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If you have been told that your shoulder pain with overhead movements is the result of “Shoulder Impingement Syndrome” the next questions are: “What is Shoulder Impingement?” and “How can get rid of it?”

Supraspinatus Tendon Impingement

Shoulder Impingement Syndrome is typically diagnosed with orthopedic tests that closely resemble a poorly executed sumo deadlift high pull. Shoulder impingement is caused by the joints of your shoulder moving in a way that causes it to bind upon its own soft tissues. A single incidence easily becomes a chronic condition as the swollen and irritated soft tissues then become a likely pinch point for future impingement. The same mechanics are at work when you continually bite the same place on your tongue. This is a common problem for novice weight lifters and crossfit athletes who have recently made rapid gains in overhead strength without cultivating equal overhead stability and middle back flexibility.

The Sumo Deadlift High Pull puts the shoulder in the same position as the Hawkins Kennedy Test for shoulder impingement. Photo courtesy of becomethebull.blogspot.com

2- How do I get rid of it?

Your family practitioner will tell you to ice the shoulder, take 800mg ibuprofen/ day and to stop lifting heavy objects overhead. That is fine for the short-term, but the only way to resolve the condition is to address the faulty movement patterns within the shoulder that created the initial impingement. The process that we use at Sports Medicine Northwest is two-fold: 1- We address any motor imbalances that are identified in exam, and 2- We optimize joint centration. We achieve both of these objectives through corrective exercise prescriptions.

With shoulder impingement syndrome “Optimizing Motor Imbalances” can mean everything from treating a rotator cuff muscle injury to scapular dyskenisia and a rigid upper back. In the absence of an acute tissue injury, joint centration movements such as the kettlebell arm bar, turkish get-up, and the kettlebell windmill are useful for regaining joint centration. At Northwest Strength and Performance and at Sports Medicine Northwest, we acclimate the injured athlete to the kettlebell windmill with the banded version demonstrated below.

After initiating these movements under traction, overhead lifts are progressively reintroduced and weight is added. When progressive weight is increased, the athlete is often stronger and more stable than they were before their initial injury.

Avoiding Back injury in deadlifts and Olympic Lifts

The spine alone is a flexible stack of blocks that is vulnerable to buckling under compressive load. With the surrounding musculature removed, the ligamentous support has been demonstrated to buckle under as little as 20 pounds of compressive load. (first noted in 1961 in cadaver studies by Lucas and Bresler.) We are very good at fixing those injuries here at SMNW, but prevention is king.

There is no single muscle that stabilizes this osteoligamentous structure so forget about targeting the multifidus or transverse abdominis. The system that supports the spine is the collective tension of all of the intrinsic and extrinsic muscles firing with equal tension from all sides. It is a guy wire system.

image from Low Back Disorders 2nd Edition.

The guy wire system only functions when all “wires” in our case muscles, fire equally. This is why I see athletes vulnerable to back injury in deadlifts during light weight (warm-up) weight pulls. They lack the ability to engage all of the tissues necessary for stability at lighter loads and their spines buckle. At higher weights they are less vulnerable as all of the tissues fire necessarily just to move the bar. The key to avoiding this warm-up weight movement fault is priming the tissues to fully engage by firing first with speed, then with load.

I use a lot of corrective exercises in practice but what I’m demonstrating today is more of what I’d call Joint Prep Movements. These are to be performed immediately before a loaded lift to prime your neurologic sequencing and set the table for for successful and coordinated firing patterns.

Here are two good examples:

It was a good weekend of gritty work and unexpected results. We held a top 10 spot all three days keeping us in the championship heat for all seven events. We had a plan and when our bodies broke down, we didn’t. We helped each other up and kept grinding. This was my 6th trip to the CrossFit Regionals and it is that human element that has made this the year’s run the one that I am most proud of.
While there, the good people at CrossFit Football sponsored the team with some free swag securing my “volunteer professional athlete” status for another season. We even made the site! Which is awesome. http://crossfitfootball.com/training/todays-training/

www.crossfitfootball.com

Come catch the CFFB peeps at their upcoming “How to Build a POWER ATHLETE” Seminar here at Northwest Strength and Performance June 13th and 14th. More info HERE.

This racked version of the double kettlebell turkish get-up takes the mobility and stability demands off of the shoulders and places it instead on the hips. That makes this an accessible transition for those with limited shoulder flexion mobility. If you have difficulty with this movement, it is likely because you lack the capacity for internal rotation at the hip. Try warming up with the Tactical Frog mobility the hockey stretch mobility before hand for greater range of motion in the transition. Balancing out your internal/external active range of motion is always a good idea anyway so if this applies to you, you may see you hip hinging patterns improve as well.

Here’s a quick reminder on how to do the hockey and tac frog mobilities:

We’ll be addressing the overhead version of the double kettlebell turkish get-up on the quick and dirty as well. That version is very difficult to perform correctly. Even for high level movers, attention to detail and excellent shoulder and thoracic mobility are prerequisites along with midline rib flare control. I’ll post up a different set of joint preps to go along with that version of the movement.

After the sports massage work I had done by my staff last week, I had to fight the compulsion to right a gushing Yelp! review as I typically would when someone goes above and beyond. I’ll go the blog post route instead.

About 8 months ago I partially tore my vastus lateralis in a snatch pull. It began as a typical quad pull but has settled in as a deep visceral ache in the lateral hip that keeps me from being able to put any pressure on that side and sometimes gets in the way of squatting motions. This is a nuisance as it wakes me up at night. I work the rehab/ prehab moves regularly and that keeps it functional during training but I haven’t caught any heavy snatches successfully in 8 months and the direct pressure issue is persistent. That is, until I had some deep tissue work done last week.

The work was indirect focusing mostly on the posterior side of the joint and distally near the lateral side of the knee at the muscle’s insertion. I can’t say that it was a pleasant experience but the local tenderness was gone immediately after the session. The next morning I woke up to the sound of my alarm for the first time in 8 months. I realized then that I usually wake with hip pain a couple times per night. I can now sleep on either side and I’ve hit 4 consecutive snatches at 95% of my 1RM. I’m now 100% for the 1RM snatch in event #4 of this weekend’s Crossfit West Regionals. These are the sorts of results that people need when they come to me for help here in the clinic. I am fortunate to work with such a talented team. I can say without reservation that when searching for the best sports massage in Seattle, look no further than Shannon Lindstrand and Sonya Rosenberger here at Sports Medicine Northwest.

Thank You!!!

Shoulder Chiropractor Seattle

I work with a lot of athletes who require tremendous speed and power in the overhead position.  This is a way to incorporate speed and and all-important shoulder flexion lockout position into your band work.