Preventing Shoulder Injury

This is the second post to address common volleyball injuries. The first post addressed patella tendonitis or “jumper’s knee.”

PS…thanks for all the feedback on the jumper’s knee post!

In the post below, Blain Empey (MS PT, ATC, EMT) shares  insights into common shoulder issues and exercises that can be very helpful in preventing shoulder problems. At the end of the article there is a link to some workout recommendations that can be done before or after practice to help limit shoulders problems.

PREVENTING SHOULDER INJURY

Although the shoulder is a complex joint, athletes can do a few simple things to help prevent soreness and injury. Some of these include strengthening and stretching exercises, and limiting abnormal loads on the shoulder. Utilizing such a program doesn’t have to take much time, and much of it can be incorporated into a general lifting/conditioning program.

Just like any other joint, the total overall load on the shoulder can contribute to pain. Abnormal loads include sudden increases in repetitions, poor biomechanics, and strength/flexibility imbalances. As always, a coach does not usually have to provide complete rest to alleviate a problem with shoulder pain; simply decreasing practice time may have dramatic results. Spotting and fixing poor biomechanics may not be as simple but is obviously an essential part of controlling abnormal load. That leaves the problem of strength and flexibility imbalances.

I’ve found that addressing three common problem areas with imbalance issues solves most problems. These are scapular weakness, rotator cuff weakness, and internal rotation tightness/weakness. Luckily, the last two are related!

Scapular (shoulder blade) weakness is one culprit of shoulder pain. This is because the upper arm sits on the scapula, which acts as a stable base for power movements like serving, etc. The scapula will actually wing or flip into the upper arm bone (humerus) and pinch structures there if the muscles that stabilize the scapula are at all weak. Normal, everyday weight room exercises are excellent at strengthening these muscles: rows, lat pull-downs, shrugs, etc. Including these exercises in any shoulder injury prevention program is essential.

The rotator cuff does many things including stabilizing the shoulder joint and preventing impingement of the structures that cross the joint. If it’s not working correctly, athletes can experience biceps and rotator cuff tendinitis, bursitis, and many other problems. Isolating the rotator cuff using external and internal shoulder rotation strengthens those muscles; however, the external rotators are usually the weak link and prevention programs should focus on these.

The component of external rotation muscle weakness and tightness is the most complex part of this discussion. Any overhead athlete moves through shoulder internal rotation motion as they swing through the last part of a throw, a kill, a serve, and so on. The part of the rotator cuff that does external rotation actually has to be very strong to decelerate that motion; if it’s not strong those muscles will be subjected to huge loads that they can’t handle and become injured. Also, if those external rotation muscles are tight, they will be overstretched and injured, or cause abnormal motion leading to injury of the shoulder joint. Therefore, strengthening and stretching the shoulder external rotators will help alleviate problems.

One more aspect of preventing injury is trunk or core strength. Power in overhead motion comes from strength originating from abdominal, back and hip strength—commonly called the core. If an athlete has any weakness here, they may overcompensate with their shoulder and cause the abnormal loads that lead to injury. Although it’s almost overstated lately, core strength does play a vital role in shoulder injury prevention.

A few simple exercises can address most of these problem areas. Simply strengthening the upper back or scapular muscles, while strengthening and stretching the external shoulder rotators addresses most of what we’ve discussed here. I’m attaching a document I put together for the athletes at BYU. There are many, many more exercises than these; however, the benefit in this program is its simplicity.

Try incorporating this or a similar program before practice. If you’re lucky enough to have a weight room, you can include these types of exercises as a part of that program. If your athlete develops or continues to have shoulder pain despite trying these suggestions, it’s probably time to have a professional take a look! Otherwise, these are a few simple things that can alleviate many problems.

Blain Empey