Rotator cuff in CrossFit

What is the rotator cuff?

The rotator cuff is a set that is composed of the tendons of four muscles, which are the teres minor, infraspinatus, supraspinatus and subscapularis. 

What is the function of the rotator cuff?

Its function is to provide some stability to the shoulder, with increased activation during overhead gestures or rotations.

It works in synergy - together - with all the other shoulder muscles, such as the deltoid or the different portions of the trapezius.

crossfit rotator cuff pain

The movements found in CrossFit can take this muscle group to maximum levels of work and effort.as well as demanding work from your hamstrings.

Power or plyometric movements (in which there is a change of direction, storage and release of energy) are the most demanding at the tendon - rotator cuff level. 

In CrossFit, there are many exercises with this feature, such as the kipping in pull ups and toes to bar or the famous burpees (if we stay at the shoulder). In this type of movement, the tendon acts like a "rubber band" that stretches - accumulating energy - and then shortens - releasing energy - while transmitting and supporting the forces produced by the muscles.

It is necessary to be prepared to face this type of exercises if we want to reduce the risk of suffering an injury. 

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Data 

The shoulder is the area of the body where most injuries occur during CrossFit practice according to studies published to date.

most injured area crossfit

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6201188/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5089356
https://pubmed.ncbi.nlm.nih.gov/28253059/
https://pubmed.ncbi.nlm.nih.gov/24276294/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5358031/

However, if we look at the ratio of injury per number of hours, it is not higher than in other sports such as soccer or basketball.

Moreover, running has a higher ratio, moving between 2.5 and 17 per 1,000h of training, while in CrossFit we move around 2.5-3.5.

Sport/activityInjury rate per 1000 hours
Elite weightlifting0.42-0.53 (Shoulders only)
Swimming1
Walking1.2
Cycling2
CrossFit2.4-3.1
Triathlon (preseason)2.5
Running (long distance)2.5
Weightlifting2.6-3.3
Gym training3.1
Gymnastics3.1
Running (in general)3.6
Triathlon (competitive season)4.6
Tennis4.7
Women's soccer (practice)5.2
Soccer7.8
Basketball9.1
Men's soccer (practice)9.6

Even so, the shoulders are still, together with the knees, the ones that can give us the most problems or worries.

Why are shoulders injured more in CrossFit?

Many factors have an influence here. Some extrinsic (external weight, load, volume of work, technical movements, speed, ...) and others intrinsic (mobility, strength, fatigue, athlete's capabilities, ...).

The most important and characteristic factors of CrossFit:

High intensity movements, high volume of repetitions and very technical exercises.

High intensity work has many benefits and is necessary for health and performance. The important thing is to adjust it to the capabilities of each athlete so that it can be performed within a framework of certain safety.

If, in addition to the intensity, we add a high volume of repetitions, it is easy to reach a state of high fatigue. At this point, the different structures of the shoulder have to work hard to maintain stability and continue to produce the necessary force. Sometimes, with the adrenaline of the WODIn the end, we end up working beyond our capabilities, increasing the risk of injury.

Finally, remember that there are many complex exercises, which can take a long time to master. Executing these exercises at high intensity and volume without having the necessary control can also be dangerous and is something we often see during the WOD in some classes.

How to avoid shoulder injuries

It is very important to know that we have the mobility and strength to be able to do these exercises in the WOD.

For example, having a well-established kipping is essential to perform pull ups - with kipping or butterfly - in the WOD. If this is not the case, we will have to dedicate more hours to technical, specific strength and mobility work to master kipping. Until then, look for regressions or adaptations to be able to work at high intensity without increasing the risk of injury.

Increases strength and mobility work

Low proportion of strength/mobility work compared to high intensity work (WOD).

If we count the hours spent doing WODs and compare them to the hours spent on mobility and strength work, we will probably see that the latter are very few.

As we said in the previous point, before performing a movement at high intensity and volume, with significant fatigue, we must be sure that we have the necessary capabilities to do so.

We are talking about the range of motion of the joint and the strength in this range, body control or the strength of the kinetic chain (other muscle groups working in synergy to produce the necessary strength and stability), among other factors.

If we want to progress not only safely, but also efficiently, it is necessary to introduce specific strength and mobility work that allows us to bring out our full potential and performance in the WODs.

Something quite common is to see athletes with insufficient ranges of motion or lack of strength in some points of these ranges. For the proper functioning of our shoulders it is necessary that other parts of our body also have good ranges of strength and mobility.

We are talking mainly about the thoracic or dorsal spine, which can limit the mobility of our shoulders or put much more load on them. In exercises in which we add the movement of squat (overhead squat, snatch PR...) we must also look at the mobility of the hip or ankle.

In CrossFit there are many exercises performed overhead, all with different characteristics. Some are rack-holding, such as pull ups, others are throwing exercises, like wall balls and others with a maintained or moving weight, such as the snatch, jerkor the overhead squat.

There are few sports in which we see such a large list of movements that require so much strength and mobility to perform overhead gestures.

As we can see, there is a lot of work we can do to improve our shoulder function, performance, efficiency and injury prevention.

Variability of the technique

Technique and its relation to the risk of injury is a very complex issue. Our body will decide how we perform a movement taking into account our own capabilities (strength, fatigue, ...) and the external or environmental characteristics (object, weight, ...).

This process is basically mediated by our nervous system, which will learn from each lift or repetition we do to become more and more efficient.

Giving information to our nervous system, by performing specific technique work in different environments, will allow us to progress towards more solid and harmonious gestures (beautiful to look at).

At the same time, we will integrate this movement in a more automatic way, which means that we will have to make less effort (spend less energy) to execute it.

This is very important, since during the training or WOD we will accumulate a certain level of fatigue that will make it increasingly difficult for each of our systems to continue functioning.

If our technique, or ability to perform a movement, is efficient and well integrated, it will be more difficult for it to be altered and therefore we will be able to perform better and in an environment with a lower risk of injury.

Elite or more experienced athletes suffer hardly any variations in their technique as the WOD progresses, while in more novice athletes we can observe changes already between the first repetitions of the WOD.

Avoid shoulder injuries

Some of the most important points that would be interesting to comply with:

Good programming

Control and adapt the training volume, avoid peaks, sudden increases that are not programmed.. Following a meaningful program is something basic that we sometimes fail to do in CrossFit.

While it is true that this sport is characterized by a certain "randomness" in their WODs or tests and that we must be prepared for it, it is also true that this does not exempt us from following a schedule in our workouts.

Scheduling increases in load, volume and other parameters as well as PR days will help us to progress and improve our capabilities faster than doing it irregularly.

Training intensity

Control the intensity of training is also very important, and nowadays we know that there are quite practical and simple ways to do it.

We have subjective effort scales such as RPE (Rate of perceived effort) and RIR (Reps in reserve) that help us to know how far to go in each training session.

Technique always in the forefront

Be consistent in technique before adding more weight or speed to movements or lifts.

Improving the technique of our movements, making them more efficient, easier and more aesthetic will be a key factor that can make a difference.

We know that the technique of the same movement can vary between different athletes, this will depend on their intrinsic factors and their way of interacting with the environment.

Even so, within this interpersonal variety, there are key points that will always coincide and that we must master as well as possible.

For example, we can view any event of the CrossFit Games. Let's look at the different grips to perform the pull ups, the different arm and hand positions to execute the push ups between each competitor.

They all vary from each other.

It may have to do with the proportion between the length of the arm and the body, the distribution of force between muscle groups, ... But they all have points in common that make that movement efficient and we see it "beautiful", in the sense that there is no extra effort, apart from the essential to continue working, aimed at maintaining that technique.

That should be the goal, that our movements look somewhat "easy" to execute from the outside and that we do not have to expend additional effort beyond what is necessary.

To achieve this we will need time and perseverance.

A lot of specific work on technique, strength and mobility. Until then, manage the different training parameters well and be able to tolerate changes and variations in our movements, which we are sure there will be.

Work on strength

Perform strength exercises in the range of motion we need to execute the exercises we will encounter in CrossFit practice.

Mobility is not only the ability to be able to reach a given range of motion, but also to be able to perform strength and have control throughout that range.

The greater the control and strength throughout the range of motion, the lower the risk of injury.

There are many exercises to be able to adapt our tissues (tendons, muscles, ligaments, ...) of the shoulders to CrossFit movements that need such control and range of motion.

Eccentric exercises

A good tool is the eccentric exercisesin which we produce a stretching of the different structures and an increase in the range of motion. while contracting the muscles.

This allows us to gain control over the full range of motion as well as to increase our mobility.

Performed at high speed, they are very interesting to improve energy storage capacities, an action that is mainly carried out by our tendons, to later release it through the concentric phase.

The more we control this process of storing and releasing energy, the more efficient we will be in our movements and reduce the risk of injury.

Some characteristic CrossFit exercises that demand this capacity in the shoulder are: kipping, the burpeeswall balls or handstand push ups.

Sometimes we think that external weight is the biggest risk factor for our tendons, when in fact exercises with our own body weight can be much more demanding.

Other types of work may include end-range isometrics, exercise variations, partial range work, chain/rubber work and other advanced methods.

Shoulder injury prevention exercises

Here are some suggestions for exercises you can use to prevent shoulder injuries.

Check out how to execute some of these exercises in the YouTube video I have embedded above.

Isometrics

  • Isometric external rotation walking sideways at 0º abd.
  • Isometric external rotation front rack position
  • Isometric rot ext + flexion with miniband
  • OH farmer carry (KB, DB, bar, bar+rubber+rubber+weight - disturbances -)
  • Disturbances with rubber with disc in between

Eccentrics

  • Eccentric standing shoulder flexion (with spike+rubber, with barbell, with disc)
  • Eccentric shoulder flexion with FR lying down
  • Eccentric with pike+rubber attached to the rack - latissimus dorsi - also perform isometric if we move away from the rack walking in the opposite direction keeping the pike above (+ change it for a barbell)

Strength

  • Transnasal press (+ sots press) - Snatch or jerk balance, drop snatch or jerk (receptions)
  • Turkish get up and variations/progressions
  • Bottom up KB carry, press, ...
  • Wide grip shrugs
  • YT in rings
  • YTWL on bench (with discs)
  • External rotations with rubber (progressions)
  • Pull apart, "cable" pull apart
  • Pendlay row o rowing Chinese
  • Progress with basics (press, pull, ...) and gymnastics (HSPU with deficit, ...)
  • Drop and pick up ball in DP or BP (storage and release)
  • Medicine ball throws

Heating

  • Shoulder dislocations with bent-over rubber band
  • Shoulder dislocations with pike + rotations
  • Transnasal/frontal press with pike
  • Controlled rotations
  • Prone angels
  • Launches
  • Face pull, pull apart, ...
  • Dorsal mobility
  • Add some isometric or eccentric exercise.
  • Add low load exercise, increasing speed and load (e.g. snatch, jerk, kipping, ...)

As always, there are many exercises, but the secret lies in knowing how to choose the ones that will be most useful to you. and progress with them in terms of load, difficulty and volume.

There is no need to do a thousand different exercises, there are no magic exercises, the key is to dose them correctly, to work constantly and adapt them to each situation or based on the objectives we need.

When to perform these exercises?

This type of work can be performed in each session. Just before, as part of the warm-up, during the workout itself, between sets or during breaks, or at the end of the workout as complementary work.

In case of pain or injury it is important to have a health or sports professional to accompany you in the process of recovery, rehabilitation or injury prevention.

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