• Physiofit

The overhead athlete - Richard Saxton

Most sports require the participant or athlete to be able to move and perform above their heads such as completing a tennis serve, bowling a cricket ball, front crawl in swimming or catching a stray pass in rugby. This requires the shoulder, the most mobile joint of the body, to be flexible, stable and strong all at the same time.

Athletes can often therefore develop shoulder injuries due to the exposure to repetitive, propulsive and explosive movements often at the extreme end of range of movement of the shoulder.

As each sport is different, the demands the athlete places of their shoulder is therefore different. It’s important to understand the biomechanics of the sport in order to help make a diagnosis and aid rehabilitation.

What is the shoulder complex?

The shoulder complex involves the acromioclavicular, sternoclavicular, glenohumeral and scapulothoracic joints. This is often considered a single functional unit, but injuries can occur in one or more of the joints. The associated musculature and ligaments provide the stability and movement.

The glenohumeral joint (shoulder) is the largest joint within this complex and is often the area of injury. It is a ball and socket joint, with the socket being relatively shallow to allow the complex movement to occur. The stability of the shoulder joint is provided by the rotator cuff muscles, labrum (fibrocartilage making the socket deeper) and associated ligaments.

How to reduce injury

Break down your sport. What does it involve and how does the shoulder work? For example, in a tennis serve, although the movement looks like it all comes from the shoulder look at the picture above. During the service motion the player normally jumps off the floor, as well as moving their arm behind their head to start with. This is because power is transferred though the body from the legs, through the core and into the shoulder and down into the arm ending in the racket. If you don’t have the required strength in the legs, players often try to increase the serve speed by increasing arm speed, increasing the racket head speed and therefore ball speed. This increase in compensatory arm speed can overload the shoulder resulting in injury. Other things to test for include localised shoulder muscle strength, stability and proprioception (the ability of the body to know what the shoulder is doing). Posture may also be important but not necessarily.

At the beginning on the season, remember the same logic you would apply to training for a marathon. Start slowly and build up the volume gradually. If you play too much at the start of season after a winter break, your tendons and muscles are not strong enough to cope with the stress placed upon them and tend to break down with tennis elbow and rotator cuff tendinopathy occuring frequently.

What can we do to help?

At Physiofit, even if you are an overhead athlete with a shoulder injury, we look at your whole body to make sure you are incorporating your legs, core and upper body in your sport. This leads to reduced pain in the shoulder as well as improving your performance and preventing future injury. If you would like to have a full assessment of your strengths and weaknesses to build an individual strength and conditioning programme, then our 1-hour screening programme is for you. It can be adapted for your sport and we have specific physios whose knowledge extensice across tennis, cricket and swimming. We can add on 1:1 sessions to implement your programme so that you know exactly what to do and how.

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