It’s been bugging you for a while now.
There’s a dull ache in your shoulder and the more you play the sorer it gets.
Resting up isn’t an option. If you stop now all you hard work training will be lost. And what’s more, it might give someone else the chance to take your spot on the team.
So you push on.
The pain goes away when your shoulder ‘warms up’ so you figure it can’t be that bad. It’s not until after the game that you really feel it. And now the pain it affecting your sleep.
You should really see a physio. But you’re too busy and just can’t find the time.
Then, two weeks out from the biggest game of the season, things change.
Instead of just an aching shoulder after training, there’s a shooting pain running down your arm. You can’t lift it above your head because it hurts too much.
And it’s not going away.
The Problem with Repetitive Action in Sport
What are the skills and movements in your sport that you do over and over again?
Many sports are built upon throwing skills (e.g., water polo and cricket), hitting skills (e.g., volleyball and tennis) or skills that involve reaching overhead (e.g. badminton and swimming.
But when these skills are performed repetitively, structures of the shoulder are placed under major stress. Therefore, athletes who complete in these sports are more susceptible to shoulder pain and associated risk of injury.
Common to all these sports are propulsive and ballistic movements of the shoulder (e.g., throwing, striking and pulling). And repetitive action of these movements increases the wear and tear on the joint. So to resist injury the different structures of the shoulder must be moving properly.
The Anatomy of the Shoulder Girdle
The shoulder girdle comprises three different joints or ‘articulations’.
The most well-known structure is a ball and socket joint. The rounded head of the humerus bone (ball) rests in the cup-like glenoid fossa (socket) of the scapula, or shoulder blade. Around the joint sits a very loose joint capsule, which is home to a number of fluid-filled sacs called bursae.
Compared to the hip (another ball and socket joint in the body) the shoulder socket is quite shallow. This permits large ranges of motion of the arm.
The scapula itself is also highly mobile – it can glide and tilt upwards, downwards and around the thorax. Which means you can easily change the position and orientation of the socket.
A highly mobile scapular with a shallow socket is why you have enormous mobility at the shoulder. For instance, try testing the range of motion of your shoulder compared to your hip.
But there is a trade-off between mobility and stability. A shoulder joint that moves around a lot comes at the cost of it being much less stable.
And rather than strong ligaments holding the shoulder joint together – which happens in the knee joint – the shoulder is reliant on muscles for stability. The biceps brachii and rotor cuff muscles surround the shoulder joint and prevent the head of the humerus slipping away from the ‘cup’ it rests in. Other muscles are responsible for movement of the scapula, controlling the position and orientation of the ‘socket’.
But here’s the thing.
The muscles that control the shoulder must be well-balanced and working in unison. If the socket is not in a good place, or imbalances develop between muscles, physical load and stress go to all the wrong places – like the joint capsule, ligaments and tendons.
When this happens, it’s just a matter of time before you’ll experience pain. Which over time, becomes a chronic injury.
The Importance of Physical Training
By nature, the repetitive actions of sport place stress on the body. Over time, this will increase the potential for further stress and harm. That’s why your physical preparation is critical to restore the balance.
The first challenge is to identify the issue(s) causing the problem. And as it turns out, your posture is a likely culprit.
If it’s held forward of your torso, rather than resting on top of your spine, your upper back muscles will constantly strain to hold it there. And the resting position of your shoulders will put the shoulder ‘socket’ out of alignment.
Do you have a rounded upper back and ‘caved in’ shoulder position?
This may just be a bad habit – i.e., you can fix it easily when asked. Or, tightness of the pectoral muscles might be pulling your shoulders forwards.
Regardless of the cause, poor upper back posture tilts the shoulder ‘socket’ forward and alters where the ‘ball’ sits. Which can result in shoulder impingement when you throw, strike or reach overhead.
What can you do about it?
It might be as simple as making a conscious effort to hold good posture.
But it’s more likely some remedial will be required. Which typically includes:
- Exercises to improve your shoulder mobility
- Basic self-therapy work to release your tight shoulder muscles and increase range of motion
- Exercises to improve the resting position and range of motion of your thoracic spine.
Strength training is also a great way to combat shoulder issues.
The two main areas to focus on are the stabiliser muscles of the scapula and the group of muscles that collectively serve to hold the head of the humerus (‘ball’) in the socket – i.e. the ‘rotator cuff’.
Crucially, each individual shoulder muscle must be working properly and strong enough to do its job. But more importantly, all of the shoulder muscles must function in an integrated and coordinated manner.
What are you doing to prevent a shoulder injury?