Shoulder injuries and pain are common in a variety of sports. Whether it is in throwing a pass in football or a pitch in baseball, athletes need tremendous shoulder strength and coordination to achieve athletic excellence. But the constant strain and pressure on the shoulder often leads to irritation and can result in an overuse injury.
As a physical therapist, I am often asked why some athletes seem more prone to shoulder injuries than others, how shoulder injuries are treated when they occur, and how can the risk of injury or re-injury be reduced? To answer these questions, we need to start with a discussion of the anatomy of the shoulder.
While the basic structure of the shoulder is the same for every athlete, there are important differences between athletes. First, the shoulder joint is inherently a very unstable joint. The ligaments around the shoulder joint are supposed to hold it in place and provide stability. When those ligaments are loose (what we PTs call "lax"), the joint requires more muscle strength to maintain support, so if those muscles aren't strong, the risk of injury increases.
Second, other structures around the shoulder joint can increase the risk of injury. A young athlete with scoliosis, congenitally weak neck muscles or spinal vertebra, or poor (e.g. flexed or bent) spinal posture will have trouble keeping the shoulder joint stable. While these deficiencies can be corrected to an extent through training, such underlying conditions will cause the athlete to work harder to maintain balance in the shoulder.
Finally, the shape of the acromion - a hook shaped bone that sits off the rotator cuff - can effect stability: some have a shape that permits increased clearance in the shoulder joint while others are hooked-shaped, increasing the risk for pinching or tearing on the rotator cuff.
As with any joint, previous injury is one of the strongest indicators for future injury.
Repetitive overhead motions put the shoulder at greater risk for injury. Baseball, softball, tennis, swimming, and volleyball are a few examples of sports involving repetitive overhead motions. Athletes who sustain repeated hits to the upper body, such as in football and wrestling, are also at increased risk of traumatic injury to the shoulder joint. The fact that the majority of injuries to the shoulder joint result from repetitive motion, regardless of sport, suggests there are ways to avoid serious injury.
An athlete experiencing any of the following symptoms should be immediately evaluated by a physician:
The failure to immediately address and treat any of these symptoms will put the athlete at risk of a more severe injury. Even at this stage, the majority of injuries that are addressed medically will resolve in time. Allowing an athlete to continue play increases risk of a severe injury that will permanently affect sport performance for their remainder of their career.
So on what does the athletes need to focus in order to avoid injury and stay on the field? There are many shoulder exercises and training regimens that will maximize an athletes potential. The most important, and often overlooked, exercises for the shoulder are the ones that build a foundation of support.
Links:
[1] http://www.thesmartestteam.com
[2] https://mail.momsteam.com/sports/exercises-assess-strength-pitching-shoulder
[3] https://mail.momsteam.com/health-safety/stretching-exercises-maintain-shoulder-flexibility-reduce-injury-risk
[4] https://mail.momsteam.com/health-safety/muscles-joints-bones/stretching-reduces-risk-shoulder-injuries-in-young-pitchers
[5] https://mail.momsteam.com/health-safety/recurring-shoulder-dislocations-new-repair-technique-helps
[6] https://mail.momsteam.com/sports/baseball-players-in-warm-weather-climates-more-prone-injuries-pitching-shoulder