Injuries in the Overhead Athlete

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Topic: Injuries in the Overhead Athlete

An overhead athlete is an athlete who participates in any overhead sport or where that upper arm and shoulder arcs over the athlete’s head. Overhead athletes are prone to a variety of injuries based on the position of the shoulder and the arm during the repetitive movements.

How do you define an overhead athlete? Which sports would they play?

Dr. Kim Bauernfeind: An overhead athlete is an athlete who participates in any overhead sport or where that upper arm and shoulder arcs over the athlete’s head. This repetitive position places the athlete at a risk of traumatic or degenerative changes in the shoulder. Overhead sports may include baseball, volleyball, javelin throwing, tennis, swimming or weightlifting but there are others out there as well.

What are some of the injuries that overhead athletes are prone to?

Dr. Kim Bauernfeind: Overhead athletes are prone to a variety of injuries based on the position of the shoulder and the arm during the repetitive movements. Our bodies are not naturally pleased with our arms overhead so when we do that –  motions such as throwing or whipping, hitting with a tennis racket – that places our arm at risk for external forces to cause injury to the shoulder. Some of these injuries that athletes are prone to include shoulder impingement within the joint, labral tears, muscle strains or muscle tendinitis, tendon tears and also shoulder blade instability. I’ll explain each of these injuries briefly so you can get an idea.

Shoulder impingement simply refers to compression of the structures within the shoulder during shoulder elevation –  like when you raise your arm overhead, this can cause pain and instability in the shoulder. The labrum is a soft, fibrous rim that surrounds the shoulder and helps to keep the shoulder in place and sometimes with overhead injuries, you can cause tears in this labrum which leads to pain and instability as well. When the shoulder is in a position overhead and repetitive forces are placed on it like throwing repetitively –  a pitcher – they can lead to muscle tendonitis and one of the common ones is the biceps muscle and this really is inflammation and it can be very painful and debilitating to an athlete. And then one of the other common ones is with the shoulder blade also known as the scapula. The muscles in the back of the shoulder can get over-lengthened and stretched out and the front of the shoulder actually will tighten up and this discrepancy can cause instability, pain and lack of coordination in the shoulders so that it places the athlete at a risk of injury.

Is there anything an overhead athlete can do to try to prevent these type of injuries?

Dr. Kim Bauernfeind: An injury prevention program should definitely be part of every overhead athlete’s training program. Exercises that include shoulder, shoulder blade, trunk mobility, stability and strength are essential to preventing injury in an athlete. A trained physical therapist can create a prevention program that is specific to the athlete’s sport. For example, a baseball pitcher’s preventive program may include mobility training to allow that athlete to obtain maximum range of motion in the shoulder and in the trunk so that they can achieve optimal position for throwing. It would also be beneficial to have a progressive strengthening program that would target this overhead position so that the athlete can build strength and stability in that position, preventing risk of overuse. By tailoring treatment to the athlete’s sport, there’s definitely a reduction in risk, injury.

After an injury is sustained, how do you determine the best treatment plan and what would be involved?

Dr. Kim Bauernfeind: When an injury to the shoulder complex occurs, pain, swelling and instability may be immediate symptoms that the athlete feels. My personal medical advice would be to have a medical professional exam the shoulder after the injury rather than just hoping it will go away over time because most likely, it won’t. Athletes with acute or chronic injuries can be examined by a physical therapist who is trained to assess the type and severity of the injury. After careful assessment and possibly conservative treatment, we can then determine if the injury requires the athlete to be referred out to an orthopedic doctor for further assessment or to obtain imaging via x-ray or MRIs.

What can happen to an athlete’s body if they ignore their pain or injury for too long?

Dr. Kim Bauernfeind: Ignoring symptoms and pain in an overhead athlete, it will most likely worsen the condition over time. Overhead athletes are prone to repetitive stresses on the arm and shoulder and if the pain or injury isn’t treated, it will just get worse, leading to a loss of function and definitely a loss of playing time. Many athletes come to see me months after the initial injury and when we start doing a treatment program, they regret having waited so long and say that they missed out on more time playing on the field. With overhead sports, when there is pain or injury, the body is telling you something.  It needs to change. The best advice I can give is to get treatment sooner rather than later so you can return to your sport.

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