The second injury I want to highlight in our list of volleyball injuries is shoulder pain in a volleyball player. This usually occurs in the arm that is used for attacking and serving and is due to the repetitions in volleyball. Throughout the season, players swing at a volleyball thousands of times. This includes warming up for practice, during practice, during matches, and the swings that are taken outside of the gym. That is a lot of swings and it makes sense this is a relatively common complaint. 

Shoulder Exercises for Volleyball Players

Before we jump into the individual shoulder exercises, I wanted to explain the rationale about why the chiropractors at Elite Sport & Spine rehab shoulder pain in volleyball players (specifically the adolescent player) a certain way. 

First of all, for most of these players, mobility of their shoulder joint is not an issue. Which means shoulder pain won’t be resolved by stretching. With the volume of attack and serving the players do throughout each practice or game, their swinging shoulders are being taken through a large range of motion, repeatedly. The player’s body becomes accustomed to this range of motion and our mobility increases. 

In addition to that, the shoulder joint itself is a highly mobile joint to begin with. The glenohumeral (shoulder) joint is an extremely shallow ball and socket joint, when compared to the hip, which allows it to move freely in many directions. This usually only changes due to our bodies response to trauma (adhesive capsulitis) or congenital defects. So, in volleyball players, the solution to a shoulder pain problem isn’t to make a highly mobile joint, more mobile. Our solution is to: improve rotation through the mid back, build strength in the muscles around the shoulder joint, AND improve biomechanics of the arm swing itself. 

Thoracic Spine Rotation

The first exercise provided in the video is a variation of a thoracic spine rotation exercise. If you look at videos or images of some of the best rotational sport athletes in the world (golfers, volleyball players, etc.), they all have a tremendous ability to rotate through their thoracic spine (the area between the neck and lower back).

Doing this allows the athlete to generate more rotational power, which means hitting the ball further in golf, or faster in volleyball (I think everyone would like that!). In a volleyball player, as seen down below, the player is able to rotate through his thoracic spine, allowing his left shoulder to come forward and his hitting shoulder to rotate backwards, similar to drawing back a bow. If a player is unable to rotate well through the mid back, they are solely relying on the muscles around the shoulder joint to generate more force to transfer into the ball, rather than some of the rotational trunk muscles. This can put more load on the shoulder joint and the surrounding structures, thus leading to symptoms. 

So, I like to start with a thoracic rotation exercise to get the player used to rotating in this fashion. I generally recommend the individual to sit their butt back to their heels, because this can help limit motion through the lower back, pelvis, and hips. 

Open Book Exercise

The second exercise is a difficult progression, but one that allows the player to begin to control motion through the affected shoulder by building up strength. We like to begin with the player pushing the downside arm into the table. This is going to create an isometric contraction of the rotator cuff muscles and some of the other muscles affecting the shoulder joint. An isometric contraction refers to contraction of a muscle, but no movement of the joint it affects. 

From this, we try to move the body around the shoulder joint, so the player will progress to an open book exercise. This will begin to challenge their shoulder stability as we introduce movement of the body, while keeping the shoulder stable. The progression after this will be a shoulder uprighting exercise. Here, the player will use many of the muscles around the shoulder joint to lift their upper body off the table, and then lower it back down. There will also be an introduction of internal and external rotation of the shoulder, which is an important requirement of a volleyball swing.

A necessary component of rehabbing shoulder pain in any overhead athlete is strengthening the shoulder in the overhead position. I like to use a banded facepull to overhead press because the initial pull simulates the drawback of a volleyball swing really well. From there, we are challenging external rotation of the shoulder joint as we reach the arms up over head. Having strong, adequate shoulder flexion and external rotation is necessary for a volleyball player, and they are both addressed in this exercise.

Bear Progression

The final exercise is going to be a bear progression. Bear is an exercise where a person goes from a quadruped position (on hands and knees) and comes up on their toes to hover the knees about 2-3 inches off the floor. This exercise is great to strengthen the serratus anterior muscle, which is the prime mover of shoulder blade protraction (the opposite of pinching your shoulder blades together). In order to get the arm up overhead in the arm swing, the shoulder blade has to move out and up to create some space for the upper arm bone. The serratus anterior is an important muscle in that motion. 

To start we will have the player hold this bear position for time to build some endurance in the serratus anterior. Then, the player will begin to transition from bear to a “high bear” position, which will train some upward shoulder blade rotation. Lastly, once “high bear” becomes too easy, the player can hover a hand off the ground, which will challenge individual shoulder stability. 

The player can perform these exercises as both a warm up to practice and matches, but also during this down time. 

This blog was written by Dr. Adam Cosson.