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TRIA Sports Medicine:

The Female Overhead AthleteBreakout

Erika Sandell-Savor PT, DPT, SCSFebruary 2nd, 2019

Objectives

• Pearls for treatment

• Exercise progression

• My specific pearls for OH athletes

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Pearls for Treatment

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Deconditioned rotator cuff

SICK scapula syndrome

Glenohumeral internal rotation

deficit (GIRD)

Medial Elbow

Thoracic Spine

Cervical Spine

Pearls for Treatment

• Clear the spine and postural concerns

• Restore AROM and proper mechanics

• Strengthen and stabilize

• Sport specific considerations

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Set expectations

and make a plan

Exercise progression

• Supine or side-lying

• Favor eccentric activity

• Add holds

• Change angles/levers

• Change surface

• Add perturbations

• MAKE IT FUN!

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Exercise progression

• Videos of:

• Wall angel

• Ball dribble with perturbations

• Band for ER with wall slide or SA all 4’s

• SA punch trunk rotation sit up

• ER with isometric hold and alternation

• wall push up with alternating lift

• ER in side plank with or without ball tosses

• Tall plank knees to elbow on bosu

• Rotation planks

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Mechanics matter

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Mechanics matter

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Mechanics matter

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All overhead sports…

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Consider what the sport demands

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Use video, be a student, then a teacher

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Don’t neglect trunk and LE

Form is key Have them video their form at home too!

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Common form fails

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Case Study 1: Club to College VB player

• Diffuse anterior and lateral shoulder pain

• Severe, sharp pain at medial scapular border

• Pain for 2+ months that has gradually worsened past 3 weeks

• 8/10 pain after practice and games

• 4/10 pain at rest

• Pain worsens with prolonged sitting, serving, hitting, lifting OH

• Olympic lifting training at club is very painful

• PMH: Thoracic spine stress fracture (T7) 11 months ago

• National tournament is in 1 month

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What else do you want to know?

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Where do you start?

Club to College VB player: TREATMENT

• Soft tissue treatment to UT, LS, Rhomboids

• Mobilization of ribs 6,7,8

• Repeated thoracic extension (seated with rotation or foam roller)

• Trialed kinesiotape for volleyball activities

• Rotator cuff strengthening and scapular stabilization exercises

• Primary focus with LE and core exercises (all planes)

• Mechanics drills for serving/hitting

• Recommended Intelliskin shirt

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Case Study 2: HS softball short stop

• Plays on club and HS team (10 months per year)

• Diffuse anterior shoulder pain

• Worsens with throwing, lying on that side and OH lifting

• Strength 3+/5 with flexion, abd, ER

• Pain 5/10 with AROM in abduction (painful arc and ERP)

• Pain 2/10 ERP flexion and ER at 90/90 and at side

• Hair thinning, recent weight loss, but normal menses

• Lacks 30 deg of passive extension

• Diagnostic tests were unremarkable

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HS softball short stop: TREATMENT

• Soft tissue treatment to UT, LS, and Pecs

• Posterior shoulder mobilizations

• Repeated passive shoulder extension

• Cuff strengthening and scapular stabilization

• Video analysis of throwing mechanics

• Throwing mechanics drills

• Return to throwing program

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Case 3: Elite Gymnast

• HS Senior with full ride to Division I school

• 5 hours/day

• 3+ months of pain and recurring sx each of the last 3 years

• Rest x 2 weeks (twice without results)

• Not currently doing bars or vault

• Pain in the anterior shoulder, lateral arm, upper trap

• 7/10 pain with elevation

• Moderate scapular winging

• State and Regional Qualifiers are 6-8 weeks away

Elite Gymnast: TREATMENT

• Soft tissue treatment to UT, LS, latissimus, and LHOB

• Posterior/ Inferior shoulder mobilizations

• Cuff strengthening and scapular stabilization

• Repeated thoracic extension with cervical retraction/extension

• Modifications of training and graded return to floor, beam, vault and bars

• Gradual progression of closed-chain activity and body weight

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Case Study 4: HS Softball Catcher

• Elite club player (plays 10 months a year with club and HS)

• 9-12 games a week from May-August

• Recurrent shoulder sx the past 2 years, better after PT 1 yr ago

• Participates in hitting/catching sessions 2-3x/wk in off-season

• Anterior shoulder pain, dead arm sx, UT pain and headaches

• Pain 8/10 after first inning of play

• Rested 2 weeks without change, pain now 5/10 at rest

• Pain worsens with prolonged sitting, running, throwing, carrying

• 15 deg of total arc of motion loss

• MR shows SLAP tear (10-12) and tendinopathy at LHOB

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HS Softball Catcher: TREATMENT

• Soft tissue treatment to UT, LS, and Pecs

• Posterior shoulder mobilizations

• Repeated cervical retraction with extension

• Cuff strengthening and scapular stabilization

• Video analysis of throwing mechanics

• Throwing mechanics drills

• Return to throwing program

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Thank You!Erika Sandell-Savor DPT, SCS esandel1@fairview.org763-420-9960