Shoulder Mobility and CrossFit

Hey everyone! My name is Dr. Allan Buccola, PT, DPT. I am a Physical Therapist in Greensboro, North Carolina and the owner of Impetus Physical Therapy. I promised I would do a post on CrossFit shoulder mobility, but of course good shoulder mobility is a necessity for lots of tasks, so don’t turn away just yet if you aren't a CrossFitter. This article is going to be helpful for everyone who has difficulty performing overhead tasks like Yoga, volleyball, putting dishes away, and everything in between.

Just a disclaimer, this blog post is intended to serve as educational only, not medical or professional advice. Having not personally examined or evaluated you, please do not consider this post professional advice. If you are experiencing pain or movement related dysfunction, please contact me or another medical professional who is qualified to thoroughly assess movement related dysfunction or pain.

Most of us will eventually succumb to postural changes that completely alter the mechanics of the scapulothoracic (shoulder blade on trunk) complex, leading to an inevitable decrease in functional mobility of the should joint itself, and it has nothing to do with 'aging,' so much as the "use it or lose it" principle. Whenever the hand goes overhead, the humerus and the shoulder blade move together effortlessly in a 2:1 ratio, described in clinical settings as scapulohumeral rhythm, and when this becomes disturbed, motion is lost, and pain quickly becomes a limiter. 

Humans are decedents of primates, arboreal in nature if you go far back enough, and although our upper extremities have evolved in ways more specified to manipulation tasks such as making spears, throwing baseballs, and texting, we continue to harbor a primate shoulder joint, clearly designed for impressive mobility and seriously impressive stability in the most unique of positions. Just the mere fact that you have EVER been able to do the monkey bars says a great deal about the human shoulder. 

In CrossFit, I thought a good place to start would be a maneuver clairvoyantly named the 'dislocate' or 'pass-through.'I've read some great training and mobility tips in the official CrossFit literature, but if I had to pick one thing that I would personally expand upon, it would be this. Use of this maneuver varies from box (CrossFit gym) to box, but basically, it's used either as a shoulder warm-up, or as a means to increase shoulder mobility for the overhead squat.

Before I go farther, and before I upset some friends: I don’t want to give the impression that I'm picking on CrossFit or condemning any particular exercise. The goal of this post is simply to educate athletes to improve performance and reduce injuries. So, with that aside, these are my main points:

1. Dislocates are risky; 2.Dislocates will do very little as a 'mobility exercise'; 3. Opening up the shoulder in other ways will improve performance and decrease injury risk

DISLOCATES ARE RISKY

Healthy normal shoulder function requires the amazingly innate coordination of the humerus on the scapula, the scapula on the thorax, and essential extension/rotation of the spine.The really cool thing about the human shoulder is that when the arm goes straight overhead, the scapula will naturally move almost completely beneath it, just like a hand balancing a broomstick.

When the scapula becomes locked down, humeral head support must rely more heavily on ligaments, capsule, and the rotator cuff. Over time this equates to a torn labrum, impingement, or even dislocation. I mention this because a significant portion of adults, unless they are gymnasts or swimmers, are going to have difficulty getting arms overhead, and a significant portion of that difficulty will arise from the scapula.

If you feel resistance with overhead movements , it could be from a lengthy list of restrictions, with a strong chance that you are trying to squeeze around some tightness in the pecs, the triceps, the lats, the traps, or other soft-tissue. You may get the bar overhead, while putting the shoulder in a precarious position. The dynamics of the shoulder stabilizers will be totally altered, and as Kelly Starrett or Gray Cook would agree, loading a system at the extreme limits of mobility is asking for trouble. Relying on a springy exercise like dislocates is the perfect way to encounter tendinopathy in the shoulder, i.e. rotator cuff problems, or worse.

DISLOCATES Will not improve MOBILITY 

As many CrossFit coaches will tell you, mobility is sometimes related to weakness or bad form, but as a PT, I'll say that mobility can also be limited by ligamentous or capsular tightness in the joint itself. It takes a trained expert to help find the limiter in such a complex system, and a varied approach to improve each one. Adding in fast dynamic stretching in form of repetitions of the dislocate maneuver might serve as a good warm-up option, but it is unlikely to increase true mobility. Research shows pretty clearly that if you add ballistic/dynamic stretching activity to muscles, you will neurologically excite them and in effect make them tighter.

True changes in mobility might require addressing muscular imbalances. These changes take time and persistence. I will include some supplemental activities at the end of this piece. I should also note, most importantly, that as mobility improves, motor control must be relearned, so start again with low weights and gradually work your way back up.

OPENING THE SHOULDER WILL IMPROVE PERFORMANCE

The overhead squat is an high level activity that requires healthy, functional range of motion and proper motor control. Any deficit in ROM will alter the kinetic chain, and will almost certainly lead to compensation elsewhere. It is difficulty to generalize shoulder mobility deficits, but I will address the top three most common types that I see.

Keep in mind that if you have specific mobility problems that don’t seem to be responding to traditional stretching routines, it will benefit you to see me or another qualified professional. If your mobility deficits include clicking, popping, swelling, or pain, I would strongly suggest that you cease loaded activities prior to being evaluated by me or another qualified professional who specializes in movement related dysfunction.

Glenohumeral joint mobility:

The movement of the humeral head (ball) on the glenoid (socket) of the scapula can easily be restricted by tight rotator cuff musculature. Keeping in mind that shoulder range is often asymmetrical, the goal is not to make both shoulders equal but to improve mobility for the task at hand. If you suspect tightness in these areas, the following stretches may typically be applied. Be sure to hold stretches for at least 3x45 seconds, and avoid aggressively pushing into the tightness. I've included here stretches for the shoulder internal and external rotators. 

Scapular Mobility Restriction

The second most common mobility restriction is likely found in the shoulder blade itself. The scapula has almost a dozen muscles imposing movement upon it, any of which can become tight and create a loss of mobility and altered mechanics.  Probably the most common are the triceps, pectoralis minor, or lats (latissimus dorsi). The trapezius can also be problematic, but it's relationship to scapular mechanics is a bit more tricky.

If you suspect your shoulder blades to be a little tight, investigate these stretches to assess your mobility. I've included a standing triceps stretch, the prayer stretch, and a floor rotational pecs stretch, all of which can be performed at home with minimal equipment. 

Limited Thoracic Mobility or altered posture

Another crucial component of the overhead squat is adequate spine mobility. Athletes who are stuck in excessive thoracic kyphosis (rounding of the upper back) will have limited overhead arm mobility, poor scapular excursion, and likely excessive lower back curvatures to make up for the difference. These compensations add to risk of lumbar spine fractures and hip impingement.

Adding mobility to a chronically stiff upper back can take a little time, and should really be conservative, as aggressive stretching in this area is dangerous. The following two stretches can be performed with a rolled up beach towel (i'm using a long half-foam-roll), running from your tailbone to head. These two stretches are best when help for a minimal 2-3 minutes. 

So there you go! Mobility is a big deal, and should be examined closely with a coach when pain is consistent with activity. I hope this post has changed the way you think about shoulder mobility. My hope is that this may be useful information for many, whether athletes, CF coaches, or just regularly everyday people with shoulder pain. The concepts are broad. If things are consistently painful, or just don't seem to get better, you can get in touch with me at my website, and even schedule a free 10-minute phone consultation if you aren’t sure where best to go.

Keep moving!

-Allan 

Be sure to check out www.ImpetusPT.com and Like us on Facebook: https://www.facebook.com/ImpetusPT