Superior labral lesions, or SLAP lesions, are common shoulder injuries. In fact, they may be more common in asymptomatic people than we think.
Surgery to repair these labral tears can often over-constrain the joint and lead to loss of motion, so it is typically used as a last resort.
Here are some tips for how to treat nonoperative SLAP tears without surgery.
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#AskMikeReinold Episode 284: Nonoperative Treatment for SLAP Tears
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Show Notes
Transcript
student:
All right. So, Lauren from Arkansas asked, what treatments or aspects of treatment have you found to be the most effective for non-surgical SLAP tears?
Mike Reinold:
Good job, Sean. That was well articulated.
Lenny Macrina:
Well read.
Mike Reinold:
I mean… Just good job, Sean. That’s great. It’s refreshing, to be honest with you. But, anyway. So great question, Lauren. I really appreciate that one. This is a good question. What treatments are effective for a non-operative SLAP? Because I think as we’re evolving our knowledge… And maybe this has already happened, some we’ve evolved. I think we’re trying to get away from doing surgery on SLAP lesions. As much as we can. So superior labral lesions of the shoulder. We’re trying to get away from just anchoring those down and just realizing that some of that may be okay.
Mike Reinold:
But I like this question because I like the way Lauren phrased it. She wants to know what treatments we do for SLAP tears. And I don’t think we’re going to answer the question that way. I don’t think there’s like a magic “This is what we do for SLAPs.” I think we’re going to talk about principles. I think that’s the important part, But I didn’t want to lead everybody. But who would like to start? Dan, why don’t you start, Dan? Because I know you have been excited for this question.
Dan Pope:
SLAPs are my favorite thing. SLAP tears are great.
Mike Reinold:
Dan works with a lot of like high-level fitness people, and I think shoulder pain happens. I think MRIs happen when you have shoulder pain. And I think SLAP tears are found on MRIs quite a bit. So this is probably one of those things you see a ton of. So what do you think, Dan?
Dan Pope:
Yeah, that’s a good point. We do know that SLAP tears are fairly common in overhead athletes in general. Sometimes they’re symptomatic. Maybe sometimes not. The surgeons I like in the CrossFit world, in the fitness world. I think their public enemy number one is the biceps tendon. And the biceps tendon comes up and attaches on the labrum. And oftentimes folks have pain somewhere in the front side of the shoulder. That could be relate to the labrum. Maybe it’s an irritation of the biceps tendon. It’s hard to know exactly where that pain is coming from.
Dan Pope:
But like you said, they’re coming to see you. Maybe they had an MRI, they show that there’s a SLAP tear, right? What do you do at this point? Generally speaking, A) We don’t know exactly where the pain is coming from, right? Maybe this is an asymptomatic tear. Maybe it’s more pain from the cuff. It’s hard to tell. But my rehab is very similar regardless of the pathology. I’m trying to identify which movements… At least if this person is a fitness individual that’s trying to get back to weight train in the gym. I just identify the movements that are painful or problematic.
Dan Pope:
One of the things I think we forget about with the long head of the biceps is that it’s a shoulder flexor. It actually flexes the shoulder somewhat. So if you’re doing any resisted shoulder flexion, which is pretty much most pressing exercises in the gym, oftentimes that can be irritating to the front part of the shoulder joint. So most folks that come in to see me that say they have some sort of pain in the shoulder, when I start asking which movements bother them, usually it’s pressing exercises. If it’s a SLAP tear, you can kind of make that argument that maybe biceps related exercises like pulling exercises can tug on the SLAP area a little bit. But usually that’s not exactly what I’m finding. More it’s problems with pressing.
Dan Pope:
So, generally speaking, I’m pulling back on the movements that are really irritating, and then I’m trying to work on the muscles that support the shoulder. Like the rotator cuff. And then I slowly expose that person to more stress over the course of time. In the form of the movements that used to be very provocative. And usually that’s pretty helpful for folks with SLAP tears over the course of time.
Mike Reinold:
And I like that approach too. Because I think what you’re saying is it doesn’t really necessarily matter if it’s a SLAP tear or what the exact pathology is. You’re going to take a step back and you’re going to treat the person in front of you and what you find. And I think that’s it. Oftentimes when we have a diagnosis… I think sometimes the diagnosis doesn’t necessarily tell you all the time what to do. Oftentimes it tells you what not to do. And with the SLAP, I think it’s an interesting one.
Mike Reinold:
I mean, I don’t think there’s anything specific that we would say “You can’t do this because you have a SLAP tear.” I think it’s going to be more activity specific. And you just said “Pressing.” But I think Dave could probably say the same thing with gymnastics. We can say the same thing for baseball. Mike can say the same thing for golf. Lisa can say the same thing for rowing. Right? I think everybody probably gets that anterior shoulder pain. That type thing. If you do an MRI, you’re going to find a SLAP tear in a lot of people. So I like that principle approach who else wants to jump in on this one?
Dave Tilley:
Dan kind of took the thing I was going to say. Because I think it’s important to start with the fact that most people have an issue with workloads, and with programming and modification, and stuff like that. I think unfortunately, an error that I used to make… I see a lot of the people make, is as soon as they get someone in for a SLAP tear, they think all the really fancy technical stuff. The flexibility of the cuff. All the strengthening. Which is important for sure.
Dave Tilley:
But nine times out of 10, people typically get into hot water because they’re either doing a lot of the same thing over and over again. And maybe they don’t have the best programming balance of how they’re approaching that during a weekly volume. Or there may be a little bit of an ego getting in the way. And they’re not willing to take some weight off the bar, or fix their technique, or change their programming so that they’re not doing the same thing over and over. And they can have some other movements or just balance their strength conditioning program to do more upper back work or cuff work.
Dave Tilley:
And the majority of the time, I think that a lot of people come to us and we’re just maybe more honest with them and delicate around like “Hey, how can we work? Still keep you training or in the gym, but not cause something that’s going to bug you.” And a lot of people just want to do the same thing over and over and over again. And the answer that they hear is like “Okay, well stop doing that.” I hear that all the time. It’s like “Well, just stop gymnastics and your shoulder will be fine.” It’s like “Well, that’s not a realistic goal for them.” So [inaudible 00:06:48] another opportunity. So I would just say spend more time on that conversation.
Mike Reinold:
Nice. I like it. Who else?
Lenny Macrina:
Yeah, I would say Dave and Dan both gave great explanations. I think it’s not necessarily about the SLAP tear. It’s about outlining a plan for the person so they understand that it’s very normal to have that. Don’t let them think that they’re freaky because they have it. Explain what the anatomy is. What it means. But then also have a plan for them to get back. So whether or not it’s having “What’s the ultimate goal? Let’s outline how we can get you there. What strengthening can we do? What modifications in your life can we do? What can we do at home that will help you?” So it’s about that person feeling like they are empowered to do stuff on their own and to get through it. And you’re going to be there to guide the process. And without throwing fancy words at them. So I think you have to really explain what is potentially going on. How common it is that they have it. But then also what you have done in the past to help other people. And how you can help them and give them that kind of guidance.
Mike Reinold:
I like that. It- [crosstalk 00:07:53]
Lenny Macrina:
It goes a long way.
Mike Reinold:
We say that all the time, right? It’s not about treating the SLAP. It’s starting a checklist of things that you find on the person that are suboptimal that you need to work on. So I guess I’ll end it with this, Lauren. But I’ll give you a little bit of what you’re looking for, even though everybody here was “That’s how we treat SLAPs.” But if you want to actually say “Okay, we’re going to treat SLAPs. There’s one specific thing.” I want you to take a step back and just think not necessarily of what a SLAP is in terms of it’s the biceps attaching, it’s a pain source type thing. When we take a step back and think about what happens to the shoulder joint when you have a SLAP tear. And if you actually look at the biomechanics of the joint, by having a SLAP tear, you increase the amount of translation of your glenohumeral joint.
Mike Reinold:
So what happens when you have some issues with your SLAP tear, you technically have a loss of static stability. So you have a loss of ability to stabilize your shoulder joint because it moves more. So if you want to say like “Well, how do you treat it?” I think that’s the thing is take a step back. Do everything everybody said here. Treat the things we found. Workload management. Build them back into that capacity. But I want you to think in your back of your mind that what’s really happening here… It’s not that they have a SLAP tear it’s that they now have a loss of static stability because of that. You’re not going to fix the SLAP tear. So we have to treat that loss of static stability. And I think that’s where your focus then goes on. Is to kind of attack it from that approach, if that makes sense.
Mike Reinold:
So hopefully Lauren, that gives you a little specific there. But I’ll be honest, we all don’t say “Hey, we’re specific. We’re going to do the SLAP protocol.” It’s more about doing that checklist of what we find with a person and getting them back into their activities. But hopefully that’s a little bit to understand so… Awesome.
Mike Reinold:
I actually have a bunch of articles on this on my website. That I did back in the day, because SLAPs were so mysterious five to 10 years ago or so. So there’s a bunch to dig into and read. But go check those out. Thanks, Lauren. I appreciate it. Please if you have a question like Lauren, head to mikereinold.com. Click on that podcast link and you can fill out the form to ask us a question. And please head to Apple Podcasts, Spotify, subscribe to us so we can keep doing these amazing episodes to help you out. Thanks again.
