Thursday, December 25, 2014

Stretching to prevent shoulder and elbow injuries

The shoulder is a complex body part made up of 4 different joints, each of which is vital for proper movement and performance.

Stretching to prevent shoulder and elbow injuries


The shoulder is a complex body part made up of 4 different joints, each of which is vital for proper movement and performance. In my last post, we discussed the importance of scapula (shoulder blade) strength for overhead sports.

Scapula strengthening and flexibility addresses movement at one of the 4 shoulder joints, the scapulothoracic joint, which is where the scapula and thorax (rib cage) meet. When the shoulder blade moves properly over the rib cage, the scapulothoracic joint is performing optimally. Each joint has a significant role in shoulder movement, with the glenohumeral joint playing an integral role.

When the shoulder is discussed in general terms, it is the glenohumeral joint that is often being referenced, the area in which the humeral head (ball) rotates in the glenoid fossa (socket). Two major actions occur at this joint, stability and mobility. When the shoulder complex works properly, the rotator cuff muscles work to stabilize the ball within the socket. Often, however, the soft tissue (muscles, tendons, and capsule) become excessively tight leading to decreased motion of the shoulder.

The most common form of shoulder tightness occurs in the back or posterior shoulder. This is known as glenohumeral internal rotation deficit or more commonly as GIRD. GIRD often occurs with everyday activities, and contributes to various shoulder conditions including rotator cuff strains/ tears and shoulder impingement. GIRD is even more common in baseball, swimming, tennis, and overhead sports and leads to a host of conditions in the shoulder. GIRD’s relationship to preventing and rehabilitating shoulder injuries has been extensively studied and researched. Preventing and correcting GIRD is imperative to properly care, train, and rehabilitate athletes participating in overhead sports.

Preventing and reducing GIRD can be performed multiple ways:

  1. Posterior capsular, muscle stretching, and various manual therapy techniques performed by a qualified clinician;
  2. Assuring proper thoracic (rib and upper body) positioning via good (diaphragm) breathing techniques (which I will discuss in future posts) and;
  3. Performing a self-stretching technique known as the Sleeper Stretch. The Sleeper Stretch is easy to perform and is very effective in reducing posterior shoulder tightness. It can be performed in most populations from youth baseball players to older individuals.

The most important part of the sleeper stretch is to assure that the stretch is felt in the back of the shoulder. If pain or stretching is felt in the front of the shoulder, do NOT perform the stretch!  Consult with a qualified clinician to discuss if the Sleeper Stretch is the right technique for you.

Scapula weakness, GIRD, and poor mechanics are leading predictors of shoulder and elbow injuries in athletes. With the presence of each, the risk of injury greatly increases. Upper extremity injuries can be reduced and rehabilitated by assuring good motion which often includes the Sleeper Stretch.

Sleeper Stretch instructions
Start the stretch by lying on your side, with your elbow at a 90 degree angle, directly across from your shoulder. Place your head on a pillow to keep your spine straight. While keeping your weight on your shoulder blade, gently lower your forearm with your opposite hand. You should feel a light stretch in the back of your shoulder. Hold for 30 seconds and repeat 3 times. Perform the Sleeper Stretch on your opposite side to compare tightness. Repeat the stretch 2-3 times per day until the right and left shoulders are equal.

Read more Sports Doc for Sports Medicine and Fitness.

Brian Cammarota, MEd, ATC, CSCS, CES Partner at Symetrix Sports Performance
About this blog

Whether you are a weekend warrior, an aging baby boomer, a student athlete or just someone who wants to stay active, this blog is for you. Read about our growing list of expert contributors here.

Brian Cammarota, MEd, ATC, CSCS, CES Partner at Symetrix Sports Performance
Ellen Casey, MD Physician with Drexel University Sports Medicine
Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
Michael G. Ciccotti, M.D. Head Team Physician for Phillies & St. Joe's; Rothman Institute
Julie Coté, PT, MPT, OCS, COMT Magee Rehabilitation Hospital
Peter F. DeLuca, M.D. Head Team Physician for Eagles, Head Orthopedic Surgeon for Flyers; Rothman Institute
Joel H. Fish, Ph.D. Director of The Center For Sport Psychology; Sports Psychology Consultant for 76ers & Flyers
R. Robert Franks, D.O. Team Physician for USA Wrestling, Consultant for Phillies; Rothman Institute
Ashley B. Greenblatt, ACE-CPT Certified Personal Trainer, The Sporting Club at The Bellevue
Eugene Hong, MD, CAQSM, FAAFP Team Physician for Drexel, Philadelphia Univ., Saint Joe’s, & U.S. National Women’s Lacrosse
Martin J. Kelley, PT, DPT, OCS Advanced Clinician at Penn Therapy and Fitness, Good Shepherd Penn Partners
Julia Mayberry, M.D. Attending Hand & Upper Extremity Surgeon, Main Line Hand Surgery P.C.
Jim McCrossin, ATC Strength and Conditioning Coach, Flyers and Phantoms
Kevin Miller Fitness Coach, Philadelphia Union
Heather Moore, PT, DPT, CKTP Owner of Total Performance Physical Therapy, North Wales and Hatfield, PA
Kelly O'Shea Senior Health Producer,
Tracey Romero Sports Medicine Editor,
David Rubenstein, M.D. Team Orthopedist for 76ers; Main Line Health Lankenau Medical Center
Robert Senior Event coverage, Sports Doc contributor
Justin Shaginaw, MPT, ATC Athletic Trainer for US Soccer Federation; Aria 3B Orthopaedic Institute
Thomas Trojian MD, CAQSM, FACSM Associate Chief of the Division of Sports Medicine at Drexel University
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