Shoulder Anatomy and Dealing with a Shoulder Injury
An interview with former Major League Baseball
Head Athletic Trainer & Physical Therapist
The shoulder is the most mobile joint in the human body.
As a shallow ball and socket joint designed to move in all three planes, the shoulder can flex, extend, adduct, abduct, internally rotate, externally rotate and transversely flex, extend, adduct and abduct.
The high degree of mobility in the shoulder allows the arms to move in a wide range of positions around the body and to perform a wide range of actions.
This mobility, however, comes at the cost.
A Joint Prone to Injury
As an extremely mobile joint, the shoulder joint is prone to instability, often causing compensations and risk of injury in the components that make up the shoulder, such as the rotator cuff muscles, glenoid labrum, tendons and ligaments.
These problems plague both competitive athletes as well as the general population.
Athletes whose sports require them to move their arms overhead when they throw, pitch or swing often subject the shoulder to enormous forces and velocities that stress and degrade it.
For example, a baseball pitcher can subject the shoulder to a peak force of over 600N, and an internal rotation velocity of over 6000 degrees per second when pitching a fastball.
Rotator cuff tears, bursitis and tendonitis, SLAP tears and shoulder impingement are common problems in baseball, softball, football, cricket, water polo, tennis, javelin, racquetball and volleyball.
And while the general population may not subject their shoulders to the amount of force athletes do, shoulder problems are still a major problem.
Muscle imbalances caused by poor posture, poorly designed training programs or repetitive motions can cause compensations that lead to shoulder issues.
Common complaints include frozen shoulders, an impression of ‘bone-on-bone’ during shoulder movements, shoulder pain when rolling over on one side and pain that runs from the shoulder down the arm.
The Cost of Shoulder Injuries
For athletes, shoulder problems and shoulder injuries can throw them off their form, create discomfort or pain during movements or worse, lead to season-ending or career-ending injuries that require surgery.
For non-athletes, shoulder problems and injuries can cause pain and discomfort throughout the day, and stop them from enjoying the activities they love.
An Expert in Preventing and Managing Shoulder Problems
That’s why we decided to asked Sue Falsone, an expert who’s had years of experience working with overhead athletes at the highest level, a few questions about looking after the shoulder.
Sue Falsone is the owner of Structure and Function, a consulting and education company dedicated to educating healthcare clinicians and equipping them with the skills they need to improve the outcomes of their patients.
She worked with Major League Baseball’s L.A. Dodgers for six years as their head athletic trainer and physical therapist, being the first female head athletic trainer in any of the four major professional sports in the United States.
Sue also worked at Athletes’ Performance (now EXOS) for 13 years, last serving as the Vice President of Performance Physical Therapy and Team Sport.
Sue currently works with the US Men’s National Soccer Team as the Head of Athletic Training, and sits on the board of various organizations such as KinetIQ Global, Katalyst Shoulder Training, Performance Health, the Korean Institute of Sports Science and Baseball New Zealand.
Looking After The Shoulder With Sue Falsone
Unique challenges when working with overhead athletes
What stresses do overhead athletes experience that are unique to them? What are the common issues, compensations and adaptations you see in overhead athletes?
The amount of torque generated at the shoulder and elbow during the overhead athlete’s throwing motion is unlike that of any other athlete.
Because of these large forces, it is almost impossible to replicate these during training sessions.
We therefore need to train the body as a whip. We need to teach the body to summate forces created at the ground and move through the body to create the speed needed at the upper body to throw the ball.
When this summation of forces breaks down, the body has to make up for lost energy. More force needs to be created at the shoulder or elbow to try to make up for lost energy in the system.
These excess forces can cause tissue overload, tissue tears (muscle or tendon) and lesions in the passive restraint systems of the joints (the labrum in the shoulder or the UCL in the elbow).
Other problems caused by stress placed on the shoulder
What problems do these cause for the athlete?
Over time the body may create compensations to make up for the excess load placed on the shoulder.
Meaning, they may begin to develop asymmetries that are not necessary or advantageous. They may develop movements that overload other parts of the body and can cause pain elsewhere in an effort to spare the shoulder or elbow.
They may traumatically tear or gradually wear down a tissue until it is completely torn. Once that happens, a surgical intervention is often required, causing a significant loss of time from the sport.
Should coaches and trainers address asymmetries in athletes who participate in sports requiring asymmetrical movements?
Overhead athletes usually participate in sports that require asymmetrical movements. While this asymmetry is an inherent part of sports, what issue can arise due to this?
Asymmetries are an inherent part of human movement and sport.
While I don’t necessarily try to fully correct these asymmetries (for example, looking for the exact same shoulder range of motion on each side), I also do not feed into the asymmetry.
At the same time, studies have shown that there isn’t a difference in hip ROM in healthy baseball players (American Journal of Sports Med…my research).
We need a lot more information as far as what asymmetrical adaptations are a necessary part of sport, and what are not.
Any time there is asymmetrical movement, certain tissues can get overloaded, while other tissues are underloaded.
Balancing what is necessary for the health of the tissue and the need of the sport is the art of what we do as sports medicine professionals.
Sue’s The Shoulder DVD and relevance to non-overhead athletes
How relevant is what you cover in your DVD, The Shoulder, to people who work with non-overhead athletes? Are there issues that are addressed that are applicable to other populations?
We take a look at the anatomy in a way that can be easily related to everyone so they understand the total body connection.
We break up the corrective exercises in a way that addresses the specific movement dysfunctions we see, not by diagnosis.
This DVD really covers shoulder interventions across the board. Whether you are dealing with an overhead athlete or someone who is having difficulty with the activities of daily living due to shoulder pain, the interventions demonstrated and discussed with be valuable across the board.
Progressions and regressions are also discussed so you can make the exercise harder or easier, based on the client or patient’s level.
Looking after the shoulder and preventing shoulder injuries
What are some things overhead athletes should pay attention to when looking after the shoulder and trying to prevent injury?
Overhead athletes need to remember that yes, the shoulder is important, but so is the rest of the body!
The shoulder and arm is the vehicle with which the ball is delivered.
Force is created and transferred from the ground, up the legs, through the trunk and transferred to the arm.
They need to be concerned about their feet, hips, core stability and strength, and more.
Shoulder health is not just dealing with the shoulder. It is dealing with the body as a whole.
Are You Working With People
Who Are Prone To Shoulder Problems?
If you work with overhead athletes or have clients who are prone to shoulder pain and shoulder injuries, and you want to learn how to help prevent or manage these problems, Sue’s got a great DVD that will show you:
- Areas to pay attention to when working with athletes
- How to assess the shoulder and identify possible issues
- Four common shoulder compensations and how to correct them
She’s designed this lecture, The Shoulder: Implications for the Overhead Athlete and Beyond, to help professionals from clinicians to ATCs, and strength coaches or personal trainers to physical therapists and chiropractors.
Anyone working with athletes, clients or patients who have movement-based shoulder issues can help ease shoulder aches and pains and help prevent crippling injury.
So whether you’re working to help elite overhead athletes playing 162 games a season avoid shoulder injuries that can end a season or cost them a career…
… or with recreational athletes or desk jockeys looking to restore function without niggling injuries or pain, check out The Shoulder: Implications for the Overhead Athlete and Beyond and learn the skills you need to look after your clients.
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