ERFORMANCE P VOLLEYBALL CONDITIONING ANEWSLETTER DEDICATED TO IMPROVING VOLLEYBALL PLAYERS Postural Priorities- Rib Cage Influences on Volleyball Attacking Mechanics Lisa Bartels, DPT, Postural Restoration Institute, Lincoln, NE Lisa was a member of the shoulder blade and provided an overview of rib cage mechan- University of Nebraska volleyball ics and a brief explanation of the relationship between opti- team from 1995-1997. She was intro- mal diaphragmatic breathing and shoulder function. The sec- duced to the science of Postural ond article discussed the rib cage and scapula mechanics Restoration as a patient under the needed for effective blocking. The purpose of this discussion care of Ron Hruska. She had suffered is to demonstrate to the reader how rib cage and scapular from long-standing injuries sustained position alters the biomechanics of humeral (arm) glenoid during her collegiate volleyball (socket) motion and rotator cuff function during the volley- career and found success with the ball attack, and why suboptimal rib cage position, and lack of treatment techniques she learned at Lisa Bartels left diaphragmatic activity promotes faulty attacking mechan- the Hruska Clinic and later received ics and frequently precedes shoulder dysfunction and pain on from the Postural Restoration Institute. Lisa returned to prac- the right side. tice physical therapy at the Hruska Clinic Restorative The angular velocity and joint compressive forces Physical Therapy Services in Lincoln, Nebraska after com- generated in the shoulder joint during the volleyball attack pleting her Doctorate of Physical Therapy from the are tremendous. These forces should be created, absorbed, University of Nebraska Medical Center in Omaha. Lisa is a and dissipated not only by capsular restraints and rotator cuff member of the American Physical Therapy Association. musculature in the shoulder joint itself but also by appropri- ate synchronous interaction between the scapula, rib cage and any volleyball athletes struggle to effective- pelvis. Although abdominal integration and pelvic stability BEG ly master efficient attacking technique play a significant role in optimal shoulder girdle function, it INT because the mechanics around the shoulder is beyond the scope of this article to include specific mechan- ADV girdle they are attempting to use are faulty. ical description of pelvis mechanics. For the purpose of this m In addition, there are those athletes that are discussion, the volleyball attack has been divided into three hindered in their ability to compete and train rotator cuff phases; cocking phase, acceleration, and follow because of chronic shoulder pain. Bicipital tendonitis, shoul- through. der impingement, rotator cuff pathology, and labrum patholo- During the cocking phase the superior and posterior gy are extremely common in competitive volleyball players. rotator cuff muscles, supraspinatus, infraspinatus and teres There are many etiologic factors that are commonly discussed minor, concentrically contract to position the arm in abduc- in the orthopedic literature which include capsular laxity, soft tion and external rotation. Simultaneously the trunk is rotat- tissue restriction of the posterior shoulder capsule, rotator ing to the right as the ribs on the right externally rotate and cuff imbalance, and poor scapular mechanics. Of those fac- the scapula is being pulled into retraction and upward rotation tors, scapular mechanics receives a limited amount of atten- by the posterior scapula thoracic stabilizers. The arm then tion, and when it is considered, rib position beneath the begins to accelerate forward, to contact the ball, by strong scapula is not considered. This discussion is part three in a concentric contraction of the internal rotators; primarily by series that has focused on rib cage biomechanics and the the subscapularis, the anterior rotator cuff muscle, and sec- influence of the ribs on appropriate function of the shoulder. ondarily by the latissimus and pectoralis. During humeral The first article introduced the concept of ribs directing the acceleration the trunk begins to rotate to the left as the right ribs now begin to internally rotate. During the follow through optimal scapular position. phase after the hand has made contact with the volleyball, the In addition to presenting with a rib cage that is not in posterior rotator cuff decelerates the arm with eccentric activ- a neutral resting state, in many right arm dominant volleyball ity, while the middle and lower traps, rhomboids, and serratus players the right scapula is in a passive position of protrac- anterior continue to control scapular motion. tion. It may appear that the scapula is winging. The reason For the optimal rotator cuff and scapular mechanics for this is because the thorax is essentially matched to the fol- that were just described to occur, as well as effective hitting low through position of the volleyball attack because the ability, the athlete must have a scapula that is retained on the trunk is rotated to the left. Trunk rotation to the right can not thorax, specifically lying over ribs two to seven. occur during cocking phase if the athlete constantly remains Atmospheric pressure, the weight of the arm, and correct in a state of trunk rotation to the left. The following patho- muscular engagement by the trapezius, the serratus anterior, mechanics must now occur for an athlete to attack the volley- and the rhomboids are the physical and biomechanical strate- ball. With the right ribs internally rotated and the scapula gies that retain the scapula on the thorax. The concave-con- passively protracted, the serratus anterior and lower and mid- vex relationship of the scapula on the thorax is essential for dle traps are not in a position to retract the scapula in con- the scapula thoracic force couples to properly stabilize the junction with humeral abduction and external rotation. The glenoid during the volleyball attack and can only occur if the upper trap is therefore heavily recruited to elevate the scapu- athlete is able to achieve and maintain a state of rib cage neu- la via its clavicle insertion. The latissimus forces the thoracic trality. In other words, their bony anatomical midline must be spine into extension while the (short head) of the biceps, with parallel with the frontal plane and the ribs must be in a state its tendon in a lengthened position, pulls or helps elevate the of neutral rotation. Rib cage neutrality enables appropriate arm. The infraspinatus and teres minor continue to work as rib rotation and trunk rotation to occur. Rib rotation not only the primary external rotators, but they have a tendency to provides the physiological means by which the lungs and tho- become very short and tight because they are not sufficiently rax inflate and deflate during respiration, but also accompa- opposed by the anterior rotator cuff, the subscapularis. As nies motion of the thoracic spine and provides the required acceleration phase begins, pure humeral internal rotation is convex surface for the scapula thoracic joint. impossible for two reasons; the subscapularis is incapable of Many of the right arm dominant volleyball players engaging because the scapular position has severely that are treated and screened by the Postural Restoration decreased the mechanical advantage in its lengthened posi- Institute™, initially present with a spine and rib cage that is tion and posterior superior humeral glenoid impingement oriented to the right and compensating with upper trunk rota- does not allow for internal rotation in this thoracic scapular tion to the left. Trunk rotation to the left positions the left position. The latissimus is now recruited as a powerful inter- ribs into external rotation and the ribs on the right into inter- nal rotator that has a more distal attachment on the neck of nal rotation. The reason for this predominant pattern is com- the humerus than the subscapularis. This leverage allows the pensatory overuse of the left anterior interior muscular chain, humeral head to be pulled or translated forward as the lat as defined by the Postural Restoration Institute™, to stabilize internally rotates the arm, avoiding bony contact during the the trunk and pelvis during repetitive right leg and hip func- attack. Unfortunately repeated forward motion of the humer- tion and repetitive right extremity use. The left diaphragm is al head during the attack can begin to compromise the integri- one of several muscles in this chain that begins to function ty of the anterior shoulder capsule. The overused shortened dyssynchronously. The primary function of the left external rotators can compound this problem because as the diaphragm is to expand the lungs, especially the right apical infrapinatus and teres minor shorten and tighten, the associat- lung. The left and the right diaphragms possess the greatest ed posterior capsule can also become very restricted which mechanical advantage for inhalation function when the left further promotes anterior translation of the humeral head. and right ribs are in internal rotation which is synonymous All right hand dominant athletes have tendencies with trunk or spinal flexion. In this position the diaphragms toward the pathomechanics just described. Training strate- are in a cylindrical domed-shape that can contract to external- gies should emphasize correct asymmetrical trunk rotation ly rotate and elevate the rib cage thus increasing the volume and rib rotation before rotator cuff training