“Overhead athlete” is a broad term that encompasses many different sports including baseball, volleyball, tennis, javelin throwers, softball and more. While swimming could be grouped in this series because it is an overhead sport, it will have it’s own topic series in the future. Most research studies have been performed on baseball players, however, the mechanics of throwing, as well as the findings in the literature, can be extrapolated to the other aforementioned sports.
In order to effectively treat an overhead athlete, the therapist will need to understand the neural/mechanical relationships that exist in the shoulder joint and assess movement quality during an overhead throwing/hitting motion. I will not be listing treatments for specific diagnoses in this topic series – they will be addressed as separate topics in the future. Here I will outline the basics of the overhead athlete through anatomy and include clinical considerations that will be followed up with subsequent posts in much more detail.
The shoulder is a complicated joint due to its 3 degrees of freedom in ROM as well as its connections to the thorax and upper extremity. It is also the third most commonly injured joint. It plays an important role in stability and mobility. The glenohumeral joint is a ball and socket joint, a direct connection between the humerus and glenoid of the scapula. The scapula sits on the posterior aspect of the rib cage, and therefore is an indirect connection to the thoracic spine – indirect due to no true joint surface between the scapula and ribs/T-spine. The scapula is also connected to the clavicle, through the acromioclavicular joint. This connection as well as the thoracic spine’s relationship to the cervical spine warrants a deeper look into the shoulder’s mechanical relationship to the cervical spine – as well as its neurological relationship through the brachial plexus.
The above only lists the direct, bone-to-bone, articular connections. However, in order to produce movement, there are many, many muscular and ligamentous connections. The superficial back muscles including, but not limited to, the latissimius dorsi, all 3 aspects of the trapezius muscles, the rotator cuff muscle group and many more all control motion of the scapula and have a role in overhead movement.
Not only should the overhead athlete’s shoulder be considered during treatment, we should also be looking at the client’s core and lower extremity strength as well. Through many sources including Tom Meyer’s “Anatomy Trains” book, we know that there is a connection between the shoulder and the opposite hip through fascial lines, both anterior and posterior. We also know, through video analysis and understanding of each of the above sports, that power and speed are generated through the hips and core. Therefore the core and both lower extremities cannot be neglected when rehabbing an overhead athlete back to their sport.
This is basic anatomy, however, the application of this basic information and formulating treatment can be tricky because there are many things to consider. When treating an overhead athlete, there are a few physical characteristics to consider; TOTAL arc of motion between external and internal rotation and comparing them Right to Left, quality of scapular motion, visual positioning of scapula, visual spinal postural assessment, and overall strength including hips, RTC, lower traps, and core muscles. Stay tuned for Part 2 in the Overhead Athlete series: Physical Characteristics of the Overhead Athlete.
Reinold et al 2014 Current Concepts in the Evaluation and Treatment of the Shoulder in Overhead Throwing Athletes, Part 1