SLAP Tear Prevention

So how do we get SLAP tears? One mechanism is falling onto our shoulders, another is traction that we talked about earlier and another is repetitive stress. People will complain of clicking in that shoulder that they do not have in the other shoulder. Others will feel like something is moving around in their shoulder. They will typically point to the front and top of their shoulder right at the AC joint or sometimes even the back upper half of their shoulder. Sleeping can be painful as the labrum can get pinched as the humerus rolls into it with compression.  Reaching out away from their body and picking up a heavy bag can also be painful.

Diagnosing can be done with a physical exam as there are a multitude of tests that are described to determine if one has a tear. Sometimes an MRI with contrast is recommended to see if there is a tear. As you can see below fluid which is white travels underneath the black triangle at the top of the cup or glenoid and illustrates the tear.

slap-tear-prevention
Now that we know people have tears, what can be done? There is rehab to try to strengthen the muscles around the shoulder. Sometimes this works and sometimes it does not. If the pain persists and people are having trouble with activities of daily living or sports, then we can fix the problem. You can see the sutures that are tied around the labrum holding it into place in the picture below. The bone will then grow into the labrum and reestablish the connection between the biceps labral complex and the glenoid. Rehab from this can be 4 months for normal activities and 6-9 months for aggressive lifting, throwing or pull-ups. Initially the arm is moved passively by the therapists to maintain motion without stretching. Then once the labrum is partially healed to the bone active motion can be initiated. You can see the protocol for rehab at my site www.orthopedicsne.com.

slap-tear-repair


As I mentioned in an earlier post and you may be asking, “what if I don’t have a SLAP and don’t want to get one?”


Remember our previous pictures of massive external rotation in the pitcher and the pullup Gumby person.

Kipping-pull-up
Well sometimes people with that type of external rotation have what is called internal rotation contractures where their shoulders have adapted and become stretched out in the front half and very tight in the back half of their shoulder joint. When this happens you lose internal rotation because the ligaments in the capsule are tight and don’t allow you to move your arm in that direction as seen here.

internal-rotation-contracture


So you can imagine if the back half of the shoulder is rigid and not loose, the ball of the socket will get pushed forward when you are doing a kipping pullup. And this finally brings us to prevention. If you can loosen up the back half of your shoulder joint then the ball will not get pushed forward, during pull-ups or any overhead activity like snatches and overhead squats. Stretching the back half of the shoulder can be accomplished in a few ways- here is a great shot of a few exercises.


We can see the cross body stretch and in the lower left the sleeper stretch. Other great forms of stretching are with elastic bands and lacrosse or baseballs put right in the back of the shoulder and rolling out the muscles in the back of the shoulder. The other way that we can be smarter about our shoulders is keeping our pull-up form tight and not throwing our body forward violently on the kip. This will keep the shoulder from rotating too far into external rotation and keep a more neutral position on the ligaments on the front of our shoulders. In order to do this the legs also have to be in control and not flailing too far forward or backward on the swing. Legs need to be underneath and slightly extended at hips as opposed to the heels hitting the back and arching as seen with out of control kips.


As Isaac Newton said,
“If I have seen further, it is by standing on the shoulders of giants.”  He was saying he learned because of the people who came before him helped him see and taught him more.  I hope the CrossFit community can learn from the past, improve our mobility and decrease any injuries by adopting new techniques and protect the giants’ shoulders.

10 Comments

  1. I wouldn’t say you are wasting your time, because a lot of things get better on their own. If you modify and they improve then you have saved yourself surgery. If however things are not improving, then you can get more aggressive with the workup.

  2. I’ll try to be brief. I injured my shoulder in December going heavy on bench press. Tried to force a final rep and form broke down. Did not feel a pop or tear, however the top to back part of my shoulder hurt. Thinking it was just a strain I tried to work through it for a couple of months and to no ones surprise the imjury did not improve. Took a couple of weeks off, the shoulder felt good and I attempted to workout. I reaggravated the injury. Took more time off and visited an orthapedic surgeon. He tested my shoulder and determined I had a slap tear. No MRI however. He recommended Meloxicam and 6 weeks PT. He advised I could still workout during PT as long as the shoulder doesn’t hurt. I completed the first week of PT and the physical therapist encouraged me to workout. Naturally I did and was probably a little to agressive and now it hurts again. With all of this said, am I wasting my time with physical therapy? Am I simply delaying the inevitable? And with conservative therapy, can I expect to recover to a degree that I will be able work out at an intense level? I love heavy deads, compound movements and crossfit in general and will not be satisfied with a modified workout regimen that prevents me from doing the things I enjoy. This is very frustrating. Thanks in advance.

  3. Hi Ben sorry fro the delay we had a software glitch, I wasn’t getting the posts from peopleStarting at the beginning usually people can feel the worst exercises for themselves through trial and error. I would give up any that cause a bad pain as yes tears can get bigger and go on to becoming a biceps rupture which I have seen. Worsening or asymptomatic depends on the seveirty of the tear. Happy to see you.

  4. Last year I had surgery for a SLAP tear in my left shoulder and just recently found out that my right shoulder is torn too. Honestly, I’m a little freaked about whether or not I’ll end up tearing the right one again if I get surgery on it and am also scared that the left one didn’t heal all the way. I participate in Crossfit on my own, but have a lot more emphasis on Kettlebell lifting. I’m trying to figure out which exercises are the worst for me, and it seems like kipping pull-ups, barbell snatches, and overhead squats are all tough on the external rotation. Should I be giving these up? If my left shoulder is re-torn, how bad is it to leave a SLAP tear untreated? What are the chances of it going asymptomatic or getting worse?
    My doctor seems to know a good bit, but I would really appreciate some insight from someone who both knows the medical aspects as well as the specifics of the Crossfit lifestyle.. Any thoughts you may have would be very appreciated.

  5. was good, and now back, but not as bad

    • Maybe deadlift gave a little Gleno humeral distraction loosening up the capsule a bit. There are a bunch of great stretches/mobs you can do using a Superband that may help.

  6. shoulder was crunchy all week. rolled out with lacrosse ball and roller,and other mobility. did not feel better until i did ‘CrossFit Total’ (PR’d on DeadLift and BackSquat).

    why would a heavy DeadLift make my should feel better?

    • maybe it was tight and needed to be loosened up. is it still better?

  7. excellent post. i need more shoulder mobility and will work on lacrosse ball roll out.

    what about the stretch lying on your stomach with arms out perpendicular, raising hands off the floor with thumbs facing ceiling?

    • Hey rich sorry for the delayed response, i was stretching. That is a good one with a ball in front and works the front side of your shoulder not the back side.

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About Me

Dr. Sean Rockett is an Orthopedic Surgeon specializing in Sports Medicine. His group is Orthopedics New England with offices in Dedham, Natick and Newton, Massachusetts. Dr. Rockett is a CrossFit Level 1 Trainer and has been a CrossFitter at CrossFit New England since 2007. Dr. Rockett is on the Medical Team for the CrossFit Games and the Northeast Regionals.

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