What Baseball, CrossFit, and Volleyball Have in Common
Overhead athletes, whether they’re throwing fastballs, perfoming barbell snatches, spiking volleyballs, or swimming, place unique demands on the shoulder complex. And while the sports differ in movement patterns and intensity, the underlying causes of shoulder pain are often rooted in similar biomechanical imbalances and loading issues.
At Cleveland Performance Chiropractic, we see these patterns daily and take a functional, movement-based approach to diagnosing and managing shoulder injuries in active individuals.
Common Injury Patterns in Overhead Athletes
The shoulder is the most mobile joint in the body, which also makes it one of the least inherently stable. When overhead volume increases and control breaks down, several conditions can develop:
1. Subacromial Impingement (now referred to as SIS or rotator cuff-related pain)
- Symptoms: Pain with reaching, pressing, or throwing
- Mechanism: Compression of rotator cuff or bursa beneath the acromion, often worsened by poor scapular mechanics
- Contributors: Lack of scapular upward rotation, excessive anterior humeral glide, and overuse without adequate recovery
- Evidence says: Active rehab improves outcomes more than passive modalities (Littlewood et al., 2013)
2. Internal Impingement / GIRD (Glenohumeral Internal Rotation Deficit)
- Common in: Baseball pitchers and CrossFit athletes
- Presentation: Posterior shoulder pain during late cocking phase of throw or overhead lifts
- Findings: Loss of internal rotation, posterior capsule tightness, and humeral head shift
- Clinical relevance: Associated with altered scapulohumeral rhythm and increased risk of labral stress (Wilk et al., 2011)
3. Rotator Cuff Tendinopathy
- Mechanism: Overload of supraspinatus or infraspinatus due to repetitive overhead force production
- Key sign: Pain with resisted abduction or external rotation, decreased endurance
- What matters: Progressive loading improves tendon resilience more than rest alone (Malliaras et al., 2013)
Why Shoulder Mechanics Break Down
While the causes of pain can vary, most overhead athletes share three common deficits:
1. Poor Scapular (Shoulder Blade) Control
- Inadequate upward rotation, posterior tilt, or external rotation during overhead motion
- Leads to earlier impingement and compensatory humeral positioning
2. Rotator Cuff Fatigue
- Repetitive movements (serves, throws, snatches) lead to cumulative fatigue
- Rotator cuff fails to center the humeral head in the glenoid, leading to microinstability
3. Thoracic Mobility Restrictions
- A stiff thoracic spine alters shoulder blade mechanics
- Compensation increases demand on glenohumeral joint structures
These breakdowns may not be painful at first—but they create movement inefficiencies that gradually exceed tissue capacity.
Our Clinical Approach at CPC
Our evaluation goes beyond locating pain. We assess how the entire shoulder complex and surrounding regions function under movement and load.
Assessment includes:
- Functional movement analysis: Full body motion-captured movement assessment to help determine the source and potential causes of your pain
- Muscle testing: Strength and endurance of the rotator cuff, serratus anterior, and lower trapezius
- Joint-specific mobility testing: Glenohumeral capsule, AC joint, scapulothoracic articulation, and thoracic spine
- Palpation and soft tissue evaluation: Identifying overactive, restricted, or tender regions (e.g., supraspinatus, infraspinatus, posterior deltoid)
- Scapular dyskinesis screening: Observation of scapular upward rotation, posterior tilt, and external rotation
- Cervical spine screening: Including McKenzie repetitive motion exam to rule out referred symptoms from C4–C6 roots
Cervical radiculopathy or sclerotomal referral from the lower cervical spine can present as vague shoulder pain, particularly in the deltoid region or with overhead activity. We always rule out cervical involvement before labeling the shoulder as the primary source.
You would be surprised how often a patient comes in our office thinking they have a shoulder issue when in reality it as a cervical spine issue.
CPC Treatment Strategies
Our rehab model is progressive, individualized, and structured around both pain reduction and long-term performance goals.
Phase 1: Reduce Irritation and Restore Motion (Calm things down)
- Active Release Technique (ART) and Self-Myofascial Release for restricted rotator cuff muscles (infraspinatus, supraspinatus), posterior capsule, deltoid, pec minor, and many other muscles
- Joint mobilizations for posterior capsule stiffness and scapulothoracic restriction
- Dry Needling to treat specific tight muscles around the shoulder complex
- Load modification: Strategic deloading of overhead volume (barbell, throwing, or serves) rather than complete rest
- Isometric and low-load exercises: External rotation isometrics, band pull apart, and banded serratus exercises
This simple self-myofascial release exercise for the lattisiumus dorsi and posterior shoulder helps relieve tension along the posterior shoulder. This is a great exercise to start loosening up the surrounding muscles around the shoulder and to increase pain-free overhead movement.
Phase 2: Improve Scapular Control and Shoulder Mechanics
- Closed-chain scapular drills: Wall slides, bear hold variations, Dynamic Neuromuscular Stabilization exercises
- Eccentric cuff loading: Banded serratus flexion exercises, banded diagonals, and 90/90 external rotation
- Thoracic extension mobility: Foam rolling, open books, thoracic mobility exercises
This phase emphasizes restoring dynamic stability—the ability to maintain humeral head centration during functional movement.
This simple, yet challenging exercise forces you to stabilize your scapula against your rib cage. We see many patients with shoudler pain struggle to maintain good scapular positioning with this exercise. This exercise is a great way to start working on scapular control in a low risk position.
Phase 3: Strengthen and Reintegrate to Sport
- Active hang variations to increase stability overhead
- Overhead press variations to reintroduce overhead loading with a stable base
- Medicine ball throws and reactive plyometrics for advanced neuromuscular control
- Sport-specific drills: Exercises that place your body in a sport specific position while loading the shoulder overhead
Once overhead range of motion is pain free, we like to start our pressing exercises in this position. It keeps the low back locked in safe position and the arm position allows you to press in a safer overhead angle. We also like that your hips are in flexion and extension. Most sport positions require one hip to be flexed and one hip to be extended or neutral. This exercise is great intro to sport specfic exercises.
When to See Us
Not all shoulder pain requires immediate care—but some signs suggest it’s time for a clinical evaluation. Consider scheduling with us if:
- Pain has lasted more than 2–3 weeks and isn’t improving with rest or self-care
- You experience pain or weakness during overhead lifting, throwing, or pressing
- Symptoms interrupt training, or you’ve begun modifying movements to avoid discomfort
- You feel a consistent “pinch” or catching sensation in the front or top of the shoulder
- You’ve had recurring flare-ups, especially with similar movements or workouts
- Over-the-counter treatments, massage, or stretching have not provided lasting relief
- You suspect pain may be referred from the neck but aren’t sure how to test it
Shoulder injuries often start small but build up over time—especially in high-volume athletes. Early diagnosis and focused rehab can significantly shorten recovery and prevent more complex issues like labral tears or chronic tendon breakdown.