SLAP Tear: Exercises to Avoid, Rehabilitation, and When to Seek Help

What exercises should you avoid with a SLAP tear?

When managing a Superior Labrum Anterior Posterior (SLAP) tear, it is crucial to avoid exercises that place excessive stress on the biceps anchor and superior labrum, particularly those involving overhead movements, forceful biceps contractions, and end-range external rotation.

Understanding the SLAP Tear

A SLAP tear is an injury to the superior (top) part of the labrum, a rim of cartilage that deepens the shoulder socket (glenoid) and helps stabilize the shoulder joint. This specific tear often extends from the front (anterior) to the back (posterior) of the labrum. Critically, the long head of the biceps tendon attaches to the superior labrum, meaning a SLAP tear frequently involves or affects this tendon's anchor point.

Common causes include:

• Acute trauma: Falling onto an outstretched arm, a direct blow to the shoulder, or a sudden, forceful pull on the arm (e.g., trying to lift a heavy object).
• Repetitive overhead activities: Common in athletes who perform overhead movements, such as baseball pitchers, tennis players, and swimmers. These repetitive motions can lead to fraying and eventual tearing of the labrum.
• Degenerative changes: Tears can also occur due to age-related wear and tear, even without a specific injury.

Biomechanical Principles of Avoidance

Understanding the mechanics of a SLAP tear is key to identifying problematic movements. The primary mechanisms that aggravate a SLAP tear involve:

• Biceps Tension: Any movement that puts significant tensile stress on the long head of the biceps tendon can pull on its labral attachment, exacerbating the tear.
• Shear Forces: Movements that cause the humeral head to translate excessively against the superior glenoid labrum can create damaging shear forces.
• Peel-Back Mechanism: In overhead positions, especially with abduction and external rotation, the biceps tendon can twist or "peel back" the superior labrum from the glenoid, placing significant stress on the tear.
• End-Range Stress: Moving the shoulder into its extreme ranges of motion, particularly into abduction and external rotation, can compress or stretch the injured labrum.

Exercises and Movements to Strictly Avoid

Based on these biomechanical principles, the following exercises and movements should be avoided or significantly modified if you have a SLAP tear:

• Overhead Presses (Barbell, Dumbbell, Machine):
  • Behind-the-Neck Press: This variation places the shoulder in a highly vulnerable position of abduction and external rotation, significantly increasing peel-back forces on the superior labrum.
  • Overhead Shoulder Press (in front): While less extreme than behind-the-neck, any pressing movement directly overhead can still load the biceps anchor and create unwanted shear forces.
• Lat Pulldowns (Behind-the-Neck): Similar to behind-the-neck presses, this position stresses the superior labrum and biceps anchor.
• Upright Rows: This exercise can cause impingement in the subacromial space and place stress on the superior capsule and labrum, especially with a narrow grip.
• Biceps Exercises (Heavy or Forceful):
  • Heavy Biceps Curls (especially with supination): Direct, forceful contraction of the biceps pulls on its labral attachment.
  • Hammer Curls (heavy): While slightly less supination, heavy loads still generate significant biceps tension.
  • Concentration Curls: The isolated nature and potential for excessive load can be problematic.
• Pull-ups and Chin-ups:
  • Explosive or Wide-Grip Pull-ups/Chin-ups: These exercises place substantial tension on the biceps and stress the shoulder joint, especially during the eccentric (lowering) phase or with a wide grip that increases shoulder abduction.
• Dips (especially deep): Deep dips push the shoulder into extreme extension and internal rotation, potentially stretching the anterior capsule and placing undue stress on the labrum.
• Overhead Triceps Extensions (e.g., Skull Crushers, Overhead Dumbbell Extension): These exercises put the shoulder in a vulnerable overhead position, leading to potential stress on the labrum.
• Plyometric Upper Body Exercises:
  • Medicine Ball Throws (especially overhead or rotational): The sudden, explosive nature of these movements can create high, uncontrolled forces on the shoulder joint.
  • Clap Push-ups: Uncontrolled impact and joint stress.
• Any Exercise Causing Pain, Clicking, Popping, or Grinding: This is a critical rule. If a movement elicits symptoms, stop immediately, regardless of whether it's on this list. Pain is your body's signal of distress.

Activities and Sports to Modify or Halt

Many sports and daily activities involve the movements listed above and should be approached with extreme caution or temporarily avoided:

• Throwing Sports: Baseball, softball, javelin, football quarterbacking.
• Overhead Racket Sports: Tennis, badminton, volleyball.
• Swimming: Freestyle, backstroke, and butterfly strokes involve repetitive overhead arm movements.
• Weightlifting: Any exercises involving heavy overhead lifting, Olympic lifts (snatch, clean & jerk), or heavy bench pressing (which can cause anterior shear).
• Contact Sports: Rugby, American football, wrestling, where falls or direct impacts to the shoulder are common.

Safe Movement Principles and Rehabilitation Considerations

While avoiding aggravating movements is crucial, complete immobility is not the answer. A structured rehabilitation program, guided by a physical therapist, is essential. This typically involves:

• Pain-Free Range of Motion: Working within ranges that do not provoke symptoms.
• Scapular Stability: Strengthening the muscles that control the shoulder blade (rhomboids, serratus anterior, lower trapezius) to provide a stable base for arm movement.
• Rotator Cuff Strengthening: Focusing on exercises that strengthen the rotator cuff muscles below 90 degrees of abduction to improve dynamic stability without stressing the superior labrum.
• Core Stability: A strong core provides a stable platform for all limb movements.
• Progressive Loading: Gradually increasing resistance and complexity as healing progresses and strength improves.

When to Seek Professional Guidance

If you suspect you have a SLAP tear or are experiencing persistent shoulder pain, it is imperative to consult a healthcare professional. This includes:

• Orthopedic Surgeon: For definitive diagnosis, imaging (MRI with contrast often required), and discussion of surgical options if conservative treatment fails.
• Physical Therapist: For a personalized rehabilitation program, guidance on safe exercises, and progression back to activity.

Self-diagnosing or attempting to manage a SLAP tear without professional guidance can lead to chronic pain, further injury, and prolonged recovery. Your rehabilitation should be a carefully planned progression under expert supervision.