Neck & Shoulder Pain
As the heat picked up at the 2015 Games, local competitions and participating athletes ramped-up their games as well. As a sponsor of many large local competitions and events, I get to see around 60-80 people in an 8 hour period. So, injury patterns are easy to detect. Although the athletes I work on at these competitions are very equipped athletically, a few common and too frequent musculoskeletal issues arise.
During a recent competition in Houston, the two most common treated areas were; the shoulder area, especially during the overhead dominant WOD - ("there is this knot behind my shoulder blade I can never get it out," "my shoulder makes a pop sound," "my neck/upper trap hurts and it's super tight," and have a hard time doing overhead squats without hurting afterwards."). Followed by the pelvic or the SI joint - ("I hurt right on my tail bone", or, "on the right/left/both dimples, and my lower back gets real tight").
For today, let us cover the shoulder complex. I will follow-up with a case study I have done on Kerri Walsh to help simplify everything down.
I hear this question asked a lot...
"How can my neck (The Cervical Spine Complex) negatively affect my shoulder area (The Shoulder Complex)?"
I work with a demanding group of fitness patrons and recreational athletes that are prone to shoulder and neck injuries (CrossFit and Olympic Weightlifting). Loaded and unloaded overhead movements are particularly common amongst Olympic Weightlifting and CrossFit participants. The population diversity of CrossFit is quite fascinating since the majority of its members are average behind the desk office workers. In addition to the frequency of CrossFit and Olympic Weightlifting related neck and shoulder injuries, modern behaviors that negatively influence the cervical spine and shoulder complex account for the third highest injury in America. These overhead athletes lack a fine balance of shoulder mobility and stability in order to meet the functional demands of their distinct sport (1)(4)(5).
The gracious @Kim Holway (Masters 45-49) had to drop out due to a shoulder injury while warming up minutes before the WOD.
Most individuals I currently work with, demonstrate pretty good shoulder mobility but lack enough stability to overcome the physiological demands of overhead movements. According to Borsa, Laudner, and Sauers (2008), shoulder mobility in the overhead athlete has been found to be both hypermobile and hypermobile (1). The debate continues amongst researchers, "whether altered shoulder mobility is inherent or acquired through adaptive change to joint structures" (Borsa, Laudner & Sauers, 2008). Furthermore, structural damages to the glenohumeral joint capsule, ligaments, glenoid labrum, or rotator cuff musculatures might be a secondary response of shoulder hypermobility and hypomobility during repetitive overhead activities (1)(3).
Clark, Lucett, and Sutton (2014) identify the cervical spine as a particularly sensitive region of the body with extensive influence on the inferior and superior structures. Restricted Cervical spine mobility (or lack of stability) caused by dysfunctions such as Upper Crossed Syndrom, rounded shoulders, forward head carriage, or asymmetrical head shift will eventually equate to musculoskeletal abnormalities which can lead to potential pathologies of the shoulder complex (2). Moreover, dysfunction of the trapezius, levator scapulae, and serratus anterior can altered the uniform posture of the cervical spine leading to scapula thoracic dysfunction (2).
The musculatures of the Cervical Spine and the Shoulder Complex share similar cross-sectional responsibilities and might be recruited simultaneously for particular movements. The battle between the overactive and underactive muscle of the cervical spine might contribute to shoulder injuries or vise virsa.
Sometimes, only treating the shoulder by itself may not as effective as we once thought. You will be surprised to see the magnitude of results when we look at the whole picture. By improving the neck, the shoulder will become stronger. Unfortunately, I most people really don't take the time or the patience to take care of a potential shoulder injury.
On February 13th, 2015, @Leia Mendoza wrote a pretty cool article about Kyle Kasperbauer published by @CrossFit (CLICK HERE). Evidently, Kasperbauer injured himself while training for the 2015 Games, doing a double 53-lbs Russian kettlebell swings. Reportedly, his shoulder popped out and jammed back into place. He finished the workout, thinking it's only a strain, and surely it'll heal on its own. The 6 X CrossFit Games athlete and the 3 X regional champion had experienced a torn labrum and a partial (75%) rotator cuff tear. He received proper methods of rehabilitation, now stronger than ever, watch this man kill it at the 2016 Games.
So take it from one of the guys we all want to be like...
“If something is not right, fix it, don’t wait around and hope it will get better. An injury doesn’t mean your career is over. It just means you may be out for a bit.” - Kyle Kasperbauer
References:
1. Borsa PA1, Laudner KG, Sauers EL. (2008) Mobility and stability adaptations in the shoulder of the overhead athlete: a theoretical and evidence-based perspective. Sports Med. 38(1):17-36.
2. Clark, M., Lucett, S & Sutton, B. (2014). NASM Essentials of Corrective exercise training. Jones & Bartlett Learning, Burlington, MA. p.102-103
3. Joshi, M., Thigpen, CA., Bunn, K., Karas, SP., Padua, DA. (2011). Shoulder External Rotation Fatigue and Scapular Muscle Activation and Kinematics in Overhead Athletes. Journal of Athletic Training: 46(4):349–357. www.nata.org/jat.
4. Leia Mendoza. (2015). SHOULDER INJURY SIDELINES KASPERBAUER. Published by CrossFit Inc. http://games.crossfit.com/article/shoulder-injury-sidelines-kasperbauer
