Your daughter comes home from practice and complains of her elbow hurting. You immediately put ice in a small plastic bag and the pain temporarily goes away. The next couple of days goes by and the pain continues to get worse. A doctor’s visit later and you’ve been given a strong anti-inflammatory and some stretches. You do some research and learn about everything from Pitcher’s elbow all the way to a lack of internal rotation and as a result, more stretches. By now weeks have gone by and the inflammation is worse and now the front of her shoulder hurts. Now you have to see a specialist where an MRI shows a small tear in the shoulder. The cause of all of this you come to find out is too much flexibility? Isn’t flexibility supposed to be a good thing?
For a while now, Physical Therapists, Strength Coaches, and even some informed parents have had insight to what are known as compensation patterns in terms of how athletes move. Especially for throwing athletes (i.e. softball, lacrosse, track), the shoulder joint is of great importance. The shoulder joint releases the pitch, spikes the ball and can be a deciding factor in how long an athletic career can last. Improper movement mechanics not only lead to losses in ability to create power, but also put unnecessary strain on joints of the body creating overuse injuries that could have been avoided. What is less understood is that it’s not just a loss flexibility, but hypermobility that can cause injury. Without going into too much jargon, hypermobility is when an athlete has more range of motion than they need.
There are various reasons to what can cause hypermobility. Everything from genetics, different hormone levels, to mechanical loading. All of which can decrease the rate of collagen synthesis weakening connective tissue. For whatever reason, there is a much higher number of young female athletes being affected than male athletes. We must also understand that movement in the body and the mechanism of injury is not just one muscle independently firing or not firing, but a group of muscles being synchronized for dysfunction. For example, too much external rotation at the shoulder without the proper control can stress part of the rotat or cuff and bicep tendon. Tissue will shorten when healing and prolonged inflammation will cause pain. This will make your young athlete alter her throwing pattern which now puts more strain on the elbow. Ignored even longer and now there is nothing protecting the labrum in the shoulder which can lead to a tear.
Through proper assessment and a few simple exercises, we can ensure your athlete stays healthy. First start by using a simple test called the Beighton score. You find out how to perform this test by clicking the following link, The Beighton Score. If your score is 4 or more, your athlete is very likely to be hypermobile. Next, use a postural observation. Look to see if the shoulder rolls forward or elevates. This can happen to just one side or both. Also, look to see if one or both shoulder blades point straight up and down or wing out.
(Scapular Winging) (Shoulders Rolling Forward)
Both of these images are a sure sign of compensation patterns at the shoulder. These are more than likely the result of some flexibility issues. Positive signs of hypermobility would be while isolating the shoulder joint, the young athlete still has a normal range of motion if not more. It should be noted that because of the possible hypermobility, there may be no visual postural distortions at all. To make this determination, be sure to get an evaluation from a qualified practitioner.
Once it has been determined than hypermobility is the cause of dysfunction, remember that more stretches are not the answer. This also doesn’t mean that more bench pressing or overhead barbell movements are any better. The key to establishing good control through the shoulder is making sure it’s allowed to move through a full range of motion. A great exercise for stability in the front of the shoulder and proper firing of the muscles between the shoulder blades is a Scapular or Serratus Push Up.
- Get into a push up position, but instead of having the hands directly outside the body, make sure the hands are directly under the shoulder.
- Without allowing the elbows to bend, let the shoulder blades come together.
- From this position, push up push up to protract the shoulder blades to slightly above the original starting positon.
- Do not allow the hips to sag, and pull the ribcage slightly downward to keep the core tight.
- Remember to keep the chin tucked as not to allow the head to protrude forward.
- Elevate the back feet to add load with a 6-12in. box or bring down to a quadruped stance if a neutral spine can’t be maintained.
This position can be very difficult if there is a lack of core strength. If the proper alignment can’t be maintained, you can regress to using a quadruped stance as a regression.
Another great exercise for stability of the front of the shoulder and proper movement through the shoulder blade would be a Wall Angel. The great things about all of these exercises is that they can easily be put into a more dynamic warm up.
- Start by placing your hips, upper back, and head against a wall. It’s ok to bring them out slightly but make sure to maintain a small curve in your lower back while pulling the rib cage down in front to keep the core tight.
- Place the elbow at a 90⁰ angle while maintaining contact with both wrist and elbow to the wall.
- Slide your arms upward in a straight line as far as you can keep all points of contact.
- Without forcing the range of motion, slide the arms back down in a straight trying to tuck the elbows into your ribs and pinching your shoulder blades together and then repeat.
- Remember it is important to keep all points of contact through the entire exercise.
When placing these exercises into a young athlete’s program regiment, be aware of their training history. Also, make note of past and current injuries and where they are in terms of their playing season. Being more conscious of how injuries can occur and being more proactive with injury prevention will ensure a healthier and better performing athlete. Remember, you’re looking at an entire athletic career not just one season.