Article by Jason Lau

WHAT ARE OVERHEAD SPORTS?

A sport in which the arm and shoulder arks above an athlete’s head is defined as an overhead sport. Volleyball, badminton, tennis, swimming and baseball all fall under this category. As someone who has been involved in volleyball, badminton and swimming, as well as coached volleyball and badminton athletes, I encourage a holistic approach to every strength & conditioning program to mitigate non-contact injuries. By managing load from training and practise strategically, injury mitigation and athletic performance can be achieved in a synergistic manner.

PROBLEMATIC AREAS

The shoulder and elbow joints are often common problematic areas seen within overhead sports. The force from frequent movement patterns such as throwing, spiking and smashing can be the cause of impingement and overuse injuries. The section below identifies the possible causes of these injuries.

SHOULDER

Injury:

Shoulder Impingement – when a tendon or tissue is pinched between the humerus and the socket of the shoulder due to swelling leading to less space for the rotator cuff tendons as the shoulder moves within certain ranges.

Causes:

This injury is caused by repeated exposure to high concentric and eccentric forces during spiking, smashing and throwing movements. Other contributing factors can be weak external rotators and weak supporting musculature developing imbalances and instability within the shoulder joint of the athlete.

The decrease in space between the shoulder joint and humerus (impingement) will greatly affect range of motion leading to mobility restrictions. Mobility restrictions can also be affected from inflexible latissimus dorsi and pectoralis muscles hindering shoulder/scapula movement resulting in poor sport specific positions.

ELBOW

Injury:

Epicondylosis. (2014, November 20). Retrieved April 11, 2020

Golfers (medial epicondylitis) and Tennis (Lateral epicondylitis) Elbow – Inflammation, pain and/or impaired function of the epicondyle and the tendons that attach to the elbow.

Causes:

This injury is usually caused by repetitive trauma of external forces applied to the elbow during the acceleration phase of spikes/smashes/throws. Chronic stress overload to the joint, surrounding musculature and tendons causing inflammation of the epicondyle.

Mitigation Principles

Overuse and overloading are factors that contribute to common injuries in overhead sports. That means strength needs to be addressed so the joints and tendons are strong enough to handle the work capacity it is given.

The key to a successful S&C program is inducing the right amount of training stimulus for adaptions but not too much where it will fatigue the athlete and take away from their sport specific practice. To determine this, a form of athlete readiness monitor or assessment similar to the one shown below (Taken from one of my S&C programs) can be helpful in making these decisions.

Load management

Load management is a balance between training, competition/practice and recovery. This needs to be exercised correctly, closely monitored and adjusted on a daily and weekly basis to reduce negative effects of intensive training. If practice has taken a toll on the athlete’s body/joint, then scaling back intensity and/or volume in the weight-room will be necessary. The opposite also holds true. If the athlete is well recovered, increasing load can be prioritized if it does not negatively affect sport specific practice later in the day/week.

Below are several methods that can be used to monitor and aid load management for an athlete.

Daily/Weekly Monitoring and Active Athlete Feedback: Communication is key between a coach and an athlete. Something similar to Table 1 can be used to assess the athlete prior or post training. If the athlete is reports signs of fatigue, then a last minute adjustment in their training is made to accommodate by reducing training load.

Obtaining the athlete’s post-training feedback one or two days later, is just as crucial. This will tell the coach how the athlete responded towards their training and what further adjustments requires to be made.

RPE and sRPE: Rate of perceived exertion or RPE, is a scale used to quantify the amount of effort used during physical activity. Session RPE or sRPE, is a scale for effort used for the session as a whole. For those unfamiliar with the RPE scale, I have provided a table below that will provide further explanation.

Sets/loads or sessions that rank higher on the RPE scale will require longer recovery periods. Programming activities on the higher end of the scale will need to be exercised strategically. Additionally, if an athlete reports a sudden increase in RPE regarding an exercise targeting the problematic areas, adjustments should be made to lower the risk of injury.

Play Duration and Workload Increase: Sudden increases in practice and workload places athletes at a higher risk of injury. The ability to sustain higher loads has to be achieved gradually. Monitoring both playtime and workload in the weight-room will indicate when and what adjustments can be made to maintain a healthy athlete. If an athlete’s feedback indicates that there was a high focus on throwing, spiking or smashing during a long practise, then workload will need to change to reduce risk of overuse.

Mitigation Movements

While managing training load, it helps to further categorize exercises and movements into three different categories:

Slow Velocity: Aimed to reinforcing and strengthening the musculature surrounding the problematic area(s).

High Velocity: Higher velocity movements which is the most effective method in strengthening the tendons as well as mimicking the speeds seen in sports.

Isometric/Holds: For stability purposes around the localized joint.

To be clear, this is not for rehabilitation as athletes who are already suffering from injury should have a coach and/or a specialist treat it. If you are looking for any sort of rehabilitation or return-to-play coaching and programming, please click here.

Shoulder

Slow Velocity: Face-pull (see video below), External Rotation & Press (see video below), Overhead Press (any variation), any form or horizontal Rowing, body weight or weighted Push Ups.

High Velocity: External Rotation Catches (see video below).

Isometric/Holds: Overhead Carries, Shoulder & Toe Taps, Kettlebell Windmills.

Elbow

Slow Velocity: Forearm Curls, Kettlebell Wrist Turns (Supination to pronation) (see video below), DB Holds with rotations, Grip trainer.

High Velocity: Weighted Flips/Catches (see video below).

Isometric/Holds: Heavy Carries, any form of heavy rowing to challenge grip strength.

Compound exercises should be placed at the beginning of the training session to capitalize on strength adaptions for the specific movement pattern and muscle group. Performing exercises using all three velocity categories are imperative as each category targets a specific goal.

Wrapping It Up

Injury mitigation and strength training go hand-in-hand. By improving on an athlete’s strength, we make the athlete more robust. The athlete can then handle a higher capacity of stress becoming less susceptible to the forces applied in sport. Mitigation should not be viewed separate from an S&C program, but as an integral part within. We cannot completely eliminate the risk of injury but we can minimize the chances by manipulating variables in training (intensity, volume and frequency), by utilizing proper load management. Each exercise prescribed within a program should always lead back to the question of “How will this contribute to the overall goal of athletic development?”

Here are the principles to follow when mitigating injury:

Closely monitor and adjust training stimulus on daily/weekly basis
Include all three velocities in the S&C program to address all weaknesses
Increase workload gradually to sustain healthy development

Read part two of my Mitigating Injury Series - “Mitigating Injury in Jumping Sports”

For Strength & Conditioning Coaching, Personal Training and Powerlifting Coaching, please click here for more information or visit my Coaching Services up top. If you have any questions, please do not hesitate to contact me via email or Instagram.

References

Pitcher’s elbow: medial elbow pain in the overhead-throwing athlete. (2016, June 1). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4896887/
Prevention of shoulder injuries in overhead athletes: a science-based approach. (2015, September 1). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4647145/
Horschig, V. A. P. B. D. A. (2019, May 20). The Lifter’s Guide To Elbow Pain. Retrieved from https://squatuniversity.com/2019/04/05/the-lifters-guide-to-elbow-pain/
Horschig, V. A. P. B. D. A. (2019a, April 1). Stabilizing the Shoulder Blade & Joint. Retrieved from https://squatuniversity.com/2018/10/06/stabilizing-the-shoulder-blade-joint/
Horschig, V. A. P. B. D. A. (2019b, April 1). Why We Develop Shoulder Pain. Retrieved from https://squatuniversity.com/2018/07/19/why-we-develop-shoulder-pain/
Gazzano, F. (n.d.). How to Fix the 7 Most Common Load Management Mistakes in Sport. Retrieved April 14, 2020, from https://simplifaster.com/articles/load-management-sport/
ENERGY SYSTEM DEVELOPMENT AND LOAD MANAGEMENT THROUGH THE REHABILITATION AND RETURN TO PLAY PROCESS. (2017, August 1). Retrieved April 14, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5534159/
Epicondylosis. (2014, November 20). Retrieved April 11, 2020, from http://www.vereencenter.com/eliminating-elbow-pain/epicondylosis/
Hunt, J. H. (2016, February 16). Shoulder Impingement Syndrome (SIS) [Photograph]. Retrieved from https://www.pilates.org.au/shoulder-impingement-syndrome-sis/

MITIGATING INJURY IN OVERHEAD SPORTS