Overhead Athletes & Shoulder Injuries
By Jillian Seamon, MS, LAT, ATC
The shoulder is one of the most fascinating joints in the entire body. It can do really cool things, like spin like a windmill to pitch a softball, reach up way high overhead to spike down volleyball, and hold an almost seven foot long metal stick before chucking it like a spear to throw a javelin.
That’s not to mention the everyday things, like opening a door, putting your hair up in a ponytail (seriously, have you ever tried to do that with an injured shoulder?!), and reaching for a plate in a kitchen cabinet. The shoulder is so mobile and versatile!
Most people will experience some sort of shoulder pain or injury at some point in their life. As athletes, we ask our shoulders to do A LOT for us. We put it in weird positions, we want it to be strong and sturdy, but fast and explosive.
But sometimes, our shoulder fights back…and we suffer shoulder pains
HURT vs. INJURED
When you ask too much of your shoulder, whether in volume or intensity, and without proper recovery and maintenance, your shoulder may hurt. Of course, there’s a difference between it just HURTING and it being INJURED.
Option One: Let’s say you’re a softball pitcher who just pitched an extra innings game to take your team to the championship.
The next day you wake up and your arm feels like it weighs a ton. There is no specific pain or spot, just a general, overall soreness or nagging ache (remember soreness is expected with a novel stimulus…such as higher sport volume!)
This is normal HURTING/soreness. If your championship game is tomorrow, it could definitely cause a problem. To mitigate the pain or reduce the soreness, active recovery modalities (of course after your sleep & nutrition intake is well established) can help!
In fact, if you have a big game coming up and you normally feel achey after pitching 11 innings straight, it’s a good idea to start the recovery process as soon as the game ends. Some great active recovery methods include light exercises to get blood flowing to the area- like band pull a-parts, stabilization drills, and dynamic stretching.
Rolling out the sore muscles with a foam roller or ball and holding some long low load stretches will also make you feel better. Just like throwing a bag of ice on it will reduce inflammation!**
**remember, increased recovery time comes at the cost of decreased adaptive potential! If it is your championship game, ice up baby! If it during your pre-season when you are training HARD to prepare & adapt, embrace the soreness:)
Option 2: Now let’s say you’re a softball pitcher, and you throw one pitch that for whatever reason that pitch felt different.
You threw HARD but something felt different on that one… you brushed it off and kept pitching. You noticed your velocity started to decrease as the game continued,, and by the end it hurts to lift your arm overhead in one specific spot at the front of your shoulder. This is an INJURY.
Here are some things to think about if your shoulder feels off:
Does the feeling last longer than a day or two?
Does this feeling happen after specific drills or hard games?
Do you remember one specific instance when it started hurting or has it been a gradual onset?
Is this the first time you’ve ever felt this or is it something you’ve experienced in the past?
If it’s not a new pain, when does it go away?
Can you point to the pain with one finger or is it a general area?
Does it feel better or worse after you get moving?
The answers to these questions will generally tell you if you’re hurting or if you’re injured. Click here if you would like to talk through your answers with us!
Getting to know your shoulders
The shoulder is susceptible to all sorts of nagging pains and aches. There are three main joints of the shoulder and 17 muscles that connect to the scapula. They work together and oppositely to make the shoulder move perfectly.
Think of a symphony: there are so many separate parts, but together, produce a beautiful movement. However, if any are out of tune or out of rhythm, it doesn’t sound right.
The same goes for the shoulder, if you are training only force production and not force aborption, the shoulder could be at risk for injury if high levels of stress are placed upon it (like in the 75th minute of your volleyball match and you spike the ball for the 100th time that game).
Whether it be the muscles that help produce the force to spike the ball, or the other muscles that help stabilize the joint in the follow through, overly fatigued muscles exposed to forces higher than their capacity to handle become injured.
Preparing the Shoulder for Sports
Playing sports is an wonderful opportunity most of us are blessed to have. However, most movements in sport are not always performed with beautifully symmetry or executed with efficiency. More often, they are movements producing high amounts of force, at high velocities, and often under high fatigue conditions.
As athletes, It’s our responsibility to strengthen our entire shoulders (and the rest of our bodies) to learn how to improve our capacity to handle the high forces of sport!
For example, in a recent study regarding shoulder strength ratios in adolescent female volleyball athletes, researchers found that those who had a previous injury had a lower level of eccentric external rotation compared to concentric internal rotation.
This mean the female volleyball players who experienced shoulder injuries expressed more strength in hitting a ball hard, but less strength in controlling the follow through.
To help reduce the chance of shoulder injuries, it is important to strengthen the entire shoulder: not just concentrically, but also eccentrically! This means we want to make sure the shoulder is able to PRODUCE force as well as ABSORB force!
We can do this in 4 main ways….
How to reduce your chance of shoulder injuries:
According to research there are four major principles of shoulder injury risk reduction programs (5):
(1) Range of Motion
An athlete should be able to lift her arms equally overhead without any compensation from the spine.
Meaning, athletes who go overhead in sport should be able to reach that range of motion while maintaining stability at the core
(2) Build Strength in that Range of Motion
Research demonstrates shoulders are at a reduced chance of injury when they are able to both PRODUCE and ABSORB force (acceleration & deceleration baby) and to stabilize in a variety of positions!
It’s imperative to maintain adequate strength throughout the entire upper extremity as strength allows the joint to both produce AND absorb higher forces.
(3) Develop Neuromuscular Control
“Neuromuscular control techniques should be included in rehabilitation programs for the overhead athlete—specifically, rhythmic stabilization, reactive neuromuscular control drills, closed kinetic chain, and plyometric exercises.” (5)
Simply put, overhead athletes must be able to stabilize parts of their shoulder girdle while asking other parts of it to produce force away or towards the body (hello lacrosse throw or catching a softball)
It is imperative that athletes strengthen their shoulders while also developing an AWARENESS of how to use them!
[Want to know what kind of exercises these are exactly? Click here to schedule your intro/assessment to find out!]
(4) Core & Lower Body Training
Since most sports are not played from a seated position or with muscles in isolation, we are able to generate a lot of our power that we use at the shoulder from the lower body.
As females, we have a greater amount of strength in our lower body. Our core acts to help transfer the force produced from our lower body up to our upper body!
Imagine a slingshot: it must be tight and stable (like your core core), so that the end part can move and adjust as it gets pulled back (like your arm in a basketball shot). If the stable end is flimsy, the slingshot will not go very far; if the core is not tight, there will be less power at the shoulder.
When you think of core strength, understand exercises done in isolation are less likely to transfer to sport performance than those done in compound movements.
Yes dead bugs & planks will help you FEEL how to stabilize your core.
However, repeating that feeling of stabilization in more compound exercises such as a back squat will have more carry over to improving your ability to produce force and improve your sport performance.
Focusing on the ATHLETE before the PLAYER
As a female athlete, it is important to be athletic & well-rounded.
This includes partaking in a strength program as well as playing multiple sports (up until a certain training age)!
By exposing your body to a training program (not random workouts) & by monitoring your training load you make yourself more resilient to stressors you will be exposed to throughout your sports career.
If you find yourself dealing with a shoulder issue, the worst thing you can is nothing at all.
The second worst thing you can do is stopping everything all together. Since the shoulder has such a great range of motion, you can often find a smaller range within it that is not painful but allows you to continue to train (and maintain your fitness!) Your normal exercises or sport might need to be modified, but the shoulder NEEDS strength!
If you do sustain an actual shoulder injury and can’t use that arm at all, keep working the other arm!!!!
Through the phenomenon known as the crossover effect, training your uninjured arm can help you gain up to 39% of the strength gained in your injured arm (7)!
Taking a few days off and just “stretching it” is not going to fix it.
In all, the shoulder is a wonderful joint, but it must be trained to stay healthy and strong!
Terry, G. C., & Chopp, T. M. (2000). Functional anatomy of the shoulder. Journal of athletic training, 35(3), 248–255.
Stickley, C. D., Hetzler, R. K., Freemyer, B. G., & Kimura, I. F. (2008). Isokinetic Peak Torque Ratios and Shoulder Injury History in Adolescent Female Volleyball Athletes. Journal of Athletic Training, 43(6), 571-577. doi:10.4085/1062-6050-43.6.571
Barrentine, S. W., Fleisig, G. S., Whiteside, J. A., Escamilla, R. F., & Andrews, J. R. (1998). Biomechanics of Windmill Softball Pitching With Implications About Injury Mechanisms at the Shoulder and Elbow. Journal of Orthopaedic & Sports Physical Therapy,28(6), 405-414. doi:10.2519/jospt.1922.214.171.1245
Ernst A.T. & Jensen R.L. (2015). Rotator Cuff Activation During the Olympic Snatch Under Various Loading Conditions. Proceedings of the 33rd International Society of Biomechanics in Sport. 200-203.
Reinold, M. M., Gill, T. J., Wilk, K. E., & Andrews, J. R. (2010). Current Concepts in the Evaluation and Treatment of the Shoulder in Overhead Throwing Athletes, Part 2: Injury Prevention and Treatment. Sports Health, 2(2), 101–115. https://doi.org/10.1177/1941738110362518
Barfield, J., & Oliver, G. (2018). What Do We Know About Youth Softball Pitching and Injury? Sports Medicine - Open,4(1). doi:10.1186/s40798-018-0168-6
Cirer-Sastre, R., Beltrán-Garrido, J. V., & Corbi, F. (2017). Contralateral Effects After Unilateral Strength Training: A Meta-Analysis Comparing Training Loads. Journal of sports science & medicine, 16(2), 180–186.