Shoulder Injury Prevention Program For The Overhead Athlete

This article will go through a 7 Month, 3 Phase Shoulder Injury Prevention Program. This Program was designed for in-season handball players, however, these principles will apply for any overhead athlete. 

We have collaborated with Dr. Alex Cascone from Tennis Prehab Lab breaking down a study conducted in 2017 by Andersson et al. which examined the effects of shoulder injury prevention program implemented 3x/week during a 7-month handball season. The study was a prospective cluster randomized control trial that included participation of 45 teams equating to 660 players.

The program was developed to improve:
1. Shoulder internal rotation (IR)
2. Shoulder external rotation (ER)
3. Scapular muscle strength
4. Kinetic chain & Thoracic Spine mobility

5 exercises were selected & were employed as the teams’ warm-up &, took approx. 10 mins. to perform. These 5 exercises were progressed in 3 phases.

Impairments are similar for most overhead athletes including: Total shoulder rotation (ER>IR), ER weakness & scapula dyskinesis (faulty shoulder blade movement). This will cause anterior humeral head translation, posterior cuff tightness, chronic capsular stress ultimately resulting in potential rotator cuff & labrum pathology.

Results of this study demonstrated a 28% lower risk of shoulder problems & 22% lower risk of substantial shoulder problems in the intervention group compared with the control group who performed routine warm-up.

Phase 1 of 3: Weeks 1-6

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1. Push up plus w/ Trunk Rotation: 3 x 8-16 reps
a. Drive shoulder blades toward the floor & out
b. Maintain push up plus position, scapular stability during trunk rotation.

2. Standing Y with resistance band: 3 x 8-16 reps
a. Maintain neutral spine position
b. Do not shrug shoulders
c. ER shoulders (thumb pointed up) during arm elevation.

3. Quadruped trunk rotation w/ ball: 3 x 8-16 reps
a. Maintain neutral lumbar spine position
b. Maintain shoulder stability of grounded arm during rotation
c. Exhale as you rotate through the T/S

4. Sleeper Stretch: 3×30 second holds
a. Lie on side & ensure shoulder blade is blocked by ground
b. Gently press on hand to stretch the post cuff

5. Standing 90/90 ER: 3 x 10-20 reps
a. Maintain 90° at the shoulder and elbow
b. Maintain scapular stability (avoid shrugging shoulder)
c. Slowly lower med ball down to floor

Phase 2 of 3: Weeks 7-12

1. Push up plus plank with Passing: 3 x 8-16 reps
a. Drive shoulder blades toward floor “push up plus position”
b. Maintain shoulder & pelvic stability

2. Standing Bow and Arrow: 3 x 8-16 reps
a. Pre-position shoulders by lifting chest & pulling shoulders down back
b. Follow through w/ arm & trunk rotation

3. Wall Slide: “Dynamic Latissimus dorsi stretch”: 3 x 8-16 reps
a. Slide arms upward
b. Maintain forearms neutral or slightly inward
c. Maintain neutral spine

4. Partner Cross body stretch: 3×30 seconds
a. Maintain shoulder at 90°
b. Partner blocks shoulder blade from moving and moves elbow across body
c. Stretch perceived in back of shoulder

5. Drop and Catch: 3 x 10-20 reps
a. Keep elbow & Shoulder at 90°
b. Drop ball and catch quickly
c. Return to start position
d. Small .5 kg med ball to start.

Phase 3 of 3: Weeks 13-24

1. Push-up plus with backward slide: 3 x 8-16 reps
a. Drive shoulder blades toward the floor and out
b. Maintain neutral spine position and shoulder stability

2. D2 PNF Slow Arm Lowering: 3 x 8-16 reps
a. Preposition shoulder blades back and down
b. Rotate trunk with both arms to tension elastic band
c. Slowly lower band (eccentrically) across body engaging posterior shoulder musculature.

3. Wall Angels:  3 x 8-16 reps
a. Maintain forearms, head, sacrum and heel against wall
b. Maintain neutral cervical & lumbar spine position

4. Partner Cross body stretch: 3 x 30 seconds
a. Maintain shoulder at 90 degrees
b. Partner blocks shoulder blade from moving and moves elbow across body
c. Stretch perceived in back of shoulder

5. Reverse catch PNF D2 Diagonal Pattern: 3 x 10-20 reps
a. Pre-position shoulder blade back and down
b. Catch ball with thumbs pointing behind you
c. Slowly lower ball across body with thumb down position.

Of note, this is not a steadfast program. In other words, the exercise showcased are not the end all be all. Instead, this article highlights the importance of implementing a comprehensive shoulder prehabilitation program that addresses 1. Scapular muscle function and control 2. rotator cuff muscle function 3. common flexibility and mobility deficits of the overhead athlete (i.e. posterior cuff tightness). Lastly, once appropriate exercises are selected, it is imperative to adhere to the program for optimal adaptation.

This Program is not designed to prevent all shoulder injuries, however it has been shown to mitigate risk of shoulder injuries.

If you want more on Shoulder Prehab, check out Tennis Prehab Lab!

Citation:
Andersson, Stig Haugsboe, et al. “Preventing overuse shoulder injuries among throwing athletes: a cluster-randomised controlled trial in 660 elite handball players.” Br J Sports Med 51.14 (2017): 1073-1080.

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