Shoulder and Shoulder Injuries: Anatomy, Symptoms and Rehabilitation * Crossfit

The shoulder joint is the most mobile joint in the human body. There is no other joint in the body that has the same number of degrees of freedom. It is here that you can simultaneously perform movements such as flexion-extension, abduction, rotation. But such mobility, in addition to its advantages, also has its disadvantages - the more freedom of movement in the joint, the less protected it from accidental injuries. For this reason, the shoulder joint is very easily exposed to various injuries under the influence of physical exertion. What is the most common shoulder injury, what types of injuries are, how to avoid them, and what to do if the shoulder is already injured - we will tell you in this article.

Shoulder anatomy

The shoulder joint is a complex structure in the human body. To understand how it functions and in what situation there is a risk of injury, you first need to understand its structure and anatomical features.

Joint structure

The bone base of the shoulder joint is:

scapula with articular surface and 2 processes (humeral and coracoid);
the humerus with its head;
collarbone.

The listed bone elements are interconnected by a number of ligaments, namely:

the coracoacromial ligament is stretched between the coracoid process of the scapula and the humeral process of the scapula;
coracohumeral - a ligament stretched between the head of the humerus and the head of the humerus;
articular capsule - a ligament that encompasses the head of the humerus and attaches along the edges of the articular surface of the scapula. It is formed by the upper, middle and lower articular-humeral ligaments;
The acromioclavicular ligament is between the clavicle and the humeral process of the scapula. Although it has nothing to do with the shoulder joint directly, shoulder movements are not possible without concomitant movement in the clavicular-acromial joint. It is about abducting the arm above 90 degrees, rotating the arm, bending the shoulder above 90 degrees.

Muscular component of the shoulder joint

The inner surface of the scapula is lined with the subscapularis muscle. She gives her tendon to the head of the humerus. It is the first muscle whose tendon forms the rotator cuff. By the way, shoulder tendon injury is quite common in sports practice. Its danger is that often the treatment of such damage is not complete without surgical intervention.

On the outer surface of the scapula (or on the posterior surface, if the anatomical classification of the BNA is observed) there are two muscles:

supraspinatus;
infraspinatus.

The fact is that these muscles are attached directly to the body of the bone and the rationale for their name is the bony landmark on the body of the scapula - the axis of the scapula. The tendons of both of these muscles are attached to the head of the humerus, respectively, they are number two and three among the muscles of the rotator cuff.

From the lateral edge of the middle third of the body of the scapula, the fourth muscle stretches to the head of the humerus, forming the rotator cuff of the shoulder - the small round muscle. The rotor cuff strengthens the shoulder joint and provides the correct position for the humerus head.

The role of the biceps and deltas in shoulder work

The tendons of the biceps heads “strengthen” the shoulder joint along the front surface: the long head is attached to the supra-articular tubercle of the scapula, and the short one to the coracoid process of the scapula. Both heads form a muscular abdomen, which is attached by a wide tendon to the tuberosity of the radius. Thus, the biceps flexes not only the elbow joint, but also participates in flexion of the shoulder.

The long head of the triceps originates from the sub-articular tubercle of the scapula and participates in strengthening the shoulder joint along the posterior surface. All three heads, with combined tension, contribute to shoulder extension.

The deltoid muscle covers the entire joint from above, uniting the entire upper limb girdle (clavicle, scapula, humerus) into a single whole and directly providing the entire range of motion in the shoulder joint. Such a functional unification is possible due to the fact that the attachment points unite all designated areas. The muscle itself, functionally, can be divided into three "portions":

front - provides a raise of the hand in front of you;
medium - is responsible for moving the hand away from the body;
back - provides abduction of the humerus back.

Common injuries

So, if you have already formed a certain idea of how our shoulder joint works and how it works, you can proceed to familiarize yourself with its most frequent injuries. Below we will look at some of the types of shoulder injuries and discuss which crossfit exercises are the most traumatic and how to avoid injury.

In CrossFit, the most traumatic exercises for the shoulder are exercises with force on the rings, jerks, and jerks.

Moreover, it is not so much the exercises themselves that are dangerous, but the mode in which they are performed. Repeated movements in the shoulder joint, performed with maximum and submaximal loads, and even in a large amplitude, provoke the formation of a large number of microtraumas, including in the ligaments. Therefore, the recovery factor must always be strictly considered in training planning.

Shoulder dislocation

The most common injury to the shoulder joint, or rather the ligamentous apparatus, is dislocation. The essence of the damage lies in the fact that the head of the humerus is displaced slightly forward or slightly backward from its physiological position.

Most often, dislocation occurs due to the displacement of the bone forward. In this case, the hand is naturally pressed against the body, the acromial (humeral) process of the scapula is sharply contoured. A "cavity" is formed between the head of the humerus and the acromion. The area of the shoulder joint swells, movement in the joint is impossible.

The most traumatic exercises in terms of getting this type of injury are force output on the uneven bars, push-ups on the uneven bars with additional weights.

Rotator cuff injury

The rotator cuff is easily damaged by direct traumatic effects - blows to the joint area, excessive twisting forces passing through the axis of the joint, when the shoulder is injured when falling and landing on the shoulder joint area. These exercises top the list of exercises that can damage the rotator cuff.

It is very easy to injure the rotator cuff when jerking and doing push-ups with the arms along the body. This happens at the moment when one of the hands is not held in the "along the seam" position. In this case, an eversion of the humerus occurs: its head goes forward relative to the axis of the joint. In the worst case, a rupture of the joint capsule or rupture of one or several muscles of the rotator cuff is possible, in the best case - the formation of spasm in the muscles of the cuff (most likely - the supraspinatus and infraspinatus muscles) with displacement of the head relative to the joint and difficulty in movement in the joint, up to complete impossibility raise your arm above 60 degrees from the body.

Sprains and muscle tears

Another common type of injury among CrossFitters is shoulder ligament injury.

The angular velocity in the snatch and clean and jerk exercises is very high. With excessive weight of the projectile or poor intermuscular coordination, the humerus can go beyond the plane of the body, thereby creating excessive tension on the ligamentous apparatus of the joint and provoking either a stretching of the shoulder ligaments or, more likely, a spasm of a group of short muscles - rotators, with a simultaneous tear or rupture one of them (the most likely here is the rupture of the small round muscle).

Ligament ruptures can be fraught with exercises on the uneven bars and rings. In exits by force on the uneven bars, the body weight falls on the shoulder joints. Let us make a reservation in advance that the load on the joints is much higher on the rings than on the crossbar, due to the lower stability of the position of the hands in the exercises performed with the help of this sports equipment. For this reason, when performing the listed exercises, stretching of the muscles of the shoulder and ligaments, and sometimes their ruptures, are also common.

Biceps, Triceps and Delta Injuries

It is very easy to injure the biceps when doing the ragged deadlift with a lot of weight. With strong tension in the body, accompanied by a jerk force, hyperextension of the tendon apparatus occurs. The muscle body, conventionally, tenses in one direction, while the effort is directed in the other. As a result, injury to the shoulder muscles can occur. Most often, this is a rupture of the muscle fibers of the biceps. When the biceps breaks, the tendons of this muscle shorten, which can further complicate such movements as raising the arm in front of you.
Triceps are most often injured in heavy basic movements aimed at developing the specified muscle: push-ups on the uneven bars, when doing a French press or a bench press with a narrow grip. The situation is very similar to what happens with a biceps injury, with the only difference that as a result of the injury, it will be difficult to move the arm behind the back.
The centering of the shoulder head depends not only on the state of the "rotator cuff", but also on the uniform development of all three "heads" of the deltoid muscle. The underdevelopment of any area creates conditions under which the function of the “weak” site begins to take on deep muscles that are not adapted to perform this function (the same “cuff”). This leads to the fact that they spasm, that is, shorten and limit some of the movements in the shoulder joint. The condition that is formed in this case is included in a set of diseases called humeral-scapular periarthritis. The easiest way to get injured by the deltoid is when swinging over the sides with excessive weight, without first warming up (middle portion. Similar shoulder injuries are also quite common when pressing a barbell or when performing a heavy press under the same conditions.

Shoulder arthrosis

The head of the humerus is covered with cartilage, as well as the articular surface of the scapula. This formation is called the glenoid lip, into which the said head of the bone is "sunk". Under the influence of excessive physical exertion, the cartilage tissue begins to thin out, exposing the bone tissue under it. If in some part of the joint the cartilaginous covering completely disappears, the exposed bone, when it comes into contact with another articular surface, receives a signal to repair - to restore the lost integrity.

Thus, the work of osteoblast cells, which are the "builders" of bone tissue, is activated. As a result, a kind of growths are formed - bone spines, which have a secondary traumatic effect on the joint.

When congruence, that is, the mutual correspondence of the articular surfaces, is violated, a kind of vicious circle is formed: the more movements are performed, the larger the damage becomes. But a decrease in motor activity in such a situation does not help: a smaller number of movements of the shoulder joint leads to a decrease in the blood circulation rate and this also entails a variety of injuries to the shoulder and shoulder joint due to a lack of nutrients. Thus, a disease called arthrosis of the shoulder joint is formed, which is a direct consequence of any acute injury to the shoulder.

What to do with a shoulder injury?

In this section, we want to share some recommendations on what to do if injury still cannot be avoided. First, let's figure out how to recognize this or that shoulder joint injury in order to take the necessary initial measures.

Injury symptoms

Shoulder injuries are always accompanied by sharp pain in the joint area, sometimes you can hear a sound as if something burst. At the same time, as a rule, the joint increases in volume, when pressed it becomes painful. The position of the humerus can be unnatural - shifted forward or backward. As a rule, the hand falls down involuntarily. Movement in the shoulder joint is impossible or severely difficult, depending on the injury.

It is quite difficult to recognize on your own what exactly happened, under an hour, and sometimes impossible. Rupture of the rotator cuff, rupture of the joint capsule, and rupture of the anterior portion of the deltoid muscle are clinically quite similar. However, you can focus on such an indicator as the intensity of the edema and its localization.

The formation of a subcutaneous hematoma is most typical for damage to the deltoid muscle, the difficulty of all types of movements in the shoulder joint is a characteristic feature of rupture of the joint capsule. In this case, there may also appear a feeling of "instability" of the joint, the hand seems to "dangle", while the level of the shoulder joint will be visually lower from the side of the injury.

First aid

Any sports injury to the shoulder is a very serious injury, so every athlete should know what to do in this case. First aid will consist of three main points:

Something cold should be immediately applied to the damaged joint. Ideally, this should be an ice pack. But if it is not there, you can do with improvised means - a pack of dumplings, a piece of frozen meat, in general, anything that has a low temperature will do. This compress has a local anesthetic effect - it reduces swelling and pain after a shoulder injury.
Next, you need to fix the limb, ensuring the damaged joint is in a motionless position. This is important during the “acute” period of the injury. The simplest and most affordable way to fix the shoulder joint is a time-tested bandage - a kerchief. The injured arm must be gently bent at the elbow and pressed tightly to the body. After that, a triangular scarf is put on, the ends of which are fixed on the neck, and the hand is placed in the resulting bed.
After that, you should immediately consult a doctor, preferably a specialized specialist - orthopedic traumatologist. He will order the necessary research. It is highly discouraged to go to diagnostic centers on your own and try to "self-heal"! The more time has elapsed from the moment of joint damage to the start of treatment, the less chances for a complete recovery and return of the shoulder joint to its former mobility.

Shoulder injury treatment

The course of treatment should be prescribed only by a doctor! In no case do not try to heal yourself, since the slightest mistake can lead to the fact that you will have to forget about returning to the sport.

But in order for you to have a general idea of what the healing and recovery process looks like for a shoulder injury, we will tell you about its main stages.

In general terms, treatment for a shoulder injury is as follows:

An acute period of injury lasts from 2 weeks to a month, during which movement in the shoulder joint is highly undesirable.During this period, non-steroidal anti-inflammatory drugs, cold compresses, physiotherapy procedures are used.
After a month of the acute period, the rehabilitation period begins. It can last as long as you like. As a rule, it is quite long - 4-6 months, sometimes more, depending on the severity of the injury. We will tell you more about this period later.

Post-traumatic rehabilitation

Recovering from a shoulder injury is not a quick process. Rehabilitation, on average, can begin one month after the injury. Again, this is an individual matter and requires the advice of specialists in traumatology and sports medicine.

The simplest equipment is a rubber band. In principle, you can buy nothing else besides it. It is necessary to perform the following set of exercises 3-5 times a week, each movement is performed for 15-20 repetitions, as slowly and under control as possible, clearly feeling the work of the muscles. In addition, you will need a place where you can attach the aforementioned rubber band, so that you can change its position - at the level of the belt, above and below it.

Starting position - standing facing the place of attachment of the expander (or rubber band). The latter is fixed below the belt level. In the injured hand, there is a spader, it is stretched, creating an initial tension in the muscles of the shoulder joint. Due to the combined movement of the shoulder and shoulder blade, we pull the rubber band to the belt; we return to the starting position.
© natapetrovich - stock.adobe.com
The exercise is similar to the previous one, but the expander should be at waist level, the starting position in this case is sitting. Thus, the expander is approximately in line with the shoulder joint. The deadlift follows the same rules.
The starting position is similar to that described in clause 2. The expander is fixed above the level of the shoulder joint. We also perform the pull of the expander towards ourselves.
Developing a rotator cuff: This exercise requires a dumbbell. We bend the arm at the elbow, press the elbow joint to the edge of the wing of the ilium, the shoulder is fixed in this position. The forearm is at 09 degrees to the body. Smooth movements are performed with the forearm to the left and to the right, in a small amplitude, until a burning sensation inside the joint is felt.
© pololia - stock.adobe.com

Training after a shoulder injury

It is possible to resume training with a shoulder injury only after the initial range of motion in the shoulder joint has been restored and the painful sensations have completely disappeared. At first, it is forbidden to perform in training movements such as:

push-ups on the uneven bars;
ring exercises;
weightlifting movements with arms extended overhead (snatch, clean and jerk, overhead, shvung).

You can perform single-joint movements. For example, the following exercises for a shoulder injury will be very helpful in developing joint mobility:

swings across the sides, in front of you, in an inclination;
shrugs;
presses for the pectoral muscles, preferably in the Smith machine;
back rows in upper and lower block row machines.

In these exercises, you should start with small weights, working at full amplitude, but trying not to bring the shoulder joint into an uncomfortable position. Any discomfort in the shoulder joint is a reason to remove the exercise for a period of time from your arsenal.

Initially, work in all exercises should be no more than 15 repetitions, as slowly as possible, causing a burning sensation in the working muscles. Thus, we contribute to an increase in the production of endogenous growth hormone and to accelerate healing and strengthen the tendon-ligamentous apparatus.

Every 2 weeks, you need to gradually increase the load. It is recommended to practice in this mode for at least 3 months. Further actions are a strictly individual question.

What is stated in this article should not serve as a reason for self-diagnosis and self-treatment in case of injury! Always consult a specialist before doing something!

The main motive of this article is to urge all athletes to conduct a thorough warm-up before the main training session, to correctly plan the training process. Technique supplied by a professional and good recovery will protect your joints from injury, because it is always easier to prevent injury than to cure it!

Be healthy!