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Old 06-29-2011, 09:50 AM   #1
Colin McNulty
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Torn Rotator Cuff (PASTA) possible Labrum (SLAP) from Butterfly Pullups

It looks like I'm joining the people who have reported rotator cuff tears (93 search hits on this forum). I've spent the morning reading posts from current and past suffers Troy, Kevin, Michael, Barry, Frank, Everett, David, Shayle, Justin etc and just want to say, respect to you guys, I feel your pain, literally!

I'll keep a typically long story short: 4 months ago I decided to try to master butterfly pullups. The morning after a 30 minute focus session, I couldn't raise my arm to scratch my head. 4 months of complete rest (read no CrossFit, argh!), a sports therapist and physio later (neither diagnosed a tear), brings me to last week's ultrasound by the consultant surgeon and he confirmed a partial rotator cuff tear of the supraspinatus (PASTA). See my blog post for an ultrasound picture showing the torn rotator cuff WFS.

Showing him the video on that same blog post, he suspects I'll also have a labrum tear (SLAP). He says the butterfly pullup movement, if it goes wrong (as it frequently does when learning it) and you thud into the bottom, is very similar to the SLAP injuries that rock climbers get when they lose their foot hold and yank down on raised arms and open shoulders.

So now I'm waiting for the appointment for an contrast MRI (where they inject dye into the shoulder to show up the labrum). It's likely I'll need at least an arthroscopy for a debridement (cutting away the frayed edge of the tear). The surgeon reckons if it's a <50% tear, it may not need anchors, which would be a blessing I guess? If the labrum has torn too (which the constant dull aching suggests I think, on top of the sharp pains from the tear) then I'm guessing anchors are very likely.

Either way, from what I've read here and elsewhere, it's a year's recovery. I've already cancelled a CrossFit gymnastic cert I was booked on. I'm on a CrossFit olympic weightlifting cert this weekend with Coach Burgner (not going to enjoy sitting at the back of that just watching), I'm on my third PDR cert with Tony Blauer the weekend after that and won't be able to participate much I think and my PDR Coaching is generally suffering. *sigh* On top of the 4 months already, plus probably 3-6 months delay to come before the op, it's going to make for 2 sucky years. How I wish I'd never tried those butterfly pull ups!
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Old 06-29-2011, 10:40 AM   #2
Kevin McCahill
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Re: Torn Rotator Cuff (PASTA) possible Labrum (SLAP) from Butterfly Pullups

Hey Colin, sorry brotha….seriously I am sorry. Try and fight off the temptation to “go back in time” and not try those butterfly pull-ups. I have had two surgeries this year and wished like crazy I could go back to the moment just before both tears. Not gonna happen.

I just sat in the back of my local box’s oly lifting cert and it sucked!! I watched my friends and colleagues rock amazing snatches, cleans, and jerks. Find a way to control the things you can control. I started running and indoor biking again. Nothing is like the cfit rush but at least I’m doing something. I am a few weeks out of RC tear surgery #2 and am taking a break from cfit. I don’t blame cfit, I just need to get away from it because I tend to try and work out around my injury. Yea, 1.5 yrs or so and altering your upper body programming may be in order.

Good luck!
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Old 06-29-2011, 12:15 PM   #3
Mark Sun
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Re: Torn Rotator Cuff (PASTA) possible Labrum (SLAP) from Butterfly Pullups

Sorry to hear about your injury. Thanks for sharing with the community. If you don't mind, can I get some history prior to the injury. This would help people understand the progression leading up to your unfortunate injury.

How long have you been CrossFitting?

How long did it take you to get your first strict pull-up?

How many dead hang pull-ups did you have?

How many kips did you have?
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Old 06-29-2011, 01:13 PM   #4
Colin McNulty
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Re: Torn Rotator Cuff (PASTA) possible Labrum (SLAP) from Butterfly Pullups

Cheers Kevin, you're right of course. I'm just annoyed with myself as it was an unnecessary injury (I have no illusions of grandeur that would see me competing in anything CrossFitty). Though to be fair, had I realised the potential risks, I probably would not have attempted them.

Of course Mark, the point of my post was to give information back to the community. CrossFit has given me so much and if my experience helps others in any way, then at least some good has come of it:

> How long have you been CrossFitting?
4 years now, ranging from 1-5 times a week (on the low side recently due to life issues).

> How long did it take you to get your first strict pull-up?
I was always able to get a 1 or 2.

> How many dead hang pull-ups did you have?
I'm not really sure, I don't recall ever properly going for a max set. Certainly upper body strength is not my forte but I would say about 10.

> How many kips did you have?
Again I'm not too sure, but I remember getting 30 once and have got mid twenties on a few occasions.

The irony is, I though the butterfly pull up session went quite well! Starting it I wasn't able to do 1. After 30 minutes I could string 3-4 together before the timing went to pieces. That's where the damage was done I'm sure.
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Old 06-29-2011, 01:45 PM   #5
Bo Riser
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Re: Torn Rotator Cuff (PASTA) possible Labrum (SLAP) from Butterfly Pullups

Ironically, I think I tore something in my rotator cuff yesterday. It's been about ten years ago but I have had surgery on each shoulder. On my shoulder I had impingement, a partial tear and part of the bone on the socket broken. They did my surgery with a scope. The first week after surgery I wasn't moving my arm more than a few inches. I got more range the next week and then improved leaps and bounds following that. I was doing extremely light weights after two months and slowly progressed to about 80% at six months. At a year I would say I was back to normal but my shoulder still felt "weird". The second surgery was on my left shoulder to clean up impingement. That didn't take long to get over.
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Old 06-29-2011, 02:48 PM   #6
Aushion Chatman
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Re: Torn Rotator Cuff (PASTA) possible Labrum (SLAP) from Butterfly Pullups

Good starter questions Mark, I would add a few things to the list:

Colin,

1) Do/Did you do any routine shoulder pre-habilitation work? Especially external rotation/posterior work?

Scap push-ups
Cuban rotations - with weight
Reverse Planks
Rowing (correctly with shoulders down)

2) Do you work at a desk all day?

3) Do you maintain good posture (shoulders back and down)?



The reason your shoulder went is not because you did or didn't do a laundry list of mitigating techniques. It went because the butterfly pullup is a dynamic exercise that can put the joint under loads in compromised positions...There are gymnasts who have trained since they were 2 yrs old who can get up on an apparatus and tear their shoulder. So, while VERY important, joint prepartion and strong shoulders and the like do not remove the risk, these only mitigate.

Everyone must decide "is the butterfly pullup worth it for me to pursue"? To me unless you plan on competing maybe the risk isn't worth it, but that's me. We all have to decide for ourselves what risks we will take and which we won't. In my gym beginner clients (if I catch them) will not be working on these...doesn't sound like you were a beginner, though you mention time off. Sometimes coming back to the gym when life has recently gotten in the way is the most dangerous time for us.
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Old 06-29-2011, 03:02 PM   #7
Mark Sun
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Re: Torn Rotator Cuff (PASTA) possible Labrum (SLAP) from Butterfly Pullups

Thanks for the history.

Jonathan Kinnick posted this video on butterfly pull-ups on the affiliate forum section.

http://www.youtube.com/watch?v=UabNwmk0oUM(wfs)

I'm aware of the increase chance of shoulder injury with butterfly pull-ups and have a slow progression just for the standard kips. I very rarely teach the butterfly until they are higher level athletes. I was thinking of implementing this type of butterfly technique for members that want to learn it.

My follow up question is: When you were doing the butterfly kips, did you bottom out? Bottoming out, like in that video, is coming down violently to the bottom of the kip. Or were you in a more swooping type of motion?
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Old 06-29-2011, 03:18 PM   #8
Mark Sun
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Re: Torn Rotator Cuff (PASTA) possible Labrum (SLAP) from Butterfly Pullups

You are right on Aushion...

We focus on mechanics and posture before our members can even start pulling. Going over the hollow position and then transferring it onto the pull-up bar. Then we teach the movement leading with our shoulders/lats not our elbows/biceps, also not breaking the hollow through the full ROM. That is equivalent to hips leading and not the knees in the squat, easy for members to understand. I feel that this has kept our members safe during pull-up training.

I'm trying to understand the injury risk of butterfly pull-ups. Is it the bottoming out? Or is the majority of the injuries due to a poor progression, poor technique? Could the swooping motion help CrossFitters avoid slap tears?
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Old 06-29-2011, 07:41 PM   #9
Gravel Brown
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Re: Torn Rotator Cuff (PASTA) possible Labrum (SLAP) from Butterfly Pullups

Sorry to hear about your tear Colin. My SLAP thread may be of some interest to you, im 8 days post SLAP surgery with 4 anchors, ive attached the link below..

I know what you mean re looking back in hindsight as i do it all the time. I constantly question myself about the session i was doing when i tore mine. Mine didnt involve kipping at all though, just bench press and shoulder press. Personally i dont agree with the kipping movement and think it has no place, thats just me though.

Whats done is done mate and you cant change it now. Just focus on learning as much now about what lies ahead. Its a shame you have to wait for your surgery, i must say it is a huge mental relief just to know that mine is done and i can now focus on getting it strong again. I waited 3 months from when i found out mine was torn, longest 3 months of my life.

Try to stay positive.

http://www.board.crossfit.com/showth...895#post954895

Last edited by Gravel Brown : 06-29-2011 at 07:51 PM.
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Old 06-30-2011, 01:04 AM   #10
Colin McNulty
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Re: Torn Rotator Cuff (PASTA) possible Labrum (SLAP) from Butterfly Pullups

Aushion, answers:

1) Do/Did you do any routine shoulder pre-habilitation work? Especially external rotation/posterior work?

I had seen a sports therapist months before for shoulder twinges whilst doing SDHPs. He'd given me some shoulder exercises and stretches to do (I couldn't tell you what they were called) which had resolved my issue. I had followed his full 20 minute shoulder warm up before doing the the butterflies.

2) Do you work at a desk all day?

Yes.

3) Do you maintain good posture (shoulders back and down)?

I try to. I've also never had a problem with should flexibility and could do OHSs from day 1 of CrossFit for example. I was also one of only a handful of people at the gym able to do a squat jerk with weight on the first attempt.

> Everyone must decide "is the butterfly pullup worth it for me to pursue"? To me unless you plan on competing maybe the risk isn't worth it, but that's me.

Agreed. However I didn't go through that decision making process. I had no idea there was any increased risk at all, any more than say kipping or dead hang pullups. For me it was just another CrossFit skill to learn and tick off the list. Of course now I realise that it appears to be common knowledge (amongst some anyway, if that's not a contradiction!) that it has an increased injury risk. My current (probably now biased) view is: fine if you want to compete, not worth it if you don't.

> Sometimes coming back to the gym when life has recently gotten in the way is the most dangerous time for us.

Agreed. I'd been back training 3-4 times a week for 3 months prior to the injury, so think I was back in the groove as it were. I was careful to ramp up, which is why I waited 3 months before trying the butterflies.

Mark: yes it's the "bottoming out" where the injury occurred for sure. However it wasn't by design. I was trying for the swooping style, but when I got the timing wrong was when I bottomed out by accident. You can see the woman in the video do exactly that at 4:04. It's an inevitable consequence whilst learning the skill I think.

Just to be clear, I had followed a full shoulder warm up and followed a slow progression (though a different one to that video) under the expert eyes of my coach. I believe my injury occurred once I had mastered the basic movement and was trying to string several full ROM butterflies together (I got up to 3 or 4 by the end of the session). When the timing of arms and leg swing went wrong and got out of sync, that's when I bottomed out by accident.

Gravel: I did read your thread, sorry forgot to mention you in my list of shoulder injury alumni! I hope you're now well on the road to recovery.
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