Preventing Shoulder Injury In Overhead Sports

Shoulder injuries plague athletes of all description at all levels of sport, however they are more commonly seen in sports that involve overhead movements of the shoulder, such as swimming, and cricket. A majority of shoulder injuries in both cricket and swimming arise from over use of the shoulder joint. It has been reported that shoulder injury may account for up to 7% of all injuries amongst elite cricket players. Repetitive actions place a large degree of stress on muscles and joint structures over time and often create muscle imbalances or exacerbate existing ones.

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Muscle imbalances in the shoulder can cause the scapula to sit abnormally and inhibit the natural movement of the shoulder joint. In both swimming and cricket it is common to see an athlete present with the scapula sitting in an inferiorly rotated position caused by tightness in the muscles that inferiorly rotate or depress the scapula, such as latissimus dorsi, pectoralis minor, teres major, and the rhomboids. This constant downwards rotational force reduces the scapula’s ability to rotate superiorly during shoulder flexion. As flexing the shoulder to 180 degrees (directly overhead) requires 60 degrees of superior scapula rotation and 120 degrees of glenohumeral flexion, any reduction in the scapula’s ability to superiorly rotate will increase the strain on the glenohumeral joint.

It has been hypothesised that an inferiorly or downwardly rotated scapula (see picture below) is associated with shoulder problems in athletes such as instability and impingement. A recent study investigated instances of shoulder pain in young cricketers and the relationship between shoulder pain and inferior rotation of the scapula. The sample group for this study was quiet young, with a mean age of 18 years old, however 15% of athletes studied exhibited a degree of shoulder pain already. As an athlete’s career progresses, instances of overuse injury increase accordingly, so injury at this early stage is a good indicator for serious problems in the future.

scapuladyskinesis
It was noted that almost all of the athletes in the study who experienced shoulder pain exhibited excess inferior scapula rotation in most positions. Participants stated that their shoulder pain was most debilitating during throwing, fielding and bowling, all of which are overhead activities. These actions are most likely causing the muscle imbalances which led to excess inferior scapula rotation. This supports the belief that inferior or downward rotation of the scapula is a good indicator of current or future shoulder injury.

Athletes and coaches involved in sports that stress the arm or shoulder should be mindful of utilising clinical screening for inferior scapula rotation and starting an exercise program to correct the causative muscle imbalance. Exercise programs will focus on training the effected muscles both eccentrically and concentrically in order to strengthen the shoulder muscles equally. Once these muscles have equal strength in both directions the scapula will return to its proper neutral position and an athlete’s chance of shoulder injury is significantly reduced.

Rodney, A. G., Taylor, F. T., Watson, L., & Ardern, C. (2013). Altered scapula position in elite young cricketers with shoulder problems. Journal of Science and Medicine in Sport, 22-27.

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