Can You Workout With a SLAP Tear?

SLAP tears are a common injury in athletes, especially overhead throwing athletes, gymnasts, and weightlifters. Because this is such a common injury, people often do not require surgery and usually have good success with physical therapy and a specific exercise routine. In this blog you will learn more about how to exercise with a labral tear. However, this is not a substitute for an evaluation by a physical therapist or orthopedist. If you think you may have a labral tear that is limiting your ability to move the way you want to, please get it addressed.

So let’s dive in! Since this is such a common injury, let’s talk a little more about the specifics. A SLAP tear is a disturbance of the labrum in the shoulder joint. The labrum is a ring of cartilage that functions to give more stability to the shoulder joint. The shoulder joint itself is a relatively unstable joint so the labrum helps to give extra stability and acts to “seal” the shoulder joint. In a SLAP tear, the top (superior) portion of the labrum is torn from front to back (anterior to posterior), hence the letters SLAP. SLAP tears can be caused by acute trauma to a shoulder such as a fall on an outstretched hand or a shoulder dislocation. However, the most common cause for SLAP tears is overuse of the shoulder joint and is thought to be a normal progression of aging. One study found that people over the age of 65 have an 81% likelihood of having a SLAP tear. SLAP tears are the most common type of shoulder labral tears accounting for 80-90% of all labral injuries and 4-8% of all shoulder injuries. Because of the close association of the biceps tendon to the superior labrum, the biceps can be injured as well.

Clinically, people with SLAP tears tend to have pain in the fully flexed and externally rotated position of the shoulder. This position is required for overhead reaching and in the gym we see this position in overhead squats, snatches, kipping, etc. These patients usually feel okay when the motion is slow and controlled, such as a front squat, strict press or strict pull up as opposed to a more dynamic and powerful movement of a snatch, push jerk, or butterfly pull up. In the initial phases of rehabilitation it is wise to avoid the more dynamic and powerful movements that are causing more strain on the shoulder in favor of the controlled, strict movements. This does not mean that you will never be able to do toes to bar again! It just means dynamic movements will need to be placed on hold while your shoulder is healing.

One of the most common things that we see associated with a SLAP tear is a weak rotator cuff, specifically the posterior rotator cuff. These are the muscles that lie on top of your shoulder blade. Shockingly, (or maybe not so) these muscles are responsible for external rotation of your shoulder. They also function as dynamic stabilizers of the shoulder joint. So anytime you move your arm overhead, your rotator cuff is working to keep the ball of the joint in the socket. One of my favorite posterior rotator cuff exercises is the sidelying shoulder trio exercise. I am also a big fan of using bands to work on posture and positional strength of the scapular region such as this exercise here.

One of the other most common things we see clinically with someone that has a SLAP tear is that they have mobility issues in their torso. They typically either have tightness in their lats or a restriction in their thoracic spine. Sometimes they have both. If there is a restriction in how your torso moves, your shoulders will react in one of two ways: the shoulder itself will become restricted in its range of motion or the shoulders will compensate and become hypermobile to make up for the lack of mobility in the torso. If you are wondering if you have lat tightness, try this test at home. If you think you may have a lack of thoracic mobility, try this test at home.

Now you are ready to start working on the stability of your shoulder. Exercises where you are weight bearing on your hands such as plank and pike variations can be a great way to improve the stabilizing effect of your shoulder. You will be working on improving your dynamic stabilizers in this position so that your static stabilizers (i.e. your labrum) does not have to work so hard.

Okay, so say you have been a model student and have been committed to dedicating 6-8 weeks to work on your mobility restrictions, your shoulder weaknesses, and you have been modifying exercises in the gym. Great! Now it is important to make sure that when you go back to these more dynamic exercises that you have good form and technique with these movements in order to not re-injure yourself. This is where having a performance based physical therapist that knows the movement standards is super important. It is also invaluable to have good coaching, especially a coach that will stop you if the movement looks unsafe. You may find out that when you break down your snatch that you have too much of a forward torso because you have an underlying ankle mobility issue and because of this you are having to catch the barbell further behind you, placing more strain on your shoulders. It would be a real shame to put in all that work to get your shoulder feeling better and then to realize that something other than your shoulder and thoracic spine was the true culprit of your SLAP tear.

In conclusion, please do not avoid exercising if you have been diagnosed with a SLAP tear. There are endless modifications that you can incorporate to exercise safely. If you need more guidance, please contact us at Outlast Health and Performance.

Be well!

Shannon Hall, PT, DPT

Resources:

https://orthoinfo.aaos.org/en/diseases--conditions/slap-tears/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6141924/