Q: I’m a baseball pitcher who was diagnosed with a posterior labral tear. Since I was young and the doctor didn’t feel that the tear was too extensive, he recommended physical therapy and not surgery. I’m still training the rest of my body hard, but am finding that I can’t back squat because it causes pain in the shoulder. Any idea why and what I can do to work around this?
A: It isn’t surprising at all, given the typical SLAP injury mechanism in overhead throwing athletes. If there is posterior cuff tightness (and possibly capsule tightness, depending on who you ask), the humeral head will translate upward in that abducted/externally rotated position. In other words, the extreme cocking position and back squat bar position readily provoke labral problems once they are in place. The apprehension test is often used to check for issues like this, as they are commonly associated with anterior instability. Not surprisingly, it’s a test that involves maximal external rotation to provoke pain:
The relocation aspect of the test involves the clinician pushing the humeral head posteriorly to relieve pain. If that relocation relieves pain, the test is positive, and you’re dealing with someone who has anterior instability. So, you can see why back squatting can irritate a shoulder with a posterior labrum problem: it may be the associated anterior instability, the labrum itself, or a combination of those two factors (and others!).
On a related note, most pitchers report that when they feel their SLAP lesion occur on a specific pitch, it takes place right as they transition from maximal external rotation to forward acceleration. This is where the peel-back mechanism (via the biceps tendon on the labrum) is most prominent. That’s one more knock against back squatting overhead athletes.
If you’re interested in reading further, Mike Reinold has some excellent information on SLAP lesions in overhead throwing athletes in two great blog posts:
The solutions are pretty simple: work with front squats, single-leg work (dumbbells or front squat grip), and deadlift variations. If you have access to specialty bars like the giant cambered bar and/or safety squat bar, feel free to incorporate work with them.
And, alongside that, work in a solid rehabilitation program that focuses not only on the glenohumeral joint, but also scapular stability and thoracic spine mobility.