink), you are much more likely to become injured down the road.
(3) Load: Max Lifts
Anytime you are pushing your body to the limits, the potential for injury is higher. Load is one limit. Regardless of what movement you are lifting heavy in, you are more likely to get injured doing it the higher it is as a percentage of your one rep max.
Muscles are peaking out tension and joints are under massive compressive forces.
So…it makes sense that things are more likely to break.
This doesn’t mean stop pushing your limits, it simply means you need to be diligent about how you prepare to handle those loads and the positions you are in while under those loads.
(4) Fatigue: Core / Respiratory
Similar to loading, fatigue is another extreme. The more fatigued you are, the less you can exercise active control over the systems of your body, and the more likely you are to become injured.
This inability to control your movement is known as a compensation pattern. Anytime you begin to compensate and move differently due to fatigue (similar to load or speed) risk increases.
One of the most problematic types of fatigue is that of core or respiratory musculature. These two are intertwined because the diaphragm is a major spinal stabilizer.
If your core and breathing musculature fatigue, you lose the ability to maintain good axial skeleton alignment, which -as we already covered- can be a precursor to injury.
(5) Multiple Factors
Rarely does an injury happen for a singular reason, much more often it is the convergence of factors that results in a tissue’s loading capacity being exceeded.
I’ve seen countless CrossFit athletes lifting heavy under fatigue in sub-optimal positions.
Again, it’s not to say that this is bad, but it’s important to know the risks of your choices and to do everything in your power to reduce those risks.
Pain vs. Injury
A common question I heard my wrestling coaches ask growing up was, “Are you injured or does it just hurt?”
While most of the time that was being asked it came with an undertone of “Stop being dramatic and suck it up.”
However, the premise was a good one for me to understand.
There is an important distinction between pain and injury that every athlete and coach needs to understand.
Both pain and injury are an inevitable part of athletics…and life.
The difference is injury involves damage. Pain is a signal from your body to get you to stop doing something.
There are obviously times when these two overlap. Like my story. Or like my client Avery, who pulled a heavy deadlift, heard a pop, and his back seized up. His pain was intense for a few days. Clearly there was something that got damaged (hence the pop), and pain signals coursed through the body as a result.
However, there are times when you experience pain without being injured. Metabolic pain is a familiar example. Anyone who completes a 400m Run Time Trial knows pain. It’s the “acid in your veins,” “I am sucking on the tailpipe of a truck like a straw” kind of feeling.
However, there was no meaningful amount of structural damage to accompany this pain.
Pain in these types of scenarios is acting as a governor. Personified it’s: “Stop! It isn’t a smart move to keep going like this.”
Or it could be an immense amount of mechanical pressure being placed on your wrists in heavy overhead squats. The pain is saying, “You’re not in a great position here. You’d be smart to back off.”
Pain in Healthy Tissue
Pain as a damage prevention signal makes sense.
Where it gets more complicated is when the damage and associated risk fade, but the signal remains strong.
The back tweak from three years ago has been rehabbed and strengthened, but you still receive pain signals. You’re safe, yet you get pain every time you load that pattern.
For me, I could do almost everything: from heavy snatches, to handstand walks to bar muscle-ups…but kipping Chest-to-Bar Pull-Ups always caused pain.
In these scenarios the neural pathway of pain has been trained; Pain has become efficient.
Getting Out of Pain: A 3-Step Process
This is the process I used, which did (eventually) get me back to doing kipping Chest-to-Bar Pull-Ups without any shoulder irritation or pain. Now I can easily do over 100 reps in a workout without having any joint pain during or in the hours or days following the session. But I had to work my way through these steps over the course of several months.
Also, I would highly advise you to work closely with a medical professional as you go through this process who can help light your path.
Step #1: Restore Pain Free Range of Motion
First of all, if you can’t move your joint through the entirety of the joint’s Range of Motion (ROM) passively, without pain, you have no hope of moving with speed or loading in athletic movement without pain.
Here you want to work within your pain free range of motion and build quality and controlled movement, unloaded.
Things like Controlled Articular Rotations (CARs) can be potent tools to drive change in the pain free range you already have. Use your bodyweight and the natural tension in your tissues to provide a touch of resistance for loaded stretching and end range isometrics.
Related Read: PAILS & RAILS for CrossFit
Step #2: Increase Loading in Pain Free Variations
Once you have claimed the entirety of the ROM, you can begin to load the range. Start conservative and build slowly. Nearly all exercises should be performed at a controlled tempo. Only pick variations patterns that do not cause any pain.
For me, within a few weeks I built up to cable rows, lat pulldowns, dumbbell pullovers, ring rows, and even strict pull-ups with zero pain when I did them in a controlled manner.
However, as soon as I stop obeying the tempo or layered on systemic fatigue, the joint would become agitated.
Start low. Go slow.
Step #3: Controlled Exposures of Painful Movement
Let’s revisit the idea of having pain in a healthy tissue.
Regardless of how well you have completed steps one and two, you may still get pain when you go back to doing the specific thing you want to do.
Again, for me it was kipping chest-to-bar pull-ups. Even a few reps would leave my shoulder feeling banged up and achy.
The answer here is easier said than done: Slowly begin to build the volume of that movement back in unfatigued settings. Building slowly is between 5 and 10 percent of the total volume per week. As long as your pain and joint irritation is tolerable and doesn’t last longer than 36-48 hours, you’re okay to continue.
If the pain is not dull and/or extends past the 48 hour mark, you’ve overdone it.
But, provided the pain is mild and clears up within a day or two, build the load, volume or density conservatively.
Over time, you should inoculate yourself to that stressor and your pain will diminish.
For me, this process started by building unfatigued volume. Once I got up to ~130 reps, I began to add density, doing more reps per minute, so fatigue was higher. Lastly, I added the movement back into intervals and MetCons where systemic fatigue was high.
Joint Health in Sport
There will always be a price to pay for performance. If you want to be the highest level athlete you can, you have to make sacrifices.
There’s no way around it: to be a great athlete will mean some level of joint pain.
This reality often lures athletes, like you, to ignore their movement quality and stop taking care of their body, until their joints are so beat up they are forced to stop.
Don’t choose between doing the things you love and living with joint irritation.
If you want to be “in the game” over the long-term you must be willing to do the boring, unsexy work to keep yourself healthy.
Every week the athletes I coach and the people doing The Protocol do specific exercises and routines to keep their bodies healthy, restore range of motion and move better with less pain.
I’ve taken those protocols and routines and put them into one comprehensive program: the Joint Bundle.
Let’s say goodbye to fragile joints.
Tired of cranky joints halting your training?
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Buy the bundle and get instant access to 12 routines for the Shoulder, Knee, Back and Wrist.