How Can a Lack of Dorsiflexion Lead to Shoulder Pain in a Person Who Plays Volleyball?

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 20o while this patient showed only about 5o. 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 strike instead of letting it land smoothly. This action would weaken the subtalar joint, which is located in between the talus and the calcaneus. This constant slapping of her foot would also produce a tight calf. Many lower limb disorders are related to calf muscle tightness and reduced dorsiflexion of the ankle. The calf muscles consist of the gastrocnemius, which is the big muscle at the back of the leg and the soleus muscle, which is a smaller muscle lower down in the leg and under the gastrocnemius. With a tight calf muscle, tibialis anterior and extensor digitorum longus would lengthen. Due to this imbalance, the subtalar join would rotate and swivel causing an internal rotation of the tibia. This excessive tibial rotation moment is transmitted to the knee to cause internal rotation and adduction of the knee joint. If increased internal rotation of the knee causes excessive overstretching or twisting of the ligaments or tendons or increased shearing forces on the bursa surrounding the knee, then pathology can occur. According to Olson, "common knee injuries caused by these mechanisms include medial peripatellar retinaculitis, pes anserinus bursitis, iliotibial band tendinitis (as the iliotibial band attempts to restrict excessive internal rotation of the tibia), and patellofemoral dysfunction (as excessive internal rotation of the tibia may also cause lateral mistracking of the patella in the patellar groove of the femur.)" At this stage of the evaluation, I notice that the hamstrings could also be tight. They are made up of the three posterior muscles: the semitendinosus, the semimembranosus, and the long head of the biceps femoris. The proximal attachment of these muscles is the ischial tuberosity. They attach distally, just below the knee, at the medial and posterior surface of the superior part of the tibia, and the lateral side of the head of the fibula (Southmayd.) The primary actions are hip extension and rotation, and knee flexion. Hamstrings are at their longest stretch when there is a presence of an anterior pelvic tilt. In this situation, the hip would over flex, and the knee would hyperextend. This knee abnormality together with a tight hamstring alters the hip joint stability. This instability causes a compression that creates a torque at the sacroiliac joint. In the sacroiliac joint, there is a shortening of the hip extensors (hamstrings & gluteus maximus) and tight abdominals. The psoas is also short. The psoas is the only muscle that attaches the lower extremity (femor) to the spine through the lumbar vertebrae including the intervertebral disc (from T12 to L5). This powerful muscle passes from the abdomen to the thigh deep into the inguinal ligament. It is very involved in many body functions such as walking and running. During these movements, the ilio-psoas muscles of one side initiate movement of that leg forward, while the abdominals bring the hip (same side) inward. According to Hanna, during a standing position, a contracted psoas muscles would move the pubis backward; the abdominal muscles would then move the pubis forward (antagonists.) Unilateral contraction of the psoas muscles causes rotation of the torso away from the side of contraction and sidebending