 So, let’s talk about the shoulder: It is a very dynamic joint with little surface area between the humeral head and the glenoid fossa. The analogy we often use is a golf ball on a golf tee. There’s a reason why you hear more about shoulder dislocations than hip. We have numerous muscle attachments and ligaments that surround the joint itself. These can be broken down into active (muscles/tendons) and passive stabilizers (ligaments). When we are going through different movements at the shoulder (whether that’s an overhead press, push up, clean, etc.), if we do not have the requisite range of motion, coordination or strength, then our passive stabilizers take on a lot of that stress. As I’ve said before, every single tissue (muscle, tendon, ligament, bone, etc.) in our body has a certain capacity and threshold. Stress is how we build those thresholds up. Stress is also how we break those down. When those thresholds are surpassed significantly or repeatedly, pain and injuries start to pop up. The dosage is the difference in having the poison or the antidote (- quote from someone smarter than me). Now, how can we create more buffer room or bandwidth to withstand these stressors? Smart and well thought-out training. Sure. But, what about creating more freedom and control at the shoulder joint? Then, those tissues are less prone to getting overstressed and everyone is doing their jobs. Today, our focus will be on the overhead archetype – which is an expression of shoulder flexion and external rotation. This can be anything related to pressing, reaching overhead, hanging, or throwing overhead. I see people in the clinic every day that have pain with these movements and when we break these positions and joints down, we tend to see a limitation in one or both flexion and external rotation. Next, we’ll go through a test that you can utilize to see how your overhead position checks out. Wall Test: Common faults we see related to this are:
Try to avoid these mistakes and see where your true baseline overhead position is. After the techniques provided below, come back to this test and re-test the movement. Can you go further? How does the quality of getting there feel? Next, we’ll look at some strategies to improve the mobility aspect of the shoulder joint. Subscapularis Mobilizations: Shoulder Overhead Opener: When discussing the shoulder joint, I would be remiss not to mention the thoracic spine. The shoulder blade and thoracic spine/ribcage are very intimately related which directly impacts shoulder mechanics and position. Next, we’ll go through some techniques to address the thoracic spine. T-Spine Mobilization: Half-Kneeling Wall T-Spine Rotation with Lift Off: Lastly, we will cover my favorite component in the performance process which is the strength and control of the shoulder joint for the overhead position. Supine Eccentric Shoulder Flexion – Dowel or Single Arm with Plate: Dowel Shoulder Flexion PAILS/RAILS: Chaos Overhead Band Carry: Now, you may be thinking, "These are great exercises, but how do I implement them?" Try them as movement prep prior to an overhead workout, accessory work on upper body days or even on recovery days. Do you have to do all of them? Nope. Find the ones that you feel had the best impact on you via the test-retest on the Wall Test and start implementing them in consistently. An active approach tends to work better in the long term compared to the passive approaches and exercises. You’ll be surprised how quickly your overhead position will improve and your overall shoulder health.
If you’re dealing with an injury, reach out with any questions. We design and implement rehab and performance programs to help our athletes, whether you’re someone who doesn’t know where to start or has had an unsuccessful rehab experience. It is our goal for the people we work with to return to their sport or activity performing better than they did before. Cheers, Dr. Ravi Patel, PT, DPT, CSCS
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 Shoulder volume. This is the first thing that comes to mind with I have the opportunity to work with youth swimmers. A typical club or high school swim team will average around 40,000 to 60,000 yards in a week of practice and the average athlete will have a stroke count of about 12 to 15 strokes per 25 yards, giving you a range of 19,200 to 36,000 strokes per week...that’s a TON of volume on the shoulders! With such a high demand on swimmers’ shoulders, injuries are incredibly common, so common in fact experts coined the term “swimmer’s shoulder” as an umbrella diagnosis. That being said though there are a number of steps you can take to prevent injury, the most crucial of which being to improve your movement efficiency. Movement efficiency is key to not just preventing injury, put to improving performance. Think of it this way. Performing 36,000 strokes a week with poor mechanics is like trying to drive a Ferrari with the handbrake on; sure, you’ll still be able to move and potentially pretty damn fast, but you’re going to leave a ton of performance on the table, in addition to breaking down way quicker and more often. In order to know to know where a deficiency is happening, you must break down each stroke into its component parts. For the sake of this article, we will focus on freestyle. Each freestyle stroke can be broken down into five main phases:
When looking over all the different component phases that make up a freestyle swimming stroke, something becomes abundantly clear… internal rotation is crucial. From the catch phase all the way through the recovery phase, internal rotation is necessary in order to perform the freestyle stroke effectively and efficiently. That’s why you’re always hearing your coaches scream out cues like: “Keep a high elbow;" “Drag your fingers;” and “Point your elbow to the ceiling.” All are various cues for internal rotation.  The problem is though, we see a ton of swimmers who are missing adequate internal rotation. When you’re missing internal rotation and you try to go into a “hang position” (see picture above) you will compensate by dipping your shoulder forward. This is a big problem because when you dip your shoulder forward you’re putting your rotator cuff in a weakened position, putting unneeded stress on your biceps tendon and labrum, and decreasing your power output. Add all that together and multiply it 36,000 strokes you're doing in an average week and it becomes easy to see why this is a recipe for disaster. So how do you know if you’re missing internal rotation and what can you do if you are? Well, check out the video below to assess your shoulder range of motion and see if you hit the minimum of 70 degrees of internal rotation we like to see our athletes to hit. If you don’t have the needed range or it is a struggle to get there, check out the following two videos for a couple of our favorite ways to improve your shoulder rotation. (Internal Rotation Self-Assessment) (Internal Rotation Superfriend Stretch) (Banded Internal Rotation Stretch)
Lacking internal rotation is one of the main reasons why we see swimmers, especially youth swimmers, in our clinic in Decatur, GA. However, the shoulder is an incredibly complex joint and there could be a number of reasons in addition to a lack of internal rotation causing pain in a swimmer’s shoulders. If you’re still struggling with shoulder pain or noticing a decrease in performance after working on your shoulder internal rotation you live we’d love to help. Simply give us a call at 470-355-2106 or fill out the contact request form below and we’d be happy to contact you. Thanks for reading, -Dr. Jake, PT, DPT, CSCS Coming at you with the the final part of our two-part series for ensuring healthy shoulders while improving your pull-ups. In this part we’re talking about how to develop appropriate strength in the appropriate areas. For those of you who missed it, part one is super important and I highly recommend reading that before moving on with part two. For those of you who are caught up, let’s get after it. Part II: Strength In any training program, it’s important to make sure your movements are balanced and that your shoulders are working in multiple directions (ex: vertical pulling, horizontal pushing, horizontal pulling, etc). The pull-up is an excellent example of a vertical pull strengthening exercise. With most pulling exercises, your body is primarily moving through two movements: elbow flexion and shoulder extension. This means your primary shoulder extension (latissimus dorsi, teres minor, post delt) and primary elbow flexion (biceps brachii, and brachialis and brachioradialis) muscle groups need to work synergistically to perform this movement appropriately. Unfortunately this synergistic relationship isn’t normally the case. More often than not I find that people way over utilize elbow flexion and underutilize shoulder extension. When this happens bad things happen and those bad things usually end up manifesting themselves as pain along the front of the shoulder. As you can tell in the picture above, the long of of your biceps tendon crosses the shoulder joint and when you rely too much on elbow flexion with pulling based exercises, you can end up agitating that tendon, which leads to shoulder pain. I see the aforementioned situation happen all the time in athletes who do a lot of kipping pull-ups vs strict pull-ups, specifically in those who don’t have the requisite strength to perform consecutive strict pull-ups but are repping out 15+ kipping pull-ups at a time. Now I’m not saying kipping pull-ups are bad or that you shouldn’t do them, but kipping pull-ups should be an expression of strength, not a way to avoid a weakness. To ensure you’re not overusing your biceps while doing the pull-up you want to have strong, engaged lats (latissimus dorsi). To make sure this is the case, check out our top 3 exercises below for improving shoulder lat strength and control. Drill #1: Active Hangs This drill is an all time favorite of mine for a couple of reasons. First, it allows you to feel how your lats should be contracting while you are going a pull up. Second, it allows you to strengthen your shoulders in a vulnerable/weak position. You’re only as strong as your weakest link and being strong in a weak position is a great way to prevent injuries. Drill #2: Lat Pull Over This one is a great example of “killing two birds with one stone” because not only are you able to improve lat strength with this drill, but because of the long eccentric phase (muscle contracting while lengthening) of this drill, it’s also a great way to improve shoulder mobility. Drill #3: Single Arm Banded Lat Pull Downs Breaking up a bilateral movement (using both arms) into a unilateral movement (using one arm) is a highly underutilized training modality that allows to balance out weaknesses. Plus, as an added bonus, you’re able to perform a vertical pulling drill at a slightly different angle which, as we talked about above, is how you train for healthy shoulders. If you have shoulder pain while doing pull-ups, or want to prevent pain from coming, this two-part post is a great place to start. Ensuring appropriate mobility and then building appropriate strength is a common occurrence in the rehab world. If you’re in the Atlanta area and are interested in working with a unique professional that can help you optimize your health in all of these areas, we need to talk. Being proactive and staying on top of your health will help you avoid serious health problems down the road. Submit a contact request by clicking the button below and we’ll get you set up with one of our Doctors for a free 15-minute phone consult. Thanks for reading, Dr. Jacob, PT, DPT, CSCS Whether you’ve never stepped into a gym or are a diehard fitness enthusiast, chances are you’ve attempted a pull-up. That’s a good thing! It’s hard to argue an exercise that is more foundational to upper body strength than the pull-up. That being said, for how much I love this exercise and think it is something everyone should be doing (or at least a type of modification), I treat patients all the time in the clinic with shoulder pain related to the pull-up. Whether it be mobility issues, strength, or poor technique, there are a number of reasons why your shoulder can hurt during or after pull-ups and this article is the first of a two-part series that will teach you how to keep hitting your pull-ups pain-free! Part 1: Mobility First and foremost, let’s take a look at what exactly is happening at the shoulder joint while doing a pull-up. When you raise your arms over your head to get in the starting position for this exercise, your shoulder joint has to do a combination of two movements: flexion and external rotation. If you're limited in any of these two ranges of motion your body will make compensations to get your arm in position, which will eventually set you up for a higher risk of injury. Think of it this way: If your car tires are out of alignment, nothing will happen right away, but eventually there is going to be uneven tread wear and you’ll end up blowing a tire sooner than later. The same can be said for your shoulder if you're lacking requisite mobility with either shoulder flexion or external rotation. The videos below are great ways to test if you have enough shoulder range of motion, as well a favorite drill of ours to improve any range that needs work. 1. Flexion  (Shoulder Flexion Self-Assessment (Performed by Norcal Strength and Conditioning)
(Banded Overhead Opener)
(Thoracic Spine Opener)
2. External Rotation  (Shoulder External Rotation Self-Assessment - Performed by Michael Carroll)
(Chest Opener)
(Front Rack Opener)
To recap, if you have shoulder pain while doing pull-ups, or want to prevent pain from coming, the first place to start is to make sure you have enough shoulder flexion and external rotation to perform the exercise without compensation. Be on the lookout for Part II of this blog post which will dive into the common mechanical flaws and strength imbalances that can lead to shoulder problems with the pull-up. If you’re in the Atlanta area and are interested in working with a unique professional that can help you optimize your health in all of these areas, we need to talk. Being proactive and staying on top of your health will help you avoid serious health problems down the road. Submit a contact request by clicking the button below and we’ll get you set up with one of our Doctors for a free 15-minute phone consult. Thanks for reading,
Dr. Jacob, PT, DPT, CSCS Pain on the outside of the elbow is classically called “tennis elbow” or tendinitis. Although, people who don’t play tennis can also have this pain from grip-heavy or repetitive activity. There are also many structures that can cause this same pain, outside of the usual tendinitis. Tendinitis is thought to be caused by increased inflammation due repetitive stress in the area and micro-tears to the muscle. It is acute, meaning it just happened. However, many folks that we see have had symptoms for months (sometimes years!!) and so the process is different and chronic. We call this tendinosis. There is no longer acute inflammation or swelling, rather long term changes to the tissues in that area from improper healing and continuous repetitive trauma. The area that is irritated to cause the pain at the outside of the elbow is called the extensor tendon. That is, the common tendon where all of the smaller forearm muscles that extend the wrist, join at the elbow. Often times, players who are playing frequently throughout the week without proper mobility and recovery plans will present with this issue. Over-gripping the racket is also another major cause. If the muscles and therefore the tendon or irritated, a great place to start for self-care would be to perform the forearm release (seen below). Doing this for two minutes, 1-2x/day, can have a positive impact on the pain you feel.  So while many tennis players have pain at their elbow, only a fraction will actually have “tendinitis”. Another tissue that is often the culprit is the nervous tissue. Nerves course throughout our entire body for muscle function, sensation, etc. Irritation of the nerve, from repetitive activities or rubbing against another structure can send pain signals to the same area. However, treating the muscle in this case will not clear up the symptoms. The major nerve that runs by the outside of the elbow is called the radial nerve. Muscles nearby are commonly overused in tennis and can be the cause of the symptoms. Irritation of this nerve can also begin at the neck, but that is a discussion for another time! I often see players who are changing their grip or adding more top spin to their balls tend to have more issues with nerve irritation.  The best way to address the radial nerve irritation is a radial nerve glide (see video below). Try 15 of these before a lesson or match to improve the mobility of the nerve and decrease the pain. With nerve glides, keep the tension that you create 5/10 tension/pulling or less to avoid extra irritation! Try 15 of these before a lesson or match to improve the mobility of the nerve and decrease the pain. With nerve glides, keep the tension that you create 5/10 tension/pulling or less to avoid extra irritation! While both of these strategies above are a great way to decrease your pain, the best way to keep it from happening again is to address the shoulder. Shoulder weakness changes how your arm (elbow and wrist) move through space. With tennis players, overhead strokes and serving can be particularly irritating if proper shoulder position, strength and control are not achieved. Does your back look like this? Notice how the inside edges of her shoulder blade are prominent? Not ideal. That demonstrates weakness in muscles that are essential for overhead movement.  You can begin to address this weakness and shoulder position with a simple and effective exercise called the single arm punch out. It strengthens a muscle called the serratus anterior to help normalize scapular position. Try 2 sets of 15 reps per side, 3x/week. This is a great warm up on the court or at the gym! Summary:
Thanks for reading, Dr. Jackie, PT, DPT  Shoulder volume: This is the first thing that comes to mind with I have the opportunity to work with youth swimmers. A typical club or high school swim team will average around 40,000 to 60,000 yards in a week of practice and the average athlete will have a stroke count of about 12-15 strokes per 25 yards, giving you a range of 19,200 to 36,000 strokes per week...that’s a TON of volume on the shoulders! With such a high demand on swimmers’ shoulders, injuries are incredibly common, so common in fact experts coined the term “swimmer’s shoulder” as an umbrella diagnosis. That being said though there are a number of steps you can take to prevent injury, the most crucial of which being to improve your movement efficiency. Movement efficiency is key to not just preventing injury, put to improving performance. Think of it this way. Performing 36,000 strokes a week with poor mechanics is like trying to drive a Ferrari with the handbrake on; sure, you’ll still be able move and potentially even move pretty damn fast, but you’re going to leave a ton of performance on the table and you’re going to break down way quicker and more often. In order to know to know where a deficiency is happening, you must break down each stroke into its component parts. For the sake of this article, we will focus on freestyle. Each freestyle stroke can be broken down into five main phases:
When looking over all the different component phases that make up a freestyle swimming stroke, something becomes abundantly clear… internal rotation is crucial. From the catch phase all the way through the recovery phase, internal rotation is necessary in order to perform the freestyle stroke effectively and efficiently. That’s why you’re always hearing your coaches scream out cues like “keep a high elbow”, “drag your fingers”, “point your elbow to the the ceiling”, all those are various cues for internal rotation.  The problem is though, we see a ton of swimmers who are missing adequate internal rotation. When you’re missing internal rotation and you try to go into a “hang position” (see picture above) you will compensate by dipping your shoulder forward. This is big problem because when you dip your shoulder forward you’re putting your rotator cuff in a weakened position, putting unneeded stress on your biceps tendon and labrum, and decreasing your power output. Add all that together and multiply it 36,000 strokes you're doing in an average week and it becomes easy to see why this is a recipe for disaster. So how do you know if you’re missing internal rotation and what can you do if you are? Well, check out the video below to assess your shoulder range of motion and see if you hit the minimum of 70 degrees of internal rotation we like to see our athletes to hit. If you don’t have the needed range or it is a struggle to get there, check out the following two videos for a couple of our favorite ways to improve your shoulder rotation. (Internal Rotation Self-Assessment): (Internal Rotation Superfriend Stretch): (Banded Internal Rotation Stretch): Lacking internal rotation is one of the main reasons why we see swimmers, especially youth swimmers, in our clinic in Decatur, GA. However, the shoulder is an incredibly complex joint and there could be a number of reasons in addition to a lack of internal rotation causing pain in a swimmer’s shoulders. If you’re still struggling with shoulder pain or noticing a decrease in performance after working on your shoulder internal rotation you live we’d love to help. Simply give us a call at 470-355-2106 or fill out the contact request form below and we’d be happy to contact you.
Thanks for reading, -Dr. Jake, PT, DPT Elbow pain can be one of the most irritating and inconvenient issues. I once had a patient say that the most painful part of his day was just cutting butter for his toast in the morning. Classically, we tend to blame the tissues at the joint—wrist extensors/flexors. Sure, the common insertion for these muscles becomes inflamed, but what causes that? I like to view the elbow similarly to the knee; it is a joint that is pushed and pulled on either side by very complex joints. The shoulders will largely influence the biomechanics of your elbow and the amount of torque that passes through the joint. Although somewhat simplified, we could group you as either tight and immobile or mobile and bendy. Each characteristic has its own pros and cons, but the cons are where pain manifests. With decreased shoulder mobility and/or control, the elbow will take the brunt of the force when lifting weights or swinging a racquet. Shoulder stabilization and control are important for correct biomechanics of the shoulder girdle and upper extremity. Lack of control upstream, allows more movement downstream at the elbow. The repetitive, small insults at the elbow joint will eventually result in elbow pain.  Hammering away at the soft tissue around the elbow is often where athletes start when self-treating. Don’t get me wrong, a little forearm smash with a lacrosse ball or barbell is great. But if it does not improve your problems, move on! In this case, we are going to check out the shoulder. Less mobile folks: To decrease the torque at the elbow, it would be ideal to improve both the external rotation (front rack) and flexion (overhead position) or your shoulder. Tight lats can often be the cause of the restrictions. Try these two mobility pieces:
  More mobile folks: Shoulder stabilization is going to be the key for you. A simple way to start on this is kettlebell carries, all variations! Here are two simple, yet effective stabilization drills:
  As always, do a movement screen/ form check first. Get a coach or super friend to watch you move and see if they notice any faults. Racquet sport athletes—if you constantly have elbow pain, check your grip size. Grips too small or too large can cause elbow issues as well. If you are a desk jockey, check out your work station and the ergonomics!
Try these mobility exercises and tips out. If you continue to have issues, come see us at Athletes’ Potential. We see elbow pain often and are able to effectively treat it with an evaluation! Keep devoting time to making your body work and feel better. Thanks, Dr. Jackie, PT, DPT, OCS, CSCS  Shoulders can be particularly tricky for the athletic population. A history of overhead sports and hand dominance can set us up for difficulty later down the line, especially if we choose to move to a mode of exercise that is very symmetrical (rowing, barbell movements). Also, repetitive overhead movements with poor form or overuse during overhead sports can lead us to shoulder pain. The shoulders hold a particularly difficult role because they have a demand for stability and mobility at the same time. This is a fine balance that can result in pain and dysfunction, if not optimal. Fun fact: the shoulder complex, or the shoulder blade and arm, connect to the body only by attachment of muscles. It is unlike the hip or knee joint that articulates bone to bone with some cartilage in between. So the muscles need extra attention! To work on both stability and mobility, a few items need to be checked off before we go snatching a weighted barbell over our heads or swinging away at a tennis ball. We must make sure the tissues are warm and the neurological system is primed for overhead movements. Pain in this area may be caused by muscular tension, shoving the shoulder into poor positions due to lack of mobility and/or lack of control of the shoulder. The best way to attack this area is a proper warm-up, mobility or soft tissue work and movement preparation. Of course, all of this is worthless without making sure that you are moving properly. #1 Inch Worm- this exercise prepares the shoulder complex by adding a weight bearing component. With the push up, the scapular and pec muscles will be prepped for the following mobility drills. 10 repetitions would be a good place to start. #2 Banded wall slides- these closely resemble an overhead squat or overhead sports movement (but both sides involved!) The band provides constant tension to engage the scapular muscles and the movement overhead allows them to work to stabilize the joint. At the top, the pulling away from the wall engages the lower trap and mimics the position of the barbell in an overhead lift. Try 10 slow slides then 5 lift-offs per arm, keeping tension the entire time. If you need mobility work, the green band at the gym is a great place to start. If you tend to be more mobile but still have some tissue tension, the lacrosse ball should be your buddy. #3 Overhead shoulder distraction- using the green band for this mobility exercise allows distraction at the shoulder joint as well as a stretch to the lats and pecs, depending on angle of pull. Two minutes minimum each side! #4 Subscap smash- The subscapularis muscle can limit external rotation if tight and this can impact overhead lifts, front racks or the throwing/hitting motion. Whether flexible or not, the subscap generally has a good but of tension in weightlifters and overhead athletes. Pressure based techniques are best done for about 2 minutes each side. A specific shoulder warm-up is important depending on the task for the day. Say the workout is snatches or overhead squats—behind the neck presses and snatch balance will be ideal for adding speed and change of direction. If you are warming up for an overhead sport, start slow and short with the movements the slowly add speed and distance. #5 Snatch Balance- weightlifters/CrossFitters: this can be a difficult warmup for many, as it can expose your deepest, darkest mobility secrets! The idea is to quickly push your body under the barbell without allowing it to raise at all. If you have never done this, try it with a PVC pipe and a coach nearby. Athletes: choose a task specific warm up or drill and begin to add the speed. #6 Change how you move- as always, appropriate biomechanics can “cure” many athletes’ pains. Video yourself during a movement that is painful for your shoulder and then watch it in slow motion. You may be surprised! Ask a coach or experienced athlete to give you a few pointers. There are ways to smash with lacrosse balls for a temporary fix, but to make a lasting change and prevent the reoccurrence--move better. If you don’t have the ideal positions yet, then chip away with mobility.
These are some of our favorite exercises for people with shoulder pain. As great as these are, the fastest and best results will come from working with us directly. We help people just like you get out of pain and back to the activities they love. Shoulder pain can be very frustrating but you don't have to deal with it anymore. With our unique three step process we eliminate pain, fix the root cause of the problem and teach you how to keep yourself healthy long term. Click the blue Get Started button below and one of our team will reach out to you. You can also call us at 470-355-2106. Thanks for reading! The Athletes' Potential Team Tennis players need a combination of speed, agility, flexibility and power to become successful at the sport. As with any overhead sport, it is not unusual to have shoulder and elbow pain, but tennis can be especially hard on the torso and lower body as well. Whether you are a serious competitor or a weekend warrior, there are a few key areas to keep supple and strong to avoid injury and improve skill. Feet & Ankles: The ability to move laterally and sprint is essential for a tennis player. But how can you do this effectively with stiff, painful ankles and feet? My favorite way to mobilize feet and ankles is using a lacrosse ball. Mobilizing the fascia on the bottom on the feet can decrease foot pain and allow for more range of motion of your big toe- which is a big deal for push off! Pressure-based soft tissue work to the calves can decrease tightness and pain in these areas as well. Many people ask if a tennis ball would be sufficient, but it’s too soft! Our recommendation is using a lacrosse ball for 2 minutes in each area, per side, daily. Try it before and/or after a match and see which timing works best for you! Hips: Pain in the hips can occur with faulty movement patterns or tightness elsewhere, but I want to focus on hip strength. I’m always surprised when athletes come in and have poor balance on one foot or less than ideal hip strength. Running and cutting is essentially moving from single leg stance on one side to single leg stance on the other. Without balance and control in this position, your knee will take a beating. Do you ever have sore knees? Don’t blame your knee, first look at your hip! A great exercise for single leg balance and hip strength/control is the single leg deadlift. There are many ways that you can adapt it to make it more or less challenging. When you try it, notice what happens at the knee. With poor control and strength at the hip, your knee may be moving in towards the other or shaking a bit. This is not ideal and likely the root of the knee issues. Work these into training days, 8-10 repetitions for 2 sets will be a good place to start. They can be sneaky and make you quite sore the next day! Thoracic spine: Having the ability to rotate the torso is important for power production in concert with the hips. A stiff spine will disrupt the power couple and the hips will have to compensate. As mentioned before, dysfunction at the hips can then cause knee pain. Disrupting this kinetic chain can have severe effects on your tennis game! My go-to for thoracic spine rotation is the open book. This works well as a warmup exercise. As you rotate through the exercise, be sure to keep the knees stacked so that the rotate comes from the spine and not the pelvis turning! Shoulder: Undoubtedly, shoulder strength is an important variable for efficient strokes but it can also directly affect elbow pain. Similar to the hip and knee relationship, if there is shoulder weakness then the elbow can take the brunt of the force. The rotator cuff is made up of four small muscles that stabilize the shoulder joint. Without strength of these muscles, the prime mover muscles then must take over for stabilization. When this happens, there will be less power production at the shoulder. Dysfunction at the shoulder can effect nerves passing through the area with may cause elbow pain. To keep the shoulder stabilizers strong and healthy, the exercise that will give you the most bang for your buck is the WY negative using a small band. This covers external rotation (cocking back before serving), overhead stabilization and posterior cuff control during deceleration. What was that last part? The muscles at the back of the shoulder work to slow the shoulder after the acceleration to hit the ball. A good indicator of dysfunction here is pain at the back of your shoulder. Elbow: The elbow is effected so often by tennis that it was named after the sport! Tennis elbow, or lateral epicondylalgia, is pain at the outside part of the elbow. Its sibling, golfer’s elbow, is pain at the inside of the elbow. Despite the names, tennis players are susceptible to both. As mentioned before, it can be coming from up the chain- cervical spine or shoulder. The pain can also be coming from down the chain- wrist. The forearm muscles that move the wrist connect from the elbow and run to the hand. After hundreds of reps during a match or practice, forearm muscles can become irritated and tight. The triceps also crosses the elbow joint and can be a culprit with elbow pain. This muscle extends the elbow, so are very active with backhands and serves. Early on, the best focus of your time with elbow discomfort is soft tissue work using a lacrosse ball. After pinning down the ball in an area of tension, it is important to move the wrist and elbow to give the muscles a stretch. If you are a tennis player looking to improve your game or ebb nagging pain, give these self-management techniques a try! By keeping the body mobile and strong you will have less pain and improved function. At Athletes’ Potential we work with multiple tennis athletes in all skill ranges that want to get back to the court quickly and feel better than ever. Not sure? Give us a call. We would love to chat with you and find the best fit.
Thanks for reading! Dr. Jackie, PT, DPT, OCS, CSCS Appropriate shoulder rotation is essential for overhead athletes; I want to discuss this in the context of volleyball. My bread and butter. Think of a volleyball player hitting a cut shot or winding up to swing away at a set. You will see a great amount of external rotation during the cocking phase (the middle frame in the photo above). The greatest demand for internal rotation range of motion would be the follow through for a cut shot or “thumb down." The amount of shoulder rotation range of motion for a volleyball player is that of a normal individual but you need a balance of range of motion, strength and control. A quick side note worth mentioning: as an overhead athlete, you are likely to have greater range of motion in external rotation and less internal rotation. This is normal due to the demands of your sport. The baseline that we look for is that total range of motion side-to-side is the same. So you may look like the guy on the right in the picture below. It is also common for volleyball players to demonstrate greater internal rotation rather than external rotation strength, which may lead to injury down the road if the ratio becomes too skewed.  Let’s go through the steps of an arm swing and see where a weakness may be and how to address it:
Check your external rotation by laying on your back, arm out to the side and elbow bent. See how far you can drop the back of your hand down to the floor. Lacking here? Try this out: Subscap Smash
The shoulder joint is one of the most complex in the body due to its high mobility demands that compromises the stability. For volleyball players, shoulder maintenance is key for longevity, pain-free function, power and control. I broke the attack down very simply to highlight a few major areas of weakness that is often found in volleyball players. Give these mobility and strengthening exercises a try and see what works best for you. At Athletes’ Potential, we believe that self-maintenance should be the first step toward managing pain and recovering properly. But if you have a nagging volleyball shoulder and cannot seem to find that silver bullet, give us a call! Thanks for reading, Dr. Jackie, PT, DPT |
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