About the Authors

Ben Ashworth
Director and High Performance Consultant
Athletic Shoulder

@benphysiocoach

Ben Ashworth is the Director of Athletic Shoulder, working as a consultant with teams and individuals
to help solve shoulder performance problems. He has over two decades of experience as a practitioner
with Masters in both Physiotherapy and Strength & Conditioning and is currently undertaking his PhD
at Liverpool Hope University – a shoulder centre of excellence.
Ben’s interest and experience in shoulders developed from his time in professional rugby at London
Wasps (2002-2005) and was accelerated through his work with the English Institute of Sport and,
in particular, the British Judo team in the lead-up to his Team Great Britain role at the Olympics in
London 2012. The Athletic Shoulder testing and monitoring philosophy combines Ben’s shoulder
expertise with over 15 years of monitoring athletes in performance environments.

“ Our athletic shoulder testing framework relies heavily on force assessment, enabling us to gather critical
insights that shape rehabilitation and recovery programs. We utilize VALD technology for comprehensive
athlete profiling, ongoing monitoring and supporting the return-to-performance process. This approach has
been instrumental across a broad range of elite performers, their coaches and performance teams, ensuring
data-driven decisions that optimize shoulder health and performance outcomes for all our clients.

Jo Clubb
Founder and Sports Science Consultant
Global Performance Insights

@joclubbsportssci

Jo Clubb is the Founder and Sports Science Consultant at Global Performance Insights, which
provides sports science support to professional teams, athletes, practitioners and sports tech
companies all around the world. Previously, she worked as an Applied Sports Scientist for the Buffalo
Bills in the NFL and Buffalo Sabres in the NHL, as well as Chelsea Football Club and Brighton and Hove
Albion in English soccer. She shares sports science insights through her blog, YouTube channel and
scientific publications and textbooks.

“ The shoulder plays a pivotal role in many sporting activities, yet its complex anatomy and biomechanics
make it one of the most challenging joints to understand. Recent advancements in technology and
assessments, led by VALD, have greatly improved our ability to objectively measure and monitor shoulder
function. Moreover, given the significant influence of the lower body on upper body tasks, it’s crucial to
integrate assessments of both in evaluating shoulder performance comprehensively.

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The Importance of
Shoulder Health
Shoulder health is critical for both everyday life Athletes across
and sporting performance. disciplines – such as
pitchers in baseball, swimmers, tennis
The shoulder complex, with its wide range of athletes or weightlifters – rely heavily on
motion (ROM) and intricate biomechanics, is shoulder stability, strength and flexibility.
pivotal in many sports that require overhead
Shoulder function is also critical in many
activities, throwing or contact actions, such as
workplaces, making shoulder health, injury
tackles and scrums.
prevention and rehabilitation relevant
Given these high demands, the shoulder is in health settings.
susceptible to a variety of injuries, particularly
when subjected to repetitive stress, improper A dysfunctional shoulder can significantly
technique or muscular imbalances. hinder an individual’s ability to perform, often
leading to compensatory movements that
Maintaining optimal shoulder function is
exacerbate the problem or create new issues
essential, not only for maximizing performance
elsewhere in the kinetic chain.
but also for injury prevention.

Should injury occur, a well-structured rehabilitation program focusing on restoring ROM, strength and
rate of force development (RFD) is essential to avoid reinjury and ensure a safe return to sport (or the
workplace). The body is a kinetic chain, so the influence of the lower body on upper body performance
and injury risk must not be overlooked either.

Advancements in assessment technologies, including dynamometers and force plates such as VALD’s
DynaMo, ForceFrame and ForceDecks, allow for more precise diagnosis and targeted interventions.
They provide deeper insights into shoulder function, capturing not just peak forces but the RFD, which
helps practitioners make data-informed decisions on programming.

Practitioner’s Guide to Shoulders | 3

In this document, we will cover a wide range of topics and
answer some common questions, including:

Tip: Click any heading to jump to section

Importance of Shoulder Health

Shoulder Assessment

Shoulder Complex Overview

Range of Motion Testing

Common Pathologies
and Injuries
Strength Testing

Data Interpretation and ASH Test Spotlight

Analysis

Training and
Case Studies
Rehab Strategies

Core Components of Football Tennis

Shoulder Prehab Athlete Athlete

Rehab of Common Baseball Warehouse

Shoulder Issues Athlete Stocker

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Contents
The Importance of Shoulder Health.................................................. 3

Shoulder Assessment....................................................................... 10

Data Interpretation and Analysis...................................................... 21

Training and Rehabilitation Strategies.............................................. 30

Case Studies..................................................................................... 41

23

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Anatomy and Biomechanics
of the Shoulder
The shoulder complex is one of the most intricate and mobile regions of the human body, enabling
a wide range of movements necessary for daily activities and athletic performance. This wide ROM
comes at the expense of joint stability and, therefore, is prone to dislocation and injury.

…most readers will be familiar with the anatomy of the

shoulder, [but] given its complexity, we thought it would
be worthwhile to provide a short refresher.
Shoulders are subjected to stress, both through everyday life and particularly in certain sports and
playing positions. Very minor changes in joint integrity can make the shoulder symptomatic
and dysfunctional.

While we acknowledge that most readers will be familiar with the anatomy of the shoulder, given its
complexity, we thought it would be worthwhile to provide a short refresher.

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Shoulder Complex Overview
In brief, the shoulder complex consists of three primary bones:

• Humerus (upper arm bone);

• Scapula (shoulder blade); and

• Clavicle (collarbone).

These bones articulate at four main joints:

• Glenohumeral (GH) joint;

• Acromioclavicular (AC) joint;

• Sternoclavicular (SC) joint; and

• Scapulothoracic (ST) articulation.

Together, these structures allow the shoulder to achieve ROM across multiple planes, including flexion,
extension, abduction (Abd), adduction (Add), internal rotation (IR) and external rotation (ER).

The GH joint, often referred to as the true shoulder joint, is a ball-and-socket joint that provides the
majority of the shoulder’s mobility. In fact, it is the most mobile joint in the body.

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It is stabilized by a combination of static structures, such as the labrum and joint capsule, and
dynamic structures, including the rotator cuff muscles. The rotator cuff comprises four muscles:
the supraspinatus, infraspinatus, teres minor and subscapularis.

These muscles work synergistically to stabilize The ST articulation, although not a true joint,
the humeral head within the glenoid fossa of is the interface between the scapula and the
the scapula, allowing for controlled and precise thoracic rib cage and is crucial for the smooth
movements. upward and downward rotation of the scapula
during arm movements.
The AC joint, located between the acromion
of the scapula and the clavicle, plays a key The complex interplay between these joints
role in the scapula’s rotational movements and their surrounding muscles allows the
and contributes to the overall shoulder girdle’s shoulder to perform an array of tasks, from
function. lifting and throwing to stabilizing the arm in
various positions.
The SC joint connects the clavicle to the sternum,
acting as the only bony attachment of the upper However, this mobility comes at the cost of
limb to the axial skeleton. stability, making the shoulder susceptible to
injuries and pathology.

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Common Pathologies and Injuries
Given its complexity and ROM, the shoulder is prone to a variety of injuries and pathologies, particularly
in athletes and individuals involved in repetitive overhead activities. Understanding these conditions is
crucial for effective diagnosis, treatment and prevention.

Symptoms typically include pain, weakness and limited ROM, particularly during activities involving
overhead lifting or reaching. These injuries can also influence each other. For example, shoulder
impingement syndrome, if left untreated and exacerbated by repetitive overhead activities, can lead to
rotator cuff tears.

A frozen shoulder* can be associated with prolonged immobility, systemic diseases such as diabetes
or post-surgical recovery. Similarly, chronic GH instability can lead to recurrent dislocations and long-
term joint damage.

Clearly assessing functions of the shoulder is beneficial in order to assess the strength capacity of the
shoulder joint, identifying weaknesses that need attention and monitoring ongoing challenges in the
physical capacity of the shoulder, all with a view to preparing individuals for repetitive overhead strain.

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Shoulder Assessment
Shoulder assessment is critical for tailoring training and rehabilitation programs to individual athletes
and patients. In particular, assessing shoulder strength and ROM is essential for understanding an
athlete’s shoulder function and identifying potential asymmetries and deficiencies in order to maximize
performance and minimize injury risk.

Assessment Tools and Technology

Advancements in technology have significantly enhanced the precision and scope of shoulder
assessments. Technology adds value by:

• Quantifying shoulder function through objective data;

• Calculating asymmetries between left and right sides and imbalances within the shoulder joint;

• Providing biofeedback to improve exercise application during training;

• Allowing training to be used as testing in an ongoing monitoring process;

• Enhancing criteria-based progression; and

• Benchmarking – enabling greater insights by comparison to normative data.

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Technology relevant to upper body assessments includes:

Isokinetic Dynamometers (IKDs)

IKDs have been used in clinical settings to test joints in different positions and contraction types
(i.e., isometric and eccentric), particularly focused on peak torque measurement.

IKDs are a complex and cumbersome technology and are limited in terms of practicality and
portability, but can assist by quantifying dynamic shoulder strength. Some examples of IKDs include
HumacNorm, Biodex and Cybex machines.

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Fixed-Frame Dynamometers (FFDs)
FFDs are increasingly used in clinical and sports settings due to their accessibility and ease of use.

They allow for the assessment of isometric strength in various positions, helping to identify muscle
imbalances and guide rehabilitation. Some examples of FFDs include VALD’s NordBord Hamstring
Testing System and ForceFrame Strength Testing System range.

Force Plates
Force plates are increasingly used in shoulder assessments to measure strength and RFD. By
capturing high-quality isometric data in specific positions and providing dynamic assessment options
like push-up analysis, force plates offer a more comprehensive understanding of shoulder function,
particularly in the context of athletic performance.

Common examples of modern force plate technology include the ForceDecks range, such as Mini,
Lite and Max.

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Handheld Dynamometers (HHDs)
These portable devices offer a more accessible
alternative to isometric strength assessment
compared to FFDs.

While they provide valuable data, their accuracy

can be affected by inter-tester variability, so it is
essential to standardize testing procedures to
minimize these inconsistencies.

Dynamometers that have both handheld and

fixed-point options include the DynaMo range,
including DynaMo Max, Plus and Lite.

ROM can be measured using tools such as and multi-joint ROM screening for better
goniometers, inclinometers, inertial sensors or orthopedic health information.
camera-based technologies.
Yet, standardization of the testing protocol
The development of inclinometry-enabled remains critical to collect precise data.
dynamometers, such as VALD’s DynaMo
For example, during IR and ER tests, ensuring
range, has improved the reliability of such
consistent positioning of the shoulder and elbow
measurements.
is crucial to obtaining reliable data.
Similarly, camera-based technologies, like
HumanTrak, have simplified both single-joint

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Range of Motion Testing
Testing ROM provides crucial information about the mobility of the shoulder joint. Given the shoulder’s
complex structure (outlined earlier), it is important to assess the movement in multiple planes: flexion,
extension, abduction, horizontal adduction and abduction, and IR and ER. In each of these movements,
multiple positions exist:

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For more information on testing protocols for each of these positions, head to VALD’s Knowledge Base
for DynaMo setup and testing protocols.

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Strength Testing
Shoulder strength testing is particularly important Strength testing focuses on evaluating the
for athletes involved in high-demand, overhead force-generating capacity of the shoulder
activities such as throwing, tackling or catching. muscles, particularly the rotator cuff and
scapular stabilizers.
Traditional strength assessments often involve
manual muscle testing, which, while useful, can Isometric strength tests are commonly used,
be limited by their subjective nature and variability as they provide reliable data without inducing
between testers. significant fatigue.

To overcome these limitations, more objective Devices like HHDs and FFDs, such as VALD’s
methods have been developed. DynaMo and ForceFrame, are frequently
employed for this purpose.

For throwing athletes and others involved in overhead sports, it is particularly important to assess
the strength of internal and external rotators, given their role in stabilizing the GH joint during
high-velocity movements.

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Examples of Shoulder
Strength Testing Options

The ratio of ER to IR strength is a critical metric (ER:IR), as significant imbalances can increase the risk
of injury, and we will explore how to interpret this ratio in the data interpretation and analysis section.

Isometric Strength

Isometric training is a strength method where the joint angle

remains unchanged during contraction. Its popularity has
grown due to its safety, simplicity and effectiveness.

A major benefit of isometric training is the ability to assess

and train force in nearly any position. It allows for greater
force production than traditional weights, as it removes
technical demands, enabling more intensive muscle training.

For more on the science and application of isometric training,

download VALD’s Practitioner’s Guide to Isometrics.

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Spotlight: Athletic Shoulder (ASH) Test
What is it?
The ASH Test is a battery of three long-lever test positions, designed to test the shoulder in a range of positions
to expose strengths, deficiencies and asymmetries.

Why was it developed?

“The ASH Test was created to solve the problem of quantifying long-lever
force transfer and RFD.

We needed a valid, reliable and sensitive field-based test to quantify an athlete’s

ability to transfer high-forces fast in vulnerable long-lever positions. The ASH Test
Ben Ashworth does that, with rate of force data correlating with overhead athlete velocity and
Director peak force data correlating with athletes who have a history of upper quadrant
Athletic Shoulder
injury or surgery.”

What are the testing positions?

full abduction in 135° abduction 90° abduction

line with the body

What normative data is available?

In addition to VALD's Norms, Ben has also published a range of normative scores for each of the
ASH Test positions, as seen in the tables below and elaborated on in the ASH Test Normative Data
in the appendix.

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Don’t Forget the Lower Body!
Even though this is a guide to the shoulder, it is Assessing lower limb force through tests
crucial to consider the body as a kinetic chain, like the isometric mid-thigh pull (IMTP)
where lower-body strength impacts shoulder or countermovement jump (CMJ) and
performance and injury risk. comparing it with upper body strength
helps identify imbalances.
The lower body generates around 50% of the
force in upper-body actions like throwing. Athletes who focus on building lower body
strength and power but neglect upper body
When lower-limb strength is lacking, athletes may
development may face an imbalance.
overcompensate with their shoulders, leading to
altered mechanics and increased injury risk.

Such imbalance between lower and upper body strength can cause shoulder overload, contributing to
overuse injuries like rotator cuff tendinopathy or degenerative labral pathology. Equally, this is especially
evident in fatigued athletes, who may struggle to generate force from their legs, relying excessively on
the shoulder, thus exacerbating injury risk.

Combining upper and lower body testing can provide invaluable insights to drive effective long-term
athlete development programs.

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Data Interpretation
and Analysis
Interpreting data collected from shoulder assessments requires an understanding of normative values,
sport-specific demands and individual athlete characteristics to best apply the insights to your specific
setting and clients. Key measures include ROM, force production, RFD, asymmetry and imbalance,
each of which we will discuss in the following section.

Range of Motion Analysis

Shoulder ROM is typically measured across multiple planes. The American Academy of Orthopedic
Surgeons (AAOS) defines the normal active range as 180° of flexion, abduction, and 90° of ER.
However, as mentioned throughout this guide, the requirement for ROM can differ with occupation and
the individual’s demands and fitness.

One of the most commonly used ROM

measures in throwing athletes is shoulder IR
and ER to quantify the GH ROM arc. From this,
the following can be assessed:

Total Range of Motion (TROM): Adding IR and

ER together for each side individually.

ER Gain: ER of the dominant side compared to

the non-dominant side.

A thrower’s shoulder often has gains in ER

compared to IR. A player’s ER gain on their
throwing side can contribute to the demands
of throwing, especially during the late-cocking
phase of a pitching motion.

Shoulder flexion ROM assessment using DynaMo.

Glenohumeral Internal Rotation Deficit (GIRD): Defined as a loss in the GH IR degrees of the dominant
side compared with the non-dominant side.

Typically, throwers demonstrate GIRD as a normal adaptation to their throwing demands, with gains in
ER compared to IR on the dominant side. This is referred to as anatomical GIRD (aGIRD).

However, pathological GIRD (pGIRD) represents excessive changes caused by repetitive microtrauma
to the shoulder joint or a thickening or contracture of the joint capsule.

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pGRID Criteria
Collated research findings and criteria options
According to Senigagliesi et al., (2024) pathological GIRD (pGIRD) has been defined in the literature
using different values and parameters, such as:

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Strength Testing Analysis
Peak force represents the maximum force a The goal is to assess the strength of the rotator
muscle or muscle group can generate during cuff, deltoids and surrounding muscles that
a contraction, providing insight into the joint’s contribute to shoulder stability.
ability to handle physical demands.
Modern technologies, such as ForceDecks,
This is especially useful for athletes who rely on ForceFrame and DynaMo, provide age- and
their shoulder function for overhead movements, gender-matched Norms for nearly all strength
such as throwers, swimmers and tennis players. assessments for both the lower and upper body.

Commonly, an athlete performs resisted This normative data is cultivated from millions
isometric contractions in IR and ER at various of individual data points, allowing practitioners to
degrees of shoulder abduction or flexion to assess how their clients compare to the general
evaluate their peak force capacity, measured in population.
Newtons (N) using a dynamometer or force plate.

However, large data sets cover a large population and may not display information specific to the
population of interest.

For example, overhead athletes will have greater strength numbers compared to the general population.
Therefore, basing decisions on general population data may over-predict readiness to return to sport.

Normative data reports, such as those provided to VALD users, focus on distributions of specific
athletes and levels of sport (e.g., collegiate and professional) to help better benchmark and individualize
athlete training and rehabilitation.

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IR and ER strength are measured for both arms and from this data, both between-limb asymmetry and
within-limb imbalance (ER:IR) can be determined. It may be helpful to think of these data in a matrix,
like so:

If there is a significant body mass variation

between individuals or within the same individual
over time, normalizing the force outputs by body
weight allows for better comparison.

For instance, relative benchmarks for elite male

throwers are 2.0N/kg in ER and 2.1N/kg in IR.

For those who have assessed hip and groin

strength to determine the Abd:Add ratio, we can
observe parallels in how strength is analyzed
between hip and shoulder joints.

NB: Use left and right or dominant and non-dominant,

as relevant in your specific setting.

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Between-Limb Asymmetry
For athletes with asymmetrical sports demands, such as throwers, it is valuable to assign the left and
right sides to dominant and non-dominant. Although some asymmetry is expected and even normal,
particularly in overhead athletes, monitoring changes over time helps prevent injury.

As discussed in this Global Performance Insights video, there exists a “calculation conundrum” with at
least 10 different asymmetry calculations available to practitioners.

Therefore, it is important to know which methods are used as there are strengths and weaknesses to
different approaches. In the case of VALD, the following calculation is used for asymmetry:

The pertinence of asymmetry depends on the population. For example, a bilateral strength balance
is important to swimmers, given the symmetrical demands of their sport.

However, left-to-right asymmetries can be large in those with asymmetrical demands, such as
throwing athletes, volleyballers or tennis athletes. To a certain degree, significant asymmetries in
these athletes are expected but still warrant tracking in case the magnitude becomes too great.

External Rotation: Internal Rotation Strength Ratio

The ER:IR ratio represents the strength balance between the external rotators (primarily the
infraspinatus and teres minor) and the internal rotators (subscapularis, pectoralis major,
latissimus dorsi).

A balanced ER:IR ratio helps ensure that the shoulder can generate enough ER torque to decelerate
the arm during throwing or striking motions.

An imbalance, particularly when internal rotators are significantly stronger than external rotators, is
associated with an increased risk of shoulder injuries.

ER:IR = ER Peak Force (N) / IR Peak Force (N)

Internal rotators tend to be stronger than external rotators, so the ratio in the general population is
commonly below 1. For instance, one study of 200 healthy males and 200 healthy females spanning 20
to 60 years found ER:IR values from 0.71 to 0.86 (Bradley and Pierpoint, 2023).

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…one study of 200 healthy males and 200 healthy
females spanning 20 to 60 years found ER:IR values
from 0.71 to 0.86.
However, the ER:IR ratio varies greatly between sporting populations, depending on their demands.
For example, swimmers consistently demonstrate a low ratio, approximately 0.70 bilaterally, in one
study (Boettcher et al., 2020) due to relatively greater IR strength as a result of high IR loading during
the propulsive phase.

Outputs can also vary within sport, depending on each playing position’s demand (as well as individual
variability). For example, another study found Minor League Baseball (Michener et al., 2021) ER:IR
varied as follows:

Therefore, it is important to understand the

variability within your own populations, as well
as to track individuals over time to watch for any
noticeable changes in their ER:IR, which could
signal a deterioration in strength.

With such rampant variability, it is important that practitioners don’t assume an athlete’s capability
simply based on their sporting background or position. Evidence clearly demonstrates both within-
sport and within-individual variation in overall shoulder function.

Technology-enabled metrics and calculations allow for personalized data that aid in making better
decisions for the athletes in front of you.

When looking at group data, it is useful to use visualization techniques that show the spread of data
and ideally, each individual data point. Dot plots like the one below show the distribution of a group’s
data points, as well as summary statistics like the median average, quartiles and outliers.

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When using data from research as benchmarks, measuring with isokinetic dynamometry), testing
it is important to be aware of potential differences positions (e.g., shoulder abduction angle) and
in technologies and testing protocols – in terms populations (e.g., sex, age, sport, playing position,
of contraction type (e.g., isometric vs. eccentric training history, injury history).

Rate of Force Development

RFD measures how quickly force can be RFD is captured by analyzing the slope of the
produced, which is crucial for explosive force-time curve during muscle contraction,
movements, especially in sports like baseball typically measured in milliseconds. Athletes are
or tennis that demand rapid acceleration and cued to push or pull “hard and fast” to ensure
deceleration of the upper limbs. accurate results.

Athletes with high RFD can stabilize the shoulder However, during early rehabilitation stages, this
during high-velocity actions, thereby reducing approach might need adjusting to accommodate
the risk of injury. healing constraints.

It is common for peak force to return before RFD

following injuries, including those of the lower
limb (e.g., ACL, hamstring), and the same is true
for the shoulder.

Athletes who regain strength may still struggle

with explosiveness if RFD lags behind, potentially
leading to pain or instability during rapid
movements. Therefore, achieving peak force and
high RFD is crucial for full functional recovery.

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Athletic Shoulder (ASH) Test
As outlined earlier in this guide, the ASH Test quantifies long-lever force and RFD capacities.
The ASH Test positions the athlete in ways that replicate sport-specific actions.

By evaluating the different positions, practitioners can identify strength imbalances and areas where
explosiveness is lacking. An athlete who demonstrates sufficient peak force but lags in RFD might
require additional explosive training to enhance shoulder stability during rapid movements.

Similarly, identifying specific weaknesses across

different positions allows for more targeted
interventions, promoting balanced shoulder
function and reducing injury risk.

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As such, analyzing both peak force
and RFD in all three positions in
combination adds greater meaning.

These variables could be analyzed

together in a matrix format, generating
the axis positions based on normative
data, such as:

Putting It All Together

While each of these metrics provides valuable insights independently, their combined interpretation
offers a more holistic view of shoulder function. For instance, an athlete with high peak force but a
poor ER:IR ratio may have the strength to perform overhead movements but could be at risk of injury
due to a lack of stability.

Similarly, an athlete with strong peak force but low RFD may struggle with explosive movements,
highlighting the need for power training in their regimen.

Ultimately, data from ROM and strength testing should be integrated into an athlete or client’s overall
health performance profile. This approach allows for the identification of specific areas of weakness
or imbalance, facilitating the creation of tailored training programs that address these issues.

Over time, tracking these metrics

can provide a clear picture of an
individual’s progression, ensuring
they are adequately prepared for
the demands of their sport while
minimizing the risk of injury.

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Training and
Rehabilitation Strategies
Once shoulder assessment data is collected, it can help guide training and prevention plans, as well as
serve as baseline data should an injury occur in the future. Prehabilitation aims to reduce injury risks by
addressing weaknesses before they develop into issues.

For shoulder health, this typically involves strengthening the rotator cuff and scapular stabilizers,
improving ROM and correcting muscular imbalances tailored to the sport’s demands. Similar
adaptations are required in rehabilitation but must respect the biological healing process and specific
injury constraints.

Prehabilitation and Injury Prevention

In VALD’s Practitioner’s Guide to Preseason, we discussed a three-tiered risk management approach
to prevention: group, cluster and individualized. Depending on the sport or setting, shoulder testing
may often be best suited to a cluster approach in which particular playing positions or roles are
targeted for testing and interventions.

Adopted from Roe et al., 2017

In a sport with high overhead demands across Throwing athletes are particularly susceptible
all players, such as volleyball or netball, a group to overuse injuries, rotator cuff pathology and
approach may be employed. shoulder instability.

In other sports, only certain positions may need Implementing a structured, individualized
tailored shoulder programs (a cluster approach), prehabilitation program can mitigate injury risks
such as goalkeepers or quarterbacks. and enhance athletic performance.

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A tailored approach is crucial, emphasizing Tracking shoulder function over time via
regular monitoring of adaptations in peak force ROM and strength testing allows practitioners
and RFD. Implementing targeted exercises, like to assess the effectiveness of interventions
isometric holds for those with ER deficits, can and make data-informed decisions to optimize
improve strength and performance. prehabilitation and performance.

In everyday settings, individuals required to Regular re-testing is essential to monitor

perform overhead activities, such as warehousing progress and adjust the training program as
staff, may be at greater risk of workplace-related needed.
shoulder injuries.
Modern technologies such as ForceFrame
Such a workplace may want to consider baseline incorporate “Training Modes,” allowing
testing of shoulder function, such as shoulder practitioners to precisely program the intensity
ER:IR examination, for all staff who are required and volume of shoulder training and can be
to frequently lift and reach overhead. highly effective at encouraging compliance in
rehabilitation or preparation.
Such information can assist with intervention
plans, ongoing monitoring and benchmarking for
rehabilitation if or when injuries are suffered.

Modern technologies such as ForceFrame incorporate

“Training Modes,” allowing practitioners to precisely
program the intensity and volume of shoulder training…

Using such Training Modes, manipulating effective doses can be used to impact pain reduction,
strength and capacity and sit conveniently within a (daily) session warm-up prior to training
or rehab sessions.

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Core Components
of Shoulder
Prehabilitation
Shoulder injury prevention programs improve
the joint’s ability to withstand the demands of
the sport or workplace, thereby reducing the
likelihood of injury. Such programs can focus on:

• Strengthening the rotator cuff • Developing neuromuscular control and

proprioception
• Stabilizing the scapula
• Addressing kinetic chain deficiencies
• Optimizing mobility and flexibility

The rotator cuff muscles play a crucial role in stabilizing the GH joint. In throwing athletes, these
muscles are often subjected to fatigue and strain, leading to compensatory movement patterns and an
increased risk of injury. Monitoring IR and ER force output in 90° abduction with VALD’s ForceFrame or
DynaMo can be a useful means of tracking rotator cuff strength as part of a shoulder prehab program.

Poor scapular control can alter shoulder

mechanics and lead to increased stress
on the rotator cuff and labrum.

Scapular stabilization exercises are a key

component of shoulder prehabilitation,
promoting proper scapulohumeral rhythm and
reducing the risk of shoulder dysfunction.

Training and testing in the prone Y position strengthens the lower trapezius, which can improve
scapular control.

While strength is essential, maintaining adequate mobility and flexibility is equally important for
injury prevention. Throwing athletes often develop tightness in the posterior shoulder capsule and the
pectoral muscles, leading to altered shoulder kinematics and increased injury risk.

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Some level of adaptation is expected, as environments, such as upper-body oscillatory
discussed earlier. However, it is important to movements or lower limb instability (e.g., single
prevent reductions in flexibility from becoming leg drills) with upper extremity movement.
too large and leading to pathology.
The kinetic chain describes the transfer of
This delicate balance lends further support to energy from the lower body through the core and
objectively monitoring ROM with dynamometry, into the upper extremities.
even in healthy athletes.
Deficiencies in any part of the kinetic chain can
Neuromuscular control refers to the ability of the increase the load on the shoulder, leading to
nervous system to coordinate muscle activity, compensatory movements and potential injuries.
ensuring stability during dynamic movements.
For example, weak hip abductors or poor core
Throwing athletes, in particular, must have stability can lead to compromised throwing
highly refined neuromuscular control to perform mechanics, forcing the shoulder to work harder
efficiently and reduce the risk of injury. than necessary.

Prehabilitation programs should include exercises Prehabilitation should, therefore, not only focus
that challenge the athlete’s proprioceptive on the shoulder but also address strength and
abilities, particularly in unstable or unpredictable mobility in the lower body and core.

Monitoring Workload and Recovery

In addition to exercise-based interventions, Prehabilitation programs should include
monitoring an athlete’s workload is essential for strategies to monitor and regulate training loads,
preventing overuse injuries. ensuring that athletes gradually increase their
workload while allowing adequate recovery time.
Sudden spikes in throwing volume or intensity
can overwhelm the shoulder’s ability to recover,
leading to overuse injuries such as tendinitis or
labral pathology.

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 Customizable Dashboard:
Monitor the groups that
matter to you, while
customizing the tests and
metrics that matter most.

Immediate Comparisons:
Identify who is above,
below and meeting group
averages at a glance. Flags:
VALD Hub compares each
individual’s assessment to their
personal averages, highlighting
those who may be fatigued or at
increased injury risk.

Utilizing tools like force plates and dynamometers

to track shoulder capacity can then provide
valuable insight into how an athlete is coping with
their training load and their subsequent readiness
to perform.

Moreover, ensuring athletes get sufficient rest,

proper nutrition and sleep is critical for tissue
repair and overall shoulder health.

Recovery strategies such as cryotherapy, massage and active recovery should complement the
prehabilitation program to promote optimal performance and injury prevention.

Rehabilitation for
Common Shoulder Issues
Rehabilitation of shoulder injuries benefits from
an outcome-driven approach to ensure optimal
recovery and a safe, sustained return
to performance.

While several factors – including physical, mental,

technical and tactical elements – play a role in
the rehabilitation process, this guide focuses
on the physical aspects and the progressive
planning necessary to achieve a high-level return
to performance in sport or the workplace.

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Stages of Rehabilitation
Rehabilitation typically follows a structured plan divided into several phases:

01 Initial Protection Phase

This phase is focused on safeguarding the healing
tissues post-injury or post-surgery. Guided by the
surgeon’s protocols and the natural healing process,
individuals are protected from excessive movement
or loading that could disrupt recovery. This period
often involves immobilization or controlled
movement to prevent atrophy while allowing
the repair process to unfold.

02 Rebuild Phase
Once the tissues have sufficiently healed, the focus
shifts toward minimizing muscle atrophy and rebuilding
capacity. Strength and conditioning programs are
progressively introduced to restore tissue tolerance,
especially in the muscles and tendons surrounding the
shoulder joint. Exercises are generally low-load at this
stage to prevent excessive strain on the injured area.

03 Preparation Phase
At this stage, the focus is on restoring general strength
and conditioning across the entire shoulder and kinetic
chain. Sport-specific drills are usually avoided, but
athletes will begin performing exercises that address
identified weaknesses and imbalances. Progress is
closely monitored using objective tests, with special
attention to any underlying issues that may have
predisposed the athlete to the injury in the first place.

04 Return-to-Activity Phase
This phase prepares the athlete for the demands of
their specific sport or activity. Exercises become more
dynamic and chaotic, mimicking activity-specific
movements and stressors. Despite returning to exercise,
the individual’s progress is still closely monitored to
ensure they are building the necessary physical and
mental resilience for their competition or activity.

05 Return-to-Performance Phase
In the final stage, athletes fully reintegrate into regular
training and competition with no restrictions on
intensity or volume. Ongoing testing ensures the
athlete’s strength and mobility are optimized, and
consistent monitoring for up to three months post-
return is recommended to prevent recurrence.

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The Importance of Regular Monitoring
“If you’re not assessing, you’re guessing.”
A key aspect of the rehabilitation process is Athletes are at heightened risk of reinjury
continuous assessment. within the first three months of returning to full
competition, with shoulder reinjury rates reported
Without data, it is difficult to know whether between 3.4 and 7% (Otley et al., 2022).
an athlete needs to be pushed harder or pulled
back to prevent overloading or reinjury. Regular testing and monitoring can highlight any
potential issues early, allowing for adjustments in
Objective testing provides clear markers for training and rehabilitation programs.
progression and benchmarks for a safe return
to sport. This approach is particularly effective when
applied consistently across different injury types.

Injury-Specific Rehabilitation Considerations

There are four primary types of shoulder injuries commonly seen in sports: instability, joint injuries,
tendon injuries and muscle injuries. While the general framework for rehabilitation – protection,
rebuild, preparation and return – remains consistent, each injury type requires a tailored approach
with sport-specific considerations.

Instability Injuries
Instability, particularly anterior shoulder
dislocations or labral tears, often leads to deficits
in IR strength and muscle cross-sectional area.

A rugby player, for example, who undergoes

anterior shoulder stabilization may suffer from a
loss of IR force and muscle mass.

Monitoring IR peak force becomes crucial,

using objective markers like force frames or
dynamometry.

The restoration of IR strength is essential before

allowing the athlete to return to contact sports.
Key Metric: IR peak force

Assessment Tool: FFD (ForceFrame) or HHD (DynaMo)

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Joint Injuries
AC joint injuries often require isometric testing
over dynamic movements, as isometric exercises
better control shear forces in the joint.

The AC joint is vulnerable to injury in collision

sports like rugby, where athletes are frequently
exposed to heavy contact.

Key Metric: Isometric RFD in ASH Test T

Assessment Tool: Tension dynamometry

(VALD DynaMo Plus or Max)

Plyometric push-up assessments are useful in later stages of rehabilitation for athletes returning to
collision sports, providing insight into shoulder explosiveness and upper body strength before they
re-engage in full contact.

Tendon Injuries
Pectoralis major tendon injuries, including
ruptures, require careful rehabilitation due to the
complex fiber orientation of the muscle.

Testing the pec major in the T and Y positions on

an ASH Test can help identify any imbalances or
weaknesses in force production.

Early in the process, individuals should be tested

in shortened positions, then gradually progressed
into longer lever and more demanding positions.

Key Metric: Peak force in ASH Test T and Y positions

Assessment Tool: ASH Test (particularly T and Y positions)
on a force plate, FFD or HHD (e.g., ForceDecks,
ForceFrame or DynaMo)

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Muscle Injuries
Muscle injuries, particularly those affecting the rotator cuff, need to be rehabilitated with a focus on
building endurance and capacity early on.

High-volume, low-intensity exercises should begin as soon as the athlete can tolerate them. This
prevents extended periods of rest, which can lead to deconditioning.

If rehabilitation programs are too conservative, athletes may have to rapidly increase training intensity
in the final weeks, leading to a heightened risk of reinjury.

Key Metric: Volume tolerance and capacity

Assessment Tool: High-volume, low-intensity program tracking (ForceFrame Training Mode)

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The Role of Mobility and Force Production
One of the key considerations in shoulder rehabilitation is the balance between mobility and stability.
While it is important to restore full ROM, there may be situations where some loss of mobility is
acceptable, particularly in contact sports where a more stable, slightly stiffer joint can protect
against reinjury.

For athletes in sports requiring high levels of shoulder flexibility – such as tennis players, goalkeepers
or baseball pitchers – restoring full ROM is a priority. Conversely, rugby players or outfield footballers
who do not engage in repetitive overhead movements can afford to sacrifice some mobility in
exchange for greater joint stability.

An emphasis on RFD is also critical in shoulder RFD training ensures that the shoulder is capable
rehabilitation. High rates of force production are of withstanding dynamic and unpredictable
necessary not only for absorbing impact from forces. Correlations between RFD in an ASH Test
falls or collisions but also for generating explosive have been seen in baseball and volleyball.
movements in sports.

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The Importance of a Structured, Data-Informed
Approach to Rehabilitation
An effective shoulder rehabilitation program is structured, systematic and data-informed. The stages
of rehabilitation should follow a clear progression, from protection to performance, with regular
monitoring at each step to ensure the athlete is responding appropriately to increased intensity.

Capacity, mobility, peak force and RFD should be key markers of progress, allowing coaches and
athletes to confidently return to sport-specific activities.

Utilizing objective tools like force plates, dynamometers and protocols such as the ASH Test provides
reliable data to guide decisions and track rehabilitation outcomes. In doing so, the likelihood of
reinjury is reduced, and athletes are better prepared to meet the demands of their sport at pre-injury
performance levels.

In the following section, we will discuss case studies that illustrate how such rehabilitation programs
may be approached.

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Case Studies
Post-Surgical Shoulder Rehab for a
Professional Footballer

Premier League footballer, wide midfielder

Phase 1
Early Post-Operative Care (Weeks 0-4)
Rehabilitation stages use objective criteria to determine progression to the next stage. For the sake of
this case study, timeframes are given as an illustration to demonstrate how long this specific athlete
spent in each stage.

Key Goals:
• Protect surgical repair

• Minimize muscle atrophy

• Begin low-intensity muscle activation

During the initial four weeks post-surgery, the focus is on respecting the healing process while carefully
introducing submaximal isometrics. Using VALD’s DynaMo, the team is able to safely assess the
player’s IR and ER force output in neutral shoulder positions.

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Data Collection
Early isometric testing was performed with the arm by the side in a safe zone force production.
Metrics from the DynaMo provided real-time feedback on whether the athlete was producing adequate
force without overloading the injured shoulder. Targets were prescribed as follows:

• Neutral Position: 20-30% of pre-injury baseline max force was deemed safe

• ER: 25-40% of max force was deemed safe, dependent on pain response

Quantifying these sub-maximal isometric contractions allowed the medical team to determine
whether the player was ready to progress to higher-intensity exercises without relying solely on
subjective feedback.

Programming: Progressive Isometric Work

Pain-controlled, low-threshold isometrics were performed every four hours to maintain muscle
activity. Data-driven feedback from force output guided adjustments to these exercises, ensuring
optimal progression.

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Phase 2
Building Shoulder Strength and Kinetic Chain
Conditioning (Weeks 4-6)

Key Goals:
• Improve muscle hypertrophy

• Introduce progressive strength work

(peak force) for shoulder stabilization

Once the initial soreness and inflammation had subsided, the use of dynamometry was expanded to
assess shoulder IR and ER at 90° abduction using the ForceFrame, as it is a key position for assessing
rotator cuff force production capability.

Data Collection
At this phase, ForceFrame testing revealed a
significant IR force deficit, which was expected
following surgical repair.
Shoulder External Rotation
Max Force
ER Peak Force: 70-80% of pre-injury values 64th pct.

IR Peak Force: 40-50% indicating

134N 15
125

subscapularis inhibition 17.1%

1
75
Asym. 21.2% Left

Programming: Isometric and Strength Testing Protocol

Using real-time data from dynamometry, a twice-daily strength program was implemented with the
following thresholds:

The quantification of isometric strength allowed monitoring ensuring no negative responses

for tailored adjustments to volume and intensity or overall reduction in player readiness. Grip
while mitigating pain. Additionally, grip strength strength is a surrogate marker of shoulder
was used as a secondary marker for overall strength and system fatigue (Hawkes et al., 2018).
system readiness, with frequent

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Phase 3
Advanced Testing and
Sport-Specific Readiness (Weeks 6-10)

Key Goals:
• Achieve pre-injury shoulder strength levels

• Prepare the athlete for return to full competition

At this stage, maximal force testing was introduced using VALD’s ForceDecks. In 90° abduction,
the player’s internal and external rotator cuff force outputs were tested to assess whether shoulder
stabilization had returned to pre-injury levels.

Data Collection: Comparison to Benchmark Testing

The Ash Test was incorporated at this

stage, where specific testing positions
were assessed to ensure readiness for
dynamic, high-impact movements like
diving, tackling and dueling.

Testing showed that the player had achieved over 80% of their pre-injury values, a strong indication
that they were ready for more sport-specific drills. However, RFD was slower to return than peak force
output, but improvements were consistent with a safe progression.

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Phase 4
Return to Sport-Specific Drills and Final Testing (Weeks 10+)

Key Goals:
• Prepare for full contact

• Avoid reinjury

As the athlete approached full return, plyometric movements. ForceDecks metrics provided
tests such as the plyometric push-up were added detailed insight into limb asymmetries and
to the program to ensure readiness for explosive identified any weak points in force transfer.

The footballer successfully returned to full team training and competition, demonstrating minimal
strength imbalances and improved shoulder peak and rate of force output across all metrics at return
to performance compared to baseline measures.

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Ongoing Shoulder Monitoring of a
Club Tennis Player

Lauren (24 years old)

Lauren, a tennis player who had played representative tennis as a junior, began experiencing increasing
shoulder pain, particularly during first serves, after making significant gains in lower body strength and
power through consistent training over the past year.

Despite the physical progress, her shoulder could not keep up with the demands, leading to pain that
began to disrupt her game.

Initial Profile and Assessment

Lauren sought help from a physiotherapist after the discomfort in her shoulder began impacting her
tennis sessions. The physio used a detailed assessment to identify the root cause of the issue:

Lower Body: Her countermovement jump (CMJ) and lower body strength were well above average for
her age and weight, indicating strong lower limb performance.

Shoulder Performance: Significant deficits were found in the posterior shoulder:

• ER (90° Abduction): 1.4N/kg (below expected)

• IR: 2.1N/kg (very good score)

This imbalance between anterior and posterior shoulder strength was thought to contribute to the
pain and inability to decelerate forces generated during serves. The physio hypothesized that this
imbalance, combined with the increased workload from playing more tennis, was leading to
tendon overload.

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Intervention Strategy
Rather than initially reducing tennis time, the physio suggested incorporating daily isometric shoulder
exercises to address the imbalance while continuing to monitor shoulder strength regularly.

Exercises:

• Isometric holds in a side-lying position to specifically target the posterior cuff

• 90° Abduction in the scapular plane against a wall

Monitoring:

• DynaMo used to track IR and ER strength three times a week

• Post-match drops in ER strength observed:

• The day after play: To around 1.2-1.3N/kg

• By day 3: Recovery to around 1.4N/kg

Progress:

• Two Weeks: ER strength improved to 1.6-1.7N/kg

• Six Weeks: Reached 1.85N/kg, restoring balance in the rotator cuff

• Pain Reduction: No more shoulder pain, allowing full tennis participation

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Key Takeaways
This case highlights the importance of profiling and ongoing monitoring for athletes, particularly in
sports with high shoulder demands like tennis.

Practical Application
For overhead athletes like tennis players, regularly monitoring shoulder strength and
addressing imbalances through targeted interventions is crucial for preventing injuries
and maintaining performance.

Elite tennis athletes targets:

• IR and ER strength of around 2.0-2.1N/kg at 90° of abduction

• Balanced ratio of 0.85-1.0 ER:IR (depending on shoulder position)

• ASH Test scores (T-position) should aim for 1.5-1.6N/kg and RFD >500N/s 0-100ms

Using isometric exercises as an early intervention,

along with force assessment tools, helps restore
balance, reduce pain and improve overall shoulder
resilience, allowing athletes to stay in the game
while managing a grumbling shoulder in-season.

So many shoulders are not trained

with sufficient intensity for them to be
able to tolerate the demands of sport.

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Post-Surgical Shoulder Rehab
for a Warehouse Stocker

Jerry (28 years old)

Jerry, a warehouse stocker for a large His limited schedule accommodates only two to
manufacturing company, recently suffered a three physiotherapy visits per month, requiring
shoulder instability incident during his shift. Jane, his physiotherapist, to creatively adapt his
home exercise program and focus on prioritizing
After multiple consultations and various imaging quality assessments of his shoulder function
methods, Jerry and his medical team decided during their sparse visits.
to undergo a labrum repair operation to restore
normal shoulder function. Utilizing the ForceFrame, Jane was able to abide
by post-operative precautions while objectively
Aiming to return to work as quickly and safely as evaluating Jerry’s performance and using his
possible, Jerry now faces new, temporary roles data to tailor his home exercise plan.
and responsibilities post-surgery.

Early-Stage Testing to Training

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Mid-Stage Testing to Training

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After demonstrating improved force production, decreased pain and improved ROM from the clinical
examination, Jane progressed Jerry’s rehabilitation testing and training to a more compromising
position to continue building strength through his ROM.

She continued to use grip training and testing as an upper extremity proxy for strength decline as
maximal effort upper extremity testing was contraindicated.

Late-Stage Testing to Training

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After progressing Jerry’s home exercise plan to progressively more difficult isometric exercises, Jane
initiated ASH testing to assess Jerry’s ability to quickly generate high forces in compromising positions
to ensure he is ready to return to his demanding warehouse job.

She used his asymmetry and RFD data from ASH testing to prescribe self-monitored home exercises
focusing on RFD endurance and peak force to optimize his end-stage rehabilitation.

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Post-Surgical Shoulder Rehab for a
Professional Baseball Pitcher

About the Author

Matt Witt: PT, DPT, MS, CSCS is a Physical Therapist and Business Development Manager for VALD.
Prior to joining VALD, Matt worked as a PT for the New York Mets and Cleveland Guardians.

Phase 1
Early Post-Operative Care (Weeks 0-4)

Key Goals:
• Protect surgical repair

• No active movement of the shoulder

• Begin passive range of motion (PROM)

in protected ranges (no ER)

Sammy’s shoulder is immobilized for four weeks

post-surgery. During this time, only passive
motion within the scapular plane was allowed.

The medical staff was able to measure and

progress the passive range of the shoulder using
the DynaMo strapped to Sammy’s upper arm.

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Phase 2
Initiate Low-Intensity Muscle Activation (Weeks 5-8)

Key Goals:
• Progress active range of motion (AROM)
of flexion and abduction

• PROM and active assisted range of motion

(AAROM) of ER in increasing angles of
shoulder abduction

• Introduce submaximal isometrics in

neutral ranges

Active assisted ROM was initiated at week five.

Traditional AAROM progressions were applied
with progress indicated through DynaMo
measurements weekly.

Additionally, kinetic chain and scapular

strengthening exercise progressions
were initiated.

Once full AAROM of flexion and abduction was

achieved, AROM exercises and rotator cuff
strengthening exercises began.

Phase 3
Reconditioning (Weeks 8-16)

Key Goals:
• Increase and maintain shoulder ROM

• Progressive shoulder strengthening (peak force)

• Progressive submaximal testing cadence

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Shoulder flexion and abduction were maintained while ER in increasing angles of shoulder abduction
were gradually restored. Progress was continuously measured using DynaMo. Once fully restored,
weekly ROM checks were completed to gauge tolerance to exercise progression.

An isometric rotator cuff strengthening program within protected ranges was initiated at week
eight. The medical staff first used the DynaMo to measure Sammy’s subjective output with flexion,
abduction, IR and ER in the neutral position.

Once the subjective output was

objectified, a long-duration, low-intensity
isometric training program was initiated
on the ForceFrame.

In conjunction with traditional isotonic rotator

cuff and kinetic chain exercises, the low-intensity,
long-duration isometric program was progressed.

Gradually, intensity was increased and duration

shortened to a scheme promoting max strength.

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Additionally, the amount of shoulder abduction with ER and IR training was progressed from neutral to
a 90/90 (layback) position, all being performed on the ForceFrame.

Tolerance to the isometric strength training

program could be tracked through ForceFrame’s
“time in zone” and “variance” metrics.

Using the feedback from those metrics,

modifications to intensity and duration could
be made to ensure the desired stimulus
was achieved.

A submaximal testing cadence was created

to begin estimating max force production while
conditioning the shoulder to increase
force production.

Submaximal Testing Cadence (Subjective % Effort)

Objective measurement of the submaximal tests combined with Sammy’s subjective report gave the
staff insight into the progress of Sammy’s shoulder strength. Using pre-injury data, the medical staff
could benchmark his progress and set realistic goals for Sammy’s max force capacity.

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Phase 4
Sport-Specific Readiness (Weeks 17-23)

Key Goals:
• Begin upper body and throwing plyometric
progression

• Progress shoulder RFD training

• Maximal shoulder strength testing

At week 17, training was shifted to prep the

shoulder for the high-speed demands of throwing.

Sammy’s ForceFrame training program included

high intensity (>85%) and short duration (<5”) reps.
Upper body plyometrics and throwing plyometric
exercises were initiated and progressed through
the phase.

Max testing of shoulder ER:IR was performed

and used to inform the medical staff if shoulder
strength was adequate to begin a throwing
program.

ASH testing was also initiated in this phase, as

the staff was interested in the RFD value from
performance on the ForceDecks.

Clearance Testing Cadence

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Phase 5
Throwing Program Progression (Weeks 24-48)

Key Goals:
• Progress throwing load to sports demand

• Begin testing cadence for routine monitoring

• Maintain strength and ROM

A summary of Sammy’s objective shoulder strength testing demonstrated readiness to begin his
throwing program at week 24.

*ASH Test Y RFD normative value not reported

Routine monitoring of shoulder ER:IR strength

was collected biweekly.

Modifications to the throwing program and

deloads were built in as acute changes in
shoulder strength were observed.

Weekly ROM checks were also conducted,

as acute changes in ROM could indicate poor
tolerance to the throwing program.

Sammy progressed through the throwing

program and was able to return to games.

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Ongoing Shoulder Monitoring of a
Baseball Pitcher
About the Author
Matt Witt: PT, DPT, MS, CSCS is a Physical Therapist and Business Development Manager for VALD.
Prior to joining VALD, Matt worked as a PT for the New York Mets and Cleveland Guardians.

Tommy (21 years old)

Tommy is a recently drafted professional pitcher Baseline shoulder strength testing was collected
in the MiLB (Minor League Baseball). As part of using VALD’s ForceFrame system and ROM using
the routine spring training screening process, VALD’s DynaMo Plus.
Tommy’s ROM and strength data are collected at
two time points during the first month.

After a successful spring training, Tommy has Given the jump in velocity and the demand for an
been assigned to his Minor League affiliate, increased pitch count in his new role, Tommy is
where he is setting fastball velocity personal monitored closely with VALD’s systems to track
bests and excelling in the starter role. his shoulder function during the inning build-out
phase of the season.
Since he started his professional career in a
reliever role, the pitching staff has decided to
implement a slow inning progression as the
season begins.

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Weekly Monitoring
Tommy is on a 6-day starting rotation with his affiliate team. Objective strength and ROM
measurements are collected at different points within the week to correspond with Tommy’s weekly
plan. Additionally, a weekly CMJ is performed to gather information on lower-body fatigue.

The timetable below illustrates his workload and monitoring plan for two weeks:

In one start, his workload extends notably past the scheduled pitch count. Weekly testing indicated
he had not recovered well from his last outing. Tommy’s shoulder ER strength decreased by 22%.
Similarly, shoulder ROM testing revealed a global decrease in all directions.

Shoulder External Rotation

Max Force

64th pct.

134N 15
125
1
17.1%
75
Asym. 21.2% Left

Considering the increase in pitch count, decrease in ER strength and decreased global shoulder ROM,
the sports science team recommends delaying Tommy’s next start to allow for more recovery.

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 The pitching coaches agree and skip
Tommy’s scheduled start, opting for a
lower-intensity bullpen session.

Tommy continues his normal testing

schedule the next week. Testing reveals
a return to baseline values for all
metrics.

The sports science team and pitching

coaches agree to resume Tommy’s
inning progression.

Identifying a baseline for shoulder strength and ROM is critical for monitoring the throwing load
response in baseball pitchers.In-season adaptations of shoulder strength and ROM are expected in
pitchers. However, those will be seen as slow trends rather than acute changes.

Generally, there will be an increase in ER ROM and a decrease in IR ROM. Additionally, ER strength
typically decreases as IR stays the same or increases.

Intervening with rest at the right time could avoid compounding fatigue and overtraining. Objective
measurement can give insight into that optimal window.

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What Next?
Like any area of healthcare, sports medicine and sports science, to stay at the forefront of shoulder
care, it is essential for practitioners to continuously update their knowledge and skills.
Here are some tips for staying ahead in the field:

Continuing Education Networking and Collaboration

Regularly participate in workshops, seminars Engage with other professionals in the field,
and courses focused on the latest developments including physiotherapists, orthopedic surgeons
in shoulder assessment and rehabilitation. and sports scientists.

This includes VALD webinars, which are free Collaborative efforts can lead to new insights
interactive, educational presentations ranging and approaches that improve patient outcomes.
from product tutorials to seminars from
performance and health industry leaders.

Collaborative Networks
Worth Following
Online Educational Content
Worth Following

Research and Innovation Patient-Centered Care

Stay informed about the latest research Prioritize the patient’s needs and preferences
and technological advancements. Consider when designing assessment and rehabilitation
contributing to the field by participating in or protocols. Involving patients in the decision-
conducting research studies, which can provide making process can lead to better adherence
valuable data and improve clinical practices. and outcomes.

Embrace Technology Holistic Approach

Incorporate the latest tools and technologies Always consider the patient’s overall health
into your practice to provide more accurate and lifestyle when designing treatment plans.
assessments and enhance the effectiveness Factors such as nutrition, mental health and
of rehabilitation and prehabilitation programs. sleep can significantly impact recovery and
performance.
Want to learn more about any of the VALD
technologies discussed in this guide? Follow @JoClubbSportSci and @athleticshoulder
Get in touch via: [email protected] on Instagram, as well as @VALDPerformance
and @VALD_Health, for more insights.

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 Normative Data

Supine Shoulder ER/IR 90°

male
Shoulder IR
Age Age

Shoulder R
Age Age

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 Normative Data

Supine Shoulder ER/IR 90°

Female
Shoulder IR
Age

Shoulder R
Age

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 Normative Data

Athletic Shoulder
ISO I/Y/T

iSO-I iSO-Y iSO-T

male
ASH iSO-I

Ae Ae

male
Female
ASH iSO-
ASH iSO-I
Ae Ae

Ae

male
Female
ASH iSO- Practitioner’s Guide to Shoulders | 63
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ASH iSO-
 Normative Data

Athletic Shoulder
ISO I/Y/T

iSO-I iSO-Y iSO-T

male
Female
ASH iSO-
ASH iSO-I
Ae Ae

Ae

male
Female
ASH iSO-
ASH iSO-
Ae Ae

Ae

Female
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ASH iSO-
 Ae

Normative Data

Athletic Shoulder
ISO I/Y/T

iSO-I iSO-Y iSO-T

male
Female
ASH iSO-
ASH iSO-
Ae Ae

Ae

Female
ASH iSO-

Ae

Practitioner’s Guide to Shoulders | 65

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