Shoulder injuries during weightlifting II: capsulolabral injuries

As we discussed in the previous article, Olympic weightlifting consists of two events: the snatch and the clean and jerk.

The snatch exercise consists of lifting the barbell from the floor to overhead with the arms fully extended in a single movement. The bar is placed horizontally in front of the lifter's legs, with an overhand grip, and raised to hip height. The lifter then squats and extends the arms, achieving full extension of both arms vertically above the head. This exercise is the most technical in weightlifting.

The clean and jerk exercise consists of lifting the barbell from the floor to the shoulders with a squat (clean). The clean and jerk is then returned to a standing position and the second phase (jerk) is initiated by performing a leg curl and raising the barbell above the shoulders with both arms extended.

These biomechanical stresses under intense loading conditions, in extreme joint positions, repeatedly, are a perfect substrate for injury.

Chronic Injuries to the Capsulolabral Complex
Chronic injuries to the capsulolabral complex affect any athlete with overhead activity, and weightlifters are included in this group. Various studies have determined that up to 35% of injuries in weightlifters occur in the capsulolabral complex. There is some consensus that chronic and repeated loading of this capsulolabral complex causes capsular tension, hidden instability, and persistent pain.

Lifters' desire to gain strength and muscle hypertrophy (increase in muscle size) in larger muscles often leads them to neglect the muscles responsible for stability and mobility. Proper shoulder function requires a subtle balance between mobility and strength of the different muscle groups that function synchronously during exercises. Training routines biased toward targeting a specific muscle group can disrupt this balance.

If these biased training routines are combined with repetitive loads and unfavorable positioning, the lifter's risk of labral injuries in the form of capsulolabral junction dysfunction, labral tears, or shoulder instability increases.

Exercise Variations to Prevent Injury
Given weightlifters' predisposition to chronic pain and shoulder dysfunction, it is essential to understand the risks to which certain exercises are exposed and the modifications that can be made to prevent injury.

Although the relationship between a specific exercise and a specific injury is not well defined in the literature, some authors describe a range of pathologies related to the bench press. Unfavorable rotator cuff positioning, the rapid alternation between concentric and eccentric muscle contraction, and repetitive forces can lead to rotator cuff injuries and posterior labral injuries. On the other hand, bilateral glenohumeral dislocations have been described in the literature with the bench press.

Other authors have proposed additional variations in bench press technique that would protect the shoulder of lifters diagnosed with rotator cuff tendinopathy, acromioclavicular problems, instability, or labral/biceps pathology:

A narrow grip on the bench press reduces shoulder torsion and minimizes shoulder adduction and extension.
A higher chest contact point, above the xiphoid process, also reduces shoulder torsion.

In cases of posterior instability, a wider grip is beneficial, and avoiding maximum repetitions as much as possible due to posterior capsular and labral tension.

Another exercise frequently performed by weightlifters is the shoulder press. Preventive recommendations for this exercise include avoiding the barbell dropping behind the neck and leaning back 30° while performing the exercise.

The basis of treatment for these chronic shoulder problems will be training regimen modification, symptomatic management, and physical therapy. Avoiding high-risk exercises and strengthening stabilizing muscles will be essential. Implementing these measures will, in many cases, allow the athlete to avoid surgical treatment.