The problem shoulder and why it hurts to lift overhead

Working with many different CrossFit boxes, the number one complaint is anterior shoulder pain, particularly with pressing and overhead movements. In my experience, a vast majority of cases are due to impingement resulting from a lack of mobility and/or control. Considering how much overhead pressing is involved in CrossFit (clean and jerks, snatches, push press/jerk, thrusters, pull ups, muscle ups, handstand push ups), it is extremely important for shoulder health to be able to raise your arms overhead and be strong in that position.
 
The shoulder girdle is a complex joint consisting of multiple moving parts. It involves the thoracic spine, the scapula, and also the glenohumeral ("true shoulder" joint). In CrossFit and gymnastics in particular, athletes require full overhead motion during movements such as overhead presses and handstands. If this is not achieved, there will be a compensation somewhere else in the body, typically with lumbar hyperextension and/or an anterior pelvic tilt.

Restoring full mobility and strength in these end ranges is crucial for safe and successful performance of these movements. Not only will it limit the risk of injury, it will also make the athlete more efficient and improve performance.

Broadly speaking, the reason that an athlete is unable to achieve full overhead flexion is due to:

• Soft tissue restriction
• Joint restriction
• Motor control deficit

This can occur in any of the joints involved in the shoulder complex, which can be affected by other regions of the body such as the pelvis or the feet. This needs to be assessed by a trained movement therapist.
 
A quick screen to assess overhead mobility is to place your back flat against a wall and raise your hands over your head. With palms facing forwards, the back of your hands should be able to touch the wall behind you without any arching of your lower back or flaring of your ribcage. If you are unable to do this comfortably without cheating, how can you support a heavy barbell overhead or do handstand pushups safely? You can't. Now add speed and dynamic movement (such as in the snatch) and fatigue (in metcons) and you have more opportunities for dysfunction and pain to occur.
 
Addressing the thoracic spine
A dysfunctional thoracic spine will limit overhead motion as well as lead to compensatory patterns such as lumbar hyperextension. Therefore it is important not to overlook this area as it can contribute to lower back/pelvic pain as well as shoulder pain. We must ensure adequate thoracic extension as well as sufficient anterior core control.

• Restoring thoracic extension
  • Thoracic extension mobility drill with foam roller - https://www.youtube.com/watch?v=uzWOECAhsAM
  • Anterior core release - https://www.youtube.com/watch?v=C8sSUsJ-bTY
• Restoring anterior core control
  • Standing anterior core control - https://www.youtube.com/watch?v=nxkawQ_sanc

 
Addressing the scapula
In full overhead motion, the scapula must exhibit adequate upward rotation and posterior tilt to allow the shoulder joint to face upwards and accommodate for the arm.

• Restoring scapular upward rotation
  • Pec and rotator cuff releases - https://www.youtube.com/watch?v=RmGgYuMWf1A
  • Lats and levator scap releases - https://www.youtube.com/watch?v=hzozw2Aso3M
• Restoring scapular motor control
  • Wall slides - https://www.youtube.com/watch?v=EugElNVC2BU

 
Addressing the shoulder joint
The final piece of the puzzle involves the actual shoulder joint. For an overhead press, fullshoulder flexion and external rotation is a requirement to ensure safe and efficient movement.

• Restoring full shoulder motion
  • Subscapularis release - https://www.youtube.com/watch?v=lWRX-vyB9Jw

 
This is by no means an extensive list of the causes and fixes of restricted overhead mobility but it does provide a good starting place to address some of the limitations you may have. A strong suggestion is to incorporate some of these into your warm-up routine prior to performing more complex movements such as pullups, overhead squats and handstands. This will lead to better movement patterns, increased efficiency and greater safety and longevity in your sport.