by Sue Falsone
Implications for the Overhead Athlete and Beyond
Former Major League Baseball Head Athletic Trainer and Physical Therapist Shows You How You Can Prevent Painful, Potentially Season-Ending Shoulder Injuries in Overhead Athletes
Athletes whose sports require them to swing or throw achieve amazing feats of power and precision with their bodies. Baseball pitchers often throw fastballs at speeds in excess of 90 miles per hour into the strike zone. Top tennis players can serve balls at speeds greater than 110 miles per hour into the court… …while pro quarterbacks are regularly called to throw passes over 40 yards or more to a moving teammate down field. These amazing feats place enormous force, torque and stress on one of the most complex structures in the human body—the shoulder. For example, during a baseball pitch, the shoulder of the pitching arm can—
- abduct 90 degrees or more
- externally rotate up to 180 degrees
- experience a peak force of over 600N
- be subjected to an internal rotation velocity of the shoulder of over 6000 degrees per sec
…as the ball is thrown as fast as possible. The shoulder is a complex structure made up of an array of bones, ligaments and muscles, all of which work with precision to create the wide range of motion needed in daily activity and in sports. The repetitive and enormous amount of stress occurring in rapidly changing directions during overhead sports such as baseball, softball, football, cricket, water polo, tennis, javelin, racquetball and volleyball can degrade these finely balanced parts of the shoulder. This can create compensations. Common conditions and injuries in overhead athletes include—
Rotator cuff tendonitis—also known as swimmer’s shoulder, pitcher’s shoulder or tennis shoulder
Rotator cuff tendonitis is an inflammation of the rotator cuff that can cause—
- loss of mobility and strength in the affected arm
- pain and swelling in the shoulder that can get worse over time
Rotator cuff bursitis
Rotator cuff bursitis often accompanies rotator cuff tendonitis, and is an inflammation of any one of the fluid-filled sacs that help reduce friction in the shoulder spaces. Rotator cuff bursitis can cause—
- A gradually increasing pain that starts in the shoulder and can spread down the arm towards the wrist
- A pain that worsens when moving the arm up and outwards, but disappears when the arm is by the side
Rotator cuff tendonitis and bursitis reduce the space inside the shoulder, and this can cause shoulder impingement, which occurs when the rotator cuff tendons become trapped and compressed during shoulder movements. This injury can cause pain at rest, or when the arm is moved. Failure to treat this injury can cause it to recur.
Rotator cuff tear
The rotator cuff is subject to micro trauma in overhead athletes again and again as they throw, pitch or swing. This micro trauma can cause small or severe tears in the rotator cuff. Depending on the severity, these tears can cause mild pain during shoulder movement, or a complete inability to move the arm.
A SLAP tear is an injury to the superior part of the labrum where the biceps tendon attaches and can cause—
- Pain when moving the arm overhead
- Decreased shoulder mobility and strength, often described as a ‘dead arm’ by pitchers
- A feeling of locking, popping or grinding
These conditions and injuries can put an athlete out for weeks or months, costing precious game or practice time. Shoulder injuries can also lead to costly surgery and the frustrating process of rehabilitation, often players never returning to their original form prior to the injury.
For athletes climbing the ranks in the early stages of the career, this can cost them the experience they need to ‘break’ into the team they want.
For athletes in the later stage of a career, these conditions and injuries can put an end to their careers and send them into early retirement.
But most of all, these shoulder conditions and injuries can cause constant pain, a decrease in form and can stop people from playing the sports they love.
Whether your clients are professional athletes whose multi-million dollar contracts rely on their shoulder performing optimally and pain-free… … or weekend warriors who just want to enjoy playing their favorite sports pain-free for as many years as possible, you need to learn how to look after the shoulder.
In The Shoulder: Implications for the Overhead Athlete and Beyond, physical therapist Sue Falsone will tell you what you need to know about the shoulder, including—
- Areas to pay attention to when working with overhead athletes
- How to assess the shoulder and identify possible issues
Four common shoulder compensations found in overhead athletes, and how to correct them
What’s Covered In The Lecture
In disc one, Sue starts by looking at the anatomy of the shoulder, describes common issues she sees in clients, and explains how to identify them. After you’ve studied this video, you’ll better understand the interconnected components that make up the shoulder, and the common problems your clients and athletes may experience. Here’s what she covers (including transcript page references)—
- Where shoulder problems often originate from. pg.1
- Which area of the shoulder you should pay attention to prevent possible shoulder impingement problems. pg.2
- The wrong way most people think about the scapula. pg.4
- Does one of your clients have a winged scapula? Sue shows you which muscle may not be working properly. pg.4
- The four muscles that make up the rotator cuff (if we don’t keep these four muscles functioning well, we may develop tendonitis or bursitis in the shoulder, which can cause pain and movement restriction). pg. 4
- Myofascial slings: How muscle fibers in the shoulder are connected to other parts of the body—if you want to do a successful intervention on the shoulder, you must understand which other areas may be impacting it. pg.5
- Why it’s physically impossible for some people to throw properly. pg.5
- What to do before assessing movement patterns: assessing posture using Janda’s famous Upper and Lower Crossed Syndrome (once you learn to identify each syndrome, you’ll be able to quickly identify which problem areas you need to address in your clients). pg.5
- How prolonged sitting impacts the function of the shoulder. pg.6
- Which types of athletes usually suffer from Lower Crossed Syndrome, and how it impacts their performance on the field. pg.6
- What ‘ideal’ alignment is and what areas you need to focus on to restore it . pg.7
- How to identify whether the shoulder is aligned properly. pg.7
- The two types of scapula winging. pg.8
- How high above the SC joint the AC joint should be sitting. pg.9
- Where the humeral head should ideally be located within the shoulder complex (if you are working with an overhead throwing athlete, you must learn this). pg.9
- One reason why there are so many asymptomatic labral tears in overhead athletes. pg.9
- Combining the Functional Movement Screen and a test done on the table to assess the thoracic mobility of an overhead athlete. pg.9
In disc two, Sue demonstrates four common shoulder compensations found in overhead athletes and using athlete models, she demonstrates her favorite exercises to correct them. Here’s what she covers (including transcript page references)—
- Identifying the presence of a shoulder dysfunction in clients. pg.2
- Three exercises you can use to fix poor eccentric control in the scapular stabilizers (scapular controlled-mobilizers)—do this if your client is able to lift the arm overhead in a controlled manner, but can’t do the same when bringing it back down. pg.3
- How to help your clients improve eccentric control of the shoulder blade. pg.3
- How overhead athletes tend to position their arms when in the quadruped position—and how to identify mobility and strength issues in the shoulder complex using the quadruped position. pg.4
- How to modify the third eccentric control exercise for athletes who have trouble executing it. pg.4
- A simple cue to use to take any excessive sway out of the low back when standing face against the wall. pg.5
- A common compensatory pattern seen in people with significant shoulder pain, shoulder impingement, tendonitis, bursitis, or in the post-operative stage—and three exercises to help fit it. pg.5
- What compensations you might see in someone who has a weak rotator cuff in the posterior aspect. pg.8
- Three posterior external rotation exercises. pg.8
- How to help facilitate stability and keep the thoracolumbar junction in a more neutral position during exercises. pg.10
- The internal rotators of the shoulder (there are more powerful internal rotators other than the subscapularis). pg.10
- How to open up a throwing athlete’s shoulder: Three exercises to stretch the anterior structures of the chest, increase mobility, and restore muscle length in the internal rotators. pg.11
Get Your Copy Today
If you work with people suffering from shoulder problems, get Sue Falsone’s The Shoulder: Implications for the Overhead Athlete and Beyond and learn how to treat these common shoulder compensations. You’ll find the tools you need to restore function, reduce pain and help avoid shoulder injuries in your clients.
Sue Falsone is the President and Founder of Structure & Function Education and Falsone Consulting, along with being an Associate professor at A.T. Still University in the Athletic Training program.
After graduate school, Sue spent 13 years at Athletes’ Performance where she began her focus on Bridging the Gap from Rehab to Performance, working closely with the performance and nutritional teams to create an integrative experience for all athletes.
For over two decades, Sue has immersed herself in the culture, education, and advancement of the athletic training, physical therapy, and strength and conditioning professions.
“Over the course of her career, Sue has been one of the very few individuals who has had a chance to work in all different domains of sports medicine, including injury prevention, rehabilitation, and performance training. This unique experience has given her an amazing perspective on how all three of those areas can, and should, work together. Her new book, “Bridging the Gap from Rehab to Performance,” overviews her approach to this spectrum and shares an amazing perspective laced with clinical pearls that only someone with her experience could offer.”
~ Mike Reinold, PT, DPT, SCS, ATC, CSCS, Champion PT and Performance, Boston, MA
“My rehab process with Sue was like getting a personal MBA! Outlining the process of bridging the gap from rehab to performance educated and motivated me on a daily basis and allowed me to return to the field healthier and stronger than before my injury. I didn’t just rehab my shoulder injury…I felt like I was rehabbing my whole body and mind. I came out moving better and more efficiently, knowing the concept and process before beginning the rehab process created immediate buy-in and allowed me to be relentless in focusing on the daily process toward returning to the field better than before. Sue is simply phenomenal!”
~ Matt Kata, Manager of Youth Baseball Development, Cleveland Indians, Former MLB player