Shoulder Injuries in Striking Sports

Here’s a premiere – I’m proud to present the first guest post on my blog. Today, physical therapist Anna from POS Tehrapie here in Vienna (https://www.pos-therapie.at/) shares insights on the issue of shoulder injuries. Anna has trained with me for years and was quite successfull as both a kickboxer and taekwondo player. Her athletic hightlight so far was winning the 2017 European TaekwonDo Championships in Czestohowa. Being an athlete herself, Anna understands the realities of training and the demands that are placed on fighters. The topic of Anna’s Bachelor thesis was – probably not coincidentally – shoulder injuries in striking sports. More recently, she has created her brand of physical therapy, POS, and takes care of most of my combat athletes. If you’re involved in combat sports that involve strikes (such as Boxing, Kickboxing or MMA), you should definitely read this. Without further ado, here’s the article:

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Shoulder injuries and shoulder pain are well known and researched in many fields of sport. Especially in overhead and throwing athletes pathologies such as shoulder girdle instabilities, range of motion restrictions, lesions, scapula dyskinesises, tendinopathies and impingement syndromes are common (Dann, Grimm, & Sperner, 2016). When it comes to Martial Arts, the majority of research focuses on injuries happening during competition. These include head injuries (66,8%-78,0%) and wrist sprains (6,0%-12,0%) (Lystad et al., 2014). Chronic pain or overuse injuries occurring in fight preparation and training settings are not well analysed yet (Thomas & Thomas, 2018).

Striking sports place the shoulders of athletes under repetitive stress. This may lead to micro-traumatic injuries of the skeletal muscles, especially in the presence of a weak rotator cuff, which may continue to terminate in range of motion restrictions throughout the athlete’s years of training (Staley, 1999). Due to the characteristics of the fighting position and physiological adaptations caused by the biomechanical forces of a punch, changes in the shoulder girdle can be observed: the humeral head stands more ventrally compared to the glenoid and the elevation of one shoulder can be observed (Kittel et al., 2005).

Especially the Jab, Cross and Hook, when missing their target, or thrown with the corkscrew technique place a heavy burden on the shoulder, potentially leading to lesions of the rotator cuff and impingement pathologies (Engelhardt & Grimm 2016). Kittel et al. (2005) discovered in a pilot study about the musculoskeletal system of boxers, that the athletes present many physiological changes: elevation of the ilium, protraction of the cervical spine and shoulders and reduced flexibility of the M. Pectoralis major/minor, M. Levator Scapulae and M. Trapezius pars descendens. Additionally, Kittel et al. (2005) concluded that the shoulder joint was in an elevated position of 64% of the athletes and the range of motion was restricted in external rotation by 17,8°.

As a Physical Therapist, Martial Arts Coach and competitive Combat Athlete I see overuse injuries and chronic pain all the time. Pain in the shoulder joint, thoracic spine, hip/groin and lumbar spine are part of the daily struggles of the athletes. So it surprises me that research in this field is rare. Individualized strength and conditioning with proper prehab is crucial for fighters because the body needs to be prepared for the biomechanical forces that emerge in classes and competition.

Addressing exposed muscle groups and joints such as the shoulder joint should be the main focus of proper prehab, rehab and strength and conditioning for Combat Athletes A proposed taxonomy for the muscles of the shoulder complex in different functional groups are the 5 P’s by Jobe: Pivoters, Protectors, Positioners, Propellors and Preparators (Jobe & Pink, 1993).

Name	Muscles	Function
Pivoters	Scapulafixators: M. Serratus Anterior M. Trapezius M. Rhomboideus major/ minor M. Levator Scapulae M. Pectoralis minor	Aligning the humeral head in relating to the cavitas glenoidalis
Protectors	Rotator Cuff M. Bizeps Brachii	Muscles which are important for the centralisation and caudalisation of the humeral head
Positioners	M. Supraspinatus M. Deltoideus	Important for flexion/extension/abduction. Note that an imbalanced relation between strong deltoid muscles and weak protectors can lead to pain related with an impingement syndrome.
Propellors	M. Latissimus Dorsi M. Pectoralis Major M. Triceps Brachii	Their primary task is to move the upper extremity, but disbalances can lead to destabilization because of their effectiveness.
Preparators	Core Muscles Muscles of the lower extremity

Note that muscles in one functional group do not necessarily need the same treatment or training. As Janda indicates, muscles are divided into two groups due to their different operation: tonic and phasic muscles. While muscles, such as M. Serratus Anterior and M. Rhomboideus major/minor, profit from strengthening, M. Pectoralis minor and M. Levator Scapulae benefit from reducing muscle tension. The main goal is to ensure balance between all muscles of one category. Only then alignment, centralization, or proper movement, can be guaranteed.

What I love about my job as a Physical Therapist is, that problems can be solved best in an interdisciplinary team. When it comes to matters of training, I always turn to the Performance Engineer Lukas Pezenka. I know that concerning the field of training and sports he is always up to date, having a large amount of exercises categorized for every muscle group and their different functions. Additionally, he knows exactly how to program them to reach the athlete’s specific goals. That is why I think that when it comes to the question how the functional groups mentioned above should be trained specifically, the answer should come from the Performance Engineer.

I am looking forward reading about it.

• Dann, Grimm, & Sperner. (2016). Die Schulter (Vol. 3). München: Elsevier.
• Engelhardt, M., & Grim, C. (2016). Die Sportlerschulter. Stuttgart, Germany: Schattauer.
• Jobe, F. W., & Pink, M. (1993). Classification and treatment of shoulder dysfunction in the overhead athlete. Journal of Orthopaedic & Sports Physical Therapy, 18(2), 427-432.
• Kittel, R., Misch, K., Schmidt, M., Ellwanger, S., Bittmann, F., & Badtke, G. J. S. S. (2005). Boxsportartspezifische Auswirkungen auf funktionelle Parameter des Bewegungsapparats. 19(03), 146-150.
• Lystad, Gregory., & Wilson. (2014). The epidemiology of injuries in mixed martial arts: a systematic review and meta-analysis. Orthopaedic journal of sports medicine, 2(1), 2325967113518492.
• Staley. (1999). The Science of Martial Arts Training (Vol. 2). California, United States of America: Multi-Media Books.
• Thomas, R. E., & Thomas, B. C. (2018). Systematic review of injuries in mixed martial arts. The Physician and sportsmedicine, 46(2), 155-167.
• Colley, J. (2018). Revisiting Tonic and Phasic Muscles for Increased Performance and Position. http://www.elitefts.com. https://www.elitefts.com/education/revisiting-tonic-and-phasic-muscles-for-increased-performance-and-position/
• Ophey, M. J. S. (2014). Einführung-Schulterinstabilität: Eine unsichere Angelegenheit für Patienten und Sportphysiotherapeuten?! , 2(04), 153-159.

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