Sports Are Back! Are Your Shoulders Ready?
With public health restrictions in Alberta easing, many of us will have the opportunity to start playing some of our favorite summer sports very soon. Several of these sports may involve what is referred to as ‘overhead’ skills such as throwing in softball or football, spiking/serving in volleyball, serving/attacking in tennis and even front/back crawl during swimming. These skills are referred to as ‘overhead’ for obvious reasons because of the position of the arm/shoulder and they often require a lot of force and power in this position which can be tough on the shoulder joint and the muscles surrounding it. Due to COVID-19 closures, many of us have had to take a year or more off from a game-level intensity of these skills which has likely led to deconditioning of our shoulder and the healthy mechanics that are required for these skills. The risk of injury after a prolonged hiatus from these sport-specific skills is remarkably high due to the complexity and speed of these movements. It is important to prepare our bodies to handle these specific movements in a progressive and targeted way in order to resume these sports without pain or injury.
Phases of overhead skills
Understanding the phases of an overhead skill is important in realizing the complexity of the skill and the anatomy involved and to acknowledge the value in training the shoulder properly for this skill.
The first phase, which helps prepare the athlete for the throw, is the ‘wind-up' and involves shifting the athlete’s weight away from the target. This phase has minimal upper extremity activity and involves more trunk rotation and weight shift.
Phase two helps prepare the shoulder and arm for the throwing and is referring to as the ‘cocking phase’. It involves significant activation of the posterior musculature of the shoulder (posterior rotator cuff, posterior delts, scapular retractors) as well as rapid lengthening of the anterior musculature (pectorals, anterior rotator cuff, biceps) to allow the shoulder to extend and externally rotate. It is important to have sufficient strength and muscle activation in the scapular stabilizers as well as good length in the anterior musculature to avoid injury in this phase.
Phase three is the first portion of the main throwing action where significantly more force is generated and is referred to as the ‘acceleration’ phase. The bulk of the muscle activation shifts dramatically from the posterior chain to the anterior muscles which need to create forward and internal rotation power in their lengthened state. It is important to have these muscles healthy and well-prepared for this as this generation of power when on stretch carries a higher risk of injury to these muscles.
Phase four occurs after the ball is released or struck and is referred to as the ‘deceleration’ phase as it serves to stabilize and control the shoulder to interrupt the momentum created during the acceleration phase. This phase is crucial in prevention of injury to the shoulder joint, but the posterior muscles also need to be highly trained eccentrically (loading while lengthening) to prevent injury to these muscles as well.
Phase 5 is the final phase as the torso rotates toward the target to finish decelerating the rest of the body as it comes to rest. There is minimal upper extremity involvement here.
Anatomy & Function of the Shoulder Girdle
To elaborate on the musculature mentioned above, as well as gain a better understanding of how these muscles work together, here are some diagrams of the rotator cuff and larger muscles that generate the force of the overhead skill:
While those larger muscles are extremely important for generating the force and power during overhead skills, the smaller scapular stabilizers are equally as important in creating an anchor for the larger muscles to promote efficiency and stability during the skill (which results in higher velocity) as well as significant reduction of injury risk.
Dysfunction in any portion of the shoulder girdle can lead to:
- Shoulder and elbow tendonitis
- Shoulder and elbow muscle strains or tears
- Neck pain
- Loss of power & velocity
- Loss of accuracy
- Loss of endurance
- Poorer recovery from playing game level
Given the complexity of the shoulder, as well as the specific and significant forces generated through the upper limb during an overhead skill, it is crucial that the shoulder is mechanically sound, and that the athlete’s technique is correct. While coaches and experts within the sport are the best resource for skill technique, it is extremely important that an overhead athlete that has had significant time off from their sport for any reason, see a professional for a detailed assessment. A clinical assessment will involve isolated testing of the muscles in the upper limb, as well as analysis of motor patterns to determine areas of concern or in need of improvement. The clinician will then treat and prescribe accordingly to help the athlete fully prepare for the upcoming season.
Feel free to reach out to any of our Momentum Health physiotherapists or rehabilitation professionals for a consult and/or assessment to help you successfully get back to your overhead sport!
Written by Carlee Anderson, PT, MScPT, BKin, BDN
Carlee is a graduate with a Master’s of Science in Physical Therapy at the University of Alberta in 2015 and has also completed her Bachelor of Kinesiology at the University of Calgary in 2012. She is a CPA Orthopedic Level III Manual Therapist who is certified in Biomedical Dry Needling. She is also experienced with athletic taping/strapping and Kinesiotaping. Her clinical interests include SI joint dysfunction, acute low back pain, neck pain, TMJD, craniovertebral dysfunction and shoulder injuries. Growing up in Champion, AB, Carlee was involved in several sports at competitive and recreational levels as both an athlete and a coach. She is most passionate and experienced with figure skating, equestrian, volleyball and softball. She also has an avid interest in fitness and nutrition which keeps her committed to living her best and healthiest life. She looks forward to continuing to complete the CPA Orthopedic levels as well as becoming certified as a Sports Therapist. Carlee believes in taking a comprehensive approach to rehab in order to maximize your recovery and performance.
