The overhead athlete’s shoulder provides some unique challenges when it comes to shoulder injury rehabilitation. We are fundamentally all built from the same mold; however, some adaptive changes exist in the overhead athlete’s shoulder that is imperative for a physical therapist specializing in treating this population to understand.
At Rose City Physical Therapy, we know shoulders! Last year we saw 2,849 patient visits for shoulder rehab. And 15,254 patient care visits over five years from January 2016 through year-end December 2020 for shoulder-related problems.
These visits include the injured adolescent from a fall off their bike, the gardener or contractor overdoing it, the aging arthritic shoulder, and the collegiate and professional overhead athlete, including but not limited to tennis, handball, swimming, rock climbers, volleyball, and baseball athletes. Additionally, approximately 50% of these shoulder treatment visits were for post-surgical rehab for decompression surgeries, fracture repairs, rotator cuff and labral repairs, total shoulder and reversed total shoulder replacements and complex surgeries.
Learn how to help your shoulder
Not only do we treat, but we teach shoulders. As co-owner of Rose City Physical Therapy, staying abreast of the research is essential and instilled in our physical therapists. My primary role in the practice is staff mentorship and education on the shoulder and evidence-based rehabilitation. I provided community workshops on the fundamentals of a shoulder injury. Before Rose City Physical Therapy, I spent 15 years teaching shoulder rehabilitation to physical therapists and physicians nationally to private groups and large national conferences.
Three primary risk factors exist that tend to be unique to the overhead athlete:
1) imbalances in rotator cuff strength
2) scapula dyskinesia (alterations in normal motion of your shoulder blade—I call it “wacky scapy”)
3) adaptive changes in the shoulder’s normal range of motion (GIRD: Glenohumeral Internal Rotation Deficit); the latter most unique to the baseball pitcher and tennis player.
The adaptive changes can include tightness patterns in one or more directions and/or laxity—increased range of motion—in other directions. I’ll keep it elementary and forego the complexities and mouthful of medical jargon explaining each’s intricacies.
These risk factor adaptations are typical, and often the athlete develops no problems despite having one or more of the risk factors. However, they can become relevant to an overuse injury in the athlete due to the alterations in normal biomechanics, muscle balance, and muscle activation patterns. The physical therapist’s job is to provide a comprehensive clinical exam, correlate the findings to the athlete’s pain patterns, and understand the evidence regarding the contribution of each of these risk factors individually or as a whole and treat accordingly.
Are you an overhead athlete with pain?
Give us a call if you are dealing with shoulder pain or limited function, and have one of our physical therapists help. Rarely do these issues go away on their own. We also offer a 20-minute complimentary shoulder screening to discuss your shoulder problem history, screen the shoulder, and discuss what successful treatment would include. Email reception@rosecitypt.com with ‘Shoulder Screen’ in the subject line, or call today to set up an appointment.
Karl has been practicing orthopedic and sports physical therapy for 29 years, with his experience focused on shoulder rehabilitation and the injured runner. He has taught shoulder rehab nationally for 15 years. Karl is board-certified in both orthopedic and sports specialties. His practice is closed to new patients as his primary role is staff education and mentorship to create excellence in care by all physical therapists at Rose City Physical Therapy.