Resolving Shoulder Pain in Overhead Athletes By: Karli Sewell

Odds are if you train overhead athletes you have dealt with numerous cases of shoulder pain. No matter the circumstances, minor or major, acute or chronic, our job as performance coaches is to re-establish a baseline of shoulder health. 

For overhead athletes, a well functioning kinetic chain is the medium in which shoulder health exists. Too often we address the shoulder itself –  re adjusting scapulae positioning, establishing glenohumeral rhythm, etc.  – without taking into consideration how the athlete is utilizing their kinetic chain to reach an overhead position. Take into consideration an athlete that struggles to maintain an overhead position due to a lack of strength in their lumbopelvic region,  prescribing shoulder movements would be the last thing we address and the first would be lumbopelvic strength. 

Start with the assessment. If you haven’t screened your athlete to see where their mobility challenges are, or what stability issues they’re facing then you’re practically solving a puzzle without knowing what the end result should look like. Reverse engineering movements and finding the root of an athlete’s pain can only be done when we know exactly what we’re aiming for. Post assessment you may find that the athlete needs little to no change in their workout and more work on mobility in their daily warm ups.  

When it comes to prescribing movements, sets, and reps – keep in mind a) the needs of the athlete b) the challenges of the athlete c) the training age or proficiency of lifting skill in the athlete 

kinetic chain

Let’s go over a case study example together: 

“Athlete X” is a softball pitcher who struggles with latissimus dorsi mobility, hip flexion, and tilting her pelvis posteriorly and anteriorly. She has been lifting in high school for a year now and performing only bilateral movements. 

The struggle to get into hip flexion, overhead position, and pelvic tilting tells me automatically that we are dealing with major trunk stability issues. Her background in lifting tells me she’s experienced and probably fairly strong so loading her up with weight won’t be an issue but rather how we do it will be the challenge. 

                                                        Here’s the game plan:

A1) Heel Elevated Goblet Squat 5×5 B1) 1KB Offset Split Squat 3×5/side w/Tempo
A2) Side Plank Hold 4x5breathes per side B2) Bear Crawl External Rotation 4×4/side
B3) 2DB Chest Supported Incline Row 4×4 w/Tempo

proximal distal

Anytime I program, I always work proximal to distal. Front loading stability allows better kinesthetic awareness to occur throughout a training session – in this specific case scenario I’m front loading pelvic stability and targeting scapulae stability last. The amount of sets for the goblet squat ensures that the load is heavy and lays a base to allow her distal segments to unlock. When we attack the scapulae in the last portion of this session we are aiming for low reps with heavy weight and a tempo – both of which are solid ways to address motor learning changes and increase muscle hypertrophy.

Next time you have an athlete struggling with shoulder pain, use that opportunity to dive deeper into their movement profile and build a game plan that emphasizes building a foundational structure from the ground up to support their workload overhead.