The CrossFit Shoulder
To paraphrase some Yoda-ic Jedi wisdom: Tissue overload can lead to Injury. Injury usually leads to pain. Pain leads to missed sessions and missed sessions make us miserable.
We can therefore infer that getting injured is miserable.
Whilst research suggests that injury risk within CrossFit is comparable to that of other sports, if you are going to get injured, there is a strong possibility that your shoulder will be involved.
We know this because academic types have done some bean counting and published their findings in peer-reviewed scientific journals. This is what they said:
1) 2016: According to the study published in the Sports Health Journal, the shoulder is the most common site of injury in individuals who train CrossFit. Of the 187 participants, 23.5% had experienced a shoulder injury in the last 6 months.
2) 2018: A study covering a four-year period and 3049 CrossFit participants, 30.5% had experienced an injury in the last 12 months, 39% of which were shoulder related.
3) 2020: Data showed that of 284 athletes who have experienced CrossFit related pain in the past 6 months, 59.6% was shoulder related.
Shoulder pain and injury in CrossFit is a problem, and the literature suggests it might be getting worse.
So, to help you, here are three evidence-backed ways to help you enjoy CrossFit and Functional Fitness whilst not blowing up your shoulder.
1) Train the small muscles
One important finding from the research is that those athletes who included exercises of a more isolated focus experienced less injuries.
Some call it prehab, others prefer corrective exercise. I call it having a properly designed training programme.
I am yet to train anyone who doesn’t need or doesn’t benefit from exercises that target the systems that help them to move better. Here, I am mostly referring to improving stability in both local and global.
Disclosure: The data in the study showed ‘significance’ when it came to knee injuries and indicated a strong correlation with reducing shoulder pain.
However, I propose that the lack of ‘significance’ may be largely due to exercise selection and execution which is more complicated for the upper limb as opposed to it not being of benefit.
Doing the WOD (workout of the day) warm-up is not sufficient to address individual sub-optimal movement issues.
Most of us bring some dysfunctional movement baggage to the CrossFit party so to considerably reduce your risk of injury you need to rethink your warm-up/movement preparation work as a starter.
Arrive early for the session and do the things that you need to do before the workout starts.
If you’re including other non-group WOD/open gym sessions throughout the week, those should include some form of specific dynamic stability work for your shoulders.
Try this seated external rotation, targeting the external rotators of the shoulder that will translate really well into our overhead pressing patterns.
2) Respect your history
Of the 23.5% of athletes who had experienced shoulder injury in the 2016 study, 38.6% reported it being an exacerbation of a previous issue.
The wider literature on recurrent rates of shoulder instability will back this up. Once you have had an instability event, you are highly likely to have another one.
It’s is my opinion that there is an opportunity to positively affect this statistic through improving the return to training practices. Often following injury, individuals seek support from a physiotherapist. Upon discharge they are often pain-free, have restored range of motion and done some work to improve dynamic stability.
This, however, is often not enough to prepare that individual to return to the chaos of the CrossFit environment.
If you’re coming to CrossFit with a history of upper limb niggles or injury you need to be proactive about looking after your shoulders. The group-based warm-up may not be enough, and this is where a supplementary programme that also incorporates point one above would be advisable.
3) Manage your athleticism
Many people come to CrossFit having played other sports in the past. This is both an asset and a liability.
The positive is that they bring with them training age and athleticism. The downside is that they can therefore progress quickly with the movements and exercises used within CrossFit.
The issue, however, is that they will often not be accustomed to the volumes used and lack the ability to do those movements well whilst under fatigue.
Confidence with weightlifting movements and ‘gymnastics’ skills combined with an athlete mindset, experienced in pushing the tempo from an intensity perspective, can be a precarious combination.
Whilst the movement system may ‘know’ these patterns, it does not know them under time-based constraints and high levels of fatigue.
We see this evidenced in the research where Bernstrorff et al found that mastering a movement did not lead to a reduction in pain or injury. In fact, it was the opposite.
Athletes who had mastered certain exercises were reported to have increased incidences of pain.
Athleticism is always your friend but if you’re starting CrossFit, aim low and build up gradually. Just because you’re competent in one or more components such as weightlifting or gymnastics, does not mean that you can hold it all together at the intensity that you think you can when things get sweaty.
You can maximise your enjoyment of CrossFit and avoid becoming a statistic by:
Committing to a strategic movement preparation programme that addresses your individual needs.
Manage your ego, especially if you have a history of being competitive.
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Are you frustrated by shoulder pain, instability and lack of confidence that's holding you back and restricting your training progression? We can help you build strong, stable shoulders you can rely on and have confidence in.
Summitt RJ, Cotton RA, Kays AC, Slaven EJ. Shoulder Injuries in Individuals Who Participate in CrossFit Training. Sports Health. 2016
Feito Y, Burrows EK, Tabb LP. A 4-Year Analysis of the Incidence of Injuries Among CrossFit-Trained Participants. Orthop J Sports Med. 2018
Bernstorff MA, Schumann N, Maai N, Schildhauer TA, Königshausen M. An Analysis of Sport-Specific Pain Symptoms through Inter-Individual Training Differences in CrossFit. Sports (Basel). 2021