labral tear shoulder injury Mar 03, 2020

As much as I wish my SLAP story was something as cool as Slapsgiving, it isn’t. (How I Met Your Mother reference if you don’t get that). SLAP = Superior Labrum Anterior Posterior…aka a labral tear in your shoulder.

Keep reading for how I got one and what I did about it to get back to doing everything I love, including CrossFit (spoiler alert: NO surgery!)…And if you’re dealing with this injury…def grab the eBook at the bottom with a more detailed account of the program I did!


My (Shoulder) Labral Tear Story 

On Feb 17, 2018, a group of friends and I went snowboarding for my birthday. Now, I am not a seasoned snowboarder. This was my 3rd time out. In 5 years. So I knew I would take some tumbles, but I also know I’m a strong person and felt I could take a few hits. What I didn’t account for was how much the mental and emotional turmoil and stress I’d been through recently would affect physical function. You see, I lost my father just 4 months prior, October 2017, after being his main caregiver for his last few months (Took FMLA from my job as a physical therapist and went home to help out). I had stayed home to help my mom adjust to her “new normal” until the end of the year, and then returned to AZ. So at this point, I was a month into being back somewhere where I had no family, and while I did have a support system, grief had really just begun to really hit and I had not yet begun to feel ok with reaching out for help. I felt beyond alone. If you’ve been through loss, you probably know the feeling I’m talking about. I knew that my motivation to go workout had been off, and my energy at the gym was more easily drained, but I kept pushing through and felt prepared for this trip. 


The first half of the day went ok. I was so focused on just staying up on the board that I think it distracted me from “life.” After lunch, we went back out and I decided to try a blue. I completed the run only taking one small fall. I was pumped! So naturally, I went back up for round 2. No clue why, but thoughts of my dad and grief started to set in on that lift ride. I even felt a little “fuzzy” for lack of a better way to describe it. I shook it off by the time we got to the top, and I was smiling and ready to go again. 

snowbowl 2018.png

(me at the top about to go down the run where I got injured)

Half way down, those same feelings hit out of nowhere. Again, if you’ve been through loss or hardship, you know how this goes. Well, that split second of feeling off again was enough for me to catch the edge of the board in the snow and slam me forward against the snow. I tucked my arms against my chest and my head ricocheted against the (now packed and mildly icy) snow. Now would have been when I really wish I’d worn a helmet. I got up and made it the rest of the way down, just feeling a little sore in my neck and right shoulder. But when I got to the bottom and tried to raise my right arm to wave my friend over, I had searing pain shoot through the shoulder joint. and couldn’t lift it very high I tried again and the same thing happened. Clearly done for the day, I packed up, waited for the others to finish, and headed home. 


Over the course of the next few weeks, I popped more Ibuprofen than I’d like to admit, just to get through treating patients while in pain. But during this time I also had colleagues help me run through some tests. I knew at least some of the pain was referred form the neck as it felt better if I rested that hand on top of my head and relaxed the shoulder (positive test for referred pain from the neck), but I was worried that wasn’t all. The pain was flip flopping between the front and the back of the joint, and I started to notice some painful clicking with movement - one of the signs of a labral tear, though I have definitely seen many people with tears that did not exhibit this symptom, and seen plenty with clicking that don’t have a labral tear. At first, most of the shoulder tests for every possible injury were positive, simply because it was so aggravated. But once I got symptoms calmed down a little, it became more clear that it was a SLAP (superior labrum, anterior to posterior) tear. The test that was the most accuracy per research is this: perform a biceps contraction against resistance with the arm up 120 degrees into abduction (out to the side and up) while laying down - positive for SLAP tear. (click here if you wanna see what this test looks like)

I decided against imaging as that would just be a lot of money for a picture when I knew what the symptoms were and knew if I could just regain shoulder and neck stability and strength without aggravating pain, I’d be good. No need to waste that time and money on an MRI. 


Of course this is where so many people, even others in my profession, told me to rest from working out and to just take it easy for awhile. However, 1. I’m stubborn 2. The gym was my mental and emotional release and, really, it needed to keep happening for the sake of everyone around me and 3. I knew that strength and stability were actually what I needed. So rather than stop, I modified. 


I kept doing CrossFit, but nothing that involved repeatedly pressing overhead, no kipping, no cleans, no double unders, no wall balls, no snatches, (I’m sure I’m forgetting a few, but you get the idea)- all of those caused increased pain. Sometimes the pain would be during the workout itself, or sometimes it felt fine and then a few hours later I’d be in excruciating pain (for example, double unders would feel fine, but I’d be flared up later). I added in accessory work, and I kept doing what I could. FOr example, I would do Russian KB swings instead of cleans and snatches, I did heavy goblet squats instead of wall balls, sled push instead of overhead squats, etc and I kept doing everything that didn’t bother me like deadlifts, strict pull ups, and back squats. So while it may seem like I couldn’t do a lot, there was still plenty that I COULD do. And best of all, this allowed me to stay with my gym community, which was much needed, especially during a hard time in my life.


The pain was worst at night when I went to bed. Mostly I think because the brain had nothing else to focus on. It was very difficulty to find a comfortable sleeping position since I normally sleep on my stomach in the mountain climber pose. If you’ve ever dealt with this injury, you know what I’m talking about. The searing pain that runs through the shoulder joint and the ache that can go up into your head, down the shoulder blade, and down your arm. The best option I found was sleeping on my opposite side with a pillow between my knees and hugging a pillow with my right arm, so that the shoulder was supported and it couldn’t roll forward.

The other time it really bothered me was actually work. That was way worse than the gym, but that’s because my job is very physical. I found it was really hard to do any manual work on patients where I had to put my weight through my arms, such as spinal mobilizations and manipulations. Some things I could modify, and others I simply had to be very transparent with the patient, let them know what was going on, and grab the other PT if they were able to perform whatever it was. This was super hard for me, but in the end I knew this was better than injuring myself further. 


Brief overview of my treatment:

-Dry needling performed by a colleague at least once a week to C5/6 (the levels of the neck involved in the referred pain) and the right shoulder complex. This was always immediately followed by me doing some accessory work (see below movements), as dry needling should be an adjunct - movement and strength is where the magic really happens.

- PAIL/RAILs shoulder flexion and shoulder CARs. These were some of the first things I was able to do to work on getting range of motion back (insert videos)

- mixing in accessory work into my Crossfit workouts. Here are a few of my faves: 

-bottoms up KB carry (and any progressive unstable carry)

-banded pull aparts

-farmers carry

-sled pushes

-scap angels

-arm bars

(most of these are on my IG and youtube and will be in the eBook that will be sent out to subscribers)

As I mentioned before, I think the main factor as to why I got injured regardless of the strength and stability in my shoulder is the emotional and mental trauma I was going through at the time. My sympathetic nervous system (fight or flight response) was heightened and that tipped the scale. It also affected recovery. The entire time I was rehabbing my shoulder, I was also going through grief and PTSD. So in order for my shoulder to recover, I also needed to address that. And I did through counseling and EMDR (Eye Movement Desensitization and Reprocessing). Now that could be an entire other post, but feel free to message me with any questions you may have. I especially loved what EMDR did for me. But my main point here is that a rehab that otherwise would have maybe taken 4-6 months took closer to 8-9 months before I was back doing everything without pain or feeling unstable. So know that if you are going through an injury, it is normal for it to take longer if you are also dealing with stress, grief, poor sleep, or anything else of that nature. And it’s okay. Keep with the process, address all factors, and you’ll get through it! 

Last winter was a year since my injury. And you know what I did? I went snowboarding. (With a helmet this time) I fell so many times, especially when I accidentally ended up on a black diamond. I fell hard. But I was fine! And then I competed in the CrossFit Opens in Feb and Oct 2019 and completed all of the workouts, including things I had previously had to stop: wall balls, muscle ups, all of the overhead lifts. And I did just as well as I would have expected had the injury never occurred. Actually, scratch that. I did way better. I’ve since learned to handstand walk and have significantly PRed all of my lifts. Yes, there have been some mild shoulder flare ups, but they are infrequent and short lived. And generally they occur when I’ve let something else slide (stress, sleep, etc) or I’ve overtrained.

Moral of the story: be smart about it, and address lifestyle factors, but stay moving and stay active. The more strength (physical and mental) you maintain and build, the more resilient you are.


***EBOOK including EVERYTHING I did to come back from this injury HERE


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