Rotator Cuff Injuries in Goalkeepers
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Research from Norway, published in the British Journal of Sports Medicine, found that 36% of goalkeeper injuries are to the upper extremity. This is in stark contrast to outfield positions where most injuries are to the lower extremity.1
In practice, goalkeepers are more likely to be injured during goalkeeper-specific training versus standard soccer training. The Norwegian study revealed that 23.6 injuries occur per 1000 hours of goalkeeper-specific training versus 9.1 injuries per 1000 hours of standard soccer training. 27.9 injuries occur per 1000 hours of goalkeeping during matches, making matches the most likely time for an injury.
Statistically, goalkeepers are most likely to be injured during aerial duels defending crosses. The risk of injury appears to be increasing as the modern game is evolving. Teams are requiring more and more from their goalkeepers. These players are expected to clear balls swinging into the box, intercept long through-balls outside the box, and receive back passes. This aggressive play wasn’t seen in decades past.
More aggressive play leads to more injuries. Goalkeepers suffer a variety of shoulder injuries. SLAP tears and Bankart lesions are injuries to the labrum, a rim of fibrocartilage in the socket of the shoulder. These often require surgical intervention. After diving, shoulder separations (to the A.C. Joint) can occur when landing directly on the point of the shoulder. Most shoulder separations do not require surgery. These injuries will be the focus of a later article. Instead, we will focus on the most common injury to the goalkeeper’s shoulder: a rotator cuff injury.
Left: Image showing the anatomy of labrum.
During the 2010 Champions League campaign, elite footballing injuries were analyzed and reviewed. This research was presented at the International Sports Science & Sports Medicine Conference in Newcastle, England. The most common shoulder injury site in goalkeepers was the rotator cuff. 50% of goalkeepers had a chronic rotator cuff pathology. The severity of injury was widely varied. Many injuries were classified as minor impingement, where injury and irritation cause pain in the shoulder during certain movements like overhead motions or reaching behind the back. If untreated, shoulder impingement can lead to inflammation of the shoulder tendons aka rotator cuff tendinitis or bursa inflammation aka bursitis. Long standing irritation and inflammation can result in a tear of the rotator cuff. Tears can also result from the trauma of landing on outstretched arms or on the shoulder. 2
When landing on the arm, the humerus typically subluxates anteriorly (upper arm bone misaligns toward the front of the shoulder). The rotator cuff muscles attach to the humerus, so abnormal position of the arm, in the shoulder socket, can result in added stress to the muscles and other tissues. For that reason, adjustment of the shoulder is critical to prevent injury and to facilitate quicker healing post-injury.
The rotator cuff is comprised of four muscles: Supraspinatus, Infraspinatus, Teres Minor, and Subscapularis. These muscles not only stabilize the shoulder, but help to move the arm in all directions. Goalkeepers use their rotator cuff muscles for throwing, catching, deflecting balls and often land on the arms and shoulders resulting in injury to the muscles, tendons, and ligaments of the shoulder. However, a significant trauma is not the only way the rotator cuff is damaged.
The nature of goalkeeping is repetitive. Keepers dive and land on the arms and shoulders. They jump in the air and come down on their arms and shoulders. This repetitive trauma leads to longstanding irritation and inflammation which leads to scar tissue or adhesions in the shoulder. Scar tissue is dense, fibrous material which restricts motions and prevents normal function of the muscles and joints. Scar tissue must be removed to restore normal function. In goalkeeping, shoulder range of motion is critical to performance.
Treatment for rotator cuff injuries is primarily conservative. Steroidal injections are often used to reduce inflammation. There is some belief that soft tissue mobilization should wait for a few days after an injection, due to the fact that soft tissue mobilization will increase blood flow and range of motion, allowing the steroidal injection to migrate away from the injection site.
Rehabilitation of a partial rotator cuff injury can take up to three months. For that reason, some elite players will opt to have the shoulder repaired in a procedure called arthroscopic debridement: a procedure performed with a tiny camera, where instruments are inserted through a small incision. Damaged tissue and debris is then removed from the shoulder. More serious tears of the rotator cuff may require surgical intervention to reattach the muscle in the case of a complete tear.
Video below: A dry, but very thorough explanation of the rotator cuff muscles:
At Epic Chiropractic, Dr. Saenz utilizes a combination of Graston Technique and Soft Tissue Mobilization to detect, remove scar tissue from the rotator cuff, and restore normal motion in the shoulder.
Scar tissue adhesions commonly present in all four muscles of the rotator cuff. They are also found in associated muscles that attach near the shoulder such as the deltoid, pectoralis, trapezius muscles, and in the joint itself. The removal of scar tissue adhesions from these structures will dramatically improve range of motion in the arm and shoulder.
Graston Technique is a system to treat and remove scar tissue adhesions from injury sites using steel instruments. The procedure takes less than fifteen minutes and is performed, generally, twice per week for 4-5 weeks. Results are noticeable after only a few treatments. This is the technique used in the training facilities at Arsenal, Everton, Fulham, and Wolverhampton football clubs.
We also use cold laser technology to accelerate the healing process. Specific frequencies of laser can be used to decrease pain, improve blood flow to injured areas, and treat scar tissue. The MR4 is the only laser in the world to combine cold laser and electric stimulation to further enhance repair and recovery.
We use the Multi Radiance MR4 laser, the same laser used in treatment facilities of many teams in the English Premier League, MLS, NFL, NBA, NHL, MLB. The laser is also utilized in international soccer by the US National Team, French National Team, and Russian National Team.
Chiropractic care is essential to optimal performance and injury treatment. Goalkeepers tend to have subluxations of the humerus, where the arm bone misaligns forward. Adjustment of the arm back into the shoulder joint ensures proper biomechanics and decreases tension in muscles preventing injury and allowing for quicker healing.
Maintaining proper spinal health and shoulder health can prevent injury and can decrease the severity of injuries if they should occur. Adhesions/scar tissue in the rotator cuff begin long before they present with pain. Therefore, its is prudent to determine whether you have adhesions developing in the shoulder, to have your shoulder and spine periodically checked to ensure proper alignment, and to strengthen the rotator cuff with shoulder exercises.
Below: Some of the top Goalkeeper saves of last season.
Jesse J. Saenz, D.C. is a Chiropractor in Sacramento, CA who specializes in soccer (football) injuries at Epic Chiropractic.
References
1. Br J Sports Med 2011;45:331
2. J Ekstrand, M Hgglund, M Waldn. Injury incidence and injury patterns in professional football: the UEFA injury study. Br J Sports Med doi:10.1136/bjsm.2009
