SHOULDER INJURIES IN SPORTS
The shoulder joint, or glenohumeral joint, is a ball and socket joint between the humerus (upper arm) and the scapula (shoulder blade). It is a very mobile joint and relies heavily on the rotator cuff muscles to hold the shoulder in the socket. The shoulder is often involved in lots of repetitive work and heavy lifting. If the muscles, ligaments or tendons are not working well together or coordinating properly, we can get pain and inflammation in the muscles, tendons, bursa and the joint itself.
Our previous blog post looked more generally at shoulder pain. This month we will be looking in more detail at the most common sports that cause shoulder injuries.
Tennis
Shoulder injuries are common in tennis, often caused by the forceful motion of serves or smashes. The motion of the tennis serve carries an increased risk of overloading various structures around the shoulder, especially if there is tightness or weakness causing muscle imbalances. This can occur with a muscle strain, or during growth spurts in children as the muscles can become tight as the bones are lengthening. Frequent overuse of the rotator cuff muscles can also cause the bursa (a fluid filled sac), to get impinged between the muscles and the bony prominence of the shoulder, leading to inflammation and pain.
During the early stages of injury, pain limits an athlete’s ability to serve at a maximal level, as well as perform a smash. Forehand and backhand strokes may also be impaired in later stages. Most people complain of pain during tennis, and stiffness after having cooled down. They may also have feelings of instability or clicking sensations with movement.
Physiotherapy aims to reduce pain and swelling with gentle massage, ultrasound, ice and TENS. We can also provide a sling or tape the shoulder if appropriate. Gentle shoulder stretches are prescribed to help maintain the range of motion, and strengthening exercises begin once the pain starts to settle.
It is important that strengthening exercises focus on the muscles that rotate the shoulder outwards (external rotators) as they are generally much weaker than the muscles that rotate the shoulder inwards (internal rotators), which are assisted by the bigger muscle groups in your chest. All tennis strokes involve some external rotation and strong external rotator muscles will prevent future overuse injuries which cause chronic inflammation or tendon tears.
To reduce the risk of injury, a thorough assessment should be performed to identify any muscle imbalances or weaknesses. A physiotherapist can then prescribe you with an individually tailored exercise program to target your strength deficits as well as work on flexibility, stability and endurance. We can also provide advice on your training load, as any increases in the amount of training or competition must be gradual to avoid overloading the shoulder. For example, repetitions of a serve should be increased gradually to allow the body to adapt to the increased workload.
Cricket
Shoulder pain is common in cricket due to the forceful, repetitive motion of throwing the ball. In most cases the pain is caused by inflammation of the rotator cuff tendons, often due to overuse. Pain can refer down into the upper arm, as well as around the shoulder blade. You may have difficulty lying on the injured side which can affect your sleep.
Treatment initially aims to reduce pain and swelling, and will involve resting the shoulder and taking anti-inflammatory medication. Physiotherapy helps to restore movement with massage, gentle joint mobilisations and a progressive program that will target strength, flexibility, and endurance, in order to restore the function of the shoulder.
It is important to strengthen the back of the shoulder to balance the front rotator cuff muscles, which often tend to be stronger. Shoulder stabilisation exercises are important to help prevent damage and reduce your risk of injury. Ensuring you have correct throwing and bowling techniques are essential in preventing injury. Any increases in training or competition must be gradual, particularly bowling and fielding practice, to allow time for the rotator cuff tendons to adapt.
Rotator cuff tears respond well to physiotherapy, but a small percentage may require surgical intervention. Physiotherapy is essential before and after surgery to get the best outcome possible. Treatment before surgery helps to improve strength and flexibility to speed up recovery, and after surgery to get you ready to return to sport.
Swimming
Swimmers can suffer from rotator cuff tendinitis (inflammation of the tendon) or tears, as well as impingement (catching) when the arm is lifted overhead. Causes of swimming injuries can include overtraining without adequate rest, poor stroke mechanics, overtraining in one stroke, poor breathing technique, poor flexibility or range of motion, decreased strength and stability.
Swimming with poor stroke mechanics or decreased flexibility and strength can cause an overuse injury. It is important to vary which strokes you are doing, and not just stick to one stroke eg freestyle as this can contribute to developing muscle imbalances and weaknesses. Backstroke and breaststroke help in opening up the shoulder. Take caution with butterfly as this can sometimes cause trauma due to the forceful nature of the overhead motion.
Preventing shoulder injuries in swimming is best done by adequate warm ups, and taking part in preseason strength and conditioning programs. It is important to gradually increase the intensity and length of swims to avoid overtraining. Adequate rest periods between training sessions and competitions are vital to allow the body to heal and recover.
Physiotherapy is aimed at easing the pain and swelling with gentle massage, ultrasound, ice and taping, or providing a sling. We do gentle shoulder stretches to help correct the range of motion of the shoulder, and strengthening exercises once the pain starts to settle. It is important to restore the shoulder biomechanics to prevent future damage to the shoulder tendons. We also can liaise with your swim coach to discuss training and stroke correction.
Preventative exercises
Doorway pectoral stretch
- Elbows bent to 90* and arms lifted until shoulders are 90*.
- Feet level with the door frame.
- Lean forward gently until you can feel a stretch in the front of the shoulders.
- Hold for 60 seconds.
External rotation
- Begin by lying on the opposite side to your injured shoulder
- With a 1-2kg in your hand, rotate your forearm up towards the ceiling, making sure to keep your elbow tucked into your side
- Complete 3 sets of 10 repetitions
Theraband rows
- Hook a resistance band around a door handle
- Begin standing with arms outstretched holding each end of the band.
- Squeeze shoulder blades together and pull the band backwards until your elbows are inline with your trunk.
- Complete 3 sets of 10 repetitions
If you are suffering from a shoulder injury and would like more information or help please call us on 9875 3760 or email us at info@wphphysio.com.au. We would be more than happy to assist you in your recovery.
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