Shoulder Impingement in Crossfit
Many Crossift movements involve heavy overhead lifting. This heavy load on the shoulder can lead to irritation of the rotator cuff or bursa which is called shoulder impingement syndrome. Shoulder impingement is usually worse with overhead movements and is similar to rotator cuff tendinopathy in a lot of ways.
Cause of Shoulder Impingement in Crossfit
The glenohumeral joint is created by the glenoid fossa of the scapula and the humeral head of the arm. Above the glenohumeral joint is the acromioclavicular joint, also called the AC joint. With overhead movements, the scapula and the humerus should rotate upward together as a unit. However if there is a dysfunction in the movement, the humerus translates up compressing the subacromial bursa and supraspinatus tendon against the acromioclavicular joint. The compression of the bursa and the rotator cuff tendon leads to irritation and pain just below the AC joint. This is why shoulder impingement syndrome is also been described as subacromial pain syndrome.
Treating crossfit athletes with shoulder impingement
There are several options for conservative pain management in Crossfitters with shoulder impingement.
- Manual therapy, such as massage, myofascial therapy, and/or Graston, can all be used to help reduce the pain with shoulder impingement.
- Joint manipulations and mobilizations can be used to restore range of motion and decrease pain in the shoulder. Joint manipulations to the thoracic spine (mid-back) increases extension which will restore the proper biomechanics to the area.
- Kinesiology taping like RockTape is another option to help decrease pain. Kinesiology tape works by stimulating the receptors in the skin which helps reduce the pain.
Rehabilitation and strength training are crucial in the treatment of shoulder impingement. With all shoulder conditions, strengthening the rotator cuff muscles can help increase the stability of the shoulder joint. Also strengthening the muscles around the scapula (shoulder blade) can also help with upward rotation of the shoulder blade during overhead activities. The muscles which help to upwardly rotate the shoulder blade include the upper trapezius, lower trapezius, and the serratus anterior muscles.
For Crossfit athletes specifically, rehab should transition towards increasing shoulder stability in overhead positions. After all, if you are going to be doing kipping pull ups, clean & jerks, and snatches it is important that rehab adequately prepares you for those movements. If the rehab program doesn't focus on overhead stability and loading the shoulder, it could be setting you up for re-injury when going back to Crossfit.
Surgery for Shoulder Impingement
In some shoulder impingement cases, a subacromial decompression surgery for a bone spur on the acromioclavicular joint is recommended. The bone spur formation is thought to lead to irritation and tearing of the rotator cuff and bursa under the AC joint. However, there has been some debate about whether subacromial decompression is appropriate for shoulder impingement.
The first problem is whether a bone spur is actually the cause of pain in the shoulder. Acromioclavicular joint osteoarthritis and bone spur formation are relatively common in those without shoulder pain. One study found 65 percent of individuals with no history of shoulder pain had osteoarthritis in the AC joint. Just because imaging shows osteoarthritis and bone spurring in the subacromial space, doesn't mean shoulder impingement and pain
Another problem is how effective subacromial decompression surgery actually is for shoulder impingement. In a study that compared shoulder strengthening to surgical treatment, there was no difference between treatment groups after 12 months. While more research is needed, it appears that even if bone spurs were the cause of shoulder impingement conservative strengthening is just as effective as surgery.