Back injuries in combat sports
Why does my shoulder hurt when I try to shrimp?
Anatomy: The shoulder is a complex joint, relying on the neck, thoracic spine, clavicle, scapula, glenohumeral, acromioclavicular and sternoclavicular joints to provide movement. If just one of these joints cannot move freely, there will be a loss of range of motion, pain or weakness. A weak muscle can cause impingement of the supraspinatus (a rotator cuff muscle) under the acromioclavicular joint, throwing off the mechanics of the entire arm. Reaching overhead, across the chest and behind the back can create a sharp pain in the front of the arm.
An AC joint separation is often the result of being slammed on the shoulder. An AC joint separation can usually be felt as a big “step” if you run your thumb across the clavicle to the end of the bone by the shoulder.
Neck issues can even alter how well you move the arm. Fear of aggravating your neck pain may cause you to guard the affected side and favor that side of the body.
Injury: Medical doctors or surgeons typically suggest injections in the shoulder for acute shoulder pain. As a competing athlete I would not recommend this intervention for several reasons. One, you are not addressing the underlying issue (tendon tear, nerve entrapment); secondly, the pain relief will mask any additional injury you may sustain because you cannot feel which positions or movements aggravate the problem; thirdly, the material used for injections destroy the underlying tissue, essentially degenerating the tendon.
Typical shoulder injuries might appear low grade at first and then rapidly deteriorate if not treated in due time. Pinching in the front of the shoulder when reaching overhead or across the chest might suggest supraspinatus (rotator cuff) impingement. The muscle itself is “wrung out” between two bones- the AC joint and the head of the humerus, the attachment site for the muscle. This constant pinching causes fraying of the tendon, leading to microscopic tears. The body begins to deposit fat in these tears to stabilize the area. Unfortunately, fat does not do as good a job as the original tendon for transferring force from the muscle into the shoulder to produce movement (reaching overhead). This microscopic tearing reduces the work capacity of the muscle and other muscles must compensate for poor movement patterns.
Other injuries include labral tears, AC joint separation and GH dislocations. The labrum provides stability and congruency to the shoulder joint. If the head of the humerus rides over the scapular fossa or the muscles attached to the labrum pull with too much force, the labrum can tear. This is often reported as a deep, achy type feeling across the side of the shoulder, is often very uncomfortable to sleep on and at times may feel as if the arm is “giving way” when lifting heavy weight. An AC (acromioclavicular) joint dislocation may result from landing hard on the shoulder. Sometimes you can see a visible step deformity, lose the ability to fully reach overhead or hear a “clunking” sound with certain arm movements. Glenohumeral (GH) dislocations occur when the head of the humerus is driven or stretched out of the scapular fossa (bowl-like bony part of the scapula). This can be a result of a very lax (loose) joint capsule (similar to a ligament) after the joint is excessively stretched. Grappling submissions such as the Kimura, Americana or Omoplata are perfect examples of submissions that can dislocate the GH. Once the shoulder dislocates, the portion of the capsule that is compromised may not return to its normal resting length for up to a year. This does not mean you will have pain for a year, but it might increase your risk for recurrent dislocation. If you suffered from a GH dislocation you should NOT continue to stretch out the shoulder into positions of instability. Instead, you need to retrain the muscle spindles and sensory organs (nerves that sense where the body is in space) of the joint capsule to become sensitized to positions of instability as well as develop musculature to limit the possibility of future dislocations.
Prevention: preventing shoulder injuries requires maximizing mobility while maintaining its strength, especially at the end range of movement where the joint is most likely to suffer injury (reaching overhead, behind the back, out to the side). Dumbbell and barbell exercises can help develop a solid base for shoulder strength, but it may lack the necessary components that are performed when competing. Calisthenics based exercises provide the appropriate strength and mobility with an additional stimulus for how well you control your body in unstable environments. There are dozens of calisthenic based programs out there and I have included a handful of movements and their progressions for what I consider essential for the combat sport athlete.