As we finished up last week, I said repetitive injuries are relatively common in the CrossFit athlete. Secondary shoulder impingement following scapular instability is probably the most common thing we see in our office in this population.
What does that even mean!?
Basically, your arm and shoulder blade are held onto your body with small ligaments and muscles. If not trained properly, some of these muscles are not used enough and become weak. This is most commonly seen in the lower part of the trapezius and in the serratus anterior muscles. So your on the bar and kipping away at some pull-ups or toes to bar followed by a snatch or ground to overhead, all movements that require a lot of stability of the shoulder, you will start to get far too much motion to your shoulder. Because you are not recruiting the proper muscles, your body begins to compensate and over-use the upper traps and pecs. Over-time we see a severe roll forward and upward of the shoulders. In someone who sits at a desk all day with this forward posture in their shoulders, this starts to reek havoc.
Myofascial restrictions begin to form in the overactive muscles and the shoulder joint will not be allowed to move properly. The shoulder joint wants to be centralized at all times. When this does not occur, the small muscles that make up the rotator cuff start to rub against the various ligaments and bones that surround the joint.
In the rounded forward posture, the supraspinatus muscle is locked long, meaning it is at its full length and being pulled on all the time. This tiny muscle is responsible for initiating the movement of your arm to the overhead position. When it is locked long, this initiation is not done as efficiently. The muscle is fatigued from being stretched all the time and gets pinched in the fully locked overhead position. In the photo above, the acromion process will be the piece of anatomy putting pressure on this muscle in the overhead position.
Through myofascial release techniques, mobilizations to the shoulder and take home stretches and exercises, this can be treated. Although treatment is not overly fun or easy to handle in the room, fascial restrictions are a very common cause of this and the results are normally seen shortly after beginning treatment. The best way to prevent this injury? Make sure you are doing proper strict pull-ups prior to adding a kip. You should be able to fully engage the shoulder complex in all overhead movements. If you feel overly wobbly as you catch weight in a snatch or during an overhead squat position, scale back to the bar and work from there. Work up to 1 minute holds overhead with your shoulder blades squeezed down and in. Try adding in a bottoms up kettle bell press to your accessory work after workouts.
The next very common complaint we get coming into the office is some sort of mechanical low back pain. This shows up in a number of ways from different movements, but many times after a functional analysis we get to the root cause of the symptoms. Following this years Open, specifically workout 17.4, many people were complaining of low back pain. If you recall, the 13 minute AMRAP started with 55 relatively heavy deadlifts.
A deadlift is a very feared exercise in the general population, and for good reason! If you do not have good form in this movement, you might have back pain, neck pain, knee pain or hip pain for weeks following. This exercise, however, is one of the best exercises we as a society could be doing to prevent injury in our everyday lives. Since starting at the local gym here in town, this movement is my only complaint.
Within CrossFit, a deadlift is performed for almost every single movement both in the strength portion and in the WOD portion. I have posted a video explaining proper deadlift form to minimize low back injury and it starts with a fill of the belly with air along with a proper hip hinge. Each time you pick up a kettle bell for swings or a wall ball or a bar bell or plate from the ground for any movement, you are performing a deadlift. Ingrain this movement into your brain in order to prevent injury to the back. As soon as you get lazy in the middle of a 20 minute AMRAP and bend over to lift something from the ground or want to hit that 5 pound PR at whatever cost, remember it takes at least 4-6 weeks for a strained muscle to heal.
Finally, I would say knee pain is third on my list of common injuries. This comes in various forms and is can be caused by several mechanisms. If you are having knee pain, I would say the best thing to do immediately is have someone look at it. When there is a minor strain to any of the tissues around the knee, compensation begins to occur. If you continue to go as hard as you can through your daily workout, there is a chance these changes in biomechanics from a minor injury will cause a much greater issue. Don’t be scared to take a day off, or an entire weekend even! The knees get a lot of stress put on them in the CrossFit arena, both with weighted loads and with a run, row or bike. Keep in mind that form is important all the way through a long WOD. Once you begin to break form and your knees start creep forward or in towards each other, all of the load will start to build up on the tendons of the knee joint.
As a chiropractor, I am able to assess your biomechanics and perform an examination with orthopedic tests to see if there is anything serious going on and refer you to the proper person. However, if you just having nagging knee pain that you feel when you do almost any movement, chances are you are putting too much stress on your knees. There may be an issue in your ankle, hip or pelvis that is preventing you to have proper shared motion in the leg. Almost always, decreased motion in any of these areas shows up as pain in the knee. Once we get things moving properly, the knee pain should decrease. I also have several exercises that I give patients to allow them to activate their entire posterior chain and foot which helps decrease stress to the knee and leg.
Although I am biased, I do believe that every athlete at every level should be getting a full body adjustment at least once every 4-6 weeks. By improving biomechanics, stretching areas that are tight and strengthening areas that are weak, injury prevention results will go through the roof. Along with prevention, overall increase in weight should start to occur as well as an overall feeling of stability with that increased weight. I am an advocate for all things CrossFit, as I find it a fun way to workout and it gives a strong sense of community. If you enjoy this type of workout and are looking for ways to improve your overall health, feel free to give my office a call.
I offer free consultations and am happy to answer any questions you have. As a functionally based chiropractor; I do a very thorough exam that includes gait and deep squat analysis to get a better picture of each of my patients complete biomechanics. Our phone number is 704-845-0777 and you can ask for Dr. Kylie. We do our best to get you in for same day appointments and have early morning, evening and Saturday morning appointments for your convenience!
“Do something today that your future self with thank you for.”