Kipping pull-ups, snatches and overhead squats are incredible feats of strength — until your shoulder labrum disagrees.
PATIENT STORY
“I felt a pop during a snatch at my CrossFit box. It did not feel terrible right away, so I finished the WOD. That was six months ago. Now I cannot sleep on that side, and my shoulder clunks every time I reach overhead.”
*Composite patient story. No identifying information used.
I have tremendous respect for CrossFit athletes. The dedication, the community, the willingness to push limits — it is genuinely inspiring. CrossFit builds real strength, real conditioning and real confidence. As a surgeon who believes that movement is essential to a long and healthy life, I am absolutely in favor of people finding a fitness culture they love and sticking with it.
I just also happen to repair a lot of CrossFit shoulders. The sport — by design — asks the shoulder to do extraordinary things repeatedly. High-volume Olympic lifts, kipping movements, ring work and overhead loading place unique and sometimes relentless demands on the shoulder joint. When the shoulder's soft tissue structures are not ready for those demands, or when fatigue causes technique to break down, injury can follow.
The structure most commonly injured in overhead CrossFit athletes? The labrum.
of overhead athletes experience labral pathology
annual injury rate in competitive CrossFit athletes
of labral repair patients return to their sport
most common CrossFit injury site: the shoulder
What Is the Labrum and Why Does It Matter?
Your shoulder socket — the glenoid — is relatively shallow. If it were a coffee cup, the ball of the humerus would be balancing on a saucer. That is where the labrum comes in. The labrum is a ring of tough fibrous cartilage that lines the edge of the socket, deepening it and making it more like a bowl. It is also where several important structures attach, including the biceps tendon and key shoulder ligaments.
A SLAP tear (Superior Labrum Anterior to Posterior) is a tear at the top of this ring — often right where the biceps tendon anchors to the labrum. SLAP tears are especially common in overhead athletes: baseball pitchers, volleyball players, swimmers and CrossFit athletes who perform high-repetition kipping movements and heavy overhead lifts.
Non-Surgical Treatment: When We Try First
Not every labral tear requires surgery. Partial tears and low-grade injuries often respond well to a focused rehabilitation program aimed at strengthening the muscles that take load off the labrum — particularly the rotator cuff, the scapular stabilizers and the posterior capsule. Modifying training (taking kipping movements and heavy overhead work off the table temporarily) gives the tissue a chance to settle down.
Physical therapy and Airrosti treatment can be extremely helpful here for managing soft tissue tension and improving shoulder mechanics. Physical therapy with a therapist who understands overhead athletes is essential. A well-designed return-to-training protocol — gradually reintroducing overhead loading in a controlled way — is the bridge back to the box.
CLASSIC SLAP TEAR SYMPTOMS
A deep ache in the shoulder that is hard to locate, pain with overhead activity or throwing motions, a clunking or catching sensation, pain when reaching behind your back, weakness or instability during heavy lifts and — very commonly — pain at the front of the shoulder near the biceps tendon. If this sounds familiar, it is time for an evaluation. An MRI with contrast (called an MR arthrogram) is often the best imaging tool to confirm the diagnosis.
Surgery for a SLAP tear: What to Expect
SLAP repair or biceps tenodesis is performed arthroscopically. Using a tiny camera and instruments, I reattach the torn labrum to the glenoid rim using small anchors. In cases where the biceps tendon is heavily involved or is a significant source of pain, an alternative procedure called a biceps tenodesis — where the biceps tendon is moved to a new attachment point — may be a better option. The decision depends on the exact anatomy of the tear, your age and your activity goals.
After surgery, you will be in a sling for 4 to 6 weeks, followed by a carefully structured physical therapy program. Return to CrossFit typically takes 4 to 6 months for most athletes. Return to heavy overhead Olympic lifting may take 6 to 9 months.
CrossFit and Long-Term Shoulder Health
The comeback story is real. I have watched patients come back from labral repair or biceps tenodesis and perform better than they did before — because they used the recovery period to rebuild a healthier foundation. Movement is one of the best things you can do for your body and mind. CrossFit, done intelligently, can be part of a healthy, active life for decades.
Shoulder clicking, catching or feeling unstable?
Dr. Jamie Lynch specializes in overhead athlete shoulder injuries. TruOrtho, San Antonio.
Book an Appointment: www.sportssurgeryspecialist.com |
REFERENCES
- Weisenthal BM, Beck CA, Maloney MD, et al. Injury rate and patterns among CrossFit athletes. Orthopaedic Journal of Sports Medicine. 2014;2(4).
- Brockmeyer M, Tompkins M, Kohn DM, Lorbach O. SLAP lesions: a treatment algorithm. Knee Surgery, Sports Traumatology, Arthroscopy. 2016;24(2):447-455.
- Neri BR, ElAttrache NS, Owsley KC, et al. Outcome of type II superior labral anterior posterior repairs in elite overhead athletes. American Journal of Sports Medicine. 2011;39(1):114-120.
- Maffet MW, Gartsman GM, Moseley B. Superior labrum-biceps tendon complex lesions of the shoulder. American Journal of Sports Medicine. 1995;23(1):93-98.
This blog is for educational purposes for personalized medical advice you must see me or another qualified physician for diagnosis and treatment of any medical condition. | Dr. Jamie Lynch, M.D. | TruOrtho, San Antonio, TX | www.tru-ortho.com | www.sportssurgeryspecialist.com
