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Don’t Shrug off Shoulder Pain


As young athletes return to hitting volleyballs, throwing baseballs and softballs, and other overhead activities, there are going to be some sore shoulders out there.

The shoulder is a pretty amazing set of joints that allows for a complex range of movements. While there are many possible causes of shoulder pain, there are three main issues that tend to be seen in young athletes. I’ll emphasize that “seen” part because each has a visual that is pretty apparent even to the relatively untrained eye.

Click here for a video that will help you also “see” those main issues

Let’s take the opportunity to review each one, and also make predictions on when parents and coaches will see them as athletes make their comebacks.

1) Your posture stinks

There’s little doubt that this will be the first problem to arise.
Well, how have kids been spending the last several months?
Does this position look familiar to your child (or to you as well)?

The need for increased device/screen time often leads to poor posture with the head, neck and shoulders all tightened up in a more forward position. Throw in growth spurts that often happen when kids take time away from sports (due to more sleep and calories being dedicated to growth instead of exercise) and there you have it, a tight front of the chest.

This tightness tends to be at the coracoid process which comes off the scapula (shoulder wing bone) with the attachment of the pectoralis minor and short head of biceps muscles. It’s often not hard to find the coracoid in an overhead athlete with poor posture – push on the front part of the shoulder and when the child jumps or grimaces, you’ve found it.


Tightness at the coracoid will limit reaching up or backward to start a throw or overhead hit. As a result, there will be less accuracy and speed.

Taking the time to stretch the front part of the chest will help reduce this problem.

If not corrected, not only will hits and throws look bad, but then problem #2 will start to show up.

2) Your scapula is SICK

Those tight muscles in the front of the chest will also affect the scapula position in the back of the shoulder.

Pull on the coracoid, and the scapula responds by being rotated into an abnormal position on the chest wall.

If the muscles that support the scapula are appropriately able to respond, then this rotation may not occur, or only have a small change in position. However, if those same muscles are weak (like let’s say from a few months of inactivity) or get tired too quickly (perhaps from rapidly amping up overhead work), then that bad position is a bigger issue that shows up after a few weeks into new or increased activity.

To see if you are dealing with a SICK scapula, take a look at your athlete from behind. Ideally, the top of both shoulder blades should be on the same level and the distance between the inner border of the scapula and the spine should be even.

ACtiveKid Shoulder

SICK scapula is actually an acronym for overuse and fatigue of the muscles that support the scapula and shoulder. The SICK scapula is often down and out compared to the non-throwing/overhead hitting arm.

Now, for some reason, teenagers (I have 3 at home, so pretty aware of their lingo) seem to use “SICK” as a positive. Well, this type of SICK isn’t too positive, especially when there now is pain along with weakness when overhead hitting or throwing a ball.

Once again, specific exercises can build up the scapula support. In order to properly build up that strength, there might have to be several weeks off from activity, which can be a major bummer after waiting for months to get back at it.

The untreated SICK scapula can be selfish and contribute to problem number 3.

3) Poor ability to follow-through on what you’ve started

Those muscles that support the scapula are not just there to maintain proper position. They also help slow the arm down as it goes through the follow-through.

If those muscles aren’t doing the job, then over the course of several weeks, the capsule that surrounds the glenohumeral (ball and socket) joint becomes tighter.

A tight capsule leads to less follow-through which can affect both the shoulder and elbow as illustrated by these pictures.

Photo three: Limited left shoulder internal rotation or follow-through

Now, don’t go looking for a tight capsule or limited follow-through when an athlete first returns to activity.

If anything, rest allows for correction of internal rotation issues. Studies of throwers and other overhead athletes after an off-season often show both shoulders have even amount of internal rotation.

So yes, this might be one potential problem that actually got better over the prolonged break. However, those same studies showed that with a usual progression of shoulder use, internal rotation limitations on the dominant hitting/throwing arm commonly show up weeks or months down the road.

In fact, specific stretching programs have been developed to reduce the loss of internal rotation. If these programs are recommended in more “normal” times, then you can imagine how important they might be after abnormal periods of downtime.

So now you can play detective and identify potential issues hopefully before they reduce accuracy and speed of throwing and overhead hitting, cause pain, or worse off force a child back on the sidelines.

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Athlete Health