Can’t Reach Overhead? Pain Reaching Overhead? Check Your Serratus Anterior

Reaching overhead is one of the most important movements in daily life. It is also crucial for baseball and other overhead sports. Research by Wilk, et al. showed that decreased shoulder flexion before the season increased elbow injury risk during the season for major and minor league pitchers. I have spoken before about how elbow injuries are increasing in baseball, and assessing the joints above and below are important in injury treatment and prevention.

The questions to ask are: how do we assess overhead motion and what do we do to fix it?

First, assessing overhead motion can be done in a number of ways. The simplest way is just standing and reaching your arm as high as you can. This looks at your gross movement capabilities while using all of the strategies available to you. By using all of your strategies, I mean that you can arch your back, shrug your shoulders, and do any other compensations you like in order to gain range. To give you an example of this, slouch down as if you have terrible posture and then reach as high as you can. Now sit up tall and reach up as high as you can, you can probably reach a lot higher when you sit with an extended posture. It is not a bad thing to reach further, but it is important to understand. If you have difficulty extending your spine, then your range of motion may be limited. Conversely, if you are very flexible in your spine, then your shoulder range of motion could be limited and you would have no idea because your back is able to compensate.

So, how can we measure shoulder range of motion by itself? We need to get into a position where we can control all of the other joints and take them out of the equation. This involves lying on your back. Relaxing your neck and back muscles will provide for a better estimation of shoulder mobility. A key with this test is to look for aberrant movements. Commonly, people will raise their head up to compensate for tight neck muscles. If you notice your head coming off of the ground, try to gently press it down. Consider yourself as reaching the end of your mobility if you are unable to keep your head down. Another common compensation involves your low back arching upwards. This creates more extension in your thoracic spine and is typically a result of tightness in your latissimus dorsi. Try to keep your low back relaxed and follow the same rule: if you are unable to stop your low back from arching, you have reached your mobility limits.