One of my favorite diagnoses to treat in CrossFit athletes is SLAP tears. Quite frequently, athletes have been told their only option is surgery. But, many athletes with SLAP tears in their shoulders can successfully rehab back to full shoulder health and performance without needing to go under the knife. Skipping an often unnecessary surgery saves athletes from months of rehab and decreased fitness. So how do you get back to CrossFit after a labrum tear? The following principles should help you, along with working with a medical professional that understands the needs of fitness athletes.
Note: this article is written towards non-surgical rehab of labrum tears (SLAP is a specific term for tearing the labrum), but these principles also apply to those wanting to return to CrossFit after a SLAP repair, these principles just apply to later rehab.
Fitness After a SLAP Tear
KEY #1. A STRONG POSTERIOR ROTATOR CUFF
The rotator cuff serves to provide stability to the shoulder joint. The labrum also provides stability to the shoulder. So if the labrum is torn, we want to maximize rotator cuff strength to make up for the labrum’s deficit.
There are a million rotator cuff strength drills out there to choose from, and typically, it will require a progression of drills to get back to CrossFit after a SLAP tear, but these are two of my favorites to use.
The Side-lying Trio is a posterior rotator cuff BURNER. Think of it as a drop set designed to get a ton of strength & hypertrophy to those muscles in a short amount of time. This exercise is great because the positions it takes the shoulder to aren’t typically stressful, so this serves as a great early rehab exercise.
Another one of my favorite exercises for returning to CrossFit after a labrum tear is prone swimmers. These are a more advanced exercise, but because they move the shoulder through more extreme positions, it is great for learning to control those spots that typically irritate a hot shoulder.
KEY #2. TRAIN THE ROTATOR CUFF AS A STABILIZER
As mentioned above, the rotator cuff’s job is to stabilize the joint. So I believe strongly that we must work the shoulder hard in that role. Simply doing banded rotator cuff drills doesn’t cover it if you want to get back to CrossFit after a labrum tear.
My absolute favorite is kettlebell arm-bars held for a few rounds of 30 seconds.
There are many other exercises I’ll use to train the rotator cuff in its stabilizing role, but one of my favorite late-stage rehab drills is hanging band technique walks, as shown below.
KEY #3. MOBILITY OF THE LATS AND INTERNAL ROTATION
There are two important mobility components to returning to CrossFit after SLAP tear. First, we need good mobility of the lat muscles because when tight, the lats will negatively affect technique in some of the most challenging movements for athletes with a labrum tear to perform…the snatch, overhead squat, and kipping pullups. Internal rotation of the shoulder will also often be limited in athletes wanting to return to CrossFit after a labrum tear. And opening this range of motion can greatly improve your shoulder health and performance.
The biggest key to improving your mobility is knowing exactly where your work needs to be focused. To help you out here, I have created a free Ultimate Mobility Checklist as a mobility guide. Download the eBook and self-assess your mobility to create a specific game plan of attack!
KEY #4. GREAT MOVEMENT PATTERNS
This is the BIG one…the one I frequently see missed because athletes are doing standard rehab plans after a SLAP tear typically don’t see medical providers that really understand the movements performed by fitness athletes.
So I commonly see athletes that have done structured versions of our first 3 keys discussed above. But because they don’t have someone to really refine their technique with kipping, overhead squats, jerks, dips, and the Olympic lifts, they often fail.
I’ve even seen technique faults further aggravating SLAP tears and preventing successful rehab in several CrossFit coaches and Games-level athletes.
The details here would be too much to cover in an article, but I will point you to a few resources:
- An article/video on kipping pull-up pain that translates very well to this population
- This podcast I recorded on “The CrossFit Shoulder”
- This article on improving overhead squat positioning
For those dealing with SLAP tears wanting to return to functional fitness, I highly suggest finding a qualified sports physical therapist familiar with CrossFit movements. Inside of Performance Plus Programming, we have several programs that will complement your rehab plan:
- Bulletproof Shoulders – an aggressive accessory plan for building rotator cuff strength & stability that translates to CrossFit performance
- Overhead Mobility Overhaul – for athletes dealing with shoulder stiffness, this plan will unlock mobility and build control simultaneously
- Lats to Fly – a plan designed to build lat strength for better control and performance in gymnastics skills
- We have 30+ other plans to address any other need or progression you need to get back after it in your box!