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Q: My son has been having shoulder problems when playing lacrosse. He states that when he goes to shoot the ball, he often feels his shoulder “pop,” and then it becomes very painful for the rest of the game. A doctor parent on the team said that he may have rotator cuff problems. Is there something we should be doing?

A: Since he seems able to continue playing even after the onset of pain, I doubt there is a full-blown rotator cuff tear. That would leave the possibility of a rotator cuff strain, tendonitis, instability or a labral tear. The part that concerns me is the “popping” that he is feeling. If you have not already, I would recommend seeing an orthopedic specialist to rule out possible labral involvement. Assuming that it is not the labrum, the popping is most likely due to shoulder instability. You will need to know a little anatomy of the shoulder to understand mechanics involved in instability.

The rotator cuff is a term given to the continuous soft tissue that attaches to the shoulder. The rotator cuff is a group of four tendons called the supraspinatus, infraspinatus, teres minor and subscapularis. These tendons act with the deltoid muscle (which is the bigger muscle covering the shoulder) in a force-couple mechanism that acts to stabilize the humerus (upper arm bone) in its movement in the cavity of the shoulder joint.

For the shoulder joint to be stable and functional within its range, the muscles must generate sufficient force throughout the entire range. In your case, the forceful movement involved with shooting in lacrosse may have caused the shoulder to temporarily dislocate, or “pop,” and then relocate moments later in the same movement. This brief dislocation causes the shoulder capsule to stretch, resulting in pain and inflammation.
The good news is this is a common problem among athletes. The bad news is that you need to get started immediately with rehabilitation if you want to play the rest of the season.

If your physician friend did not prescribe any exercises, then a licensed physical therapist can help. One of the best resources for pictures as well as a description of rotator cuff strengthening exercises is the Internet. Try a search for the “Thrower’s 10″‘ which is a fairly comprehensive list of rotator cuff exercises using light dumbbells and band/tubing resistance.

Start with these, progressing in resistance and repetitions over the next several weeks. You can then utilize other equipment such as a Body Blade to help challenge the small muscles of the rotator cuff throughout the shooting motion. I would start with two hands on the blade through the range and then progress to isolated sides, backhand and forehand, both right and left.

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