Injuries Happen

At the highest level of competition, injuries happen. When you're asking people to compete and push their body to its limits, things will happen. I think everyone would agree we want to try and minimize that as much as possible. But in every sport, people get injured. It's important, though, when one particularly injury seems to happen with a high frequency, that we figure out why so we can prevent it.

This year during the CrossFit Regionals, we've seen a theme of injuries among the male competitors: pec injuries

While watching the first weekend of regionals this year we saw the first pec injury. And then the second. And then the third.

This was pretty consistent among all the regions that have gone so far, so I wanted to do some digging to figure out:

  1. Why was this happening?
  2. People do tons of ring dips, why are they suddenly injuring their pecs on a movement they've done many times before?
  3. Is there a way to prevent this?
  4. Why are females not getting this same injury?

This article is my opinion and take on the issue.

What do we know so far?

As of this writing (May 30, 2017) I've counted 14 pec injuries (and I've heard as high as 22) from mild strains to tears across the regions, all have been males as far as I have seen. Whether these are injuries to the pectoralis major or pectoralis minor is yet to be seen. I have talked with several athletes who had this injury and are waiting to get imaging in the next week or two.

So why is this happening?

As I watched all of this happen, I started thinking: what is going on here? Why are these highly conditioned and strong athletes injuring their pecs on a movement they've done thousands of times? Why is it only males? Why does it seem to be some of the strongest athletes?

Some of the things I was thinking:

  • Which muscle is it? Pec major? Pec Minor? I could see arguments for both (but ultimately time will tell)
  • Is it because the athletes competing have suddenly started doing more volume of ring work in preparation for regionals? We do know that increasing volume of training suddenly increases injury risk
  • Are athletes doing more single arm dumbbell overhead work than usual and that is overloading their pec major/minor?
  • Does it have to do with the depth of the ring dip standard and how fast the athletes are pushing out of a stretched position?
  • I hear people saying it's because these athletes are on steroids and their tendons are weak and muscles are way stronger....I disagree. I highly doubt that's part of this equation and I don't assume athletes are taking anything just because they get injured (and it's disrespectful)

None of those seemed to really explain what was happening (except the FAST ring dips out of the bottom).

Then it hit me after a conversation with Nolan Gouveia and Hank Lopez, both from the California region and both having suffered pec injury: they are doing a TON of weighted chest to bar pull ups, 96 reps with a 20lb vest.

Part 1 of the equation, in my opinion, is the volume of weighted chest to bar pull ups, a movement many athletes don't train regularly above 

While researching this, I discovered there isn't much research on pec activity during chest to bar pull ups, especially kipping.

But there is research on pec major activity during different phases of throwing, tennis racket swinging, and volleyball spiking. The action of the shoulder and pec in those movements is seemingly more similar than comparing a strict pull up to a butterfly chest to bar.

While the arm is being cocked back and then accelerated forward in those movements (throwing a ball / volleyball spike / tennis serve), the pec major is a heavy contributor.

In a football throw, for example, the pec major is at 86% +/- 33% of it's MVIC (maximum voluntary isometric contraction).

During a volleyball spike, the MVIC of the pec major was 59 +/- 24%.

During a tennis service, the MVIC of the pec major was 115%.

When the arm is cocked backward in a throw, it goes into external rotation. The pec major has to contract to eccentrically control that motion. This external rotation also occurs during butterfly chest to bar pull ups. Add more weight than the athlete is used to, and it could be a factor in the overload of the pec major.

After this overload, the athlete then goes and spends 90 minutes resting, cooling down, and then warming up again before event two.

Part 2 of the equation, in my opinion, is how hard and fast the athletes can push out of the bottom of the dip. 

That may explain why some of the top athletes are having this injury; they're stronger and can push harder and faster out of the bottom.

The other factor with this is to go fast, you have to get to the bottom of the dip quickly. So there is a fast negative with little eccentric muscle contraction and then a strong push out of that position. That's a common mechanism for an injury at the muscle-tendon junction.

It also could explain why males are having this issue and not females. Top males have more developed upper bodies and can push harder, generating more force through the muscle.

Part 3 of the equation, in my opinion, is the longer straps on the rings that may have thrown off the ability to control the shoulder well during the ring dips if it differed from their normal training 

During event two, the ring dips are done fast and hard on rings with very long straps. These straps, as I learned from the athletes I interviewed, were longer than what they were used to in training and felt wobbly, require more stabilization than usual.

This may explain why event 2 (ring dips) has seemingly caused more issues than event 5 (muscle ups) because the rings are substantially higher in the muscle up. The strap is shorter and therefore more stable.

This Study, for example, show increased muscle activation of the pec major when the apparatus is less stable versus more stable. I think we could extrapolate that to a dip.

After being fatigued from event 1 in the arms, pecs, and shoulder muscles from the weighted CTB butterfly pull ups (that presumably isn't trained frequently), the stabilizing muscles that help the shoulder to move precisely were challenged by longer than normal straps (for some athletes) increasing the demand on shoulder stabilization, which could be a factor in the pec injuries.

Add that to going fast and hard out of the bottom of the dip after all the weighted CTB butterfly pull ups and you could make an argument for where these pec issues are coming from.

What about the pec minor?

It is possible we will hear from people after getting MRIs that they have pec minor tears, but I think that's less likely than tears/strains of the pec major musculotendinous junction.

What I would do if I were competing in an upcoming region?

There are still a few regions that haven't competed yet and I am sure this pec issue is on the minds of the competitors.

My opinion is this:

  • I would consider doing less chest to bar pull ups and more conventional C-Kip pull ups to decrease the rotational stresses on the shoulder joint that require large pec contraction
  • I would break up the ring dips into smaller sets so the pec muscle/tendon can recover
  • I would do the ring dips slower and more controlled to avoid really hard pec contractions
  • I would stay warm between events 1 and events 2

What can/should we learn?

In competition, injuries happen. It's inevitable that people get injured when you physically have to push yourself as hard as possible. But we should also try to minimize injury to keep competitors as safe as reasonably possible.

This is likely a combination of multiple factors: Fast dips with little eccentric control, large volume of a heavier movement than many athletes train (the butterfly weighted CTB), and longer straps than many athletes trained with.

I wish everyone who had an injury a speedy recovery and hope we don't see any more pec injuries in the coming week.

Thank you for reading and thank you to all the athletes who allowed me to interview them after their injury,