Shoulder Pain: Lack of Dorsiflexion

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How can a lack of dorsiflexion lead to shoulder pain in a person who plays volleyball?

I am going to start by imagining a student who would walk into my tennis club for a lesson. This student would tell me about a shoulder discomfort that surfaces especially when performing overhead motions. I would then find out that she has been a volleyball player for quite some time. During my evaluation, which would include walking and light running, I would notice poor ankle dorsiflexion (maybe due to an ankle sprain). I would then continue to use my observation skills to trace out a path of the injury from the foot to the shoulder. The first thing I noticed is a shoe scrape (Hoppenfeld, 142). This occurred because the athlete had a loss of ankle dorsiflexion which is an upward foot movement produced by the activity of the front part of the shin muscles. According to Dr. Romanov, "the front part of the foot would be higher than the rear part in relation to the horizontal plane." The dorsiflexion action is not a lift of the toes, but rather a lifting of the front part of the foot. The plantar flexion action has to be done in such a manner that it applies maximum force against the ground in the shortest possible time. The more time the person spends on the ground applying force, the longer it takes. This student for instance, scraped the toe of the shoe during gait. The student also flexed her hip excessively during gait. I believe that this was due to her trying to bend the knee just enough to allow the foot to clear the ground. I then started my evaluation beginning from the ankle 's range of motion. Normal dorsiflexion should be around 20° while this patient showed only about 5°. The ankle joint (the subtalar joint) acts as a shock absorber and it also allows the foot to move into plantar flexion through eccentric elongation so that the foot flattens smoothly on the ground. Because of poor dorsiflexion though, this particular student slaps her foot down after heel



Cited: Hoppenfeld, Stanley. Physical Examination of the Spine and Extremities. East Norwalk, CT: Appleton-Century-Crofts, 1976. Romanov, Svetlana. "Dorsiflexion." posetech.com. 31 October, 2006. <http://www.posetech.com/training/archives/000398.html>. Olson, William R. D.P.M. "Overuse knee injuries: evaluation and management." http://www.aapsm.org/ct1100.htm Southmayd William, MD. Sports Health. New York, N.Y: Perigee Books, 1981. Hanna, Thomas. "The psoas muscles and abdominal exercises for back pain." 2004 <http://www.somatics.com/psoas.htm >.

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