Understanding The Shoulder Pain Epidemic in CrossFit Athletes (Part 3 : Load and Volume Management)

A very popular name in the world of sports medicine right now is Tim Gabbett.  I’ve written a few articles about his research in the past.  Tim has pioneered the research of injury as it relates to training volume.  Tim has shown that both total volume as well as spikes in volume are important from an injury prevention standpoint (In elite Rugby and Soccer players).  More specifically Tim has created something called the acute to chronic workload ratio.  Basically, this ratio determines how much the current or acute training load (1 week of total training) compares to chronic (4 weeks) training load.  The higher the acute training load in comparison to what you normally do training wise, the higher your risk of injury.  I made a quick video below to help outline how training load and volume influence your risk of injury:

It makes sense, if you don’t prepare thoroughly for an upcoming large bout in training, you’re more likely to get hurt.  This seems like a no brainer but what’s interesting to me is by how much your risk of injury goes up based on these spikes.  In 1 study Tim showed a 70 x increased risk of injury with too much total training volume.  Now, although this research was performed in elite field sports I feel the mechanism of injury for these athletes is similar to the way my athletes get hurt while training in the gym.  They typically have a period of time where they spike their training volume and start to hurt.

  • I wanted to get better at handstand pushups and started doing them 3 x per week.  Now my shoulder hurts
  • I did push jerks monday, strict handstand pushups tuesday, bench press wednesday, burpees thursday and my shoulder hurts on friday.   

The other interesting aspect Tim has brought to the table are a few ways to try and measure training load in our athletes.  Now, if we’re working with gym athletes it’s pretty easy to very slowly and gradually increase training volume week by week and month by month.  I’ll go over programming a bit more in the next section.

However, in a crossfit gym this becomes challenging because the workouts have so much variety.  One week might be relatively low training volume and the next completely different.  One thing I’ve been messing around with for myself and patients is using an RPE (rate of perceived exertion) scale to quantify the amount of stress the body is taking.  This is an idea I got from Tim Gabbett in a podcast HERE.

Here’s how to do it.  Rate the workout on a scale of 0 to 10 for how difficult it was.  10 being the hardest you could ever imagine working and 0 is doing nothing.  Next, multiply the workout by the duration of the workout in minutes.

Let’s say I rate my workout a 6/10 and the workout lasted 60 minutes:

6 x 60 = 360 load score

This gives you a training load score of 360 for the day.  Add together the training load score each day for an entire week and you’d get the acute training load.  Continue adding together training load for another 3 weeks, take the average and you’ve got a chronic score.

Using this number you can begin to figure out if you’re creating any training spikes with your training.  It’s also a nice tool to figure out how to gradually begin adding additional volume to your training over time.

The last area where I feel like this tool is very helpful is with rehabilitation from injury.  Let’s say I have an athlete who is recovering from a shoulder injury and is starting to get back to training at their crossfit gym.  Now, we really don’t know what workouts are going to pop-up in class unless you’re friendly with the coaches and they write and show you their programming in advance.  Because of this it becomes very challenging to help the athlete modify their training volume.  One idea I’ve been trying with my patients is the same RPE scale for stress on a specific joint.  Let’s use the shoulder as an example since it fits the nature of this article series.

Using the same scale we can get some numbers for how much the shoulder gets stressed with training.  Let’s say your workout was 60 minutes long and the stress on your shoulder is rated as a 3 / 10.

60 x 3 = 180

Let’s say initially we want to keep the training stress on the shoulder below 200 each day of the week and to reach no higher then a cumulative load of 600 for the week.  We can now quantify the amount of stress the shoulder is taking and slowly allow more and more over time.

With these concepts in place it will start to give you an idea of how not only can we start avoiding shoulder injuries with our athletes but also how to slowly ramp back up our patients after injury.

In case you haven’t realized it, I’ve been on a shoulder kick lately.  This is because Dr. Dave Tilley from shiftmovementscience.com and myself have been working on a big new shoulder product to help physical therapists, coaches and athletes get out of shoulder pain, back to level high levels of performance and to stay pain free for the long run.  Sign up below if you’re interested in being notified when the product comes out and to receive a special discounted offer.   


  1. The Development and Application of an Injury Prediction Model for Noncontact, Soft-Tissue Injuries in Elite Collision Sport Athletes. (n.d.). Retrieved August 01, 2016, from https://www.researchgate.net/publication/46288877_The_Development_and_Application_of_an_Injury_Prediction_Model_for_Noncontact_Soft-Tissue_Injuries_in_Elite_Collision_Sport_Athletes
  2. Relationship Between Training Load and Injury in Professional Rugby League https://www.researchgate.net/profile/Tim_Gabbett/publication/49775412_Relationship_between_training_load_and_injury_in_professional_rugby_league_players/links/551894590cf2d70ee27b41ad.pdf
  3. Training and game loads and injury risk in elite Australian footballers. (n.d.). Retrieved from https://www.researchgate.net/profile/Brent_Rogalski/publication/234699103_Training_and_game_loads_and_injury_risk_in_elite_Australian_footballers/links/53dadd6b0cf2a19eee8b3f9f.pdf
  4.  The acute:chronic workload ratio predicts injury: high chronic workload may decrease injury risk in elite rugby league players. Retrieved from http://bjsm.bmj.com/content/50/4/231 Hulin, Gabbett, Lawson, Caputi, Sampson

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