Sports Sciences Feature: Shoulder Injuries and Rehabilitation in Lacrosse

March 1, 2005

Terrance Gee, M.S., ATC
University of Maryland Sports Medicine

Shoulder injuries are very common throughout the sport of lacrosse. They occur through a variety of mechanisms such as falling on an outstretched arm, checking, slashes, and repetitive motions during practice and drills. Some of the most common injuries that occur in this sport are burners/stingers, subluxations, shoulder separations, and various muscle strains.

A burner/stinger occurs when an athlete's head is forced laterally as the opposing shoulder is depressed downward, causing the brachial nerves of the neck and shoulder to become stretched. The athlete, in turn, will complain of a burning sensation that extends from the shoulder into the hand, giving the athlete a feeling of a "dead arm". This sensation can last from several seconds to several minutes.

Other injuries that are quite frequent in lacrosse are shoulder separations and subluxations. Shoulder separations are a catch-all phrase referring to any injury to the ligaments of the shoulder joint. The primary mechanism for a separation is a fall directly on the shoulder joint itself, which results in a sprain to one or more of the ligaments. There may be visible deformity and/or a palpable gap to the bony portion of the shoulder, accompanied by pain and swelling. Subluxations occur when the humerus (upper arm bone) slides out of place and returns to the joint on its own. The primary mechanism for shoulder subluxations are falls on an outstretched arm.

Regardless of which injury occurs to the shoulder, rehabilitation protocol includes many of the same basic exercises. The goal of any rehabilitation program is to first minimize pain and restore range of motion, and then gradually progress to strengthening and functional activities. Some of the most common exercises that an athlete can perform to return to play with few complications include: internal/external rotation, empty cans, shoulder shrugs, and shoulder raises. Any of these exercises can be performed with the athletes own body weight with progression to either surgical tubing or hand weights.

The exercises below are listed with a starting position and the appropriate motion to produce for maximum benefit. The first three are used primarily to strengthen the rotator cuff muscles, which in turn help to maintain shoulder stability through its entire range of motion. Shoulder shrugs and raises are performed to strengthen the neck, upper shoulder (trapezius) and shoulder girdle, respectively. Each should be completed in sets of 3 with at least 10-20 repetitions, and should be performed at least 2 to 3 times a day.

1. Internal Rotation
Starting Position: Arm at side of body with elbow flexed to 90 degrees.
Motion: Rotate arm across the body until hand is against the abdomen. Hold for 2-3 seconds and return to the starting position.

2. External Rotation:
Starting position: Arm at side of body with a pillow or rolled towel between the elbow and body. Elbow is bent to 90 degrees.
Motion: Rotate arm away from the body, in a semi-circle pattern, keeping the elbow against the pillow. Ending position should include forearm being inline with the body. Hold for 2-3 seconds and return to the starting position.

3. Empty Can:
Starting position: Arm is at a 45 degree angle to the body. The thumb is then pointed downward towards the floor putting the shoulder in an internally rotated position.
Motion: Raise the arm upward until it is at shoulder level. Be sure to keep the thumb pointed downward toward the floor during the entire motion. Hold for 2-3 seconds and return to the starting position.

4. Shoulder Shrugs:
Starting position: Standing with arms at the side of the body.
Motion: Shrug shoulders towards the ears. Hold for 2-3 seconds and return to starting position.

5. Shoulder Raises:
Forward Raises
Starting position: Arms at the front of body with hands rested on thighs. Motion: Raise arms straight ahead to shoulder level. Hold for 2-3 seconds and return to starting position. Thumbs may either point up or held sideways.

Lateral (side) Raises
Starting position: Arms at the side of body.
Motion: Raise arms away from body to shoulder level. Hold for 2-3 seconds and return to starting position.

The above exercises should be performed in a pain-free range of motion. If at any time the athlete experiences pain while performing these exercises, the weight or tension (depending on the resistance being used) should be reduced or the range of motion should be decreased. As an injury heals, more weight and larger ranges of motion may be added to increase shoulder strength and stability. If an injury happens to persist further medical attention may be needed. At no time should an injury linger with the hopes that it will simply go away on its own. The use of ice and anti-inflammatory medications (Ibuprofen, Advil, Aleve) should be used in cooperation with these exercises to obtain the best therapeutic benefits. In following these simple guidelines, an athlete should be able to return to full, functional participation and enjoy a successful lacrosse season.