Here is the scenario:

17 year old female volleyball player
plays club and school alternating seasons
no other sports
Pain in anterior shoulder
go through normal muscle eval
pain on Speed’s test
pain with Yergason’s

Start with heat and ROM exercises
Progress to body weight exercises
Then to t-band exercises

Pain free return to play in about 4 weeks

There are lots of other treatment types we did not do, and likely some evaluations we forgot.  One way to improve is to look back, but here we do it with the help of some of my friends and injury experts.

Contact Josh Ogden
Email:

Contact Mike McKenney
Email:

Show Notes 195

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Tri-Planar performance above T8 requires stability and control of sagittal and frontal plane movements at the pelvis/hip (below T8)
Scapular position is directly related to orientation of Rib-cage over pelvis
Finding reference centers for landing mechanics
Fatigue
Lack of Upper thoracic movement variability (need Subscap/Serratus/Low Trap)
TRICEP facilitation
In the air, you shoulders become your hips, you need controlled mobility
Thoracic mobility is essential for overhead motion
Pec inhibition

Is it really bicep tendonitis?

Differential Diagnoses:

Thoracic Outlet Syndrome
Rotator Cuff/Supraspinatus
Deltoid
Trigger/Tender point referral pattern from infraspinatus/anterior deltoid
Scap Dyskinesis w/compensatory HG IR = “impingement”?
etc.

Concurrent findings:

Overall Hx
Overall tension (e.g. chronic upper trap contraction)
Breathing patterns esp. c/restriction upper R chest?

Neck breather w/rib cage elevation?

Overall posture

Slumped shoulders?  Kyphotic?  Lordotic? etc.
Forward head/posterior rotated head posture?
Shoulder height variance?

Spinal rotation/curvature
Rib cage/thoracic positioning & mobility
Pelvic stability?
FA IR/ER & Flex limitations?

Imaging - Musculoskeletal US or Arthrogram?
Injections?  Relief or no?

Treatment (I use PRI techniques mixed with a lot of traditional techniques, but use whatever you have in your toolbox)

Frontal Plane control thru pelvis and Transverse plane control thru thorax
Rib cage mechanics

Breathing pattern retraining (or manual techniques) as needed to restore IR/ER & remove restrictions

Restore thoracic rotation
Improve Scap Positioning

Inhibit Pecs, lats, upper traps, etc. as needed

Pec minor involvement?

Low Trap & Tricep First
Serratus Anterior

Make sure scap is moving on thorax due to SA activation, NOT Pec activation

SA moves scap on thorax
Pec reinforces anterolateral tilt

Subscapularis
Contralateral side

Low Trap/Tricep
SA
Subscap
No injury is unilateral.  Rehabilitate bilaterally.

Compensatory thoracic rotation, pelvic obliquity, etc. needs to be addressed.

RTP considerations

Hitting program

Pay attention to core engagement with hitting
Flying open into extension reduces scap control

Jumping program

Poor jump mechanics places the arm in a poor hitting position before the arm motion even starts
Poor landing mechanics increase injury risk as well as neurological apprehension = decreased power output and increased stress on LHBT, Cuff, etc.