Who hasn’t been bit by the pickleball bug? This fast-paced sport has exploded in popularity in recent years. As a physical therapist, I’ve enjoyed seeing this rapid growth. It gives people of nearly all ages and abilities a fun way to get active.
With this growth in popularity, we have unfortunately also seen an increase in injuries. Specifically, shoulder health is one of the main areas I’ve personally seen a spike in injuries. These injuries are typically treated with physical therapy, but, ideally we can prevent many of these injuries from even happening in the first place! Listen up for some up to date information on how to unlock your shoulder health and prevent injury as a pickleballer.
Shoulder Health Anatomy and Biomechanics
First, let’s discuss the shoulder. The shoulder is made up of three main bones: the clavicle, the scapula, and the humerus. These three bones then create four joints of the shoulder girdle: the sternoclavicular joint, the acromioclavicular joint, the glenohumeral joint, and the scapulothoracic joint.
It’s important to note that the scapulothoracic joint is not a “true” joint. It doesn’t have a joint capsule, or synovial fluid (the lubricant present in other joints). It simply describes the motion of the scapula over the ribs and thoracic spine. It’s also important to note that the only true attachment of the shoulder girdle to the thorax is with the sternoclavicular joint on the sternum. These two points are key reasons why the thoracic spine is so integral to shoulder health.
The Hidden Culprit: The Thoracic Spine
The thoracic spine is situated in the upper and mid-back region, and is a key player in shoulder function. Thoracic mobility refers to the ability of the thoracic spine to move freely and efficiently. Our thoracic spine provides flexion, extension, and rotation – all of which assist nearby areas to move properly, especially our shoulders. Most of us have mobility restrictions here, in part due to a society which spends a lot of time on our computers and phones.
Insufficient mobility in the thoracic spine forces the shoulders to compensate for the lack of movement. This compensation places extra stress on the shoulders. When we are tight in one area we often “steal” movement from an adjacent area. Consider the dynamic rotational nature of pickleball. When our body rotates, 45 degrees of this rotation comes from the thoracic spine. Moves that require this rotation are: serves, forehand, and backhand. We also extend 20-30 degrees in our thoracic spine, which aids in rotation but also comes into play for hitting anything overhead. We can see how freeing up our thoracic spine will ensure we don’t place extra stress on our shoulders.
Try it out!
To show you how important the thoracic spine is for shoulder range of motion, try this example. Sit down and slouch forward with poor posture. Make sure to create rounding in your mid back. Now, try to raise your arm overhead. Notice how you can’t quite get your arm fully overhead. It feels like it just stops, and you may even experience a pinching sensation or pain in your shoulder. Next, sit up nice and tall with good posture and repeat reaching overhead.
Most people will notice a big difference in shoulder range of motion. This is because in a slouched position we lock out the movement in our thoracic spine, and it cannot contribute its motion to the shoulder’s range of motion. When we sit up tall, we are allowing our thoracic spine to move and help support our shoulder.
Below are two of my favorite exercises for thoracic mobility:
Thread the Needle
Half Kneeling Archer Bow & Arrow
The Rotator Cuff and the Scapula
This conversation wouldn’t be complete without a discussion of the rotator cuff and the periscapular muscles. It depends on the individual, but in the thoracic spine we typically need mobility, and for the rest of the shoulder – strength and stability is often needed.
The rotator cuff is made up of four muscles: the supraspinatus, infraspinatus, teres minor, and subscapularis. These four muscles help to stabilize the glenohumeral joint or the “ball and socket” of our shoulder. This area can further be described as a “golf ball on a tee” due to the larger head of the humerus placed on the smaller glenoid fossa of the scapula. Due to this mismatch our glenohumeral joint has A TON of motion, say compared to the hip.
The rotator cuff’s main function is to stabilize this movement, especially for shoulder motion away from the body, such as a paddle swing in pickleball. If the rotator cuff is underperforming, it allows for excess movement within the glenohumeral joint, which increases stress on the shoulder and may lead to pain or set us up for overuse injuries.
Below is one of my favorite rotator cuff stability exercises to assist with shoulder heath as it relates to pickleball.
90/90 External Rotation/Internal Rotation
The periscapular muscles are a second group of muscles that aid in shoulder stability. These are the serratus anterior, rhomboids, and middle/lower trapezius. They help to create movement and provide stability of the scapula on the ribs and thoracic spine. When we raise our arm overhead about 60 degrees of this movement comes from upward rotation of the scapula. These muscles are also much larger than the rotator cuff, and strength here will help support the rotator cuff. Keeping these muscles strong will help ensure shoulder health for the long term.
Below is a great exercise to strengthen the serratus anterior.
Serratus Plank Push Up
Conclusion
I hope reading this article has helped highlight the importance of thoracic mobility and shoulder strength for injury prevention while playing pickleball. These exercises only provide a basic foundation. For anyone who needs a little extra help, we recommend consulting with someone from our team. We can help determine which components of the shoulder are functioning well, and which areas may need additional work. Play safe out there!
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If you’re curious about more ways to prevent injury, talking with a Doctor of Physical Therapy is a great place to start.
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