Sunday, November 29, 2015

Shoulder Pain in Overhead Athletes and Hip Tightness

Although my main focus is injury prevention for runners, I want to address an area of concern I see in the clinic with overhead athletes (athletes who have to bring their arm above their head). Shoulder and elbow injuries are very common in overhead athletes such as baseball players and volleyball players. Rehab typically focuses on the injured shoulder or elbow. However, for a complete recovery, assessment of the whole body must be performed. Otherwise, the injury will linger or affect another body region.

Example 1

Patient presented difficulty lifting his left arm to his ear after a work injury. We focused on his shoulder but the last bit of motion remained painful and limited. I noticed his right leg position rested outward when he was lying on his back. As a result, I decided to take action on his hip mobility. I stretched and mobilized his hip to allow for more neutral position. After 5 minutes of stretching and mobilizing, he had full pain free shoulder motion.

Shows foot pointed outward
as a result of tight hips
Picture shows fascial connections between the
 hip/pelvis and the shoulder girdle
Picture from Born to Walk: Myofascial
Efficiency and the Body in Movement
by James Earls


Our body is held together by connective tissue which connects our muscles so our body can work together as a system. Tight hip flexors will stiffen the anterior aspect of the trunk and turn the leg outward. This tightness will increase the tension when lifting the arm overhead.

Try This: Raise your right arm overhead and take notice of how your shoulder feels. Now, with the left hand grab and hold the bottom corner of your shirt in your hand. How does it feel? It should feel harder to lift your arm.

Hip Flexor Stretch

Adding arm movements to your stretches allows you to capture the 3 planes of motion, target different angles of the muscles, and ultimately provides a more comprehensive stretch. After the stretch, I recommend performing high knee marches at different angles to activate the newly stretched muscle tissue.

Example 2

A baseball player has shoulder pain only when he pitches. Standard treatment would address his tendonitis. After checking his hip rotation in a standing position, he has limited external rotation of his right hip. Performing joint mobilizations to provide more external rotation eliminates his shoulder pain while throwing.

Pitching Mechanics 

The top video shows pitching mechanics with a throwing warm up but before hip flexor stretching. The bottom video shows pitching mechanics with a throwing warm up and hip flexor stretching. Notice the difference in mechanics. The bottom video shows improved hip opening, shoulder position upon release, and improve knee flexion during the follow through.


Proper throwing mechanics require the right hip to rotate throughout the movement. When this motion is limited,  the trunk stops rotating and the shoulder has to absorb the energy.

To loosen the hips to prepare for pitching, I recommend hip flexor stretches in all 3 planes. As a follow up, perform a lunge matrix focusing on the rotational lunge.

Bottom Line

These examples demonstrate how the hip can affect the shoulder in everyday tasks and in overhead athletes. The body is connected and works as a system. We need to find the source of the problem and not just treat symptom.

Sunday, November 15, 2015

Knee Pain: The Adductors Role

It's the last several weeks before the big marathon. You're out for your 20 mile run and feel great. BAM at mile 11, an ache develops at the side of the knee. You try to ignore it. You try to run it off. But it gets worse. You have to do the walk of shame home.
A basic Google search brings up ITB tendonitis. You foam roll your ITB, you ICE and you do glute strengthening. Your knee pain is slightly better but is still nagging. What is causing this continue?

A running analysis reveals something unexpected.

The left leg lands under the center of the body. However, the injured leg drifts towards OVER the center of the body when it hits the ground. Each time the foot lands the ITB is getting injured.

What can cause this?

Adductor mobility

Adductor muscle group. Thieme: Atlas of Anatomy General Anatomy and Musculoskeletal System

Left: normal running position Right: Tightness of the left adductor
bringing the right leg closer to midline as it lands.
A closer look at her adductors revealed the UNINJURED leg lacks 15 degrees of mobility. The trail leg extends behind the body AND is stretched sideways from the body. Lack of mobility of the adductors of the trail leg pulls the front leg laterally. When the leg hits the ground it lands under the center of the body. This will put a stretch stress to the lateral side of the leg. The connective tissue of the out side of the leg gets over stretched causing ITB tendonitis.

Adductor Stretch

Place one foot up onto bench with foot turned away with the knee bent. Shift body weight towards the bent knee to feel stretch on the inner thigh. Drive hip forward and backwards, side to side and twist. 

Follow up the stretch with a tri-plane lunge. This will help keep the adductors strong and mobile.

The next time your ITB flares up, take a look at your adductor mobility.