One of the questions that we most often get asked is “how do I fix my shoulder pain?” This is a very tough question for us to answer as the shoulder girdle is the most complex set of joints in the human body. There are many variables that will dictate the performance of the shoulder, especially when elevating the arm, that include the resting position of scapula, length of musculature that attaches to scapula, position of rib cage, strength of the muscles that attach to scapula, and the motor control of the actual movement that needs to be performed. If one of these variables is dysfunctional, then pain is likely for a quarterback that has to elevate the arm overhead to throw for thousands of repetitions. Today, we talk ALL about shoulder pain and give you a ton of exercises to fix it!
This is a never ending battle for the young people in our world today. The constant urge to look down at a device is destroying the ability of the shoulder to work properly. Looking down at a cell phone or tablet for many hours of the course of the day is one of the worst things a quarterback can do for themselves. This is creating adaptations in the spine, shoulder, and rib cage that are inevitably going to lead to dysfunction. As you see in the picture above, upper crossed syndrome is running rampant in athletes all over the world right now that is causing higher rates of rotator cuff strains, neck pain, biceps tendonitis, and tennis elbow than ever before. The first step to decreasing pain and increasing performance for an athlete that presents this way is to go after these areas specifically. We did a very specific blog post on upper crossed syndrome specifically a couple weeks ago so please check that out before you read further. We have attached that below!
The Overlooked Neck Flexors
One Area that doesn’t get any love in the article above are the deep neck flexors. These literally never get any love, but are so important when it comes to functionality of the shoulder. These smalls muscles need to be able to stabilize the neck during all motions so the upper traps on the back of the neck don’t have to work as much. The longus colli and longus wapitis muscles stabilize the neck just like the transverse abdominis and rectus abdominis stabilize the trunk. Below is an exercise that we use for people that have upper crossed syndrome! All you have to do is tuck the chin down like shown in the video then bring the head off the ground about an inch. Hold for 30 to 60 seconds with the chin still tucked! This is tough!
Specificity in the Weight Room
For a player that has shoulder pain, it is extremely important that this athlete is monitored and progressed very specifically so he does not perform improper movements that are going to continue to exacerbate the injury. There should be a very specific order in which athletes perform movements overhead to decrease the rate of injury when returning. After a lot of the posture issues are cleaned up, here is a good shoulder exercise continuum to aid in the proper return of the athlete in the weight room.
- Pressing Overhead while lying down on back (gravity minimized position)
- Pressing Overhead while lying down on stomach (no weight, add band to progress)
- Wall Slide in Wall Sit Position (all variations)
- Landmine Press (Scaption first and then progress)
- Kettle bell Press (All variations)
- Barbell Press (All variations)
For the overhead athlete that stops having pain after a couple weeks of rest, it is EXTREMELY IMPORTANT that this sequence is taken into consideration. Often times, players and coaches think that quarterbacks can return to what they were doing before because they are not having pain anymore, but this is not the case by any means. Being able to acknowledge the source of the problem and where an athlete fits in this continuum is extremely important for success. The ability to progress and regress overhead exercises for a QB is one of the most important aspects to success as a thrower and also to decrease injury risk. We have attached a video below of one of our favorites to perform with our athletes. Please notice how I am upward rotating the scapula at the very end of the press to emphasize turning on serrates anterior. This is called adding a “plus” to the exercise. We perform this with a lot of our overhead pressing movements, as well as push-up variations.
Learning to Decelerate
Many of the quarterbacks that we talk to always ask about ways to strengthen the shoulder to improve performance and decrease pain. While strengthening the shoulder is great, it’s so important to pay attention to a very specific part of the throwing motion when dealing with pain. This is especially true for players that present with a lot of elbow pain or pain in the rotator cuff. The deceleration of the motion is critical for athletes to control the movement after the ball is released. This would be the deceleration phase and the follow through for the quarterback
Why is this important you might ask? Well, as the muscles try to slow down down the arm, they are lengthened. If the joints are in a bad position, the motor control is poor, or there is not enough eccentric strength present, muscle strain can occur. This is especially true for a QB that can produce high arm velocity and is very prominent when an athlete is fatigued.
How do we Improve?
Quarterbacks can only improve if they work on the deceleration aspect of the motion in the PNF pattern that is the follow through of the throwing motion for a quarterback. If you don’t know what PNF means, then that is alright. For the purpose of this article, it doesn’t matter. We want to replicate what the arm is doing after the ball is released and gradually overload that motion to help with the eccentric portion of the throwing motion. We have an awesome example below!
Once again, we are using the landmine to help us with this exercise. If you don’t have a landmine, you need to get one because there’s so many great exercises athletes can perform with one. With the athlete in a kneeling position, the rib cage is stacked on top of the ribs with no rib flare. The arm is in a 90/90 position, just like at the end of the loading phase. From here the QB will lower the EZ Curl bar down in a motion that is similar to that of the throwing motion. Speed of the movement and weight of the bar are variables that can be changed over time. The higher the speed of the movement, the harder the exercise. The higher the weight on the bar, the harder the exercise. It’s important that the body position of the athlete doesn’t change as we are also working on a lot of trunk stability and motor control of the trunk.
This exercise is an awesome one to continue to work on the mechanics of the arm, but we also need to take into consideration all the other parts of the body that need to be extremely stable when slowing down the throwing motion. It’s important to realize that the shoulder will have to be overused during deceleration when other parts of the body can’t stabilize. Sometimes, it is not the shoulder’s fault. It might be a lack of hip stability on the plant leg or a lack of eccentric strength in the trunk. This is exactly what this exercise is working on.
By going into single leg stance on the left leg, the ankle and hip stabilizers are working like crazy to balance the body weight, but also accommodating for the angle of the resistance from the band. This is extremely challenging for these muscles as I bring the arm down and across the body. This is challenging the stability in multiple planes all at the same time. We are also challenging the eccentric control of the trunk. As the band pulls the body down and across, the obliques have to work eccentrically in order to control the movement of the body. This is an awesome one!
For the quarterbacks that have a ton of range of motion, but no stability, rehab can be totally different. This is why it is so important to have an educated practitioner or movement specialist screen you because there is no one size fits all for quarterbacks or any other overhead athletes. Stability is the key for these types of players. The rotator cuff works as the primary stabilizer of the glenohumeral joint (shoulder joint). There are many ways to stabilize the cuff. If you haven’t checked out our youtube channel, I would suggest doing so to see all the varieties. We have added one of them below that is stabilizing the cuff, but is also working on a lot of other important areas.
With the weight dangling from the band, the shoulder has to accommodate for the constant change in the band which will tug on the shoulder. This is the stability portion of the exercise. As the QB moves, the weight will be slightly behind the movement in which the arm now has to not let the arm go into internal and external rotation. This is EXCELLENT for a QB to learn where to load the ball properly. The weight is also trying to pull the QB into right side bending which is really common for quarterbacks to perform when throwing. Try to keep the shoulders level during the entire movement. As you can see, you can make the exercise harder by making the band longer. Once again, it is really important to have progressions and regressions of the exercises.
Do you see how complex the shoulder is now? From going to doing shoulder presses on the ground to this wild exercise in a very QB specific manner takes a long process. This is a process that a QB needs to navigate with an experienced coach, especially if he consistently has pain in the shoulder from throwing. There’s no reason for this! We would love to help so please reach out if you have any questions! You can reach me at email@example.com or call/text at 812-343-4226.
-Drew Kiel PT, DPT, CSCS