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-   -   Labrum/SLAP Repair Surgery Flexibility Issues (http://www.catalystathletics.com/forum/showthread.php?t=5712)

Kyle Redinger 09-09-2010 12:06 PM

Labrum/SLAP Repair Surgery Flexibility Issues
 
Hey guys first post on here. We have a bunch of athletes following your programming for CF Games competitions at CrossFit Charlottesville and I really appreciate your commentary.

Anyway, here's an issue.

I had a Type 2 SLAP Repair (which included 5 anchors for a tear in the front and back) for a Labrum Tear in my left shoulder about 8 months ago. Prior to surgery I had very bad shoulder instability. After surgery, I did rehab which included long painful stretching sessions with a PT and a lot of strengthening/band work on my own. I was cleared 6 months after surgery and I'm back in the groove. My lower body lifts have recovered nicely, my pulling strength is stronger than before, but pressing or overhead movements are giving me problems.

Here are some specific issues:

Overhead Squat: My OH squat on my left side has started to compensate for lack of shoulder flexibility by twisting my right shoulder back so the weight isn't supported in a true lock out position. Imagine my shoulder being 90% open and it causes a slight twist in my body. I've also noticed that I'm compensating for some lack of shoulder flexibility by either an exaggerated arch in my back or a wrist that isn't in a neutral position.

Press: My OH Press doesn't properly activate my scapula in that on my left side, my scapula flairs slightly outside and doesn't move underneath my shoulder as it should with a perfect lockout. It's really hard to get my left wrist in a neutral position under the bar.

Backsquat: Similar issue with the wrist not being straight because I can't get my elbow back far enough to give my full forearm length behind the bar.

I'm pretty sure these issues are related. My mobility regime includes a lot of external rotation, lacrosse ball massage and overhead prone stretches. I follow the KSTAR mobility blog pretty religiously, but I haven't seen much progress over the last month.

Has anyone dealt with these issues before? Am I getting too impatient with my recovery period or should I implement something more specific to attack these issues?

Steven Low 09-09-2010 01:32 PM

What is your current flexibility/mobility routine for your shoulder?

I want all of it if possible to see if you're missing something.

Also, shoot me a call if you want.

Initially it seems like you probably want some serratus work (serratus punches for example), internal rotation stretches, and then some more specific external rotation stretches. Also, may need some rotator cuff work ebcause of other scapular dysfunction.

Depending on what you are doing currently you may need to modify a bunch of it. Post up what you're doing and we'll see....

Garrett Smith 09-09-2010 04:39 PM

I really hope you've stopped kipping pull-ups by now.

Kyle Redinger 09-09-2010 06:04 PM

Steven - My warmup is typically row 300 meters, dynamic stretching protocol influenced by Catalyst warmup. Lots of focus on shoulder warm up and dynamic flexability. Lots of yoga positions to open shoulder (down dog, childs pose, etc).

I will often incorporate bands (ido portal style) and do internal and external rotations then I do the small circles by my side, out to the side and overhead. I spend some extra time with a band overhead just pulling back on my left side. Depending on what my day is like I will then get people to help me stretch out with various positions. Often times I am lying on my back/stomach and someone is pushing down/up on a bar I hold over my head. I will also get people to help push my shoulders into a wall (as if I were starting a wall slide with some various positions). My forearm will stay bent 45 degrees and I can't move it any closer if I try to setup for a wall slide by myself.

I've gone through the diesel crew protocol twice, done a lot of hanging on bars with various grips and spent a lot of time doing turkish getups and light weight high rep pressing to get back some mass and stability in my shoulder.

I ended my PT about a month ago, but the guy was really good and hit everything pretty hard.

Garrett - the injury happened on a jerk. I haven't had any issues with my kipping pullups and the doc and PT said it was cool to do them. I don't have any pain so I feel comfortable doing it.

Garrett Smith 09-09-2010 09:21 PM

Kyle,
My suggestion is to review the mechanisms of how SLAP tears occur, then compare that to kipping pull-ups and what happens in that movement. The movement where you noticed the "injury" is not necessarily the same movement that wore down the soft tissues. This pattern is very obvious in blown lumbar discs, just ask Stuart McGill.

Also, you might want to search the CF injury board under SLAP tear (or shoulder labrum tear). This injury is all too common among the CF community...my vote is that the high-rep kipping pull-ups are the culprit.

That said, do what you like.

Steven Low 09-10-2010 12:15 PM

So you're having problems gaining back the last 10-20 degrees in overhead/somewhat externally rotated position if I'm reading what you wrote correctly.

Here's some things that may help that you're not already doing:

1. Hanging on a bar for an extended period of time (30-60s per rep) just to stretch everything out better. However, to put a twist on what you are already doing focus on activating your shoulders and holding for 5ish seconds and then letting go and relaxing everything. That should help a lot more than what you are already doing (kind of like PNFing it).

2. Doorway stretch... except facing the corner of a wall (convex corner). Much better stretch.

3. Wall slides... I also like CORNER wall slides in the above (#2) setup. These erally stretch out anterior capsule and chest/lats pretty well.

4. More external rotation stretching. Emphasis on longer and not necessarily harder.


When you are doing a lot of the stretching focus on pushing your hands as far away from the shoulder as possible... get it into that active position which will put much more stretch on the capsule and muscles which is what you want. Plus, help to not impinge anything

Kyle Redinger 09-19-2010 10:43 AM

that sounds about right way to describe it. I'll add those and keep the time on it. thanks for the advice

Steven Low 09-19-2010 12:11 PM

No prob. Let me know how it goes.


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