I’m Dr. Taylor Ptacek, a sports chiropractor at Kinetic Sports Medicine and Rehab in Centennial, CO. Today, we’re going to discuss the high-intensity functional training landscape—specifically Hyrox—and the physiological mechanisms behind the shoulder pain that often derails performance around Station 6 or 7.
As Hyrox gains significant momentum across the US, from Denver, down to Dallas, over to Chicago, we are seeing a high frequency of athletes presenting with what they believe are “blown-out” shoulders. However, if we look at the mechanistic data, the weight itself is rarely the primary driver of injury. A 9kg wall ball is a submaximal load for a trained nervous system. This alone should not be causing your shoulder to become “damaged”.
The real culprit? A failure of the fatigue-compensatory mechanism and a breakdown in the neural drive required for joint stabilization.
Joint Stability: Intra-Abdominal Pressure (IAP)
To understand why your shoulder fails during Wall Balls but feels fine on the SkiErg, we have to look at Intra-Abdominal Pressure (IAP). Think of IAP as a pressurized biological cylinder. When the diaphragm, pelvic floor, and abdominal wall co-activate, they create a rigid anchor for the ribcage and thoracic spine.
When you are 6 kilometers deep into a race, several physiological shifts occur:
- Core temperature rises, impacting neural conduction velocity.
- Metabolic byproducts (lactate, hydrogen ions) accumulate.
- Central Nervous System (CNS) fatigue sets in.
As these variables shift, your IAP “leverages” begin to fail. Your thoracic spine rounds, your scapula tips forward into a mechanically disadvantaged position, and suddenly, the small muscles of the rotator cuff are forced to act as primary movers rather than stabilizers. This is a biological mismatch that leads to tissue pathology.
The Three Pathological Profiles
The peer-reviewed literature suggests that 26% to 33% of high-intensity athletes will experience shoulder issues. These generally fall into three distinct categories:
- Subacromial Pain Syndrome: This is a failure of the supraspinatus to keep the humerus centered. Under fatigue, the deltoid “wins” the tug-of-war, pulling the bone upward and compressing the tendon against the acromion.
- Biceps Tendinopathy: Often seen after the Sled Pull. The biceps is recruited as a “backup stabilizer” for the shoulder, performing double duty until the tendon becomes reactive.
- AC Joint Irritation: Common in the Burpee Broad Jump. This is a classic “weightlifter’s shoulder,” caused by repetitive high-velocity impact and compression.
The Protocol: Science-Based Recovery
The good news is that the data—including a landmark 2018 study—shows that conservative exercise protocols are often as effective, if not more effective, than surgical intervention.
1. Heavy Slow Resistance (HSR) Training
Forget the low-tension “pink dumbbell” exercises. To signal the tenocytes to produce collagen and repair the matrix, you need mechanical loading.
- Protocol: 3 sets of 8–10 reps.
- Cadence: 3 seconds concentric (up), 3 seconds eccentric (down).
- Biological Goal: Stimulate structural remodeling of the tendon.
2. Neuromuscular Re-patterning (The “Bear” Position)
We leverage Dynamic Neuromuscular Stabilization (DNS) to retrain the brain-to-muscle connection. By performing the “Bear” hold—hands and feet on the ground, knees hovering—you force the serratus anterior to anchor the scapula, removing the “cheat” mechanism of the biceps.
3. Therapeutic Windows
Tools like dry needling and shockwave therapy are highly salient for pain modulation. They don’t necessarily “fix” the anatomy, but they provide a neuro-suppressive effect on pain, opening a “window” that allows you to perform the necessary heavy loading without CNS guarding.
Phase-Based Return to Competition
I don’t believe in “complete rest” for athletes unless there is a structural tear. Total rest leads to atrophy and de-conditioning of the nervous system. Instead, at Kinetic Sports Medicine and Rehab, we use a tiered program to get you back to full activity pain-free: release, reload, rebuild.
Closing Thoughts
If you’re in the Centennial area and your training has hit a wall, remember: Your shoulder isn’t broken; your stabilization strategy is simply failing under metabolic stress. By fixing the underlying mechanics, you don’t just return to the race—you return with a higher ceiling for performance.
At Kinetic Sports Medicine and Rehab, we apply these exact mechanistic principles to get you back to the starting line.
Book here: Centennial Colorado Shoulder Experts