As a proud parent of young daughters pursuing the sport of volleyball, it gives me great pleasure to discuss the complexities of the shoulder joint and how any overhead sport athlete can run into trouble. We have recently entered the exciting and competitive world of Club Volleyball, which places demands on the shoulder that many other sports don’t. Being subspecialized in Spine Surgery, I had to go back and review some of the literature myself, so I can only imagine how confusing it can be for the young athlete and parents alike. Basically the bottom-line on the shoulder is it is DESIGNED to be unstable and it is our job to make sure our young women and men playing volleyball do their best to protect the joint from injury. Injury prevention and protection from overuse is the key.
I spent a little time at the Belmont Volleyball camp this summer and listened to the closing comments of their coach addressing our girls. He brought up some very interesting points about the sport, especially when we look at the position of a hitter. Much of the same motion of hitting along with the follow through is similar to pitching in baseball. There is great interest at all levels in baseball of pitch counts and rest time for pitchers. Typically a pitcher, in all levels of baseball, will have 3-4 days of rest after pitching a game, especially if the pitch count exceeds 100 pitches. Let’s now look at a busy middle or outside hitter at a weekend tournament. A good hitter may have 1-2 hits on EVERY POINT of each set, with matches lasting 2-3 sets. As teams are more evenly matched, most sets will require 40-50 points to complete. So in one match, a hitter may strike the ball 200-300 times. That is just in ONE match. Most tournament weekends require 2-3 matches each day, so the math adds up: Volleyball is tough on the shoulder.
What can a player do to protect themselves? A basic understanding of the shoulder anatomy is critical to understanding what we can do to prevent injury. As I said before, the shoulder is designed to be unstable. In order for us to place our arms and hands into extreme positions, the shoulder anatomy must be looser than hip and the knee for instance. The ball and socket joint made up of the head of the humerus and the glenoid of the scapula looks like a giant golf ball on a little tee. This allows a lot more potential motion of the humeral head. One way to think about the humeral head is it is constantly going to try to slide off the golf tee and everything else around the shoulder is trying to keep it on. So…what keeps the ball on the tee? This can be lumped into two categories: static stabilizers and dynamic stabilizers. These terms are complex though, so to keep it simple: let’s think about those as “things we can’t change” and “things we CAN change”.
Things we can’t change are the actual bony anatomy of the joint, our pre-determined genetic laxity or looseness of the capsule surrounding the joint, and the anatomy of some of the ligaments strengthening the joint. The labrum, which is a thick piece of cartilage acting like a chock block stabilizing the joint comes in many shapes and sizes and these variations can really alter the stability of the shoulder. Sometimes players can tear the labrum which can really alter its function. Some authors suggest that this also reduces the “suction cup” effect of the normally air-tight joint, potentially adding to the problem. Sounds depressing, especially for those who have really loose joints or are already dealing with a labral problem. There is a bright side however….
There are things we CAN we change? In comes the role of the dynamic stabilizers, which in reality are the muscles and the ability to control the muscles in space. The muscles can be divided into two major groups:
1. Stabilizers of the humeral head: mainly the rotator cuff
2. Stabilizers of the scapula (or shoulder blade)
The control of these muscles require specific training sequences in order to get the most benefit and the most protection. The rotator cuff muscles should be trained with VERY light weights or light rubber bands and the key is endurance training (more “reps”). A lot of the rotator cuff exercises may be performed with the shoulder elevated to 90 degrees from the side of the body, internally and externally rotating the joint. This is because at 90 degrees, all of the muscles of the rotator cuff are typically firing at their maximum strength. This position however can create more stress on the joint, so a lot of physical therapists and trainers will modify this position, keeping the arm down to the side for exercises. Keeping all four muscles of the rotator cuff equally strong will give you the best chance of having a balanced and stable joint. The stabilizers of the scapula actually require more complex motions. The rhomboid, trapezius, serratus anterior and even the lower pectoralis muscles are key stabilizers for the scapula. Using heavier weights in such exercises as the upright row, shoulder shrugs and decline chest presses and dips will really help with keeping the scapula in good position to support the shoulder.
Finally, the last thing we CAN control as players, parents and coaches is REST. Our coaches have been great at cooling things off for a few days after big tournaments. Taking some time off between seasons and over the summer is key to allowing recovery time. Using ice after practice around the shoulder will help with inflammation and occasionally medicines to control inflammation may be prescribed.
Any of our physical therapists here at ELITE Sports Medicine and Orthopaedic Center would agree that cross-training and doing shoulder stabilizing exercises throughout the season is the recipe for success. For more information on these exercises or to schedule an appointment regarding shoulder pain, please contact us at 615-342-0200.
Good luck and we will see you on the courts.
The Glattes Family