We discussed what happened to the end of the biceps tendon if it completely tears off from the cup or the glenoid. Now what happens if you get a tear at the end of the biceps where it attaches to the glenoid via the labrum? Let’s look at the anatomy for a second and then we will discuss SLAP (Superior Labrum Anterior Posterior) tears.
The end of the biceps attaches to the labrum which attaches to the glenoid as seen here. It serves as the anchor for the biceps muscle, so it is very important for lifting things from the ground, i.e. cleans, farmer’s carry, deadlifts. Imagine a weight pulling down on your arm and the rotator cuff, biceps, and all the other shoulder stabilizer muscles resisting that force and contracting to keep your arm from being pulled down.
There are things called traction injuries where the arm is pulled suddenly from the socket. One example of such an injury is what I often will call Big Dog Traction injuries (not Big Dawg). It comes from people who have large dogs and when those dogs pull violently after seeing another dog, squirrel or postal worker, they yank the leash that is attached to the person’s hand and pain develops from the traction of the biceps and labrum pulling off the glenoid.
Getting back to CrossFit stuff, can you imagine that the same traction type injury that can occur with that initial moment of pulling on a deadlift, if you are not using proper form and technique? So, it is important not to pull at the weights and yank away but to keep your whole shoulder girdle locked in with straight arms and shoulders back squeezing your scapula or shoulder blades together. Then with your arms extended and solid, initiate the lift with your legs not your upper body. If you do not have proper form and rotate your shoulders forward, you are eliminating the scapular stabilizers or the muscles located in the back of your shoulders (another topic for later) and putting more strain on your structures in the front of the shoulder like your biceps.
The other important point for this topic is to stay in line with your progression. Yes, we see unbelievable changes in conditioning and strength at CrossFit, but please don’t think this is an exponential curve once you are comfortable with the movements. I think there is a tendency for new people to start looking at the leader boards checking the records and saying to themselves “I can get that tomorrow or the next day” as opposed to staying in control and gradually work up their progression of weight. Don’t get me wrong unleashing the Dogs of Fury is great and fun, but I just want people to unleash the Dogs as opposed to be getting pulled by the leash.
The other main way that people can develop SLAP tears are from abduction external rotation stresses as in pitching, volleyball, and pull-ups. Look at the tremendous amount of what is called external rotation that occurs in the shoulder of this pitcher when he throws.
In the shoulder joint the biceps tendon and labrum are rotating back and doing what is called “peeling back” or lifting off the glenoid or socket. See the biceps tendon/labrum on top of the glenoid peeling back away from the glenoid as the arm is rotated externally as it does in a throwing motion.
Now look at the Kipping pull-up picture below, pretty similar.
So this brings us to the question, “Are we all destined to develop SLAP tears?” NO. What can we do about it? Stay tuned- next installment how to prevent SLAP tears and what happens if you have one.