Dan Michael
Dan Michael

The shoulder has long been a special interest of mine as a former NCAA Division I swimmer at Purdue University and now a Certified Chiropractic Sports Physician® by the American Chiropractic Board of Sports Physicians. The shoulder poses many problems for patients and physicians because it is the most difficult joint in the body to treat, but that is part of what makes it so much fun to work with.

The shoulder is a biological miracle and also an enigma, as it can pose complex challenges for overhead athletes.

“Who is an overhead athlete,” you might ask? Webster’s Medical Dictionary has its own definition, but mine would include any individual who plays a sport that requires overhead motions (ie. swimming, tennis, volleyball, baseball, etc.). Here are three common challenges for overhead athletes with some introductory solutions at the bottom.

The first challenge is range of motion. Shoulders (and hips) have round “ball-like” bones that fit into “socket-like” receptacles that give the shoulder a large range of motion. Large range of motion might sound like a good thing, but too much range of motion is harmful and susceptible to instability. Secondly, a large range of motion can be associated with a greater amplitude of imbalance of its support structures. These support structures ensure that the shoulder stays in place as we use our arms, and overhead motions in particular require strong and balanced structures to support movement.

The second challenge is coordination.

As previously mentioned, the shoulder is a type of “ball-in-socket” joint, but that may be too generous. Perhaps better would be to say a “golf ball on a golf tee,” which creates a different and more accurate mental picture. The “golf tee” on which the shoulder rests is small in size and shallow in depth, allowing for the exceptionally large range of motion that the shoulder provides, but the muscles around the shoulder blade (all 17 of them) coordinate the motion to keep the “golf ball” under the “golf tee.” Like a seal balancing a ball on its nose, good shoulder coordination can keep your shoulder well balanced in overhead positions.

The third challenge is load management. Whether you are a youth sports athlete, an adult recreational athlete or an occasional social situational athlete, dynamic overhead repetitive motions must be managed purposefully and intentionally to avoid unwanted consequences. With load management there is always the question of “what have you been up to lately?” which helps to guide how much load one could or should bear in a given window of time.

If your activity is very low, your tolerance for an overhead sport may be only 10 to 20 minutes of play depending on the sport. If you are a young and highly trained athlete with a long sports history, it may be closer to three to four hours of play. Both ends of the activity spectrum run into the same problem of social competitive pressures that lure them into doing more than they should. As for overhead activity, low and slow really is the way to go.

Solutions: Like every good puzzle, I will put the answer sheet here at the bottom. Regarding mobility, if you can touch the hand/fingertips of your opposite hand behind your back, you may be too mobile and at risk of injury for repetitive overhead movements and you may want to focus on strengthening over stretching.

Regarding coordination, if you cannot move your shoulder blades independent of the rest of your arm in all directions, you may be at a coordination deficit so start there first.

Finally, for load management, it is generally safe to increase your load overhead 10 percent per week on a weekly basis. If you are starting at 0 minutes, then for this example, assume that everyone gets 10 minutes of “overhead activity” per week at a moderate level by way of everyday life activity.

 

— Dr. Dan Michael is a Certified Chiropractic Sports Physician® at NW Sports Rehab in Madison Park.