Staying in the Game: Avoiding Shoulder Pains
Youth sports continue to thrive in this country. Children are becoming more and more involved in a large variety of athletics, dance, and martial arts. Participation in these activities has also lead to a higher incidence of injury from overuse and repetitive trauma.
Common ComplaintsA common complaint heard from young athletes is shoulder pain, especially from overhead athletes (swimmers, pitchers, etc.) Most cases are treated with rest, NSAIDS, and ice, yet glenohumeral instability is often the primary cause of the pain. If symptom management is the only treatment offered, the athlete will continue to have recurrences whenever training is increased. Most cases of underlying instability have no history of subluxation or dislocation, however excessive motion in the glenohumeral joint is evident during evaluation. Instability without impingement is usually pain free, so the athlete does not realize a deficit is present, until inflammation within the soft tissue increases. This delay in symptoms leads to increasing muscle imbalances, a breakdown in scapulo-humeral rhythm and an overall decline in shoulder function.
Pain Presents a Problem
When the athlete presents to the team physician or athletic trainer, symptoms are usually very pronounced with losses of shoulder ROM and strength. Palpation can reveal irritation in the rotator cuff and bicipital tendon insertion from chronic impingement. The development of this type of injury can occur over weeks, or even seasons, with no particular trauma. The mechanism of injury is slow to develop, therefore returning the athlete to the field quickly is very difficult, unless the muscular dysfunctions can be found prior to the development of pain.
A thorough kinetic chain evaluation can reveal some of the early signs of shoulder dysfunction. A multi-planar postural assessment of the athlete may show discrepancies in scapular resting positions, and muscular over-activity / under-activity. The athlete often presents with an upper extremity postural distortion pattern. Tightness in the anterior chest musculature, specifically the pectoralis complex and latisimus leads to reciprocal inhibition of the scapular stabilizers ( serratus anterior , rhomboids , middleand lower trapezius ) as well as the external rotators of the rotator cuff ( supra spinatus , infra spinatus and teres minor ).
Finding the CulpritThe Overhead Squat Test can reveal tightness through the pectoralis complex and latissimus dorsi musculature. Compensations often observed include the arms falling forward, an inability to fully straighten the arms overhead, and scapular protraction.
After an athlete has been identified with a dysfunction, a specific stretching and strengthening program can be developed to correct these findings.
Example Corrective programming should include:
|INHIBIT Self Myofascial Release||LENGTHEN Static/Active Flexibility||ACTIVATE & INTEGRATE Core Training|
Many exercise programs have been studied as a non-surgical approach to decreasing instability and improving shoulder complex mechanics. Rotator Cuff strengthening programs including theraband, free weights, plyometrics, and PNF have all been shown to increase glenohumeral stability and improve shoulder mechanics. Proprioception and muscle endurance deficits have been shown to increase glenohumeral instability and predispose the shoulder to impingement; therefore exercise selection must address these issues. The OPT training method is a systematic, progressive, and solutions based method for addressing these muscular imbalances and dysfunctions.
Prevention is the Key
Non-traumatic shoulder dysfunction can often be avoided by a sound assessment of the entire kinetic chain. The earlier these deficits can be corrected, the better the chances of avoiding shoulder pain. The prevention of dysfunction and maintenance of proper shoulder mechanics will allow athletes to remain competitive throughout their careers.