When Tendons tear...It's usually not the exercise, it's you.



With the Crossfit Games Regional competitions taking place, we have seen multiple pectoralis tendon tears on event 2 which requires the athlete to perform 45 Ring Dips. As unfortunate as it is that these injuries happen, it is not due to a poor exercise being programmed for competition. Its also not an accident that these injuries happened. 45 ring dips on day 1 of competition is not an absurd amount and when performed correctly the ring dip is not a dangerous movement. The injuries are an incident (not an accident) which illustrate the way their system (their body) is set up.

Confused? Lets take a deeper look at what has probably occurred.

Now, I have never assessed these athletes and I have never met these athletes. This breakdown is my logical thought process of what I feel happened. I am in no way, no shape, or form trying to disrespect anyone. It has nothing to do with their athletic abilities. They are some of the fittest people in the Crossfit World and their exercise capacity is amazing. Its important to understand though that even the best athletes with the highest capacities still present with their own mobility and motor control sins.


Tendons what are they? Why do they tear?


What is a Tendon?

A tendon is a connective tissue which connects muscle to bone. A tendon transmits tensile (tension) load from the muscle to the bone to which its anchored. They are created from collagen fibers. These collagen fibers are what give the strength and flexibility to the structure. It's what allows them to withstand the forces that they do. Tendons have a limited blood supply, which ultimately affect how well and how quickly they heal from injury or exercise. They are viscoelastic in nature. Meaning they become more stiff with a higher rate of loading.

Tendon Injuries?

There are a few different mechanisms for tendon injuries. They can either have a high stress/load traumatic event, or a low stress/load (high strain) overuse event. With a low load (high strain) injury, you get a chronic accumulation of micro-trauma to the structure. In addition to the form of stress the tendon undergoes, muscle contraction is a factor in tendon injuries as well. A maximal concentric contraction (tensile stress) followed by rapid eccentric movement leads to increased stress through the tendon. This happens in a situation involving a rapid change of direction by a person performing a movement. However, it is more likely to tear a MUSCLE or suffer an avulsion fracture (BONE) then it is to tear a TENDON. Why? Tendons are about 2 times stronger in tensile loads than muscles are. The weak point in the system is the muscles and bones, not the tendons. In an healthy individual the weakest link in the chain is the musculotendinous junction.

Tendons like other tissues in the body are going to adapt to the stress placed upon it. However with altered movement and altered/dysfunctional loading (or overuse and under recovery) through the tendon, we can ultimately get a weakening and/or degeneration of the tendon itself. This process is not necessarily painful! You can have degeneration and weakening of the tendon without pain.

With altered mobility and motor control, we get altered/dysfunctional loading on the tissues. When we get dysfunctional loading on the tissues, we often get degeneration or weakening of the tissues. When these tissues are placed upon massive stress or massive load that exceeds their new maximum load, they break. We get injured.


How does this apply to the recent pec injuries in the regional competitions?

These individuals are amazingly fit individuals. Their work capacity is amazing. They also carry an enormous training volume in order to compete at the level in which they compete . However, amazing work capacity and amazing athletic ability is not synonymous with perfect movement. The majority of athletes are going to have their mobility and motor control sins. They just have found a way to work around them in order to complete the task at hand.

When looking at the movement in which they are getting injured on, its logical to believe that these individuals had underlying mobility and motor control dysfunctions. Specifically in the area of shoulder extension with internal rotation. Limitations in both of these movements are common for me to find within a competitive athlete within my practice. It has actually been pretty rare that I find a competitive Crossfit athlete (often with anterior shoulder pain) without these dysfunctions.

These movement limitations ultimately restrict the athlete from reaching full depth (for Crossfit standard) without movement compensations throughout the shoulder girdle. The is a multifactorial situation injury. With a demanding training volume and often under-recovery by athletes (the microtrauma out weighs the recovery process), they begin to develop degeneration and weakening of the tendon. The increased deep -ring dip volume through prepping (and less variability in their training) for regionals increased the stress and weakening of the pec tendon. With degeneration, the collagen structure which creates the strength of the tendon, is now not as strong. Thus it cannot withstand the tensile load it could before. The muscle however, did not get any weaker. The athletes are incredible strong and powerful.

During event 2 of the Crossfit Regional, an event which includes 45 ring dips (which is actually a relatively small volume of ring dips), the athletes were under increased intensity, increased fatigue, and increased situational stress. The individuals were trying to move as quickly as they could (A rapid concentric contraction followed by a rapid eccentric contraction). They were however (probably) doing this on a weakened structure which could not withstand the tensile forces which the muscle was producing. The tensile force then surpassed the maximal strength of the tendon...which then resulted in the injury. The injury and the final ring dip were just the result of an extended microtrauma and under-recovery process initiated by poor movement patterns and underlying mobility and motor control deficits. This was also seen after event 5 as well. When an athlete injured his pec during a warm up muscle up rep before event 5. The muscle up dip was the final straw which created the injury which pulled him from the competition.

There was nothing wrong with the workout. There is nothing inherently wrong or dangerous about an athlete performing 45 ring dips. Injury was an unfortunate result of a chronic degenerative process.

Disclaimer: These are my thoughts on the situation. I use logical biomechanical and physiological reasons to support my conclusion. I have never assessed the individuals and do not know if they are truly limited in mobility or have motor control deficits. Its an unfortunate series of events that I wish never happened. I wish all the athletes that got hurt, didnt. I wish all the athletes were able to go out and let their training and dedication shine on the regional stage.

I hope you guys learned something from the article, and found it beneficial. As you move through your training in the future, spend the time to solidify and own the positions you are performing. It will help you not only perform better, but work to fend off future injury as well.

Dr. Michael Tancini, DPT

Ground to Overhead Physical Therapy

Email: Tancini@groundtooverheadphysicaltherapy.com

Phone: (619) 354-6591

Address: 10999 Sorrento Valley Rd, San Diego, CA 92121

Website: www.groundtooverheadphysicaltherapy.com

Instagram @groundtooverheadpt

San Diego, California, Physical Therapy, Crossfit, Sports Therapy, Recovery, Rehabilitation , Movement Specialist, Knee pain, Back Pain, Hip pain, Shoulder pain, Specialist


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