For the most part , pickleball involves motion of the arm below shoulder level . However , there are times when reaching above shoulder height is necessary , such as during an overhead smash , or just reaching up for a high ball . Most often , when our opponent has hit a high ball or “ popped ” it up , we end up hitting the ball harder in order to win the point . While the overhead position of the shoulder is not inherently bad for the shoulder , it may cause pain or discomfort to someone who has an underlying rotator cuff problem , especially as we generate more force as we hit the high ball harder .
In this article , we will cover basic shoulder anatomy and gain an understanding of the role of the rotator cuff musculature as it applies to pickleball . So , what is the rotator cuff and what is its role ? The shoulder joint is made up of the end of the humerus ( humeral head ), the scapula ( shoulder blade ), and the clavicle ( collar bone ), ligaments , all the muscles surrounding the joint , as well as connective tissue that forms the shoulder capsule . The shoulder , however , is not a stable joint . When compared to the hip ( which is a ball-and-socket type of joint , with a deep socket ), the shoulder joint has a very shallow socket , and the ball of the humerus sits atop this shallow socket .
So , unlike the hip joint , the shoulder relies on the external structures such as ligaments and muscles in order to create stability . The benefit of a less stable joint is that it provides plenty of mobility ( and enables us to reach up , down , and side to side with our arms ). However , when the external structures ( capsule , ligaments , muscles ) are compromised , this is when the shoulder can be in big trouble and lead to pain , discomfort , and difficulty with overhead activities . The rotator cuff is comprised of four muscles : the supraspinatus , infraspinatus , teres minor , and subscapularis . These four muscles work in unison to maintain the head of the humerus into the socket as we move our arms up and down . At the top of the shoulder , there is a roof-like structure called the acromion , which is the end portion of your shoulder blade . There are structures ( supraspinatus tendon , subacromial bursa , articular capsule ) that pass under this shoulder “ roof .” When one of the rotator cuff muscles is compromised , these structures under the acromion get pinched with active motion ( usually above shoulder height ), which can give you pain . This is called secondary impingement of the shoulder .
The medical literature tells us that in about 80 percent of cases involving the rotator cuff , the supraspinatus muscle is the one that is injured . If you look at a picture of a shoulder joint , you will see that it passes just underneath the acromion , which is why this muscle can easily get pinched in that space .
The most common signs and symptoms associated with rotator cuff pathology are pain in the upper arm ( often along the biceps or in the deltoid area ), pain at nighttime , difficulty / pain with overhead activities , difficulty / pain with reaching out ( such as reaching for a parking garage ticket out of a car ), difficulty / pain reaching across your body , weakness of the shoulder with certain motions , and increased pain and tenderness in the back of the shoulder and upper trapezius muscle .
So , what should you do if you are experiencing these signs and symptoms ?
The best thing to do when experiencing pain in your shoulder is to not ignore it . Most people think the pain will eventually go away and continue with their regular activities . After a few months , the problem usually will not have resolved on its own , and the condition may now be much worse .
The best approach is to consult a health care professional ( ideally a physical therapist ) as soon as possible when you start having pain in your shoulder . While the signs and symptoms are common , it is important to consult an expert to determine the cause of your pain ( since there could be other causes ) and start you on the appropriate program in order to accelerate your recovery .
Your physical therapist will be able to identify impairments and build an individual program for you to get you back on the courts . The best approach to treating rotator cuff injuries is using a combination of hands-on manual techniques such as mobilizations , dry needling , and IASTM ( instrument-assisted soft tissue mobilization ) with targeted functional exercises . •
The Pickleball Doctor , Noe Sariban , is the owner of Move It Physical Therapy in Chapel Hill , NC (
moveitpt . com ). Free consults are available , as well as virtual sessions . You can contact Noe directly at
noe @ moveitpt . com to schedule .
JANUARY / FEBRUARY 2022 | MAGAZINE 81