Spike Higher, Play Longer!
- Persistence Chiropractic Care
- 7 days ago
- 5 min read
Chiropractic Care for Shoulder Health in Overhead Volleyball Movements
What do shoulder structures look like?
About the Bones & Joints:
The shoulder is a highly mobile but also fragile joint, known scientifically as the glenohumeral joint.
It consists of the head of the humerus (the "ball") and the glenoid cavity of the shoulder blade (the "socket"). As the socket is much shallower than that of the hip, the shoulder enjoys the extra mobility, which is necessary for overhead sports like volleyball, but this also makes it prone to misalignment, dislocation, and overuse injuries.
About the Ligaments & Muscles:
This joint is maintained by ligaments for stability and supported by powerful muscles, particularly the rotator cuff, which is essential for centering and stabilizing the humeral head during movements. In volleyball players, especially spikers and setters, these muscles are under constant demand during serves, spikes, sets, and blocks.
About the Nerve Supply:
Proper function requires intact nerve supply, originating from the spinal cord in the neck and upper back before reaching the shoulder, arm, and hand. If spinal bones become misaligned, these nerves can become compressed, resulting in weakness, tingling, or impaired muscle activation like an electrical wire that has been pinched.
Biomechanics of Volleyball Overhead Movements
In volleyball, overhead movements such as serving, spiking, setting, and blocking rely on an energy transfer sequence from the shoulder through the elbow and wrist into the ball. Disruption in any part of this chain, due to misalignment, tightness, or weakness can reduce power and increase injury risk.
A frequent adaptation in volleyball athletes is GIRD (Glenohumeral Internal Rotation Deficit), where the dominant shoulder gradually loses internal rotation compared to the non-dominant side. While moderate GIRD may be a functional adaptation, excessive GIRD correlates with increased injury risk and impaired performance. For example, a cross-sectional study found volleyball players with shoulder pain had significantly higher GIRD versus those without [1].
In adolescent players, GIRD occurred in about 38% of participants, highlighting its prevalence even in youth athletes [2]. Another study of professional and semi-pro players reported that 89% had GIRD; approximately 53% presented pathological GIRD, which was associated with experience, practice time, and position on court [3].
Additionally, imbalances between large internal rotators (IR) (eg. pectoralis major, latissimus dorsi, subscapularis) and smaller external rotators (ER) (eg. infraspinatus, teres minor)are common. This disparity destabilizes the humeral head and contributes to impingement and overuse injuries. A sport-specific comparison revealed that volleyball players had lower ER:IR strength ratios in their dominant arm compared to handball players [4].
Common Shoulder Injuries in Volleyball
Rotator cuff tendinopathy or tears develop over time due to repetitive overhead motions like spikes and serves. A study of volleyball players with rotator cuff tendinopathy showed altered shoulder blade motion, specifically less upward rotation during the early phase of arm abduction along with delayed muscle activation in key shoulder blade stabilizers.
The rotator cuff plays a key role in stabilizing and moving the shoulder. When the tendons become irritated or overloaded, they can swell and weaken — a condition known as rotator cuff tendinopathy, often linked to pain and limited mobility. Shoulder impingement arises when the rotator cuff tendon or bursa is pinched beneath the acromion, the roof of the shoulder, leading to the familiar “painful arc” between 60° and 120° of arm elevation [6].
Shoulder impingement often shows up as pain in the ‘painful arc’ — usually between 60° and 120° of lifting the arm. This happens when the supraspinatus tendon and bursa get compressed under the acromion, causing irritation.
Scapular dyskinesis, defined as abnormal shoulder blade movement or positioning, is significantly more prevalent in overhead athletes (61%) compared to nonoverhead athletes (33%) [7,8]. This dysfunction disrupts shoulder mechanics and increases stress on the rotator cuff.
Acute Phase of Injury Management
In the first 3–4 days after injury (acute phase), inflammation and swelling dominate. While the classic POLICE protocol (Protection, Optimal Loading, Ice, Compression, Elevation) is widely recommended in sports medicine, specific volleyball-based trials are limited. However, the general principle of gentle, pain-free loading via exercises like pendulum swings is supported in rehabilitation literature [6].
The Role of Spinal and Scapular Mechanics
Restrictions in the thoracic spine limit extension, forcing compensatory overuse of the shoulder and increasing rotator cuff strain. Similarly, shoulder blade and collarbone limitations interfere with proper load distribution and may impose nerve compression due to altered biomechanics.
Chiropractic Perspective
Chiropractic interventions aim to restore mobility and alignment in the spine, shoulder blade, and collarbone, thereby enabling better shoulder mechanics.
A mobile thoracic spine provides a stable platform for shoulder blade movement. While studies directly evaluating spinal manipulation in volleyball are lacking, the biomechanical rationale is well established.
Prevention and Performance Strategies
These principles help maintain shoulder health and joint integrity:
Strengthen external rotators and shoulder blade stabilizers (e.g., banded external rotations, shoulder blade retractions).
Stretch the posterior shoulder to counteract GIRD.
Employ the whole kinetic chain (legs, core, torso) rather than relying solely on the arm.
Conduct structured warm-ups to activate relevant musculature.
Conclusion
Volleyball requires a delicate balance between shoulder mobility and stability. Understanding shoulder biomechanics, addressing spinal and shoulder blade dynamics, and targeting muscle balance are key to prevention and peak performance. Chiropractic care supports these goals by enhancing joint function and restoring neuromuscular alignment.
References
Alqarni AM, Nuhmani S, Muaidi QM. Glenohumeral internal rotation deficit in volleyball players with and without a history of shoulder pain. Res Sports Med. 2022;32(2):225–34. https://doi.org/10.1080/15438627.2022.2102915. [Cited in text as 1]
[Authors]. Prevalence of Glenohumeral Internal Rotation Deficit and Sex Differences in Range of Motion of Adolescent Volleyball Players: A Case-Control Study. Medicina (Kaunas). 2024;10(11):2263. https://doi.org/10.3390/medicina10112263. [Cited as 2]
[Authors]. Comparative Analysis of Anatomical and Pathological Glenohumeral Internal Rotation Deficit Among Volleyball Players: A Cross-Sectional Study. Int J Sports Phys Ther. 2023;... [Cited as 3]
[Authors]. Sport-Specific Shoulder Rotator Adaptations: Strength, Range of Motion, and Asymmetries in Female Volleyball and Handball Athletes. Symmetry (Basel). 2024;17(8):1211. [Cited as 4]
Challoumas D, Stavdalis P, Dimitrakakis G. The volleyball athlete’s shoulder: biomechanical adaptations and injury associations. Sports Med Arthrosc Rehabil Ther Technol. 2016;? (systematic review). [Summarized from 15-study review, used for muscle imbalance concept]
LL Chau et al. Rotator cuff tendinopathy alters the muscle activity onset and kinematics of scapula in volleyball players. J Electromyogr Kinesiol. 2017;35:47–53. Cited as [1] PubMed
Struyf F, et al. Prevalence of scapular dyskinesis in overhead and non-overhead athletes: a systematic review. Orthop J Sports Med. 2016;4(2):2325967115627608.
Burn MB, McCulloch PC, Lintner DM, et al. Prevalence of scapular dyskinesis in overhead and non-overhead athletes: a systematic review. Orthop J Sports Med. 2016;4(2).
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