Returning patients to CrossFit after shoulder pain

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Returning patients to CrossFit after shoulder pain

Today’s guest blog post comes to us from Dr. Joseph LaVacca, DPT, of Perfect Stride Physical Therapy in New York. Shoulder pain is the leading cause of pain and missed training days for CrossFit athletes. This blog takes a look at some of the common exercises used by Dr. LaVacca to return an athlete back to overhead lifting. As he mentions, it is important to FIRST assess your overhead mobility, and if limited, correct it before moving on to stability work.

Shoulder dysfunction is one of the most common things we treat and assess in a rehab setting. Regardless if your client is an overhead athlete or someone who simply needs to reach into high cabinets, reaching (and lifting) overhead is a part of life. How can we get our patients there safely? Of course local muscle strength and posture is important, but how can we progress our patients through a spectrum while following principles of mobility, stability and development? First things first we need to make sure that we have enough overhead mobility. Here is a great article and video on how you can assess and work on overhead mobility:

Now we are ready for the next steps. We have progressed our “traditional” RTC exercises (sidelying ER, prone Y, serratus punches) to the point where we have symmetrical firing and balance through glenohumeral and scap stabilizers. Here is a simple progression that we have used with great success to combine several different philosophies with our patients to get acclimated to the motor control of overhead work, starting with the simplest and ending with the most difficult.

Video 1: Supine Arm Slides with Breathing

Maximal body contact while working on active range of motion and rib depression/core activation through breathing. Although we start our progression here this exercise can be done in sitting or standing as well as part of an advanced HEP.

Video 2: Sidelying Arm Bar

Decrease in body contact with increased stability requirement while allowing GH/scap to work in greater isolation and control in gravity resisted patterns. This may be done with resistance or adding a shoe to build motor control.

Video 3: Mission Impossibles

The name speaks for itself! Here we continue our focus of scap and GH stabilization while eliminating weight bearing through the spine and hips. Multiple positions are possible here including keeping the knees down, placing feet against a wall or using something more sturdy such as a weight bench if the patient is unable to control motion on the stability ball.

Video 4: Tall or ½ Kneeling Overhead Carry

Further increased stability requirement by reducing points of contact while progressing to loaded spine now requires further demand on proper breathing and scap kinematics. Static holds are done first to re-educate overhead stabilization: Control motion before you “create” it. Challenge further by varying front foot position (ie wide to narrow)

Video 5: Standing Overhead Press with Midline Stabilization

Progressed to functional positioning (standing) and resisted transverse plane motion to control midline while overhead pressing. This prevents arching/hinging through the thoracolumbar region which is a common “overhead fault”.

Was this helpful? Have you tried different variations with your patients? What do you think we missed/what would you add?

Until next time Happy Rehabbing!

References:
Boyle, Michael, Mark Verstegen, and Alwyn Cosgrove. Advanced in Functional Training: Training Techniques for Coaches, Personal Trainers and Athletes. Santa Cruz, CA: On Target Publications, 2010. Print.

D’Agati, Eric. “FMS Level 2.” FMS Level 2. Montclair, NJ. 22 Aug. 2014. Lecture.

Honarbakhsh, Behnad. “SFMA.” SFMA. Philadelphia, PA. 3 Oct. 2014. Lecture.

Reinold, Michael, et al. “Current Concepts in the Scientific and Clinical Rationale Behind Exercises for Glenohumeral and Scapulothoracic Musculature.”JOSPT 39.2 (2009): 105-17. Web.

Bio of our Guest Blogger, Joseph LaVacca, DPT
Joe is an experienced outpatient orthopedic clinician who graduated from Sacred Heart University with his Bachelor of Exercise Science Degree in 2008, and his Doctorate of Physical Therapy in 2010. Joe began his career with Sports PT of NY where he was facility manager of their Midtown location for several years. During that time he progressed his knowledge and understanding of SFMA/FMS principles and received his certification in Fascial Movement Taping. Joe is strongly interested in education and injury prevention with a strong passion for teaching. Joe has served as a mentor for many student physical therapists from prestigious academic institutions. Through the national continuing education company, Medical Minds in Motion, Joe frequently travels throughout the country to teach healthcare practitioners about Kinesiology Taping and Movement Assessment Principles for Post-Surgical Populations and Return to Sport with the hopes of rolling out additional courses in the near future. Like his counterparts, Joe prides himself in staying current in the most up-to-date evidence-based research, and has experience in Neurokinetic Therapy, Maitland-Based Manual Treatments, Instrument-Assisted Soft Tissue Mobilization, Kinesiology Taping and movement assessment/performance screening which allows him to give individualized care to each of his patients. Joe is a member of the American Physical Therapy Association. In his free time, Joe likes to read, spend time with his family, and participate in interval training. Joe lives with his wife and daughter in Long Island.

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